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Abedi M, Aplin T, Gane E, Johnston V. "No Man's Land": the experiences of persons injured in a road traffic crash wanting to return to work in Queensland, Australia. Disabil Rehabil 2024; 46:48-57. [PMID: 36469639 DOI: 10.1080/09638288.2022.2153178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE This study aimed to explore individuals' experiences of return to work (RTW) following minor to serious road traffic injury (RTI) in Queensland, Australia; seek their recommendations if any, on how to provide support for RTW after RTI; and identify the strategies and resources used to return and remain at work after their RTI. METHODS The interpretive description methodological approach was used. Semi-structured interviews were conducted with eligible participants (n = 18) aged 18-65 y who had experienced a minor to serious RTI at least 6 months earlier. Thematic analysis was used to analyse the data. RESULTS Five themes emerged: (1) physical and mental consequences of RTI negatively impact RTW; (2) money matters; (3) RTW support makes a difference; (4) feeling alone and confused in the RTW process; and (5) several strategies and resources helped with return/stay at work after RTI. Regular contact and cooperation with employers and insurers, job modifications, and using social media to obtain information and social support were helpful RTW strategies. Participants recommended timely and appropriate medical care, financial assistance, and educational support. CONCLUSIONS Policy changes to reduce financial stress, increase employer support, and improve injured individuals' knowledge following a RTI are recommended in jurisdictions operating a fault-based scheme.IMPLICATIONS FOR REHABILITATIONThis study identified several factors that can influence return to work (RTW) following minor to serious road traffic injuries (RTIs) in a jurisdiction operating a fault-based compensation scheme.Legislative changes that provide financial assistance to all injured people regardless of their fault-status could reduce financial stress arising from reduced work ability following a road traffic injury.Increasing employer' awareness of the importance of return to work for those with road traffic injuries and reimbursement for possible expenses of providing RTW support for these individuals could increase employability of injured people following RTI.Improving injured individuals' knowledge about return-to-work processes after a road traffic injury could accelerate recovery and return to work.
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Affiliation(s)
- Masoumeh Abedi
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Tammy Aplin
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Australia
| | - Elise Gane
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
| | - Venerina Johnston
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Abedi M, Aplin T, Gane E, Johnston V. Exploring the perspectives of key stakeholders in returning to work after minor to serious road traffic injuries: a qualitative study. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:93-106. [PMID: 35723805 DOI: 10.1007/s10926-022-10051-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/22/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE This qualitative study conducted in Queensland, Australia aimed to explore various stakeholders' perspectives on (1) the barriers and facilitators of Return to Work (RTW) for injured persons following minor to serious Road Traffic Injuries (RTI) in a fault-based scheme, and to investigate the changes needed to better support RTW following RTI. METHODS The study was performed using the Interpretive Description methodological approach. Data were collected during interviews (n = 17), one focus group (n = 4), and an open-ended survey (n = 10) with five categories of stakeholders: treating health providers, workplace representatives, legal representatives, rehabilitation advisors, and insurers. Participants were eligible to participate if they had at least one year of employment history in their respective profession in Queensland, Australia, and were experienced in assisting the RTW of people with RTI. Thematic analysis was used to analyse the data. RESULTS Seven themes were extracted reflecting the barriers and facilitators of RTW along with stakeholders' recommendations to address these barriers. These themes were: (1) knowledge is power; (2) stakeholder expertise; (3) early and appropriate treatment matters; (4) insurers could do better; (5) necessity of employers' support; (6) fix the disjointed system; (7) importance of individual factors pre- and post- injury. The main barriers identified were stakeholders' insufficient communication and knowledge on RTW process following RTI. CONCLUSIONS Individual and system barriers identified in this study suggest that RTW after RTI occurs in a complex system requiring the commitment of all stakeholders. This is particularly important for managing knowledge-related barriers by provision of high quality and easily accessible information about the RTW process, disability schemes, and the nature of RTI.
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Affiliation(s)
- Masoumeh Abedi
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.
| | - Tammy Aplin
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Australia
| | - Elise Gane
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
| | - Venerina Johnston
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
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Kasch H, Carstensen T, Ravn SL, Andersen TE, Frostholm L. Cervical Motor and Nociceptive Dysfunction After an Acute Whiplash Injury and the Association With Long-Term Non-Recovery: Revisiting a One-Year Prospective Cohort With Ankle Injured Controls. FRONTIERS IN PAIN RESEARCH 2022; 3:906638. [PMID: 35875480 PMCID: PMC9300940 DOI: 10.3389/fpain.2022.906638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Aims To explore the development of cervical motor and nociceptive dysfunction in patients with whiplash (WPs) and non-recovery based on injury-related work disability 1-year after injury when compared with ankle-injured controls (ACs). Methods A 1-year observational prospective study examining consecutive WPs and age- and sex-matched ACs at 1 week,3 months, 6 months, and 1 year post-injury using semi-structured interviews; global pain rating (VAS0-10) and the pain rating index (PRI-T) and number-of-words-chosen (NWC) from the McGill Pain Questionnaire; examining nociceptive functioning using the cold pressor test (CPT), pressure algometry, and methodic palpation, and central pain processing using counter-stimulation; and examining motor functioning by active cervical range-of-motion (CROM), and neck strength [maximal voluntary contraction flexion/extension (MVC)]. One-year work disability/non-recovery was determined using a semi-structured interview. Results A total of 141 WPs and 40 ACs were included. Total pain rating index (PRI-T) NWC were higher in ACs after 1 week but higher in WPs after 3 months, 6 months, and 1 year. Ongoing global pain was higher in WPs after 1 week and after 3 and 6 months but not after 1 year. Pressure pain thresholds were reduced, and palpation was higher in the neck and jaw in WPs after 1 week but was not consistently different afterward from ACs. Cervical mobility was reduced in WPs after 1 week, 3 months, and 6 months but not after 1 year, and MVC was significantly reduced in WPs when compared with ACs after 1 week and 1 year but not after 3 and 6 months. One-year non-recovery was only encountered in 11 WPs and not in the AC group. Non-recovered WPs (N-WPs) had consistently significantly higher VAS0−10, PRI-T, NWC, reduced pressure pain thresholds, raised muscle-tenderness, reduced active cervical range-of-motion, reduced active-neck-flexion/extension, and reported higher neck disability scores than recovered WPs. Of special interest, there was increasing tenderness in trigeminal-derived muscles based on palpation scores, and marked reduction of PPDT was most pronounced in N-WPs when compared with recovered WPs and ACs. Conclusion Cervical motor dysfunction and segmental nociceptive sensitization were present from early after injury in WPs and prolonged in N-WPs. Differences in trigeminal and cervical motor and sensory function in N-WPs could be of interest for future treatment studies.
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Affiliation(s)
- Helge Kasch
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- *Correspondence: Helge Kasch
| | - Tina Carstensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Sophie Lykkegaard Ravn
- Specialized Hospital for Polio and Accident Victims, Roedovre, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | | | - Lisbeth Frostholm
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
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Fabero-Garrido R, Plaza-Manzano G, Martín-Casas P, Del Corral T, Navarro-Santana M, López-de-Uralde-Villanueva I. Negative Psychological Factors' Influence on Delayed Onset Muscle Soreness Intensity, Reduced Cervical Function and Daily Activities in Healthy Participants. THE JOURNAL OF PAIN 2022; 23:1025-1034. [PMID: 35021115 DOI: 10.1016/j.jpain.2021.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/30/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
We examined the influence of negative psychological factors (catastrophizing, distress and kinesiophobia) on delayed onset muscle soreness (DOMS) intensity, cervical function (strength and range of motion) and on daily activities (ADL), and the suitability of an exercise protocol designed to induce DOMS within the cervical region. Psychological factors and cervical function were assessed in 86 healthy participants at baseline before applying a DOMS provocation protocol in the cervical flexor muscles. After 24hour, cervical function was reassessed. In addition, at 24hour and 48hour, the intensity of DOMS and its impact on ADL were assessed using the visual analog scale (VAS). The protocol was effective given that it generated low-moderate intensity DOMS (VAS≈30 -40mm) and a statistically significant reduction in cervical strength and range of motion. Psychological distress (anxiety and depression), but not kinesiophobia and catastrophism, predicted a loss of cervical strength (explained 43% of the variance) and range of motion (explained 22% of the variance) after induction of DOMS. In addition, participants' anxiety level predicted DOMS intensity at 24hour (explained 19% of the variance). PERSPECTIVE: The present findings highlight the relevance of evaluating psychological distress as a preventive/therapeutic measure, given that high levels of distress could lead to more intense and disabling pain in acute injuries, and all these aspects are considered risk factors for the chronification of symptoms.
