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Bellosta-López P, Doménech-García V, Ortiz-Lucas M, Lluch-Girbés E, Herrero P, Sterling M, Christensen SWM. Longitudinal Changes and Associations Between Quantitative Sensory Testing and Psychological Factors in Whiplash-Associated Disorders: A Systematic Review and Meta-Analyses-Based Data Synthesis. THE JOURNAL OF PAIN 2024; 25:12-30. [PMID: 37517451 DOI: 10.1016/j.jpain.2023.07.021] [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: 11/25/2022] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/01/2023]
Abstract
Whiplash-associated disorders (WAD) represent a multifactorial condition often accompanied by altered nociceptive processing and psychological factors. This systematic review on acute and chronic WAD aimed to investigate the relationship between quantitative sensory testing (QST) and psychological factors and quantify whether their trajectories over time follow a similar pattern to disability levels. Eight databases were searched until October 2022. When 2 prospective studies examined the same QST or psychological variable, data synthesis was performed with random-effects meta-analysis by pooling within-group standardized mean differences from baseline to 3-, 6-, and 12-month follow-ups. From 5,754 studies, 49 comprising 3,825 WAD participants were eligible for the review and 14 for the data synthesis. Altered nociceptive processing in acute and chronic WAD, alongside worse scores on psychological factors, were identified. However, correlations between QST and psychological factors were heterogeneous and inconsistent. Furthermore, disability levels, some QST measures, and psychological factors followed general positive improvement over time, although there were differences in magnitude and temporal changes. These results may indicate that altered psychological factors and increased local pain sensitivity could play an important role in both acute and chronic WAD, although this does not exclude the potential influence of factors not explored in this review. PERSPECTIVE: Acute WAD show improvements in levels of disability and psychological factors before significant improvements in nociceptive processing are evident. Facilitated nociceptive processing might not be as important as psychological factors in chronic WAD-related disability, which indicates that chronic and acute WAD should not be considered the same entity although there are similarities. Nonetheless, pressure pain thresholds in the neck might be the most appropriate measure to monitor WAD progression.
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Affiliation(s)
- Pablo Bellosta-López
- Universidad San Jorge, Campus Universitario, Autov. A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Víctor Doménech-García
- Universidad San Jorge, Campus Universitario, Autov. A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - María Ortiz-Lucas
- Universidad San Jorge, Campus Universitario, Autov. A23 km 299, 50830, Villanueva de Gállego, Zaragoza, Spain
| | - Enrique Lluch-Girbés
- Physiotherapy in Motion, Multi-Specialty Research Group (PTinMOTION), Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Pablo Herrero
- iHealthy Research Group. IIS Aragon/University of Zaragoza. Department of Physiatry and Nursing. Faculty of Health Sciences, Zaragoza, Spain
| | - Michele Sterling
- Recover Injury Research Centre, The University of Queensland, Herston, Australia; Centre of Research Excellence, Better Health Outcomes for Compensable Injury, The University of Queensland, Herston, Australia
| | - Steffan W M Christensen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark; Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark
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Stupar M, Côté P, Carroll LJ, Brison RJ, Boyle E, Shearer HM, Cassidy JD. Multivariable prediction models for the recovery of and claim closure related to post-collision neck pain and associated disorders. Chiropr Man Therap 2023; 31:32. [PMID: 37626364 PMCID: PMC10464149 DOI: 10.1186/s12998-023-00504-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE Few clinical prediction models are available to clinicians to predict the recovery of patients with post-collision neck pain and associated disorders. We aimed to develop evidence-based clinical prediction models to predict (1) self-reported recovery and (2) insurance claim closure from neck pain and associated disorders (NAD) caused or aggravated by a traffic collision. METHODS The selection of potential predictors was informed by a systematic review of the literature. We used Cox regression to build models in an incident cohort of Saskatchewan adults (n = 4923). The models were internally validated using bootstrapping and replicated in participants from a randomized controlled trial conducted in Ontario (n = 340). We used C-statistics to describe predictive ability. RESULTS Participants from both cohorts (Saskatchewan and Ontario) were similar at baseline. Our prediction model for self-reported recovery included prior traffic-related neck injury claim, expectation of recovery, age, percentage of body in pain, disability, neck pain intensity and headache intensity (C = 0.643; 95% CI 0.634-0.653). The prediction model for claim closure included prior traffic-related neck injury claim, expectation of recovery, age, percentage of body in pain, disability, neck pain intensity, headache intensity and depressive symptoms (C = 0.637; 95% CI 0.629-0.648). CONCLUSIONS We developed prediction models for the recovery and claim closure of NAD caused or aggravated by a traffic collision. Future research needs to focus on improving the predictive ability of the models.
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Affiliation(s)
- Maja Stupar
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Canada
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Pierre Côté
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Canada.
