External validation of a clinical prediction rule to predict full recovery and ongoing moderate/severe disability following acute whiplash injury

Ritchie, Carrie, Hendrikz, John, Jull, Gwendolen, Elliott, James and Sterling, Michele (2015) External validation of a clinical prediction rule to predict full recovery and ongoing moderate/severe disability following acute whiplash injury. Journal of Orthopaedic and Sports Physical Therapy, 45 4: 242-250. doi:10.2519/jospt.2015.5642


Author Ritchie, Carrie
Hendrikz, John
Jull, Gwendolen
Elliott, James
Sterling, Michele
Title External validation of a clinical prediction rule to predict full recovery and ongoing moderate/severe disability following acute whiplash injury
Journal name Journal of Orthopaedic and Sports Physical Therapy   Check publisher's open access policy
ISSN 0190-6011
1938-1344
Publication date 2015-04-01
Year available 2015
Sub-type Article (original research)
DOI 10.2519/jospt.2015.5642
Volume 45
Issue 4
Start page 242
End page 250
Total pages 9
Place of publication Alexandria, United States
Publisher American Physical Therapy Association
Collection year 2016
Language eng
Formatted abstract
Study Design
Retrospective secondary analysis of data.

Objectives
To investigate the external validity of the whiplash clinical prediction rule (CPR).

Background
We recently derived a whiplash CPR to consolidate previously established prognostic factors for poor recovery from a whiplash injury and predicted 2 recovery pathways. Prognostic factors for full recovery were being less than 35 years of age and having an initial Neck Disability Index (NDI) score of 32% or less. Prognostic factors for ongoing moderate/severe pain and disability were being 35 years of age or older, having an initial NDI score of 40% or more, and the presence of hyperarousal symptoms. Validation is required to confirm the reproducibility and accuracy of this CPR. Clinician feedback on the usefulness of the CPR is also important to gauge acceptability.

Methods
A secondary analysis of data from 101 individuals with acute whiplash-associated disorder who had previously participated in either a randomized controlled clinical trial or prospective cohort study was performed using accuracy statistics. Full recovery was defined as NDI score at 6 months of 10% or less, and ongoing moderate/severe pain and disability were defined as an NDI score at 6 months of 30% or greater. In addition, a small sample of physical therapists completed an anonymous survey on the clinical acceptability and usability of the tool.

Results
The positive predictive value of ongoing moderate/severe pain and disability was 90.9% in the validation cohort, and the positive predictive value of full recovery was 80.0%. Surveyed physical therapists reported that the whiplash CPR was simple, understandable, would be easy to use, and was an acceptable prognostic tool.

Conclusion
External validation of the whiplash CPR confirmed the reproducibility and accuracy of this dual-pathway tool for individuals with acute whiplash-associated disorder. Further research is needed to assess prospective validation, the impact of inclusion on practice, and to examine the efficacy of linking treatment strategies with predicted prognosis.
Keyword Neck Disability Index
Prediction
Prognosis
Whiplash-associated disorder
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Health and Rehabilitation Sciences Publications
 
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