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Affiliation(s)
- Raúl Fabero-Garrido
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Patricia Martín-Casas
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Tamara Del Corral
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
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Abedi M, Gane E, Aplin T, Zerguine H, Johnston V. Barriers and Facilitators Associated with Return to Work Following Minor to Serious Road Traffic Musculoskeletal Injuries: A Systematic Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:13-26. [PMID: 34241769 DOI: 10.1007/s10926-021-09994-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
Purpose To identify factors impeding or facilitating Return to Work (RTW) after minor to serious musculoskeletal Road Traffic Injuries (RTI). Methods Six electronic databases were searched for studies published 1997-2020. Quantitative and qualitative studies were included if they investigated barriers or facilitators associated with RTW in people with minor to serious musculoskeletal RTI aged over 16 years. Methodological quality was assessed using McMaster Critical Review Form for Quantitative studies and McMaster Critical Review Form for Qualitative Studies. Results are presented narratively as meta-analysis was not possible. Results Eleven studies (10 quantitative and 1 qualitative) were included. There was strong evidence that individuals with higher overall scores on the (short-form or long-form) Örebro Musculoskeletal Pain Questionnaire (ÖMPQ) at baseline were less likely to RTW, and individuals with higher RTW expectancies at baseline were more likely to RTW after musculoskeletal RTI. There was weak evidence for higher disability levels and psychiatric history impeding RTW after musculoskeletal RTI. Conclusions Post-injury scores on the ÖMPQ and RTW expectancies are the most influential factors for RTW after minor to serious musculoskeletal RTI. There is a need to identify consistent measures of RTW to facilitate comparisons between studies.
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Affiliation(s)
- Masoumeh Abedi
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.
| | - Elise Gane
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, QLD, Australia
| | - Tammy Aplin
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Haroun Zerguine
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Venerina Johnston
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, QLD, Australia
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Prego-Domínguez J, Khazaeipour Z, Mallah N, Takkouche B. Socioeconomic status and occurrence of chronic pain: a meta-analysis. Rheumatology (Oxford) 2021; 60:1091-1105. [PMID: 33276382 DOI: 10.1093/rheumatology/keaa758] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/10/2020] [Accepted: 10/07/2020] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To examine the association between socioeconomic status (SES) and the occurrence of chronic pain, defined as pain that persists or recurs for >3 months. METHODS We performed a structured search in Medline, Embase, WHO Global Index Medicus and Conference Proceedings Citation Index-Science databases to identify cohort and case-control studies on chronic pain and SES and its subgroups (SES combined index, educational level, income and occupational status). We extracted study characteristics, outcome measures and measures of association and their 95% CIs. Literature search, data extraction and risk of bias assessment were conducted by two independent researchers. We performed main and subgroup meta-analyses using random-effects model, and formally assessed heterogeneity and publication bias. RESULTS A total of 45 studies, covering a population of ∼175 000 individuals, were meta-analysed, yielding a pooled Odds Ratio (OR) of 1.32 (95% CI: 1.21, 1.44) and 1.16 (95% CI: 1.09, 1.23) for low and medium SES levels, respectively, compared with high level. We obtained similar results in all the subgroup analyses. Heterogeneity was generally moderate to high across strata, and some evidence of publication bias for low socioeconomic status was found. CONCLUSION Our results support a moderate increase in the risk of chronic pain for low and medium SES when compared with high SES, a feature that remained constant in all measures of exposure or outcome used. Further prospective research on populations from developing countries are needed to confirm our findings as the studies available for this meta-analysis were carried out exclusively in developed countries.
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Affiliation(s)
- Jesús Prego-Domínguez
- Department of Preventive Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Zahra Khazaeipour
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Narmeen Mallah
- Department of Preventive Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER-ESP), Madrid, Spain
| | - Bahi Takkouche
- Department of Preventive Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER-ESP), Madrid, Spain.,Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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Elliott JM, Rueckeis CA, Pan Y, Parrish TB, Walton DM, Linnstaedt SD. microRNA let-7i-5p mediates the relationship between muscle fat infiltration and neck pain disability following motor vehicle collision: a preliminary study. Sci Rep 2021; 11:3140. [PMID: 33542428 PMCID: PMC7862492 DOI: 10.1038/s41598-021-82734-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/11/2021] [Indexed: 01/30/2023] Open
Abstract
Persistent neck-pain disability (PNPD) is common following traumatic stress exposures such as motor vehicle collision (MVC). Substantial literature indicates that fat infiltration into neck muscle (MFI) is associated with post-MVC PNPD. However, little is known about the molecular mediators underlying this association. In the current study, we assessed whether microRNA expression signatures predict PNPD and whether microRNA mediate the relationship between neck MFI and PNPD. A nested cohort of 43 individuals from a longitudinal study of MVC survivors, who provided blood (PAXgene RNA) and underwent magnetic resonance imaging (MRI), were included in the current study. Peritraumatic microRNA expression levels were quantified via small RNA sequencing, neck MFI via MRI, and PNPD via the Neck Disability Index two-weeks, three-months, and twelve-months following MVC. Repeated measures regression models were used to assess the relationship between microRNA and PNPD and to perform mediation analyses. Seventeen microRNA predicted PNPD following MVC. One microRNA, let-7i-5p, mediated the relationship between neck MFI and PNPD. Peritraumatic blood-based microRNA expression levels predict PNPD following MVC and let-7i-5p might contribute to the underlying effects of neck MFI on persistent disability. In conclusion, additional studies are needed to validate this finding.
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Affiliation(s)
- James M Elliott
- Faculty of Medicine and Health, The Northern Sydney Local Health District, The Kolling Institute, The University of Sydney, St. Leonards, NSW, Australia
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Cathleen A Rueckeis
- Institute for Trauma Recovery, University of North Carolina, Campus Box #7010, Chapel Hill, NC, 27599-7010, USA
| | - Yue Pan
- Institute for Trauma Recovery, University of North Carolina, Campus Box #7010, Chapel Hill, NC, 27599-7010, USA
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Todd B Parrish
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - David M Walton
- School of Physical Therapy, Western University, London, ON, Canada
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, University of North Carolina, Campus Box #7010, Chapel Hill, NC, 27599-7010, USA.
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA.
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Silva Guerrero AV, Setchell J, Maujean A, Sterling M. A Comparison of Perceptions of Reassurance in Patients with Nontraumatic Neck Pain and Whiplash-Associated Disorders in Consultations with Primary Care Practitioners-An Online Survey. PAIN MEDICINE 2020; 21:3377-3386. [PMID: 33036025 DOI: 10.1093/pm/pnaa277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Neck pain remains highly prevalent and costly worldwide. Although reassurance has been recommended as a first line of treatment, specific advice on the best ways to provide reassurance has not been provided due to lack of evidence. Pain symptoms and experiences differ between patients with whiplash-associated disorder (WAD) and those with nontraumatic neck pain (NTNP). The aims of this study were to 1) identify and compare the concerns, fears, and worries of patients with WAD and NTNP; and 2) determine if patients believe their concerns are addressed by primary care providers. METHODS These questions were investigated through an online survey, with a convenience sample of 30 participants with NTNP and 20 with WAD. RESULTS A thematic analysis of survey responses resulted in the following seven themes related to common concerns, and two regarding how well concerns were addressed. Common concerns expressed by both groups shared four themes: 1) further structural damage, 2) psychological distress, 3) concerns about the future, and 4) hardships that eventuate. Theme 5), pain/disability is long term, was specific to WAD. Themes 6), pain is current or reoccurring, and 7), interference with daily life, were specific to NTNP. Regarding how well patient concerns were addressed, two overarching themes were common to both conditions: 1) concerns were addressed, with both groups sharing the subthemes "successful treatment," "reassurance," and "trust"; and 2) concerns were not addressed, where all subthemes were shared with the exception of two unique to NTNP. CONCLUSIONS This detailed comparison provides information about neck pain patients' concerns and fears, while providing health practitioners support for selecting strategies to promote reassurance appropriately for individual patient needs. Our findings from patients' perspectives enhance the understanding for providing reassurance for neck pain as proposed by our analysis.
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Affiliation(s)
| | - Jenny Setchell
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Annick Maujean
- Centre for Applied Health Economics, Menzies Health Institute, School of Medicine, Griffith University, Brisbane/Gold Coast, Australia
| | - Michele Sterling
- Recover Injury Research Centre, The University of Queensland, Brisbane, Australia.,NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Brisbane, Australia
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Smits EJ, Gane EM, Brakenridge CL, Andrews NE, Johnston V. Expert consensus and perspectives on recovery following road traffic crashes: a Delphi study. Disabil Rehabil 2020; 44:3122-3131. [PMID: 33305970 DOI: 10.1080/09638288.2020.1855677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To reach expert consensus on a definition for recovery following minor and moderate road traffic crash-related injuries and key factors that influence recovery, and to explore expert perspectives on risk identification methods. MATERIALS AND METHODS A three-round Delphi study was conducted in which 47 experts (insurance representatives, health care professionals and researchers) were consulted. RESULTS Strong expert agreement (86%) was reached for the definition: "Recovery is multifaceted and includes return to activities of daily living (ADLs), work and social/leisure activities at pre-injury level or at a level deemed acceptable by the individual, with minimal ongoing pain and symptoms, considering physical and mental health and wellbeing". Agreed key factors that influenced recovery included: resilience; coping skills; recovery expectations; pre-existing physical and mental health; workplace support; and, collaboration between the injured individual, treating providers and claim handlers. Expert perspectives on risk identification methods were mixed. CONCLUSIONS An accepted definition for recovery following minor and moderate road traffic crash-related injury was established, which could facilitate communication and engagement between different rehabilitation stakeholders. Strong consensus was achieved on nine key factors that influenced recovery. Further research is needed to evaluate whether injured persons agree with this definition and on the utility of risk identification methods.Implications for rehabilitationExpert consensus was established for a definition of recovery following minor and moderate road traffic crash-related injuries and nine key influencing factors.An established definition could facilitate communication and engagement between all rehabilitation stakeholders, which could improve the recovery process of the injured person.Rehabilitation professionals need to be familiar with the role of psychosocial factors, such as recovery expectations, resilience and coping skills, in the recovery process.The use of physical and psychological outcome measures at regular intervals could help to identify risk of poor recovery following minor and moderate road traffic crash-related injuries.
