Clinical Assessment of Prognostic Factors for Long-Term Pain and Handicap After Whiplash Injury: A 1-year Prospective Study

Eur J Neurol. 2008 Nov;15(11):1222-30. doi: 10.1111/j.1468-1331.2008.02301.x. Epub 2008 Sep 18.


Background and purpose: Physical mechanisms are the possible factors involved in the development and maintenance of long-term handicaps after acute whiplash injury. This study prospectively examined the role of active neck mobility, cervical and extra-cervical pains, as well as non-painful complaints after a whiplash injury as predictors for subsequent handicap.

Methods: Consecutive acute whiplash patients (n = 688) were interviewed and examined by a study nurse after the median of 5 days after injury, and divided into a high- or a low-risk group by an algorithm based on pain intensity, number of non-painful complaints and active neck mobility [active cervical range of motion (CROM)]. All 458 high-risk patients and 230 low-risk patients received mailed questionnaires after 3, 6 and 12 months. Two examiners examined all high-risk patients (n = 458) and 41 consecutive low-risk patients at median 11, 109, 380 days after injury. The main outcome measures were: handicaps, severe headaches, neck pain and neck disability.

Results: The relative risk for a 1-year disability increased by 3.5 with initial intense neck pain and headaches, by 4.6 times with reduced CROM and by four times with multiple non-painful complaints.

Conclusion: Reduced active neck mobility, immediate intense neck pain and headaches and the presence of multiple non-painful complaints are the important prognostic factors for a 1-year handicap after acute whiplash.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cervical Vertebrae / injuries
  • Cervical Vertebrae / physiopathology
  • Disability Evaluation*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neck Muscles / injuries
  • Neck Muscles / physiopathology
  • Neck Pain / diagnosis*
  • Neck Pain / etiology*
  • Neck Pain / physiopathology
  • Neurologic Examination / methods
  • Pain Measurement / methods
  • Pain, Intractable / diagnosis*
  • Pain, Intractable / etiology*
  • Pain, Intractable / physiopathology
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Range of Motion, Articular / physiology
  • Severity of Illness Index
  • Surveys and Questionnaires
  • Time
  • Whiplash Injuries / complications*
  • Young Adult
  • Zygapophyseal Joint / injuries
  • Zygapophyseal Joint / physiopathology