Recovery In Whiplash-associated Disorders Research Articles

Confirming the geography of fatty infiltration in the deep cervical extensor muscles in whiplash recovery

Previous preliminary work mapped the distribution of neck muscle fat infiltration (MFI) in the deep cervical extensor muscles (multifidus and semispinalis cervicis) in a small cohort of participants with chronic whiplash associated disorders (WAD), recovered, and healthy controls. While MFI was reported to be concentrated in the medial portion of the muscles in all participants, the magnitude was significantly greater in those with chronic WAD. This study aims to confirm these results in a prospective fashion with a larger cohort and compare the findings across a population of patients with varying levels of WAD-related disability one-year following the motor vehicle collision. Sixty-one participants enrolled in a longitudinal study: Recovered (n = 25), Mild (n = 26) and Severe WAD (n = 10) were studied using Fat/Water magnetic resonance imaging, 12-months post injury. Bilateral measures of MFI in four quartiles (Q1–Q4; medial to lateral) at cervical levels C4 through C7 were included. A linear mixed model was performed, controlling for covariates (age, sex, body mass index), examining interaction effects, and comparing MFI distribution between groups. The recovered group had significantly less MFI in Q1 compared to the two symptomatic groups. Group differences were not found in the more lateral quartiles. Results at 12 months are consistent with the preliminary study, indicating that MFI is spatially concentrated in the medial portions of the deep cervical extensors regardless of WAD recovery, but the magnitude of MFI in the medial portions of the muscles is significantly larger in those with severe chronic WAD.

Investigating the Causal Mechanisms of Symptom Recovery in Chronic Whiplash-associated Disorders Using Bayesian Networks.

The present study's objective was to understand the causal mechanisms underpinning the recovery of individuals with whiplash-associated disorders (WAD). We applied Bayesian Networks (BN) to answer 2 study aims: (1) to identify the causal mechanism(s) of recovery underpinning neck-specific exercise (NSE), and (2) quantify if the cyclical pathway of the fear-avoidance model (FAM) is supported by the present data. We analyzed a prospective cohort data set of 216 individuals with chronic WAD. Fifteen variables were used to build a BN model: treatment group (NSE with or without a behavioral approach, or general physical activity), muscle endurance, range of motion, hand strength, neck proprioception, pain catastrophizing, fear, anxiety, depression, self-efficacy, perceived work ability, disability, pain intensity, sex, and follow-up time. The BN model showed that neck pain reduction rate was greater after NSE compared with physical activity prescription (β=0.59 points per month [P<0.001]) only in the presence of 2 mediators: global neck muscle endurance and perceived work ability. We also found the following pathway of variables that constituted the FAM: anxiety, followed by depressive symptoms, fear, catastrophizing, self-efficacy, and consequently pain. We uncovered 2 mediators that explained the mechanisms of effect behind NSE, and proposed an alternative FAM pathway. The present study is the first to apply BN modelling to understand the causal mechanisms of recovery in WAD. In doing so, it is anticipated that such analytical methods could increase the precision of treatment of individuals with chronic WAD.

Is kinematic analysis useful as a clinical test during whiplash associated disorders recovery? A clinical study

The development of low platinum catalysts for automotive fuel cells is a way to solve platinum resource constraints. We successfully prepared Pt-nanoflower supported on carbon black in aqueous solution with the aid of Cetyltrimethyl Ammonium Bromide (CTAB). Those nanoflowers showed uniform particle size distribution with average particle size of 27.0 nm. XRD indicated lattice compression for Pt from as-synthesized Pt/C. 71.6% of Pt existed in the form of elementary substance based on XPS. All those assembly nanostructure contributed to remarkable area-specific and mass-specific activities in oxygen reduction reaction.

The Impact of Posttraumatic Stress Disorder on Physiological Arousal, Disability, and Sensory Pain Thresholds in Patients With Chronic Whiplash.

