Physical and psychological factors predict outcome following whiplash injury

Abstract

Predictors of outcome following whiplash injury are limited to socio-demographic and symptomatic factors, which are not readily amenable to secondary and tertiary intervention. This prospective study investigated the predictive capacity of early measures of physical and psychological impairment on pain and disability 6 months following whiplash injury. Motor function (ROM; kinaesthetic sense; activity of the superficial neck flexors (EMG) during cranio-cervical flexion), quantitative sensory testing (pressure, thermal pain thresholds, brachial plexus provocation test), sympathetic vasoconstrictor responses and psychological distress (GHQ-28, TSK, IES) were measured in 76 acute whiplash participants. The outcome measure was Neck Disability Index scores at 6 months. Stepwise regression analysis was used to predict the final NDI score. Logistic regression analyses predicted membership to one of the three groups based on final NDI scores (<8 recovered, 10-28 mild pain and disability, >30 moderate/severe pain and disability). Higher initial NDI score (1.007-1.12), older age (1.03-1.23), cold hyperalgesia (1.05-1.58), and acute post-traumatic stress (1.03-1.2) predicted membership to the moderate/severe group. Additional variables associated with higher NDI scores at 6 months on stepwise regression analysis were: ROM loss and diminished sympathetic reactivity. Higher initial NDI score (1.03-1.28), greater psychological distress (GHQ-28) (1.04-1.28) and decreased ROM (1.03-1.25) predicted subjects with persistent milder symptoms from those who fully recovered. These results demonstrate that both physical and psychological factors play a role in recovery or non-recovery from whiplash injury. This may assist in the development of more relevant treatment methods for acute whiplash.

Pain neurophysiology education improves cognitions, pain thresholds, and movement performance in people with chronic whiplash: A pilot study

“…Little is known about the continuum of WAD from the time of injury through transition to either recovery or chronicity [7]. Several mechanisms such as altered central pain processing and central sensitization [8][9][10][11] and the role of cognitions and behaviors [12][13][14][15] have been suggested, and evidence that supports these theories is rising.…”

“…In addition, psychological factors such as depression, anxiety, expectations concerning recovery, and high psychological distress have been identified as important prognostic factors for patients with WAD [7,18,[23][24]]. Söderlund and Lindberg described the importance of using positive coping strategies in dealing with whiplash-related complaints [22,25].…”

Pressure Algometry: What Does It Really Tell Us?

“…Recent data indicate that augmented central pain processing mechanisms (central hyperexcitability) is a likely feature of various musculoskeletal conditions, including WAD, 8 cervical radiculopathy, 1 and arthritis. 5 More importantly, sensory responses indicative of augmented pain processing, such as cold hyperalgesia, have demonstrated predictive capacity to identify those likely to have poor functional recovery following whiplash injury, 4,7,9 resulting in recommendations that such measures be included in the assessment of people with acute WAD. 11 Walton et al 15 provide further data to support these findings by showing that pressure pain thresholds, measured at a site distal to that of the injury (over the tibialis anterior), also demonstrate predictive capacity.…”

The clinical presentation of chronic whiplash and the relationship to findings of MRI fatty infiltrates in the cervical extensor musculature: a preliminary investigation

“…Range of active cervical movement was measured using an electromagnetic motion-tracking device (Fastrak, Polhemus, USA-www.polhemus.com) [11,62]. The Fastrak system has been used previously to document cervical active range of movements in patients with neck pain disorders [11,53,61] and has demonstrated accuracy [40]. Three recordings each were obtained for active ROM in flexion, extension, rotation left and right, lateral flexion left and right.…”