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The evidence suggests that approximately 50% of those with WAD will report neck pain symptoms 1 year after their injuries. Greater initial pain, more symptoms, and greater initial disability predicted slower recovery.

Fifty consecutive patients with soft-tissue neck injuries following rear end collisions were studied prospectively to assess their rate of recovery. Patients were seen within 5 days of the accident, after 3 months, 1 year and 2 years, and their symptoms were classified into one of four groups (A, asymptomatic; B, nuisance; C, intrusive; D, disabling). Fourteen of 15 patients (93%) who were asymptomatic after 3 months remained symptom-free after 2 years. Of 35 patients with symptoms after 3 months, 30 (86%) remained symptomatic after 2 years. After 1 year, 26 (52%) stated that they had recovered completely, but after 2 years this had fallen to 19 (38%). Nine of the 15 patients who had improved between 3 months and 1 year deteriorated to their previous status, or worse, between 1 and 2 years. In asymptomatic cases, a prognosis that is 93% accurate after 2 years can be given after 3 months, and 86% of patients who are symptomatic after 3 months will remain so after 2 years. However, the severity of their symptoms will change during this period and will be at the same degree of severity in less than 50%.

We performed a prospective study of patients with a whiplash trauma to the cervical spine to describe the incidence of these injuries and to evaluate prognostic factors for disability and recovery.

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All the patients received a comprehensive questionnaire after the injury, and 296 cases responded to the follow-up protocol more than 1 year after the accident. Disability related to the whiplash trauma was used as the outcome variable for the assessment of prognostic factors.

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​Thirty-two percent reported persisting disability at follow-up. The following factors were significantly associated with a poor prognosis: pretraumatic neck pain, low educational level, female gender, and whiplash-associated disorder grades 2–3.

Female gender, previous back surgery, high intensity leg pain, somatization, and positive treatment expectations increased the odds of being referred to spinal surgery, while being obese, having comorbidities, pain in the thoracic spine, increased walking distance, and consultation location decreased the odds.

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​Currently, however, reliable tools for triaging CLBP patients to spinal surgery are lacking. As a better patient selection will likely result in reduced waiting time and healthcare costs and improved surgery outcomes [9], future research should focus on identifying subgroups for which spinal surgery is most likely to be effective, including imaging parameters. In the meantime, this study was the first to indicate that some patient-reported predictive factors of spinal surgery referral can be identified, indicating that surgeons are aware and to some extent adhere to the current scientific evidence. Nonetheless, although the identified predictive factors are known as common predictive factors of surgery outcome, they could only partly predict spinal surgery referral. 

Results: 136 (30%) participants developed chronic disability. High baseline disability (OR 3.3, 95% CI 1.97 to 5.55), longer predicted recovery time (OR 2.4, 95% CI 1.45 to 3.87), psychological distress (OR 1.9, 95%CI 1.05 to 3.51), passive coping (OR 1.8, 95% CI 1.07 to 2.97) and greater number of symptoms (OR 1.7, 95% CI 1.07 to 2.78) were associated with chronic disability. One risk factor resulted in 3.5 times the risk (95% CI 1.04 to 11.45) of chronic disability but this risk increased to 16 times (95%CI 5.36 to 49.27) in those with four or five risk factors.

Conclusion: Baseline disability had the strongest association with chronic disability but psychological and behavioural factors were also important. Treatment strategies should reflect this which may require a change to current physiotherapy approaches for acute WAD. The number of risk factors present should be considered when evaluating potential for poor outcome.

A Prospective 20-year Follow-up Study Comparing Patients with Whiplash-associated Disorders with Asymptomatic Subjects

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After 20 years, whiplash injuries significantly impacted the residual symptoms of shoulder stiffness, headache, and arm pain when compared with initially asymptomatic volunteers. 

In this follow-up, the prevalence of shoulder stiffness (72.0% vs. 45.9%), headache (24.0% vs. 12.2%), and arm pain (13.3% vs. 3.9%) were significantly greater in WAD patients than in control subjects. 

The ODI as the primary outcome measure was used to define successful treatment. ‘Normal’ healthy populations have an ODI mean score of 10 (SD 2–12) [25]. Therefore, being successful was defined as having reached a maximum of 22 points on the ODI at the 1-year follow-up, including the maximum reported standard deviation of 12 points (mean plus 2 SD). The scores of the patients were then dichotomised into ‘success’ (value = 1) and ‘failure’ (value = 0) for the programme, and both groups were compared to pre-treatment characteristics.

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The most important finding of this longitudinal study is that being employed and the level of disability before treatment are predictive factors for relevant improvement in CLBP patients’ functional status at 1-year follow-up. 

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The authors undertook a case-control study of chronic neck pain and whiplash injuries in nine states in the United States to determine whether whiplash injuries contributed significantly to the population of individuals with chronic neck and other spine pain.

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The study findings suggest that injuries resulting from MVAs contribute significantly to the population of individuals with chronic spine pain in the United States. In addition, individuals with chronic pain in the neck, and neck and back, are more likely to have acquired their pain as a result of an MVA, in comparison with individuals with chronic back pain alone. The present study suggests that chronic symptoms following whiplash, or ‘late whiplash’, is considerably more prevalent than previously reported, affecting about 15.5 million Americans.

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