title: Mid-term follow-up of whiplash with Bournemouth Questionnaire: the significance of the initial depression to pain ratio.
abstract: BACKGROUND
  The Bournemouth Questionnaire (BQ) was used to report the short to mid-term outcome of a prospective cohort of patients who had sustained Whiplash Associated Disorder (WAD), and establish whether outcome could be predicted on initial assessment.
  
  
  METHODS
  One hundred patients with WAD grades I-III on the Quebec Task Force Classification were referred for physiotherapy (neck posture advice, initially practised under the direct supervision of a therapist). BQ scores were recorded on the first visit, at six weeks, then at final follow-up.
  
  
  RESULTS
  Seventy-six percent of patients were available at final follow-up, 58% women. The mean age was 43.2 years old and follow-up time 38 months (28-48). Symptoms plateaued after six weeks in the majority and improved gradually thereafter. When the individual BQ components on initial presentation were reassessed, patients who score disproportionately highly in BQ Question 5 (Depression) had a worse outcome. To quantify this, the ratio of BQ Questions 5 (Depression)/1 (Pain) was calculated. BQ5/1 ratio greater than 1 on initial presentation had an odds ratio of 2 for poor outcome (p= 0.02).
  
  
  CONCLUSIONS
  The BQ can therefore be used to identify patients with a disproportionately high depression score (BQ5) who are highly likely to clinically deteriorate in the medium term.
authors.affiliation: Bristol Royal Infirmary, Bristol, UK.
authors.forename: R K L
authors.initials: RK
authors.lastname: Griggs
authors.affiliation: The Treatment Network, Bristol, UK.
authors.forename: J
authors.initials: J
authors.lastname: Cook
authors.affiliation: Bristol Royal Infirmary, Bristol, UK.
authors.forename: M
authors.initials: M
authors.lastname: Gargan
authors.affiliation: Avon Orthopaedic Centre, Bristol, UK.
authors.forename: G
authors.initials: G
authors.lastname: Bannister
authors.affiliation: Bristol Royal Infirmary, Bristol, UK.
authors.forename: R
authors.initials: R
authors.lastname: Amirfeyz
mesh_terms: D000328:Adult; D003863:Depression / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014911:Whiplash Injuries / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology
keywords: Bournemouth Questionnaire; Whiplash Associated Disorders; depression; outcome; whiplash