Assesment and validation of prognostic models for poor functional recovery 12 months after whiplash injury: A multicentre inception cohort study

Sterling, Michele, Hendrikz, Joan, Kenardy, Justin, Kristjansson, Eythor, Dumas, Jean-Pierre, Niere, Ken, Cote, Julie, deSerres, Sophie, Rivest, Karine and Jull, Gwendolen (2012) Assesment and validation of prognostic models for poor functional recovery 12 months after whiplash injury: A multicentre inception cohort study. Pain, 153 8: 1727-1734.


Author Sterling, Michele
Hendrikz, Joan
Kenardy, Justin
Kristjansson, Eythor
Dumas, Jean-Pierre
Niere, Ken
Cote, Julie
deSerres, Sophie
Rivest, Karine
Jull, Gwendolen
Title Assesment and validation of prognostic models for poor functional recovery 12 months after whiplash injury: A multicentre inception cohort study
Journal name Pain  (ERA 2012 Listed)    (ERA 2010 Rank A)   Check publisher's open access policy
Publication date 2012
Sub-type Article
DOI 10.1016/j.pain.2012.05.004
Volume number 153
Issue number 8
ISSN 0304-3959; 1872-6623
Start page 1727
End page 1734
Total pages 8
Place of publication Amsterdam, Netherlands
Publisher Elsevier
Collection year 2013
Language eng
Formatted abstract Uncertainty surrounds prognostic factors after whiplash injury. Previously we identified a prognostic model for 6-month pain-related disability in a cohort of 80 participants with acute whiplash. Predictors included initial disability, older age, decreased cold pain thresholds, decreased neck rotation movement, posttraumatic stress symptoms and decreased sympathetic vasoconstriction. The objective of this study was to externally validate this model. In a multicentre inception cohort study, 286 participants with acute whiplash (I, II or III) were assessed at <3 weeks and 12 months after injury. The Neck Disability Index (NDI) was the outcome. Observed and predicted NDI scores were generated using the published equation of the original model. Model discrimination between participants with no or mild disability from those with moderate to severe disability was examined by receiver operating characteristic curves. Initial NDI and cold pain threshold predicted current observed 12-month NDI scores (r2 = 0.50, 95% confidence interval 0.42 to 0.58). There was a significant site effect, and the estimated marginal mean ± SE of 12-month NDI for Iceland (27.6 ± 1.79%) was higher than the other 3 sites (Melbourne 11.2 ± 5.03%, Canada 16.4 ± 2.36%, Brisbane 16.8 ± 1.17%). After adjusting for site, age and Impact of Events Scale scores regained significance (r2 = 0.56, 95% confidence interval 0.48 to 0.64). The tested model was not precise in predicting NDI as a continuous variable. However, it found good accuracy to discriminate participants with moderate to severe disability at 12 months (area under the receiver operating characteristic curve 0.89 [95% confidence interval 0.84–0.94], P < .001) which is clinically useful.
Keyword Whiplash-associated disorder
Prediction
Inception cohort
Validation
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Available online 1 June 2012

 
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Created: Mon, 25 Jun 2012, 13:48:08 EST by Chesne McGrath on behalf of Medicine - Royal Brisbane and Women's Hospital