The close association shown in this subject group between pre-injury back pain and both physical (NDI, GBG) and psychological (GHQ) outcome following a whiplash injury is a new observation, although one recent study showed an association with a past history of musculoskeletal complaints. Dolinis reported the significance of previous neck injury.īack pain following whiplash injury occurs in approximately one third of patients, but this differs little from matched controls. in a group of patients that overlaps with the group analysed for this study. The association between poor outcome and previous whiplash injury has been reported by Khan et al. There was a non-significant trend to worse outcome with advancing age and pre-existing cervical spondylosis reflecting the majority of a conflicting literature. It may result from physical differences in spinal musculature or psychological predisposition, as reflected by higher GHQ scores and more frequent GP attendance in females for all consultations and for those with a psychological or anxiety cause. The multivariate analysis indicates that other pre-injury factors may determine this association with gender. However, factors that predict outcome in this group of patients cannot be assumed to predict outcome in a group selected in a different manner.įemales fared worse than males, in agreement with all previous studies but one and there was an excess of female subjects in this study group. It has been termed an ‘acceptable source‘ of subjects for study by the quebec task force. Although by definition this is a selective population, it is this group that is encountered most commonly by clinicians and is the subject of many other studies. This patient population clearly differs from studies involving all patients involved in RTAs recruited from A&E departments or those patients reporting initial neck pain following injury. Īny study of subjects pursuing compensation will be heavily skewed towards more symptomatic patients. A threshold score of 5/6 is 80% sensitive and 89% specific for a diagnosable psychiatric disorder. The clinician scores the questionnaire to give a result between 0 (normal) and 28. It has four subscales that cover somatic symptoms, anxiety and insomnia, social dysfunction and severe depression. The scaled version of the general health questionnaire (GHQ) is a self-administered screening questionnaire designed for use in consulting situations to detect psychiatric disorder. To facilitate statistical analysis, the GBG was recorded numerically (1–4) rather than the original A–D. The Gargan and Bannister Grade (GBG) is a simple, reproducible, validated classification based on the severity of symptoms. Results can be doubled to create a percentage (0% normal, 100% maximum disability in every category). It combines pain and disability in a self-administered ten-item questionnaire with a maximum score of 50. The Neck Disability Index (NDI) is a validated scoring system for physical outcome, derived from the Oswestry low back pain disability questionnaire. The outcome following whiplash injury was assessed using three scoring systems: The records were also used to determine whether or not patients had presented to the GP with a depressive or anxiety-related disorder prior to the accident. The remaining 101 had incomplete or partially illegible records, and were therefore excluded from this section of the analysis. 176 (64%) reports had full copies of general practitioner (GP) records, allowing a count of the number of visits to the GP over the 5 years preceding the accident. Most of the variables were recorded directly from the reports. The variables recorded are detailed in Table 1. Subjects were excluded from the study if there was objective evidence of structural injury. Reports of 277 patients with isolated whiplash injuries examined for medicolegal reporting were analysed.
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