Whiplash Disability Questionnaire Research Articles

Developing a shortened spine functional index (SFI-10) for patients with sub-acute/chronic spinal disorders: a cross-sectional study

BackgroundBrief whole-spine patient-reported outcome measures (PROMs) provide regional solutions and future directions for quantifying functional status, evidence, and effective interventions. The whole-spine regional Spine Functional Index (SFI-25) is used internationally in clinical and scientific contexts to assess general sub-acute/chronic spine populations. However, to improve structural validity and practicality a shortened version is recommended. This study developed a shortened-SFI from the determined optimal number of item questions that: correlated with criteria PROMs being highly with whole-spine, moderately with regional-spine, condition-specific and patient-specific, and moderately-low with general-health and pain; retained one-dimensional structural validity and high internal consistency; and improved practicality to reduce administrative burden.MethodsA cross-sectional study (n = 505, age = 18-87 yrs., average = 40.3 ± 10.1 yrs) of sub-acute/chronic spine physiotherapy outpatients from an international sample of convenience. Three shortened versions of the original SFI-25 were developed using 1) qualitative ‘content-retention’ methodology, 2) quantitative ‘factorial’ methodology, and 3) quantitative ‘Rasch’ methodology, with a fourth ‘random’ version produced as a comparative control. The clinimetric properties were established for structural validity with exploratory (EFA) and confirmatory (CFA) factorial analysis, and Rasch analysis. Criterion validity used the: whole-spine SFI-25 and Functional Rating Index (FRI); regional-spine Neck Disability Index (NDI), Oswestry Disability Index (ODI), and Roland Morris Questionnaire (RMQ), condition-specific Whiplash Disability Questionnaire (WDQ); and patient-specific functional scale (PSFS); and determined floor/ceiling effect. A post-hoc pooled international sub-acute/chronic spine sample (n = 1433, age = 18-91 yrs., average = 42.0 ± 15.7 yrs) clarified the findings and employed the general-health EuroQuol-Index (EQ-5D), and 11-point Pain Numerical Rating Scale (P-NRS) criteria.ResultsA 10-item SFI retained structural validity with optimal practicality requiring no computational aid. The SFI-10 concept-retention-version demonstrated preferred criterion validity with whole-spine criteria (SFI-25 = 0.967, FRI = 0.810) and exceeded cut-off minimums with regional-spine, condition-specific, and patient-specific measures. An unequivocal one-dimensional structure was determined. Internal consistency was satisfactory (α = 0.80) with no floor/ceiling effect. Post-hoc analysis of the international sample confirmed these findings.ConclusionThe SFI-10 qualitative concept-retention version was preferred to quantitative factorial and Rasch versions, demonstrated structural and criterion validity, and preferred correlation with criteria measures. Further longitudinal research is required for reliability, error, and responsiveness, plus an examination of the practical characteristics of readability and administrative burden.

Novel Internet Support for Neck-Specific Rehabilitation Improves Work-Related Outcomes to the Same Extent as Extensive Visits to a Physiotherapy Clinic in Individuals with Chronic Whiplash-Associated Disorders: A Prospective Randomised Study.

To address the current lack of information about work-related factors for individuals with whiplash-associated disorders (WAD) we investigated the effectiveness of 3months of neck-specific rehabilitation with internet support in combination with four physiotherapy visits (NSEIT) compared to the same exercises performed twice a week (24 times) at a physiotherapy clinic (NSE). This is a prospective, multicentre, randomised controlled trial regarding secondary outcomes of work-related factors in 140 individuals with chronic moderate/severe WAD with 3- and 15-month follow-up. There were no group differences between NSE and NSEIT in the Work Ability Scale or work subscales of the Neck Disability Index, Whiplash Disability Questionnaire or Fear Avoidance Beliefs Questionnaire (FABQ-work). Both groups improved in all work-related outcome measures, except for FABQ-work after the 3-month intervention and results were maintained at the 15-month follow-up. Despite fewer physiotherapy visits for the NSEIT group, there were no group differences between NSEIT and NSE, with improvements in most work-related measures maintained at the 15-month follow-up. The results of the present study are promising for those with remaining work ability problems after a whiplash injury. Protocol registered before data collection started: clinicaltrials.gov NCT03022812.

Recommendations for a core outcome measurement set for clinical trials in whiplash associated disorders.

