Factors predicting outcome after whiplash injury in subjects pursuing litigation

Abstract

Records of 277 patients presenting for medicolegal reporting following isolated whiplash injury were studied retrospectively. A range of pre-accident, accident and response variables were recorded. Multivariate analysis was used to determine the main factors that predict physical and psychological outcome after whiplash injury. The factors that showed significant association with poor outcome on both physical and psychological outcome scales were pre-injury back pain, high frequency of General Practitioner attendance, evidence of pre-injury depression or anxiety symptoms, front position in the vehicle and pain radiating away from the neck after injury. The strongest associations were with factors that are present before impact. In this selected cohort of patients, there is a physical and a psychological vulnerability that may explain the widely varied response to low violence indirect neck injury.

The Relationship Between Self-Rated Disability, Fear-Avoidance Beliefs, and Nonorganic Signs in Patients with Chronic Whiplash-Associated Disorder

“…Others interpret NOS to indicate more deliberate attempts by WAD patients to obtain "secondary gain." [45][46][47][48] The concerns here may range from hypochondriasis to frank malingering behavior. On this interpretation, the importance of psychological maladaptation is downplayed.…”

Pre-injury health-related factors in relation to self-reported whiplash: longitudinal data from the HUNT study, Norway

“…In contrast, Lankester et al [22] and Turner et al [23] used information from GP reports and found that both physical and psychological outcomes were associated with pre-injury musculoskeletal complaints [23] and with preinjury back pain, high frequency of GP attendance, anxiety and depression symptoms [22]. It was concluded that these factors may represent vulnerability for a more unfavourable outcome after a neck trauma in a low velocity motor vehicle accident.…”

“…We could not explore the reasons for reporting of poor health at HUNT 1, as the questions concerning the self-reported pre-injury health were broad and non-specific. Both pre-injury anxiety and depression [22,26] and preinjury musculoskeletal pain [23] have been associated with whiplash and the course of symptoms after a whiplash injury. It is reasonable to assume that these factors contributed to poor pre-injury health also in this study.…”

Chronic Pain Assessment

“…There are other patients who have a more complex relationship between their emotional state and their physical disability, evidenced within my clinical practice and in the literature on chronic whiplash. [4][5][6][7] For example, patients who have a history of posttraumatic stress disorder (PTSD) may have this condition reactivated by a motor vehicle crash. In this setting, these patients often do poorly unless psychological factors can be addressed in addition to their physical pain.…”