The influence of prognostic factors on neck pain intensity, disability, anxiety and depression over a 2-year period in subjects with acute whiplash injury

Abstract

The influence of potential prognostic factors (occupant- and crash-related factors, initial neck pain intensity and headache, whiplash injury severity, helplessness, locus of control, socioeconomic status) on neck pain intensity (VAS), disability (DRI), anxiety and depression (HADS) was estimated in a cohort of 3704 subjects with whiplash injury following a motor vehicle crash. Questionnaires were administered (baseline, 1-, 6-, 12-, 24-month follow-ups). VAS was trichotomized; "low" (0-30), "moderate" (31-54), "severe" (55-100). A cumulative logit model with a proportional odds assumption was applied. Results regarding depression differed somewhat from the other outcomes. Overall, initial neck pain intensity was an important prognostic factor, but acted also as an evident effect modifier. Females had slightly increased odds for all outcomes but depression, for which no gender differences were shown. Injury severity was associated with all outcomes, but was most pronounced regarding disability among those who perceived numbness/pain in arms/hands and also had severe initial neck pain (proportional odds ratio [OR] 6.5; 95% confidence interval [CI] 2.5-17.0). Initial headache influenced all outcomes. Income was not related to any of the outcomes, whereas a lower level of education was associated with all outcomes but depression. Locus of control was not a factor of importance. In contrast, helplessness was related to all outcomes, but was most pronounced regarding neck pain intensity and depression for subjects with severe initial neck pain (OR 4.8; 95% CI 2.9-7.8; OR 6.6; 95% CI 2.6-17.0). Associations seem to be established early, and then to be relatively constant over time.

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

“…36,37,46 We therefore argue that a more equal sex distribution would not alter the conclusions of the study.…”

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

“…Catastrophic beliefs about pain are associated with heightened pain and disability in people with chronic WAD and play an important role in the transition from (sub)acute to chronic WAD [12,[21][22]. 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]].…”

The Role of Perceived Injustice in the Experience of Chronic Pain and Disability: Scale Development and Validation

“…At least for some individuals, life following injury will be characterized by significant and persistent physical and emotional suffering [3,4]. In addition, post-injury life might be replete with losses such as the loss of employment, the loss of financial security, loss of independence and loss of sense of identity [5][6][7].…”