- Faculty of Health Sciences, Ontario Tech University, Ontario, Canada.
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Linda J Carroll
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Robert J Brison
- Kingston General Hospital Research Inst, Kingston, Canada
- Department of Emergency Medicine, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Eleanor Boyle
- Thunderbird Partnership Foundation, Bothwell, ON, UK
| | - Heather M Shearer
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Canada
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - J David Cassidy
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Gane EM, Plinsinga ML, Brakenridge CL, Smits EJ, Aplin T, Johnston V. The Impact of Musculoskeletal Injuries Sustained in Road Traffic Crashes on Work-Related Outcomes: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111504. [PMID: 34770019 PMCID: PMC8582890 DOI: 10.3390/ijerph182111504] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022]
Abstract
Musculoskeletal injuries occur frequently after road traffic crashes (RTCs), and the effect on work participation is not fully understood. The primary aim of this review was to determine the impact of sustaining a musculoskeletal injury during an RTC on the rate of return to work (RTW), sick leave, and other work outcomes. The secondary aim was to determine factors associated with these work-related outcomes. An electronic search of relevant databases to identify observational studies related to work and employment, RTC, and musculoskeletal injuries was conducted. Where possible, outcome data were pooled by follow-up period to answer the primary aim. Fifty-three studies were included in this review, of which 28 were included in meta-analyses. The pooled rate of RTW was 70% at 1 month, 67% at 3 months, 76% at 6 months, 83% at 12 months, and 70% at 24 months. Twenty-seven percent of participants took some sick leave by one month follow-up, 13% by 3 months, 23% by 6 months, 36% by 12 months, and 22% by 24 months. Most of the factors identified as associated with work outcomes were health-related, with some evidence also for sociodemographic factors. While 70% of people with RTC-related musculoskeletal injury RTW shortly after accident, many still have not RTW two years later.
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Affiliation(s)
- Elise M. Gane
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia; (T.A.); (V.J.)
- Recover Injury Research Centre, The University of Queensland, Brisbane 4066, Australia; (M.L.P.); (C.L.B.); (E.J.S.)
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane 4102, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane 4102, Australia
- Correspondence:
| | - Melanie L. Plinsinga
- Recover Injury Research Centre, The University of Queensland, Brisbane 4066, Australia; (M.L.P.); (C.L.B.); (E.J.S.)
| | - Charlotte L. Brakenridge
- Recover Injury Research Centre, The University of Queensland, Brisbane 4066, Australia; (M.L.P.); (C.L.B.); (E.J.S.)
| | - Esther J. Smits
- Recover Injury Research Centre, The University of Queensland, Brisbane 4066, Australia; (M.L.P.); (C.L.B.); (E.J.S.)
| | - Tammy Aplin
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia; (T.A.); (V.J.)
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane 4032, Australia
| | - Venerina Johnston
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia; (T.A.); (V.J.)
- Recover Injury Research Centre, The University of Queensland, Brisbane 4066, Australia; (M.L.P.); (C.L.B.); (E.J.S.)
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Rasmussen MK, Kongsted A, Carstensen T, Jensen TS, Kasch H. Revisiting Risk-stratified Whiplash-exposed Patients 12 to 14 Years After Injury. Clin J Pain 2020; 36:923-931. [PMID: 32826406 PMCID: PMC7688078 DOI: 10.1097/ajp.0000000000000877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 06/15/2020] [Accepted: 08/07/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the long-term predictive value of the Danish Whiplash Group Risk Assessment Score (DWGRAS) with 7 risk strata. DESIGN E-questionnaire-based follow-up study (n=927) combining 2 cohorts of whiplash-injured patients, 1 observational (n=187) and 1 interventional randomized controlled trial (n=740). METHODS Nine hundred twenty-seven previously healthy persons exposed to acute whiplash injury during motor vehicle collision were sent letter by postal service asking the addressee if they would respond to an E-questionnaire. Outcome measures were: whiplash-related disability, pain, use of medication/nonmedical treatment, work capacity. RESULTS The response rate was 37%. Fifty-five percent reported whiplash-related disability. Fourteen percent reported daily symptoms. A strong relationship was found between risk strata and impact of event and between risk strata and disabling symptoms. CONCLUSIONS Internal and long-term validation of DWGRAS was performed, but a low response rate indicates that results should be interpreted with caution. Furthermore, external validation needs to be done in long-term studies. An receiver operating characteristics curve of 0.73 (95% confidence interval 0.67; 0.79) predicting daily or weekly whiplash-related disability after 12 to 14 years was found using the DWGRAS risk score.
