Citation

Elliott JM, Pedler AR, Theodoros D, Jull GA. J. Orthop. Sports Phys. Ther. 2012; 42(11): 912-918.

Copyright

(Copyright © 2012, Orthopaedic Section and Sports Physical Therapy Section of the American Physical Therapy Association)

DOI

10.2519/jospt.2012.4280

PMID

22951528

Abstract

STUDY DESIGN: Prospective. OBJECTIVE: To quantify the temporal development of MRI changes in oropharyngeal morphometry in subjects with varying levels of disability following a whiplash injury. BACKGROUND: A recent cross-sectional investigation has identified reductions in the size and shape of the oropharynx in subjects with chronic whiplash related disability when compared to healthy controls. The temporal development of such changes and their relationship to persistent disability has yet to be investigated. METHOD: 41 subjects with acute whiplash injury were included. Repeated measures T1-weighted MRI was used to measure and compare cross-sectional area (CSA-mm2) and shape-ratios (SR) for the orophayrnx at 4 weeks, 3 months and 6 months post injury. Subjects were classified at 6-months using scores on the Neck Disability Index: recovered (< 8%), mild disability (10-28%) or moderate/severe disability (> 30%). The effects of time and group and the interaction effect of group by time on oropharynx morphometry (CSA, SR) were investigated using repeated measures linear mixed model analysis. Based on previous research findings, age, gender and Body Mass Index (BMI) were entered into the analyses as covariates. Where significant main or interaction effects were detected, pairwise comparisons were performed to investigate specific differences in the dependent variable between groups and within groups over time. RESULTS: There was a significant interaction effect for group by time for both the CSA and SR values. Age significantly influenced SR (p = 0.024) and Body Mass Index significantly influenced CSA (p = 0.001). There was no difference in CSA or SR across all groups at 4-weeks post injury. However, at 6-months, CSA was significantly different between the recovered group and the moderate-to-severe group (p = 0.001). The recovered group demonstrated a significant increase in CSA (p = 0.04) over time whereas the moderate-severe group significantly decreased (p = 0.01). At 6-months, the moderate-severe group had a reduced SR when compared to the mild group (p = 0.03). No differences in CSA or SR of the oropharynx were found between the mild and recovered groups throughout the study. CONCLUSION: Temporal reductions in CSA of the oropharynx occur following whiplash and only in those with moderate/severe symptoms at 6 months post-injury. Studies are planned to 1) better investigate the underlying mechanisms, 2) determine their relevance to functional recovery and production of voice following whiplash and 3) support the multidisciplinary assessment and management of these patients. J Orthop Sports Phys Ther, Epub 17 August 2012. doi:10.2519/jospt.2012.4280.

Language: en