Self-rated disability, fear-avoidance beliefs, nonorganic pain behaviors are important mediators of ranges of active motion in chronic whiplash patients

Abstract

Purpose: The influence of self-rated disability and fear-avoidance beliefs on whiplash sufferers in their performance of active ranges of motion has not been studied well. We undertook a cross-sectional study to determine this. Methods: Chronic whiplash subjects completed a standard clinical examination. They completed the Neck Disability Index (NDI), the Tampa Scale for Kinesiophobia (TSK) and pain visual analog scale (VAS). Active ranges of motion (goniometer) and cervical nonorganic simulation signs (C-NOSS) were obtained by the examiner. Univariate and multivariable analyses were conducted on these scores. Results: Sixty-four subjects (37 female) with a mean age of 41.4 (SD 16.1) years completed all scores. NDI, pain VAS and C-NOSS correlated significantly with ROM. In a multivariable model, only the NDI score contributed significantly to the variance of the ROM scores (14%). Conclusion: As chronic whiplash sufferers perform ROM in a clinical examination, these ranges are importantly influenced by their self-perceived disability. Cervical nonorganic simulation signs can be helpful in distinguishing high from very high levels of disability and motion restriction. The lack of correlation with the TSK may present a challenge to the Fear Avoidance Model in whiplash.Implications for RehabilitationSelf-ratings of disability in chronic whiplash sufferers are influenced by their fear-avoidance beliefs.While self-ratings of disability are known to predict chronicity of whiplash, there is less known about how these ratings affect impairment assessment during recovery.This study shows that self-ratings of disability influence the presentation of impairment by chronic whiplash sufferers with respect to their ranges of neck motion.Signs of nonorganic behavior also influence ranges of motion and self-ratings of disability.These findings should be incorporated into the interpretation of impairment findings in chronic whiplash sufferers in order to improve management.