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Affiliation(s)
- Martin K. Rasmussen
- Danish Pain Research Centre Aarhus University Hospital
- Center for Translational Neuromedicine, Copenhagen University, Copenhagen, Denmark
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics, Odense
| | - Tina Carstensen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital
- Department of Clinical Medicine, Health, Aarhus University, Aarhus
| | - Troels S. Jensen
- Danish Pain Research Centre Aarhus University Hospital
- Department of Clinical Medicine, Health, Aarhus University, Aarhus
| | - Helge Kasch
- Department of Clinical Medicine, Health, Aarhus University, Aarhus
- Department of Neurology, Viborg
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Wendahl A, Abd-Elsayed A. A 65-Year-Old Man with Chronic Neck Pain (Cervical Facet Disease). PRACTICAL CHRONIC PAIN MANAGEMENT 2020:65-69. [DOI: 10.1007/978-3-030-46675-6_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Pedersen MM, Fink P, Kasch H, Frostholm L. Development of an Internet-delivered educational video for acute whiplash injuries. Pilot Feasibility Stud 2019; 5:60. [PMID: 31061715 PMCID: PMC6487037 DOI: 10.1186/s40814-019-0445-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 04/09/2019] [Indexed: 11/12/2022] Open
Abstract
Objective To describe the development of a preventive educational video for patients exposed to whiplash trauma following motor vehicle accidents. Methods The development followed a systematic approach and was theory-driven supplemented with available empirical knowledge. The specific content was developed by a multidisciplinary group involving health professionals and visual production specialists. Results A 14-min educational video was created. The video content focuses on stimulating adaptive recovery expectations and preventing maladaptive illness beliefs. The video presents a multifactorial model for pain incorporating physiological and cognitive-behavioural aspects, advice on pain relief, and exercises. Subjects interviewed for a qualitative evaluation found the video reassuring and that it aligned well with verbal information received in the hospital. Conclusions The development of the visual educational intervention benefitted from a systematic development approach entailing both theoretical and research-based knowledge. The sparse evidence on educational information for acute whiplash trauma posed a challenge for creating content. Further knowledge is required regarding what assists recovery in the early stages of whiplash injuries in order to improve the development of educational interventions.
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Affiliation(s)
- Majbritt Mostrup Pedersen
- 1The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Nørrebrogade 44, Bygn. 2C, 8000 Aarhus, Denmark
| | - Per Fink
- 1The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Nørrebrogade 44, Bygn. 2C, 8000 Aarhus, Denmark.,3Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark
| | - Helge Kasch
- The Spinal Cord Injury Centre of Western Denmark, Department of Neurology, Regional Hospital of Viborg, 8800 Viborg, Denmark.,3Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark
| | - Lisbeth Frostholm
- 1The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Nørrebrogade 44, Bygn. 2C, 8000 Aarhus, Denmark.,3Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark
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Walton DM, Phares P. The potential and perils of prognosticating persistent post-traumatic problems from a postpositivist perspective. Spine J 2018; 18:1483-1488. [PMID: 29355787 DOI: 10.1016/j.spinee.2018.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 01/05/2018] [Accepted: 01/11/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Predicting recovery after traumatic neck pain has become an active area of research but is moving in several different directions with currently little consensus on the important outcomes to predict or relevant variables to predict them. PURPOSE This editorial explores the current state of prognostic (risk)-based tools or algorithms for predicting the likelihood of chronic problems after acute axial trauma, with a focus on traumatic neck pain (ie, whiplash-associated disorder). STUDY DESIGN/SETTING This paper has an editorial study design. METHOD This is a narrative commentary. RESULTS Prognostic efforts have value in guiding clinical decision-making and optimizing resource allocation to those at highest risk while minimizing iatrogenic disability for those at lower risk, but there are also several important caveats that should be observed when applying and interpreting the results of such tools. These include the biases associated with predicting outcomes based on findings from a single administration of a tool, inappropriate assumptions of causality, assumptions of linear relationships, and inability to consider the unique individual traits and contexts of patients that likely interact with clinical variables to influence the actual degree of risk they impart. CONCLUSIONS The paper concludes with a brief overview of trends that are likely to dramatically change the field, including creation of large clinical databases and big data analytics.
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Affiliation(s)
- David M Walton
- School of Physical Therapy, Western University, Rm. EC1443, 1201 Western Rd, London, Ontario, N6G 1H1, Canada.