Whiplash-associated disorders (WAD) are common and incur substantial personal and economic costs. Research has shown that persistent posttraumatic stress reactions predict poorer functional recovery in WAD; however, the specific mechanism through which this occurs is unclear. The current study is the first to examine the direct impact of posttraumatic stress disorder (PTSD) symptoms in WAD using laboratory tested pain measures. A mixed experimental design was used to examine the impact of exposure to accident cues on chronic WAD individuals with (n=33) and without (n=39) PTSD. Groups were compared at baseline and postaccident cue on self-reported pain and negative effect and laboratory tested arousal and sensory pain threshold measures. At baseline, WAD individuals with PTSD reported greater disability, negative effect, pain, arousal, and lower pain thresholds than those without PTSD. As expected, exposure to accident cues resulted in greater increases in arousal and negative effect for those with PTSD. Changes in sensory pain thresholds revealed a hyperalgesic effect in cold pain thresholds for the PTSD group compared with the No PTSD group and mixed findings for pressure pain thresholds. Findings from the current study highlight the negative impact of PTSD on both physical and psychological outcomes in chronic WAD. From a clinical perspective, data suggest that patients exposed to accident cues may experience arousal that lowers their threshold to certain pain stimuli. Further investigation of effective multidisciplinary interventions and in particular the treatment of PTSD in WAD is identified as an important area of further investigation.

Coping and Recovery in Whiplash-associated Disorders

Coping is shown to affect outcomes in chronic pain patients; however, few studies have examined the role of coping in the course of recovery in whiplash-associated disorders (WAD). The purpose of this study was to determine the predictive value of coping style for 2 key aspects of WAD recovery, reductions in neck pain, and in disability. A population-based prospective cohort study design was used to study 2986 adults with traffic-related WAD. Participants were assessed at baseline, 6 weeks, and 4, 8, and 12 months postinjury. Coping was measured at 6 weeks using the Pain Management Inventory, and neck pain recovery was assessed at each subsequent follow-up, using a 100 mm visual analogue scale (VAS). Disability was assessed at each follow-up using the Pain Disability Index (PDI). Pain recovery was defined as a VAS score of 0 to 10; disability recovery was defined as a PDI score of 0 to 4. Data analysis used multivariable Cox proportional hazards models. Those using high versus low levels of passive coping at 6 weeks postinjury experienced 28% slower pain recovery and 43% slower disability recovery. Adjusted hazard rate ratios for pain recovery and disability recovery were 0.72 (95% CI, 0.59-0.88) and 0.57 (95% CI, 0.41-0.78), respectively. Active coping was not associated with recovery of neck pain or disability. Passive coping style predicts neck pain and self-assessed disability recovery. It may be beneficial to assess and improve coping style early in WAD.

Delayed recovery in patients with whiplash-associated disorders

BackgroundPrognosis of whiplash injury has been found to be related to a number of sociodemographic, treatment and clinical factors. In the current study, we attempt to identify several novel prognostic factors for delayed recovery in whiplash-associated disorders (WADs), using a validated and reliable measure of recovery. Patients and methodsRetrospective review of a large database of a national network of physiotherapy and rehabilitation service providers in Canada yielded 5581 individuals injured in motor vehicle collisions. Cases were grouped into 3 cohorts based on time lapsed between injury date and initial presentation. Acute (n=3075), early chronic (n=958) and chronic (n=1548) patient cohorts were compared regarding treatment outcome and relative distribution of 29 prognostic factors. Outcome was defined by a minimally important clinical change (10%) on a previously validated disability questionnaire between initial and discharge rehabilitation visits. ResultsAnalysis demonstrated positive outcomes to be proportionally fewer in the chronic cohort (52.1%) relative to the early chronic (61.4%), which was in turn lower than the acute cohort (72.3%). Furthermore, individuals presenting with chronic pain were more likely to: (1) be female; (2) present with lower limb pain or nonorganic signs; (3) have returned to work; (4) have retained a lawyer; or (5) have undergone previous spinal surgery, and were less likely to: (1) present with neck or midback pain; (2) live in Ontario or Nova Scotia; or (3) have modified duties upon return to work. Acute, early chronic and chronic cohorts were also found to differ in the distribution of several other prognostic factors at initial clinical visit. ConclusionsRecovery in whiplash-associated disorder appears to be multifactorial with both medical and non-injury related factors influencing outcome. Further characterisation of these factors may prove invaluable in guiding future clinical treatment and referral practices.

