Michele Sterling1. 1. Centre of National Research on Disability and Rehabilitation Medicine, The University of Queensland, Queensland, Australia. m.sterling@uq.edu.au
Abstract
STUDY DESIGN: Nonsystematic review. OBJECTIVE: Review of prognostic indicators for outcome after whiplash injury and the implications for clinical practice and future research. SUMMARY OF BACKGROUND DATA: The capacity to predict outcome after whiplash injury is important to guide the management of the condition. There have now been numerous cohort studies and several systematic reviews of prognosis. It is not clear if the current knowledge of prognostic indicators is useful for clinical practice and to improve outcomes after injury. METHODS: Nonsystematic review of research investigating the prediction of chronic pain/disability and psychological outcomes after whiplash injury. RESULTS: There remains considerable uncertainty surrounding the identification of clear prognostic indicators after whiplash injury. All systematic reviews note the moderate or lower quality if primary cohort studies and only one systematic review performed meta-analysis. There have been no studies attempting validation of predictive models. At the present time, the knowledge base stands that higher initial pain levels are the most consistent predictor of poor functional recovery. Additional promising factors include physical factors of cold hyperalgesia and loss of neck range of movement, although the latter is inconsistent. Psychological factors of pain catastrophizing, symptoms of post-traumatic stress and recovery perceptions are also prognostic of poor recovery and the presence of depressed mood is inconsistent. Further research is needed to validate predictive models, investigate interactions between factors, and to determine whether modification of predictors is possible and leads to improved outcomes. CONCLUSION: The understanding of factors predictive of poor recovery after whiplash injury is evolving. Although more research is required to validate predictive models, some factors show consistent predictive capacity and could be used in clinical practice as potential indicators of poor recovery. It is not known if the specific targeting of modifiable prognostic indicators can be achieved or will lead to improved outcomes.
STUDY DESIGN: Nonsystematic review. OBJECTIVE: Review of prognostic indicators for outcome after whiplash injury and the implications for clinical practice and future research. SUMMARY OF BACKGROUND DATA: The capacity to predict outcome after whiplash injury is important to guide the management of the condition. There have now been numerous cohort studies and several systematic reviews of prognosis. It is not clear if the current knowledge of prognostic indicators is useful for clinical practice and to improve outcomes after injury. METHODS: Nonsystematic review of research investigating the prediction of chronic pain/disability and psychological outcomes after whiplash injury. RESULTS: There remains considerable uncertainty surrounding the identification of clear prognostic indicators after whiplash injury. All systematic reviews note the moderate or lower quality if primary cohort studies and only one systematic review performed meta-analysis. There have been no studies attempting validation of predictive models. At the present time, the knowledge base stands that higher initial pain levels are the most consistent predictor of poor functional recovery. Additional promising factors include physical factors of cold hyperalgesia and loss of neck range of movement, although the latter is inconsistent. Psychological factors of pain catastrophizing, symptoms of post-traumatic stress and recovery perceptions are also prognostic of poor recovery and the presence of depressed mood is inconsistent. Further research is needed to validate predictive models, investigate interactions between factors, and to determine whether modification of predictors is possible and leads to improved outcomes. CONCLUSION: The understanding of factors predictive of poor recovery after whiplash injury is evolving. Although more research is required to validate predictive models, some factors show consistent predictive capacity and could be used in clinical practice as potential indicators of poor recovery. It is not known if the specific targeting of modifiable prognostic indicators can be achieved or will lead to improved outcomes.
Authors: Tony Bohman; Pierre Côté; Eleanor Boyle; J David Cassidy; Linda J Carroll; Eva Skillgate Journal: BMC Musculoskelet Disord Date: 2012-12-29 Impact factor: 2.362