| | - Paul Phares
- School of Physical Therapy, Western University, Rm. EC1443, 1201 Western Rd, London, Ontario, N6G 1H1, Canada
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Cluster Analysis of an International Pressure Pain Threshold Database Identifies 4 Meaningful Subgroups of Adults With Mechanical Neck Pain. Clin J Pain 2017; 33:422-428. [DOI: 10.1097/ajp.0000000000000421] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Clinical prediction rules for prognosis and treatment prescription in neck pain: A systematic review. Musculoskelet Sci Pract 2017; 27:155-164. [PMID: 27852530 DOI: 10.1016/j.math.2016.10.066] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/12/2016] [Accepted: 10/12/2016] [Indexed: 12/21/2022]
Abstract
Clinical prediction rules (CPRs) developed to identify sub-groups of people with neck pain for different prognoses (i.e. prognostic) or response to treatments (i.e. prescriptive) have been recommended as a research priority to improve health outcomes for these conditions. A systematic review was undertaken to identify prognostic and prescriptive CPRs relevant to the conservative management of adults with neck pain and to appraise stage of development, quality and readiness for clinical application. Six databases were systematically searched from inception until 4th July 2016. Two independent reviewers assessed eligibility, risk of bias (PEDro and QUIPS), methodological quality and stage of development. 9840 records were retrieved and screened for eligibility. Thirty-two studies reporting on 26 CPRs were included in this review. Methodological quality of included studies varied considerably. Most prognostic CPR development studies employed appropriate designs. However, many prescriptive CPR studies (n = 12/13) used single group designs and/or analysed controlled trials using methods that were inadequate for identifying treatment effect moderators. Most prognostic (n = 11/15) and all prescriptive (n = 11) CPRs have not progressed beyond the derivation stage of development. Four prognostic CPRs relating to acute whiplash (n = 3) or non-traumatic neck pain (n = 1) have undergone preliminary validation. No CPRs have undergone impact analysis. Most prognostic and prescriptive CPRs for neck pain are at the initial stage of development and therefore routine clinical use is not yet supported. Further validation and impact analyses of all CPRs are required before confident conclusions can be made regarding clinical utility.
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The Traumatic Injuries Distress Scale: A New Tool That Quantifies Distress and Has Predictive Validity With Patient-Reported Outcomes. J Orthop Sports Phys Ther 2016; 46:920-928. [PMID: 27594662 DOI: 10.2519/jospt.2016.6594] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Observational cohort. Background Outcomes for acute musculoskeletal injuries are currently suboptimal, with an estimated 10% to 50% of injured individuals reporting persistent problems. An early risk-targeted intervention may hold value for improving outcomes. Objectives To describe the development and preliminary concurrent and longitudinal validation of the Traumatic Injuries Distress Scale (TIDS), a new tool intended to provide the magnitude and nature of risk for persistent problems following acute musculoskeletal injuries. Methods Two hundred participants recruited from emergency medicine departments and rehabilitation clinics completed the TIDS and a battery of other self-reported questionnaires. A subcohort (n = 76) was followed at 1 week and at 12 weeks after the inciting event. Exploratory factor analysis and concurrent and longitudinal correlations were used to evaluate the ability of the TIDS to predict acute presentation and 12-week outcomes. Results Exploratory factor analysis revealed 3 factors explaining 62.8% of total scale variance. Concurrent and longitudinal associations with established clinical measures supported the nature of each subscale. Scores on the TIDS at baseline were significantly associated with variability in disability, pain intensity, satisfaction, anxiety, and depression at 12 weeks postinjury, with adequate accuracy to endorse its use as part of a broader screening protocol. Limitations to interpretation are discussed. Conclusion We present the initial psychometric properties of a new measure of acute posttraumatic distress following musculoskeletal injury. The subscales may be useful as stratification variables in subsequent investigations of clinical interventions. J Orthop Sports Phys Ther 2016;46(10):920-928. Epub 3 Sep 2016. doi:10.2519/jospt.2016.6594.
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Research Priorities in the Field of Posttraumatic Pain and Disability: Results of a Transdisciplinary Consensus-Generating Workshop. Pain Res Manag 2016; 2016:1859434. [PMID: 27445598 PMCID: PMC4923601 DOI: 10.1155/2016/1859434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/27/2015] [Indexed: 12/02/2022]
Abstract
Background. Chronic or persistent pain and disability following noncatastrophic “musculoskeletal” (MSK) trauma is a pervasive public health problem. Recent intervention trials have provided little evidence of benefit from several specific treatments for preventing chronic problems. Such findings may appear to argue against formal targeted intervention for MSK traumas. However, these negative findings may reflect a lack of understanding of the causal mechanisms underlying the transition from acute to chronic pain, rendering informed and objective treatment decisions difficult. The Canadian Institutes of Health Research (CIHR) Institute of Musculoskeletal Health and Arthritis (IMHA) has recently identified better understanding of causal mechanisms as one of three priority foci of their most recent strategic plan. Objectives. A 2-day invitation-only active participation workshop was held in March 2015 that included 30 academics, clinicians, and consumers with the purpose of identifying consensus research priorities in the field of trauma-related MSK pain and disability, prediction, and prevention. Methods. Conversations were recorded, explored thematically, and member-checked for accuracy. Results. From the discussions, 13 themes were generated that ranged from a focus on identifying causal mechanisms and models to challenges with funding and patient engagement. Discussion. Novel priorities included the inclusion of consumer groups in research from the early conceptualization and design stages and interdisciplinary longitudinal studies that include evaluation of integrated phenotypes and mechanisms.
