Recovery From Acute WhiplashWhiplash injuries have been around even before the car was invented. Modern studies are ongoing to find ways to prevent an acute injury from becoming a chronic pain condition. Keeping up with the latest research results is important for healthcare professionals treating these patients.
A group of scientists from the Back Pain Research Group (Australia) have reviewed recent data and findings on the course and prognostic factors of whiplash. They performed a systemic review and meta-analysis of all studies published through April 2007.
Of the thousands of studies done, 67 articles were selected for review. The authors were looking for ways to predict recovery rate following an acute whiplash injury. Alternately stated, they were trying to identify prognostic factors linked with poor recovery.
They chose studies that were of high quality. All studies focused on adults with neck pain present within six weeks of an automobile accident. Outcomes were measured by pain, disability, and recovery rates. Recovery was measured by the Neck Disability Index, pain levels, and asking the patients if they felt all better.
The authors found a wide range of results for rate of recovery. They suggested this was as a result of different ways studies defined, measured, and reported recovery and recovery rates. Overall, it looks like most people get better during the first three months after the accident. If they haven't improved by then, they are likely to become chronic pain patients.
Many prognostic factors were tested. These included age, gender, initial pain intensity, prior neck pain or headaches, and direction of impact. Other potential factors reviewed included psychologic distress (e.g., depression, anxiety), presence of neurologic symptoms, and social function. Coping strategies, quality of life, and fear avoidance behaviors were also assessed. All together, there were 42 possible factors tested for strength of association with prognosis.
The authors were unable to pin down the most important prognostic indicators of a poor recovery. The studies done had a wide variation in the ways the information was assessed and reported. The best they could tell, high levels of pain right after the accident is an indicator of poor recovery.
Psychologic factors such as anxiety and depression are likely important prognostic factors. Gender (male versus female) did not appear to be a factor. Older age and crash-related factors (direction, speed) were not related to recovery either.
Future studies are needed that consistently use quality methods and techniques of measures. It is advised that researchers use a validated instrument to measure recovery. The Quebec Task Force made this same recommendation more than 10 years ago when they did a systematic review of whiplash. They even listed measurement methods proven to be valid and reliable at that time.
For now, the results of this review suggest it looks like the early recovery period after a whiplash injury is very important. More successful treatment strategies to address this group of patients are needed.
Steven J. Kamper, et al. Course and Prognostic Factors of Whiplash: A Systematic Review and Meta-Analysis. In Pain. September 2008. Vol. 138. No. 3. Pp. 617-629.
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