Outcome of ‘whiplash’ neck injury

doi:10.1016/S0020-1383(96)00114-3

Injury

Volume 27, Issue 9, November 1996, Pages 617-623

https://doi.org/10.1016/S0020-1383(96)00114-3 Get rights and content

Abstract

Psychological factors have been alleged to be important in the course and outcome of ‘whiplash’ neck injury but there is little quantitative evidence. This study uses quantitative methods involving a prospective interview assessment to describe psychological and quality of life predictors, and 3 and 12 month outcome. Consecutive attenders to the Accident and Emergency department of a teaching district hospital with a clinical diagnosis of ‘whiplash’ neck injury were included and there were follow-up interviews at home. Neck symptoms were recorded, and there was a standard mental-state interview with added questions about post-traumatic symptoms and a semi-structured interview for disability and consequences for quality of life. There was a wide individual variation in course and outcome; the majority of subjects complained of persistent neck symptoms and a sizeable minority reported specific post-traumatic psychological symptoms (intrusive memory, phobic travel anxiety), similar to those described by patients suffering multiple injuries. Social impairment, including effects on travel, were considerable in one-quarter. Reports of persistent neck symptoms were not associated with any baseline psychological variables or with compensation proceedings; psychological factors appeared to be more important in determining the extent of social impairment. We conclude that travel, social and psychological morbidity is substantially greater than previously recognized.

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Cited by (98)

