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

BMC Musculoskeletal Disorders

Anne Söderlund²  Annika Bring¹  Pernilla Åsenlöf¹ 

[1] Department of Neuroscience, Uppsala University, BMC, Box 593, S-751 24 Uppsala, Sweden;School of Health, Care and Social Welfare, Physiotherapy, Mälardalen University, P.O.Box 883, SE-721 23 Västerås, Sweden

关键词: Risk factors;    Pain-related disability;    Prognosis;    Whiplash injury;    Acute whiplash associated disorders;   

Others  :  1129003
DOI  :  10.1186/1471-2474-14-361

 received in 2013-04-15, accepted in 2013-12-13,  发布年份 2013

【 摘 要 】

Background

Different 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.

Methods

The 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.

Results

The 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).

Conclusion

A 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.

【 授权许可】

   
2013 Åsenlöf et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Carroll L, Holm L, Hogg-Johnson S, et al.: Course and prognostic factors for neck pain in whiplash-associated disorders (WAD): results of the Bone and Joint decade 2000–2010 Task Force on Neck Pain and Its associated Disorders. Spine 2008, 33:583-592.
• [2]Hartling L, Pickett W, Brison R, al e: Derivation of a clinical decision rule for whiplash associated disorders aming individuals involved in rear-end collisions. Accid Annal Prev 2002, 34:531-539.
• [3]Sterling M, Carroll L, Kasch H, Kamper S, Stemper B: Prognosis after whiplash injury. Spine 2011, 36(25S):S330-S334.
• [4]Kamper S, Rebbeck T, Maher C, al e: Course and prognostic factors factors of whiplash: a systematic review and meta-analysis. Pain 2008, 138:617-629.
• [5]Walton D, Pretty J, MacDermid J, al e: Risk factors for persistent problems following whiplash injury: results of a systematic review and meta-analysis. J Orthop Sports Phys Ther 2009, 39:334-350.
• [6]Williamson E, Williams M, Gates S, Lamb SE: A systematic literature review of psychological factors and the development of late whiplash syndrome. Pain 2008, 135(1–2):20-30.
• [7]Söderlund A, Åsenlöf P: The mediating role of self-efficacy expectations and fear of movement and (re)injury beliefs in two samples of acute pain. Disabil Rehabil 2010, 32(25):2118-2126.
• [8]Kamper SJ, Maher CG, Menezes Costa Lda C, McAuley JH, Hush JM, Sterling M: Does fear of movement mediate the relationship between pain intensity and disability in patients following whiplash injury? A prospective longitudinal study. Pain 2012, 153:113-119.
• [9]Sterling M, Hendrikz J, Kenardy J: Compensation claim lodgement and health outcome developmental trajectories following whiplash injury: A prospective study. Pain 2010, 150(1):22-28.
• [10]Pate RR, O'Neill JR, Lobelo F: The evolving definition of "sedentary". Exerc Sport Sci Rev 2008, 36(4):173-178.
• [11]Spitzer W, Skovron M, Salmi L, Cassidy D, Duranceau J, Suissa S, Zeiss ES: Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: Redefining "Whiplash" and its management. Spine 1995, 20:7-73S.
• [12]Tabachnick BG, Fidell LS: Using multivariate statistics. 4th edition. Needham Heights, United State of America: Allyn & Bacon; 2001.
• [13]Söderlund A, Bring A, Åsenlöf P: A three-group study, internet-based, face-to-face based and standard- management after acute whiplash associated disorders (WAD) - choosing the most efficient and cost-effective treatment: study protocol of a randomized controlled trial. BMC Musculoskelet Disord 2009, 10(1):90. BioMed Central Full Text
