Factors predicting outcome in whiplash injury: a systematic meta-review of prognostic factors

Abstract

BackgroundWhiplash injuries are among the leading injuries related to car crashes and it is important to determine the prognostic factors that predict the outcome of patients with these injuries. This meta-review aims to identify factors that are associated with outcome after acute whiplash injury.Materials and methodsA systematic search for all systematic reviews on outcome prediction of acute whiplash injury was conducted across several electronic databases. The search was limited to publications in English, and there were no geographical or time of publication restrictions. Quality appraisal was conducted with A Measurement Tool to Assess Systematic Reviews.ResultsThe initial search yielded 207 abstracts; of these, 195 were subsequently excluded by topic or method. Twelve systematic reviews with moderate quality were subsequently included in the analysis. Post-injury pain and disability, whiplash grades, cold hyperalgesia, post-injury anxiety, catastrophizing, compensation and legal factors, and early healthcare use were associated with continuation of pain and disability in patients with whiplash injury. Post-injury magnetic resonance imaging or radiographic findings, motor dysfunctions, or factors related to the collision were not associated with continuation of pain and disability in patients with whiplash injury. Evidence on demographic and three psychological factors and prior pain was conflicting, and there is a shortage of evidence related to the significance of genetic factors.ConclusionsThis meta-review suggests an association between initial pain and anxiety and the outcome of acute whiplash injury, and less evidence for an association with physical factors.Level of evidenceLevel 1.Electronic supplementary materialThe online version of this article (doi:10.1007/s10195-016-0431-x) contains supplementary material, which is available to authorized users.

Influence of Clinical, Psychological, and Psychophysical Variables on Long‐term Treatment Outcomes in Carpal Tunnel Syndrome: Evidence From a Randomized Clinical Trial

“…For instance, some studies have reported that higher disability scores at baseline were associated with greater reduction in the same clinical outcome in subjects with whiplash‐associated neck pain after undergoing an exercise intervention . However, it is important to consider that cohort studies have shown that higher levels of pain intensity at baseline are a consistent factor for predicting poor outcomes in the same population . It is possible that the prognostic role of higher levels of pain and related disability would be different if patients underwent treatment vs. just following the natural history of the condition.…”

“…40,41 However, it is important to consider that cohort studies have shown that higher levels of pain intensity at baseline are a consistent factor for predicting poor outcomes in the same population. 42,43 It is possible that the prognostic role of higher levels of pain and related disability would be different if patients underwent treatment vs. just following the natural history of the condition. Physical therapy: R 2 adjusted = 0.276 for step 1, R 2 adjusted = 0.312 for step 2.…”

Long-term follow-up of whiplash injuries reported to insurance companies: a cohort study on patient-reported outcomes and impact of financial compensation

“…It has been suggested that involvement by the insurance company could affect the outcome [10,11], but also that the compensation model [12] and the time from the MVA to claim closure play a significant role [13]. The "compensation hypothesis" suggests that the outcome is worse if financial compensation is given [14].…”

Central sensitization and the biopsychosocial approach to understanding pain

“…Conversely, people reporting severe pain may have few objective markers consistent with the report of pain (e.g., Lee et al., ). Thus, there appears to be a discordance between objective tests and pain reports and impact on functioning across such diverse disorders as back pain (Brinjikji et al., ; Lee et al., ), whiplash (e.g., traumatic injuries; Sarrami, Armstrong, Naylor, & Harris, ), and knee osteoarthritis (OA) (e.g., disease‐related; Finan et al., ; Thomas et al., ). Furthermore, identical surgical treatments may produce diverse reports of pain severity across individuals (e.g., Gerbershagen et al., ) and treatments targeting the same symptoms may have differing effectiveness across people with the same diagnosis (Rusu, Boersma, & Turk, ).…”

“…A wide variety of methodologies (experimental, case‐controlled cohort, longitudinal, cross‐sectional) have demonstrated a relationship between catastrophic thinking and measures of pain, psychological disability, physical disability, and gait velocity in patients with OA, response to surgery in the immediate post‐operative period (Roth, Tripp, Harrison, Sullivan, & Carson, ), as well as at 1‐year follow‐up (e.g., Riddle, Wade, Jiranek, & Kong, ; Sullivan et al., ), worsened pain experience overall (e.g., Arnow et al., ; Theunissen, Peters, Bruce, Gramke, & Marcus, ), and disability following traumatic injury (Sarrami et al., ). Furthermore, reductions in catastrophic thinking have been associated with symptom improvement (Smeets, Vlaeyen, Kester, & Knottnerus, ; Weissman‐Fogel, Sprecher, & Pud, ).…”