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Level of pain baseline and follow-ups for the compensated and non-compensated groups. n = responders in the compensated group. N = responders in the non-compensated group. Error bars: 95% CI
Source publication
Purpose:
The long-term outcome of Whiplash-associated disorder (WADs) has been reported to be poor in populations from medical settings. However, no trials have investigated the long-term prognosis of patients from medico-legal environment. For this group, the "compensation hypothesis" suggests financial compensation being associated with worsened...
Citations
... Consistent with the present study, some reports showed that the highest prevalence of accidents was related to the use of motorcycles. [3][4][5]22,23 Motorcycle riders turned out to be the victims of other vehicles, such as cars, as shown in Table 2, and those injuries had a longer recovery time. According to the National Road Safety Agency of Colombia, from 2021 to 2022 there were 12,062 people who suffered motorcycle accidents, representing 59.01% of the total number of traffic accidents. ...
Objective:
To prospectively determine injury recovery time in the medical-legal examinations of non-fatal injuries and their associated factors, carried out by the National Institute of Legal Medicine and Forensic Sciences of Colombia to create a multivariate analysis.
Methods:
A prospective medical-legal assessment of non-fatal injuries was carried out on 281 individuals with complete follow-up, in which the observational unit of analysis was the most serious injury. Variables, such as sex, circumstances of the injury, the mechanism that caused the injury, medical certificate of incapacity to work, among others were related to the injury recovery time, measured in days. The Kruskal Wallis (K-W) ANOVA and a multivariate analysis using the ordinal regression model were applied.
Results:
In the multivariate analysis, the factors most associated with longer recovery time were the extent of joint damage (CR95%:1.47-5.94,p = 0.0001) and bone damage (CR95%:2.92-7.42,p < 0.001). In terms of circumstances of the injury, traffic accidents (CR95%:1.03-2.96,p < 0.001), medical-legal impairments (CR95%:0.34-2.19,p = 0.007), and complications of the primary injury (CR95%: 1.18-2.57,p < 0.001) had the greatest impact on recovery time. Others factors that significantly impacted injury recovery time are surgical treatments (IC95%: 0.33-3.26,p = 0.0164) and delayed treatment (CR95%:1.41-4.72,p < 0.001). A direct correlation (significant and moderately strong) was found between the recovery time of the injury and the days of incapacity for work (r = 0.802, p < 0.001).
Conclusion:
This prospective analysis determined which variables were most strongly related to the medical-legal assessment of non-fatal injuries and the recovery time of said injuries. Further studies aimed at improving the strategies to help individuals complete the legal process are required.
... Whiplash-associated disorder (WAD) describes a spectrum of head and neck symptoms triggered by an accident with an acceleration-deceleration energy transfer including MVCs. 24 Consistent with the present findings, nonrecovery after whiplash injury has been associated with cervical degeneration seen in patients of older age, 25,26 ongoing litigation including worker's compensation cases, [27][28][29] and psychological factors such as ADHD. 30 Unique to this investigation, identified patients with severe neck symptoms and concussions had a higher incidence of reported motion sickness history and scored higher on concussion indices (CP screen, VOMS, and ImPACT). ...
Objective:
To examine the frequency and association of neck pain symptoms in patients with a concussion.
Study setting and participants:
Three-hundred and thirty-one consecutively enrolled patients aged 9 to 68 years with a diagnosed concussion 1 to 384 days post-injury were enrolled at a concussion clinic from a single integrated healthcare system in Western Pennsylvania between 2019 and 2021.
Design:
Retrospective cohort analysis of prospectively collected concussion screening tool intake survey responses and clinical outcomes data. The primary outcome was self-reported neck pain or difficulty with neck movement on the Concussion Clinical Profiles Screening (CP Screen) tool, recovery time, and incidence of treatment referral. Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) composite scores, Vestibular/Ocular Motor Screening (VOMS) item scores, type and severity of neck symptoms, mechanism of injury, time from injury to clinic presentation, medical history, and concussion symptom profile were secondary outcomes.
