The clinical course over the first year of Whiplash Associated Disorders (WAD): pain-related disability predicts outcome in a mildly affected sample

Abstract

BackgroundDifferent recovery patterns are reported for those befallen a whip-lash injury, but little is known about the variability within subgroups. The aims were (1) to compare a self-selected mildly affected sample (MILD) with a self-selected moderately to severely affected sample (MOD/SEV) with regard to background characteristics and pain-related disability, pain intensity, functional self-efficacy, fear of movement/(re)injury, pain catastrophising, post-traumatic stress symptoms in the acute stage (at baseline), (2) to study the development over the first year after the accident for the above listed clinical variables in the MILD sample, and (3) to study the validity of a prediction model including baseline levels of clinical variables on pain-related disability one year after baseline assessments.MethodsThe study had a prospective and correlative design. Ninety-eight participants were consecutively selected. Inclusion criteria; age 18 to 65 years, WAD grade I-II, Swedish language skills, and subjective report of not being in need of treatment due to mild symptoms. A multivariate linear regression model was applied for the prediction analysis.ResultsThe MILD sample was less affected in all study variables compared to the MOD/SEV sample. Pain-related disability, pain catastrophising, and post-traumatic stress symptoms decreased over the first year after the accident, whereas functional self-efficacy and fear of movement/(re)injury increased. Pain intensity was stable. Pain-related disability at baseline emerged as the only statistically significant predictor of pain-related disability one year after the accident (Adj r2 = 0.67).ConclusionA good prognosis over the first year is expected for the majority of individuals with WAD grade I or II who decline treatment due to mild symptoms. The prediction model was not valid in the MILD sample except for the contribution of pain-related disability. An implication is that early observations of individuals with elevated levels of pain-related disability are warranted, although they may decline treatment.

Low Pain Catastrophization and Disability Predict Successful Outcome to Radiofrequency Neurotomy in Individuals with Chronic Whiplash

“…Our finding that lower disability levels are a predictor of success for cRFN is not surprising. The presence of higher disability levels (NDI > 28%) in the acute stage of WAD has frequently been shown to predict poor long‐term health outcomes following the injury, with our study demonstrating the complementary finding that lower disability is a predictor of responsiveness to cRFN. Our previous results also demonstrated that individuals who did not respond to initial facet joint block injections (prior to undergoing cRFN) presented with higher levels of pain catastrophizing .…”

Is kinesiophobia and pain catastrophising at baseline associated with chronic pain and disability in whiplash-associated disorders? A systematic review

“…There is preliminary evidence showing that kinesiophobia34–37 and pain catastrophising34 37 38 may be associated with the course of neck symptoms following a whiplash injury facilitating the transition from acute to chronic WAD. However, findings of these preliminary studies remain inconsistent34–38 regarding both the strength and even the direction of the associations. Several systematic reviews14 39–42 have analysed whether pain catastrophising and kinesiophobia are prognostic factors of WAD chronicity.…”

Whiplash associated disorders: A prospective investigation of the effects of cervical medial branch radiofrequency neurotomy on sensory, motor and psychological Features

“…Our finding that lower disability levels are a predictor of success for cervical RFN is not surprising. The presence of higher disability levels (NDI > 28%) in the acute stage of WAD has frequently been shown to predict poor long-term health outcomes following the injury [6,231,421,426,427], with our study demonstrating the complementary finding that lower disability is a predictor of responsiveness to cervical RFN. Our previous results also demonstrated that individuals who did not respond to initial facet joint block injections (prior to undergoing cervical RFN) presented with higher levels of pain catastrophizing [413].…”