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Affiliation(s)
- Esther J Smits
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
| | - Elise M Gane
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Australia.,Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
| | | | - Nicole E Andrews
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia.,Occupational Therapy Department, The Professor Tess Cramond Multidisciplinary Pain Centre, The Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Venerina Johnston
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
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Abstract
OBJECTIVES The reason why some individuals develop chronic symptoms, whiplash-associated disorder, following whiplash trauma is poorly understood. We explored whether precollision pain-related diagnoses, medically unexplained symptoms, and psychiatric diagnoses are related to whiplash-associated disorder. MATERIALS AND METHODS A cohort of 719 individuals exposed to whiplash trauma and subsequently experiencing symptoms within 72 hours (whiplash-exposed cohort) and 3595 matched controls were included in this observational prospective study. At 12 months postcollision, the whiplash-exposed cohort rated their neck pain using the Visual Analog Scale. Data on health were obtained from the Danish National Patient Register for the whiplash-exposed cohort and for the controls for a 5-year period before collision. RESULTS The whiplash-exposed cohort had significantly increased incidences of precollision pain-related diagnoses: χ(1)=17.42, P<0.001 and medically unexplained symptoms: χ(1)=22.2, P<0.001 but not psychiatric diagnoses: χ(1)=3.60, P>0.05 compared with controls in the 5-year period. Participants from the whiplash-exposed cohort with precollision pain-related diagnoses (odds ratio=2.46; 95% confidence interval, 1.39; 4.35) and medically unexplained symptoms (odds ratio, 1.72; 95% confidence interval, 1.04; 2.84) had significantly increased odds for neck pain at follow-up. DISCUSSION Precollision pain and medically unexplained symptoms predict chronic neck pain following whiplash trauma. This may indicate that a sensitization process was initiated before the collision or that individuals with precollision low threshold for contacting health care services maintain this behavior postcollision. The collision may trigger existing individual vulnerabilities that constitute to be a risk factor for chronic whiplash.
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How are pain and traumatic stress symptoms related in acute whiplash-associated disorders? An investigation of the role of pain-related fear in a daily diary study. Pain 2020; 160:1954-1966. [PMID: 30985618 DOI: 10.1097/j.pain.0000000000001581] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Comorbidity of pain and posttraumatic stress disorder is well recognized, but the reason for this association is unclear. This study investigated the direction of the relationship between pain and traumatic stress and the role that pain-related fear plays, for patients with acute whiplash-associated disorder. Participants (n = 99) used an electronic diary to record hourly ratings of pain, traumatic stress, and fear of pain (FOP) symptoms over a day. Relationships between pain, traumatic stress, and pain-related fear symptoms were investigated through multilevel models including variables lagged by 1 hour. Traumatic stress was associated with previous pain, even after controlling for previous traumatic stress and current pain; current pain was not associated with previous traumatic stress. The relationship between traumatic stress and previous pain became negligible after controlling for FOP, except for traumatic stress symptoms of hyperarousal that were driven directly by pain. Overall, these results support a pain primacy model, and suggest that pain-related fear is important in the maintenance and development of comorbid pain and traumatic stress symptoms. They also confirm that traumatic stress symptoms of hyperarousal are central in this relationship. Differences between this study and others that reported mutual maintenance can be understood in terms of different stages of whiplash-associated disorder and different intervals between repeated measurements. Traumatic stress may affect pain over longer time intervals than measured in this study. Future research could explore how relationships between traumatic stress symptoms, pain, and FOP change over time, and whether previous experiences of traumatic stress influence these relationships.
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12
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Shearer HM, Carroll LJ, Côté P, Randhawa K, Southerst D, Varatharajan S, Wong JJ, Yu H, Sutton D, van der Velde G, Nordin M, Gross DP, Mior S, Stupar M, Jacobs C, Taylor-Vaisey A. The course and factors associated with recovery of whiplash-associated disorders: an updated systematic review by the Ontario protocol for traffic injury management (OPTIMa) collaboration. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1736150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Heather M. Shearer
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Linda J. Carroll
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Pierre Côté
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Canada Research Chair in Disability Prevention and Rehabilitation, Ontario Tech University, Oshawa, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | | | - Danielle Southerst
- Occupational and Industrial Orthopaedic Centre, NYU Langone Orthopaedic Hospital, NY, USA
| | - Sharanya Varatharajan
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Jessica J. Wong
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Hainan Yu
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Deborah Sutton
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Canada
| | - Gabrielle van der Velde
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, Canada
- Institute for Work and Health, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, Occupational and Industrial Orthopedic Center of NYU School of Medicine, New York University, NY, USA
| | - Douglas P. Gross
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - Silvano Mior
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Canada
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Maja Stupar
- Graduate Education and Research Programs, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Craig Jacobs
- Division of Clinical Education, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Anne Taylor-Vaisey
- UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Ontario Tech University and Canadian Memorial Chiropractic College (CMCC), Oshawa, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
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Åkerblom S, Larsson J, Malmström EM, Persson E, Westergren H. Acceptance: a factor to consider in persistent pain after neck trauma. Scand J Pain 2019; 19:733-741. [DOI: 10.1515/sjpain-2019-0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/08/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Background and aims
Studies on the interaction between acceptance and pain-related processes after neck trauma are to our knowledge sparse and such treatment strategies are rarely incorporated in management and treatment of posttraumatic neck pain. Thus, the aim of the present study is to investigate how acceptance relates to persistent pain in patients after neck trauma, when controlling for the influence of other psychological factors, trauma characteristics and demographic variables.
Methods
Consecutive patients with persistent pain and disability after neck trauma (n = 565) were assessed by a multi-professional team at a specialized pain rehabilitation clinic. Separate regression analyses were conducted with three outcomes: pain distribution, pain interference, and pain severity. Predictors were age, sex, education, time since trauma, type of trauma, anxiety, depression, and acceptance.
Results
Acceptance was the only factor associated with all outcomes, and patients with lower acceptance displayed more widespread pain and greater interference and severity of pain. The results also showed that higher depression was associated with worse pain interference and severity, whilst anxiety only mattered significantly for pain severity and not for pain interference. Female sex was related to more widespread pain and greater pain interference.
Conclusions
Overall acceptance stood out as the most important factor for the different outcomes and lower acceptance was associated with more widespread pain distribution and greater pain interference and severity.
Implications
The findings of this study add to a growing body of literature confirming that the development of chronicity after neck trauma should be understood as a multidimensional process, best described by a biopsychosocial model. The results also suggest that psychological factors and especially acceptance might be important processes with implications for enhanced recovery after neck trauma.
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Affiliation(s)
- Sophia Åkerblom
- Department of Pain Rehabilitation , Skåne University Hospital , Lund , Sweden
- Department of Psychology , Lund University , Lund , Sweden
| | - Johan Larsson
- Department of Pain Rehabilitation , Skåne University Hospital , Lund , Sweden
- Department of Orofacial Pain and Jaw Function , Malmö University , Malmö , Sweden
| | - Eva-Maj Malmström
- Department of Pain Rehabilitation , Skåne University Hospital , Lund , Sweden
- Department of Clinical Sciences, Otorhinolaryngology , Skåne University Hospital, Lund University , Lund , Sweden
| | - Elisabeth Persson
- Department of Pain Rehabilitation , Skåne University Hospital , Lund , Sweden
| | - Hans Westergren
- Department of Pain Rehabilitation , Skåne University Hospital , Lund , Sweden
- Department of Health Sciences , Lund University , Lund , Sweden
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Kasch H, Jensen LL. Minor Head Injury Symptoms and Recovery From Whiplash Injury: A 1-Year Prospective Study. Rehabil Process Outcome 2019; 8:1179572719845634. [PMID: 34497461 PMCID: PMC8282153 DOI: 10.1177/1179572719845634] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/01/2019] [Indexed: 11/15/2022] Open
Abstract
Aim: To examine concussion-related disability in neck injuries, the Rivermead Head Injury Follow-Up Questionnaire (RHFUQ) was applied. Furthermore, we wanted to investigate symptoms found in post-concussion syndrome (PCS) and global pain, neck pain intensities obtained from acute whiplash patients within 1 week and at 6 months after injury in a prospective study on 1-year work disability. Methods: A total of 143 consecutive acute whiplash-injured patients were admitted to the study from the Emergency Unit (Aarhus University Hospital). Patients with direct head trauma or reported retro- or anterograde amnesia were excluded from the study. Average neck pain and global pain intensity were measured on a Visual Analogue Scale (VAS 0-10). The RHFUQ (10 items, score from 0 to 4, total score from 0 to 40) was fulfilled after 1 week and 6 months. Patients underwent neurological examination within 1 week after injury. Recovery (return to work) was assessed 1 year post-injury. Results: In total, 97% completed the study, and 9% (12/138) did not recover. Non-recovered patients reported more neck pain and global pain after 1 week (P < .003) and 6 months (P < .008) and higher PCS symptom score after 1 week (P < .001) and 6 months (P < .002). Using the RHFUQ total score as a predictive test, a receiver-operating characteristic curve (ROC) area of 0.77 (0.61-0.92) and a cut-off at 10 points revealed a sensitivity of 75% and a specificity of 67.2%. At 1 week, 8 of 10 items reached higher scores among non-recovered and 10 of 10 items after 6 months post-injury. Conclusions: RHFUQ is useful in acute whiplash patients for predicting 1-year work disability. PCS-related symptoms along with neck pain and global pain are more burdensome in the non-recovered group. This emphasizes that post-concussion symptoms are not a sign of brain injury alone, but are found in other types of mishaps like whiplash injuries.
