StressModex: Stress inoculation training and exercise delivered by physiotherapists for acute whiplash injury: A randomised controlled trial

National Health and Medical Research Council

Research Team Members: Professor Michele Sterling (RECOVER), Emeritus Professor Justin Kenardy (UQ), Professor Rob Smeets (Maastricht University), Dr Rachel Elphinston (RECOVER).


This study compared the effectiveness of stress inoculation training integrated with physiotherapy exercise and delivered by physiotherapists  to standard physiotherapy exercise for people with acute whiplash-associated disorder at risk of poor recovery.


  • The primary aim was to establish the effectiveness of an integrated intervention comprised of Stress Inoculation Training (SIT) and a standard clinical guideline recommended physiotherapy exercise approach program to decrease pain and disability in individuals with acute (<4 weeks duration) whiplash injury.
  • The second aim was to investigate the effect of the intervention on post-traumatic stress symptoms, anxiety and depression.


This study is now complete.

Stakeholder engagement

Key stakeholders, the Motor Accident Insurance Commission (MAIC) and the NSW State Insurance Regulatory Authority (SIRA), were consulted at the time of the initial drafting of this project.


Five research papers have been published:

The results have been presented to multidisciplinary audiences including:

  • MAIC Insurer Group (2018)
  • World Pain Congress, Boston (September 2018)
  • RECOVER Research Forum (November 2018)
  • South Australia CTP/Return to Work SA Providers Forum (September 2018)
  • World Physiotherapy Congress (Geneva 2019)


  • Following a secondary analysis using structural equation modelling of the randomized controlled trial, reductions in stress mediated the effect of the integrated intervention on disability and health-related quality of life at 12 months.
  • Funded by MAIC QLD, the StressModex training modules for clincians, developed by Professor Michele Sterling, Dr Rachel Elphinston, Dr Yanfei Xie and Chloe-Emily Eather, are now available in the mywhiplashnavigator online resource.

Who benefits from this research?

Clinicians and claimants/motorists injured in road traffic crashes. The compulsory third party (CTP) scheme may also benefit if costs are reduced with more effective treatments.