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Croft AC, Milam B, Meylor J, Manning R. Confirmatory Factor Analysis and Multiple Linear Regression of the Neck Disability Index: Assessment If Subscales Are Equally Relevant in Whiplash and Nonspecific Neck Pain. J Chiropr Med 2016; 15:87-94. [PMID: 27330510 DOI: 10.1016/j.jcm.2016.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 03/10/2016] [Accepted: 03/25/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Because of previously published recommendations to modify the Neck Disability Index (NDI), we evaluated the responsiveness and dimensionality of the NDI within a population of adult whiplash-injured subjects. The purpose of the present study was to evaluate the responsiveness and dimensionality of the NDI within a population of adult whiplash-injured subjects. METHODS Subjects who had sustained whiplash injuries of grade 2 or higher completed an NDI questionnaire. There were 123 subjects (55% female, of which 36% had recovered and 64% had chronic symptoms. NDI subscales were analyzed using confirmatory factor analysis, considering only the subscales and, secondly, using sex as an 11th variable. The subscales were also tested with multiple linear regression modeling using the total score as a target variable. RESULTS When considering only the 10 NDI subscales, only a single factor emerged, with an eigenvalue of 5.4, explaining 53.7% of the total variance. Strong correlation (> .55) (P < .0001) between all variables was found. Multiple linear regression modeling revealed high internal consistency with all coefficients reaching significance (P < .0001). The 4 NDI subscales exerting the greatest effect were, in decreasing order, Sleeping, Lifting, Headaches, and Pain Intensity. CONCLUSION A 2-factor model of the NDI is not justified based on our results, and in this population of whiplash subjects, the NDI was unidimensional, demonstrating high internal consistency and supporting the original validation study of Vernon and Mior.
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Affiliation(s)
- Arthur C Croft
- Director, Spine Research Institute of San Diego, San Diego, CA
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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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Walton DM, Lefebvre A, Reynolds D. The Brief Illness Perceptions Questionnaire identifies 3 classes of people seeking rehabilitation for mechanical neck pain. ACTA ACUST UNITED AC 2015; 20:420-6. [DOI: 10.1016/j.math.2014.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/16/2014] [Accepted: 10/28/2014] [Indexed: 10/24/2022]
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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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Littleton SM, Hughes DC, Poustie SJ, Robinson BJ, Neeman T, Smith PN, Cameron ID. An early intervention programme had no detectable influence on the health status of people with musculoskeletal injuries following road traffic crashes: comparative study. Injury 2014; 45:304-11. [PMID: 22770872 DOI: 10.1016/j.injury.2012.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 05/20/2012] [Accepted: 06/02/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the health status of people with minor injuries from road traffic crashes that are exposed to an early, active intervention programme (intervention group) with those receiving usual care (control group) over a 12 month period. DESIGN Prospective comparative study using sequential cohorts. SUBJECTS People presenting to hospital emergency departments with mild to moderate musculoskeletal injuries following road traffic crashes. MAIN OUTCOME MEASURES Physical Component Score (PCS) and Mental Component Score (MCS) of the Short Form 36 (SF-36) health status measure; Hospital Anxiety and Depression Scale (HADS) and the Functional Rating Index (FRI) recorded immediately post-crash, at 6 months and at 12 months after injury. RESULTS There were 95 participants allocated to the control group and 98 allocated to the intervention group. Participants were enrolled at a mean of 9.3 days following the crash. There were no significant differences in baseline health measures between the groups. Apart from a small improvement in anxiety for the intervention group, there were no significant differences in health status between the groups. Twenty percent of participants in the intervention group received treatment from external healthcare providers that was inconsistent with the recommendations of the intervention programme. CONCLUSIONS The intervention programme failed to result in a clinically significant improvement in health outcomes compared with usual care. There is some evidence to suggest that the intervention had some psychological benefits, as evidenced by the small improvement in anxiety levels. Limited adherence, frequent use of co-interventions, or other factors (such as intervention content or intensity) may have reduced its effect.
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Affiliation(s)
- S M Littleton
- College of Medicine, Biology and Environment, Australian National University, Australia.