• [14]Pollard CA: Preliminary validity study of Pain Disability Index. Percept Mot Skills 1984, 59:974.
• [15]Tait C, Pollard CA, Margolis RB, Duckro PN: The Pain Disability Index: Psychometric and Validity Data. Arch Phys Med Rehabil 1987, 68:438-441.
• [16]Denison E, Åsenlöf P, Lindberg P: Self-efficacy, fear avoidance, an pain intensity as predictors of disability in subacute and chronic musculoskeletal pain patients in primary health care. Pain 2004, 111:245-252.
• [17]Åsenlöf P, Denison E, Lindberg P: Behavioural Goal Assessment in patients with persistent musculoskeletal pain. Physiotherapy Theory and Practice 2004, 20:243-254.
• [18]The Swedish Centre on Health Technology Assessment (SBU): Rehabilitation in chronic pain. A systematic review. In SBU report no 177/1+2. Edited by SBU. Stockholm: SBU; 2010.
• [19]Bergström G, Bodin L, Jensen I, Linton S, Nygren Å: Long-term, non-specific spinal pain: reliable and valid subgroups of patients. Beh Res Ther 2001, 39:75-87.
• [20]Altmaier E, Russell D, Kao C, Lehmann T, Weinstein J: Role of self-efficacy in rehabilitation outcome among chronic low back pain patients. J Couns Psychol 1993, 40:335-339.
• [21]Vlaeyen J, Kole-Snijders A, Boeren R, van Eek H: Fear of movement/(re)injury in chronic low back pain in general practise:prognostic indicators of outcome. B J Gen Pract 1995, 46:519-523.
• [22]Bunketorp L, Carlsson J, Kowalski J, Stener-Victorin EJRM, Jensen IL: Evaluating the reliability of multi-item scales: a non-parametricapproach to the ordered categorical structure of data collected with the Swedish version of the Tampa Scale for Kinesiophopia and the Self-Efficacy Scale. J Rehabil Med 2005, 37:330-334.
• [23]Rosenstiel AK, Keefe FJ: The use of coping strategies in low back pain patients: Relationship to patient characteristics and current adjustment. Pain 1983, 17:33-40.
• [24]Jensen I, Linton S: Coping Strategies Questionnaire (CSQ): Reliability of the Swedish version of the CSQ. Scan J Beh Ther 1993, 22:139-145.
• [25]Horowitz M, Wilner N, Alvarez W: Impact of Event Scale: a measure of subjective stress. Psychosom Med 1979, 41:209-218.
• [26]Joseph S: Psychometric evaluation of Horowitz's Impact of Event Scale: a review. J Trauma Stress 2000, 13(1):101-113.
• [27]Asenlof P, Soderlund A: A further investigation of the impolrtance of pain cognitions and behaivour in pain rehabilitation: longitudinal data suggest disability and fear of movement are most important. Clin Rehabil 2010, 24(5):422-230.
• [28]Nicholas M, Linton S, Watson P, Main C: Early identification and management of psychological risk factors ("Yellow flags") in patients with low back pain: A reappraisal. Phys Ther 2011, 91(5):737-753.
• [29]Glanz K, Rimer B, Lewis F: Health behavior and helath education. 3rd edition. San Francisco: John Wiley & Sons, Inc; 2002.
• [30]Holm L, Carroll L, Cassidy J, Skillgate E, Ahlbom A: Expectations for recovery important in the prognosis of whiplash injuries. PLos Med 2008, 5(5):760-767.
• [31]Bring A, Soderlund A, Wasteson E, Asenlöf P: Daily stressors in patients with acute whiplash associated disorders. Disabil Rehabil 2012, 34:1783-1789.
• [32]Gendreau M, Hufford MR, Stone AA: Measuring clinical pain in chronic widespread pain: selected methodological issues. Best Pract Res Clin Rheum 2003, 17(4):575-592.
• [33]Jensen MP, Lindsey RT, Turner JA, Romano JM: The use of multiple-item scales for pain intensity measurement in chronic pain patients. Pain 1996, 67:34-40.
• [34]Kamper SJ, Hancock MJ, Maher CG: Optimal Designs for Prediction Studies of Whiplash. Spine 2011, 36:S268-S274.