Results:
Of the 306 consecutively enrolled eligible patients in the registry, 145 (47%) reported neck pain, 68 (22.2%) reported difficulty moving their neck, and 146 (47.7%) reported either symptom. A total of 47 (15.4%) participants reported more severe neck symptoms, and this group took longer to recover (40 ± 27 days) than those not reporting neck symptoms (30 ± 28 days; U = 8316, P < .001). Stepwise logistic regression predicting more severe neck symptoms was significant (Nagelkerke R2 = 0.174, χ2 = 9.315, P = .316) with older age (P = .019) and mechanism of injury including motor vehicle collisions (MVCs) (P = .047) and falls (P = .044) as risk factors. MVCs and falls were associated with over 4 times and 2 times greater risk, respectively, for reporting more severe neck symptoms.
Conclusion:
Neck pain and stiffness symptoms are common in patients with a concussion following high-energy mechanisms of injury including MVCs or falls from height. These symptoms are associated with prolonged recovery. Providers should evaluate neck symptoms and consider targeted treatment strategies to limit their effects in patients with a concussion.
... [2,3] WAD often becomes chronic and incurs high financial costs. [4][5][6] Several studies have discussed the presence of mild spinal cord injuries (SCIs) in WAD patients. [7][8][9] The presence of SCI is important in determining the treatment for whiplash injury. ...
Increases in aging populations have raised the number of patients with cervical spinal cord injury (SCI) without fractures due to compression of the cervical spinal cord. In such patients, it is necessary to clarify whether SCI or cervical compressive myelopathy (CCM) is the cause of disability after trauma. This study aimed to clarify the differences in magnetic resonance imaging (MRI) features between SCI and CCM.
Overall, 60 SCI patients and 60 CCM patients with intramedullary high-intensity lesions on T2-weighted MRI were included in this study. The longitudinal lengths of the intramedullary T2 high-intensity lesions were measured using sagittal MRI sections. Snake-eye appearance on axial sections was assessed as a characteristic finding of CCM. The T2 values of the high-intensity lesions and normal spinal cords at the first thoracic vertebra level were measured, and the contrast ratio was calculated using these values.
The longitudinal length of T2 high-intensity lesions was significantly longer in SCI patients than in CCM patients. Snake-eye appearance was found in 26 of the 60 CCM patients, but not in SCI patients. On both the sagittal and axial images, the contrast ratio was significantly higher in the SCI group than in the CCM group. Based on these results, a diagnostic scale was created. This scale made it possible to distinguish between SCI and CCM with approximately 90% accuracy.
... It may also be assumed that whiplash subjects with a high degree of pain may be compensated more frequently. However, one study did not find any statistical association between the level of pain and compensation status (50). Instead, it found correlation between the relatively high levels of mental distress (not defined) and financial compensation (50). ...
... However, one study did not find any statistical association between the level of pain and compensation status (50). Instead, it found correlation between the relatively high levels of mental distress (not defined) and financial compensation (50). ...
Background
Anxiety, depression, post-traumatic stress disorder (PTSD), and sleep disturbance are reported following whiplash injury. However, the prevalence of these condition varies among studies. In this review, anxiety, depression, PTSD, and sleep disturbance will be referred as psychiatric outcomes.
Methods
We performed a systematic literature search on PubMed and Embase (from database inception until March 20, 2021) to identify studies reporting on the relative frequency of these psychiatric outcomes. Three independent investigators screened titles, abstracts and full-texts. Studies including patients with whiplash injury and where the number of patients with whiplash and anxiety, depression, PTSD, or sleep disturbances could be extrapolated, were included. Furthermore, to be included, studies had to defined psychiatric outcomes in accordance with diagnostic criteria [i.e., Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD)] or by use of a validated instrument with cut-off scores for assessing psychiatric symptoms. Quality rating was done using the Newcastle-Ottawa Scale (NOS) on the included studies. A protocol was registered with PROSPERO (CRD42021232037).
Results
The literature search identified 5,068 citations, of which five articles were eligible for inclusion. The relative frequency of depressive symptoms following whiplash injury was 32.8% at 6 months, and 34.0% at 6–12 months. The relative frequency of PTSD symptoms after whiplash injury was 9.0–22.3% at 3 months, 15.8% at 6 months and 14.6–17.1% at 12 months. No studies evaluating the relative frequency of anxiety and sleep disturbances were eligible for inclusion.
