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Kragting M, Pool-Goudzwaard AL, Coppieters MW, O'Sullivan PB, Voogt L. Illness perceptions in people with chronic and disabling non-specific neck pain seeking primary healthcare: a qualitative study. BMC Musculoskelet Disord 2024; 25:179. [PMID: 38413876 PMCID: PMC10900625 DOI: 10.1186/s12891-024-07302-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/22/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Illness perceptions can affect the way people with musculoskeletal pain emotionally and behaviorally cope with their health condition. Understanding patients illness perceptions may help facilitate patient-centered care. The purpose of this study was to explore illness perceptions and the origin of those perceptions in people with chronic disabling non-specific neck pain seeking primary care. METHODS A qualitative study using a deductive and inductive analytical approach was conducted in 20 people with persistent (> 3 months) and disabling (i.e., Neck Disability Index ≥ 15) neck pain. Using a semi-structured format, participants were interviewed about their illness perceptions according to Leventhal's Common Sense Model. Purposive sampling and member checking were used to secure validity of study results. RESULTS Participants reported multiple symptoms, thoughts and emotions related to their neck pain, which continuously required attention and action. They felt trapped within a complex multifactorial problem. Although some participants had a broader biopsychosocial perspective to understand their symptoms, a biomedical perspective was dominant in the labelling of their condition and their way of coping (e.g., limiting load, building strength and resilience, regaining mobility, keep moving and being meaningful). Their perceptions were strongly influenced by information from clinicians. Several participants indicated that they felt uncertain, because the information they received was contradictory or did not match their own experiences. CONCLUSION Most participants reported that understanding their pain was important to them and influenced how they coped with pain. Addressing this 'sense making process' is a prerequisite for providing patient-centered care.
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Affiliation(s)
- Maaike Kragting
- Department of Physical Therapy, Research Centre for Health Care Innovations, Rotterdam University of Applied Sciences, Rochussenstraat 198, Rotterdam, 3015 EK, The Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences - Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annelies L Pool-Goudzwaard
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences - Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Somt University of Physiotherapy, Amersfoort, The Netherlands
| | - Michel W Coppieters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences - Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
| | - Peter B O'Sullivan
- School of Allied Health, Curtin University, Bentley, Australia
- Body Logic Physiotherapy Clinic, Shenton Park, Australia
| | - Lennard Voogt
- Department of Physical Therapy, Research Centre for Health Care Innovations, Rotterdam University of Applied Sciences, Rochussenstraat 198, Rotterdam, 3015 EK, The Netherlands.
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
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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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Fundaun J, Kolski M, Baskozos G, Dilley A, Sterling M, Schmid AB. Nerve pathology and neuropathic pain after whiplash injury: a systematic review and meta-analysis. Pain 2022; 163:e789-e811. [PMID: 35050963 PMCID: PMC7612893 DOI: 10.1097/j.pain.0000000000002509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/29/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT There is no clear understanding of the mechanisms causing persistent pain in patients with whiplash-associated disorder (WAD). The aim of this systematic review was to assess the evidence for nerve pathology and neuropathic pain in patients with WAD. EMBASE, PubMed, CINAHL (EBSCO), and MEDLINE were searched from inception to September 1, 2020. Study quality and risk of bias were assessed using the Newcastle-Ottawa Quality Assessment Scales. Fifty-four studies reporting on 390,644 patients and 918 controls were included. Clinical questionnaires suggested symptoms of predominant neuropathic characteristic in 34% of patients (range 25%-75%). The mean prevalence of nerve pathology detected with neurological examination was 13% (0%-100%) and 32% (10%-100%) with electrodiagnostic testing. Patients independent of WAD severity (Quebec Task Force grades I-IV) demonstrated significantly impaired sensory detection thresholds of the index finger compared with controls, including mechanical (SMD 0.65 [0.30; 1.00] P < 0.005), current (SMD 0.82 [0.25; 1.39] P = 0.0165), cold (SMD -0.43 [-0.73; -0.13] P = 0.0204), and warm detection (SMD 0.84 [0.25; 1.42] P = 0.0200). Patients with WAD had significantly heightened nerve mechanosensitivity compared with controls on median nerve pressure pain thresholds (SMD -1.10 [-1.50; -0.70], P < 0.0001) and neurodynamic tests (SMD 1.68 [0.92; 2.44], P = 0.0004). Similar sensory dysfunction and nerve mechanosensitivity was seen in WAD grade II, which contradicts its traditional definition of absent nerve involvement. Our findings strongly suggest a subset of patients with WAD demonstrate signs of peripheral nerve pathology and neuropathic pain. Although there was heterogeneity among some studies, typical WAD classifications may need to be reconsidered and include detailed clinical assessments for nerve integrity.
