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Anarte-Lazo E, Liew BXW, Devecchi V, Bernal-Utrera C, Rodriguez-Blanco C, Falla D. Network analyses reveal the interaction between physical features, fear of movement and neck pain and disability in people with acute and chronic whiplash-associated disorders. Eur J Pain 2024; 28:322-334. [PMID: 37725095 DOI: 10.1002/ejp.2184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/20/2023] [Accepted: 09/02/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND AND OBJECTIVE A network analysis can be used to quantitatively assess and graphically describe multiple interactions. This study applied network analyses to determine the interaction between physical and pain-related factors and fear of movement in people with whiplash-associated disorders (WAD) during periods of acute and chronic pain. METHODS Physical measurements, including pressure pain-thresholds (PPT) over neural structures, cervical range of motion, neck flexor and extensor endurance and the cranio-cervical flexion test (CCFT), in addition to subjective reports including the Tampa Scale of Kinesiophobia (TSK-11), Neck Disability Index (NDI) and neck pain and headache intensity, were assessed at baseline in 47 participants with acute WAD. TSK-11, NDI and pain intensity were assessed for the same participants 6 months later (n = 45). Two network analyses were conducted to estimate the associations between features at baseline and at 6 months and their centrality indices. RESULTS Both network analyses revealed that the greatest weight indices were found for NDI and CCFT at baseline and for neck pain and headache intensity and NDI and TSK-11 at both time points. Associations were also found betweeen cervical muscle endurance and neck pain intensity in the acute phase. Cervical muscle endurance assesssed during the acute phase was also associated with NDI after 6 months - whereas PPT measured at baseline was associsated with headache intensity after 6 months. CONCLUSION The strongest associations were found for headache and neck pain intensity and neck disability and fear of movement, both during acute pain and when mesured 6 months later. The extent of neck endurance and measures of PPT at baseline may be associated with neck disability and headache, respectively, 6 months after a whiplash injury. SIGNIFICANCE Through two network analyses, we evaluated the interaction between pain-related factors, fear of movement, neck disability and physical factors in people who had experienced a whiplash injury. We demonstrated that physical factors may be involved in the maintenance and development of chronic pain after a whiplash injury. Nevertheless, the strongest associations were found for headache and neck pain intensity and neck disability and fear of movement, both during acute and chronic phases.
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Affiliation(s)
- Ernesto Anarte-Lazo
- Doctoral Program in Health Sciences, University of Seville, Seville, Spain
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Bernard X W Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, UK
| | - Valter Devecchi
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Carlos Bernal-Utrera
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - Cleofas Rodriguez-Blanco
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Aarnio M, Fredrikson M, Lampa E, Sörensen J, Gordh T, Linnman C. Whiplash injuries associated with experienced pain and disability can be visualized with [11C]-D-deprenyl positron emission tomography and computed tomography. Pain 2022; 163:489-495. [PMID: 34232928 PMCID: PMC8832543 DOI: 10.1097/j.pain.0000000000002381] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Knowledge of etiological mechanisms underlying whiplash-associated disorders is incomplete. Localisation and quantification of peripheral musculoskeletal injury and inflammation in whiplash-associated disorders would facilitate diagnosis, strengthen patients' subjective pain reports, and aid clinical decisions, all of which could lead to improved treatment. In this longitudinal observational study, we evaluated combined [11C]-D-deprenyl positron emission tomography and computed tomography after acute whiplash injury and at 6-month follow-up. Sixteen adult patients (mean age 33 years) with whiplash injury grade II were recruited at the emergency department. [11C]-D-deprenyl positron emission tomography and computed tomography, subjective pain levels, self-rated neck disability, and active cervical range of motion were recorded within 7 days after injury and again at 6-month follow-up. Imaging results showed possible tissue injuries after acute whiplash with an altered [11C]-D-deprenyl uptake in the cervical bone structures and facet joints, associated with subjective pain locale and levels, as well as self-rated disability. At follow-up, some patients had recovered and some showed persistent symptoms and reductions in [11C]-D-deprenyl uptake correlated to reductions in pain levels. These findings help identify affected peripheral structures in whiplash injury and strengthen the idea that positron emission tomography and computed tomography detectable organic lesions in peripheral tissue are relevant for the development of persistent pain and disability in whiplash injury.
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Affiliation(s)
- Mikko Aarnio
- Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Sweden
| | - Mats Fredrikson
- Department of Psychology, Uppsala University, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Lampa
- UCR, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Jens Sörensen
- PET Centre, Department of Medical Imaging, Uppsala University Hospital, Sweden
- Section of Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Sweden
| | - Torsten Gordh
- Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Sweden
| | - Clas Linnman
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, United States
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Rasmussen MK, Kongsted A, Carstensen T, Jensen TS, Kasch H. Revisiting Risk-stratified Whiplash-exposed Patients 12 to 14 Years After Injury. Clin J Pain 2020; 36:923-931. [PMID: 32826406 PMCID: PMC7688078 DOI: 10.1097/ajp.0000000000000877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 06/15/2020] [Accepted: 08/07/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the long-term predictive value of the Danish Whiplash Group Risk Assessment Score (DWGRAS) with 7 risk strata. DESIGN E-questionnaire-based follow-up study (n=927) combining 2 cohorts of whiplash-injured patients, 1 observational (n=187) and 1 interventional randomized controlled trial (n=740). METHODS Nine hundred twenty-seven previously healthy persons exposed to acute whiplash injury during motor vehicle collision were sent letter by postal service asking the addressee if they would respond to an E-questionnaire. Outcome measures were: whiplash-related disability, pain, use of medication/nonmedical treatment, work capacity. RESULTS The response rate was 37%. Fifty-five percent reported whiplash-related disability. Fourteen percent reported daily symptoms. A strong relationship was found between risk strata and impact of event and between risk strata and disabling symptoms. CONCLUSIONS Internal and long-term validation of DWGRAS was performed, but a low response rate indicates that results should be interpreted with caution. Furthermore, external validation needs to be done in long-term studies. An receiver operating characteristics curve of 0.73 (95% confidence interval 0.67; 0.79) predicting daily or weekly whiplash-related disability after 12 to 14 years was found using the DWGRAS risk score.
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Affiliation(s)
- Martin K. Rasmussen
- Danish Pain Research Centre Aarhus University Hospital
- Center for Translational Neuromedicine, Copenhagen University, Copenhagen, Denmark
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics, Odense
| | - Tina Carstensen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital
- Department of Clinical Medicine, Health, Aarhus University, Aarhus
| | - Troels S. Jensen
- Danish Pain Research Centre Aarhus University Hospital
- Department of Clinical Medicine, Health, Aarhus University, Aarhus
| | - Helge Kasch
- Department of Clinical Medicine, Health, Aarhus University, Aarhus
- Department of Neurology, Viborg
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Wiangkham T, Uthaikhup S, Rushton AB. Pragmatic cluster randomised double-blind pilot and feasibility trial of an active behavioural physiotherapy intervention for acute non-specific neck pain: a mixed-methods protocol. BMJ Open 2019; 9:e029795. [PMID: 31575571 PMCID: PMC6773360 DOI: 10.1136/bmjopen-2019-029795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 08/08/2019] [Accepted: 09/04/2019] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Non-specific neck pain causes pain and disability and contributes substantial socioeconomic burden internationally. Up to 50% of adults experience neck pain annually, leading to reduced the quality of life. An active behavioural physiotherapy intervention (ABPI) may be feasible to manage patients with acute non-specific neck pain to prevent transition to chronicity. A recent pilot and feasibility trial investigating an acute whiplash-associated disorder population found potential value of the ABPI with 95% of participants fully recovered (Neck Disability Index: NDI ≤4, compared with 17% in the standard physiotherapy arm); supporting a definitive trial. Qualitative findings from the physiotherapists supported the potential of the ABPI in a non-specific neck pain population. METHODS AND ANALYSIS Two phases: (1) Pragmatic cluster randomised double-blind, parallel 2-arm (ABPI vs standard physiotherapy intervention) pilot and feasibility trial to evaluate the procedures and feasibility of the ABPI for the management of acute non-specific neck pain. Six physiotherapy departments from six public hospitals in Thailand will be recruited and cluster randomised by a computer-generated randomisation sequence with block sampling. Sixty participants (30 each arm, 10 per hospital) will be assessed at baseline and 3 months following baseline for NDI, Numerical Rating Scale for pain intensity, cervical range of motion, fear-avoidance beliefs questionnaire and EuroQol-5 dimensions 5 levels outcomes, and (2) Embedded qualitative study using semistructured interviews to explore acceptability of the ABPI to participants (n=12) and physiotherapists (n=3). Descriptive analysis of the quantitative data and interpretative phenomenological analysis to code and analyse qualitative data (deductive and inductive) will inform feasibility for a future definitive trial. ETHICS AND DISSEMINATION This trial is approved by the Naresuan University Institutional Review Board (NUIRB_0380/61). TRIAL REGISTRATION NUMBER AND STATUS TCTR20180607001; Recruiting commenced 1 February 2019.
