Development of a symptom expectation questionnaire for whiplash injury

Background:Expectations and beliefs appear to be important predictors of outcome following whiplash injury.Instruments for measuring these expectations in the general population have not been well studied.The objective of this study was to develop a simple symptom expectation questionnaire for whiplash injury for use in future research studies. Methods:An existing database of 179 injury-naive subjects who completed a 56-item checklist of expected symptoms for whiplash injury was analyzed to determine which items could correctly identify an a priori case definition of an expecter(a subject who expected at least one of these symptoms would remain chronic following whiplash injury).A total of seven of the 56 items were found to be discriminatory.The identified, discriminatory items were then tested in additional subject groups against the original questionnaire. Results:From the original database of 179 subjects completing a 56-item symptom expectation checklist,119 expected at least one of the 56 symptoms would be chronic following whiplash injury.The 119 expecters.however,all chose at least one of seven items:headache,anxious or worried,depressed,neck pain,problems sleeping,back pain,or jaw pain.Using these seven items,in two new groups of subjects given the 56- item symptom expectation checklist and then a new shortened(7-item) symptom expectation checklist one week later(and the same done for another group of 100 subjects in reverse order),all those who endorsed one of the 56 symptoms as likely to be chronic following whiplash injury (expecters) could also be identified on the 7-item checklist. Conclusion:A shortened(7-item) symptom expectation checklist of commonly reported symptoms following whiplash injury(headache, anxious or worried,depressed,neck pain,problems sleeping,back pain,and jaw pain) correctly identifies subjects who expect at least one symptom will be chronic following minor head injury(i.e.,an expecter).This shortened(7-item) symptom expectation checklist can be used in future population-based studies to understand the prevalence of belief patterns and expectations for whiplash injury.

Evaluation of the test-retest repeatability of the Injury Severity Perception score in patients with acute whiplash-associated disorder

Objective： To determine the test retest repeatability of the Injttry Severity Perception （ISP） score in participants with acute whiplash-associated disorders （WADs）. Methods： Consecutive patients with WAD, presenting in the acute stage to a primary care center, were asked to complete the 1SP score. ISP was measured with a numerical rating scale that ranged from 0 to 10, on which subjects were asked to rate how severe （in terms of damage） they thought their injury was. The anchors were labeled ＂no damage＂ （0） and ＂severe, and maybe permanent damage＂ （10）. The ISP questionnaire was administered to the participants at the time of recruitment and again 7 days later. Repeatability was evaluated by calculating percentage agreement and Cohen kappa statistic between the two time points of measurement. Results： A total of 94 subjects （34 males, 60 females, mean age 40.6 ± 10.0 years, range 19-60 years） were included. The mean 1SP score was 4.9 ± 1.7 （range 2-9 out of 10） at the time of recruitment and 5.1 ± 2.1 （range 2-9 out of 10） 7 days later. The percentage agreement between the two repeat measures of the ISP was 86% and the kappa coefficient was 0.79. Conclusion： This study suggests that the test-retest repeatability for the ISP is high and that it is thus likely to have a low risk of classification bias in prognostic studies. The ISP likely has adequate reliability for use in epidemiological research of WADs.

Effect of a pain diary use on recovery from acute whiplash injury: a cohort study

Previously,it was shown that the use of a symptom diary for two weeks,even in generally healthy subjects,results in increased recall of daily symptoms and increased perception of symptom severity(Ferrari and Russell,2010).In that study,generally healthy female subjects were asked to recall symptoms experienced in the previous two weeks,after keeping a symptom diary for two weeks,while a control group was asked to recall symptoms experienced in the previous two weeks without having kept a symptom diary.While both groups had

Biomechanics of whiplash injury

Despite a large number of rear-end collisions on the road and a high frequency of whiplash injuries reported, the mechanism of whiplash injuries is not completely understood. One of the reasons is that the injury is not necessarily accompanied by obvious tissue damage detectable by X-ray or MRI. An extensive series of biomechanics studies, including injury epidemiology, neck kinematics,facet capsule ligament mechanics, injury mechanisms and injury criteria, were undertaken to help elucidate these whiplash injury mechanisms and gain a better understanding of cervical facet pain. These studies provide the following evidences to help explain the mechanisms of the whiplash injury: (1) Whiplash injuries are generally considered to be a soft tissue injury of the neck with symptoms such as neck pain and stiffness, shoulder weakness, dizziness, headache and memory loss, etc. (2) Based on kinematical studies on the cadaver and volunteers, there are three distinct periods that have the potential to cause injury to the neck. In the first stage, flexural deformation of the neck is observed along with a loss of cervical lordosis; in the second stage, the cervical spine assumes an S-shaped curve as the lower vertebrae begin to extend and gradually cause the upper vertebrae to extend; during the final stage, the entire neck is extended due to the extension moments at both ends. (3)The in vivo environment afforded by rodent models of injury offers particular utility for linking mechanics, nociception and behavioral outcomes. Experimental findings have examined strains across the facet joint as a mechanism of whiplash injury, and suggested a capsular strain threshold or a vertebral distraction threshold for whiplash-related injury,potentially producing neck pain. (4) Injuries to the facet capsule region of the neck are a major source of post-crash pain. There are several hypotheses on how whiplash-associated injury may occur and three of these injuries are related to strains within the facet capsule connected with events early in the impact. (5) There are several possible injury criteria to correlate with the duration of symptoms during reconstructions of actual crashes. These results form the biomechanical basis for a hypothesis that the facet joint capsule is a source of neck pain and that the pain may arise from large strains in the joint capsule that will cause pain receptors to fire.

