Clinical assessment of prognostic factors for long-term pain and handicap after whiplash injury: a 1-year prospective study
H. Kasch
Danish Pain Research Center, Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
Search for more papers by this authorE. Qerama
Danish Pain Research Center, Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
Department of Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
Search for more papers by this authorA. Kongsted
Back Center Funen, Ringe, The University of Southern Denmark
Search for more papers by this authorT. Bendix
Back Center Funen, Ringe, The University of Southern Denmark
Search for more papers by this authorT. S. Jensen
Danish Pain Research Center, Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
Search for more papers by this authorF. W. Bach
Department of Neurology, Aarhus University, Aalborg, Denmark
Search for more papers by this authorH. Kasch
Danish Pain Research Center, Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
Search for more papers by this authorE. Qerama
Danish Pain Research Center, Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
Department of Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
Search for more papers by this authorA. Kongsted
Back Center Funen, Ringe, The University of Southern Denmark
Search for more papers by this authorT. Bendix
Back Center Funen, Ringe, The University of Southern Denmark
Search for more papers by this authorT. S. Jensen
Danish Pain Research Center, Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
Search for more papers by this authorF. W. Bach
Department of Neurology, Aarhus University, Aalborg, Denmark
Search for more papers by this authorAbstract
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.
Supporting Information
Figures S1 (a) Pain presentation 5 days after acutewhiplash injury. (b) Non-pain symptom presentation 5 days after acutewhiplash injury. (c) Pain presentation 1 year after acute whiplash injury.(d) Non-pain symptom presentation 1 year after acute whiplash injury. Frequenciesof symptoms are shown in percentages ± SD (from 0% to 100%).Intensities of symptoms both painful and non-painful symptoms represent afour-point ordinal scale from 0 = none; 1 = mild; 2 = moderateand 3 = severe, grading the severity of that symptom in relation tothe injury.
Table S1 Socio-demographic factors in acute high- andlow-risk whiplash patients.
Table S2 Initial properties and assessment in acutehigh- and low-risk whiplash patients.
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