Citation

Sterling M, Carroll LJ, Kasch H, Kamper SJ, Stemper BD. Spine 2011; 36(25 Suppl): S330-4.

Affiliation

Centre for National Research on Disability and Rehabilitation Medicine (CONROD), The University of Queensland, Australia Department of Public Health Sciences and Alberta Centre for Injury Control and Research, School of Public Health, University of Alberta, Canada The Danish Pain Research Center, Dept. of Neurology, Aarhus University Hospital, Denmark The George Institute for Global Health, University of Sydney, Australia Department of Neurosurgery, Medical College of Wisconsin and Veterans Affairs Medical Center, Milwaukee, WI, USA.

Copyright

(Copyright © 2011, Lippincott Williams and Wilkins)

DOI

10.1097/BRS.0b013e3182388523

PMID

22020603

Abstract

Study Design. Non-systematic review and discussion of prognosis following whiplash injuryObjective. To summarise the research and identify a research agenda for improving prognostic models following whiplash injurySummary of Background Data. With up to 50% of individuals failing to fully recover following whiplash injury, the capacity to determine a precise estimate of prognosis will be important. Systematic reviews note inconsistencies and shortcomings of research in this area.Methods. A non-systematic review and discussionResults. Most prognostic whiplash studies are Phase 1(exploratory) studies with few confirmatory or validation studies yet available. It is recognised that whiplash is a heterogeneous condition and clinicians require prognostic indicators for clinical use. Whilst the evidence is not sufficiently strong to make firm recommendations, there are some prognostic factors that have shown consistency across studies and could be considered as preliminary flags or guides to gauge patients potentially at risk of poor recovery. These include: pain and/or disability levels, neck range of movement, cold and mechanical hyperalgesia and psychological factors of recovery beliefs/expectations, posttraumatic stress symptoms, depression and pain catastrophising. It is not known if these factors can be modified or if modification will improve outcomes, thus they should not be considered directives for management. Research priorities identified to develop improved predictive models include: confirmation and validation of factors identified in Phase 1 studies; investigation of the interaction between variables; investigation of the predictive value of changes in variables over time; the inclusion of validated outcomes including measures of pain and disability as well as perceived recovery and psychological outcomes.Conclusion. The current evidence is not sufficiently robust to be able to confidently predict outcome following whiplash injury. A preliminary set of consistent factors have been proposed to assist clinicians in identifying individuals at risk of poor recovery. Directions for the development of improved prognostic models are discussed.

Language: en