To determine if an unselected group of rodeo athletes would report a more benign outcome to their motor vehicle whiplash injuries than a group of spectators at rodeo events.
This survey compares the self-reported outcome of motor vehicle collision whiplash injuries (neck and/or back sprain) in rodeo athletes and spectators attending rodeo events. Subjects were asked to recall motor vehicle collision experiences, the type of vehicle they were in, the presence of symptoms as a result, and outcomes for those symptoms.
Forty-seven percent of rodeo athletes and 59% of spectators recalled being in a motor vehicle collision. A total of 33% of rodeo athletes who had collisions recalled acute symptoms they associated with the collision compared to a recall of symptoms in 61% of spectators who had collisions. Vehicle types during collisions and occupation type at time of the survey were the same for both groups. Duration of symptoms, however, was 30 days (+/- 14 days) in rodeo athletes and 73 days (+/- 61 days) in spectators. None of the rodeo athletes recalled symptoms lasting for more than 60 days compared to 15% of spectators who had symptoms more than 60 days. Rodeo athletes took no more than 3 weeks off work, whereas among spectators, it was common to take more than 6 weeks off.
Rodeo athletes appear to be in at least as many motor vehicle collisions as rodeo spectators, and 33% suffered the acute whiplash syndrome. Rodeo athletes appear, however, to be more resistant than spectators to developing prolonged pain and disability.
General practitioners often need to track outcomes of whiplash patients, and a disability questionnaire may be useful.
Whiplash patients who attended primary care clinics in Edmonton, Canada were interviewed 3 months postcollision. Subjects were asked a global recovery question: "Do you feel you have recovered fully from your accident injuries?" Subjects then completed the Whiplash Disability Questionnaire (WDQ).
A total of 131 subjects participated. Of these, 52 (39.7%) reported that they felt they had recovered. Those who reported complete recovery had a mean WDQ score of 2.5 and those who reported they had not recovered had a mean WDQ score of 29.9. All who responded "yes" to the recovery question had a WDQ score below 13, while all those responding "no" to the recovery question had a WDQ score of 13 or more.
The WDQ as an outcome measure may be useful in clinical practice.
To investigate measurement properties of a practical test of cervical flexor endurance (CFE) in whiplash patients including inter-rater reliability, sensitivity to clinical change, criterion related validity against the Neck Disability Index (NDI), and discriminant validity for injured versus uninjured populations.
Two samples were recruited, 81 whiplash patients, and a convenience sample of 160 subjects who were not seeking treatment and met criteria for normal pain and range of motion. CFE was measured using a stopwatch while the subject, in crook lying, held their head against gravity to fatigue.
Inter-rater reliability in whiplash patients was in a range considered 'almost perfect' (Intraclass Correlation=0.96). CFE had greater inter-subject variability than the NDI or range of motion in any of three planes. However, the effect size for improvement in CFE over treatment was as large as the effect sizes for all of those measures. In multivariate regression, CFE changes accounted for changes on the NDI better than the three ranges of motion. CFE discriminated whiplash patients who were within six months of injury (n=71) from age and gender matched normals with high effect size (ES=1.5).
These findings provide evidence of reliability and validity for CFE measurement, and demonstrate that CFE detects clinical improvements. Variance on CFE emphasizes the need to consider inter-, and intra-subject standard deviations to interpret scores.
To evaluate the relation of the state of health before the accident and the significance of the symptoms reported soon after the injury to the situation 3 years after the injury. To evaluate the possibility of using simple validated questionnaires to predict long-term health problems after the injury.
A whiplash injury is generally benign in its natural course. However, some of the patients have diverse and prolonged symptoms. Although several prognostic factors have been suggested for the poor recovery, in most cases the factors leading to prolonged disability remain unclear.
In collaboration with traffic insurance companies, we gathered information of neck injuries that occurred in traffic accidents in Finland in 1998. After the insurance company received a notification of a neck injury and consent from the injured party to participate in the study, they sent the information to the research team. The first inquiry was sent to the patients as soon as possible. One- and three-year follow-up questionnaires were posted to those who responded to the first inquiry. A total of 144 persons returned the 3-year follow-up questionnaires and form the material of this study. RESULTS A poor state of health or frequent neck pain or headache before the accident did not have any significant relation to the poor outcome 3 years after the accident. The extent of neck pain and lower back pain reported soon after the accident was significantly associated to a poor outcome in the follow-up. The Neck Disability Index questionnaire was significantly related to the poor outcome after 3 years.
