title: Prognosis of patients with whiplash-associated disorders consulting physiotherapy: development of a predictive model for recovery.
abstract: BACKGROUND
  Patients with whiplash-associated disorders (WAD) have a generally favourable prognosis, yet some develop longstanding pain and disability. Predicting who will recover from WAD shortly after a traffic collision is very challenging for health care providers such as physical therapists. Therefore, we aimed to develop a prediction model for the recovery of WAD in a cohort of patients who consulted physical therapists within six weeks after the injury.
  
  
  METHODS
  Our cohort included 680 adult patients with WAD who were injured in Saskatchewan, Canada, between 1997 and 1999. All patients had consulted a physical therapist as a result of the injury. Baseline prognostic factors were collected from an injury questionnaire administered by Saskatchewan Government Insurance. The outcome, global self-perceived recovery, was assessed by telephone interviews six weeks, three and six months later. Twenty-five possible baseline prognostic factors were considered in the analyses. A prediction model was built using Cox regression. The predictive ability of the model was estimated with concordance statistics (c-index). Internal validity was checked using bootstrapping.
  
  
  RESULTS
  Our final prediction model included: age, number of days to reporting the collision, neck pain intensity, low back pain intensity, pain other than neck and back pain, headache before collision and recovery expectations. The model had an acceptable level of predictive ability with a c-index of 0.68 (95% CI: 0.65, 0.71). Internal validation showed that our model was robust and had a good fit.
  
  
  CONCLUSIONS
  We developed a model predicting recovery from WAD, in a cohort of patients who consulted physical therapists. Our model has adequate predictive ability. However, to be fully incorporated in clinical practice the model needs to be validated in other populations and tested in clinical settings.
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Box 210, Stockholm, SE-17177, Sweden. tony.bohman@ki.se
authors.forename: Tony
authors.initials: T
authors.lastname: Bohman
authors.forename: Pierre
authors.initials: P
authors.lastname: Côté
authors.forename: Eleanor
authors.initials: E
authors.lastname: Boyle
authors.forename: J David
authors.initials: JD
authors.lastname: Cassidy
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Carroll
authors.forename: Eva
authors.initials: E
authors.lastname: Skillgate
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D000367:Age Factors; D001416:Back Pain / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D003661:Decision Support Techniques; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019547:Neck Pain / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D020127:Recovery of Function; D012017:Referral and Consultation; D012307:Risk Factors; D012525:Saskatchewan; D012649:Self Concept; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014911:Whiplash Injuries / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D055815:Young Adult