Best Evidence on the Course and Prognostic Factors for Neck Pain
Course and Prognostic Factors for Neck Pain in Whiplash-Associated Disorders (WAD): Results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders

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Abstract

Study Design

Best evidence synthesis.

Objective

To perform a best evidence synthesis on the course and prognostic factors for neck pain and its associated disorders in Grades I–III whiplash-associated disorders (WAD).

Summary of Background Data

Knowledge of the course of recovery of WAD guides expectations for recovery. Identifying prognostic factors assists in planning management and intervention strategies and effective compensation policies to decrease the burden of WAD.

Methods

The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and its Associated Disorders (Neck Pain Task Force) conducted a critical review of the literature published between 1980 and 2006 to assemble the best evidence on neck pain and its associated disorders. Studies meeting criteria for scientific validity were included in a best evidence synthesis.

Results

We found 226 articles related to course and prognostic factors in neck pain and its associated disorders. After a critical review, 70 (31%) were accepted on scientific merit; 47 of these studies related to course and prognostic factors in WAD. 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. Few factors related to the collision itself (for example, direction of the collision, headrest type) were prognostic; however, postinjury psychological factors such as passive coping style, depressed mood, and fear of movement were prognostic for slower or less complete recovery. There is also preliminary evidence that the prevailing compensation system is prognostic for recovery in WAD.

Conclusion

The Neck Pain Task Force undertook a best evidence synthesis to establish a baseline of the current best evidence on the course and prognosis for WAD. Recovery of WAD seems to be multifactorial.

Section snippets

Design and Data Collection

The literature search and critical review strategy are outlined in detail elsewhere.9 In brief, we systematically searched the electronic library database Medline for literature published from 1980 through 2005 on neck pain and its associated disorders; we also systematically checked the reference lists of relevant articles and updated the search to include key articles for 2006 and early 2007. We screened each citation for relevance to the Neck Pain Task Force mandate, using a priori inclusion

Results

We found 226 articles in our literature search that pertained to course and prognostic factors for neck pain. After critically reviewing these studies, we judged 70 articles of sufficient scientific merit to be accepted for our best evidence synthesis. Twenty of these studies (19 distinct cohorts) pertained to the course of recovery of WAD; 29 studies pertained to prognostic factors for WAD recovery; 8 studies reported prognostic factors for outcomes other than recovery from WAD, and 3 were

Discussion

We critically reviewed 226 studies on the course and prognostic factors for neck pain. Of these, 70 studies were judged to be scientifically admissible, and 44 studies (plus 3 systematic reviews) were specifically related to recovery in WAD. Of the 28 studies reporting prognostic factors, 11 were Phase I studies; 13 were Phase II; and 4 were Phase III studies. As stated earlier, the most compelling evidence arises from Phase III studies which can determine the independent strength of any

Uncited Reference

16

Acknowledgments

We are indebted to Ms. Oksana Colson and Ms. Leah Phillips (MA) for their administrative assistance and to Mr. Stephen Greenhalgh (MA, MLIS), Ms. C. Sam Cheng (MLIS) and Ms. Lori Giles-Smith (MLIS), re-search librarians, for their assistance in the work of the Neck Pain Task Force. The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and its Associated Disorders is supported by a grant to the University of Alberta from: the National Chiropractic Mutual Insurance Company and the Canadian

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  • Cited by (0)

    The manuscript submitted does not contain information about medical device(s)/drug(s).

    Corporate/Industry, Foundation, and Professional Organizational funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

    Reprinted from Carroll LJ et al. Course and prognostic factors for neck pain in whiplash-associated disorders (WAD). Results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine 2008;33:S83-92. Reprinted with permission from Lippincott Williams & Wilkins.

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