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Daenen L, Nijs J, Cras P, Wouters K, Roussel N. Changes in Pain Modulation Occur Soon After Whiplash Trauma but are not Related to Altered Perception of Distorted Visual Feedback. Pain Pract 2013; 14:588-98. [DOI: 10.1111/papr.12113] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 08/05/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Liesbeth Daenen
- Department of Neurology; Faculty of Medicine; University of Antwerp (UA); Antwerp Belgium
- Department of Neurology; Born-Bunge Institute and Antwerp University Hospital; Antwerp Belgium
- Department of Human Physiology; Faculty of Physical Education and Physiotherapy; Chronic Pain and Chronic Fatigue Research Group (CHROPIVER); Vrije Universiteit Brussel (VUB); Brussel Belgium
| | - Jo Nijs
- Department of Human Physiology; Faculty of Physical Education and Physiotherapy; Chronic Pain and Chronic Fatigue Research Group (CHROPIVER); Vrije Universiteit Brussel (VUB); Brussel Belgium
- Division of Musculoskeletal Physiotherapy; Department of Health Sciences; University College Antwerp (Artesis); Antwerp Belgium
| | - Patrick Cras
- Department of Neurology; Faculty of Medicine; University of Antwerp (UA); Antwerp Belgium
- Department of Neurology; Born-Bunge Institute and Antwerp University Hospital; Antwerp Belgium
| | - Kristien Wouters
- Department of Scientific Coordination and Biostatistics; University Hospital Antwerp (UZA); Antwerp Belgium
| | - Nathalie Roussel
- Department of Human Physiology; Faculty of Physical Education and Physiotherapy; Chronic Pain and Chronic Fatigue Research Group (CHROPIVER); Vrije Universiteit Brussel (VUB); Brussel Belgium
- Division of Musculoskeletal Physiotherapy; Department of Health Sciences; University College Antwerp (Artesis); Antwerp Belgium
- Faculty of Medicine; University of Antwerp (UA); Antwerp Belgium
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Walton DM, Macdermid JC, Santaguida PL, Gross A, Carlesso L. Results of an International Survey of Practice Patterns for Establishing Prognosis in Neck Pain: The ICON Project. Open Orthop J 2013; 7:387-95. [PMID: 24115968 PMCID: PMC3793579 DOI: 10.2174/1874325001307010387] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 10/12/2012] [Accepted: 10/12/2012] [Indexed: 11/22/2022] Open
Abstract
Results of an international survey of health care providers for neck pain are reported. The survey specifically collected self-reported practice patterns for establishing a prognosis in neck pain. Over 440 responses from 27 countries were collected. Descriptive results indicate that respondents assigned large prognostic impact to factors including mechanism of injury and psychological or behavioral constructs. Range of motion, age and sex were routinely collected despite relatively moderate impact on prognosis. A comparison between chiropractic and manual/physical therapy groups showed differences in practice patterns that were unlikely to affect prognostic accuracy. The results suggest a gap exists between current best-evidence and actual practice when the goal is to establish a prognosis in neck pain.
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Affiliation(s)
- David M Walton
- School of Physical Therapy, Western University, London Ontario, Canada
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Walton DM, Carroll LJ, Kasch H, Sterling M, Verhagen AP, Macdermid JC, Gross A, Santaguida PL, Carlesso L. An Overview of Systematic Reviews on Prognostic Factors in Neck Pain: Results from the International Collaboration on Neck Pain (ICON) Project. Open Orthop J 2013; 7:494-505. [PMID: 24115971 PMCID: PMC3793581 DOI: 10.2174/1874325001307010494] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 01/02/2013] [Accepted: 01/02/2013] [Indexed: 01/08/2023] Open
Abstract
Given the challenges of chronic musculoskeletal pain and disability, establishing a clear prognosis in the acute stage has become increasingly recognized as a valuable approach to mitigate chronic problems. Neck pain represents a condition that is common, potentially disabling, and has a high rate of transition to chronic or persistent problems. As a field of research, prognosis in neck pain has stimulated several empirical primary research papers, and a number of systematic reviews. As part of the International Consensus on Neck (ICON) project, we sought to establish the general state of knowledge in the area through a structured, systematic review of systematic reviews (overview). An exhaustive search strategy was created and employed to identify the 13 systematic reviews (SRs) that served as the primary data sources for this overview. A decision algorithm for data synthesis, which incorporated currency of the SR, risk of bias assessment of the SRs using AMSTAR scoring and consistency of findings across SRs, determined the level of confidence in the risk profile of 133 different variables. The results provide high confidence that baseline neck pain intensity and baseline disability have a strong association with outcome, while angular deformities of the neck and parameters of the initiating trauma have no effect on outcome. A vast number of predictors provide low or very low confidence or inconclusive results, suggesting there is still much work to be done in this field. Despite the presence of multiple SR and this overview, there is insufficient evidence to make firm conclusions on many potential prognostic variables. This study demonstrates the challenges in conducting overviews on prognosis where clear synthesis critieria and a lack of specifics of primary data in SR are barriers.
