Whiplash injury associated disorders (WAD) cause high costs for public health care. Neck pain is number 16 on the global prevalence lists for the 50 most common sequelae. It is of importance to obtain long-term data on disability and working capacity outcomes after rehabilitation. Long-term prospective data of the outcome course of whiplash are sparse. The aim of this study was to quantify improvements of pain, function/role performance, vitality, and working capacity 5 years after whiplash injury and to compare the state of health to normative values at 5 years after rehabilitation.In this naturalistic, observational, prospective cohort study, 115 patients were assessed 5 years (60 months) after a multidisciplinary rehabilitation program. The assessment set consisted of the Short Form 36 (SF-36), parts of the North American Spine Society's cervical spine assessment questionnaire (NASS) and the coping strategies questionnaire (CSQ). The effects were quantified by effect size (ES) and standardized response mean (SRM). Score differences over the course were tested by the Wilcoxon–Mann–Whitney U test for significance.Comparing data between entry and 60 months after rehabilitation 8 of 15 parameters improved with large ES/SRM. Outcome between 6 and 60 months showed small to moderate ES/SRM. Working capacity increased from 0 at entry to rehabilitation to 21 h/wk at 6 months and to 30 h/wk at 60 months follow-up.After large improvements in health and working capacity in the mid-term, further important improvements were observed in the long-term course. It can be hypothesized that part of those can be attributed to the interventions during inpatient rehabilitation, for example, due to better coping strategies.

BackgroundPersistent pain and disability of whiplash injury associated disorders (WAD) cause high burden for the individual and costs for healthcare.ObjectivesThe aim of this study was to determine state and change of health and working-capacity five years after a standardized inpatient pain management program of four weeks.MethodsThis prospective cohort study quantified health and quality of life by the generic Short Form 36 (SF-36, 100=best), the neck-specific Northern American Spine Society (NASS) form, and the Coping Strategies Questionnaire (CSQ). SF-36 data were compared to age-, sex-, and comorbidity-specific German population norms (1). Changes of health were determined using effect sizes (ES) at the 6 month and the 60 month follow-up. Changes of health were determined using effect sizes (ES) (2).ResultsThe 59 participants had mean age of 40.3 years (sd=12.3), 83% were women, and 37% had one or more comorbidites. At 5 years, health was worse on all SF-36 scales when compared to the norms (p<0.001), varying from mean 41.5, norm 82.3 on role physical to mean 65.7, norm 71.0 on mental health (all p<0.001).Table 1Effect sizes (ES)Entry to 60 months6 months to 60 months SF-36 Physical functioning0.990.16SF-36 Role physical2.220.83SF-36 Bodily pain1.610.78SF-36 Vitality0.890.32SF-36 Social functioning0.710.47SF-36 Mental health0.610.30NASS Pain1.120.56NASS Function0.780.26CSQ Catastrophizing1.030.62Median working capacity improved from 0 at entry to 21 at 6 months and to 30 hours/week at 5 years.ConclusionsModerate to large long-term effects were observed. Substantial improvements still occurred between 6 and 60 months after start of the pain program, especially in pain, catastrophizing, and physical role performance. Improvements observed after the inpatient pain program can be maintained and expanded in the long-term at home (3).References Kurth BM, Ellert U. The SF-36 questionnaire and its usefulness in population studies: Results of the German Health Interview and Examination Survey 1998. Soz Praeventivmed 2002;47:266–277.Kazis ES, Anderson JJ, Meenan RF. Effect sizes for interpreting changes in health status. Med Care 1989;27(3 Suppl):S178–89.Haiduk P, Benz T, Lehmann S, Gysi-Klaus F, Aeschlimann A, Michel BA, Angst F. Interdisciplinary rehabilitation after whiplash injury: An observational prospective five year outcome study. Medicine 2017;in press. Disclosure of InterestNone declared