Inconsistent reporting of outcomes in clinical trials of treatments for whiplash associated disorders (WAD) hinders effective data pooling and conclusions about treatment effectiveness. A multidisciplinary International Steering Committee recently recommended 6 core outcome domains: Physical Functioning, Perceived Recovery, Work and Social Functioning, Psychological Functioning, Quality of Life and Pain. This study aimed to reach consensus and recommend a core outcome set (COS) representing each of the 6 domains. Forty-three patient-reported outcome measures (PROMs) were identified for Physical Functioning, 2 for perceived recovery, 37 for psychological functioning, 17 for quality of life, and 2 for pain intensity. They were appraised in 5 systematic reviews following COSMIN methodology. No PROMs of Work and Social Functioning in WAD were identified. No PROMs had undergone evaluation of content validity in patients with WAD, but some had moderate-to-high-quality evidence for sufficient internal structure. Based on these results, the International Steering Committee reached 100% consensus to recommend the following COS: Neck Disability Index or Whiplash Disability Questionnaire (Physical Functioning), the Global Rating of Change Scale (Perceived Recovery), one of the Pictorial Fear of Activity Scale-Cervical, Pain Self-Efficacy Questionnaire, Pain Catastrophizing Scale, Harvard Trauma Questionnaire, or Posttraumatic Diagnostic Scale (Psychological Functioning), EQ-5D-3L or SF-6D (Quality of Life), numeric pain rating scale or visual analogue scale (Pain), and single-item questions pertaining to current work status and percent of usual work (Work and Social Functioning). These recommendations reflect the current status of research of PROMs of the 6 core outcome domains and may be modified as evidence grows.

Clinical efficacy of diazepam after whiplash: a randomized controlled study.

Aim To investigate the role of short-term diazepam therapy for improving long-term outcomes and reducing neck pain after whiplash injury. Methods A total of 89 patients suffering from whiplash injury were included. They were randomly assigned into 2 groups: group A (study group), and group B (control group). The test group was prescribed with diazepam 5 mg tablets one time per day for 7 days and the control group did not get the recommendation to use diazepam. Three previously validated scales, Visual Analogue Pain Scale (VAS), the Neck Disability Index (NDI), and the Whiplash Disability Questionnaire (WDQ), were used at different intervals (7 days, 6 weeks and 6 months after the injury). Results Among 89 patients, 50 (56.2%) were males, 39 (43.8%) females. The mean age of all participants was 34.80±12.531 years. According to the Mann Whitney U -Test, no significant difference was observed in VAS, NDI, and WDQ scores between the control group and study group at any time point (p>0.05). Conclusion Diazepam provides no substantial advantage in the treatment of whiplash, and accordingly, we do not recommend diazepam therapy in patients who suffered whiplash injury. The trial was registered in the database of the Federal National Library of Medicine (NLM) (https://clinicaltrials.gov) under clinical trials (unique protocol ID:1703016).

Pain Related Functional Limitations of Persons Injured in Car Accidents

Background: In medical psychology, the Brief Pain Inventory (BPI) allows for a separate assessment of pain intensity (scales of worst, least, and average pain) and of daily functional limitations due to pain (impairments of mood, ability to walk, work, interpersonal relations, sleep, and enjoyment of life). The present study evaluates the convergent validity of BPI’s measure of such functional limitations by calculating its correlations to other relevant clinical measures of psychological impairments caused by motor vehicle accidents (MVAs). 
 Method: De-identified archival data were available on 50 persons injured in MVAs (age 20 to 86 years, mean=42.1 years, SD=16.4; 23 males, 27 females). Their MVA occurred 11 to 280 weeks prior to psychological testing with the BPI (average time lapse 73.3 weeks, SD=53.8). All patients were still experiencing active post-MVA symptoms requiring medical attention and therapy. With respect to convergent validity, we examined Pearson correlations of the BPI to the Insomnia Severity Index (ISI), Rivermead Post-Concussion Symptoms Scale, Subjective Neuropsychological Symptoms Scale (SNPSS), and to measures of depression, anger, and anxiety (Items 10 to 12 of the Whiplash Disability Questionnaire).
 Results: Functional interference of pain with daily activities (sum of BPI Items 9B to 9G) correlated significantly at p<0.05, 2-tailed with Rivermead post-concussion scores (r=0.39), post-MVA subjective neuropsychological symptoms (r=0.45), insomnia scores (r=0.41), and ratings of depression (r=0.52), anger (r=0.46), and anxiety (r=0.44). When the sum of BPI ratings of worst, least, and average pain was added to the functional interference/limitations score, then this sum of 9 BPI items correlated significantly at p<0.05, 2-tailed with Rivermead post-concussion scores (r=0.36), post-MVA subjective neuropsychological symptoms (r=0.46), insomnia scores (r=0.37), and ratings of depression (r=0.53), anger (r=0.50), and anxiety (r=0.40). 
 Discussion and Conclusion: The results lend support to convergent validity of the BPI when applied to persons injured in vehicular accidents.