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Affiliation(s)
- Joel Fundaun
- Nuffield Department of Clinical Neurosciences, The University of Oxford, Oxford, United Kingdom
| | - Melissa Kolski
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
- Musculoskeletal Outpatient Department, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Georgios Baskozos
- Nuffield Department of Clinical Neurosciences, The University of Oxford, Oxford, United Kingdom
| | - Andrew Dilley
- Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Brisbane, Queensland, Australia
| | - Annina B Schmid
- Nuffield Department of Clinical Neurosciences, The University of Oxford, Oxford, United Kingdom
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Dickson C, de Zoete RMJ, Stanton TR. From Where We've Come to Where We Need to Go: Physiotherapy Management of Chronic Whiplash-Associated Disorder. FRONTIERS IN PAIN RESEARCH 2022; 2:795369. [PMID: 35295440 PMCID: PMC8915571 DOI: 10.3389/fpain.2021.795369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/15/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Cameron Dickson
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, SA, Australia
- *Correspondence: Cameron Dickson
| | - Rutger M. J. de Zoete
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, SA, Australia
| | - Tasha R. Stanton
- Innovation, Implementation and Clinical Translation in Health, University of South Australia, Adelaide, SA, Australia
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5
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Christensen SWM, Rasmussen MB, Jespersen CL, Sterling M, Skou ST. Soft-collar use in rehabilitation of whiplash-associated disorders - A systematic review and meta-analysis. Musculoskelet Sci Pract 2021; 55:102426. [PMID: 34271416 DOI: 10.1016/j.msksp.2021.102426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 06/22/2021] [Accepted: 07/05/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Active rehabilitation of Whiplash Associated Disorders (WAD) is favoured over passive modalities such as soft-collars. However, the effectiveness of soft-collar use remains unclear. OBJECTIVE To investigate the effectiveness of soft-collar use on pain and disability in WAD. DESIGN Systematic review. METHOD Databases (AMED, CINAHL Complete, Cochrane Library, Embase, Medline, PEDro, PsycINFO, PubMed, SPORTDiscus) were searched for guidelines, reviews and RCTs on soft-collar use as part of WAD treatment. Reference lists of reviews and guidelines were screened for additional RCTs. Study quality was rated using the PEDro-scale and overall quality of evidence with GRADE. RESULTS Four RCTs (n = 409) of fair-good quality (PEDro-scores) were included with three using a soft collar in addition to other conservative treatment while one study compared soft-collar use to act-as-usual. All studies found that an active or act-as-usual approach was more effective in reducing pain intensity compared to soft-collar use, confirmed by meta-analysis (two RCTs with data: SMD of -0.80 (-1.20, -0.41)). No studies reported disability outcomes while contrasting results were found between groups regarding total cervical range of motion (two RCTs with data: SMD of 0.16 (-0.21, 0.54)) or rotation (two RCTs with data: SMD of 0.54 (-0.19, 1.27)). Overall quality of the evidence was low to very low. CONCLUSION All four RCTs favoured an active approach/act-as-usual over soft-collar treatment. However, due to methodological concerns and low certainty of evidence, future studies investigating soft collar use in combination with an active rehabilitation strategy for acute/subacute WAD are needed.
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Affiliation(s)
- Steffan Wittrup McPhee Christensen
- Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7D-3, 9220, Aalborg, Denmark; Department of Physiotherapy, University College of Northern Denmark (UCN), Selma Lagerløfs Vej 2, 9220, Aalborg, Denmark.