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Affiliation(s)
- David M Walton
- Faculty of Health Sciences, The University of Western Ontario, London Ontario, Canada
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21
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Pedler A, Sterling M. Patients with chronic whiplash can be subgrouped on the basis of symptoms of sensory hypersensitivity and posttraumatic stress. Pain 2013; 154:1640-1648. [DOI: 10.1016/j.pain.2013.05.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 05/01/2013] [Accepted: 05/01/2013] [Indexed: 12/28/2022]
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Jöud A, Stjerna J, Malmström EM, Westergren H, Petersson IF, Englund M. Healthcare consultation and sick leave before and after neck injury: a cohort study with matched population-based references. BMJ Open 2013; 3:e003172. [PMID: 23996819 PMCID: PMC3758980 DOI: 10.1136/bmjopen-2013-003172] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Recent studies based on self-assessed data on exposure and outcome suggest a negative association between poor health before neck injury and recovery. Our aim was to study actual healthcare consultation and work disability before and after neck injury (whiplash). DESIGN Cohort study with matched references studied prospectively and retrospectively via regional and national held registers. SETTING Population-based study in Region Skåne, Sweden (population=1.21 million) including all levels of healthcare. PARTICIPANTS 1443 participants aged ≥18 (54% women) with acute neck injury, Whiplash, (International Classification of Diseases-10-SE code S13.4*) in 2007 or 2008 and no such diagnosis since 1998. Each patient with a neck injury was assigned four randomly selected population references matched for age, sex and area of residence (97% of the patients and 94% of the references were followed during the whole study period). PRIMARY AND SECONDARY OUTCOME MEASURES We studied changes in healthcare consultations 3 years before to 3 years after diagnosis as well as sick leave episodes. Analyses were also stratified by preinjury frequency of consultation. RESULTS Before the injury, the mean number of total consultations over 36 months among the neck injured (n=1443) and references (n=5772) was 9.3 vs 7.2 (p<0.0001) and postneck injury 12.7 vs 7.8 (p<0.0001). In the group of high-frequent consulters, there were more women compared with frequent and low-frequent consulters (70.6% vs 32.8%; p<0.0001). Among low-frequent and frequent consulters preinjury (n=967, 67% of the cohort), 16% became high-frequent consulters attributable to the injury. The number of days of sick leave preinjury was correlated with the number of preinjury and postinjury consultations (r=0.47 (99% CI 0.38 to 0.49), r=0.32 (99% CI 0.25 to 0.37)). CONCLUSIONS People with a neck injury constitute a heterogeneous group. The preinjury level of healthcare consultation is associated with the postinjury level of consultation.
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Affiliation(s)
- Anna Jöud
- Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
- Epi-centre Skåne, Skåne University Hospital, Lund, Sweden
| | - Johanna Stjerna
- Department of Rehabilitation, Skåne University Hospital, Lund, Sweden
| | - Eva-Maj Malmström
- Department of Rehabilitation, Skåne University Hospital, Lund, Sweden
- Department of Otorhinolaryngology, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Hans Westergren
- Department of Rehabilitation, Skåne University Hospital, Lund, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Ingemar F Petersson
- Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
- Epi-centre Skåne, Skåne University Hospital, Lund, Sweden
| | - Martin Englund
- Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
- Epi-centre Skåne, Skåne University Hospital, Lund, Sweden
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA
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Jensen OK, Stengaard-Pedersen K, Jensen C, Nielsen CV. Prediction model for unsuccessful return to work after hospital-based intervention in low back pain patients. BMC Musculoskelet Disord 2013; 14:140. [PMID: 23597088 PMCID: PMC3663778 DOI: 10.1186/1471-2474-14-140] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 04/10/2013] [Indexed: 12/03/2022] Open
Abstract
Background Many studies on low back pain (LBP) have identified prognostic factors, but prediction models for use in secondary health care are not available. The purpose of this cohort study, based on a randomised clinical study, was to identify risk factors for unsuccessful return to work (U-RTW) in sick-listed LBP patients with or without radiculopathy and to validate a prediction model for U-RTW. Methods 325 sick-listed LBP patients with or without radiculopathy were included in an intervention study and followed for one year. Afterwards, 117 other LBP patients were recruited similarly, included in a validation study and also followed for one year. All patients were subjected to identical procedures and interventions and received a brief intervention by the same rehabilitation doctor and physiotherapist. Half of them received case manager guidance within a multidisciplinary setting. At baseline, they completed a questionnaire and went through a clinical low-back examination. Sciatica was investigated by magnetic resonance imaging (MRI). U-RTW was registered in a national database both initially and at 1-year. Results Neither initial U-RTW (24.0%) nor one-year U-RTW (38.2%) were statistically significantly different in the two intervention groups nor in patients with and without radiculopathy. Multivariate logistic regression analysis identified two clinical and five psychosocial baseline predictors for one-year U-RTW (primary outcome). The clinical predictors included pain score (back+leg pain) and side-flexion. The five psychosocial predictors included ‘bodily distress’ ‘low expectations of RTW’, ‘blaming the work for pain’, ‘no home ownership’ and ‘drinking alcohol less than once/month’. These predictors were not statistically significantly different in patients with and without radiculopathy, and they also predicted initial U-RTW (secondary outcome). Obesity and older age were only supplementary predictors in patients with radiculopathy. A prediction model was established and tested in the validation study group. The model predicted one-year U-RWT in patients with intermediate and high risk, but only partially in patients with low risk. The model predicted all three risk categories in initial U-RTW. Conclusions A prediction model combining baseline clinical and psychosocial risk factors predicted patients with low, intermediate and high risk for unsuccessful return to work, both initially and at 1-year.