Clinimetric Properties of Self-reported Disability Scales for Whiplash: A Systematic Review for the Whiplash Core Outcome Set (CATWAD).

A core outcomes set (COS) for whiplash-associated disorders (WADs) has been proposed to improve consistency of outcome reporting in clinical trials. Patient-reported disability was one outcome of interest within this COS. The aim of this review was to identify the most suitable tools for measuring self-reported disability in WAD based on clinimetric performance. Database searches took place in 2 stages. The first identified outcome measures used to assess self-reported disability in WAD, and the second identified studies assessing the clinimetric properties of these outcome measures in WAD. Data on the study, population and outcome measure characteristics were extracted, along with clinimetric data. Quality and clinimetric performance were assessed in accordance with the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN). Of 19,663 records identified in stage 1 searches, 32 were retained following stage 2 searches and screening. Both the Whiplash Disability Questionnaire and Neck Disability Index performed well in reliability (intraclass correlation coefficient=0.84 to 0.98), construct validity (74% to 82% of hypotheses accepted), and responsiveness (majority of correlations in accordance with hypotheses). Both received Category B recommendations due to a lack of evidence for content validity. This review identified the Neck Disability Index and Whiplash Disability Questionnaire as the most appropriate patient-reported outcome measures (PROMs) for assessing self-reported disability in WAD based on moderate to high-quality evidence for sufficient reliability, construct validity and responsiveness. However, the content validity of these PROMs has yet to be established in WAD, and until this is undertaken, it is not possible to recommend 1 PROM over the other for inclusion in the WAD COS.

Clinical Correlations of Posttraumatic Nightmares in Survivors of Motor Vehicle Accidents

Background: We evaluated the severity and clinical correlates of nightmares of persons injured in high impact motor vehicle accidents (MVAs).
 Method: De-identified data of 80 post-MVA patients (mean age 38.9 years, SD=12.8) were available and included scores on Item 2 of the PCL-5 (severity of repeated, disturbing dreams of the stressful event). Scores were also available on the Brief Pain Inventory (BPI), Morin’s Insomnia Severity Index (ISI), Rivermead Post-concussion Symptoms Questionnaire, Subjective Neuropsychological Symptoms Scale (SNPSS), Whiplash Disability Questionnaire, and on three questionnaire measures of driving anxiety (Steiner’s, Whetstone’s, and DAQ). The patients were assessed, on the average, 49.7 weeks (SD=36.3) after their MVA; all still experienced active post-MVA symptoms requiring therapy.
 Results: Clinically relevant levels of MVA nightmares were reported by 62.5% of post-MVA patients. Subjectively more aversive levels of MVA nightmares correlated with higher driving anxiety as measured by the Whetstone questionnaire and DAQ, with higher levels of average post-accident pain and insomnia, with post-accident neuropsychological symptoms as measured by the Rivermead and SNPSS, and with higher post-accident levels of depression, anger, and generalized anxiety.
 Discussion and Conclusions: Almost two-thirds of our post-MVA patients reported MVA nightmares and their level of subjectively aversive impact correlated with most variables within the typical polytraumatic symptom pattern of these patients.

Validation of the Insomnia Severity Index on Patients Recovering from High Impact Car Accidents

Background: The Insomnia Severity Index (ISI) is widely used in clinical assessments of insomnia in patients injured in high impact motor vehicle accidents (MVAs). This study examines the criterion and convergent validity of ISI on this clinical population.
 Method: De-identified archival data were available on 112 post-MVA patients (37 men, 75 women, mean age 38.8 years, SD=13.1). They completed the ISI as well as the Brief Pain Inventory, the Rivermead Post-concussion Symptoms Questionnaire, the Subjective Neuropsychological Symptoms Scale (SNPSS), Items 10 to 12 of the Whiplash Disability Questionnaire (ratings of depression, anger, and of anxiety), Whetstone Vehicle Anxiety Questionnaire, Driving Anxiety Questionnaire (DAQ), Steiner’s Automobile Anxiety Inventory, and some of them also completed the PTSD Checklist for DSM-5 (PCL-5).
 The ISI responses were also available from a community sample of 21 controls (10 men, 11 women, mean age of 39.2 years, SD=18.5).
 Results: The mean ISI total score of post-MVA patients (23.6, SD=13.1) was significantly higher than the one of the controls (6.0, SD=5.4) and significant between groups differences in the same direction were also observed on all 7 individual ISI items: the magnitude of these underlying relationships ranged from Pearson point biserial r of 0.68 to 87. The ISI total score also significantly correlated with ratings of post-MVA pain, depression, generalized anxiety, scores on measures of the post-concussion and whiplash syndrome, PTSD, and on Whetstone’s and DAQ measures of post-MVA driving anxiety.
 Discussion and Conclusions: The results show an excellent level of criterion and convergent validity of ISI for clinical assessments of insomnia in post-MVA patients.

