title: Multidimensional associative factors for improvement in pain, function, and working capacity after rehabilitation of whiplash associated disorder: a prognostic, prospective outcome study.
abstract: BACKGROUND
  Whiplash associated disorders (WAD) have dramatic consequences for individual and public health. Risk factors for better and worse outcomes are important to optimize management. This study aimed to determine short- and mid-term associative co-factors of neck pain relief, improved physical functioning, and improved working capacity (dependent variables) in patients suffering from whiplash associated disorder who participated in a standardized, inpatient pain management program.
  
  
  METHODS
  Naturalistic, observational, prospective cohort study. Outcome was measured by standardized assessment instruments. Co-factors covered sociodemographics, comorbidities, social participation, affective health, and coping abilities. Stepwise, multivariate linear regression analysis was performed at discharge and at the 6-month follow-up.
  
  
  RESULTS
  All regression models explained high proportions of variance (53.3% - 72.1%). The corresponding baseline level was significantly associated with a change in every dependent variable (explained variances: 11.4%-56.7%). Pain relief significantly depended on improved function and vice-versa (3.4%-14.8%). Improved ability to decrease pain was associated with pain relief at discharge (9.6%). Functional improvement was associated with decreased catastrophizing (19.4%) at discharge and decreased depression (20.5%) at the 6 month follow-up.
  
  
  CONCLUSIONS
  Pain relief, improved physical function and working capacity were associated with each other. Improved coping (catastrophizing and ability to decrease pain) and reduced depression may act as important predictors for pain relief and improved function. These findings offer toe-holds for optimized therapy of chronic WAD.
authors.affiliation: Rehabilitation Clinic "RehaClinic", Bad Zurzach, Switzerland. fangst@vtxmail.ch.
authors.forename: Felix
authors.initials: F
authors.lastname: Angst
authors.forename: Andreas R
authors.initials: AR
authors.lastname: Gantenbein
authors.forename: Susanne
authors.initials: S
authors.lastname: Lehmann
authors.forename: Françoise
authors.initials: F
authors.lastname: Gysi-Klaus
authors.forename: André
authors.initials: A
authors.lastname: Aeschlimann
authors.forename: Beat A
authors.initials: BA
authors.lastname: Michel
authors.forename: Frank
authors.initials: F
authors.lastname: Hegemann
mesh_terms: D000223:Adaptation, Psychological; D058443:Catastrophization; D003131:Combined Modality Therapy; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000517:prevention & control / Q000523:psychology; D006801:Humans; D016014:Linear Models; D015999:Multivariate Analysis; D019547:Neck Pain / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010351:Patient Discharge; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014911:Whiplash Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D014938:Work Capacity Evaluation
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