title: Cognitive determinants of pain and disability in patients with chronic whiplash-associated disorder: a cross-sectional observational study.
abstract: OBJECTIVE
  To delineate the relative extent to which specific cognitive factors are related to levels of pain and disability in patients with chronic whiplash-associated disorder.
  
  
  METHODS
  Cross-sectional observation study.
  
  
  METHODS
  Three secondary care physiotherapy departments in the Greater Manchester region of the UK.
  
  
  METHODS
  All patients with chronic whiplash-associated disorder referred to the participating departments were invited to take part in the study. In total, 124 patients were invited to participate, and 63 (51%) agreed to do so. Complete data were available for 55 (44%) of those invited to participate in the study.
  
  
  METHODS
  Pain and disability, as assessed by the Neck Disability Index.
  
  
  RESULTS
  Cognitive factors were strongly related to levels of disability (R(2) change=0.39, P<0.001). Specifically, greater catastrophising (beta=0.41, P<0.01) and lower functional self-efficacy beliefs (beta=-0.47, P<0.001) were significantly related to greater levels of disability. Significant univariate correlations were seen between the cognitive factors and current pain intensity. However, no significant associations were seen between the cognitive factors and current pain intensity in the multivariate analysis.
  
  
  CONCLUSIONS
  Interventions which aim to reduce catastrophising and enhance functional self-efficacy beliefs should be included alongside conventional physiotherapy interventions when treating patients with chronic whiplash-associated disorder.
authors.affiliation: Department of Physiotherapy, Pennine Acute Hospitals NHS Trust, North Manchester General Hospital, Crumpsall, Manchester M8 5RB, UK. david.thompson@pat.nhs.uk
authors.forename: Dave P
authors.initials: DP
authors.lastname: Thompson
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Oldham
authors.forename: Martin
authors.initials: M
authors.lastname: Urmston
authors.forename: Steve R
authors.initials: SR
authors.lastname: Woby
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000523:psychology*; D005239:Fear; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000523:psychology*; D020377:Self Efficacy; D012959:Socioeconomic Factors; D014911:Whiplash Injuries / Q000150:complications / Q000523:psychology*; D055815:Young Adult