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Affiliation(s)
- Helge Kasch
- Department of Neurology, Spinal Cord Injury Centre of Western Denmark, Viborg, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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15
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Samoborec S, Simpson P, Hassani-Mahmooei B, Ruseckaite R, Giummarra M, Ayton D, Evans S. Impact of comorbidity on health outcome after a transport-related injury. Inj Prev 2019; 26:254-261. [PMID: 31004008 DOI: 10.1136/injuryprev-2019-043195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/26/2019] [Accepted: 03/30/2019] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Understanding the impact of comorbidity on health outcomes is important given that comorbidities can affect survival, morbidity, service delivery costs and healthcare utilisation. However, little is known about the types of comorbidities affecting specific health outcomes after minor to moderate road trauma. METHODS This study involved 1574 participants who claimed injury compensation following transport-related injury. Cross sectional data were collected. Health outcomes were assessed using the EQ-5D-3L specific domains and summary score. Twelve self-reported pre-existing chronic conditions were assessed using a multivariate logistic regression, adjusting for demographic and injury characteristics. RESULTS Out of 1574 participants, only 17 (1%) participants reported no pre-existing comorbidities, 72% reported one, 13% reported two and 14% reported three or more comorbidities. Hypertension (15%), depression (14%) and anxiety (14%) were the most commonly reported comorbidities, followed by arthritis (13%), chronic pain (11%) and asthma (11%). Participants with a history of arthritis (adjusted odds ratio [AOR] 1.90, 95% CI 1.24 to 2.91); chronic back pain (AOR 1.59, 95% CI, 1.04 to 2.43); other chronic pain (AOR 2.73, 95% CI 1.42 to 4.24); depression (AOR 2.55, 95% CI 1.60 to 4.05) and anxiety (AOR 2.08, 95% CI 1.32 to 3.26) were at increased risk of poorer health outcomes, after controlling for age, gender, type of injury and time since injury. CONCLUSION This study found that comorbidities such as arthritis, chronic back pain, other chronic pain, depression and anxiety significantly increase the odds of poorer health postinjury, regardless of the time since injury. Regular screening of comorbid conditions may help identify people likely to have poorer outcomes, thereby enabling the implementation of interventions to optimise health despite the presence of comorbidities.
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Affiliation(s)
- Stella Samoborec
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Pamela Simpson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Rasa Ruseckaite
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Melita Giummarra
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Darshini Ayton
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sue Evans
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Andersen TE, Sterling M, Maujean A, Meredith P. Attachment insecurity as a vulnerability factor in the development of chronic whiplash associated disorder - A prospective cohort study. J Psychosom Res 2019; 118:56-62. [PMID: 30782355 DOI: 10.1016/j.jpsychores.2019.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Attachment theory represents a dynamic model for understanding how pre-existing personality factors may contribute to the development of chronic pain and disability after whiplash injury. The aim of the present study was to investigate the impact of attachment insecurity on disability 6-months post-injury. It was hypothesized that: (1) levels of attachment insecurity assessed at baseline would predict levels of disability six months post-injury, and (2) both attachment dimensions (anxiety and avoidance) would moderate associations between pain and disability, and psychological distress and disability. METHODS Questionnaire data were collected consecutively from a 1-year cohort of whiplash-injured. Data were collected from the emergency room within 1-month post-injury and at follow up 6-months post-injury (n = 205). RESULTS Both attachment dimensions were significantly associated with physical and psychosocial disability. Moreover, when attachment avoidance and attachment axiety were at the mean value (0SD) and high (+1SD), there was a significant positive relationship between pain intensity and disability (physical and psychosocial), with the exception of attachment anxiety, that only moderated the association between pain intensity and psychosocial disability when high. Also, when attachment avoidance and attachment axiety were high there was a significant positive relationship between depression and disability. Finally, when attachment avoidance was at the mean level and high there was a significant positive relationship between pain-catastrophizing and psychosocial disability. CONCLUSION Although the effects sizes for the moderations were small, the results support claims that attachment insecurity, measurable before onset of injury, represents a valuable pre-trauma vulnerability for less optimal recovery after whiplash injury.
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Affiliation(s)
| | - Michele Sterling
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, University of Queensland, Australia
| | - Annick Maujean
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, University of Queensland, Australia
| | - Pamela Meredith
- School of Health and Rehabilitation, University of Queensland, Australia
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17
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Ravn SL, Karstoft KI, Sterling M, Andersen TE. Trajectories of posttraumatic stress symptoms after whiplash: A prospective cohort study. Eur J Pain 2018; 23:515-525. [DOI: 10.1002/ejp.1325] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 10/02/2018] [Accepted: 10/09/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Sophie L. Ravn
- Department of Psychology; University of Southern Denmark; Odense Denmark
- The Specialized Hospital for Polio and Accident Victims; Roedovre Denmark
| | - Karen-Inge Karstoft
- Research and Knowledge Centre; The Danish Veteran Centre; Ringsted Denmark
- Department of Psychology; University of Copenhagen; Copenhagen Denmark
| | - Michele Sterling
- Recover Injury Research Centre; NHMRC Centre of Research Excellence in Recovery after Road Traffic Injury; The University of Queensland; Brisbane Australia
| | - Tonny E. Andersen
- Department of Psychology; University of Southern Denmark; Odense Denmark
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18
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Andersen TE, Ellegaard H, Schiøttz-Christensen B, Manniche C. Somatic experiencing® for patients with low back pain and comorbid posttraumatic stress disorder - protocol of a randomized controlled trial. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 18:308. [PMID: 30466429 PMCID: PMC6251218 DOI: 10.1186/s12906-018-2370-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 11/05/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Research has almost exclusively focused on the neck in order to explain the mechanisms of persistent pain after motor vehicle collisions (MVC). However, studies have shown that low back pain after MVC is as common as neck pain. Also, posttraumatic stress disorder (PTSD) is common after MVCs, and evidence indicate that PTSD may be linked to the development of pain and disability. PTSD has even been proposed as "the missing link" for some in the development of chronic low back pain. Unfortunately, PTSD often goes unattended in low back pain rehabilitation and very few randomized controlled studies exists targeting both conditions. Hence, the aim of the present study is to investigate the potential additional effect of the trauma therapy "Somatic Experiencing®" (SE) in addition to physiotherapy (PT) compared to PT alone for patients with chronic low back pain and comorbid PTSD. METHODS The study is a two-group randomized controlled clinical trial in which participants (n = 140) are recruited consecutively from a large Danish spine center in the Region of Southern Denmark, between January 2016 and December 2017. Patients are randomly allocated to one of the two conditions: SE + PT or PT alone. Measurements of effect are carried out at baseline before randomization, post-intervention, 6 and 12 months post-randomization. The primary outcome is a 20% reduction in disability (Rolland Morris Disability Questionnaire) at 6 months post-randomization. Secondary outcomes are: PTSD symptoms, pain intensity, pain-catastrophizing, fear of movement, anxiety and depression. DISCUSSION Comorbid PTSD is currently not targeted in back pain rehabilitation although highly prevalent. If the SE intervention shows to have an additional effect on disability and pain, the study is likely to have a positive impact on the management of chronic low back pain and will have immediate clinical applicability. TRIAL REGISTRATION Current Controlled Trials Registration August 4, 2017: NCT03244046 . Retrospectively registered.
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Affiliation(s)
- Tonny Elmose Andersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Hanne Ellegaard
- Spine Centre of Southern Denmark and University of Southern Denmark, Middelfart, Denmark
| | | | - Claus Manniche
- Spine Centre of Southern Denmark and University of Southern Denmark, Middelfart, Denmark
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19
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Psychological Factors and the Development of Chronic Whiplash–associated Disorder(s). Clin J Pain 2018; 34:755-768. [DOI: 10.1097/ajp.0000000000000597] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Samoborec S, Ruseckaite R, Ayton D, Evans S. Biopsychosocial factors associated with non-recovery after a minor transport-related injury: A systematic review. PLoS One 2018; 13:e0198352. [PMID: 29894490 PMCID: PMC5997362 DOI: 10.1371/journal.pone.0198352] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 05/17/2018] [Indexed: 11/29/2022] Open
Abstract
Background Globally, road transport accidents contribute significantly to mortality and burden of disability. Up to 50 million people suffer a transport-related non-fatal injury each year, which often leads to long-term disability. A substantial number of people with minor injuries struggle to recover and little is known about the factors leading to poor or non-recovery. The aim of this paper is to present a systematic review of biopsychosocial factors related to poor or non-recovery after a minor transport-related injury. Methods and findings Studies were selected through searches of PubMed, Medline, Embase, and Cochrane library. Methodological quality was assessed using a Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklist for quantitative cohort studies and Standards for Reporting Qualitative Research (SRQR) checklist for qualitative articles. Data were extracted using the Cochrane data extraction tool based on the biopsychosocial model of health (BPS). In total, there were 37 articles included. However, heterogeneity of the techniques and tools used to assess factors and outcomes across studies meant that pooling of results to determine biopsychosocial factors most predictive of poor or non-recovery was not possible. Hence, a narrative synthesis was conducted and shown multiple factors to be associated with poorer outcomes or non-recovery, most being identified in the biological and psychological domain of the BPS model. Factors that were the most representative across studies and have shown to have the strongest associations with poor or non-recovery were high initial pain intensity, pain duration and severity, pre-accident physical and mental health status and pain catastrophising. Conclusions This review demonstrates the complexity of recovery and a challenge in reporting on predictors of recovery. It is evident that a range of multi-factorial biopsychosocial factors impact recovery. These factors are often inter-connected and multi-faceted and therefore, it was not feasible to select or focus on one single factor. In defining the most predictive factors, further research is required, yet the consensus around which tools to use to measure recovery outcomes is needed and is highly recommended. Regardless of the descriptive nature, the review demonstrated that high levels of post-injury pain are associated with poorer outcomes such as chronic pain and physical and mental disability. Therefore, early targeting of modifiable factors such as pain, pain catastrophizing and arising comorbidities such as PTSD, depression and anxiety may assist in reducing chronic pain and ongoing related disabilities. Systematic review trial registration number Systematic review protocol was registered in International Prospective Register for Systematic Reviews (PROSPERO) on 14 December 2016. Registration number CRD42016052276.
