Interdisciplinary rehabilitation after whiplash injury

Abstract

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.

Interventions on cognitions and perceptions that influence work participation of employees with chronic health problems: a scoping review

“…Only the cognitive behavioral therapy intervention of Rolving et al [ 20 ] on pain perception, coping and pacing principles, among employees with degenerative disc disease or spondylolisthesis, which was further described in the study of Rolving et al [ 43 ], decreased catastrophizing more in the intervention group than in de control group after six months, but not after three months and one-year follow-up. All the interventions in the other studies [ 28 , 32 , 33 , 35 – 39 ] seemed to decrease catastrophizing over time, although the significance of this decrease due to the intervention on self-management skills described by Scott et al [ 37 ], was not reported. The interventions described by Chu et al [ 28 ] among employees with chronic non-cancer pain, Gagnon et al [ 36 ] among employees with chronic pain, Pietilä-Holmner et al [ 33 ] among patients with chronic musculoskeletal pain and Volker et al [ 39 ], which was among employees with chronic musculoskeletal pain as well, significantly increased work participation over time.…”

“…However, they did not report whether the increase in perceived health caused the increase in work participation either. Also, the intervention in the study of Haiduk et al [ 32 ] among employees with chronic neck pain showed a significant positive effect on perceived health after 60 months. It seemed to increase working capacity, although the statistical significance of this last effect was not reported.…”

“…Seven studies, of which three RCTs, studied the effect of an intervention on perceived health and work participation [ 17 – 19 , 28 , 29 , 32 , 33 ]. The interventions of Pedersen et al [ 18 ], Fauser et al [ 17 ] and Van Eijk-Hustings et al [ 19 ] did not have a significant effect on perceived health.…”

“…Most of the studies we found which focused on cognitions and perceptions and work participation were aimed at the factor catastrophizing. In total, ten studies were found that focused on this factor and work participation [ 14 , 20 , 28 , 32 , 33 , 35 – 39 ]. Among these studies there were two RCTs [ 14 , 20 ].…”

Investigation of the Effect of Neck Muscle Active Force on Whiplash Injury of the Cervical Spine

“…Kumar et al [ 15 ] carried out volunteer experiments to study the response of neck muscles when the head rotated during a side impact, indicating that the muscle force and the risk of muscle injury were reduced when the head was turned to the right or left in a side impact. The active force caused by the neck muscle contraction in a vehicle collision, especially in a low-speed collision, would have an important effect on the dynamic response of the human head and neck [ 16 ]. However, whiplash injuries as well as its injury mechanisms are rarely investigated in connection with neck restraint and active muscle forces, which would restrict the complete reappearance and understanding of the injury mechanism, There is still a need for better understanding of the whiplash injury mechanism for occupant injury prevention.…”