A meta-analysis and systematic review of changes in joint position sense and static standing balance in patients with whiplash-associated disorder

Research output: Contribution to journalArticlepeer-review


External organisations

  • The University of Queensland
  • London South Bank University
  • Vrije Universiteit Amsterdam



To synthesise and analyse the current evidence regarding changes in joint position sense (JPS) and standing balance in people with whiplash-associated disorder (WAD) taking the presence or absence of dizziness into account.

Data sources

PubMed, CINAHL Plus, Web of Science, Embase, MEDLINE and APA PsycINFO were searched by two independent reviewers from inception until August 2020 and reference lists of all included studies were also reviewed.

Study selection

Only cross-sectional studies that measured JPS and/or standing balance between people with WAD vs. healthy controls (HC) or people with WAD complaining of dizziness (WADD) vs. those not complaining of dizziness (WADND) were selected.

Data extraction

Relevant data were extracted using specific checklists and quality assessment was performed using Downs and Black Scale (modified version).

Data synthesis

Twenty-six studies were included. For JPS, data were synthesized for absolute error in the primary plane of movement for separate movement directions. For standing balance, data were synthesized for traditional time- and frequency domain sway parameters considering the conditions of eyes open (EO) and eyes closed (EC) separately. For meta-analysis, reduced JPS was observed in people with WAD compared to HC when the head was repositioned to a neutral head position (NHP) from rotation (standardised mean difference [SMD] = 0.43 [95%: 0.24–0.62]) and extension (0.33 [95%CI: 0.08–0.58]) or when the head was moved toward 50° rotation from a NHP (0.50 [0.05–0.96]). Similarly, people with WADD had reduced JPS compared to people with WADND when the head was repositioned to a NHP from rotation (0.52 [0.22–0.82]). Larger sway velocity and amplitude was found in people with WAD compared to HC for both EO (0.62 [0.37–0.88] and 0.78 [0.56–0.99], respectively) and EC (0.69 [0.46–0.91] and 0.80 [0.58–1.02]) conditions.


The observed changes of JPS and standing balance confirms deficits in sensorimotor control in people with WAD and especially in those with dizziness.


Original languageEnglish
Pages (from-to)e0249659
JournalPLoS ONE
Issue number4
Publication statusPublished - 8 Apr 2021