Complexities in Understanding the Role of Compensation-Related Factors on Recovery From Whiplash-Associated Disorders

In Brief Study Design. Focused discussion. Objective. To present some of the complexities in conducting research on the role of compensation and compensation-related factors in recovery from whiplash-associated disorders (WAD) and to suggest directions for future research. Summary of Background Data. There is divergence of opinion, primary research findings, and systematic reviews on the role of compensation and/or compensation-related factors in WAD recovery. Methods. The topic of research of compensation/compensation-related factors was discussed at an international summit meeting of 21 researchers from diverse fields of scientific enquiry. This article summarizes the main points raised in that discussion. Results. Traffic injury compensation is a complex sociopolitical construct, which varies widely across jurisdictions. This leads to conceptual and methodological challenges in conducting and interpreting research in this area. It is important that researchers and their audiences be clear about what aspect of the compensation system is being addressed, what compensation-related variables are being studied, and what social/economic environment the compensation system exists in. In addition, summit participants also recommended that nontraditional, sophisticated study designs and analysis strategies be employed to clarify the complex causal pathways and mechanisms of effects. Conclusion. Care must be taken by both researchers and their audiences not to overgeneralize or confuse different aspects of WAD compensation. In considering the role of compensation/compensation-related factors on WAD and WAD recovery, it is important to retain a broad-based conceptualization of the range of biological, psychological, social, and economic factors that combine and interact to define and determine how people recover from WAD. The role of compensation and specific compensation factors in recovery of whiplash-associated disorders continues to be a widely debated issue. This article outlines some of the reasons for this, including a discussion of some of the methodological challenges in conducting research and synthesizing the evidence in this field.

Beliefs and Expectations for Recovery, Coping, and Depression in Whiplash-Associated Disorders

Literature review and discussion. To discuss the role played by beliefs, expectations, coping, and depression in the transition to chronicity in whiplash-associated disorders (WAD), and to discuss their clinical and research implications. Psychological factors are important in musculoskeletal pain problems. Recently, there has been attention paid to their role in the transition from acute to chronic WAD. However, most of this attention has focused on identifying and addressing the personal and behavioral aspects of psychological factors, and little focus on the social and societal influences shaping these factors in WAD patients. A literature review was conducted to describe the evidence regarding the roles of beliefs, expectations, pain coping, and depression in WAD recovery. These psychological constructs and research findings were discussed in the context of efforts to improve beliefs, coping, and psychological well-being in WAD. There is consistent evidence negative beliefs about WAD are common in the general population and that poor expectations for recovery are associated with poor recovery. Pain coping and depression also appear to predict WAD recovery. The conceptual frameworks (such as social learning theory) for understanding these psychological constructs highlight the roles of interpersonal and societal factors. However, most research and clinical interventions related to these factors focuses on the individual, rather than also addressing the social context. Beliefs, expectations, coping, and depression all predict WAD recovery. Efforts to address these factors should take a broad-based approach. These psychological constructs should be viewed as being developed and maintained within the broader social context of family, social networks, employment, and societal processes in general. There is need for a research and clinical paradigm, which acknowledges the interrelationships between internal processes and the social context in attempts to optimize recovery and functioning in those with WAD.

December 2011 Letters to the Editor-in-Chief

Letters to the Editor-in-Chief of JOSPT as follows:"Early Prognostic Factors in Patients With Whiplash" and Author's Response "Staying Current in the Use of Ultrasound Imaging" and Author's Response"Differentiating the Soleus From the Gastrocnemius With the Heel Raise Test" and Author's ResponseJ Orthop Sports Phys Ther 2011;41(12):983-987. doi:10.2519/jospt.2011.0202.

Pain-Related Emotions in Early Stages of Recovery in Whiplash-Associated Disorders

