Psychological Factors in the Use of the Neck Disability Index in Chronic Whiplash Patients

Abstract

It appears that important psychological factors (fear avoidance beliefs and pain amplification) do have some influence on self-ratings of disability in chronic WAD sufferers. This does not appear to be larger than that found in studies of acute/subacute subjects. The influence of these factors may plateau fairly early in the post-WAD period. There is some evidence that the Pain Diagram may provide insight into nonorganic pain behavior.

The Relationship Between Self-Rated Disability, Fear-Avoidance Beliefs, and Nonorganic Signs in Patients with Chronic Whiplash-Associated Disorder

“…11 As such, NOS scores appear to be more useful in predicting concurrent NDI levels than the pain diagram.…”

“…In addition, both the NDI and the TSK are strong predictors of prognosis in WAD. 11,19,23,24 The relationship between FAB and another important construct in the biopsychosocial model-"nonorganic pain behavior"-has not received much attention. In the original work by Waddell et al, 25,26 a set of symptoms and signs was devised for use in low back pain patients to identify what they called nonorganic or abnormal pain behavior.…”

“…The NDI and the TSK appear to provide an appropriate composite standard against which to determine the validity of new measures relevant to the "biopsychosocial model" of WAD 11,19,23,24 by providing reliable and valid measures of self-reported disability and FAB. Therefore, we have undertaken to determine the construct validity of 9 standard nonorganic signs (NOSs) and 4 novel C-NOS simulation tests (C-NOSS) by investigating their use in the context of a single assessment of chronic whiplash patients by correlating NOS and C-NOSS scores with scores of self-rated disability (NDI), FAB (TSK), and pain severity as well as general and clinical demographics.…”

“…[4][5][6][7][8][9][10][11] One of these variables is "fearavoidance beliefs" (FAB). [11][12][13][14][15][16][17][18][19][20][21][22][23] When patients with WAD provide a self-rating of their sense of "disability" (by completing the Neck Disability Index [NDI]), their FAB scores, as measured by the Tampa Scale for Kinesiophobia (TSK), appear to contribute, along with pain severity, approximately one third of the variance of NDI scores. 11,23 There appears to be little difference between acute, subacute, and chronic patients in this correlation.…”

Utility of Pain Drawings Rated for Non‐Organic Pain in Chronic Low Back Pain Populations: A Qualitative Systematic Review

“…A large number of articles (53%) were eliminated because they did not include a sample of approximately half lumbar patients and, similarly, many articles (7%) had interesting information about pain drawing use, but did not include treatment. In particular, there were many articles on central sensitivity syndrome (CSS) disorders, including FM (Sipila, Zitting, Siira, Niinimaa, & Raustia, ; Strombeck, Manthorpe, & Jacobsson, ; Wigers, Skrondal, Finset, & Gotestam, ), migraine and tension headache (Broadbent, Niederhoffer, Hague, Corter, & Reynolds, ; Fraser, ; Mongini, Deregibus, Raviola, & Mongini, ; SchmidtHansen, Svensson, Bendtsen, GravenNielsen, & Bach, ), whiplash (Vendrig, van Akkerveeken, & McWhorter, ; Vernon, Guerriero, Kavanaugh, Soave, & Moreton, ), myofascial pain syndrome (Torres Lacomba, Mayoral del Moral, Coperias Zazo, Gerwin, & Goni, ), and interstitial cystitis (Tripp et al., ). The high prevalence of research studies utilizing pain drawings for assessment of CSSs lends further credence to the viewpoint that the terminology of non‐organic pain has morphed into the concept of central sensitization used today.…”