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Affiliation(s)
- Taweewat Wiangkham
- Exercise and Rehabilitation Sciences Research Unit, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
- Department of Physical Therapy, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
| | - Sureeporn Uthaikhup
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Alison B Rushton
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), University of Birmingham, Birmingham, UK
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Wiangkham T, Duda J, Haque MS, Price J, Rushton A. A cluster randomised, double-blind pilot and feasibility trial of an active behavioural physiotherapy intervention for acute whiplash-associated disorder (WAD)II. PLoS One 2019; 14:e0215803. [PMID: 31071100 PMCID: PMC6508700 DOI: 10.1371/journal.pone.0215803] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 03/31/2019] [Indexed: 12/18/2022] Open
Abstract
Whiplash-associated disorder (WAD) causes substantial social and economic burden, with ≥70% patients classified as WADII (neck complaint and musculoskeletal sign(s)). Effective management in the acute stage is required to prevent development of chronicity; an issue for 60% of patients. An Active Behavioural Physiotherapy Intervention (ABPI) was developed to address both physical and psychological components of WAD. The ABPI is a novel complex intervention designed through a rigorous sequential multiphase project to prevent transition of acute WAD to chronicity. An external pilot and feasibility cluster randomised double-blind (assessor, participants) parallel two-arm clinical trial was conducted in the UK private sector. The trial compared ABPI versus standard physiotherapy to evaluate trial procedures and feasibility of the ABPI for managing acute WADII in preparation for a future definitive trial. Six private physiotherapy clinics were recruited and cluster randomised using a computer-generated randomisation sequence. Twenty-eight (20 ABPI, 8 standard physiotherapy) participants [median age 38.00 (IQR = 21.50) years] were recruited. Data were analysed descriptively with a priori establishment of success criteria. Ninety-five percent of participants in the ABPI arm fully recovered (Neck Disability Index ≤4, compared to 17% in the standard physiotherapy arm); required fewer treatment sessions; and demonstrated greater improvement in all outcome measures (pain intensity, Cervical Range of Motion, Pressure Pain Threshold, EuroQol-5 Dimensions) except for the Impact of Events Scale and Fear Avoidance Beliefs Questionnaire. The findings support the potential value of the ABPI, and that an adequately powered definitive trial to evaluate effectiveness (clinical, cost) is feasible with minor modifications to procedures.
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Affiliation(s)
- Taweewat Wiangkham
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), University of Birmingham, Birmingham, West Midlands, United Kingdom
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom
- Exercise and Rehabilitation Sciences Research Unit, Naresuan University, Phitsanulok, Thailand
- Department of Physical Therapy, Naresuan University, Phitsanulok, Thailand
| | - Joan Duda
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom
| | - M. Sayeed Haque
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, United Kingdom
| | - Jonathan Price
- Physiotherapy Department, Birmingham Community Healthcare NHS Foundation Trust, Birmingham, West Midlands, United Kingdom
| | - Alison Rushton
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), University of Birmingham, Birmingham, West Midlands, United Kingdom
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, West Midlands, United Kingdom
- * E-mail:
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Wiangkham T, Duda J, Haque MS, Price J, Rushton A. Acute Whiplash Injury Study (AWIS): a protocol for a cluster randomised pilot and feasibility trial of an Active Behavioural Physiotherapy Intervention in an insurance private setting. BMJ Open 2016; 6:e011336. [PMID: 27412105 PMCID: PMC4947766 DOI: 10.1136/bmjopen-2016-011336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Whiplash-associated disorder (WAD) causes substantial social and economic burden internationally. Up to 60% of patients with WAD progress to chronicity. Research therefore needs to focus on effective management in the acute stage to prevent the development of chronicity. Approximately 93% of patients are classified as WADII (neck complaint and musculoskeletal sign(s)), and in the UK, most are managed in the private sector. In our recent systematic review, a combination of active and behavioural physiotherapy was identified as potentially effective in the acute stage. An Active Behavioural Physiotherapy Intervention (ABPI) was developed through combining empirical (modified Delphi study) and theoretical (social cognitive theory focusing on self-efficacy) evidence. This pilot and feasibility trial has been designed to inform the design of an adequately powered definitive randomised controlled trial. METHODS AND ANALYSIS Two parallel phases. (1) An external pilot and feasibility cluster randomised double-blind (assessor and participants), parallel two-arm (ABPI vs standard physiotherapy) clinical trial to evaluate procedures and feasibility. Six UK private physiotherapy clinics will be recruited and cluster randomised by a computer-generated randomisation sequence. Sixty participants (30 each arm) will be assessed at recruitment (baseline) and at 3 months postbaseline. The planned primary outcome measure is the neck disability index. (2) An embedded exploratory qualitative study using semistructured indepth interviews (n=3-4 physiotherapists) and a focus group (n=6-8 patients) and entailing the recruitment of purposive samples will explore perceptions of the ABPI. Quantitative data will be analysed descriptively. Qualitative data will be coded and analysed deductively (identify themes) and inductively (identify additional themes). ETHICS AND DISSEMINATION This trial is approved by the University of Birmingham Ethics Committee (ERN_15-0542). TRIAL REGISTRATION NUMBER ISRCTN84528320.
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Affiliation(s)
- Taweewat Wiangkham
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Joan Duda
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - M Sayeed Haque
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Alison Rushton
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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Baek SH, Oh JW, Shin JS, Lee J, Lee YJ, Kim MR, Ahn YJ, Choi A, Park KB, Shin BC, Lee MS, Ha IH. Long term follow-up of cervical intervertebral disc herniation inpatients treated with integrated complementary and alternative medicine: a prospective case series observational study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 16:52. [PMID: 26850111 PMCID: PMC4744400 DOI: 10.1186/s12906-016-1034-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 02/01/2016] [Indexed: 12/21/2022]
Abstract
Background Symptomatic cervical intervertebral disc herniation (IDH) presenting as neck pain accompanied by arm pain is a common affliction whose prevalence continues to rise, and is a frequent reason for integrative inpatient care using complementary and alternative medicine (CAM) in Korea. However, studies on its long term effects are scarce. Methods A total 165 patients with cervical IDH admitted between January 2011 and September 2014 to a hospital that provides conventional and Korean medicine integrative treatment with CAM as the main modality were observed in a prospective observational study. Patients underwent CAM treatment administered by Korean medicine doctors (KMDs) in accordance with a predetermined protocol for the length of hospital stay, and additional conventional treatment by medical doctors (MDs) as referred by KMDs. Short term outcomes were assessed at discharge and long term follow-ups were conducted through phone interviews after discharge. Numeric rating scale (NRS) of neck and radiating arm pain, neck disability index (NDI), 5-point patient global impression of change (PGIC), and factors influencing long term satisfaction rates in PGIC were assessed. Results Of 165 patients who received inpatient treatment 20.8 ± 11.2 days, 117 completed the long term follow-up up at 625.36 ± 196.7 days post-admission. Difference in NRS between admission and discharge in the long term follow-up group (n = 117) was 2.71 (95 % CI, 2.33, 3.09) for neck pain, 2.33 (95 % CI, 1.9, 2.77) for arm pain, and that of NDI 14.6 (95 % CI, 11.89, 17.32), and corresponding scores in the non-long term follow-up group (n = 48) were 2.83 (95 % CI, 2.22, 3.45) for neck pain, 2.48 (95 % CI, 1.84, 3.12) for arm pain, and that of NDI was 14.86 (95 % CI, 10.41, 19.3). Difference in long term NRS of neck pain and arm pain from baseline was 3.15 (95 % CI, 2.67, 3.64), and 2.64 (95 % CI, 1.99, 3.29), respectively. PGIC was reported to be “satisfactory” or higher in 79.5 % of patients at long term follow-up. Conclusions Though the observational nature of this study limits us from drawing a more decisive conclusion, these results suggest that integrative treatment focused on CAM in cervical IDH inpatients may achieve favorable results in pain and functional improvement. Trial registration ClinicalTrials.gov Identifier: NCT02257723. Registered October 2, 2014.