Validation of the PTSD Checklist for DSM-5 (PCL-5) on Patients Injured in Car Accidents

Background: The PTSD Checklist for DSM-5 (PCL-5), is presently the most widely used psychological measure of PTSD along the criteria of DSM-5. We examined the criterion validity of PCL-5 separately for each of its 20 items by comparing scores of patients injured in high impact motor vehicle accidents (MVAs) to scores of persons in a control group. In addition, we evaluated criterion and convergent validity of the PCL-5 total scores.
 Method: De-identified data of 80 post-MVA patients (mean age 38.9 years, SD=12.8) included their scores on the PCL-5, Brief Pain Inventory (BPI), Insomnia Severity Index (ISI), Rivermead Post-concussion Symptoms Questionnaire, Subjective Neuropsychological Symptoms Scale (SNPSS), ratings of depression, anger, and anxiety (Items 10 to 12 of the Whiplash Disability Questionnaire), and three questionnaire measures of driving anxiety (Steiner’s, Whetstone’s, and DAQ). The patients were assessed, on the average, 49.7 weeks (SD=36.3) after their MVA, but all still experienced active post-MVA symptoms requiring therapy.
 The PCL-5 scores were also available from 21 controls (mean age 43.0 years, SD=20.3).
 Results and Discussion: With respect to criterion validity of the PCL-5, the post-MVA patients differed significantly from the control group not only with respect to their total PCL-5 scores, but also on all 20 individual items of the PCL-5, and also on all 4 subscales of PCL-5 (Intrusion, Avoidance, Altered Cognitions/Mood, and Arousal). The PCL-5 total scores correlated significantly to all three measures of post-MVA driving anxiety, post-MVA pain and insomnia, post-MVA depression, anger, and generalized anxiety, and to post-MVA subjective neuropsychological symptoms in the post-concussion and whiplash spectrum.
 Conclusions: Both the criterion and convergent validity of the PCL-5 for the use on post-MVA patients are excellent.

Neuropsychological Correlates and Frequency of Tinnitus in Patients Injured in Motor Vehicle Accidents

Background: There is a lack of data on the frequency and neuropsychological correlates of tinnitus in distinct clinical populations such as persons injured in high impact motor vehicle accidents (MVAs).
 Method: Tinnitus severity and frequency were analyzed statistically in de-identified data of 106 post-MVA patients (mean age=39.5, SD=13.1; 31 males and 75 females). Correlations of tinnitus to the patients’ scores on the Rivermead Post-Concussion Symptoms Questionnaire, Subjective Neuropsychological Symptoms Scale (SNPSS), Brief Pain Inventory, Insomnia Severity Index, PTSD measure (PCL-5), and to ratings of depression, anger, and anxiety on the Whiplash Disability Questionnaire were evaluated. The patients were interviewed an average of 53.6weeks (SD=39.9) after their MVA; all continued to suffer from post-MVA symptoms requiring therapy.
 Results: Tinnitus was reported by 70 of the 106 post-MVA patients (66%). Slightly less than a half of the 70 rated their tinnitus as “frequent” or “persistent” and slightly more than a half as “occasional.”
 With respect to Rivermead and SNPSS items, the severity and frequency of tinnitus correlated significantly (at p<.01, 2-tailed) with oversensitivity to light, restlessness, word finding difficulty, hand tremor, stutter, and instances of reduced muscular control over hand or arm (rs ranging from .28 to .37). Tinnitus severity correlated also with tingling in the limbs (r=.31), and with impaired balance (r=.28). Tinnitus frequency correlated also with difficulty articulating words (r=.28). Tinnitus also significantly correlated with ratings of pain and of insomnia (rs ranging from .26 to .32), but not with variables such as PTSD, depression, or anxiety.
 Discussion and Conclusions: Tinnitus is correlated with some aspects of whiplash trauma and the post-concussion syndrome. However, the size of these relationships is rather weak.

Intervention with an educational video after a whiplash trauma - a randomised controlled clinical trial.