| | - Michael Bo Rasmussen
- Department of Physiotherapy, University College of Northern Denmark (UCN), Selma Lagerløfs Vej 2, 9220, Aalborg, Denmark
| | - Christoffer Lund Jespersen
- Department of Physiotherapy, University College of Northern Denmark (UCN), Selma Lagerløfs Vej 2, 9220, Aalborg, Denmark
| | - Michele Sterling
- RECOVER Injury Research Centre, Faculty of Health and Behavioural Sciences, University of Queensland, 288 Herston Road, Herston, QLD, 4006, Australia
| | - Søren Thorgaard Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230, Odense, Denmark; Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark
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6
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Griffin AR, Moloney N, Leaver A, Jagnoor J, Michaleff ZA, Lin CWC, Rebbeck T. Experiences of responsiveness to exercise in people with chronic whiplash: A qualitative study. Musculoskelet Sci Pract 2021; 54:102380. [PMID: 33971616 DOI: 10.1016/j.msksp.2021.102380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/06/2021] [Accepted: 04/10/2021] [Indexed: 11/24/2022]
Abstract
Exercise is recommended in clinical guidelines for the treatment of chronic whiplash associated disorders (WAD). However, randomised controlled trials have shown similar effects for comprehensive exercise programs and advice. To date, there is no clear understanding of why some individuals with WAD appear to respond to exercise whilst others do not. The aim of this study was to explore the experiences and self-reported characteristics of people with chronic whiplash identifying as 'responders' and 'non-responders' to exercise. Semi-structured interviews were conducted with 13 people with chronic whiplash (patients) and seven treating physiotherapists. Patients were asked whether they responded to the exercise program, and what contributed to this. Physiotherapists were asked to share their experiences about the characteristics of people that appear to respond to exercise, and those that do not. An interpretive descriptive approach was selected to facilitate the generation of discipline-specific knowledge. Four themes were generated from patient and physiotherapist interviews, including: (1) the therapeutic relationship, (2) exercise experiences and beliefs, (3) self-efficacy and acceptance, (4) physical and psychological determinants of responsiveness. Responsiveness to exercise is complex and multifaceted. Clinicians may seek to identify the presence of discrete physical impairment(s) (e.g., range of motion restriction), and where present, determine whether targeted exercise results in an immediate and positive response. Clinicians may also focus their efforts on developing aspects of the therapeutic relationship identified as important to patients, such as hope, partnership and rapport.
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Affiliation(s)
- Alexandra R Griffin
- Faculty of Medicine & Health, The University of Sydney, NSW, Australia; John Walsh Centre for Rehabilitation Research, Royal North Shore Hospital, NSW, Australia.
| | - Niamh Moloney
- Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW, Australia; THRIVE Physiotherapy, Channel Islands, Guernsey.
| | - Andrew Leaver
- Faculty of Medicine & Health, The University of Sydney, NSW, Australia.
| | - Jagnoor Jagnoor
- John Walsh Centre for Rehabilitation Research, Royal North Shore Hospital, NSW, Australia; The George Institute for Global Health, University of New South Wales, NSW, Australia.
| | - Zoe A Michaleff
- Faculty of Health Sciences and Medicine, Bond University, QLD, Australia.
| | | | - Trudy Rebbeck
- Faculty of Medicine & Health, The University of Sydney, NSW, Australia; John Walsh Centre for Rehabilitation Research, Royal North Shore Hospital, NSW, Australia.
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7
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Peolsson A, Hermansen A, Peterson G, Nilsing Strid E. Return to work a bumpy road: a qualitative study on experiences of work ability and work situation in individuals with chronic whiplash-associated disorders. BMC Public Health 2021; 21:785. [PMID: 33892672 PMCID: PMC8067290 DOI: 10.1186/s12889-021-10821-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 04/12/2021] [Indexed: 11/21/2022] Open
Abstract
Background Work resumption is a big challenge in the rehabilitation process for individuals with whiplash-associated disorders (WAD). To better meet the needs of individuals with WAD in their return to work process, more knowledge on their experiences and perspectives is needed. The aim of this study was to explore the experiences of work ability and the work situation of individuals who participated in a neck-specific exercise programme for chronic WAD. Methods This qualitative study has an exploratory and descriptive design based on data collected through open-ended interviews with 17 individuals with chronic WAD. Data were analysed inductively using conventional content analysis. Results Analysis of the data yielded the following five categories related to the participants’ narratives on their experiences of work ability and their work situation: Return to work – a process of setbacks and bureaucracy; The need to be understood by health care professionals, and to receive a treatment plan; Individual resources are important for work ability; The consequences of reduced work ability; and Working conditions are important for work ability. Conclusion Individuals with chronic WAD often struggle to return to work. Emotional and practical support from stakeholders is imperative and needs to be strengthened. Participating in a neck-specific exercise programme, including being acknowledged and receiving information about WAD, could positively affect the work ability of WAD sufferers. This study has provided management strategies to improve the ability to work for individuals with chronic WAD, and highlights the need to incorporate a healthy and sustainable return to work in the rehabilitation of individuals with WAD, thereby making their return to work a success. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10821-w.
