Physical and psychological factors predict outcome following whiplash injury

Sterling, Michele, Jull, Gwendolen, Vicenzino, Bill, Kenardy, Justin and Darnell, Ross (2005) Physical and psychological factors predict outcome following whiplash injury. Pain, 114 1-2: 141-148. doi:10.1016/j.pain.2004.12.005

Author Sterling, Michele
Jull, Gwendolen
Vicenzino, Bill
Kenardy, Justin
Darnell, Ross
Title Physical and psychological factors predict outcome following whiplash injury
Journal name Pain   Check publisher's open access policy
ISSN 0304-3959
Publication date 2005-03-01
Sub-type Article (original research)
DOI 10.1016/j.pain.2004.12.005
Volume 114
Issue 1-2
Start page 141
End page 148
Total pages 8
Editor A. Basbaum
Place of publication Amsterdam
Publisher Elsevier Science Bv
Language eng
Subject C1
321024 Rehabilitation and Therapy - Occupational and Physical
730303 Occupational, speech and physiotherapy
Abstract Predictors of outcome following whiplash injury are limited to socio-demographic and symptomatic factors, which are not readily amenable to secondary and tertiary intervention. This prospective study investigated the predictive capacity of early measures of physical and psychological impairment on pain and disability 6 months following whiplash injury. Motor function (ROM; kinaesthetic sense; activity of the superficial neck flexors (EMG) during cranio-cervical flexion), quantitative sensory testing (pressure, thermal pain thresholds, brachial plexus provocation test), sympathetic vasoconstrictor responses and psychological distress (GHQ-28, TSK, IES) were measured in 76 acute whiplash participants. The outcome measure was Neck Disability Index scores at 6 months. Stepwise regression analysis was used to predict the final NDI score. Logistic regression analyses predicted membership to one of the three groups based on final NDI scores (< 8 recovered, 10-28 mild pain and disability, > 30 moderate/severe pain and disability). Higher initial NDI score (1.007-1.12), older age (1.03-1.23), cold hyperalgesia (1.05-1.58), and acute post-traumatic stress (1.03-1.2) predicted membership to the moderate/severe group. Additional variables associated with higher NDI scores at 6 months on stepwise regression analysis were: ROM loss and diminished sympathetic reactivity. Higher initial NDI score (1.03-1.28), greater psychological distress (GHQ-28) (1.04-1.28) and decreased ROM (1.03-1.25) predicted subjects with persistent milder symptoms from those who fully recovered. These results demonstrate that both physical and psychological factors play a role in recovery or non-recovery from whiplash injury. This may assist in the development of more relevant treatment methods for acute whiplash. (c) 2004 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
Keyword Whiplash Injury
Physical And Psychological Factors
Ndi Scores
Neck Pain
Clinical Neurology
Q-Index Code C1

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Created: Wed, 15 Aug 2007, 16:17:03 EST