Clinical assessment of prognostic factors for long-term pain and handicap after whiplash injury: a 1-year prospective study.
OBJECTIVE
Physical mechanisms are the possible factors involved in the development and maintenance of long-term handicaps after acute whiplash injury. This study prospectively examined the role of active neck mobility, cervical and extra-cervical pains, as well as non-painful complaints after a whiplash injury as predictors for subsequent handicap.


METHODS
Consecutive acute whiplash patients (n = 688) were interviewed and examined by a study nurse after the median of 5 days after injury, and divided into a high- or a low-risk group by an algorithm based on pain intensity, number of non-painful complaints and active neck mobility [active cervical range of motion (CROM)]. All 458 high-risk patients and 230 low-risk patients received mailed questionnaires after 3, 6 and 12 months. Two examiners examined all high-risk patients (n = 458) and 41 consecutive low-risk patients at median 11, 109, 380 days after injury. The main outcome measures were: handicaps, severe headaches, neck pain and neck disability.


RESULTS
The relative risk for a 1-year disability increased by 3.5 with initial intense neck pain and headaches, by 4.6 times with reduced CROM and by four times with multiple non-painful complaints.


CONCLUSIONS
Reduced active neck mobility, immediate intense neck pain and headaches and the presence of multiple non-painful complaints are the important prognostic factors for a 1-year handicap after acute whiplash.
Kasch
H
H
Danish Pain Research Center, Department of Neurology, Aarhus University Hospital, Aarhus, Denmark. Helge.Kasch@dadlnet.dk
Qerama
E
E
Kongsted
A
A
Bendix
T
T
Jensen
T S
TS
Bach
F W
FW
D000293:Adolescent; D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000293:injuries / Q000503:physiopathology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009334:Neck Muscles / Q000293:injuries / Q000503:physiopathology; D019547:Neck Pain / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D009460:Neurologic Examination / Q000379:methods; D010147:Pain Measurement / Q000379:methods; D010148:Intractable Pain / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013995:Time; D014911:Whiplash Injuries / Q000150:complications*; D055815:Young Adult; D021801:Zygapophyseal Joint / Q000293:injuries / Q000503:physiopathology