The subjective experience of a notably decreased level of activity because of the neck pain when supplemented by the enhanced score of Neck Disability Index questionnaire predicts well poor outcome in long-term follow-up and can be used as a tool to identify persons who are at risk to suffer long-term health problems after whiplash injury.
To determine whether pressure pain threshold (PPT), tested at 2 standardized sites, could provide additional prognostic ability to predict short-term outcomes in people with acute whiplash, after controlling for age, sex, and baseline pain intensity.
PPT may be a valuable assessment and prognostic indicator for people with whiplash-associated disorder. The extent to which PPT can predict short-term disability scores has yet to be explored in people with acute (of less than 30 days in duration) whiplash-associated disorder in a clinical setting.
Eligible patients were recruited from community-based physiotherapy clinics in Canada. Baseline measurements included PPT, as well as pain intensity, age, and sex. Neck-related disability was collected with the Neck Disability Index 1 to 3 months after PPT testing. Multiple linear regression models were constructed to evaluate the unique contribution of PPT in the prediction of follow-up disability scores.
A total of 45 subjects provided complete data. A regression model that included sex, baseline pain intensity, and PPT at the distal tibialis anterior site was the most parsimonious model for predicting short-term Neck Disability Index scores 1 to 3 months after PPT testing, explaining 38.6% of the variance in outcome. None of the other variables significantly improved the predictive power of the model.
Sex, pain intensity, and PPT measured at a site distal to the injury were the most parsimonious set of predictors of short-term neck-related disability score, and represented promising additions to assessment of traumatic neck pain. Neither age nor PPT at the local site was able to explain significant variance beyond those 3 predictors. Limitations to interpretation are addressed.
OBJECTIVE: To compare head relocation accuracy in traumatic (whiplash), insidious onset neck pain patients and asymptomatic subjects when targeting a natural head posture (NHP) and complex predetermined positions. DESIGN: A case-control study. SETTING: University-based musculoskeletal research clinic. PARTICIPANTS: Sixty-three volunteers divided into three groups of similar gender and age: Group 1 (n = 21) an asymptomatic group; group 2 (n = 20) insidious onset neck pain; group 3 (n = 22) a history of whiplash injury. INTERVENTION: Five randomly ordered tests designed to detect relocation accuracy of the head. OUTCOME MEASURES: A 3-Space Fastrak system measured the mean absolute relocation error of three trials of each relocation test. RESULTS: A significant difference was found between groups in one of the tests targeting the NHP (p = 0.001). Post-hoc pairwise comparisons revealed a significant difference (p
OBJECTIVE: To evaluate postural performance and head stabilization of patients with chronic neck pain. DESIGN: A single-blind comparative group study. SUBJECTS: Patients with work-related chronic neck pain (n = 9), with chronic whiplash associated disorders (n = 9) and healthy subjects (n = 16). METHODS: During quiet standing in different conditions (e.g. 1 and 2 feet standing, tandem standing, and open and closed eyes) the sway areas and the ability to maintain the postures were measured. The maximal peak-to-peak displacement of the centre of pressure and the head translation were analysed during predictable and unpredictable postural perturbations. RESULTS: Patients with chronic neck pain, in particular those with whiplash-associated disorders, showed larger sway areas and reduced ability to successfully execute more challenging balance tasks. They also displayed larger sway areas and reduced head stability during perturbations. CONCLUSION: The results show that disturbances of postural control in chronic neck pain are dependent on the aetiology, and that it is possible to quantify characteristic postural disturbances in different neck pain conditions. It is suggested that the dissimilarities in postural performance are a reflection of different degrees of disturbances of the proprioceptive input to the central nervous system and/or of the central processing of such input.
This multidisciplinary in-depth investigation of accidents using 24 occupants with neck symptoms shows the complexity of whiplash-associated disorders (WAD) in frontal impacts with respect to factors that influence occurrence as well as duration of symptoms. Several different occupant kinematics have been identified, all resulting in symptoms classified as WAD. Compared to occupants restrained only by a seat belt, occupants with arm resistance influence showed a greater representation of symmetrical neck symptoms. Two cases of unbelted occupants with a neck compression mechanism far from conventional "whiplash" motion were found. Posture as well as physical and psychosocial factors such as strong negative reactions, bad prognosis expectation, and stressed daily activities influenced the duration of symptoms. Occupant characteristics and sitting posture and behavior at the time of impact are important factors when analyzing and understanding WAD.