Psychological factors such as depression affect recovery after whiplash-associated disorders. This study examined the prevalence of pain-related emotions, such as frustration, anger, and anxiety, and their predictive value for postcrash pain recovery during a 1-year follow-up. A population-based prospective cohort study design was used. Self-reported pain-related depression, anxiety, fear, anger, and frustration were assessed using 100-mm visual analog scales (VASs) at 6 weeks after crash in 2986 persons with traffic-related whiplash-associated disorder. Multivariable logistic regression was used to assess the relationship between the intensity of these pain-related emotions and pain recovery at 4 and 12 months after crash. Pain was measured at all time points on a 100-mm VAS, and pain recovery was defined as a score of 10 or lower. Pain-related frustration was the most intense, with a mean score of 52. Only 3% of the cohort reported having no pain-related frustration, and 4% reported no pain-related anxiety. Multivariable logistic regression models revealed that each pain-related emotion increased the risk of failing to recover (odds ratios for each point increase on the 100-mm VAS), ranging from 1.011 to 1.015. Specifically, with each 10-point increase in pain-related emotion, the odds of failing to achieve pain recovery at 4 months was increased by 14% (p < .001) for depression, 15% (p < .001) for anxiety, 11% (p < .001) for fear, 12% (p < .001) for anger, and 11% (p < .001) for frustration. These findings suggest that it may be beneficial for health care providers to address emotional status related to pain in the first few weeks after a whiplash injury.

Ozegovic D, Carroll LJ, David Cassidy J. Does expecting mean achieving? The association between expecting to return to work and recovery in whiplash associated disorders: a population-based prospective cohort study. Eur Spine J 2009;18(6):893-9.

Ozegovic D, Carroll LJ, David Cassidy J. Does expecting mean achieving? The association between expecting to return to work and recovery in whiplash associated disorders: a population-based prospective cohort study. Eur Spine J 2009;18(6):893-9.

Factors associated with recovery expectations following vehicle collision: A population-based study

Positive expectations predict better outcomes for a variety of health conditions including recovery from whiplash-associated disorders, but we know little about which individuals have negative expectations, and therefore may be at risk for poor whiplash-associated disorders recovery. We assessed expectations for global recovery in a population-based cohort of 6015 individuals with traffic-related whiplash-associated disorders. We used multinomial logistic regression analysis to model factors associated with expecting to recover slowly, or not recover at all, as opposed to expecting to recover quickly. Depressive symptomatology, lower education, lower income, male gender, younger age, being a passenger in the vehicle, history of neck pain, and greater initial pain (greater percentage of body in pain, greater intensity of neck pain and presence of low back and/or headache pain) were associated with poor expectations for recovery. A number of demographic, socioeconomic and injury-related factors were associated with expectations for recovery in whiplash-associated disorders. Two of the strongest associated factors were depressive symptomatology and initial neck pain intensity. These results support using a biopsychosocial approach to evaluate expectancies and their influence on important health outcomes.

Does expecting mean achieving? The association between expecting to return to work and recovery in whiplash associated disorders: a population-based prospective cohort study

To determine the association between expectations to return to work and self-assessed recovery. Positive expectations predict better outcomes in many health conditions, but to date the relationship between expecting to return to work after traffic-related whiplash-associated disorders and actual recovery has not been reported. We assessed early expectations for return to work in a cohort of 2,335 individuals with traffic-related whiplash injury to the neck. Using multivariable Cox proportional hazard analysis we assessed the association between return to work expectations and self-perceived recovery during the first year following the event. After adjusting for the effects of sociodemographic characteristics, initial pain and symptoms, post-crash mood, prior health status and collision-related factors, those who expected to return to work reported global recovery 42% more quickly than those who did not have positive expectations (HRR = 1.42, 95% CI 1.26-1.60). Knowledge of return to work expectation provides an important prognostic tool to clinicians for recovery.

Recovery in Whiplash-Associated Disorders: Do You Get What You Expect?

Positive expectations predict better outcome in a number of health conditions, but the role of expectations in predicting health recovery after injury is not well understood. We investigated whether early expectations of recovery in whiplash associated disorders (WAD) predict subsequent recovery, and studied the role of "expectations" to predict recovery as determined by pain cessation and resolution of pain-related limitations in daily activities. A cohort of 6,015 adults with traffic-related whiplash injuries was assessed, using multivariable Cox proportional hazards analysis, for association between these expectations and self-perceived recovery over a 1-year period following the injury. Recovery was assessed using 3 indices: self-perceived global recovery (primary outcome); resolution of neck pain severity; and resolution of pain-related limitations in daily activities. After adjusting for the effect of sociodemographic characteristics, post-crash symptoms and pain, prior health status and collision-related factors, those who expected to get better soon recovered over 3 times as quickly (hazard rate ratio = 3.62, 95% confidence interval 2.55-5.13) as those who expected that they would never get better. Findings were similar for resolution of pain-related limitations and resolution of neck pain intensity, although the effect sizes for the latter outcome were smaller. Patients' early expectations for recovery are an important prognostic factor in recovery after whiplash injury, and are potentially modifiable. Clinicians should assess these expectations in order to identify those patients at risk of chronic whiplash, and future studies should focus on the effect of changing these early expectations.