Discussion and Conclusion
Our results suggest that there are persistent psychiatric outcomes following whiplash trauma. However, we found considerable heterogeneity among the studies. Thus, we have focused on the most notable limitations of the included studies: 1) small sample sizes, 2) differences in enrollment criteria, 3) lack of control groups, 4) considerable variation in the method used for outcome assessment, 5) directionality of association is difficult to determine and 6) incomplete assessment of compensation factors. We highlight these methodological limitations and outline recommendations for future research. Since psychiatric outcomes are potentially modifiable, future studies should optimize and address the identified methodological limitations so psychiatric sequelae following whiplash injury may be prevented.
... In a subsequent cohort study of 210 Lithuanian motorists involved in MVCs conducted by Obelieniene and colleagues, the authors found no significant differences between motorists involved in rear end collisions and the control group concerning frequency and intensity of neck pain, and headache symptoms after one year. 117 Rydman et al. 118 offer further support for the compensation hypothesis based on a longitudinal cohort study of 144 individuals reporting neck pain after being involved in a motor vehicle collision. The authors noted a higher non-recovery rate among individuals who filed insurance claims (73%) compared to those who did not (51%) over a period of two to four years. ...
Whiplash-associated disorder (WAD) is the most common complaint and purported cause of chronic disability associated with motor vehicle collisions in North America. However, its construct validity remains controversial. This narrative review of the literature summarises the evidence underlying the most commonly theorised biological and psychosocial mechanisms of WAD pathogenesis. While the face validity of WAD is good, empirical evidence supporting the various constructs suggesting a causal link between a trauma mechanism and the development of symptoms is poor. Because individual expectations of recovery are outcome-predictive, future research is necessary to develop a better understanding of how to enhance expectancies in order to help affected motorists gain a greater sense of control over their health and wellbeing.
... While until NFHAS type 4 the ROM CV increases gradually, the type 5 shows a greater jump, not following a linear increment. Insurance environments have shown signs of negatively influencing patient reported outcomes [38]. Some incentives, such as the financial one, can encourage people to intentionally exaggerate some of their symptoms [39]. ...
The active cervical range of motion (aROM) is assessed by clinicians to inform their decision making. Even with the ability of neck motion to discriminate injured from non-injured subjects, the mechanisms to explain recovery or persistence of WAD remain unclear. There are few studies of ROM examinations with precision tools using kinematics as predictive factors of recovery rate. The present paper will evaluate the performance of an artificial neural network (ANN) using kinematic variables to predict the overall change of aROM after a period of rehabilitation in WAD patients. To achieve this goal the neck kinematics of a cohort of 1082 WAD patients (55.1% females), with mean age 37.68 (SD 12.88) years old, from across Spain were used. Prediction variables were the kinematics recorded by the EBI ® 5 in routine biomechanical assessments of these patients. These include normalized ROM, speed to peak and ROM coefficient of variation. The improvement of aROM was represented by the Neck Functional Holistic Analysis Score (NFHAS). A supervised multi-layer feed-forward ANN was created to predict the change in NFHAS. The selected architecture of the ANN showed a mean squared error of 308.07-272.75 confidence interval for a 95% in the Monte Carlo cross validation. The performance of the ANN was tested with a subsample of patients not used in the training. This comparison resulted in a medium correlation with R = 0.5. The trained neural network to predict the expected difference in NFHAS between baseline and follow up showed modest results. While the overall performance is moderately correlated, the error of this prediction is still too large to use the method in clinical practice. The addition of other clinically relevant factors could further improve prediction performance.
... The significance of the impact biomechanics for assessing the cervical vertebrae and clinical symptoms are discussed, e.g., in other studies [20,21], whereas another article [22] presents a study of the relationship between the recovery of a road accident victim with a whiplash injury and the insurance claim. ...
