Neither the WAD-classification nor the Quebec Task Force follow-up regimen seems to be important for the outcome after a whiplash injury. A prospective study on 186 consecutive patients

Abstract

A classification of injury and a follow-up schedule were proposed by the Quebec Task Force (QTF) in 1995. No general agreement about the clinical usefulness of the WAD-classification or of the suggested follow-up regimen exists. A series of 186 consecutive cases seen in the emergency room during the acute phase after a whiplash injury was prospectively studied for 1 year. All findings including history and physical findings were recorded using standardized QTF protocols. In one group follow-up visits were done according to the QTF regimen: at 1, 3, 6, 12 weeks and 1 year after the accident; in a control group no visit was scheduled. The outcome variable was neck pain at 1 year after the accident. After 1 year, 18% of the total number of patients had significant neck pain. Risk factors for chronic neck pain at 1 year after whiplash injury were: neck pain before the accident and a high degree of emotional distress at the time of the accident; both factors independently associated with a tenfold increased risk of developing chronic neck pain. Neither the WAD classification nor the QTF follow-up regimen could be linked to a better outcome. In this study the outcome was associated with patient-specific characteristics and not with physical signs of injury, the depth of the initial evaluation or the follow-up regimen.

Function in Patients With Cervical Radiculopathy or Chronic Whiplash-Associated Disorders Compared With Healthy Volunteers

“…This study included 198 patients with MRI-verified CR due to cervical disc disease who were scheduled for surgery the following day (mean age 50 years  SD 8.5 years, 104 men and 94 women; table 1) and 215 patients with chronic WAD (6 months to 3 years since accident) classified as Grade II (n=122) or Grade III (n=93) 23 (mean age 4011.4 years, 78 men and healthy volunteers (for hand strength and neck AROM: n=101, mean age 4310.5 years, 50 men and 51 women (24,25); for NME: n=116, mean age 4511.7 years, 60 men and 56 women). 28 Patients with CR (recruited from Neurosurgical clinics) and WAD (identified through electronic medical records from county councils and recruited after enquiries by mail including a short questionnaire) were participants in ongoing randomized clinical trials.…”

“…24,25 To our knowledge, only one previous randomized controlled trial 11 of patients with chronic WAD included Grade III patients. The results of the present study show that there is an urgent need for increased knowledge of the best way to treat this subgroup of WAD patients, suggesting that future randomized controlled trials should also include patients with Grade III WAD.…”

“…[5][6][7][8][9][19][20][21][22] It is important to investigate whether and to what extent these patient groups differ from a healthy population, and whether there are differences in CR patients regarding the onset of symptoms (suddenly after a special occasion, or slowly progressing) and in WAD patients regarding Quebec classification. 23 Information is contradictory regarding whether or not WAD Grade is related to outcome, 24,25 and to our knowledge the literature lacks studies investigating whether the type of symptom onset in CR patients is related to functional outcome.…”

Risk Factors for Persistent Problems Following Acute Whiplash Injury: Update of a Systematic Review and Meta-analysis

“…After a firstpass screen of title and abstract, 65 publications were retained for full-text review. As a result of the full-text review, 9 papers 5,18,20,[22][23][24][25]34,41 describing 4 additional independent cohorts were retained and added to the existing pool of 11 cohorts from the previous review. 42 The total sample size was increased from 3193 to 4314 subjects when adding these 4 new cohorts to the previous 11.…”

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

“…Hendriks et al [11] found that self-reported pre-injury health status was not predictive for functional recovery, while Holm et al [12] and Kivioja et al [13] found that fair or poor health, neck pain, shoulder pain and headache before the collision were risk factors for severe neck pain post-collision. The association between pre-injury and post-injury neck pain may reflect difficulties in distinguishing prior neck pain from present neck pain, but could also reflect a predetermined vulnerability to neck injury or symptoms after a motor vehicle collision [12].…”