Symptoms, disabilities, and life satisfaction five years after whiplash injuries
2014, Scandinavian Journal of Pain
Citation Excerpt :
On the other hand, the finding of a higher proportion of persons with neck pain in the present study than previously documented in the general population [59] and higher mean scores of symptoms reported by the participants in comparison with the control group, along with the use of validated instruments, makes it seem reasonable that the study describes the experienced situation five years after whiplash injury. Some previous studies have drawn attention to the problems with selection bias and that long term consequences of whiplash injuries vary with the patient population [11]. In contrast to studies based on patients with prolonged symptoms or patients having made claims to insurance companies, the present study was based on all whiplash cases that during one year attended the emergency room at the only medical trauma facility within a large geographical area with a well-defined population.
Chronic whiplash-associated disorders (WADs) are often associated with social functioning problems and decreased ability to perform previous activities. This may lead to decreased life satisfaction, which is insufficiently studied in the context of whiplash injuries. Symptoms included in chronic WAD are similar to symptoms frequently reported by persons who have sustained mild traumatic brain injury (MTBI)/concussion. In cases of MTBI, the severity and number of symptoms have been suggested to have a diagnostic value. The corresponding importance of symptoms in chronic WAD has not been documented. Most studies of whiplash injuries have focused on neck pain because this is the dominant complaint, while other symptoms are less studied. The frequency of long-term symptoms after whiplash injuries seems to vary. It is difficult to compare the long-term outcome since the follow-up after whiplash injury in most studies has been rather short. Therefore, the primary aim of this investigation was to study neck pain and other symptoms, disability, and life satisfaction five years after whiplash injury in a defined population and geographical area.
The study was carried out at a public hospital in northern Sweden and was a cross-sectional survey of patients five years after the injury event in a cohort of whiplash-injured patients. Five years after the emergency department visit, 186 persons aged 18–64 answered questionnaires on symptoms (Rivermead Post-Concussion Symptoms Questionnaire, RPQ), disabilities (Rivermead Head Injury Follow Up Questionnaire, RHFUQ), and life satisfaction (LiSat-11). The answers were compared to those of a comparison cohort.
The most common symptoms five years after whiplash injury were fatigue (41%), poor memory (39%), and headache (37%). Inability to sustain previous workload (44%) and fatigue at work (43%) were frequently reported disabilities. Only 39% were satisfied with their somatic health and 60% with their psychological health. Compared with healthy controls, the whiplash injured exhibited more symptoms and had lower life satisfaction. Women reported significantly higher pain intensity than men. Few significant differences between women and men regarding the other parameters were found.
This study shows that five years after a whiplash injury, patients reported symptoms that are typical of mild traumatic brain injury. Further, this study emphasizes the possibility of screening patients with chronic WAD for these symptoms as a complement to the assessment.
Untreated symptoms may negatively affect the outcome of pain rehabilitation. This implies that it might be clinically meaningful to quantify symptoms earlier in the rehabilitation process.
Do compensation processes impair mental health? A meta-analysis
2013, Injury
Citation Excerpt :
One study was excluded after contacting the authors because it turned out that the study measured mental health only once.2 Six studies were excluded because not all necessary data were provided in the article and the missing data were not retrieved after contacting the author.36–41 No additional articles were found after reference search.
Victims who are involved in a compensation processes generally have more health complaints compared to victims who are not involved in a compensation process. Previous research regarding the effect of compensation processes has concentrated on the effect on physical health. This meta-analysis focuses on the effect of compensation processes on mental health.
Prospective cohort studies addressing compensation and mental health after traffic accidents, occupational accidents or medical errors were identified using PubMed, EMBASE, PsycInfo, CINAHL, and the Cochrane Library. Relevant studies published between January 1966 and 10 June 2011 were selected for inclusion.
Ten studies were included. The first finding was that the compensation group already had higher mental health complaints at baseline compared to the non-compensation group (standardised mean difference (SMD) = −0.38; 95% confidence interval (CI) −0.66 to −0.10; p = .01). The second finding was that mental health between baseline and post measurement improved less in the compensation group compared to the non-compensation group (SMD = −0.35; 95% CI −0.70 to −0.01; p = .05). However, the quality of evidence was limited, mainly because of low quality study design and heterogeneity.
Being involved in a compensation process is associated with higher mental health complaints but three-quarters of the difference appeared to be already present at baseline. The findings of this study should be interpreted with caution because of the limited quality of evidence. The difference at baseline may be explained by a selection bias or more anger and blame about the accident in the compensation group. The difference between baseline and follow-up may be explained by secondary gain and secondary victimisation. Future research should involve assessment of exposure to compensation processes, should analyse and correct for baseline differences, and could examine the effect of time, compensation scheme design, and claim settlement on (mental) health.
Emergency department treatments and physiotherapy for acute whiplash: A pragmatic, two-step, randomised controlled trial
2013, The Lancet
Little is known about the effectiveness of treatments for acute whiplash injury. We aimed to estimate whether training of staff in emergency departments to provide active management consultations was more effective than usual consultations (Step 1) and to estimate whether a physiotherapy package was more effective than one additional physiotherapy advice session in patients with persisting symptoms (Step 2).
Step 1 was a pragmatic, cluster randomised trial of 12 NHS Trust hospitals including 15 emergency departments who treated patients with acute whiplash associated disorder of grades I–III. The hospitals were randomised by clusters to either active management or usual care consultations. In Step 2, we used a nested individually randomised trial. Patients were randomly assigned to receive either a package of up to six physiotherapy sessions or a single advice session. Randomisation in Step 2 was stratified by centre. Investigator-masked outcomes were obtained at 4, 8, and 12 months. Masking of clinicians and patients was not possible in all steps of the trial. The primary outcome was the Neck Disability Index (NDI). Analysis was intention to treat, and included an economic evaluation. The study is registered ISRCTN33302125.
Recruitment ran from Dec 5, 2005 to Nov 30, 2007. Follow-up was completed on Dec 19, 2008. In Step 1, 12 NHS Trusts were randomised, and 3851 of 6952 eligible patients agreed to participate (1598 patients were assigned to usual care and 2253 patients were assigned to active management). 2704 (70%) of 3851 patients provided data at 12 months. NDI score did not differ between active management and usual care consultations (difference at 12 months 0·5, 95% CI −1·5 to 2·5). In Step 2, 599 patients were randomly assigned to receive either advice (299 patients) or a physiotherapy package (300 patients). 479 (80%) patients provided data at 12 months. The physiotherapy package at 4 months showed a modest benefit compared to advice (NDI difference −3·7, −6·1 to −1·3), but not at 8 or 12 months. Active management consultations and the physiotherapy package were more expensive than usual care and single advice session. No treatment-related serious adverse events or deaths were noted.
Provision of active management consultation did not show additional benefit. A package of physiotherapy gave a modest acceleration to early recovery of persisting symptoms but was not cost effective from a UK NHS perspective. Usual consultations in emergency departments and a single physiotherapy advice session for persistent symptoms are recommended.
NIHR Health Technology Assessment programme.
Epidemiology of whiplash injuries
2012, Whiplash
The association of compensation on longer term health status for people with musculoskeletal injuries following road traffic crashes: Emergency department inception cohort study
2011, Injury
To compare the health status of people claiming compensation for injuries sustained in road traffic crashes (RTC), with people who do not claim compensation.
Prospective cohort study.
Australian Capital Territory, Australia and a fault based common law compensation scheme.
People presenting to the emergency department with mild to moderate musculoskeletal injury following RTC.
Physical Component Score (PCS) and Mental Component Score (MCS) of the Short Form 36 (SF-36) health status measure, Hospital Anxiety and Depression Scale (HADS) and the Functional Rating Index (FRI). These measures are recorded immediately post crash, at 6 and 12 months post crash.
95 people participated in the study and were enrolled a mean of 8.6 (median 8) days following the crash. 86% were followed up to 12 months after injury. Mean age was 37 years, 61% were female and 91% were employed at the time of their injury. 33% ultimately claimed compensation, and 25% engaged a lawyer.
There were no major differences in baseline personal characteristics or injury related factors between the groups. As expected, involvement as a passenger and in multiple vehicle crashes, were more frequent in the group claiming compensation.
Over the duration of the study claiming compensation was associated with lower SF-36 PCS (−5.5 (95%CI −8.6 to −2.4), p = 0.001), greater HADS-Anxiety (1.7 (95%CI 0.2–3.3), p = 0.048), and worse FRI (11.2 (95%CI 3.9–18.5), p = 0.003).
There was a highly significant improvement in health status between baseline and 6 months after injury, but no further significant change between 6 and 12 months after injury. There was no difference in rate of improvement between the groups.
Claiming compensation and psychological factors were independent predictors of worse health status at 12 months.
In this study the group claiming compensation had overall worse health status following mild to moderate musculoskeletal injuries over the course of the study. There was no difference in rate of improvement between the groups. However, it is not possible to determine whether this negative effect was due to claiming compensation itself or the presence of other unmeasured factors.
Epidemiology of Whiplash Injuries
2011, Whiplash: A Patient Centered Approach to Management

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PaperOutcome of ‘whiplash’ neck injury

Abstract

Injury

Injury

Neurol Clin

Lancet

Injury

J Psychosom Res

Behav Res Ther

Neck sprains after car accidents

Br Med J

Cervical whiplash injury

Whiplash injury: a reappraisal

J Neurol Neurosurg Psychiatry

Paper
Outcome of ‘whiplash’ neck injury