A problem of car insurance frauds usually refers to reporting non-existent car crash circumstances to acquire the funds required for a car repair. However, the problem is not limited only to this kind of costs. Recently, numerous damage claims connected with spine trauma caused by rear-end collisions have been reported. These are the so-called whiplash injuries caused by a rear impact. Such damage is difficult to verify and hence a necessity to use more effective claim verification methods. An analysis of a collision in the SDC convention makes it possible to determine whether its circumstances were consistent with the reports of drivers involved in it. The aim of the analysis presented in this article has been to determine a possibilityof using SRS-AIRBAG activation parameters to determine, with the SDC method, whether the circumstances of a collision reported were consistent with those responsible for a whiplash injury. The article provides an analysis of a series of rear-end collisions of vehicles moving in a column. The results have proven that the SDC procedure can be applied to verify the probability of a whiplash injury. With the above, this study is both academic and practical,and the results can provide benefits to vehicle collision researchers, experts,and students.
... The collection of these symptoms is called whiplashassociated disorder (WAD) [1][2][3]. WAD often becomes chronic, requiring high nancial costs [4][5][6]. Several studies have suggested the presence of mild spinal cord injury (SCI) in WAD [7][8][9]. The presence of SCI is important in determining the amount of insurance compensation for whiplash injury. ...
Background: When intramedullary high-intensity lesions are found on cervical T2-weighted magnetic resonance images of patients with whiplash injury, it is often required to identify whether they are due to spinal cord injury (SCI) or cervical compressive myelopathy (CCM). This is important to determine insurance coverage. Thus, this study aimed to develop a method to distinguish between SCI and CCM.
Methods: Magnetic resonance images of 20 patients who had cervical SCI were evaluated. These 20 SCI patients were age- and sex-matched to 20 CCM patients. The number of discs adjacent to T2 high-intensity lesions was counted because the T2 high-intensity lesions in SCI were characterized by sagittal dilation. The “snake-eyes appearance” was assessed as a characteristic finding of CCM. T2 values in T2 high-intensity lesions were evaluated quantitatively by its ratio with the T2 values in the normal spinal cord, including signal ratio and contrast ratio.
Results: The number of discs adjacent to T2 high-intensity lesions was significantly higher in SCI than in CCM. The snake-eyes appearance was found in 9 of 20 CCM patients, but not in SCI patients. The signal ratio and contrast ratio on axial images were significantly higher in SCI than in CCM. A new diagnostic scale was created based on these results. This diagnostic scale has made it possible to distinguish SCI and CCM with >90% accuracy from all perspectives including sensitivity, specificity, positive predictive value, and negative predictive value.
Conclusions: The features of T2 high-intensity lesions can be used to distinguish between SCI and CCM.
... Medical care, sick leave, and chronic disability that origin from WI are very expensive, having an estimated annual cost in the USA of $3.9 billions [10][11][12]. ...
Purpose
Whiplash injury (WI) represents a common diagnosis at every emergency department. Several investigations have been conducted to compare the different medical managements for non-surgical cases. However, the role of the immobilization with a non-rigid cervical collar (nRCC) for pain management and range of motion (RoM) preservation has not been completely clarified.
Methods
We performed a systematic review of the randomized control trials (RCTs) and a pooled analysis in order to investigate the role of the nRCC for pain management, scored through the visual analogue scale (VAS) and the RoM, by comparing the use of a nRCC (for 1–2 weeks) with a non-immobilization protocols, regardless of the association with physical therapy (PhT). Only patients with whiplash-associated disorders grade I–II were included. Due to a certain heterogeneity across the RCTs, follow-up period time range resetting was necessary in order to pool the data.
Results
A total of 141 papers were reviewed; 6 of them matched the inclusion criteria and were admitted to the final study. Pooled analysis showed that nRCC does not improve the outcome in terms of VAS score and RoM trends along the follow-up. Moreover, VAS and RoM trends seem to further improve at long-term follow-up in non-immobilization associated with PhT group.
Conclusions
This pooled analysis of the available RCTs shows the absence of an advantage of the immobilization protocol with a nRCC after a WI. On the contrary, non-immobilization protocols show an overall better trend of pain relief and neck mobility recovery, regardless of the association of PhT.
Graphic abstract
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... The long-term non-recovery that is 2-4 years of a whiplash injury seen in an emergency department is in the region of 30%. The paper by Rydman et al. [34] looked at the effect of non-recovery if the patient was involved in an insurance claim. The authors show that the non-recovery rate at 2-4 years in a group of 114 patients culled from insurance records in a prospective study had a non-recovery rate of 50% if not compensated and a non-recovery rate of 70% if compensated. ...