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Affiliation(s)
- Stella Samoborec
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
- * E-mail:
| | - Rasa Ruseckaite
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Darshini Ayton
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Sue Evans
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
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Westergren H, Larsson J, Freeman M, Carlsson A, Jöud A, Malmström EM. Sex-based differences in pain distribution in a cohort of patients with persistent post-traumatic neck pain. Disabil Rehabil 2017; 40:1085-1091. [DOI: 10.1080/09638288.2017.1280543] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Hans Westergren
- Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Johan Larsson
- Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
| | - Michael Freeman
- Department of Psychiatry, Oregon Health & Science University School of Medicine, Portland, OR, USA
- School for Public Health and Primary Care CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Anna Carlsson
- Chalmers Industrial Technology (CIT), Gothenburg, Sweden
| | - Anna Jöud
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine Lund, Lund University, Lund, Sweden
| | - Eva-Maj Malmström
- Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
- Department of Otorhinolaryngology, Clinical Sciences, Lund University, Lund, Sweden
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Laporte S, Wang D, Lecompte J, Blancho S, Sandoz B, Feydy A, Lindberg P, Adrian J, Chiarovano E, de Waele C, Vidal PP. An Attempt of Early Detection of Poor Outcome after Whiplash. Front Neurol 2016; 7:177. [PMID: 27812348 PMCID: PMC5072109 DOI: 10.3389/fneur.2016.00177] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 10/03/2016] [Indexed: 12/17/2022] Open
Abstract
The main concern with whiplash is that a large proportion of whiplash patients experience disabling symptoms or whiplash-associated disorders (WAD) for months if not years following the accident. Therefore, identifying early prognostic factors of WAD development is important as WAD have widespread clinical and economic consequences. In order to tackle that question, our study was specifically aimed at combining several methods of investigation in the same WAD patients at the acute stage and 6 months later. Our longitudinal, open, prospective, multi-center study included 38 whiplash patients, and 13 healthy volunteers matched for age, gender, and socio-economic status with the whiplash group. Whiplash patients were evaluated 15-21 days after road accident, and 6 months later. At each appointment, patients underwent a neuropsychological evaluation, a full clinical neurological examination, neurophysiological and postural tests, oto-neurological tests, cervical spine cord magnetic resonance imaging (MRI) with tractography (DTI). At 6 months, whiplash patients were categorized into two subgroups based on the results of the Diagnostic and Statistical Manual of Mental Disorders as having either favorable or unfavorable progression [an unfavorable classification corresponding to the presence of post-concussion symptom (PCS)] and we searched retrospectively for early prognostic factors of WAD predicting the passage to chronicity. We found that patients displaying high level of catastrophizing at the acute stage and/or post-traumatic stress disorder associated with either abnormalities in head or trunk kinematics, abnormal test of the otolithic function and at the Equitest or a combination of these syndromes, turned to chronicity. This study suggests that low-grade whiplash patients should be submitted as early as possible after the trauma to neuropsychological and motor control tests in a specialized consultation. In addition, they should be evaluated by a neuro-otologist for a detailed examination of vestibular functions, which should include cervical vestibular evoked myogenic potential. Then, if diagnosed at risk of WAD, these patients should be subjected to an intensive preventive rehabilitation program, including vestibular rehabilitation if required.
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Affiliation(s)
- Sebastien Laporte
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Metiers ParisTech , Paris , France
| | - Danping Wang
- Plateforme d'étude de la Sensorimotricité, Université Paris Descartes , Paris , France
| | - Jennyfer Lecompte
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Metiers ParisTech , Paris , France
| | - Sophie Blancho
- Institut pour la Recherche sur la Moelle épinière et l'Encéphale (IRME) , Paris , France
| | - Baptiste Sandoz
- LBM/Institut de Biomécanique Humaine Georges Charpak, Arts et Metiers ParisTech , Paris , France
| | - Antoine Feydy
- FR 3636, Université Paris Descartes, INSERM U894, Paris, France; Service de Radiologie B, APHP, CHU Cochin, Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Pavel Lindberg
- FR 3636, Université Paris Descartes, INSERM U894 , Paris , France
| | | | - Elodie Chiarovano
- COGNition and ACtion Group (COGNAC-G), Université Paris Descartes - CNRS UMR-MD - SSA , Paris , France
| | - Catherine de Waele
- COGNition and ACtion Group (COGNAC-G), Université Paris Descartes - CNRS UMR-MD - SSA , Paris , France
| | - Pierre-Paul Vidal
- COGNition and ACtion Group (COGNAC-G), Université Paris Descartes - CNRS UMR-MD - SSA , Paris , France
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Rydman E, Ponzer S, Ottosson C, Järnbert-Pettersson H. Predicting nonrecovery among whiplash patients in the emergency room and in an insurance company setting. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:1254-1261. [PMID: 27405822 DOI: 10.1007/s00586-016-4652-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 06/03/2016] [Accepted: 06/04/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE To construct and validate a prediction instrument for early identification of patients with a high risk of delayed recovery after whiplash injuries (PPS-WAD) in an insurance company setting. METHODS Prospective cohort study. On the basis of a historic cohort (n = 130) of patients with a whiplash injury identified in an emergency room (ER, model-building set), we used logistic regression to construct an instrument consisting of two demographic variables (i.e. questions of educational level and work status) and the patient-rated physical and mental status during the acute phase to predict self-reported nonrecovery after 6 months. We evaluated the instrument's ability to predict nonrecovery in a new cohort (n = 204) of patients originating from an insurance company setting (IC, validation set). RESULTS The prediction instrument had low reproducibility when the setting was changed from the ER cohort to the IC cohort. The overall percentage of correct predictions of nonrecovery in the ER cohort was 78 % compared with 62 % in the IC cohort. The sensitivity and specificity in relation to nonrecovery were both 78 % in the ER cohort. The sensitivity and specificity in the insurance company setting was lower, 67 and 50 %. CONCLUSION Clinical decision rules need validation before they are used in a new setting. An instrument consisting of four questions with an excellent possibility of identifying patients with a high risk of nonrecovery after a whiplash injury in the emergency room was not as useful in an insurance company setting. The importance and type of the risk factors for not recovering probably differ between the settings, as well as the individuals.
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Affiliation(s)
- Eric Rydman
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. .,Department of Orthopedics, Södersjukhuset, 118 83, Stockholm, Sweden.
