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Delayed recovery and chronic disability in patients with whiplash-associated disorders Dufton, John Andrew


Whiplash is a common injury after a motor vehicle collision resulting in significant pain and disability for those injured. The prognosis of these disorders is highly variable and difficult to predict and evidence suggests that both medical and external non-injury related factors are important in determining recovery. This study is an extensive exploratory analysis investigating the association between a number of personal, clinical, and non-injury related factors and delayed clinical improvement after soft-tissue injuries sustained in a motor vehicle collision. Data were collected shortly after injury ensuring each patient was enrolled in the study at a similar point of recovery, and the outcome was measured with a valid and reliable disability questionnaire. The source of the data was the clinical database from a national network of 48 Canadian physiotherapy and rehabilitation facilities. A cohort of 2185 adult patients from this database was assembled for analysis. Multivariate logistic regression analysis revealed eight predictors associated with delayed recovery as measured by a minimal clinical improvement: 1) older age, 2) female gender, 3) increasing lagtime between injury date and presentation for treatment, 4) initial pain location, 5) province of injury, 6) higher initial pain intensity, 7) lawyer retention, and 8) work status (currently working). The variable measuring increasing initial pain intensity interacted with both the lawyer retention and the work status variables. A model predicting early improvement was developed and validated. A secondary cross-sectional analysis of the acute and chronic whiplash population suggests that significant differences between these groups are apparent at 3 months and that the acute patient population should be analyzed separately from the chronic patient population. Researchers and clinicians in all jurisdictions should be cognizant of the potential for non-injury related factors to delay recovery, and aware of the interaction between the initial intensity of a patient's pain and other covariates when confirming these results.

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