Course and Prognostic Factors for Neck Pain in Whiplash-Associated Disorders (WAD): Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders

Study Design Best evidence synthesis. Objective To perform a best evidence synthesis on the course and prognostic factors for neck pain and its associated disorders in Grades I–III whiplash-associated disorders (WAD). Summary of Background Data Knowledge of the course of recovery of WAD guides expectations for recovery. Identifying prognostic factors assists in planning management and intervention strategies and effective compensation policies to decrease the burden of WAD. Methods The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and its Associated Disorders (Neck Pain Task Force) conducted a critical review of the literature published between 1980 and 2006 to assemble the best evidence on neck pain and its associated disorders. Studies meeting criteria for scientific validity were included in a best evidence synthesis. Results We found 226 articles related to course and prognostic factors in neck pain and its associated disorders. After a critical review, 70 (31%) were accepted on scientific merit; 47 of these studies related to course and prognostic factors in WAD. The evidence suggests that approximately 50% of those with WAD will report neck pain symptoms 1 year after their injuries. Greater initial pain, more symptoms, and greater initial disability predicted slower recovery. Few factors related to the collision itself (for example, direction of the collision, headrest type) were prognostic; however, postinjury psychological factors such as passive coping style, depressed mood, and fear of movement were prognostic for slower or less complete recovery. There is also preliminary evidence that the prevailing compensation system is prognostic for recovery in WAD. Conclusion The Neck Pain Task Force undertook a best evidence synthesis to establish a baseline of the current best evidence on the course and prognosis for WAD. Recovery of WAD seems to be multifactorial.

Course and Prognostic Factors for Neck Pain in Whiplash-Associated Disorders (WAD)

Best evidence synthesis. To perform a best evidence synthesis on the course and prognostic factors for neck pain and its associated disorders in Grades I–III whiplash-associated disorders (WAD). Knowledge of the course of recovery of WAD guides expectations for recovery. Identifying prognostic factors assists in planning management and intervention strategies and effective compensation policies to decrease the burden of WAD. The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and its Associated Disorders (Neck Pain Task Force) conducted a critical review of the literature published between 1980 and 2006 to assemble the best evidence on neck pain and its associated disorders. Studies meeting criteria for scientific validity were included in a best evidence synthesis. We found 226 articles related to course and prognostic factors in neck pain and its associated disorders. After a critical review, 70 (31%) were accepted on scientific merit; 47 of these studies related to course and prognostic factors in WAD. The evidence suggests that approximately 50% of those with WAD will report neck pain symptoms 1 year after their injuries. Greater initial pain, more symptoms, and greater initial disability predicted slower recovery. Few factors related to the collision itself (for example, direction of the collision, headrest type) were prognostic; however, postinjury psychological factors such as passive coping style, depressed mood, and fear of movement were prognostic for slower or less complete recovery. There is also preliminary evidence that the prevailing compensation system is prognostic for recovery in WAD. The Neck Pain Task Force undertook a best evidence synthesis to establish a baseline of the current best evidence on the course and prognosis for WAD. Recovery of WAD seems to be multifactorial.

The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders

Scott Haldeman, DC, MD, PhD,1 Linda Carroll, PhD,2 J. David Cassidy, DC, PhD, DrMedSc,3 Jon Schubert, CMA,4 and Ake Nygren, DDS, MD, DrMedSc5 1Department of Neurology, University of California, Irvine, CA; Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA 2Department of Public Health Sciences, and Alberta Center for Injury Control and Research, School of Public Health, University of Alberta, Canada 3Department of Public Health Sciences, Faculty of Medicine, University of Toronto an Division of Health Outcomes and Research, Toronto Western Research Institute, University Health Network, Toronto, Canada 4CEO–SGI, Regina, Saskatchewan, Canada 5Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Karolinska Institutet, Stockholm, Sweden