| | - Sari Ponzer
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Carin Ottosson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Hans Järnbert-Pettersson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Falla D, Peolsson A, Peterson G, Ludvigsson M, Soldini E, Schneebeli A, Barbero M. Perceived pain extent is associated with disability, depression and self-efficacy in individuals with whiplash-associated disorders. Eur J Pain 2016; 20:1490-501. [DOI: 10.1002/ejp.873] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2016] [Indexed: 11/10/2022]
Affiliation(s)
- D. Falla
- Pain Clinic; Center for Anesthesiology, Emergency and Intensive Care Medicine; University Hospital Göttingen; Germany
- School of Sport; Exercise and Rehabilitation Sciences; College of Life and Environmental Sciences; University of Birmingham; Birmingham UK
| | - A. Peolsson
- Department of Medical and Health Sciences; Division of Physiotherapy; Linköping University; Sweden
| | - G. Peterson
- Department of Medical and Health Sciences; Division of Physiotherapy; Linköping University; Sweden
- Centre for Clinical Research Sörmland; Uppsala University; Sweden
| | - M.L. Ludvigsson
- Department of Medical and Health Sciences; Division of Physiotherapy; Linköping University; Sweden
- Rehab Väst; County Council of Östergötland; Motala Sweden
| | - E. Soldini
- Department of Business Economics, Health and Social Care; University of Applied Sciences and Arts of Southern Switzerland (SUPSI); Manno Switzerland
| | - A. Schneebeli
- Rehabilitation Research Laboratory; Department of Business Economics; Health and Social Care; University of Applied Sciences and Arts of Southern Switzerland; Manno Switzerland
| | - M. Barbero
- Rehabilitation Research Laboratory; Department of Business Economics; Health and Social Care; University of Applied Sciences and Arts of Southern Switzerland; Manno Switzerland
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Andersen T, Karstoft KI, Brink O, Elklit A. Pain-catastrophizing and fear-avoidance beliefs as mediators between post-traumatic stress symptoms and pain following whiplash injury - A prospective cohort study. Eur J Pain 2016; 20:1241-52. [DOI: 10.1002/ejp.848] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2015] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - O. Brink
- Aarhus University; Aarhus Denmark
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Carstensen TBW, Fink P, Oernboel E, Kasch H, Jensen TS, Frostholm L. Sick Leave within 5 Years of Whiplash Trauma Predicts Recovery: A Prospective Cohort and Register-Based Study. PLoS One 2015; 10:e0130298. [PMID: 26098860 PMCID: PMC4476609 DOI: 10.1371/journal.pone.0130298] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 05/18/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND 10-22% of individuals sustaining whiplash trauma develop persistent symptoms resulting in reduced working ability and decreased quality of life, but it is poorly understood why some people do not recover. Various collision and post-collision risk factors have been studied, but little is known about pre-collision risk factors. In particular, the impact of sickness and socioeconomic factors before the collision on recovery is sparsely explored. The aim of this study was to examine if welfare payments received within five years pre-collision predict neck pain and negative change in provisional situation one year post-collision. METHODS AND FINDINGS 719 individuals with acute whiplash trauma consecutively recruited from emergency departments or primary care after car accidents in Denmark completed questionnaires on socio-demographic and health factors immediately after the collision. After 12 months, a visual analogue scale on neck pain intensity was completed. 3595 matched controls in the general population were sampled, and national public register data on social benefits and any other welfare payments were obtained for participants with acute whiplash trauma and controls from five years pre-collision to 15 months after. Participants with acute whiplash trauma who had received sickness benefit for more than 12 weeks pre-collision had increased odds for negative change in future provisional situation (Odds Ratio (OR) (95% Confidence Interval (CI) = 3.8 (2.1;7.1)) and future neck pain (OR (95%CI) = 3.3 (1.8;6.3)), controlling for other known risk factors. Participants with acute whiplash trauma had weaker attachment to labour market (more weeks of sick leave (χ2(2) = 36.7, p < 0.001) and unemployment (χ2(2) = 12.5, p = 0.002)) pre-collision compared with controls. Experiencing a whiplash trauma raised the odds for future negative change in provisional situation (OR (95%CI) = 3.1 (2.3;4.4)) compared with controls. CONCLUSIONS Sick leave before the collision strongly predicted prolonged recovery following whiplash trauma. Participants with acute whiplash trauma had weaker attachment to labour market pre-collision compared with the general population. Neck pain at inclusion predicted future neck pain. Acute whiplash trauma may trigger pre-existing vulnerabilities increasing risk of developing whiplash-associated disorders.
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Affiliation(s)
| | - Per Fink
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Eva Oernboel
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Helge Kasch
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lisbeth Frostholm
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
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Myrtveit SM, Carstensen T, Kasch H, Ørnbøl E, Frostholm L. Initial healthcare and coping preferences are associated with outcome 1 year after whiplash trauma: a multicentre 1-year follow-up study. BMJ Open 2015; 5:e007239. [PMID: 25795697 PMCID: PMC4368905 DOI: 10.1136/bmjopen-2014-007239] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Individuals exposed to whiplash collisions have to cope with the stressful event as well as early physical symptoms. As in other chronic pain conditions, coping has been associated with outcome after whiplash. In this study, our aim was to examine whether initial coping preferences were associated with the development of chronic whiplash. DESIGN Prospective study. SETTING Primary care. METHODS 740 acute whiplash patients were recruited from emergency units and general practitioners after car collisions in Denmark. Within 10 days postinjury, participants were asked what they believed could help them get better. At 12-month follow-up, the level of neck pain and capability to work was obtained. Whether coping preferences (baseline) were associated with outcome was investigated using multiple regression analyses. RESULTS Persistent neck pain was most strongly associated with preferring medications (mean difference=1.24 (95% CI 0.67 to 1.82)) and sickness absence (mean difference=1.18 (95% CI 0.53 to 1.82)). Reduced work capability was most strongly associated with preferring medications (OR=3.53 (95% CI 2.13 to 5.86)), sickness absence (OR=3.05 (95% CI 1.80 to 5.17)) and being referred to a physiotherapist/chiropractor (OR=3.03 (95% CI 1.33 to 6.91)). Active coping was associated with better outcomes: Participants preferring to change their lifestyle were protected against reduced work capability (OR=0.11 (95% CI 0.01 to 0.78)). Individuals who wanted to keep living as usual only (no other preference reported) were protected against neck pain (mean difference -1.62 (95% CI -2.39 to -0.84)) and reduced work capability (OR=0.09 (95% CI 0.01 to 0.64)). CONCLUSIONS A simple nine-item measure of coping preferences is associated with the development of chronic neck pain and reduced capability to work following whiplash trauma and may be used to identify individuals at risk of poor recovery.
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Affiliation(s)
- Solbjørg Makalani Myrtveit
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Division of Mental Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Tina Carstensen
- The Research Clinic for Functional Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - Helge Kasch
- Department of Neurology, Danish Pain Research Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Eva Ørnbøl
- The Research Clinic for Functional Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - Lisbeth Frostholm
- The Research Clinic for Functional Disorders, Aarhus University Hospital, Aarhus, Denmark
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Gopinath B, Jagnoor J, Nicholas M, Blyth F, Harris IA, Casey P, Cameron ID. Presence and predictors of persistent pain among persons who sustained an injury in a road traffic crash. Eur J Pain 2014; 19:1111-8. [PMID: 25487140 DOI: 10.1002/ejp.634] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is a paucity of prospective studies with long follow-up that have examined a wide range of correlates associated with persistent pain outcomes in persons who sustained a mild or moderate injury in a road traffic crash. This study aimed to establish the independent predictors of pain severity over 24 months. METHODS A total of 364, 284 and 252 persons with mild/moderate musculoskeletal injuries sustained in a vehicle-related crash participated in telephone interviews in the subacute phase, and at 12 and 24 months, respectively. The numeric rating scale (NRS) assessed pain severity. Pain-Related Self-Statements Scale-Catastrophizing (PRSS-Catastrophizing) and the Short Form Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ) were also administered. RESULTS After multivariable adjustment, each 1 SD increase in Short Form-12 Physical Component Score (SF-12 PCS) in the subacute phase was associated with 0.73 (p = 0.002) and 1.11 (p < 0.0001) decrease in NRS scores after 12 and 24 months, respectively. Each unit increase in the PRSS-Catastrophizing score in the subacute phase was associated with 0.54 (p = 0.001) and 0.43 (p = 0.03) increase in NRS scores 12 and 24 months later, respectively. Subacute phase OMPSQ scores were positively associated with NRS scores at 12- and 24-month follow-ups (p < 0.0001). CONCLUSIONS Self-perceived physical well-being, pain-related work disability and pain catastrophizing could play a role in determining long-term pain-related outcomes following traffic-related injuries.
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Affiliation(s)
- B Gopinath
- John Walsh Centre for Rehabilitation Studies, Sydney Medical School, University of Sydney, Australia.,Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Australia
| | - J Jagnoor
- John Walsh Centre for Rehabilitation Studies, Sydney Medical School, University of Sydney, Australia
| | - M Nicholas
- Pain Management Research Institute, Sydney Medical School, University of Sydney, Australia
| | - F Blyth
- Pain Management Research Institute, Sydney Medical School, University of Sydney, Australia.,School of Public Health, University of Sydney, Australia
| | - I A Harris
- South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Australia
| | - P Casey
- John Walsh Centre for Rehabilitation Studies, Sydney Medical School, University of Sydney, Australia
| | - I D Cameron
- John Walsh Centre for Rehabilitation Studies, Sydney Medical School, University of Sydney, Australia
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MPI Profile Classifications and Associated Clinical Findings Among Litigating Motor Vehicle Collision Patients. Clin J Pain 2014; 30:860-8. [DOI: 10.1097/ajp.0000000000000052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ritchie C, Hendrikz J, Kenardy J, Sterling M. Derivation of a clinical prediction rule to identify both chronic moderate/severe disability and full recovery following whiplash injury. Pain 2013; 154:2198-2206. [DOI: 10.1016/j.pain.2013.07.001] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 06/28/2013] [Accepted: 07/01/2013] [Indexed: 11/25/2022]
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Myrtveit SM, Wilhelmsen I, Petrie KJ, Skogen JC, Sivertsen B. What characterizes individuals developing chronic whiplash?: The Nord-Trøndelag Health Study (HUNT). J Psychosom Res 2013; 74:393-400. [PMID: 23597326 DOI: 10.1016/j.jpsychores.2013.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 02/05/2013] [Accepted: 02/06/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Most individuals experiencing whiplash accidents recover rapidly. A considerable proportion, however, develop chronic symptoms. Psychological factors may slow recovery, possibly by increasing the likelihood of other symptoms being misattributed to, and amplified by the whiplash injury. We aimed to investigate how pre-injury mental and somatic symptoms, self-rated health, use of health-services and medications, health-behavior and socio-demographics predict the development of chronic whiplash. METHODS Data from two waves of a large, population based study (HUNT2 (baseline) and HUNT3) were used. Individuals reporting no whiplash at baseline were identified in HUNT3. Characteristics reported at baseline were compared between those who had developed chronic whiplash in HUNT3 (n=199) and those who had not (n=20,600), using Pearson's chi-squared tests, independent sample t-tests and logistic regression analyses. RESULTS Individuals developing chronic whiplash reported worse baseline health than those reporting no chronic whiplash. Poor self-rated health was a strong risk factor for subsequent chronic whiplash (OR=2.26, 95%CI: 1.68-3.04). Musculoskeletal pain also increased the risk (OR=1.21, 95%CI: 1.15-1.26), as did diffuse somatic symptoms (OR=2.09, 95%CI: 1.47-2.96), use of different health services (OR=1.31, 95%CI: 1.19-1.45), high use of medications (OR=1.28, 95%CI: 1.14-1.43) and symptoms of anxiety (OR=1.93, 95%CI: 1.39-2.68). Physical activity was protective (OR=0.67, 95%CI: 0.49-0.91). Most socio-demographic variables were not significantly associated with chronic whiplash. CONCLUSION Poor somatic and mental pre-injury health increased the risk of subsequent chronic whiplash. This suggests that chronic whiplash is not merely an organic disorder, and highlights the importance of individual expectations, symptom reattribution and amplification in development of chronic whiplash.
