RT Journal Article
SR Electronic
T1 Recovery in Whiplash-Associated Disorders: Do You Get What You Expect?
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.080680
DO 10.3899/jrheum.080680
A1 Linda J. Carroll
A1 Lena W. Holm
A1 Robert Ferrari
A1 Dejan Ozegovic
A1 J. David Cassidy
YR 2009
UL http://www.jrheum.org/content/early/2009/02/12/jrheum.080680.abstract
AB Objective Positive expectations predict better outcome in a number of health conditions, but the role of expectations in predicting health recovery after injury is not well understood. We investigated whether early expectations of recovery in whiplash associated disorders (WAD) predict subsequent recovery, and studied the role of “expectations” to predict recovery as determined by pain cessation and resolution of pain-related limitations in daily activities. Methods A cohort of 6,015 adults with traffic-related whiplash injuries was assessed, using multivariable Cox proportional hazards analysis, for association between these expectations and self-perceived recovery over a 1-year period following the injury. Recovery was assessed using 3 indices: self-perceived global recovery (primary outcome); resolution of neck pain severity; and resolution of pain-related limitations in daily activities. Results After adjusting for the effect of sociodemographic characteristics, post-crash symptoms and pain, prior health status and collision-related factors, those who expected to get better soon recovered over 3 times as quickly (hazard rate ratio = 3.62, 95% confidence interval 2.55-5.13) as those who expected that they would never get better. Findings were similar for resolution of pain-related limitations and resolution of neck pain intensity, although the effect sizes for the latter outcome were smaller. Conclusion Patients’ early expectations for recovery are an important prognostic factor in recovery after whiplash injury, and are potentially modifiable. Clinicians should assess these expectations in order to identify those patients at risk of chronic whiplash, and future studies should focus on the effect of changing these early expectations.