Self-rated disability, fear-avoidance beliefs, nonorganic pain behaviors are important mediators of ranges of active motion in chronic whiplash patients

Abstract

As chronic whiplash sufferers perform ROM in a clinical examination, these ranges are importantly influenced by their self-perceived disability. Cervical nonorganic simulation signs can be helpful in distinguishing high from very high levels of disability and motion restriction. The lack of correlation with the TSK may present a challenge to the Fear Avoidance Model in whiplash. Implications for Rehabilitation Self-ratings of disability in chronic whiplash sufferers are influenced by their fear-avoidance beliefs. While self-ratings of disability are known to predict chronicity of whiplash, there is less known about how these ratings affect impairment assessment during recovery. This study shows that self-ratings of disability influence the presentation of impairment by chronic whiplash sufferers with respect to their ranges of neck motion. Signs of nonorganic behavior also influence ranges of motion and self-ratings of disability. These findings should be incorporated into the interpretation of impairment findings in chronic whiplash sufferers in order to improve management.

Neural Correlates of Maladaptive Pain Behavior in Chronic Neck Pain – A Single Case Control fMRI Study

“…Evidence supports the avoidance component as one key element in chronicity, especially in low back pain (14). However, the situation in chronic neck pain is less clear (15) and the present data do not point to this kind of mechanism. The patient did not show fear, documented by a low score on the fear avoidance beliefs questionnaire (Table 1).…”

Perceived pain extent is associated with disability, depression and self‐efficacy in individuals with whiplash‐associated disorders

“…There is clear evidence that psychological factors are associated with increased risk of developing chronic pain and these may include depression, anxiety, pain catastrophizing and fear avoidance beliefs (Chou and Shekelle, ; Sullivan et al., ; Thomas et al., ). Psychological status is an important factor for the prognosis of patients with WAD (Carstensen et al., ; Myrtveit et al., ; Sterling et al., ; Williamson et al., ) and psychological factors can mediate physiological changes and function in chronic WAD (Carriere et al., ; Vernon et al., ). The current results suggest that widespread pain drawn on a body chart may alert the clinician to consider more specific psychological screening, particularly for depression and self‐efficacy, in patients with WAD to evaluate the need of targeted interventions that address psychological health.…”

Establishing clinically meaningful severity levels for the Tampa Scale for Kinesiophobia (TSK‐13)

“…Higher scores have also been found to be associated with poorer physical performance on a variety of objective measures, including lifting (Vlaeyen et al., ; Swinkels‐Meewisse et al., ), walking (Doury‐Panchout et al., ), stair climbing (Nijs et al., ), strength production (Trost et al., ) and range of motion (Vaisy et al., ). However, other studies have found no, or only very weak, relationships between TSK scores and performance variables (Reneman et al., ; Demoulin et al., ; Vernon et al., ; Demirbüken et al., ).…”