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Affiliation(s)
- Ole Kudsk Jensen
- The Spine Center, Diagnostic Center, Silkeborg Regional Hospital, Silkeborg, Denmark.
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Health, social, and economic consequences of neck injuries: a controlled national study evaluating societal effects on patients and their partners. Spine (Phila Pa 1976) 2013; 38:449-57. [PMID: 23238487 DOI: 10.1097/brs.0b013e3182819203] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN National register-based matched case-control study. OBJECTIVE The aim of this study was to estimate the direct and indirect costs of neck injuries, except fractures, in a national sample of patients and their spouses. SUMMARY OF BACKGROUND DATA Despite neck injuries causing significant socioeconomic burdens, there is insufficient information about the time course, as well as the effect on their spouses. METHODS Using records from the Danish National Patient Registry 1998-2009, all patients with a diagnosis of neck injury and their spouses were identified and compared with randomly chosen controls matched for age, sex, geographical area, and civil status. Direct costs included frequency of primary and hospital sector contacts and procedures and medication. Indirect costs included the effect on labor supply. Social transfer payments were included to illustrate the effect on national accounts. All cost data were extracted from national databases. RESULTS The register contributed 94,224 patients, and 372,341 matched controls were identified. The percentages of married or cohabiting individuals were approximately 47.5% in both groups. Patients with neck injury had significantly higher rates of health-related contacts, medication use, and higher socioeconomic costs than controls. To a lesser extent, they also had lower employment rates, and those employed generally had lower incomes. Furthermore, the patients had already presented negative social- and health-related status up to 11 years before the first diagnosis, which became more pronounced for those with the highest costs. The health effects on costs were present regardless of age group and sex, and it was also seen for the patients' spouses. CONCLUSION Neck injuries are associated with major socioeconomic consequences for patients, their spouses, and the society. However, the increased expenses during subsequent years cannot be explained by the injury alone, because these patients already had elevated expenses prior to the injury. This indicates some selection of increased vulnerability for both patients and their spouses.
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Kasch H, Jensen TS. DNIC in whiplash and ankle-injured controls. 1-year prospective findings. J Headache Pain 2013. [PMCID: PMC3620242 DOI: 10.1186/1129-2377-14-s1-p179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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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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Current World Literature. Curr Opin Support Palliat Care 2012; 6:289-98. [DOI: 10.1097/spc.0b013e328353e091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
STUDY DESIGN A cohort study analyzing the cervical range of motion (ROM) of subjects with 4- or 5-level posterior laminectomy and fusion or anterior and posterior decompression and fusion operation. OBJECTIVE The purpose of this study was to evaluate the effect of extending a C3-C7 fusion to C3-T1 on subject's ROM and level of disability. SUMMARY OF BACKGROUND DATA Cadaveric studies show a reduction in the ROM of C3-C7 cervical fusion spines. In vivo, surgeons treat symptomatic cervical subaxial spine with either a C3-C7 fusion or C3-T1 fusion. While in some cases extending the fusion level to T1 is merited due to pathology, most cases are due to surgeon's preference to avoid future degeneration and reoperation of the C7-T1 junction. METHODS This study involved 44 4-level fusion and 20 5-level fusion subjects along with 18 nonoperative controls. Operative subjects were divided according to early or late postoperative clinical visit. Subjects were asked to complete the neck disability index survey and their maximum ROM during flexion/extension, axial rotation, and lateral bending was measured using a virtual reality assisted electromagnetic tracking system. In addition, the helical axis of motion was calculated for flexion and extension motions. An analysis of variance statistical test was used to determine significant differences between study groups. RESULTS Five- level subjects had significantly less ROM than 4-level subjects and both groups were significantly less than control group during all motions. There was no effect of postoperative time on subject's ROM. In addition, there was no difference in the center of helical axis of rotation across the 3 groups. Finally, both operative groups exhibited similar levels of mild disability as measured by the neck disability index. CONCLUSIONS Extending the subaxial fusion from C3-C7 to include C7-T1 resulted in a significant loss of ROM, while postoperative time healing, center of rotation, and level of disability were similar across groups. This finding merits further investigation of the intersegmental motions of the cervical spine.
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