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van der Meer S, Pieterse M, Reneman M, Verhoeven J, van der Palen J. How does injury compensation affect health and disability in patients with complaints of whiplash? A qualitative study among rehabilitation experts-professionals. Disabil Rehabil 2015; 38:211-7. [DOI: 10.3109/09638288.2015.1035455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Magin MN, Auer C. [Expert evidence in whiplash injury: interdisciplinary orthopaedic and biomechanical approach]. Unfallchirurg 2015; 117:263-73. [PMID: 24504496 DOI: 10.1007/s00113-013-2544-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Considering the controversially discussed issue of whiplash injury a pragmatic approach based on our own experience in the area of forensic expert opinion is presented. Findings of accident analysis and biomechanics are correlated with the individual situation after the accident (initial clinical appearance), the course of the ailment and the indispensable physical examination. The latter leads to determination of the individual vulnerability (not increased/increased) which is important for the evaluation of the physical condition and estimation of the physical stress limit. These limits vary widely between individuals and must be considered carefully when relating dose and effect of accident severity to a possible physical injury. Determination of the accident severity is especially important when there are no objective signs of injury and the existence of a minor whiplash injury (Quebec Task Force degree 1 or 2) is in question.
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Affiliation(s)
- M N Magin
- Spezialpraxis für Orthopädie und Unfallchirurgie, Bahnhofsweg 10, 82008, Unterhaching/München, Deutschland,
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Peterson S. Differential diagnosis and treatment of bilateral facial pain after whiplash: a case report. Physiother Theory Pract 2015; 31:442-9. [PMID: 25671352 DOI: 10.3109/09593985.2015.1010244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY DESIGN Clinical case report. BACKGROUND Symptoms in the face and jaw are common after whiplash. Few studies have reported cervicogenic headache in a trigeminal nerve distribution, and no published studies could be found describing such symptoms experienced bilaterally after whiplash. The objective of the current case report was to detail the clinical reasoning and management of an uncommon patient presentation. CASE DESCRIPTION The 41-year-old female patient of the current case complained of shooting pain in the jaw, cheek and forehead beginning 7 days after her accident. No imaging was performed, and examination ruled out serious pathology. The patient was treated primarily with deep neck flexor (DNF) and proprioceptive training for 10 visits over an 8-week period. OUTCOMES The Numeric Pain Rating Scale improved from 2/10 to 0/10, the Neck Disability Index improved from 17/50 to 1/50, and the Neck Flexor Muscle Endurance Test improved from 13 to 30 s. The patient remained symptom-free at 4-month follow-up. DISCUSSION The current case report describes a patient presentation unique to the literature. Significant changes were seen by week 3 with DNF and proprioceptive training. Additional research is required to determine the effectiveness of this intervention in similar presentations.
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van der Meer S, Reneman MF, Verhoeven J, van der Palen J. Relationship between self-reported disability and functional capacity in patients with whiplash associated disorder. JOURNAL OF OCCUPATIONAL REHABILITATION 2014; 24:419-424. [PMID: 24288054 DOI: 10.1007/s10926-013-9473-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE Patients with chronic Whiplash Associated Disorders (WAD) report symptoms and disability. Neither the relationship between self-reported disability and functional capacity, nor its predictors have been investigated in patients with WAD. This was the purpose of this study. METHOD This was a cross-sectional study. Participants were patients with WAD on sick leave. Self-reported disability was assessed with the Neck Disability Index (NDI). Functional capacity was assessed with a six-item neck functional capacity evaluation (FCE). Correlation coefficients were used to express the relationship between NDI (total and items) and FCE. Multivariate linear regression analyses were performed to identify independent predictors of NDI and FCE. RESULTS Forty patients were measured, of whom 18 (45 %) were male. Mean age was 33 years, median duration of complaints was 12 months, and 75 % had a pending insurance claim. Correlations between NDI and FCE tests varied from -0.39 to -0.70. Independent predictors of NDI were pain intensity and a pending claim, explaining 43 % of the variance. independent predictors of fce were ndi, gender, and pain intensity, explaining 20-55 % of the variance. CONCLUSIONS Self-reported disability and functional capacity are related but different. Both can part be predicted by pain intensity. A pending claim can predict higher self-reported disability. Both constructs are complementary and are recommended to determine disability in patients with WAD comprehensively.
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Affiliation(s)
- Suzan van der Meer
- Department of Research Methodology, Measurement and Data Analysis, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands,
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Marchiori DM. Trauma. Clin Imaging 2014. [DOI: 10.1016/b978-0-323-08495-6.00010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hendriks HJM, Oostendorp RAB, Bernards ATM, Van Ravensberg CD, Heerkens YF, Nelson RM. The Diagnostic Process and Indication for Physiotherapy: A Prerequisite for Treatment and Outcome Evaluation. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/ptr.2000.5.1.29] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Schwerla F, Kaiser AK, Gietz R, Kastner R. Osteopathic Treatment of Patients with Long-Term Sequelae of Whiplash Injury: Effect on Neck Pain Disability and Quality of Life. J Altern Complement Med 2013; 19:543-9. [DOI: 10.1089/acm.2012.0354] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Florian Schwerla
- German Academy of Osteopathy, Research Commission, Gauting, Germany
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Magnetic resonance imaging changes in the size and shape of the oropharynx following acute whiplash injury. J Orthop Sports Phys Ther 2012; 42:912-8. [PMID: 22951528 DOI: 10.2519/jospt.2012.4280] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Prospective longitudinal. OBJECTIVE To quantify the temporal development of magnetic resonance imaging changes in oropharyngeal morphometry in subjects with varying levels of disability following a whiplash injury. BACKGROUND A recent cross-sectional investigation has identified reductions in the size and shape of the oropharynx in subjects with chronic whiplash-related disability when compared to healthy controls. The temporal development of such changes and their relationship to persistent disability have yet to be investigated. METHODS Forty-one subjects (30 women) with acute whiplash injury were included. Repeated measures T1-weighted magnetic resonance imaging was used to measure and compare cross-sectional area (CSA) in square millimeters and shape ratio (SR) of the oropharynx at 4 weeks, 3 months, and 6 months postinjury. Subjects were classified at 6 months by their Neck Disability Index scores into the following categories: recovered (less than 8%), mild disability (10%-28%), and moderate/severe disability (greater than 30%). The effects of time and group and the interaction effect of group by time on oropharynx morphometry (CSA, SR) were investigated using repeated-measures, linear, mixed-model analysis. Based on previous research findings, age, gender, and body mass index were entered into the analyses as covariates. Where significant main or interaction effects were detected, pairwise comparisons were performed to investigate specific differences in the dependent variable between groups and within groups over time. RESULTS There was a significant interaction effect for group by time for both the CSA and SR values. Age significantly influenced SR (P = .024) and body mass index significantly influenced CSA (P = .001). There was no difference in CSA or SR across all groups at 4 weeks postinjury. However, at 6 months, CSA was significantly different between the recovered group and the moderate/severe group (P = .001). The recovered group demonstrated a significant increase in CSA (P = .04) over time, whereas the moderate/severe group significantly decreased (P = .01). At 6 months, the moderate/severe group had a reduced SR compared to the mild group (P = .03). No differences in CSA or SR of the oropharynx were found between the mild and recovered groups throughout the study. CONCLUSION Temporal reductions in CSA of the oropharynx occur following whiplash and persist to a greater extent in those with moderate/severe symptoms at 6 months postinjury. Studies are planned (1) to better investigate the underlying mechanisms of CSA reductions, (2) to determine their relevance to functional recovery and production of voice following whiplash, and (3) to evaluate multidisciplinary assessment and management of these patients.
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Myrtveit SM, Skogen JC, Wenzel HG, Mykletun A. Somatic symptoms beyond those generally associated with a whiplash injury are increased in self-reported chronic whiplash. A population-based cross sectional study: the Hordaland Health Study (HUSK). BMC Psychiatry 2012; 12:129. [PMID: 22935146 PMCID: PMC3476995 DOI: 10.1186/1471-244x-12-129] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 08/14/2012] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Chronic whiplash leads to considerable patient suffering and substantial societal costs. There are two competing hypothesis on the etiology of chronic whiplash. The traditional organic hypothesis considers chronic whiplash and related symptoms a result of a specific injury. In opposition is the hypothesis that chronic whiplash is a functional somatic syndrome, and related symptoms a result of society-induced expectations and amplification of symptoms. According to both hypotheses, patients reporting chronic whiplash are expected to have more neck pain, headache and symptoms of anxiety and depression than the general population. Increased prevalence of somatic symptoms beyond those directly related to a whiplash neck injury is less investigated. The aim of this study was to test an implication derived from the functional hypothesis: Is the prevalence of somatic symptoms as seen in somatization disorder, beyond symptoms related to a whiplash neck injury, increased in individuals self-reporting chronic whiplash? We further aimed to explore recall bias by comparing the symptom profile displayed by individuals self-reporting chronic whiplash to that among those self-reporting a non-functional injury: fractures of the hand or wrist. We explored symptom load, etiologic origin could not be investigated in this study. METHODS Data from the Norwegian population-based "Hordaland Health Study" (HUSK, 1997-99); N = 13,986 was employed. Chronic whiplash was self-reported by 403 individuals and fractures by 1,746. Somatization tendency was measured using a list of 17 somatic symptoms arising from different body parts and organ systems, derived from the research criteria for somatization disorder (ICD-10, F45). RESULTS Chronic whiplash was associated with an increased level of all 17 somatic symptoms investigated (p<0.05). The association was moderately strong (group difference of 0.60 standard deviation), only partly accounted for by confounding. For self-reported fractures symptoms were only slightly elevated. Recent whiplash was more commonly reported than whiplash-injury a long time ago, and the association of interest weakly increased with time since whiplash (r = 0.016, p = 0.032). CONCLUSIONS The increased prevalence of somatic symptoms beyond symptoms expected according to the organic injury model for chronic whiplash, challenges the standard injury model for whiplash, and is indicative evidence of chronic whiplash being a functional somatic syndrome.
