Prognostic factors for poor recovery in acute whiplash patients

&NA; The objective of our prospective inception cohort study was to identify prognostic factors for poor recovery in patients with whiplash‐associated disorders grade 1 or 2 who still had neck pain and accompanying complaints 2 weeks after the accident. The study was carried out in a primary health care setting in The Netherlands and included 125 patients. The primary outcome measure was functional recovery defined in terms of neck pain intensity or work disability without medication use. The secondary outcome measures included neck pain intensity, work disability and sick leave. The outcomes were assessed at 4, 12 and 52 weeks after the accident. Prognostic factors were identified by logistic regression analyses. One year after the injury, 64% of the patients were recovered. Factors related to poor recovery were female gender, a low level of education, high initial neck pain, more severe disability, higher levels of somatisation and sleep difficulties. Neck pain intensity and work disability proved to be the most consistent predictors for poor recovery. The accuracy of the predictions of the prognostic models was high, meaning that the models adequately distinguished patients with poor recovery from those regarded as recovered. These findings add to the growing body of evidence, indicating that socio‐demographic, physical and psychological factors affect short‐ and long‐term outcome after whiplash injury. Our findings also indicate that care providers can easily identify patients at risk for poor recovery with a visual analogue scale for initial pain intensity and work‐related activities.

[1]  Lawrence F. Borges,et al.  SPINE: State of the Art Reviews , 1993 .

[2]  L. Derogatis,et al.  The SCL-90 and the MMPI: A Step in the Validation of a New Self-Report Scale , 1976, British Journal of Psychiatry.

[3]  G. Guyatt,et al.  Users' guides to the medical literature. , 1993, JAMA.

[4]  S. Braver,et al.  The measurement of clinical pain intensity: a comparison of six methods , 1986, Pain.

[5]  C. Warfield,et al.  The measurement of pain. , 1988, Hospital practice.

[6]  J. David Cassidy,et al.  A Systematic Review of the Prognosis of Acute Whiplash and a New Conceptual Framework to Synthesize the Literature , 2001, Spine.

[7]  Gunilla Brattberg,et al.  The prevalence of pain in a general population. The results of a postal survey in a county of Sweden , 1989, Pain.

[8]  S. Suissa,et al.  The effect of socio-demographic and crash-related factors on the prognosis of whiplash. , 1998, Journal of clinical epidemiology.

[9]  J. Bolton,et al.  Reliability and concurrent validity of two instruments for measuring cervical range of motion: effects of age and gender. , 1995, Manual therapy.

[10]  R. Gunnarsson,et al.  A Comparison of Two Treatment Protocols , 2000 .

[11]  Lex M Bouter,et al.  The clinical course and prognostic factors of non-specific neck pain: a systematic review , 1998, Pain.

[12]  G L MADDOX,et al.  A critical evaluation , 2012 .

[13]  D G Ferris,et al.  Measurement of subjective phenomena in primary care research: the Visual Analogue Scale. , 1993, Family practice research journal.

[14]  Arthur C. Croft,et al.  "Whiplash Associated Disorders: Redefining Whiplash and Its Management" by the Quebec Task Force: A Critical Evaluation , 1998, Spine.

[15]  R. Ferrari,et al.  Epidemiology of whiplash: an international dilemma* , 1999, Annals of the rheumatic diseases.

[16]  Joshua M. Pearce,et al.  The late whiplash syndrome: a biopsychosocial approach , 2001, Journal of neurology, neurosurgery, and psychiatry.

[17]  E. Hendriks,et al.  Prognostic factors of whiplash-associated disorders: a systematic review of prospective cohort studies , 2003, Pain.

[18]  N. Bogduk,et al.  Resolution of psychological distress of whiplash patients following treatment by radiofrequency neurotomy: a randomised, double-blind, placebo-controlled trial , 1997, Pain.

[19]  Lr Derogatis,et al.  SCL-90-R, Administration, Scoring, and Procedures Manual-II for the R(evised) Version and Other Instruments of the Psychopathology Rating Scale Series , 1983 .

[20]  W. Rutherford,et al.  Incidence and duration of neck pain among patients injured in car accidents. , 1986, British medical journal.

[21]  P Tugwell,et al.  Users' guides to the medical literature. V. How to use an article about prognosis. Evidence-Based Medicine Working Group. , 1994, JAMA.

[22]  J. Vlaeyen,et al.  Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art , 2000, Pain.

[23]  N. Bogduk,et al.  Pain and Psychologic Symptoms of Australian Patients With Whiplash , 1996, Spine.

[24]  R. D. de Bie,et al.  The Efficacy of Conservative Treatment in Patients With Whiplash Injury: A Systematic Review of Clinical Trials , 2001, Spine.

[25]  T. Stiles,et al.  Acute Treatment of Whiplash Neck Sprain Injuries: A Randomized Trial of Treatment During the First 14 Days After a Car Accident , 1998, Spine.

[26]  E. Skargren,et al.  Prognostic factors for perceived pain and function at one-year follow-up in primary care patients with neck pain , 2002, Disability and rehabilitation.

[27]  R. B. Margolis,et al.  Psychological assessment in chronic pain. , 1985, Journal of clinical psychology.

[28]  W. A. Arrindell,et al.  SCL-90. Handleiding bij een multidimensionele psychopathologie-indicator , 2003 .

[29]  Alf L. Nachemson,et al.  Neck and back pain : The scientific evidence of causes, diagnosis, and treatment , 2000 .

[30]  L. Stovner.  The Nosologic Status of the Whiplash Syndrome: A Critical Review Based on a Methodological Approach , 1996, Spine.

[31]  W. Spitzer,et al.  Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining "whiplash" and its management. , 1995, Spine.

[32]  J. Hanley,et al.  The meaning and use of the area under a receiver operating characteristic (ROC) curve. , 1982, Radiology.

[33]  A. Verbeek,et al.  ROC curves for the initial assessment of new diagnostic tests. , 1992, Family practice.

[34]  Gordon Waddell,et al.  The Back Pain Revolution , 1998 .

[35]  Jesse A. Berlin,et al.  Assessing the Generalizability of Prognostic Information , 1999 .

[36]  N. Bogduk.  An overview of the International Congress on Whiplash Associated Disorders. , 2003, Pain research & management.

[37]  J. Balla,et al.  The late whiplash syndrome. , 1980, The Australian and New Zealand journal of surgery.

[38]  R. Gunnarsson,et al.  Early Intervention in Whiplash-Associated Disorders: A Comparison of Two Treatment Protocols , 2000, Spine.

[39]  Gordon H. Guyatt,et al.  Users' Guides to the Medical Literature: V. How to Use an Article About Prognosis , 1994 .

[40]  G. Waddell,et al.  Whiplash associated disorders: a review of the literature to guide patient information and advice , 2002, Emergency medicine journal : EMJ.

[41]  M. Sturzenegger,et al.  The effect of accident mechanisms and initial findings on the long-term course of whiplash injury , 1995, Journal of Neurology.

[42]  A. Verhagen,et al.  Randomized clinical trial of conservative treatment for patients with whiplash-associated disorders: considerations for the design and dynamic treatment protocol. , 2003, Journal of manipulative and physiological therapeutics.

[43]  T. Sand,et al.  Whiplash associated disorders: redefining whiplash and its management. , 1999, Spine.

[44]  K. Jordan,et al.  Assessment of published reliability studies for cervical spine range-of-motion measurement tools. , 2000, Journal of manipulative and physiological therapeutics.

[45]  N. Lowe,et al.  A critical review of visual analogue scales in the measurement of clinical phenomena. , 1990, Research in nursing & health.