Multidimensional associative factors for improvement in pain, function, and working capacity after rehabilitation of whiplash associated disorder: a prognostic, prospective outcome study

Abstract

BackgroundWhiplash associated disorders (WAD) have dramatic consequences for individual and public health. Risk factors for better and worse outcomes are important to optimize management. This study aimed to determine short- and mid-term associative co-factors of neck pain relief, improved physical functioning, and improved working capacity (dependent variables) in patients suffering from whiplash associated disorder who participated in a standardized, inpatient pain management program.MethodsNaturalistic, observational, prospective cohort study. Outcome was measured by standardized assessment instruments. Co-factors covered sociodemographics, comorbidities, social participation, affective health, and coping abilities. Stepwise, multivariate linear regression analysis was performed at discharge and at the 6-month follow-up.ResultsAll regression models explained high proportions of variance (53.3% – 72.1%). The corresponding baseline level was significantly associated with a change in every dependent variable (explained variances: 11.4%-56.7%). Pain relief significantly depended on improved function and vice-versa (3.4%-14.8%). Improved ability to decrease pain was associated with pain relief at discharge (9.6%). Functional improvement was associated with decreased catastrophizing (19.4%) at discharge and decreased depression (20.5%) at the 6 month follow-up.ConclusionsPain relief, improved physical function and working capacity were associated with each other. Improved coping (catastrophizing and ability to decrease pain) and reduced depression may act as important predictors for pain relief and improved function. These findings offer toe-holds for optimized therapy of chronic WAD.

Exploring patients’ experiences of the whiplash injury-recovery process – a meta-synthesis

“…The codes in the perceived struggling with control category also suggest that there is a strong need for coping strategies that affect perceived control over pain and activities, as demonstrated previously. 33 …”

Prognostic Factors for Improvement in Pain and Disability after Multidisciplinary Rehabilitation in Patients with Chronic Neck Pain

“…Higher NASS baseline scores, re ecting more pain or disability of each dependent variable, were a strong predictor for better outcomes in all three regression models. This is a well-known phenomenon in studies of outcome predictors after multidisciplinary treatment of patients with chronic musculoskeletal pain (15,32). A regression toward the mean may have contributed to these associations, as patients with very poor baseline scores have more room to improve on a closed scale when compared to patients with better relative baseline scores (33).…”

“…Risk factors for neck pain include sociodemographic factors such as female gender (4,5), physical health factors including low endurance of neck extensor muscles (14), and psychological factors such as depression (14). Predictors for better pain relief after rehabilitation of CNP patients who had a previous whiplash injury are more pain at baseline, improvement in catastrophising coping strategies, and lower catastrophising at baseline, according to a cohort study with six months of follow-up (15). However, it remains unclear if the results are generalizable to CNP patients without previous whiplash injury.…”

Erratum to: multidimensional associative factors for improvement in pain, function, and working capacity after rehabilitation of whiplash associated disorder: a prognostic, prospective outcome study

“…After publication of this work [ 1 ], we became aware of some typing errors, missing data and ambiguities in the results and discussion.…”