title: Sick Leave within 5 Years of Whiplash Trauma Predicts Recovery: A Prospective Cohort and Register-Based Study.
abstract: BACKGROUND
  10-22% of individuals sustaining whiplash trauma develop persistent symptoms resulting in reduced working ability and decreased quality of life, but it is poorly understood why some people do not recover. Various collision and post-collision risk factors have been studied, but little is known about pre-collision risk factors. In particular, the impact of sickness and socioeconomic factors before the collision on recovery is sparsely explored. The aim of this study was to examine if welfare payments received within five years pre-collision predict neck pain and negative change in provisional situation one year post-collision.
  
  
  RESULTS
  719 individuals with acute whiplash trauma consecutively recruited from emergency departments or primary care after car accidents in Denmark completed questionnaires on socio-demographic and health factors immediately after the collision. After 12 months, a visual analogue scale on neck pain intensity was completed. 3595 matched controls in the general population were sampled, and national public register data on social benefits and any other welfare payments were obtained for participants with acute whiplash trauma and controls from five years pre-collision to 15 months after. Participants with acute whiplash trauma who had received sickness benefit for more than 12 weeks pre-collision had increased odds for negative change in future provisional situation (Odds Ratio (OR) (95% Confidence Interval (CI) = 3.8 (2.1;7.1)) and future neck pain (OR (95%CI) = 3.3 (1.8;6.3)), controlling for other known risk factors. Participants with acute whiplash trauma had weaker attachment to labour market (more weeks of sick leave (χ2(2) = 36.7, p < 0.001) and unemployment (χ2(2) = 12.5, p = 0.002)) pre-collision compared with controls. Experiencing a whiplash trauma raised the odds for future negative change in provisional situation (OR (95%CI) = 3.1 (2.3;4.4)) compared with controls.
  
  
  CONCLUSIONS
  Sick leave before the collision strongly predicted prolonged recovery following whiplash trauma. Participants with acute whiplash trauma had weaker attachment to labour market pre-collision compared with the general population. Neck pain at inclusion predicted future neck pain. Acute whiplash trauma may trigger pre-existing vulnerabilities increasing risk of developing whiplash-associated disorders.
authors.affiliation: The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Tina Birgitte Wisbech
authors.initials: TB
authors.lastname: Carstensen
authors.affiliation: The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Fink
authors.affiliation: The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Eva
authors.initials: E
authors.lastname: Oernboel
authors.affiliation: Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Helge
authors.initials: H
authors.lastname: Kasch
authors.affiliation: Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Troels Staehelin
authors.initials: TS
authors.lastname: Jensen
authors.affiliation: The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Lisbeth
authors.initials: L
authors.lastname: Frostholm
mesh_terms: D000063:Accidents, Traffic; D000368:Aged; D016022:Case-Control Studies; D003718:Denmark; D005500:Follow-Up Studies; D006801:Humans; D019547:Neck Pain / Q000209:etiology*; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries / Q000706:statistics & numerical data*; D012307:Risk Factors; D018582:Sick Leave / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014911:Whiplash Injuries / Q000150:complications*; D014947:Wounds and Injuries / Q000150:complications*