Clinical assessment of prognostic factors for long term pain and handicap after whiplash injury: a 1-year prospective study
From: Eur J Neurol. 2008 Sep 18; [Epub ahead of print]
Physical mechanisms are the possible factors involved in the development and maintenance of long term handicaps after acute whiplash injury. This study prospectively examined the role of active neck mobility, cervical and extra-cervical pains, as well as non painful complaints after a whiplash injury as predictors for subsequent handicap. Consecutive acute whiplash patients (n = 688) were interviewed and examined by a study nurse after the median of 5 days after injury, and divided into a high or a low risk group by an algorithm based on pain intensity, number of non painful complaints and active neck mobility. All 458 high risk patients and 230 low risk patients received mailed questionnaires after 3, 6 and 12 months. Two examiners examined all high risk patients (n = 458) and 41 consecutive low risk patients at median 11, 109, 380 days after whiplash injury. The main outcome measures were: handicaps, severe headaches, neck pain and neck disability.
The relative risk for a 1 year disability increased by 3.5 with initial intense neck pain and headaches, by 4.6 times with reduced active neck mobility and by four times with multiple non painful complaints. Reduced active neck mobility, immediate intense neck pain and headaches and the presence of multiple non painful complaints are the important prognostic factors for a 1 year handicap after acute whiplash.
