title: Prognostic factors for poor recovery in acute whiplash patients.
abstract: The objective of our prospective inception cohort study was to identify prognostic factors for poor recovery in patients with whiplash-associated disorders grade 1 or 2 who still had neck pain and accompanying complaints 2 weeks after the accident. The study was carried out in a primary health care setting in The Netherlands and included 125 patients. The primary outcome measure was functional recovery defined in terms of neck pain intensity or work disability without medication use. The secondary outcome measures included neck pain intensity, work disability and sick leave. The outcomes were assessed at 4, 12 and 52 weeks after the accident. Prognostic factors were identified by logistic regression analyses. One year after the injury, 64% of the patients were recovered. Factors related to poor recovery were female gender, a low level of education, high initial neck pain, more severe disability, higher levels of somatisation and sleep difficulties. Neck pain intensity and work disability proved to be the most consistent predictors for poor recovery. The accuracy of the predictions of the prognostic models was high, meaning that the models adequately distinguished patients with poor recovery from those regarded as recovered. These findings add to the growing body of evidence, indicating that socio-demographic, physical and psychological factors affect short- and long-term outcome after whiplash injury. Our findings also indicate that care providers can easily identify patients at risk for poor recovery with a visual analogue scale for initial pain intensity and work-related activities.
authors.affiliation: Department of Epidemiology, Maastricht University, Maastricht, The Netherlands Department of Research and Development, Dutch Institute of Allied Health Care, Amersfoort, The Netherlands Department of General Practice, Institute for Research in Extramural Medicine, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands Center for Quality of Care Research, University Medical Center, Catholic University of Nijmegen, Nijmegen, The Netherlands Department of General Practice, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Erik J M
authors.initials: EJM
authors.lastname: Hendriks
authors.forename: Gwendolijne G M
authors.initials: GGM
authors.lastname: Scholten-Peeters
authors.forename: Daniëlle A W M
authors.initials: DAWM
authors.lastname: van der Windt
authors.forename: Catharina W M
authors.initials: CWM
authors.lastname: Neeleman-van der Steen
authors.forename: Rob A B
authors.initials: RAB
authors.lastname: Oostendorp
authors.forename: Arianne P
authors.initials: AP
authors.lastname: Verhagen
mesh_terms: D000208:Acute Disease; D000328:Adult; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019547:Neck Pain / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*; D010353:Patient Education as Topic; D026741:Physical Therapy Modalities; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome; D014911:Whiplash Injuries / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*