Citation

Walton DM, Macdermid JC, Giorgianni AA, Mascarenhas JC, West SC, Zammit CA. J. Orthop. Sports Phys. Ther. 2013; 43(2): 31-43.

Copyright

(Copyright © 2013, Orthopaedic Section and Sports Physical Therapy Section of the American Physical Therapy Association)

DOI

10.2519/jospt.2013.4507

PMID

23322093

Abstract

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To update a previous review and meta-analysis on risk factors for persistent problems following whiplash secondary to motor vehicle accident (MVA). BACKGROUND: Prognosis in whiplash-associated disorder (WAD) has become an active area of research, perhaps owing to the difficulty in treating chronic problems. The previously published review and meta-analysis of prognostic factors included primary sources up to May 2007. Since that time more research has become available, and an update to that original review is warranted. METHODS: A systematic search of international databases was conducted with rigorous inclusion criteria focusing on studies published between May 2007 and May 2012. Articles were scored and data were extracted and pooled to estimate the odds ratio for any factor that had at least 3 independent data points in the literature. RESULTS: Four new cohorts (n=1121) were identified. In combination with findings of a previous review, 12 variables were found to be significant predictors of poor outcome following whiplash, 9 of which were new (n = 2) or revised (n = 7) as a result of additional data. The significant variables included: high (>5.5 out of 10) baseline pain intensity, report of headache at inception, less than post-secondary education, no seat belt in use during the accident, report of low back pain at inception, high (>14.5 out of 50) Neck Disability Index (NDI) score, pre-injury neck pain, report of neck pain at inception (regardless of intensity), high catastrophizing, female sex, WAD grade 2 or 3, and WAD grade 3 alone. Those robust to publication bias included: High pain intensity, female sex, report of headache at inception, less than post-secondary education, high NDI score, and WAD grade 2 or 3. Three existing variables (pre-accident history of headache, rear-end collision, older age) and one additional novel variable (collision severity) were refined or added in this updated review but showed no significant predictive value. CONCLUSIONS: This review identified 2 additional prognostic factors and refined the estimates of 7 previously identified factors, bringing the total number of significant predictors across the two reviews to 12. These factors can be easily identified in a clinical setting to provide estimates of prognosis following whiplash. LEVEL OF EVIDENCE: Prognosis, level 1a.J Orthop Sports Phys Ther. Epub 14 January 2013. doi:10.2519/jospt.2013.4507.

Language: en