Prognostic Value of the Quebec Classification of Whiplash-Associated Disorders

Hartling, Lisa; Brison, Robert J.; Ardern, Chris I.; Pickett, William

doi:10.1097/00007632-200101010-00008

Cited by 125 publications

(100 citation statements)

References 17 publications

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“…An example is Whiplash Associated Disorders (WAD), the myriad of signs and symptoms that result from a whiplash mechanism of injury [2], where patients are found to have ROM reduced by approximately 25% compared to asymptomatic populations [3,4]. ROM measurements have also demonstrated the potential for categorising patients who are at risk of a poor outcome following a whiplash injury [5,6].…”

Section: Introductionmentioning

confidence: 99%

Reproducibility of the cervical range of motion (CROM) device for individuals with sub-acute whiplash associated disorders

et al. 2011

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Purpose The objective of this study was to evaluate the reproducibility of the cervical range of motion device when measuring both active and passive range of motion in a group of individuals with sub-acute Whiplash Associated Disorders (WAD). Methods Participants were recruited as part of a large multi-centre Randomised Controlled Trial from UK emergency departments. Experienced research physiotherapists measured active and passive cervical spine movements in all directions. Both intra-and inter-observer reliability and agreement were assessed using the intraclass correlation coefficient, standard error of measurement and limits of agreement methods. Results Different groups of 39 and 19 subjects were included in the intra and inter-observer studies, respectively. The CROM device demonstrated substantial intraand inter-observer reliability and agreement for all the active and passive half-cycle movements (ICC range 0.82-0.99) with the exception of one (passive right lateral flexion for inter-observer; ICC 0.77). Conclusions The CROM device has proven to be a reproducible measurement method for a symptomatic WAD population using the measurement protocol described and can be used with confidence to differentiate individuals according to a single measurement.

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Section: Introductionmentioning

confidence: 99%

Reproducibility of the cervical range of motion (CROM) device for individuals with sub-acute whiplash associated disorders

et al. 2011

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“…Grades I and II which include only soft tissue injuries represent almost 90% of whiplash injuries and represent what is usually associated with the term WAD [22]. The incidence of WAD has increased rapidly during the last 20 years and is now estimated to be approximately 4 per 1,000 persons in Western countries [2,11,14,26].…”

Section: Introductionmentioning

confidence: 99%

Symptom profile of persons self-reporting whiplash: a Norwegian population-based study (HUNT 2)

2009

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The aetiology of chronic whiplash associated disorder (WAD) is unclear and the condition has been perceived both as a chronic pain disorder, based on the injury to the neck, and as a functional somatic disorder. Based on the hypothesis that chronic WAD should be perceived as a functional somatic syndrome, we compared the symptom profile of persons with chronic WAD with the profile of persons with a functional somatic disorder, and with the profile of persons with an organic pain disorder. A sample of 55,046 persons participating in a Norwegian population-based health study (HUNT 2) was divided into four study groups: chronic WAD, fibromyalgia, rheumatoid arthritis, and controls (none of these disorders). Symptoms were categorized as pain and stiffness, cardiopulmonary and gastrointestinal symptoms, and mental disorders. Odds ratios (ORs) with 95% confidence intervals (CIs) from logistic regression were used to compare the prevalence of symptoms among the groups. The chronic WAD group had a significantly higher prevalence of symptoms from all body parts, across organ systems and also mental symptoms, compared to the control group. The fibromyalgia group had an even higher prevalence of all symptoms, while the rheumatoid arthritis group showed an increase in the prevalence of particularly pain and stiffness symptoms and also a minor increase in the prevalence of other symptoms compared to the control group. We conclude that this study provide evidence in favour of the hypothesis that chronic WAD should be perceived as a functional somatic syndrome. Persons with chronic WAD had a symptom profile more similar to people with a functional somatic disorder than an organic pain disorder, consisting of a wide array of symptoms, not only predominantly pain symptoms.

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“…However, Berglund et al [2] concluded in their prospective study that cases without symptoms after rear end collisions (i.e., WAD grade 0) do not have an increased risk of developing chronic WAD. There was a high number of cases missing in the study by Hartling et al [12], increasing from 12% at the 6 month follow-up to 25% at 24 months.…”

Section: Discussionmentioning

confidence: 79%

“…All cases were examined and treated by the same doctor (J.K.) in a standardized fashion. In a report by Hartling et al [12] on 380 cases from two emergency departments in Ontario, Canada it was concluded that the Quebec classification was useful for predicting chronic WAD. In their study, the outcome was a non-validated pain score questionnaire based on a telephone interviews.…”

Section: Discussionmentioning

confidence: 99%

Neither the WAD-classification nor the Quebec Task Force follow-up regimen seems to be important for the outcome after a whiplash injury. A prospective study on 186 consecutive patients

2008

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A classification of injury and a follow-up schedule were proposed by the Quebec Task Force (QTF) in 1995. No general agreement about the clinical usefulness of the WAD-classification or of the suggested follow-up regimen exists. A series of 186 consecutive cases seen in the emergency room during the acute phase after a whiplash injury was prospectively studied for 1 year. All findings including history and physical findings were recorded using standardized QTF protocols. In one group follow-up visits were done according to the QTF regimen: at 1, 3, 6, 12 weeks and 1 year after the accident; in a control group no visit was scheduled. The outcome variable was neck pain at 1 year after the accident. After 1 year, 18% of the total number of patients had significant neck pain. Risk factors for chronic neck pain at 1 year after whiplash injury were: neck pain before the accident and a high degree of emotional distress at the time of the accident; both factors independently associated with a tenfold increased risk of developing chronic neck pain. Neither the WAD classification nor the QTF follow-up regimen could be linked to a better outcome. In this study the outcome was associated with patient-specific characteristics and not with physical signs of injury, the depth of the initial evaluation or the follow-up regimen.

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Prognostic Value of the Quebec Classification of Whiplash-Associated Disorders

Abstract: The analyses of this study support the use of the Québec Classification of Whiplash-Associated Disorders as a prognostic tool for emergency department settings, and the authors propose a modification of the Classification using a subdivision of the Grade II category.

Cited by 125 publications

References 17 publications

Reproducibility of the cervical range of motion (CROM) device for individuals with sub-acute whiplash associated disorders

Reproducibility of the cervical range of motion (CROM) device for individuals with sub-acute whiplash associated disorders

Symptom profile of persons self-reporting whiplash: a Norwegian population-based study (HUNT 2)

Neither the WAD-classification nor the Quebec Task Force follow-up regimen seems to be important for the outcome after a whiplash injury. A prospective study on 186 consecutive patients

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