Assessment of Range of Movement, Pain and Disability Following a Whiplash Injury (original) (raw)
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European Journal of Neurology, 2008
Background and purpose: 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 extracervical pains, as well as non-painful complaints after a whiplash injury as predictors for subsequent handicap. Methods: 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 [active cervical range of motion (CROM)]. 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 injury. The main outcome measures were: handicaps, severe headaches, neck pain and neck disability. Results: 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 CROM and by four times with multiple non-painful complaints. Conclusion: 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.
Relationship between Pain and Neck Mobility in Patients with Grade II Whiplash Injury
The Medical Journal of Cairo University, 2019
Background: Patients with grade II whiplash injuries have physical signs of decreasing range of neck movement and palpable tenderness. Many patients with whiplash injury report diffuse symptoms of sensory disturbances and generalised muscle weakness. Whiplash injury has profound effects on both peripheral and central pain-processing mechanisms. Approximately 50% of subjects who sustain a whiplash injury will not recover but will continue to report ongoing pain and disability one year after the injury. Aim of Study: This study aimed to evaluate the correlation between pain and neck mobility in Egyptian patients with grade II whiplash injury. Subjects and Methods: Fifteen Egyptian patients with grade II whiplash injury from both genders were selected for this study. All the patients were assessed for pain by visual analogue scale and cervical range of motion by Cervical Range of Motion goniometer (CROM). Results: There is strong negative significant correlation between level of pain by Visual Analogue Scale (VAS) and neck bending to right and left only. Conclusion: There is negative correlation between level of pain and side bending to right and left in Egyptian patients with grade II whiplash injury.
Cervical Whiplash: Assessment, Treatment, and Impairment Rating
2000
Whiplash-associated disorder (WAD) refers to complaints attributed to a shearhyperextension then hyperflexion cervical injury, typically following a rearend motor vehicle collision (MVC). WAD is often challenging; and requires thoughtful assessment of diagnosis, causation, treatment, disability, maximal medical improvement, and impairment. Neck pain and headaches are common following motor vehicle collisions, but there is significant variation in the duration of symptoms. Research suggests chronic whiplash symptoms should be the exception rather than the rule; and most cases of WAD resolve without permanent impairment. Many factors influence the development of chronic whiplash symptoms including preexisting pathology (physical and/or psychological), the severity of the injury, individuals' expectations of pain and disability following a collision, cultural influences, and psychosocial stressors. Clinical evaluation and treatment guidelines derived from the best scientific knowledge available have failed to alter the epidemic of chronic whiplash symptoms in the United States and other countries, probably because they focus on biological treatment of WAD, ignoring cultural, psychological, and sociological influences. Given the questionable nature of much of the treatment rendered for WAD, this article will discuss appropriate care of whiplash, and a progressive approach to management, followed by impairment evaluation. Clinical Perspective Each year 5.5 million people are injured in motor vehicle collisions in the United States 1 including 2.9 million whiplash injuries. 2 Most (78%) patients report symptoms at the scene 3 , with 93% becoming symptomatic within 15 hours. 4 Neck pain generally must be present for inclusion in any statistics or study on WAD. The next most common presenting complaint is headache (17-33%), followed by upper extremity pain (6-13%). 5 Constant symptoms are reported by 43%, while the remaining 57% report intermittent complaints. 6 Recovery from acute whiplash follows a predictable course, with the majority of uncomplicated WAD cases recovering in four to six weeks. 3, 7 However, there is significant variation in the prevalence of chronic
Journal of Rehabilitation Medicine, 2013
To study the presence of cervical motor dysfunctions in acute whiplash-associated disorders, evaluate their course and assess their predictive value for long-term recovery. Design: Systematic literature review. Methods: PubMed and Web of Science databases were used to select studies of the presence of cervical motor dysfunctions within the acute stage (< 6 weeks) after whiplash trauma and/or their predictive value for the development of chronic whiplash-associated disorders. Results: The presence of cervical motor dysfunctions in the acute stage after whiplash trauma was investigated in 4 cohorts. The course of cervical motor dysfunctions in whiplash-associated disorders was examined in 4 cohorts, and the predictive value on outcome 1 year post-whiplash trauma was assessed in 3 cohorts. Reduced cervical mobility, disturbed kinaesthesia, and altered muscle activity were found in the acute stage, and these persisted over time in the moderate/severe group. The predictive value of examining the presence of cervical motor dysfunctions was doubtful. The course and predictive value of initial reduced cervical mobility was inconsistent. Conclusion: Cervical motor dysfunctions are present soon after whiplash trauma persisting in those with moderate/ severe symptoms. However, these dysfunctions have limited predictive value, and hence may not explain the complex clinical picture of whiplash-associated disorders. This systematic review highlights the need for differentiating between patients with acute whiplash-associated disorders taking into account the biopsychological framework.
Long-term Follow-up of Whiplash Injury of the Neck
Journal of Orthopaedics, Trauma and Rehabilitation, 2013
Background Whiplash injury has long-term sequelae, although little has been written about its long-term follow-up. The aim of the present study was to establish the factors affecting long-term outcome of whiplash injury. Methods This was a retrospective study in the public Russells Hall Hospital (Dudley, UK). Sixty-four patients who had whiplash injury of the neck due to road traffic accidents in 1995, 1996, and 1997 were recruited. All were treated with conservative means. Fifty-four patients replied. They were assessed using the Short Form 36 Health Survey (SF-36) and Whiplash Disability Questionnaire Score (WDQS). Results Twenty-two patients (40.7%) were still symptomatic 10 years after injury. Eighteen patients (33.3%) had pins and needles sensation in their limbs; 13 (24.1%) had frontal headache; and seven (13%) had occipital headache. The mean WDQS in patients with low back pain was 29.23 and 12.53 for those without back pain. In smokers, the mean WDQS was 32.2 compared with 1...
Prognostic factors in whiplash-associated disorders
International Journal of Rehabilitation Research, 2002
Whiplash-associated disorders (WADs) have become an increasing problem over the years and many authors have addressed the issue. The aim of the present study is to identify predictors for perceived disability and self-registered pain from a functional perspective, as well as to study the temporal evolution of patients' complaints. Eighty-three patients suffering from pain in the neck following acute whiplash injury were included in the study and they were consecutively monitored at three weeks, three months and one year after injury. The results suggest that a linear combination of sex, self-efficacy and WAD grade significantly explains 24% of the variation observed in pain intensity at the one-year follow-up, whereas a linear combination of self-efficacy, sex and age significantly explains 36% of the variation observed in disability at the one-year follow-up. Five per cent of the patients were non-symptomatic at the first monitoring occasion and 16% at the one-year follow-up. It is concluded that WAD patients' self-efficacy at an early stage after whiplash injury significantly predicts the temporal development of pain intensity and disability. It may therefore be suggested that patients' confidence in performing daily activities should be reinforced in order to optimize treatment after whiplash injury.