Midway evaluation - Solbjørg Makalani Myrtveit
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Abstract: Predictors in chronic whiplash
After being exposed to whiplash accidents, most people recover rapidly. Around 20%, however, develop chronic symptoms and report pain and reduced ability to work. Why some individuals develop chronic whiplash while others recover is not yet clearly understood. This PhD-project aims to investigate 1) predictors of development of chronic symptoms, 2) predictors of recovery and 3) predictors of ability to work.
The two first studies are based on data from the population-based Nord-Trøndelag Health Study, HUNT, wave two and three (HUNT2 and HUNT3). In the first study we followed individuals with no whiplash at baseline for 11 years till HUNT3, and here divided individuals into two groups – those having developed chronic whiplash and those not having developed chronic whiplash. In order to identify predictors of development of chronic whiplash, variables collected at baseline (HUNT2, before the accident) were compared between the two groups, using logistic regression models. In short we found that that poor health before the injury predicted development of whiplash. In particular poor self-rated health and symptoms of anxiety were strong risk factors; self-rated health was more closely associated to subsequent chronic whiplash than symptoms and somatic conditions.
In the second article individuals already reporting chronic whiplash in HUNT2 were followed for 11 years (HUNT3). In HUNT3 individuals were divided into two groups, those recovered and those still suffering from chronic whiplash. In order to identify predictors of recovery, information collected at baseline (HUNT2) was compared between the two groups, again using logistic regression models. We found that factors similar to those predicting development of chronic whiplash also predicted non-recovery among individuals already reporting chronic whiplash. Poor self-rated health was the strongest risk factor for non-recovery.
The third study is based on data from Denmark, and only preliminary results are available. Individuals who visited GPs or emergency units because of a whiplash accident were invited to participate. The participants rated their neck pain on a scale from 0-10, and were asked what treatment they believed could make them better. Twelve months later participants again rated their neck pain, and were asked whether they were working less than full time due to their whiplash injury. Using multiple logistic regression models we investigated whether initial treatment and coping preferences could predict a high level of neck pain and reduced ability to work at 12 months. We found that initial treatment and coping preferences were associated with outcome.
Our findings indicate that health before the injury, both mental and somatic, is of importance in the development of chronic whiplash. Similar factors to those predicting developments of symptoms also predict non-recovery. Further, individuals`initial preference for treatment and coping, possibly affected by pre-injury somatic and mental health, experience, expectations and illness perceptions, can predict neck pain and ability to work one year later.