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Affiliation(s)
- Solbjørg Makalani Myrtveit
- Faculty of medicine and dentistry, University of Bergen (UoB), Bergen, Norway,Division of Mental Health, Department of Public Mental Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Jens Christoffer Skogen
- Research Unit on Mental Health Epidemiology, Department of Health Promotion and Development, Faculty of Psychology, UoB, Bergen, Norway
| | - Hanne Gro Wenzel
- Division of Psychiatry, St Olav University Hospital, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arnstein Mykletun
- Division of Mental Health, Department of Public Mental Health, Norwegian Institute of Public Health, Bergen, Norway,Research Unit on Mental Health Epidemiology, Department of Health Promotion and Development, Faculty of Psychology, UoB, Bergen, Norway,University of New South Wales, School of Psychiatry, Sydney, Australia
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Delayed recovery in patients with whiplash-associated disorders. Injury 2012; 43:1141-7. [PMID: 22475071 DOI: 10.1016/j.injury.2012.03.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 01/10/2012] [Accepted: 03/04/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Prognosis of whiplash injury has been found to be related to a number of sociodemographic, treatment and clinical factors. In the current study, we attempt to identify several novel prognostic factors for delayed recovery in whiplash-associated disorders (WADs), using a validated and reliable measure of recovery. PATIENTS AND METHODS Retrospective review of a large database of a national network of physiotherapy and rehabilitation service providers in Canada yielded 5581 individuals injured in motor vehicle collisions. Cases were grouped into 3 cohorts based on time lapsed between injury date and initial presentation. Acute (n=3075), early chronic (n=958) and chronic (n=1548) patient cohorts were compared regarding treatment outcome and relative distribution of 29 prognostic factors. Outcome was defined by a minimally important clinical change (10%) on a previously validated disability questionnaire between initial and discharge rehabilitation visits. RESULTS Analysis demonstrated positive outcomes to be proportionally fewer in the chronic cohort (52.1%) relative to the early chronic (61.4%), which was in turn lower than the acute cohort (72.3%). Furthermore, individuals presenting with chronic pain were more likely to: (1) be female; (2) present with lower limb pain or nonorganic signs; (3) have returned to work; (4) have retained a lawyer; or (5) have undergone previous spinal surgery, and were less likely to: (1) present with neck or midback pain; (2) live in Ontario or Nova Scotia; or (3) have modified duties upon return to work. Acute, early chronic and chronic cohorts were also found to differ in the distribution of several other prognostic factors at initial clinical visit. CONCLUSIONS Recovery in whiplash-associated disorder appears to be multifactorial with both medical and non-injury related factors influencing outcome. Further characterisation of these factors may prove invaluable in guiding future clinical treatment and referral practices.
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Are there gender differences in coping with neck pain following acute whiplash trauma? A 12-month follow-up study. Eur J Pain 2012; 16:49-60. [DOI: 10.1016/j.ejpain.2011.06.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Stovner L. Høyesterett og sakkyndighet. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:927-8. [DOI: 10.4045/tidsskr.12.0256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Fragliche nosologische Validität des chronischen Halswirbelschleudertraumasyndroms. DER ORTHOPADE 2011; 41:147-52. [DOI: 10.1007/s00132-011-1868-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Recruitment bias in chronic pain research: whiplash as a model. Clin Rheumatol 2011; 30:1481-9. [DOI: 10.1007/s10067-011-1829-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 07/07/2011] [Accepted: 08/05/2011] [Indexed: 11/25/2022]
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Myran R, Hagen K, Svebak S, Nygaard O, Zwart JA. Headache and musculoskeletal complaints among subjects with self reported whiplash injury: the HUNT-2 study. BMC Musculoskelet Disord 2011; 12:129. [PMID: 21651816 PMCID: PMC3127807 DOI: 10.1186/1471-2474-12-129] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 06/08/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the life-time prevalence of self reported whiplash injury and the relationship to chronic musculoskeletal complaints (MSCs) and headache in a large unselected adult population. METHODS Between 1995 and 1997, all inhabitants 20 years and older in Nord-Trondelag county in Norway were invited to a comprehensive health survey. Out of 92,936 eligible for participation, a total of 59,104 individuals (63.6%) answered the question about whiplash injury (whiplash). Among these, 46,895 (79.3%) responded to the questions of musculoskeletal complaints and headache. RESULTS The total life-time prevalence of self reported whiplash injury was 2.9%, for women 2.7% and for men 3.0%. There was a significant association between self reported whiplash injury and headache (OR = 2.1; 95% CI 1.8-2.4), and chronic MSCs (OR = 3.3; 95% CI 2.8-3.8), evident for all ten anatomical sites investigated. The association was most pronounced for those with a combination of headache and chronic MSC for both men (OR = 4.8; 95% CI 3.6-6.2) and women (OR = 5.2; 95% CI 3.7-7.1). CONCLUSIONS Subjects with self reported whiplash injury had significantly more headache and musculoskeletal complaints than those without, and may in part be due to selective reporting. The causal mechanism remains unclear and cannot be addressed in the present study design.
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Affiliation(s)
- Rigmor Myran
- Norwegian University of Science and Technology (NTNU), Norway.
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Long-term functioning following whiplash injury: the role of social support and personality traits. Clin Rheumatol 2011; 30:927-35. [PMID: 21327685 DOI: 10.1007/s10067-011-1712-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 01/31/2011] [Accepted: 02/02/2011] [Indexed: 10/18/2022]
Abstract
Transition from acute whiplash injury to either recovery or chronicity and the development of chronic whiplash-associated disorders (WAD) remains a challenging issue for researchers and clinicians. The roles of social support and personality traits in long-term functioning following whiplash have not been studied concomitantly. The present study aimed to examine whether social support and personality traits are related to long-term functioning following whiplash. One hundred forty-three subjects, who had experienced a whiplash injury in a traffic accident 10-26 months before the study took place, participated. The initial diagnoses were a 'sprain of the neck' (ICD-9 code 847.0); only the outcome of grades I-III acute WAD was studied. Long-term functioning was considered within the biopsychosocial model: it was expressed in terms of disability, functional status, quality of life and psychological well-being. Participants filled out a set of questionnaires to measure the long-term functioning parameters (i.e. the Neck Disability Index, Medical Outcome Study Short-Form General Health Survey, Anamnestic Comparative Self-Assessment measure of overall well-being and the Symptom Checklist-90) and potential determinants of long-term functioning (the Dutch Personality Questionnaire and the Social Support List). The results suggest that social support (especially the discrepancies dimension of social support) and personality traits (i.e. inadequacy, self-satisfaction and resentment) are related to long-term functioning following whiplash injury (Spearman rho varied between 0.32 and 0.57; p < 0.01). Within the discrepancy dimension, everyday emotional support, emotional support during problems, appreciative support and informative support were identified as important correlates of long-term functioning. Future prospective studies are required to confirm the role of social support and personality traits in relation to long-term functioning following whiplash. For such studies, a broad view of long-term functioning within the biopsychological model should be applied.
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A Survey of Injury Claims Data After Introduction of Injury Care Protocols in Alberta, Canada. J Occup Environ Med 2010; 52:450-5. [DOI: 10.1097/jom.0b013e3181dbfa7d] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Epidemiological studies conducted in the general population point to average headache prevalence rates of 46% for 1-year prevalence and of 64% for lifetime prevalence. For migraine, most studies conducted in the adult general population of western Europe and North America indicate rates between 5% and 9% in men, and between 12% and 25% in women. Non-western countries report lower figures. Migraine shows no gender differences in children, while in the elderly its frequency appears much reduced in both genders. About one-third of migraineurs suffer from migraine with aura. For tension-type headache, prevalence data reports in the literature are few and conflicting: rates range from 11% in Singapore to 20-40% in the USA and over 80% in Denmark. It is worth noting that the highest figures are found in studies where a personal interview has been employed. This probably indicates that the prevalence of this headache subtype is particularly sensitive to the method of data collection. Cluster headache occurs in 1-3 per thousand of the general population, with a gender (M:F) ratio of about 3:1. About 4% of the adult general population suffers from chronic daily headache.
