Prognosis after whiplash injury: where to from here? Discussion paper 4

Abstract

Study Design. Nonsystematic review and discussion of prognosis after whiplash injury. Objective. To summarize the research and identify a research agenda for improving prognostic models after whiplash injury. Summary of Background Data. With up to 50% of individuals failing to fully recover after whiplash injury, the capacity to determine a precise estimate of prognosis will be important. Systematic reviews note inconsistencies and shortcomings of research in this area. Methods. A nonsystematic review and discussion. Results. Most prognostic whiplash studies are phase 1 (exploratory) studies with few confirmatory or validation studies yet available. It is recognized that whiplash is a heterogeneous condition and clinicians require prognostic indicators for clinical use. Although the evidence is not sufficiently strong to make firm recommendations, there are some prognostic factors that have shown consistency across studies and could be considered as preliminary flags or guides to gauge patients potentially at risk of poor recovery. These include pain and/or disability levels, neck range of movement, cold and mechanical hyperalgesia and psychological factors of recovery beliefs/expectations, post-traumatic stress symptoms, depression, and pain catastrophizing. It is not known whether these factors can be modified or whether modification will improve outcomes, thus they should not be considered directives for management. Research priorities identified to develop improved predictive models include confirmation and validation of factors identified in phase 1 studies; investigation of the interaction between variables; investigation of the predictive value of changes in variables over time; the inclusion of validated outcomes including measures of pain and disability as well as perceived recovery and psychological outcomes. Conclusion. The current evidence is not sufficiently robust to be able to confidently predict outcome after whiplash injury. A preliminary set of consistent factors has been proposed to assist clinicians in identifying individuals at risk of poor recovery. Directions for the development of improved prognostic models are discussed.