Background and aims Previous systematic reviews have considered that providing patient information is ineffective for patients with whiplash-associated disorders (WAD), with the exception of interventional educational videos. The aim of this randomised controlled clinical trial was to determine if use of an educational video as an intervention in the acute stage after a whiplash injury might improve self-reported recovery at 6 months after the injury. Methods In total, 289 consecutive patients with a whiplash injury following a motor vehicle collision were randomised to an intervention group (educational video) or to a control group (written information sheet). The video focused on information about pain mechanisms, deep flexor physiotherapy and reassurance. Emailed questionnaires were used to collect baseline data within 2 weeks after the accident and then to collect outcome data at 6 months post-injury. Non-responders were followed up with a brief telephone interview regarding the outcome. The primary outcome measure was self-reported recovery (yes/no) at 6 months post-injury. The secondary outcomes measures were pain level according to a numeric rating scale (NRS) and the whiplash disability questionnaire (WDQ) score at the same time point. Results The response rate for the baseline questionnaire was 70% (203/289). The follow-up rate was 97% (196/203). The non-recovery rates were similar between the intervention group, at 37.9% (39/103), and the control group, at 33.3% (31/93) (p = 0.55). No differences between the groups were noted in pain levels, NRS scores (1.9 vs. 2.2, p = 0.35) or the mean WDQ scores (17.5 vs. 21.2, p = 0.42). Conclusions The intervention with the educational video used in this study had no effect on the non-recovery rate when compared to a basic written information sheet. Implications The results of this trial add knowledge to the area of patient education for patients with acute WAD. Further studies are needed before the current recommendations for patient information are modified.

Spanish Version of the Whiplash Disability Questionnaire in Adults With Acute Whiplash-Associated Disorders

ObjectiveThe purpose of this study was to develop and validate a Spanish version of the Whiplash Disability Questionnaire (WDQ) for the Spanish population with acute whiplash-associated disorder (WAD). MethodsThis was a cross-sectional questionnaire validation study. Adults with acute WAD (grade I to III) were enrolled within 3 weeks of their injury. A blinded forward and back translation of the WDQ was made from English to Spanish, and the resulting back-translation version was compared with the original. Patients with WAD completed the Spanish version of the 13-item WDQ. The developed questionnaire was assessed using psychometric statistical analysis including correlation with the numerical rating score for pain, Northwick Park Neck Pain Questionnaire, Neck Disability Index, and 36-item Short Form Health Survey. ResultsFifty-six patients completed the questionnaire, the mean age was 33.9 years (standard deviation [SD] = 10.5), and 76.8% were women. Participants were enrolled 13.9 days (SD 4.9) after the injury, with 14.3% presenting with WAD grade I and 85.7% with WAD grade II. The mean WDQ score was 62 (SD = 31). Two factors were detected, and the factor structure remained stable after translation. Positive correlations were identified between the total WDQ score and the numerical rating score, Neck Pain Questionnaire, and Neck Disability Index results, with a strong negative correlation with the 36-item Short Form Health Survey. ConclusionThe Spanish version of WDQ is psychometrically reliable and a valid instrument to measure the disability status in patients with acute WAD within the clinic.

Reliability and validity of self-reported questionnaires to measure pain and disability in adults with neck pain and its associated disorders: part 3-a systematic review from the CADRE Collaboration.

To determine the reliability and validity of self-reported questionnaires to measure pain and disability in adults with grades I-IV neck pain and its associated disorders (NAD). We updated the systematic review of the 2000-2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders and systematically searched databases from 2005 to 2017. Independent reviewers screened and critically appraised studies using standardized tools. Evidence from low-risk-of-bias studies was synthesized according to best evidence synthesis principles. Validity studies were ranked according to the Sackett and Haynes classification. We screened 2823 articles, and 26 were eligible for critical appraisal; 18 were low risk of bias. Preliminary evidence suggests that the Neck Disability Index (original and short versions), Whiplash Disability Questionnaire, Neck Pain Driving Index, and ProFitMap-Neck may be valid and reliable to measure disability in patients with NAD. We found preliminary evidence for the validity and reliability of pain measurements including the Body Pain Diagram, Visual Analogue Scale, the Numeric Rating Scale and the Pain-DETECT Questionnaire. The evidence supporting the validity and reliability of instruments used to measure pain and disability is preliminary. Further validity studies are needed to confirm the clinical utility of self-reported questionnaires to assess pain and disability in patients with NAD. These slides can be retrieved under Electronic Supplementary Material.

Patient-Reported Outcome Measures Used for Neck Disorders: An Overview of Systematic Reviews.

