Prognosis of patients with whiplash-associated disorders consulting physiotherapy: development of a predictive model for recovery

BMC Musculoskeletal Disorders

Research Article

Eleanor Boyle¹  Tony Bohman²  Eva Skillgate³  J David Cassidy⁴  Linda J Carroll⁵  Pierre Côté⁶ 

[1] Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, LuCliff Place, 700 Bay Street, Suite 2201, M5G 1Z6, Toronto, ON, Canada;Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, M5T 3M7, Toronto, ON, Canada;Institute of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark;Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-17177, Stockholm, Sweden;Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-17177, Stockholm, Sweden;Skandinaviska Naprapathögskolan (Scandinavian College of Naprapathic Manual Medicine), Kräftriket 23A, SE-11419, Stockholm, Sweden;Institute of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark;Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, LuCliff Place, 700 Bay Street, Suite 2201, M5G 1Z6, Toronto, ON, Canada;Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, M5T 3M7, Toronto, ON, Canada;School of Public Health, University of Alberta, 4075 RTF 8308-114 Street, T6G 2E1, Edmonton, AB, Canada;University of Ontario, Institute of Technology, Faculty of Health Sciences, 2000 Simcoe Street North, L1H 7K4, Oshawa, ON, Canada;Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, M5T 3M7, Toronto, ON, Canada;

关键词: Prediction;    Prognosis;    Whiplash-associated disorders;    Neck pain;    Physical therapy;    Cohort;    Recovery;    Regression;    Discrimination;   

DOI  :  10.1186/1471-2474-13-264

 received in 2012-08-16, accepted in 2012-12-23,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundPatients with whiplash-associated disorders (WAD) have a generally favourable prognosis, yet some develop longstanding pain and disability. Predicting who will recover from WAD shortly after a traffic collision is very challenging for health care providers such as physical therapists. Therefore, we aimed to develop a prediction model for the recovery of WAD in a cohort of patients who consulted physical therapists within six weeks after the injury.MethodsOur cohort included 680 adult patients with WAD who were injured in Saskatchewan, Canada, between 1997 and 1999. All patients had consulted a physical therapist as a result of the injury. Baseline prognostic factors were collected from an injury questionnaire administered by Saskatchewan Government Insurance. The outcome, global self-perceived recovery, was assessed by telephone interviews six weeks, three and six months later. Twenty-five possible baseline prognostic factors were considered in the analyses. A prediction model was built using Cox regression. The predictive ability of the model was estimated with concordance statistics (c-index). Internal validity was checked using bootstrapping.ResultsOur final prediction model included: age, number of days to reporting the collision, neck pain intensity, low back pain intensity, pain other than neck and back pain, headache before collision and recovery expectations. The model had an acceptable level of predictive ability with a c-index of 0.68 (95% CI: 0.65, 0.71). Internal validation showed that our model was robust and had a good fit.ConclusionsWe developed a model predicting recovery from WAD, in a cohort of patients who consulted physical therapists. Our model has adequate predictive ability. However, to be fully incorporated in clinical practice the model needs to be validated in other populations and tested in clinical settings.

【 授权许可】

CC BY   
© Bohman et al.; licensee BioMed Central Ltd. 2012