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Risk factors for persistent problems following acute whiplash injury: update of a systematic review and meta-analysis. J Orthop Sports Phys Ther 2013; 43:31-43. [PMID: 23322093 DOI: 10.2519/jospt.2013.4507] [Citation(s) in RCA: 163] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE To update a previous review and meta-analysis on risk factors for persistent problems following whiplash secondary to a motor vehicle accident. BACKGROUND Prognosis in whiplash-associated disorder (WAD) has become an active area of research, perhaps owing to the difficulty of treating chronic problems. A previously published review and meta-analysis of prognostic factors included primary sources up to May 2007. Since that time, more research has become available, and an update to that original review is warranted. METHODS A systematic search of international databases was conducted, with rigorous inclusion criteria focusing on studies published between May 2007 and May 2012. Articles were scored, and data were extracted and pooled to estimate the odds ratio for any factor that had at least 3 independent data points in the literature. RESULTS Four new cohorts (n = 1121) were identified. In combination with findings of a previous review, 12 variables were found to be significant predictors of poor outcome following whiplash, 9 of which were new (n = 2) or revised (n = 7) as a result of additional data. The significant variables included high baseline pain intensity (greater than 5.5/10), report of headache at inception, less than postsecondary education, no seatbelt in use during the accident, report of low back pain at inception, high Neck Disability Index score (greater than 14.5/50), preinjury neck pain, report of neck pain at inception (regardless of intensity), high catastrophizing, female sex, WAD grade 2 or 3, and WAD grade 3 alone. Those variables robust to publication bias included high pain intensity, female sex, report of headache at inception, less than postsecondary education, high Neck Disability Index score, and WAD grade 2 or 3. Three existing variables (preaccident history of headache, rear-end collision, older age) and 1 additional novel variable (collision severity) were refined or added in this updated review but showed no significant predictive value. CONCLUSION This review identified 2 additional prognostic factors and refined the estimates of 7 previously identified factors, bringing the total number of significant predictors across the 2 reviews to 12. These factors can be easily identified in a clinical setting to provide estimates of prognosis following whiplash.
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Kasch H, Kongsted A, Qerama E, Bach FW, Bendix T, Jensen TS. A new stratified risk assessment tool for whiplash injuries developed from a prospective observational study. BMJ Open 2013; 3:bmjopen-2012-002050. [PMID: 23370009 PMCID: PMC3563124 DOI: 10.1136/bmjopen-2012-002050] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES An initial stratification of acute whiplash patients into seven risk-strata in relation to 1-year work disability as primary outcome is presented. DESIGN The design was an observational prospective study of risk factors embedded in a randomised controlled study. SETTING Acute whiplash patients from units, general practitioners in four Danish counties were referred to two research centres. PARTICIPANTS During a 2-year inclusion period, acute consecutive whiplash-injured (age 18-70 years, rear-end or frontal-end car accident and WAD (whiplash-associated disorders) grades I-III, symptoms within 72 h, examination prior to 10 days postinjury, capable of written/spoken Danish, without other injuries/fractures, pre-existing significant somatic/psychiatric disorder, drug/alcohol abuse and previous significant pain/headache). 688 (438 women and 250 men) participants were interviewed and examined by a study nurse after 5 days; 605 were completed after 1 year. A risk score which included items of initial neck pain/headache intensity, a number of non-painful complaints and active neck mobility was applied. The primary outcome parameter was 1-year work disability. RESULTS The risk score and number of sick-listing days were related (Kruskal-Wallis, p<0.0001). In stratum 1, less than 4%, but in stratum 7, 68% were work-disabled after 1 year. Early work assessment (p<0.0001), impact of the event questionnaire (p<0.0006), psychophysical pain measures being McGill pain questionnaire parameters (p<0.0001), pressure pain algometry (p<0.0001) and palpation (p<0.0001) showed a significant relationship with risk stratification. ANALYSIS Findings confirm previous studies reporting intense neck pain/headache and distress as predictors for work disability after whiplash. Neck-mobility was a strong predictor in this study; however, it was a more inconsistent predictor in other studies. CONCLUSIONS Application of the risk assessment score and use of the risk strata system may be beneficial in future studies and may be considered as a valuable tool to assess return-to-work following injuries; however, further studies are needed.
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Affiliation(s)
- Helge Kasch
- Department of Neurology, The Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
| | - Alice Kongsted
- Department of Research, Spine Center of Southern Denmark, Hospital Lillebaelt, Institute of Regional Health Research, University of Southern Denmark, Odense M, Denmark
| | - Erisela Qerama
- Department of Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - Flemming W Bach
- Department of Neurology, Aarhus University Hospital, Aalborg Hospital, Aalborg, Denmark
| | - Tom Bendix
- Department of Rheumatology, Copenhagen Spine Center, Glostrup Hospital, Glostrup, Denmark
| | - Troels Staehelin Jensen
- Department of Neurology, The Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
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Vernon H, Guerriero R, Soave D, Kavanaugh S, Puhl A, Reinhart C. The relationship between self-rated disability, fear-avoidance beliefs, and nonorganic signs in patients with chronic whiplash-associated disorder. J Manipulative Physiol Ther 2012; 34:506-13. [PMID: 21978543 DOI: 10.1016/j.jmpt.2011.08.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 05/09/2011] [Accepted: 06/02/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The purpose of this study was to determine the role of standard and novel (cervical) nonorganic signs in patients with chronic whiplash-associated disorder (WAD). METHODS Chronic WAD I to III patients (>3 months) were recruited from private chiropractic practice in Canada. Subjects completed a Neck Disability Index (NDI), Tampa Scale for Kinesiophobia (TSK), pain visual analog scale, and pain diagram. Clinical and demographic data were also obtained. Nine standard nonorganic pain behavior tests and 4 novel cervical nonorganic simulation signs (C-NOSS) tests were applied. Bivariate correlations were obtained with the Pearson correlation coefficient. Items achieving statistical significance on univariate analysis were loaded in a sequential linear regression analysis. Post hoc analyses were conducted with analysis of variance tests of NDI and TSK scores. RESULTS Ninety-one subjects were investigated (49 males and 42 females), with a mean age of 41.7 (SD, 14.7) years and a mean duration of 9.4 (SD, 11.2) months. Because mean NDI scores were 57.5 (SD, 17.8) and mean pain scores were 68.3 (SD, 21.0), this sample represents moderate-to-severe WAD. Fair to moderately strong correlations were obtained between the NDI and the TSK, pain visual analog scale and nonorganic symptoms and signs (NOS-9) and C-NOSS scores, but not with "age," "sex," or "duration." The NOS-9 and C-NOSS scores correlated most strongly at 0.70. A multivariate model accounting for 53% of the variance of the NDI scores (P < .001) was obtained with the TSK, pain severity, and NOS-9 scores. There was no significant correlation between C-NOSS and TSK scores. At least 25% of subjects scored either 5 of 9 or 2 of 4 on the NOS-9 and C-NOSS tests, respectively. CONCLUSIONS Based on the findings of this study, nonorganic signs should be considered in the interpretation of self-rated disability in patients with moderate-to-severe chronic WAD.
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Affiliation(s)
- Howard Vernon
- Division of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
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Are there gender differences in coping with neck pain following acute whiplash trauma? A 12-month follow-up study. Eur J Pain 2012; 16:49-60. [DOI: 10.1016/j.ejpain.2011.06.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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The risk assessment score in acute whiplash injury predicts outcome and reflects biopsychosocial factors. Spine (Phila Pa 1976) 2011; 36:S263-7. [PMID: 22020622 DOI: 10.1097/brs.0b013e31823881d6] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN One-year prospective study of 141 acute whiplash patients (WLP) and 40 acute ankle-injured controls. OBJECTIVE This study investigates a priori determined potential risk factors to develop a risk assessment tool, for which the expediency was examined. SUMMARY OF BACKGROUND DATA The whiplash-associated disorders (WAD) grading system that emerged from The Quebec Task-Force-on-Whiplash has been of limited value for predicting work-related recovery and for explaining biopsychosocial disability after whiplash and new predictive factors, for example, risk criteria that comprehensively differentiate acute WLP in a biopsychosocial manner are needed. METHODS Consecutively, 141 acute WLP and 40 ankle-injured recruited from emergency units were examined after 1 week, 1, 3, 6, and 12 months obtaining neck/head visual analog scale score, number of nonpainful complaints, epidemiological, social, psychological data and neurological examination, active neck mobility, and furthermore muscle tenderness and pain response, and strength and duration of neck muscles. Risk factors derived (reduced cervical range of motion, intense neck pain/headache, multiple nonpain complaints) were applied in a risk assessment score and divided into seven risk strata. RESULTS A receiver operating characteristics curve for the Risk Assessment Score and 1-year work disability showed an area of 0.90. Risk strata and number of sick days showed a log-linear relationship. In stratum 1 full recovery was encountered, but for high-risk patients in stratum 6 only 50% and 7 only 20% had returned to work after 1 year (P < 5.4 × 10). Strength measures, psychophysical pain measurements, and psychological and social data (reported elsewhere) showed significant relation to risk strata. CONCLUSION The Risk Assessment score is suggested as a valuable tool for grading WLP early after injury. It has reasonable screening power for encountering work disability and reflects the biopsychosocial nature of whiplash injuries.