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Láinez MJA, Piera A, Bono G. Headache attributed to head or neck trauma. HANDBOOK OF CLINICAL NEUROLOGY 2010; 97:501-516. [PMID: 20816452 DOI: 10.1016/s0072-9752(10)97046-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Miguel J A Láinez
- Department of Neurology, Hospital Clínic University, University of Valencia, Valencia, Spain.
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The clinical presentation of chronic whiplash and the relationship to findings of MRI fatty infiltrates in the cervical extensor musculature: a preliminary investigation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 18:1371-8. [PMID: 19672633 DOI: 10.1007/s00586-009-1130-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 06/08/2009] [Accepted: 07/30/2009] [Indexed: 10/20/2022]
Abstract
The objective was to determine whether any measurable changes in sensory responses, kinesthetic sense, cervical motion, and psychological features were related to established fatty infiltration values in the cervical extensor musculature in subjects with persistent whiplash. It is unknown if fatty infiltrate is related to any signs or symptoms. Data on motor function, Quantitative Sensory Testing, psychological and general well-being, and pain and disability were collected from 79 female subjects with chronic whiplash. Total fat values were created for all subjects by averaging the muscle fat indices by muscle, level, and side from our MRI dataset of all the cervical extensor muscles. Results of this study indicate the presence of altered physical, kinesthetic, sensory, and psychological features in this cohort of patients with chronic whiplash. Combined factors of sensory, physical, kinesthetic, and psychological features all contributed to a small extent in explaining the varying levels of fatty infiltrate, with cold pain thresholds having the most influence (r (2) = 0.28; P = 0.02). Identifying and relating quantifiable muscular alterations to clinical measures in the chronic state, underpin some clinical hypotheses for possible pathophysiological processes in this group with a chronic and recalcitrant whiplash disorder. Future research investigations aimed at accurate identification, sub-classification, prediction, and management of patients with acute and chronic whiplash is warranted and underway.
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Abstract
OBJECTIVE Assessment of emotional functioning is a critical aspect of the clinical neuropsychological evaluation of individuals following mild traumatic brain injury (MTBI). The objective of this study was to examine the utility of the Symptom Checklist-90-Revised as a brief tool for assessing psychological and symptomatic distress following MTBI. METHOD A contrasted groups approach, involving three clinical groups (MTBI, Whiplash Associated Disorder, Type I Diabetes) and a non-clinical control group, was used in this study. RESULTS The group with MTBI scored significantly higher on the majority of primary symptom dimensions and global distress indices of the SCL-90-R compared to both the diabetes and non-clinical control groups. Analysis of individual cases further revealed that 68.2% of the participants in the group with MTBI were classified as positive cases, a rate significantly higher than that of the diabetes and non-clinical control groups. The group with MTBI did not differ significantly from the group of individuals with whiplash associated disorder with respect to elevation of primary symptom dimensions or global distress indices, or the number of cases classified as positive. CONCLUSION The results of this study suggest that the SCL-90-R has considerable utility as a general measure of psychological and symptomatic distress following MTBI.
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Affiliation(s)
- M C Westcott
- Department of Applied Psychology, University of Calgary, Calgary, Alberta, Canada
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31
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Abstract
SYNOPSIS The development of chronic pain and disability following whiplash injury is common and contributes substantially to personal and economic costs related with this condition. Emerging evidence demonstrates the clinical presence of alterations in the sensory and motor systems, including psychological distress in all individuals with a whiplash injury, regardless of recovery. However, individuals who transition to the chronic state present with a more complex clinical picture characterized by the presence of widespread sensory hypersensitivity, as well as significant posttraumatic stress reactions. Based on the diversity of the signs and symptoms experienced by individuals with a whiplash condition, clinicians must take into account the more readily observable/measurable differences in motor, sensory, and psychological dysfunction. The implications for the assessment and management of this condition are discussed. Further review into the pathomechanical, pathoanatomical, and pathophysiological features of the condition also will be discussed. LEVEL OF EVIDENCE Level 5.J
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Carstensen TBW, Frostholm L, Oernboel E, Kongsted A, Kasch H, Jensen TS, Fink P. Post-trauma ratings of pre-collision pain and psychological distress predict poor outcome following acute whiplash trauma: A 12-month follow-up study. Pain 2008; 139:248-259. [PMID: 18499350 DOI: 10.1016/j.pain.2008.04.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 03/11/2008] [Accepted: 04/08/2008] [Indexed: 11/19/2022]
Affiliation(s)
- Tina B W Carstensen
- The Research Clinic for Functional Disorders and Psychosomatics, Noerrebrogade 44, Aarhus University Hospital, DK-8000 Aarhus, Denmark The Back Research Center, Backcenter Funen, Ringe, Denmark Department of Neurology, Aarhus University Hospital, Aarhus, Denmark Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
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Kasch H, Qerama E, Kongsted A, Bendix T, Jensen TS, Bach FW. Clinical assessment of prognostic factors for long-term pain and handicap after whiplash injury: a 1-year prospective study. Eur J Neurol 2008; 15:1222-30. [PMID: 18803651 DOI: 10.1111/j.1468-1331.2008.02301.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Physical mechanisms are the possible factors involved in the development and maintenance of long-term handicaps after acute whiplash injury. This study prospectively examined the role of active neck mobility, cervical and extra-cervical pains, as well as non-painful complaints after a whiplash injury as predictors for subsequent handicap. METHODS Consecutive acute whiplash patients (n = 688) were interviewed and examined by a study nurse after the median of 5 days after injury, and divided into a high- or a low-risk group by an algorithm based on pain intensity, number of non-painful complaints and active neck mobility [active cervical range of motion (CROM)]. All 458 high-risk patients and 230 low-risk patients received mailed questionnaires after 3, 6 and 12 months. Two examiners examined all high-risk patients (n = 458) and 41 consecutive low-risk patients at median 11, 109, 380 days after injury. The main outcome measures were: handicaps, severe headaches, neck pain and neck disability. RESULTS The relative risk for a 1-year disability increased by 3.5 with initial intense neck pain and headaches, by 4.6 times with reduced CROM and by four times with multiple non-painful complaints. CONCLUSION Reduced active neck mobility, immediate intense neck pain and headaches and the presence of multiple non-painful complaints are the important prognostic factors for a 1-year handicap after acute whiplash.
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Affiliation(s)
- H Kasch
- Danish Pain Research Center, Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
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Kasch H, Qerama E, Kongsted A, Bach FW, Bendix T, Jensen TS. Deep muscle pain, tender points and recovery in acute whiplash patients: a 1-year follow-up study. Pain 2008; 140:65-73. [PMID: 18768261 DOI: 10.1016/j.pain.2008.07.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Revised: 07/03/2008] [Accepted: 07/08/2008] [Indexed: 11/26/2022]
Abstract
Local sensitization to noxious stimuli has been previously described in acute whiplash injury and has been suggested to be a risk factor for chronic sequelae following acute whiplash injury. In this study, we prospectively examined the development of tender points and mechano-sensitivity in 157 acute whiplash injured patients, who fulfilled criteria for WAD grade 2 (n=153) or grade 3 (n=4) seen about 5 days after injury (4.8+/-2.3) and who subsequently had or had not recovered 1 year after a cervical sprain. Tender point scores and stimulus-response function for mechanical pressure were determined in injured and non-injured body regions at specific time-points after injury. Thirty-six of 157 WAD grade 2 patients (22.9%) had not recovered, defined as reduced work capacity after 1 year. Non-recovered patients had higher total tender point scores after 12 (p<0.05), 107 (p<0.05) and 384 days (p<0.05) relative to those who recovered. Tenderness was found in the neck region and in remote areas in non-recovered patients. The stimulus-response curves for recovered and non-recovered patients were similar after 12 days and 107 days after the injury, but non-recovered patients had steeper stimulus-response curves for the masseter (p<0.02) and trapezius muscles (p<0.04) after 384 days. This study shows early mechano-sensitization after an acute whiplash injury and the development of further sensitization in patients with long-term disability.