The evaluation of patient-reported outcome measures for the neck from multiple systematic reviews will provide a broader view of, and may identify potential conflicting or consistent results for, their psychometric properties. The purpose of this study was to conduct an overview of systematic reviews and synthesize evidence to establish the current state of knowledge on psychometric properties of patient-reported outcome measures for patients with neck disorders. In this overview of systematic reviews, an electronic search of 6 databases (MEDLINE, Embase, CINAHL, ILC, the Cochrane Central Register of Controlled Trials, and LILACS) was conducted to identify reviews that addressed at least one measurement property of outcome measures for people with neck pain. Only systematic reviews with patient-reported outcome measures were included in the analysis. Risk of bias was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR). Data on measurement properties were extracted from each systematic review. From 13 systematic reviews, 8 patient-reported outcome measures were evaluated in 2 or more reviews. Risk-of-bias scores ranged from moderate (5-7) to high (4 and lower). Findings on internal consistency, test-retest reliability, construct validity, responsiveness to change, and content and structural validity were synthesized for the Neck Disability Index (NDI) in 11 systematic reviews; the Northwick Park Neck Pain Questionnaire and Neck Pain and Disability scale (NPDS) in 6 systematic reviews; the Copenhagen Neck Functional Disability Scale in 5 systematic reviews; the Neck Bournemouth Questionnaire in 4 systematic reviews; the Core Neck Pain Questionnaire and Patient-Specific Functional Scale in 3 systematic reviews, and the Whiplash Disability Questionnaire in 2 systematic reviews. High-quality evidence was found of good to excellent internal consistency and moderate to excellent test-retest reliability for the NDI. Moderate-quality evidence was found of good to excellent internal consistency and good test-retest reliability for the Northwick Park Neck Pain Questionnaire. High-quality evidence was found of excellent test-retest reliability and good to strong construct validity with pain scales for the Copenhagen Neck Functional Disability Scale. Moderate-quality evidence was found of unclear to excellent internal consistency and moderate to strong concurrent associations with the NDI and global assessment of change for the Neck Pain and Disability scale. Moderate-quality evidence was found of excellent internal consistency for the Whiplash Disability Questionnaire and of high test-retest reliability for the Patient-Specific Functional Scale. J Orthop Sports Phys Ther 2018;48(10):775-788. Epub 22 Jun 2018. doi:10.2519/jospt.2018.8131.

A Test-Retest Reliability Study of the Whiplash Disability Questionnaire in Patients With Acute Whiplash-Associated Disorders

ObjectiveThe purpose of this study was to determine the test-retest reliability and the Minimal Detectable Change (MDC) of the Whiplash Disability Questionnaire (WDQ) in individuals with acute whiplash-associated disorders (WADs). MethodsWe performed a test-retest reliability study. We included insurance claimants from Ontario who were at least 18years of age, within 21days of their motor vehicle collision and diagnosed as having acute WAD grades I to III. The WDQ, a 13-item questionnaire scored from 0 (no disability) to 130 (complete disability), was administered to all participants at baseline and by telephone 3days later. We computed the intraclass correlation coefficient (model 2,1) and the MDC with 95% confidence intervals (CIs; MDC95). ResultsThe mean (SD) age of the 66 participants was 41.6 (12.7) years and 71.2% were female. Twenty-nine percent had WAD I and 71.2% had WAD II. Time since injury ranged from 0 to 19 days. The mean (SD) baseline WDQ score was 49.3 (28.8) and 46.5 (29.8) 3days later. The intraclass correlation coefficient for the WDQ total score was 0.89 (95% CI, 0.85-0.92) in the entire sample and 0.83 (95% CI, 0.69-0.93) for the 15 participants reporting no change in neck pain. The MDC95 of the WDQ was 21.4 (SD = 14.9) for participants reporting no change. ConclusionThe WDQ was reliable in individuals with acute WAD. There is 95% confidence that a change of approximately one-sixth of the total score is beyond the daily variation of a stable condition. This level of measurement error must be taken into consideration when interpreting change in WDQ scores.