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Gross T, Amsler F. Prevalence and incidence of longer term pain in survivors of polytrauma. Surgery 2011; 150:985-95. [DOI: 10.1016/j.surg.2011.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Accepted: 04/22/2011] [Indexed: 10/18/2022]
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Sterling M. Whiplash-associated disorder: musculoskeletal pain and related clinical findings. J Man Manip Ther 2011; 19:194-200. [PMID: 23115472 PMCID: PMC3201650 DOI: 10.1179/106698111x13129729551949] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The aim of this paper was to review the physical and psychological processes associated with whiplash-associated disorders. There is now much scientific data available to indicate the presence of disturbed nociceptive processing, stress system responses, muscle and motor changes as well as psychological factors in both acute and chronic whiplash-associated disorders. Some of these factors seem to be associated with the transition from acute to chronic pain and have demonstrated prognostic capacity. Further investigation is required to determine if these processes can be modified and if modification will lead to improved outcomes for this condition. The burden of whiplash injuries, the high rate of transition to chronicity, and evidence of limited effects of current management on transition rates demand new directions in evaluation and management. The understanding of processes underlying this condition is improving and this lays the foundation for the development of more effective management approaches.
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Affiliation(s)
- Michele Sterling
- Centre for National Research on Disability and Rehabilitation Medicine (CONROD), The University of Queensland, Australia
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Does cervical kyphosis relate to symptoms following whiplash injury? ACTA ACUST UNITED AC 2011; 16:378-83. [PMID: 21295511 DOI: 10.1016/j.math.2011.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 01/04/2011] [Accepted: 01/07/2011] [Indexed: 11/21/2022]
Abstract
The mechanisms for developing long-lasting neck pain after whiplash injuries are still largely unrevealed. In the present study it was investigated whether a kyphotic deformity of the cervical spine, as opposed to a straight or a lordotic spine, was associated with the symptoms at baseline, and with the prognosis one year following a whiplash injury. MRI was performed in 171 subjects about 10 d after the accident, and 104 participated in the pain recording at 1-year follow-up. It was demonstrated that postures as seen on MRI can be reliably categorized and that a straight spine is the most frequent appearance of the cervical spine in supine MRI. In relation to symptoms it was seen that a kyphotic deformity was associated with reporting the highest intensities of headache at baseline, but not with an increased risk of long-lasting neck pain or headache. In conclusion, a kyphotic deformity is not significantly associated with chronic whiplash associated pain. Moreover, it is a clear clinical implication that pain should not be ascribed to a straight spine on MRI. We suggest that future trials on cervical posture focus upon the presence of kyphotic deformity rather than just on the absence of lordosis.
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Pieske O, Weinhold T, Buck J, Piltz S. Seniority of the first-treating doctor does not influence the outcome of acute whiplash injury: a prospective cohort study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 19:1627-34. [PMID: 20383722 DOI: 10.1007/s00586-010-1379-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 03/01/2010] [Accepted: 03/14/2010] [Indexed: 11/29/2022]
Abstract
The aim of the prospective cohort study was to investigate the outcome of acute whiplash injury first treated either by junior doctors (JD) [≤3 postgraduate years (PGY)] or more experienced doctors (MED) (>3 PGY). At baseline, crash-related data and health parameters including the SF36 were evaluated in whiplash patients (WP), who fulfilled criteria for whiplash-associated disorders grade I-II and presented up to 48 h after motor vehicle accident to our Emergency Department. 81 WP were recruited and treated by either one of 14 JD (35 WP) or one of 22 MED (46 WP). The follow-up examination included the course of pain intensity [numeric rating scale (NRS) 0-10] by the use of a 28 days-pain-diary and the incidence of symptoms (standardized-telephone-interview at 1, 3, and 6 months post trauma) in terms of neck pain NRS > 2, analgesic medication, work-off, and utilization of further medical services as well as SF36 evaluated at the end of the study. Although the entry population seemed similar, all outcome parameters were comparable between the JD- and MED-group (p > 0.05). Therefore, we conclude that seniority of the first-treating physician does not influence the outcome of acute whiplash injury.
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Affiliation(s)
- Oliver Pieske
- Department of Trauma Surgery, University Hospital of Munich, Campus Grosshadern, Marchioninistraße 15, 81377 Munich, Germany.
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Recognition of central sensitization in patients with musculoskeletal pain: Application of pain neurophysiology in manual therapy practice. ACTA ACUST UNITED AC 2010; 15:135-41. [DOI: 10.1016/j.math.2009.12.001] [Citation(s) in RCA: 327] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 10/18/2009] [Indexed: 11/23/2022]
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Abstract
STUDY DESIGN Cross-sectional clinical study. OBJECTIVE Determine if psychological factors "fear avoidance behavior" and "pain amplification," along with age, gender, duration, and pain severity correlate with scores of self-rated disability in chronic whiplash sufferers. SUMMARY OF BACKGROUND DATA The Fear Avoidance Model has gained acceptance in the understanding of whiplash-associate disorders (WAD). While the variables important in this model have been studied in acute/subacute samples and some small chronic samples, no study has explicitly investigated the role these and other psychosocial variables play in the self-ratings of neck-related disability in chronic WAD sufferers. METHODS Chronic WAD sufferers (>3 months) were recruited from private practice. No WAD IV subjects were included. Subjects completed a Neck Disability Index (NDI), Tampa Scale for Kinesiophobia (TSK), pain visual analogue scale, and pain diagram. Clinical and demographic data were also obtained. Univariate correlations were obtained with the Spearman rank correlation coefficient. Items achieving statistical significance on univariate analysis were loaded in a step-wise linear regression analysis. RESULTS One hundred seven subjects were investigated (54 females), with a mean age of 45.4 (17) years and a mean duration of 13.4 (14.6) months. Fair to moderately strong correlations were obtained between the NDI and the TSK, pain visual analogue scale and pain drawing scores, but not with "duration." The Pain Diagram correlated with NDI scores and pain severity. A multivariate model accounting for 31% of the variance of the NDI scores (P < 0.001) was obtained with the TSK, pain severity, and pain drawing. CONCLUSION It appears that important psychological factors (fear avoidance beliefs and pain amplification) do have some influence on self-ratings of disability in chronic WAD sufferers. This does not appear to be larger than that found in studies of acute/subacute subjects. The influence of these factors may plateau fairly early in the post-WAD period. There is some evidence that the Pain Diagram may provide insight into nonorganic pain behavior.
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Rehabilitation of chronic whiplash: treatment of cervical dysfunctions or chronic pain syndrome? Clin Rheumatol 2009; 28:243-51. [DOI: 10.1007/s10067-008-1083-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Revised: 12/02/2008] [Accepted: 12/23/2008] [Indexed: 10/21/2022]
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Kasch H, Qerama E, Kongsted A, Bendix T, Jensen TS, Bach FW. Clinical assessment of prognostic factors for long-term pain and handicap after whiplash injury: a 1-year prospective study. Eur J Neurol 2008; 15:1222-30. [PMID: 18803651 DOI: 10.1111/j.1468-1331.2008.02301.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Physical mechanisms are the possible factors involved in the development and maintenance of long-term handicaps after acute whiplash injury. This study prospectively examined the role of active neck mobility, cervical and extra-cervical pains, as well as non-painful complaints after a whiplash injury as predictors for subsequent handicap. METHODS Consecutive acute whiplash patients (n = 688) were interviewed and examined by a study nurse after the median of 5 days after injury, and divided into a high- or a low-risk group by an algorithm based on pain intensity, number of non-painful complaints and active neck mobility [active cervical range of motion (CROM)]. All 458 high-risk patients and 230 low-risk patients received mailed questionnaires after 3, 6 and 12 months. Two examiners examined all high-risk patients (n = 458) and 41 consecutive low-risk patients at median 11, 109, 380 days after injury. The main outcome measures were: handicaps, severe headaches, neck pain and neck disability. RESULTS The relative risk for a 1-year disability increased by 3.5 with initial intense neck pain and headaches, by 4.6 times with reduced CROM and by four times with multiple non-painful complaints. CONCLUSION Reduced active neck mobility, immediate intense neck pain and headaches and the presence of multiple non-painful complaints are the important prognostic factors for a 1-year handicap after acute whiplash.
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Affiliation(s)
- H Kasch
- Danish Pain Research Center, Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
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