Maintaining a balance: a focus group study on living and coping with chronic whiplash-associated disorder

Kariann Krohne,Camilla Ihlebæk

doi:10.1186/1471-2474-11-158

Abstract

BackgroundThere is little qualitative insight into how persons with chronic Whiplash-Associated Disorder cope on a day to day basis. This study seeks to identify the symptoms persons with Whiplash-Associated Disorder describe as dominating and explore their self-initiated coping strategies.MethodsQualitative study using focus groups interviews. Fourteen Norwegian men and women with Whiplash-Associated Disorder (I or II) were recruited to participate in two focus groups. Data were analyzed according to a phenomenological approach, and discussed within the model of Cognitive Activation Theory of Stress (CATS).ResultsParticipants reported neck and head pain, sensory hypersensitivity, and cognitive dysfunction following their whiplash injury. Based on the intensity of symptoms, participants divided everyday life into good and bad periods. In good periods the symptoms were perceived as manageable. In bad periods the symptoms intensified and took control of the individual. Participants expressed a constant notion of trying to balance their three main coping strategies; rest, exercise, and social withdrawal. In good periods participants experienced coping by expecting good results from the strategies they used. In bad periods they experienced no or negative relationships between their behavioral strategies and their complaints.ConclusionsNeck and head pain, sensory hypersensitivity, and cognitive dysfunction were reported as participants' main complaints. A constant notion of balancing between their three main coping strategies; rest, exercise, and social withdrawal, was described.

Highlights

There is little qualitative insight into how persons with chronic Whiplash-Associated Disorder cope on a day to day basis
The Quebec Task Force developed a system for grading Whiplash-Associated Disorders (WAD): WAD I-II, III, and IV [1]
Found that high levels of passive coping strategies are associated with a slower recovery after whiplash injury [16,17], and that certain coping strategies for pain, such as catastrophizing, is associated with increased risk of disability, and that the importance of coping strategies seem to increase over time [18,19,20,21]

Summary

Introduction

There is little qualitative insight into how persons with chronic Whiplash-Associated Disorder cope on a day to day basis. The Quebec Task Force developed a system for grading Whiplash-Associated Disorders (WAD): WAD I-II (symptoms without known pathology), III (symptoms and neurological signs), and IV (symptoms and cervical fracture and/or dislocation) [1]. Expectations and coping styles might influence the outcome and prognosis after whiplash injuries [13]. The level and duration of the alarm depends on the expectancy of the outcome of stimuli, as well as the results from specific responses available for handling the situation. The CATS model emphasizes the importance of coping as positive response outcome expectancies. This means that if the individual expects to be able to handle a situation with a positive result (coping), the activation will be short and do no harm. There is considerable controversy as to the importance of psychological factors for developing chronic WAD [22]

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