Structural and construct validity of the Whiplash Disability Questionnaire in adults with acute whiplash-associated disorders

Background contextFew instruments are available to measure disability associated with whiplash-associated disorders (WAD). The Whiplash Disability Questionnaire (WDQ) was developed to measure disability resulting from WAD, but its validity is unknown for acute WAD. PurposeThe aim was to determine the structural and construct validity of the WDQ in individuals with acute WAD. Study design/settingThis was a cohort study. Patient sampleOntario adults with WAD were enrolled within 3 weeks of their motor vehicle collision. Outcome measuresThe outcome measure was the WDQ. MethodsWe included insurance claimants who were aged 18 years or older and diagnosed with acute WAD Grades I to III. All participants completed the WDQ, a 13-item questionnaire scored from 0 (no disability) to 130 (complete disability). We assessed the factor structure of the WDQ and tested its construct validity against self-perceived recovery, neck pain (Numerical Rating Scale [NRS]), neck disability (Neck Disability Index [NDI] and Neck Bournemouth Questionnaire), health-related quality of life (36-Item Short Form Health Survey [SF-36]), and depressive symptoms (Center for Epidemiologic Studies Depression Scale [CES-D]). ResultsThe mean age of the 130 participants was 42.1 years (standard deviation [SD]=13.2), and 70% were women. Twenty-six percent had WAD I, 73.1% had WAD II, and 0.8% had WAD III. Mean time since injury was 6.5 days (SD=4.9). The mean WDQ score was 49.8 (SD=29.1). Our analysis suggested that the WDQ includes two factors: daily activities and emotional status. This factor structure remained stable in sensitivity analyses (eg, zeros imputed for missing values, and the item with the most missing values or resulting in complex loading excluded). Strong correlations were found between the total WDQ score and the NDI, the Bournemouth questionnaire, the SF-36 physical function, and the NRS (for the neck, shoulder, mid and low back pain) satisfying a priori hypotheses. We found a priori hypothesized moderate correlations between the WDQ, and the CES-D and SF-36 mental function. ConclusionsThe WDQ includes two factors and has strong construct validity in individuals with acute WAD. Our results demonstrate that the WDQ is valid for use as an overall summative scale or as the daily activities and emotional subscales in clinical and research settings to determine disability status.

Long-term Follow-up of Whiplash Injury of the Neck: 頸椎過度屈伸(揮鞭式)損傷的長期隨訪

BackgroundWhiplash injury has long-term sequelae, although little has been written about its long-term follow-up. The aim of the present study was to establish the factors affecting long-term outcome of whiplash injury. MethodsThis was a retrospective study in the public Russells Hall Hospital (Dudley, UK). Sixty-four patients who had whiplash injury of the neck due to road traffic accidents in 1995, 1996, and 1997 were recruited. All were treated with conservative means. Fifty-four patients replied. They were assessed using the Short Form 36 Health Survey (SF-36) and Whiplash Disability Questionnaire Score (WDQS). ResultsTwenty-two patients (40.7%) were still symptomatic 10 years after injury. Eighteen patients (33.3%) had pins and needles sensation in their limbs; 13 (24.1%) had frontal headache; and seven (13%) had occipital headache. The mean WDQS in patients with low back pain was 29.23 and 12.53 for those without back pain. In smokers, the mean WDQS was 32.2 compared with 17.93 in non-smokers. The mean WDQS in those who did not drink alcohol was 26.73 compared with 16.58 in those who drank alcohol. ConclusionWhiplash injury patients have long-term residual symptoms; mainly pins and needles sensation in their limbs, headache, and dizziness. Increasing age and low back pain are bad prognostic factors. Claiming compensation prolongs the time for recovery. Sex, body mass index, type of treatment, smoking, and alcohol have no association with the incidence of persistent symptoms. However, smoking had a significant worsening effect on the severity of the symptoms in patients with high WDQS. WDQS, SF-36 and time to symptom relief are sensitive outcome measures of these injuries.

Psychometric Properties of the German Version of the Whiplash Disability Questionnaire

Objective: For the management of whiplash-associated disorders the use of patient oriented disability questionnaires are of uppermost importance. The Australian whiplash disability questionnaire has a high content, face and constructs validity, and an excellent short- and medium-term reproducibility. However, until now no German version of this questionnaire is available. Aim: A cross-cultural adaptation of the whiplash disability questionnaire for a German-speaking population with ensured retention of psychometric properties such as validity and reliability of the translated version. Settings: Acute and chronic settings. Subject: A total of 75 patients (67 acute/8 chronic) and a control group of 177 asymptomatic volunteers were analyzed. Interventions: All participants completed the translated 13-item questionnaire as well as documented their current health state on a visual analog scale (VAShealth) and a general disability questionnaire (EQ-5D) for comparison. For test-retest reliability assessment 16 chronic patients and 25 healthy persons completed the questionnaire twice with an interval of 2 weeks. Main measures: Construct and concurrent validity and test-retest reliability. Results : The translated version showed no floor or ceiling effects, a high internal consistency (Cronbach’s alpha=0.95) and a very good inter-item correlation (rho=0.926). The concurrent validity testing using EQ-5D score as the reference showed a significant correlation to the whiplash disability questionnaire (overall rho=0.838, acute patients rho=0.749, chronic patients rho=0.876; p<0.001 each) and to the VAShealth (overall rho=-0.74, acute patients rho=-0.66, chronic patients rho=-0.65; p<0.001 each). The intra-class coefficient (0.969) indicated high short term reproducibility. Discussion : The German version of the whiplash disability questionnaire is valid and reliable as outcome measure for acute and chronic study settings.

