Derivation of a clinical prediction rule to identify both chronic moderate/severe disability and full recovery following whiplash injury

Abstract

Recovery following a whiplash injury is varied: approximately 50% of individuals fully recover, 25% develop persistent moderate/severe pain and disability, and 25% experience milder levels of disability. Identification of individuals likely to develop moderate/severe disability or to fully recover may help direct therapeutic resources and optimise treatment. A clinical prediction rule (CPR) is a research-generated tool used to predict outcomes such as likelihood of developing moderate/severe disability or experiencing full recovery from whiplash injury. The purpose of this study was to assess the plausibility of developing a CPR. Participants from 2 prospective, longitudinal studies that examined prognostic factors for poor functional recovery following whiplash injury were used to derive this tool. Eight factors, previously identified as predictor variables of poor recovery, were included in the analyses: initial neck disability index (NDI), initial neck pain (visual analogue scale), cold pain threshold, range of neck movement, age, gender, presence of headache, and posttraumatic stress symptoms (Posttraumatic Diagnostic Scale [PDS]). An increased probability of developing chronic moderate/severe disability was predicted in the presence of older age and initially higher levels of NDI and hyperarousal symptoms (PDS) (positive predictive value [PPV]=71%). The probability of full recovery was increased in younger individuals with initially lower levels of neck disability (PPV=71%). This study provides initial evidence for a CPR to predict both chronic moderate/severe disability and full recovery following a whiplash injury. Further research is needed to validate the tool, determine the acceptability of the proposed CPR by practitioners, and assess the impact of inclusion in practice.

The rapid and progressive degeneration of the cervical multifidus in whiplash: A MRI study of fatty infiltration

“…22 While it was not the intent of this paper to validate the Australian CPR, 22 the results may be supportive, demonstrating a relationship between objective MRI findings of MFI and the CPR criteria. 22 Accordingly, this current study could be considered part of a recommended series of multi-cultural studies needed to 1) provide a preliminary validation of the CPR, and 2) replicate the findings of MFI in whiplash. 5 While the findings are intriguing, they must be interpreted with caution.…”

Recovery Pathways and Prognosis After Whiplash Injury

“…2,28 To our knowledge, there have been at least 10 statistically derived prognostic prediction tools for WAD (TABLE 2). 1,6,19,21,24,32,33,36,38,54 To ensure these statistically derived CPRs are not unique to the study population or do not reflect chance associations, validation is recommended with a unique population cohort. 2,28 Only 3 of these CPRs have begun the validation process.…”

“…37,38 This CPR analyzed 8 previously identified predictor variables for poor recovery from 262 individuals who participated in 2 prospective, longitudinal studies. A dual-pathway CPR was derived using the Neck Disability Index (NDI) as the outcome measure that predicted ongoing moderate/severe disability and also predicted full recovery.…”

The Traumatic Injuries Distress Scale: A New Tool That Quantifies Distress and Has Predictive Validity With Patient-Reported Outcomes

“…7 For WAD, Kasch and colleagues 15 have described a risk stratification screening tool that includes a wide range of variables, each of which has prognostic value. Ritchie and colleagues 20 have derived and validated a clinical prediction rule (CPR) to predict post-WAD recovery trajectory using Neck Disability Index score, age, and the Posttraumatic Stress Diagnostic Scale to categorize patients with acute WAD into risk groups. Other predictors of poor recovery identified through recent systematic reviews for acute WAD and LBP include high baseline pain intensity, elevated pain catastrophizing, elevated fearavoidance beliefs, radicular symptoms, and cold hypersensitivity.…”