Abstract
A classification of injury and a follow-up schedule were proposed by the Quebec Task Force (QTF) in 1995. No general agreement about the clinical usefulness of the WAD-classification or of the suggested follow-up regimen exists. A series of 186 consecutive cases seen in the emergency room during the acute phase after a whiplash injury was prospectively studied for 1 year. All findings including history and physical findings were recorded using standardized QTF protocols. In one group follow-up visits were done according to the QTF regimen: at 1, 3, 6, 12 weeks and 1 year after the accident; in a control group no visit was scheduled. The outcome variable was neck pain at 1 year after the accident. After 1 year, 18% of the total number of patients had significant neck pain. Risk factors for chronic neck pain at 1 year after whiplash injury were: neck pain before the accident and a high degree of emotional distress at the time of the accident; both factors independently associated with a tenfold increased risk of developing chronic neck pain. Neither the WAD classification nor the QTF follow-up regimen could be linked to a better outcome. In this study the outcome was associated with patient-specific characteristics and not with physical signs of injury, the depth of the initial evaluation or the follow-up regimen.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Barnsley L, Lord S, Bogduk N (1994) Whiplash injury (review). Pain 58:283–307
Berglund A, Alfredsson L, Jensen I, Cassidy JD, Nygren A (2001) The association between exposure to a rear-end collision and future health complaints. J Clin Epidemiol 54(8):851–856
Berglund A, Bodin L, Jensen J, Wiklund A, Alfredsson L (2006) The influence of prognostic factors on neck pain intensity, disability, anxiety and depression over a 2 year period in subjects with acute whiplash injury. Pain 125:244–256
Biering-Sorensen F (1983) A prospective study of low back pain in a general population. I. Occurrence, recurrence and aetiology. Scand J Rehabil Med 15(2):71–79
Bjornstig U, Hildingsson C, Toolanen G (1990) Soft-tissue injury of the neck in a hospital based material. Scand J Soc Med 18(4):263–267
Côté P, Cassidy JD, Carroll L, Frank JW, Bombardier C (2001) A systematic review of the prognosis of acute whiplash and a new conceptual framework to synthesize the literature. Spine 26(19):E445–E458
Côté P, Hagg-Johnson S, Cassidy JD, Caroll L, Frank JW, Bombardier C (2005) Initiated patterns of clinical care and recovery from whiplash injuries. Arch Intern Med 165:2257–2263
Côté P, Hagg-Johnson S, Cassidy JD, Caroll L, Frank JW, Bombardier C (2007) Early aggressive care and delayed recovery from whiplash: isolated finding or reproducible result. Arthritis Rheum 57:861–868
Dolinis (1997) Risk factors for ‘whiplash’ in drivers: a cohort study of rear-end traffic crashes. Injury 28(3):173–179
Fredriksson K, Alfredsson L, Thorbjornsson CB, Punnett L, Toomingas A, Torgen M, Kilbom A (2000) Risk factors for neck and shoulder disorders: a nested case-control study covering a 24-year period. Am J Ind Med 38(5):516–528
Freeman MD, Croft AC, Rossignol AM (1998) Whiplash associated disorders: redefining whiplash and its management by the Quebec Task Force. A critical evaluation. Spine 23(9):1043–1049
Hartling L, Brison RJ, Ardern C, Pickett W (2001) Prognostic value of the Quebec classification of whiplash-associated disorders. Spine 26(1):36–41
Hildingsson C, Toolanen G (1990) Outcome after soft-tissue injury of the cervical spine. A prospective study of 93 car-accident victims. Acta Orthop Scand 61:357–359
Jensen MP (1992) Self-report scales and procedures for assessing pain in adults. In: Turk DC, Melzack R (eds) Handbook of pain assessment. Guildford Press, New York
Jensen MP, Turner JA, Romano JM (1992) Chronic pain in coping measures: individual vs. composite scores. Pain 51:131–134
Leino PI, Hanninen V (1995) Psychosocial factors at work in relation to back and limb disorders. Scand J Work Environ Health 21(2):134–142
Miettinen T, Lindgren KA, Airaksinen O, Leino E (2002) Whiplash injuries in Finland: a prospective 1-year follow-up study. Clin Exp Rheumatol 20:399–402
Norris SH, Watt I (1983) The prognosis of neck injuries resulting from rear end vehicle collisions. J Bone Joint Surg Br 65:608–611
Radanov BP, Sturzenegger M, Di Stefano G (1995) Long-term outcome after whiplash injury. A 2-year follow-up considering features of injury mechanism and somatic, radiological, and psychosocial findings (review) Medicine 74:281–297
Spitzer W, Skovron M, Salmi L et al (1995) Scientific monograph of the QTF on whiplash-associated disorders. Spine 20:1S–73S
Sterner Y, Toolanen G, Gerdle B, Hildingsson C (2003) The incidence of whiplash trauma and the effects of different factors on recovery. J Spinal Disord Tech 16(2):195–199
Thorbjornsson CB, Alfredsson L, Fredriksson K, Michelsen H, Punnett L, Vingard E, Torgen M, Kilbom A (2000) Physical and psychosocial factors related to low back pain during a 24-year period. A nested case-control analysis. Spine 25(3):369–374 (discussion 375)
Zigmond AS, Smith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370
Acknowledgments
We are obliged to Per Näsman, the Royal Institute of Technology, for statistical advice
Conflict of interest statement
There is no conflict of interest for any of the authors.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kivioja, J., Jensen, I. & Lindgren, U. Neither the WAD-classification nor the Quebec Task Force follow-up regimen seems to be important for the outcome after a whiplash injury. A prospective study on 186 consecutive patients. Eur Spine J 17, 930–935 (2008). https://doi.org/10.1007/s00586-008-0675-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-008-0675-0