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Affiliation(s)
- A Peolsson
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - A Hermansen
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden
| | - G Peterson
- Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - E Nilsing Strid
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
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Toye F, Belton J, Hannink E, Seers K, Barker K. A Healing Journey with Chronic Pain: A Meta-Ethnography Synthesizing 195 Qualitative Studies. PAIN MEDICINE 2021; 22:1333-1344. [DOI: 10.1093/pm/pnaa373] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Abstract
Objective
There is a large body of research exploring what it means for a person to live with chronic pain. However, existing research does not help us understand what it means to recover. We aimed to identify qualitative research that explored the experience of living with chronic pain published since 2012 and to understand the process of recovery.
Design
A synthesis of qualitative research using meta-ethnography.
Methods
We used the seven stages of meta-ethnography. We systematically searched for qualitative research, published since 2012, that explored adults’ experiences of living with, and being treated for, chronic pain. We used constant comparison to distill the essence of ideas into themes and developed a conceptual model.
Results
We screened 1,328 titles and included 195 studies. Our conceptual model indicates that validation and reconnection can empower a person with chronic pain to embark on a journey of healing. To embark on this journey requires commitment, energy, and support.
Conclusions
The innovation of our study is to conceptualize healing as an ongoing and iterating journey rather than a destination. Health interventions for chronic pain would usefully focus on validating pain through meaningful and acceptable explanations; validating patients by listening to and valuing their stories; encouraging patients to connect with a meaningful sense of self, to be kind to themselves, and to explore new possibilities for the future; and facilitating safe reconnection with the social world. This could make a real difference to people living with chronic pain who are on their own healing journeys.
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Affiliation(s)
- Francine Toye
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Erin Hannink
- Physiotherapy Research Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Kate Seers
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Karen Barker
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
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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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10
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Rydman E, Elkan P, Eneqvist T, Ekman P, Järnbert-Pettersson H. The significance of cervical sagittal alignment for nonrecovery after whiplash injury. Spine J 2020; 20:1229-1238. [PMID: 32058085 DOI: 10.1016/j.spinee.2020.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/06/2020] [Accepted: 02/06/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Whiplash-associated disorder is a common cause of chronic neck pain. Several radiological cervical angular variables are suggested to have constitutional characteristics, that is, them being minimally influenced by body positioning. However, the association between these variables and pain conditions remains poorly understood. To our knowledge, no previous studies have investigated the association between constitutional angular variables and the outcome after whiplash trauma. PURPOSE Our objectives were (1) to study the inter-rater agreement of sagittal radiologic variables between 2 raters and (2) to investigate any association between these variables and self-perceived nonrecovery after whiplash injury. STUDY DESIGN Prospective cohort study. PATIENT SAMPLE Forty-six patients aged 16 to 70 years, attending an emergency department after a motor vehicle accident resulting in neck pain were recruited. OUTCOME MEASURES Self-perceived nonrecovery (yes/no) was the primary outcome measure. The secondary outcome measure was pain level on a numeric rating scale. METHODS The participants underwent computed tomography scans in a supine position. Sagittal alignment variables (T1 slope, neck tilt, thoracic inlet angle [TIA], and C2-C7 angle) on the computed tomography scans were measured by 2 independent raters. Inter-rater agreement was tested with a paired sample t test and Bland-Altman plots for each variable. The patients were followed up after 6 months. RESULTS No systematic differences for the assessed variables were found between the 2 raters. The overall nonrecovery rate was 28%. For the group with low neck tilt, the nonrecovery rate was 50% (95% CI: 36%-78%) and for the group with high neck tilt, 8% (95% CI: 3%-25%). The nonrecovery rate for the group low TIA was 50% (95% CI 29%-72%) and for those with high TIA 14% (95% CI 4%-26%). The associations remained significant after adjustments for possible confounders. The inter-rater analysis shows satisfactory agreement without proportional bias. CONCLUSIONS This study indicates the existence of an association between the constitutional sagittal alignment of the cervical spine and the outcome after whiplash injuries.