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Affiliation(s)
- Helge Kasch
- Danish Pain Research Center, Department of Neurology, Aarhus University Hospital, Noerrebrogade 44, DK-8000 Aarhus, Denmark Department of Neurophysiology, Aarhus University Hospital, Denmark The Back Research Center, Funen Hospital, University of Southern Denmark, Denmark
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Elliott J, Cannata E, Christensen E, Demaris J, Kummrow J, Manning E, Nielsen E, Romero T, Barnes C, Jull G. MRI analysis of the size and shape of the oropharynx in chronic whiplash. Otolaryngol Head Neck Surg 2008; 138:747-51. [PMID: 18503848 DOI: 10.1016/j.otohns.2008.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 02/04/2008] [Accepted: 02/21/2008] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To quantify differences in the size/shape of the oropharynx between female subjects with whiplash and controls. DESIGN Retrospective cohort. METHODS A total of 113 subjects (79 whiplash, 34 controls) were included. T1-weighted MRI was used to measure 1) cross-sectional area (CSA [mm(2)]) and 2) shape ratios for the oropharynx. Reliability data were established. RESULTS Whiplash subjects had significantly smaller oropharynx CSAs (P < 0.001) and shape ratios (P < 0.001) compared with healthy controls. Self-reported levels of pain and disability and duration of symptoms were not associated with size and shape of the oropharynx in whiplash subjects (P = 0.75 and P = 0.99, respectively). Age and BMI did influence the size (P = 0.01) and shape of the oropharynx (P < 0.001) in the whiplash subjects, but only 20 to 30 percent of the variance could be explained by these factors. CONCLUSION Significant difference in the size and shape of the oropharynx was noted in subjects with chronic whiplash compared with controls. Future studies are required to investigate the relationships between oropharynx morphometry and symptoms in patients with chronic whiplash.
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Affiliation(s)
- James Elliott
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
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Stovner LJ, Obelieniene D. Whiplash Headache is Transitory Worsening of a Pre-Existing Primary Headache. Cephalalgia 2008; 28 Suppl 1:28-31. [DOI: 10.1111/j.1468-2982.2008.01615.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Acute and chronic whiplash headache are new diagnostic entities in the ICHD-2 (5.3, 5.4). In a prospective cohort study, 210 rear-end collision victims were identified consecutively from police records and asked about head and neck pain in questionnaires after 2 weeks, 3 months and 1 year. The results were compared with those of matched controls who were also followed for 1 year. Of 210 accident victims, 75 developed headache within 7 days. Of these, 37 had also neck pain and complied with the criteria for acute whiplash headache. These 37 had the same headache diagnoses, headache features, accompanying symptoms and long-term prognosis as the 38 without initial neck pain who therefore did not comply with the acute whiplash headache diagnosis. Previous headache was a major risk factor for headache both in the acute and chronic stage. Compared with the non-traumatized controls, headache in the whiplash group had the same prevalence, the same diagnoses and characteristic features, and the same prognosis. Both acute and chronic whiplash headache lack specificity compared with the headache in a control group, and have the same long-term prognosis, indicating that such headaches are primary headaches, probably elicited by the stress of the situation.
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Affiliation(s)
- LJ Stovner
- Norwegian National Headache Centre, Department of Neuroscience, Norwegian University of Science and Technology, and St Olavs Hospital, Trondheim, Norway
| | - D Obelieniene
- Department of Neurology, Kaunas Medical Academy, Kaunas, Lithuania
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Verhagen AP, Scholten-Peeters GGGM, van Wijngaarden S, de Bie RA, Bierma-Zeinstra SMA. Conservative treatments for whiplash. Cochrane Database Syst Rev 2007; 2007:CD003338. [PMID: 17443525 PMCID: PMC8713438 DOI: 10.1002/14651858.cd003338.pub3] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Many treatments are available for whiplash patients but there is little scientific evidence for their accepted use. Patients with whiplash-associated disorders (WAD) can be classified by the severity of signs and symptoms from Grade 0 (no complaints or physical signs) to Grade 4 (fracture or dislocation). OBJECTIVES To assess the effectiveness of conservative treatment for patients with whiplash injuries rated as Grades 1 or 2 (neck and musculoskeletal complaints). SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2006, Issue 3), MEDLINE, CINAHL, PsycINFO, and PEDro to November 2006 and screened references of identified randomised trials and relevant systematic reviews. SELECTION CRITERIA We selected randomised controlled trials published in English, French, German or Dutch, that included patients with a whiplash-injury, conservative interventions, outcomes of pain, global perceived effect or participation in daily activities. DATA COLLECTION AND ANALYSIS Two authors independently assessed the methodological quality using the Delphi criteria and extracted the data onto standardised data-extraction forms. We did not pool the results because of the heterogeneity of the population, intervention and outcomes and lack of data. A pre-planned stratified analysis was performed for three different comparisons. MAIN RESULTS Twenty-three studies (2344 participants) were included in this update, including nine new studies. A broad variety of conservative interventions were evaluated. Two studies included patients with chronic symptoms (longer than three months), two included subacute (four to six weeks) symptoms, two had undefined duration of symptoms, and 17 studied patients with acute (less than three weeks) symptoms. Only eight studies (33.3%) satisfied one of our criteria of high quality, indicating overall, a poor methodological quality. Interventions were divided into passive (such as rest, immobilisation, ultrasound, etc) and active interventions (such as exercises, act as usual approach, etc.) and were compared with no treatment, a placebo or each other. Clinical and statistical heterogeneity and lack of data precluded pooling. Individual studies demonstrated effectiveness of one treatment over another, but the comparisons were varied and results inconsistent. Therefore, the evidence neither supports nor refutes the effectiveness of either passive or active treatments to relieve the symptoms of WAD, Grades 1 or 2. AUTHORS' CONCLUSIONS The current literature is of poor methodological quality and is insufficiently homogeneous to allow the pooling of results. Therefore, clearly effective treatments are not supported at this time for the treatment of acute, subacute or chronic symptoms of whiplash-associated disorders.
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Affiliation(s)
- A P Verhagen
- Erasmus MC University Medical Centre, Dept of General Practice, PO Box 1738, Rotterdam, Netherlands, 3000 DR.
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Abstract
Mechanical neck pain is a very common symptom that may occur with cervical spondylosis. It can be associated with cervical radiculopathy and myelopathy or can occur in isolation. Neck pain can result from a variety of causes, including trauma, tumor, infection, and degeneration. The presentation of axial neck pain varies. This article highlights the presentation, differential diagnosis, and appropriate work-up for the patient who presents with mechanical neck pain.
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Affiliation(s)
- Nicholas U Ahn
- University Hospitals of Cleveland, Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA.
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Abstract
STUDY DESIGN A retrospective study of 101 consecutive polytrauma patients with regard to whiplash injury. OBJECTIVES To investigate the incidence and evaluate long-term outcome of whiplash injury following high-energy trauma. SUMMARY OF BACKGROUND DATA Chronic whiplash injury has been widely reported in the literature, following low-energy trauma. Very few studies exist on whiplash injury following high-energy trauma. METHODS A total of 101 consecutive polytrauma patients admitted to our Level I Trauma Center over a 2-year period, fulfilling the inclusion criteria (age >18 years, high-energy trauma [a fall from a height >2 m, road traffic accidents with speed >30 km/h], and Injury Severity Score >16), were assessed. Whiplash injury was defined according to Quebec Task Force guidelines. The study group (n = 13) included patients who developed whiplash injury symptoms and the control group (n = 88) those who did not. The Neck Disability Index was calculated as an outcome measure for patients complaining of whiplash injury symptoms. The mean follow-up was 17 months. The chi2 and Student t tests were used for the statistical analysis (SPSS 12.1; SPSS, Inc., Chicago, IL). RESULTS Only 13 out of 101 patients (1 female/12 male) (13%) complained of whiplash injury. There was a significantly higher rate of neck pain at triage (P < 0.001) and higher combined mean of Abbreviated Injury Score of upper torso (P < 0.0001) in the study group, elucidating the cause of whiplash injury. The Neck Disability Index was <24 points, indicating only mild-to-moderate disability in these patients. Whiplash injury incidence in this study (13%) was similar to the incidence of neck pain in the general population. CONCLUSIONS The incidence of whiplash injury following polytrauma was found to be low in our study. There is no dose-response relation between magnitude of trauma severity and incidence of whiplash injury.
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Affiliation(s)
- Peter V Giannoudis
- Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, United Kingdom.
