Relationship between neck motion and self-reported pain in patients with whiplash associated disorders during the acute phase

Abstract

Background: Biomechanical measures quantify motor control and functional deficits in Whiplash Associated Disorders (WAD), but few studies relate those measures to the clinical scales that are routinely used to assess patients. Most studies are limited to chronic neck pain, and report poor to moderate correlations. Objective: To define a statistical model that relates measures of neck kinematics with clinical scales of neck pain, in WAD patients during the rehabilitation process in the acute phase (less than 3 months since the accident). Methods: 96 WAD patients self-assessed their pain using VAS and NPQ, and passed neck motion tests as part of their rehabilitation program. Four regression models were fitted to analyze the effects of the measured kinematic parameters and subject-specific characteristics on VAS and NPQ. Model errors were compared to minimal clinically significant differences. Results: Multiple correlation coefficients of the models were between 0.74 and 0.90. More than 66% of that correlation was accounted for by subject-specific factors, and most of the other half by the measured kinematic parameters. Range of motion of flexion-extension and axial rotation, and harmonicity of flexion-extension, where the variables most consistently related to the decrease of pain. The error of the models was within the MCSD in more than 50% of the observations. Conclusions: Part of the individual progression of pain and pain-related disability in acute WAD patients, as rated by NPQ and VAS, can be mapped to objective kinematic parameters of neck mobility tests, like ranges of motion, velocities, repeatability and harmonicity of movements.

Jaw‐neck motor function in the acute stage after whiplash trauma

“…For head‐neck movements, it has been shown that whiplash trauma can affect neck motor function already in the acute stage, as evidenced by a smaller cervical range of motion, 46,47 altered EMG activity of the sternocleidomastoid muscle and impaired positioning of the neck compared to a control group 47,48 . It has also been reported that reduced neck movements in the acute stage after whiplash trauma is related to higher neck pain intensity 49 and higher levels of neck disability 46,49 . In the present study of jaw‐neck function, the findings of smaller jaw amplitudes but no change in head amplitudes may seem contradictory.…”

A model to differentiate WAD patients and people with abnormal pain behaviour based on biomechanical and self-reported tests

“…Neck motion was analysed as described by De Rosario et al [ 37 ], measuring range of motion (ROM), maximum angular velocity (MAV), phase-area ratio (PAR), and harmonicity (HARM) of flexion–extension (FE), rotation (R), and lateral flexion (LF) movements. Spanish patients were measured using the NedCervical/IBV system, whereas the Italian cohort was measured using the WAAS/IBV system.…”

“…Spanish patients were measured using the NedCervical/IBV system, whereas the Italian cohort was measured using the WAAS/IBV system. The systems differed in the instrumentation (optical sensors in NedCervical/IBV vs. inertial sensors in WAAS/IBV), but they implemented the same measurement protocol, and a suitable placement of sensors and postural calibration were considered to ensure that the discrepancies between instruments remained below 3 degrees for ROM, 2% of the range of MAV, and less than 1% of PAR and HARM [ 37 ].…”

“…The aim of the present study was to merge two different approaches from among those most commonly used by forensic practitioners to detect WAD malingering – the mechanical approach and the qualitative analysis of the symptomatology – to obtain a malingering detection model based on a wider range of indices, both biomechanical and self-reported. To this end, we tested malingerers and genuine clinical patients using a kinematic test used in the assessment of WAD-related pain [ 37 ], and a self-report questionnaire, which was built ad hoc for this study based on rare and impossible whiplash symptoms. Then, the collected measures were used to train and validate classification models, investigating the accuracy, sensitivity, and specificity of the two approaches together in detecting WAD malingerers.…”

Improving the staging of neck injuries using a new index, the Neck Functional Holistic Analysis Score: Clustering approach to determine degrees of impairment

“…As kinematics can differentiate healthy from injured patients, there could be also differences between the kinematics of the injured ones. Moreover, the progression of pain along treatment has shown to correlate with the progression of kinematics such as ROM [28]. A classification based on ROM impairment could help with the management of these patients since it could identify the ones with more severe symptoms.…”