title: Recovery in whiplash-associated disorders: do you get what you expect?
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Public Health Sciences, School of Public Health, and Alberta Centre for Injury Control and Research, University of Alberta, Edmonton, Alberta, Canada. lcarroll@ualberta.ca
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Carroll
authors.forename: Lena W
authors.initials: LW
authors.lastname: Holm
authors.forename: Robert
authors.initials: R
authors.lastname: Ferrari
authors.forename: Dejan
authors.initials: D
authors.lastname: Ozegovic
authors.forename: J David
authors.initials: JD
authors.lastname: Cassidy
mesh_terms: D000063:Accidents, Traffic; D000203:Activities of Daily Living; D000328:Adult; D001294:Attitude to Health; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D019547:Neck Pain / Q000209:etiology / Q000523:psychology* / Q000534:rehabilitation; D011379:Prognosis; D016016:Proportional Hazards Models; D012803:Sick Role; D016896:Treatment Outcome; D014911:Whiplash Injuries / Q000150:complications / Q000523:psychology* / Q000534:rehabilitation*