Neck Disability Index Is Better in Classification of Recovery after Whiplash Injury in Comparison with Ultrasound Shear Wave Elastography of Trapezius Muscle.

Blaž Barun,Ana Krnić,Benjamin Benzon,Jure Aljinović,Tonko Vlak,Igor Barišić

doi:10.3390/diagnostics11112077

Blaž Barun, Ana Krnić + Show 4 more

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https://doi.org/10.3390/diagnostics11112077

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Abstract

A prospective observational study comparing shear wave elastography (SWE) of trapezius muscle with Neck Disability Index (NDI) in a prediction model of health status six months after a whiplash injury. Both SWE values, measured by two radiologists, and NDI scores were obtained at baseline and after physical therapy (PT) (6-month period). Those values were compared with a 3-point Likert scale (no, partial or full recovery). Twenty-two subjects completed the study. A decrease in trapezius stiffness was detected by both radiologists, statistically significant for one (Δ10.1 kPa; p = 0.04) but not for the second radiologist (Δ8.63 kPa; p = 0.07). The measurements showed excellent intra-observer (ICC 0.75–0.94) and inter-observer (ICC 0.78–0.88) reliability. After six months, fully recovered patients showed lower NDI scores than partially recovered patients (Δ22.98; p < 0.001). SWE values did not differ with the recovery status (55.6 ± 9.7 vs. 57 ± 15.8, Δ1.45; p = 0.82). The single most accurate variable in classifying health status six months after whiplash injury was the relative change of NDI, and it showed the highest accuracy (73.9%) and low Akaike information criterion (AIC = 39.2). Overall, the most accurate classification was obtained when combining NDI and SWE after physical therapy with an accuracy of 77.3% and a decrease in AIC (32.8).

Highlights

Whiplash injury is the most common injury related to traffic accidents [1,2]
All participants were informed about the study design, and informed consent was obtained in written form
When a combination of potential classifiers was calculated, shear wave elastography (SWE) obtained after the therapy combined with Neck Disability Index (NDI) after physical therapy raised accuracy to 77.3% with Akaike information criterion (AIC) 32.85 (Table 4)

Summary

Introduction

Whiplash injury is the most common injury related to traffic accidents [1,2]. 30–50% of people experience chronic pain and disability following a whiplash injury, and 13–50% do not return to work six months after the injury; it becomes a great socioeconomic problem [2,3,4]. Whiplash injury is common in modern society, and its incidence is increasing, the pathophysiological mechanism that leads to chronic disability and optimal treatment remains unclear [5]. Clinical guidelines identify the acute whiplash injury phase (90 days from the accident) as a critical period to classify patients according to the risk of developing chronic pain and disability. Patients at greater risk should be monitored more often, and their rehabilitation plans should be tailored individually [6,7]. Subjective methods are used to assess the severity of the injury, prognosis, and recovery, with Neck Disability Index (NDI) being one of the most reliable and most commonly used ones [8,9,10,11]

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