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Affiliation(s)
- Eric Rydman
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
| | - Peter Elkan
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Ted Eneqvist
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Per Ekman
- 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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11
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Ritchie C, Smith A, Sterling M. Medical and allied health service use during acute and chronic post-injury periods in whiplash injured individuals. BMC Health Serv Res 2020; 20:260. [PMID: 32228573 PMCID: PMC7106620 DOI: 10.1186/s12913-020-05146-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 03/24/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Individuals with whiplash associated disorder (WAD) frequently experience neck pain in addition to other physical, psychological and social symptoms. Consequently, treatment is sought from a variety of health professionals. The limited data available about health services use in this population are conflicting. This study aimed to characterise health service use in individuals with WAD from a motor vehicle crash. METHODS Medical (general practitioner (GP), medical specialist, emergency services (ED), radiology - x-ray, computed tomography, magnetic resonance imaging, ultrasound) and allied health service (physiotherapy, chiropractor, psychologist, osteopath, occupational therapy) use during acute (< 12 weeks) and chronic (12 weeks to 2 years) post-injury periods were analysed in adults claiming compensation for WAD in the no-fault jurisdiction of Victoria, Australia (n = 37,315). RESULTS Most WAD claimants had an acute post-injury health service payment (95%, n = 35,348), and approximately one-third (29%, n = 10,871) had a chronic post-injury health service payment. During an acute post-injury period, the most frequently compensated services were for: ED (82% of acute claimants), radiology (56%), and medical specialist (38%). Whereas, physiotherapy (64.4% of chronic claimants), GP (48.1%), and radiology (34.6%) were the most frequently paid services during the chronic period. Females received significantly more payments from physiotherapists (F = 23.4%, M = 18%, z = - 11.3, p < .001, r = 0.13), chiropractors (F = 7.4%, M = 5.6%, z = - 6.3, p < .001, r = 0.13), and psychologists (F = 4.2%, M = 2.8%, z = - 6.7, p < .001, r = 0.18); whereas, males received significantly more medical services payments from medical specialists (F = 41.8%, M = 43.8%, z = - 3.7, p < .001, r = 0.03), ED (F = 74.0%, M = 76.3%, z = - 4.9, p < .001, r = 0.03) and radiology (F = 58.3%, M = 60.1%, z = - 3.4, p < .001, r = 0.02). CONCLUSIONS Individuals with WAD claimed for a range of health services. Radiology imaging use during the acute post-injury period, and physiotherapy and chiropractor service use during the chronic post-injury period appeared concordant with current WAD management guidelines. Conversely, low physiotherapy and chiropractic use during an acute post-injury period, and high radiology and medical specialists use during the chronic post-injury period appeared discordant with current guidelines. Strategies are needed to help inform medical health professionals of the current guidelines to promote early access to health professionals likely to provide an active approach to treatment, and to address unnecessary referral to radiology and medical specialists in individuals with on-going WAD.
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Affiliation(s)
- Carrie Ritchie
- Recover Injury Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
| | - Ashley Smith
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Michele Sterling
- Recover Injury Research Centre, The University of Queensland, Brisbane, Queensland, Australia.,NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, Brisbane, Australia
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Juuso P, Skär L, Söderberg S. Recovery despite everyday pain: Women's experiences of living with whiplash-associated disorder. Musculoskeletal Care 2020; 18:20-28. [PMID: 31917514 DOI: 10.1002/msc.1434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Living with whiplash-associated disorders (WAD) means living every day under the influence of pain and limitations. As the incidence of WAD and the related intensity of pain are somewhat higher among women than men, the aim of the present study was to describe women's experiences of living with WAD. METHODS A purposive sample of seven women participated in individual in-depth qualitative interviews, the transcripts of which were subjected to qualitative content analysis. RESULTS The results of the analysis suggested six themes of women's experiences with WAD: living with unpredictable pain; trying to manage the pain; living with limitations; being unable to work as before; needing support and understanding; and learning to live with limitations. The findings showed that unpredictable pain limited women's strength to engage in activities of daily life and be as active as before. Support and understanding were important for their ability to manage changes in their daily lives. CONCLUSIONS Pain considerably affects the daily lives of women with WAD, particularly by limiting their ability to perform activities and to enjoy their professional and social lives. As women with WAD need support with managing their daily lives, nurses and other healthcare personnel should adopt a person-centred approach, in order to support such women according to their individual needs and circumstances.