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[Studies of whiplash trauma critically analyzed]. DER ORTHOPADE 2007; 36:379-80. [PMID: 17387447 DOI: 10.1007/s00132-007-1073-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Lamb SE, Gates S, Underwood MR, Cooke MW, Ashby D, Szczepura A, Williams MA, Williamson EM, Withers EJ, Mt Isa S, Gumber A. Managing Injuries of the Neck Trial (MINT): design of a randomised controlled trial of treatments for whiplash associated disorders. BMC Musculoskelet Disord 2007; 8:7. [PMID: 17257408 PMCID: PMC1802074 DOI: 10.1186/1471-2474-8-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Accepted: 01/26/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A substantial proportion of patients with whiplash injuries develop chronic symptoms. However, the best treatment of acute injuries to prevent long-term problems is uncertain. A stepped care treatment pathway has been proposed, in which patients are given advice and education at their initial visit to the emergency department (ED), followed by review at three weeks and physiotherapy for those with persisting symptoms. MINT is a two-stage randomised controlled trial to evaluate two components of such a pathway: 1. use of The Whiplash Book versus usual advice when patients first attend the emergency department; 2. referral to physiotherapy versus reinforcement of advice for patients with continuing symptoms at three weeks. METHODS Evaluation of the Whiplash Book versus usual advice uses a cluster randomised design in emergency departments of eight NHS Trusts. Eligible patients are identified by clinicians in participating emergency departments and are sent a study questionnaire within a week of their ED attendance. Three thousand participants will be included. Patients with persisting symptoms three weeks after their ED attendance are eligible to join an individually randomised study of physiotherapy versus reinforcement of the advice given in ED. Six hundred participants will be randomised. Follow-up is at 4, 8 and 12 months after their ED attendance. Primary outcome is the Neck Disability Index (NDI), and secondary outcomes include quality of life and time to return to work and normal activities. An economic evaluation is being carried out. CONCLUSION This paper describes the protocol and operational aspects of a complex intervention trial based in NHS emergency and physiotherapy departments, evaluating two components of a stepped-care approach to the treatment of whiplash injuries. The trial uses two randomisations, with the first stage being cluster randomised and the second individually randomised.
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Affiliation(s)
- Sarah E Lamb
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- Kadoorie Critical Care Research Centre, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Simon Gates
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Martin R Underwood
- Centre for Health Sciences, Abernethy Building, 2 Newark Street, Barts and The London, Whitechapel, London E1 2AT, UK
| | - Matthew W Cooke
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Deborah Ashby
- Wolfson Institute of Preventive Medicine, Barts and The London, Queen Mary's School of Medicine & Dentistry, University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Ala Szczepura
- Centre for Evidence in Ethnicity, Health and Diversity, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Mark A Williams
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Esther M Williamson
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Emma J Withers
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Shahrul Mt Isa
- Wolfson Institute of Preventive Medicine, Barts and The London, Queen Mary's School of Medicine & Dentistry, University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Anil Gumber
- Centre for Evidence in Ethnicity, Health and Diversity, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
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Schrader H, Stovner LJ, Obelieniene D, Surkiene D, Mickeviciene D, Bovim G, Sand T. Examination of the diagnostic validity of 'headache attributed to whiplash injury': a controlled, prospective study. Eur J Neurol 2006; 13:1226-32. [PMID: 17038037 DOI: 10.1111/j.1468-1331.2006.01481.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Acute and chronic headache attributed to whiplash injury are new diagnostic entities in the International Classification of Headache Disorders, second edition. A main objective of the present study was to assess the validity of these nosologic entities by studying the headache pattern in an inception cohort of 210 rear-end car collision victims and in 210 matched controls. Consecutive drivers involved in rear-end collisions were identified from the daily records of the Traffic Police Department of Kaunas, Lithuania. A standard self-report questionnaire was sent to the drivers between 2 and 7 days after the collision, and their passengers were recruited as well. Headache and neck pain were evaluated within 7 days of the collision, at 2 months and 1 year after the collision. A control group of non-traumatized subjects received questionnaires at the time of the selection and 1 year later. Of the 75 collision victims who developed headache within the first 7 days of the collision, 37 had a clinical picture in accordance with the criteria for acute whiplash headache (i.e., concomitant neck pain) and 38 did not. For acute headache after collision, concomitant neck pain was of no relevance to the headache type or its course. In both these subgroups, migraine and tension-type headache could be diagnosed in similar proportions and the prognosis after 2 months and 1 year was also similar. Preexisting headache was a strong prognostic factor in both groups for both acute and chronic pain. Compared with the non-traumatized control group, the 1-year incidence of new or worsened headache, or of headache improvement, was the same. A likely interpretation of the data is that acute headaches after rear-end car collisions mainly represent episodes of a primary headache precipitated by the stress of the situation. We conclude that the nosologic validity of both acute and chronic whiplash headache is poor as the headaches, in accordance with the criteria lack distinguishing clinical features and have the same prognosis compared with headaches in a control group.
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Affiliation(s)
- H Schrader
- Department of Neurology and Clinical Neurophysiology, Trondheim University Hospital, Trondheim, Norway.
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Voerman GE, Vollenbroek-Hutten MMR, Hermens HJ. Changes in pain, disability, and muscle activation patterns in chronic whiplash patients after ambulant myofeedback training. Clin J Pain 2006; 22:656-63. [PMID: 16926582 DOI: 10.1097/01.ajp.0000210911.88041.df] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this exploratory study was to investigate changes in pain, disability, and muscle activation patterns in patients with chronic whiplash-associated disorder (WAD) after 4 weeks of myofeedback training. METHODS Eleven WAD patients received ambulatory myofeedback training, during which upper trapezius muscle activation and relaxation were continuously recorded and processed for 4 weeks. Feedback was provided when muscle relaxation was insufficient. Pain in neck, shoulders, and upper back (Visual Analogue Scale), disability (Neck Disability Index), and muscle activation patterns during rest, typing, and stress tasks (surface electromyography) were assessed before and after the 4 weeks of training. RESULTS Pain intensity decreased after 4 weeks of training. Clinically relevant changes were found with regard to pain in the neck and upper back region (55% of the patients), right shoulder (64%), and left shoulder (18%). A trend for decreased disability was found which was clinically relevant in 36% of the patients. A remarkable reduction was found in the Neck Disability Index items concerning headache and lifting weights. Overall, muscle activation was lower and muscle relaxation was higher after the training period with the largest differences during rest. Clinically relevant changes in surface electromyography parameters were found in a minority of patients. CONCLUSION Four weeks of ambulant training may be beneficial in reducing pain and disability levels and normalizing muscle activation patterns in chronic WAD patients. A randomized-controlled study is recommended to further explore the effects of myofeedback training.
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Chen C, Lu Y, Kallakuri S, Patwardhan A, Cavanaugh JM. Distribution of A-delta and C-fiber receptors in the cervical facet joint capsule and their response to stretch. J Bone Joint Surg Am 2006; 88:1807-16. [PMID: 16882906 DOI: 10.2106/jbjs.e.00880] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND It has been proposed that cervical facet joint capsules are a major source of whiplash pain. However, there is a paucity of neurophysiologic data to support this hypothesis. The purposes of this study were to determine the distribution of A-delta and C-fiber sensory receptors in the facet joint capsule and to test their patterns of response to stretch and related sensory function. METHODS Laminectomy from C4 to C7 was performed in seventeen goats, while they were under general anesthesia, to expose the C6 nerve roots. Customized dual bipolar electrodes were used to record neural activity from one of the C6 branches. An 8 or 15-V electrical stimulus was used to provoke receptor activity in nine designated areas on the dorsal part of the C5-C6 facet joint capsule. Receptors were classified on the basis of conduction velocities. The waveform of an identified receptor was set up as a template to determine its neural activity in response to capsular stretch. The characteristics of each single receptor's response to capsular stretch were analyzed to determine its sensory function as a mechanoreceptor or nociceptor. RESULTS Two hundred and forty-eight receptors on the dorsal part of the C5-C6 facet joint capsule were evoked by electrical stimulation in the seventeen goats. More C-fiber receptors were found on the dorsolateral aspect of the facet joint capsule, where tendons and muscles were attached. The response to stretch of 120 receptors, from twelve goats, were analyzed to classify them into one of four categories (high-threshold mechanoreceptors, non-saturated low-threshold mechanoreceptors, saturated low-threshold mechanoreceptors, and silent receptors) or as unclassified receptors. CONCLUSIONS The existence of receptors in the facet joint capsule indicates that the capsule has pain and proprioceptive sensory functions.
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Affiliation(s)
- Chaoyang Chen
- Bioengineering Center, Wayne State University, 818 West Hancock Avenue, Detroit, MI 48202, USA.
