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Measurement of clinically relevant functional health perceptions in patients with whiplash-associated disorders: the development of the whiplash specific activity and participation list (WAL)



The International Classification of Human Functioning Disability and Health (ICF) provides insight into functional health status in patients with whiplash-associated disorders (WAD). In the assessment of functional limitations in patients with WAD, there are several condition-specific questionnaires available. Estimation of the true relationship between the separate constructs of the ICF is only possible if the items of the salient questionnaires measure exactly the constructs of interest, while not simultaneously measuring other constructs of the model. This study aimed to develop a condition specific and clinically relevant and usable instrument for patients with WAD that measures activity limitations and participation restrictions, as defined by the ICF framework.


Item generation consisted of (1) a semi-structured interview which was conducted among 69 WAD patients; (2) a Delphi study involving 13 health professionals experienced in the assessment of patients with WAD; (3) a literature search for items from self-assessment questionnaires for neck pain.


A 35-item condition-specific self-assessment questionnaire for patients with WAD was developed. This new questionnaire measures purely activity limitations and participation restrictions according to the ICF and is based on patients’ opinions and expert opinions.


The whiplash activity and participation list tends to measure clinically relevant activity limitations and participation restrictions in WAD patients.

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Conflict of interest

All authors state no conflict of interest.

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Corresponding author

Correspondence to Maarten A. Schmitt.



See Table 4.

Table 4 Concept version of the whiplash activity and participation list (WAL)

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Schmitt, M.A., Stenneberg, M.S., Schrama, P.P.M. et al. Measurement of clinically relevant functional health perceptions in patients with whiplash-associated disorders: the development of the whiplash specific activity and participation list (WAL). Eur Spine J 22, 2097–2104 (2013).

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  • Whiplash injury
  • Questionnaire
  • Development
  • Activity and participation
  • ICF