Delayed recovery in patients with whiplash-associated disorders
Dufton JA et al. – Recovery in whiplash–associated disorder appears to be multifactorial with both medical and non–injury related factors influencing outcome.Methods
- Retrospective review of a large database of a national network of physiotherapy and rehabilitation service providers in Canada yielded 5581 individuals injured in motor vehicle collisions.
- Cases were grouped into 3 cohorts based on time lapsed between injury date and initial presentation.
- Acute (n=3075), early chronic (n=958) and chronic (n=1548) patient cohorts were compared regarding treatment outcome and relative distribution of 29 prognostic factors.
- Outcome was defined by a minimally important clinical change (10%) on a previously validated disability questionnaire between initial and discharge rehabilitation visits.
- Analysis demonstrated positive outcomes to be proportionally fewer in the chronic cohort (52.1%) relative to the early chronic (61.4%), which was in turn lower than the acute cohort (72.3%).
- Furthermore, individuals presenting with chronic pain were more likely to: be female; present with lower limb pain or nonorganic signs; have returned to work; have retained a lawyer; or have undergone previous spinal surgery, and were less likely to: present with neck or midback pain; live in Ontario or Nova Scotia; or have modified duties upon return to work.
- Acute, early chronic and chronic cohorts were also found to differ in the distribution of several other prognostic factors at initial clinical visit.