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Scholten-Peeters GGM, Neeleman-van der Steen CWM, van der Windt DAWM, Hendriks EJM, Verhagen AP, Oostendorp RAB. Education by general practitioners or education and exercises by physiotherapists for patients with whiplash-associated disorders? A randomized clinical trial. Spine (Phila Pa 1976) 2006; 31:723-31. [PMID: 16582844 DOI: 10.1097/01.brs.0000206381.15224.0f] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Randomized clinical trial. OBJECTIVE To compare the effectiveness of education and advice given by general practitioners (GPs) with education, advice, and active exercise therapy given by physiotherapists (PTs) for patients with whiplash-associated disorders. SUMMARY OF BACKGROUND DATA Available evidence from systematic reviews has indicated beneficial effects for active interventions in patients with whiplash-associated disorders. However, it remained unclear which kind of active treatment was most effective. METHODS Whiplash patients with symptoms or disabilities at 2 weeks after accident were recruited in primary care. Eligible patients still having symptoms or disabilities at 4 weeks were randomly allocated to GP care or physiotherapy. GPs and PTs treated patients according to a dynamic multimodal treatment protocol primarily aimed to increase activities and influence unfavorable psychosocial factors for recovery. We trained all health care providers about the characteristics of the whiplash problem, available evidence regarding prognosis and treatment, and protocol of the interventions. The content of the information provided to patients during treatment depended on the treatment goals set by the GPs or PTs. Also, the type of exercises chosen by the PTs depended on the treatment goals, and it was not explicitly necessary that exercise therapy was provided in all patients. Primary outcome measures included neck pain intensity, headache intensity, and work activities. Furthermore, an independent blinded assessor measured functional recovery, cervical range of motion, disability, housekeeping and social activities, fear of movement, coping, and general health status. We assessed outcomes at 8, 12, 26, and 52 weeks after the accident. RESULTS A total of 80 patients were randomized to either GP care (n = 42) or physiotherapy (n = 38). At 12 and 52 weeks, no significant differences were found concerning the primary outcome measures. At 12 weeks, physiotherapy was significantly more effective than GP care for improving 1 of the measures of cervical range of motion (adjusted mean difference 12.3 degrees ; 95% confidence interval [CI] 2.7-21.9). Long-term differences between the groups favored GP care but were statistically significant only for some secondary outcome measures, including functional recovery (adjusted relative risk 2.3; 95% CI 1.0-5.0), coping (adjusted mean difference 1.7 points; 95% CI 0.2-3.3), and physical functioning (adjusted mean difference 8.9 points; 95% CI 0.6-17.2). CONCLUSIONS We found no significant differences for the primary outcome measures. Treatment by GPs and PTs were of similar effectiveness. The long-term effects of GP care seem to be better compared to physiotherapy for functional recovery, coping, and physical functioning. Physiotherapy seems to be more effective than GP care on cervical range of motion at short-term follow-up.
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Abstract
OBJECTIVE The purpose of this study was to investigate the factors which predict neck pain initially and at 1 year following a rear end collision. METHODS All people who reported a rear end collision to the Devon and Cornwall Constabulary were identified and formed the basis of the cohort. People were excluded if they were under 18 years of age or had suffered a head injury. The main outcome measures were neck pain lasting for more than a week after the accident and neck pain at least 1 day a week at 1 year. Logistic regression was used to investigate associations between demographic and accident related variables and outcomes. RESULTS A total of 1147 people reported rear end collisions to the police during the study period and 503 (44%) agreed to take part in the study. Of the respondents, 78% had neck pain lasting for more than a week and 52% still had pain at 1 year. Age (odds ratio, 95% confidence interval: 0.957, 0.942-0.972) and prior history of neck pain (8.32, 2.89-23.89) were the most important predictors of early neck pain. The most important predictors of pain at 1 year were the initial neck visual analogue scale (VAS) score (1.03, 1.01-1.05) and the presence of a compensation claim (4.09, 1.62-10.32). There was only weak evidence that measures of the severity of the impact were associated with outcomes. CONCLUSION Demographic variables and the presence of a compensation suit show the strongest correlation with acute and chronic neck pain following rear end collisions.
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Hendriks EJM, Scholten-Peeters GGM, van der Windt DAWM, Neeleman-van der Steen CWM, Oostendorp RAB, Verhagen AP. Prognostic factors for poor recovery in acute whiplash patients. Pain 2005; 114:408-416. [PMID: 15777866 DOI: 10.1016/j.pain.2005.01.006] [Citation(s) in RCA: 155] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2004] [Revised: 12/27/2004] [Accepted: 01/11/2005] [Indexed: 11/28/2022]
Abstract
The objective of our prospective inception cohort study was to identify prognostic factors for poor recovery in patients with whiplash-associated disorders grade 1 or 2 who still had neck pain and accompanying complaints 2 weeks after the accident. The study was carried out in a primary health care setting in The Netherlands and included 125 patients. The primary outcome measure was functional recovery defined in terms of neck pain intensity or work disability without medication use. The secondary outcome measures included neck pain intensity, work disability and sick leave. The outcomes were assessed at 4, 12 and 52 weeks after the accident. Prognostic factors were identified by logistic regression analyses. One year after the injury, 64% of the patients were recovered. Factors related to poor recovery were female gender, a low level of education, high initial neck pain, more severe disability, higher levels of somatisation and sleep difficulties. Neck pain intensity and work disability proved to be the most consistent predictors for poor recovery. The accuracy of the predictions of the prognostic models was high, meaning that the models adequately distinguished patients with poor recovery from those regarded as recovered. These findings add to the growing body of evidence, indicating that socio-demographic, physical and psychological factors affect short- and long-term outcome after whiplash injury. Our findings also indicate that care providers can easily identify patients at risk for poor recovery with a visual analogue scale for initial pain intensity and work-related activities.
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Affiliation(s)
- Erik J M Hendriks
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands Department of Research and Development, Dutch Institute of Allied Health Care, Amersfoort, The Netherlands Department of General Practice, Institute for Research in Extramural Medicine, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands Center for Quality of Care Research, University Medical Center, Catholic University of Nijmegen, Nijmegen, The Netherlands Department of General Practice, Erasmus Medical Centre, Rotterdam, The Netherlands
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Gun RT, Osti OL, O'Riordan A, Mpelasoka F, Eckerwall CGM, Smyth JF. Risk factors for prolonged disability after whiplash injury: a prospective study. Spine (Phila Pa 1976) 2005; 30:386-91. [PMID: 15706334 DOI: 10.1097/01.brs.0000153399.24457.ee] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective study of 135 patients with whiplash injury. OBJECTIVES To identify factors predictive of prolonged disability following whiplash injury. SUMMARY OF BACKGROUND DATA Although patients with whiplash associated disorders lack demonstrable physical injury, many exhibit prolonged disability. Disability appears unrelated to the severity of the collision. METHODS A total of 147 patients with recent whiplash injury were interviewed for putative risk factors for disability, and 135 were reinterviewed 12 months later to assess degree and duration of disability. Bivariate and multivariate analyses were undertaken to measure the association between putative risk factors and measures of outcome (change in Neck Pain Outcome Score [NPOS] and visual analogue pain score [VAPS], return to work, still requiring treatment, settlement of claim). RESULTS The bodily pain score and role emotional scores of the Short Form-36 health questionnaire showed a consistent significant positive association with better outcomes. After adjustment for bodily pain score and role emotional scores, consulting a lawyer was associated with less improvement in NPOS (P < 0.05), but there was no association with change in VAPS. Consulting a lawyer was associated with a lesser chance of claim settlement (P < 0.01) and a greater chance of still having treatment (P < 0.01) after 1 year, but there was no significant association with a return to work. The degree of damage to the vehicle was not a predictor of outcome. CONCLUSIONS Short Form-36 scores for bodily pain and role emotional are useful means of identifying patients at risk of prolonged disability. The findings support the implementation of an insurance system designed to minimize litigation.
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Abstract
OBJECTIVE This is a review of current concepts of chronic post-traumatic neck and head pain. In this article, I will emphasize the physiological and sociological aspects of these disorders. BACKGROUND The pathophysiology of chronic post-traumatic neck and head pain has not been well understood. Some have emphasized the organic factors and others the psychogenic aspects of these conditions. Only in recent years have this dichotomy been integrated with sociocultural concepts. METHODS The history of chronic post-traumatic head and neck pain is reviewed. Paradoxes are discussed, ie, the great differences in prevalence around the world, the inconsistent relationship of symptoms to degree of trauma, the curious phenomena of structural disease without symptoms, and symptoms without structural disease. The organic and pathophysiologic factors are reviewed, then those factors that modulate pain in these conditions are discussed. CONCLUSION Chronic post-traumatic neck and head pain is rarely either organic or psychogenic. Rather physiological, social, and cultural factors play major roles in modulating pain and either perpetuate or ameliorate these chronic pain conditions.
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Affiliation(s)
- Seymour Solomon
- Headache Unit, Montefiore Medical Center, Neurology, 111 East 210th Street, Bronx, NY 10467, USA
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