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Test Can Predict Whether Whiplash Will Lead to Disability

A test of neck movement can predict which people with whiplash\r\ninjuries will be disabled a year later, according to a study by the Danish Pain Research Centre.

A test of neck movement can predict which people with whiplash injuries will be disabled a year later, according to a study published in the June 26 issue of Neurology.

The study also found that people who filed a lawsuit within a month after the accident were no more or less likely to be disabled after a year than people who did not seek legal action.

"This is interesting, because some studies have shown that litigation does influence recovery, and you would expect that pain and other problems would persist during an on-going lawsuit, but that''s not what we found," said study author and neurologist Dr. Helge Kasch of the Danish Pain Research Centre in Aarhus, Denmark.

Researchers also found that factors including the speed of the colliding cars and the age, sex or body mass index of the injured person could not predict whether they would be disabled.

The type of therapy first used after the accident did not influence patients'' long-term recovery. The test of how far the neck can move can predict future disability with 91 percent accuracy.

The prediction is even more accurate -- up to 94 percent -- by also factoring in the intensity of the pain and the number of other problems associated with the whiplash.

People with less neck movement, greater pain intensity and more other problems, such as dizziness, nausea and blurred vision, were more likely to be disabled a year after the accident.

"Now that we can identify which patients are most likely to become disabled, we can start researching which treatments are most likely to prevent that disability," said Kasch. "Unfortunately, there is currently no ''gold standard'' treatment to avoid disability."

The study involved 141 people with acute whiplash injuries. All had been involved in motor vehicle accidents with a rear car hit.

All had no loss of consciousness during the collision and no amnesia after the accident. All also contacted the local emergency unit within the first two days after the accident with neck pain or headaches.

People with previous neck or back pain or head injury and those with previous severe headache or widespread pain were not included in the study.

The researchers also examined 40 people with acute ankle injuries as a control group.

After one year, eight percent of those with whiplash injuries had not returned to their usual level of activity or work, and an additional 4 percent had returned to a modified job function. The majority had recovered after one month.

Whiplash occurs when acceleration and deceleration forces acting on the neck during a collision cause strain and sprain of soft tissue in the neck. Reports of long-term effects, known as late whiplash syndrome, have been controversial.

"Despite intensive research, it hasn''t been possible to show specific, pathological changes that could explain late whiplash syndrome," Kasch said. "This has raised the possibility that it is a stress-related disorder."

Kasch said this study suggests that the focus and attention on the injury and symptoms may play a role in the development of late whiplash syndrome.

"The people with ankle injuries started reporting whiplash-like symptoms such as headache, neck pain, shoulder-arm and low back pain after they had been asked several times whether they had these symptoms," he said.

A new multi-center study on treatment after acute whiplash injury is being conducted. This study examines the effect of different types of treatment in a randomized, double-blind controlled form.

by Virginia Sutcliffe

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