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Affiliation(s)
- Päivi Juuso
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | - Lisa Skär
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
| | - Siv Söderberg
- Department of Nursing Sciences, Mid Sweden University, Östersund, Sweden
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13
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Samoborec S, Ayton D, Ruseckaite R, Evans SM. Biopsychosocial barriers affecting recovery after a minor transport-related injury: A qualitative study from Victoria. Health Expect 2019; 22:1003-1012. [PMID: 31155834 PMCID: PMC6803416 DOI: 10.1111/hex.12907] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 11/30/2022] Open
Abstract
Objective The aim of the study was to understand the recovery phenomena and to explore participants' perspectives on the biopsychosocial facilitators and barriers affecting their recovery after a minor transport injury. Methods A qualitative method was used involving semi‐structured interviews with 23 participants who sustained a minor transport injury. Interviews and analysis were guided by the biopsychosocial model (BPS) of health. The outcomes were themes capturing biopsychosocial barriers to, and personal experiences of, recovery using a previously defined framework. Results The themes indicate that recovery is a multifaceted phenomenon affected by comorbidities such as chronic pain, depression and anxiety. A range of subsequent complexities such as the inability to self‐care and undertaking daily domestic duties, and incapacity to participate in recreational activities were major barriers to recovery. These barriers were found to be an on‐going source of frustration, dissatisfaction and a perceived cause of depressive symptomatology in many participants. Most participants reported mixed feelings of the care received. Other common issues raised included a lack of understanding of the assessment time, regular follow‐up, guidance and on‐going support. Conclusion This study revealed that recovery after a minor transport‐related injury was a challenging, complex, demanding and a long‐term process for the individuals in this study. Findings from this limited cohort suggested that, for participants to return to their pre‐accident health status, a more coordinated approach to information and care delivery may be required.
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Affiliation(s)
- Stella Samoborec
- Department of Epidemiology and Preventive Medicine (DEPM), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Darshini Ayton
- Department of Epidemiology and Preventive Medicine (DEPM), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rasa Ruseckaite
- Department of Epidemiology and Preventive Medicine (DEPM), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susan M Evans
- Department of Epidemiology and Preventive Medicine (DEPM), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Sole G, Mącznik AK, Ribeiro DC, Jayakaran P, Wassinger CA. Perspectives of participants with rotator cuff-related pain to a neuroscience-informed pain education session: an exploratory mixed method study. Disabil Rehabil 2019; 42:1870-1879. [PMID: 30634871 DOI: 10.1080/09638288.2018.1542037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To explore perceptions and initial outcomes of patients with rotator cuff-related pain to a pain education session.Materials and Methods: Ten individuals with persistent rotator cuff-related pain (≥3 months duration) attended an individual pain education session. They completed patient-reported outcomes measures on a weekly basis, three weeks prior and three weeks following the session. Individual semi-structured interviews were conducted three weeks following the pain education. Interviews were recorded, transcribed verbatim, and analyzed using the General Inductive Approach.Results: There were two over-arching key themes: firstly, 'Participants' Perspectives' of the session generated four themes: Improved understanding of 'the whole'; Mindful self-awareness; Taking charge; "The pain is still there". Their understanding of pain was reconceptualised, evident by their ability to describe the role of neurophysiological mechanisms, stress and general well-being towards their pain. The second over-arching key theme, 'Participants' Recommendations', had two themes: Integrating neuroscience with pathoanatomical knowledge and Educating other health professionals. Pain levels decreased post-pain education compared to pre-pain education.Conclusions: Following the pain education session, participants had greater understanding of factors influencing their shoulder pain. Pain education, in addition to pathoanatomical information may be useful as part of treatment for persistent rotator cuff-related pain.
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Affiliation(s)
- Gisela Sole
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Aleksandra K Mącznik
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Daniel Cury Ribeiro
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Prasath Jayakaran
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Craig A Wassinger
- Department of Physical Therapy, East Tennessee State University, Johnson City, USA
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Reductions in Perceived Injustice Are Associated with Reductions in Posttraumatic Stress Symptoms Among Individuals Receiving Treatment for Whiplash Injury. PSYCHOLOGICAL INJURY & LAW 2018. [DOI: 10.1007/s12207-018-9326-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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