Altered thermal sensitivity in facial skin in chronic whiplash-associated disorders

There is a close functional relationship between the jaw and neck regions and it has been suggested that trigeminal sensory impairment can follow whiplash injury.Inclusion of manageable routines for valid assessment of the facial sensory capacity is thus needed for comprehensive evaluations of patients exposed to such trauma.The present study investigated facial thermal thresholds in patients with chronic whiplash-associated disorders（WADs）with both a qualitative method and quantitative sensory testing（QST）.Ten women with pain and dysfunction following a whiplash injury were compared to 10 healthy age-matched women.Thermal detection thresholds were assessed by qualitative chair-side testing and by QST according to the method-of-limits.Seven test sites in the facial skin（overlying each trigeminal branch bilaterally,and the midpoint of the chin）were examined.The detection warm and cold thresholds were defined as the mean values of 10 individual thresholds.For the WAD patients,the qualitative assessment demonstrated both reduced and increased sensitivity compared to the healthy,whereas QST systematically showed significantly higher detection thresholds（i.e.,decreased sensitivity）for both cold and warm stimuli.For the individuals who were assessed as having increased sensitivity in the qualitative assessment,the QST displayed either normal or higher thresholds,i.e.,decreased sensitivity.The results suggest that QST is more sensitive for detecting thermal sensory disturbances in the face than a qualitative method.The impaired thermal sensitivity among the patients corroborates the notion of altered thermal detection capacity induced by WAD-related pain.

Correlation between self-reported recovery and central sensitization in whiplash patients

Central sensitization has been associated with chronic pain in whiplash patients.Methods:Consecutive whiplash patients were assessed at 3 months post-whiplash injury with the brachial plexus provocation test(BPPT)as a sign of central sensitization.Self-reported recovery was assessed by the response to the question ‘Do you feel you have recovered fully from your accident injuries?'Results:Sixty-nine subjects(32 males,37 females,age 37.5±13.0 years(mean±SD),range 18-71)were included.Of these,34 reported a lack of recovery,and 35 reported recovery at 3 months post-injury.The mean BPPT elbow extension(from 180°)was 41.5±23.0°,and the mean VAS score for the BPPT was 2.2 ± 1.2(out of 10).Those who reported recovery had a mean BPPT elbow extension angle of 25.1±15.8 while those who did not report recovery had a mean BPPT angle of 58.4 ± 15.9(P＜0.05).The visual analogue scale(VAS)score for recovered subjects was 1.8 ± 1.1 and 2.7 ± 1.1(P＜0.05)for non-recovered.There was a moderate correlation between self-reported recovery and BPPT elbow extension angle(-0.44)and a lower correlation between self-reported recovery and VAS score(-0.30).Conclusion:Self-reported recovery correlates well with a lower likelihood of signs of central sensitization.Copyright(c)2012,Shanghai University of Sport.Production and hosting by Elsevier B.V.All rights reserved.

New Concept of Whiplash Injuries Rehabilitation

Whiplash injuries are a global health problem and a significant financial burden for both health care systems,and insurance providers.The diverse symptomatology after whiplash injury both in the somatic,emotional and behavioral sphere prompted separation of the Whiplash Associated Disorders(WAD)as a separate category of diseases.The exact mechanism of whiplash injury is still under debate and theories explaining pathogenesis of WAD are very diverse ranging from purely biomechanical to neurophysiological,emphasizing central sensitization but the core disability seems to be strictly connected to somatosensory dysfunction.As a result,the optimal algorithm of rehabilitation has not been established and data published in the current literature on effectiveness of such algorithms are inconsistent.Based on the presented here of Head Neutral Reference Point(HNRP),the objective of central desensitization is to restore valid somatosensory output from Cranio-cervical Junction(CCJ).This new concept of rehabilitation after whiplash presented here is based on clinical observations and is supported by initial results.

A Reflection on the Management and Treatment of Cervical Spine Neuropathies with East Asian Medicine:Acupuncture

There is much material demonstrating the use of acupuncture and moxibustion as an effective method of treatment in a variety of neurological conditions involving both peripheral and central nervous system dysfunction. Acupuncture＇s effects are experienced throughout the body but specifically acupuncture can be seen to contribute significantly to nerve metabolism and rebuilding. However, very little is written on the mechanisms for this nerve recovery. This paper will reflect on these mechanisms in relation to the treatment of neck problems associated with nerve root impingement.