German translation, cross-cultural adaptation and validation of the whiplash disability questionnaire.

BackgroundThe Australian Whiplash Disability Questionnaire (WDQ) was cross-culturally translated, adapted, and tested for validity to be used in German-speaking patients. The self-administered questionnaire evaluates actual pain intensity, problems in personal care, role performance, sleep disturbances, tiredness, social and leisure activities, emotional and concentration impairments with 13 questions rated on an 11-point rating scale from zero to ten.MethodsIn a first part, the Australian-based WDQ was forward and backward translated. In a consensus conference with all translators and health care professionals, who were experts in the treatment of patients with a whiplash associated disorder (WAD), formulations were refined. Original authors were contacted for clarification and approval of the forward-backward translated version. The German version (WDQ-G) was evaluated for comprehensiveness and clarity in a pre-study patient survey by a random sample of German-speaking patients after WAD and four healthy twelve to thirteen year old teenagers.In a second part, the WDQ-G was evaluated in a patient validation study including patients affected by a WAD. Inpatients had to complete the WDQ-G, the North American Spine Society questionnaire (NASS cervical pain), and the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) at entry in the rehabilitation centre.ResultsIn the pre-study patient survey (response rate 31%) patients rated clarity for title 9.6 ± 0.9, instruction 9.3 ± 1.4 and questions 9.6 ± 0.7, and comprehensiveness for title 9.6 ± 0.7, instruction 9.3 ± 1.4 and questions 9.8 ± 0.4. Time needed to fill in was 13.7 ± 9.0 minutes.In total, 70 patients (47 females, age = 43.4 ± 12.5 years, time since injury: 1.5 ± 2.6 years) were included in the validation study. WDQ-G total score was 74.0 ± 21.3 points (range between 15 and 117 points). Time needed to fill in was 6.7 ± 3.4 minutes with data from 22 patients. Internal consistency was confirmed with Cronbachs’s α = 0.89. Concurrent validity showed a highly significant correlation with subscale pain and disability (NASS) at r = 0.74 and subscale pain (SF-36) at r = 0.71.ConclusionsThe officially translated and adapted WDQ-G can be used in German-speaking patients affected by a WAD to evaluate patients’ impairments in different domains. The WDQ-G is a self-administered outcome measure showing a high internal consistency and good concurrent validity.

Predictive capacity of pain beliefs and catastrophizing in Whiplash Associated Disorder

IntroductionBeliefs about pain are known to be important factors in recovery, most notably in LBP. Relatively less is known about the role of pain beliefs in Whiplash Associated Disorder (WAD). The widely advocated cognitive-behavioural approach to pain management necessitates cognitive factors such as pain beliefs be examined, even early after injury. The primary purpose of this study was to explore the predictive capacity of early post-injury pain beliefs and catastrophizing in patients with WAD. MethodsPatients (n=72) undergoing treatment for acute WAD in physical therapy and chiropractic clinics were invited to participate in the study. Research participants were asked to complete measures of beliefs (Survey of Pain Attitudes (SOPA) and Pain Beliefs and Perception Inventory (PBPI)) and catastrophizing (Pain Catastrophizing Scale) at baseline (within 6 weeks of injury), and 3 and 6 months post-injury. In addition, pain severity and self-reported disability using the Whiplash Disability Questionnaire (WDQ) were recorded at each measurement occasion. Baseline belief and catastrophizing scores were examined for their relationship with future pain and disability using multiple linear regression. ResultsExpectancy beliefs (PBPI Permanence and SOPA Medical Cure) were negatively correlated with pain intensity at 6-months and uniquely accounted for 16% and 14% of explained variance, respectively, after controlling for baseline pain intensity, age, sex and history of WAD. Consistent with previous research, catastrophizing was also found to be predictive of future pain. The amount of unique variance explained by beliefs in the prediction of future disability was modest after controlling for baseline disability, age, sex and history of WAD. DiscussionThese results suggest that expectancy beliefs are potentially important constructs to include in future explanatory prognosis studies. The Medical Cure and Permanence subscales of the SOPA and PBPI are tools that could be used to measure these expectancy constructs.