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BMC Musculoskeletal Disorders

, 13:264

Rehabilitation, physical therapy and occupational health


BackgroundPatients with whiplash-associated disorders WAD have a generally favourable prognosis, yet some develop longstanding pain and disability. Predicting who will recover from WAD shortly after a traffic collision is very challenging for health care providers such as physical therapists. Therefore, we aimed to develop a prediction model for the recovery of WAD in a cohort of patients who consulted physical therapists within six weeks after the injury.

MethodsOur cohort included 680 adult patients with WAD who were injured in Saskatchewan, Canada, between 1997 and 1999. All patients had consulted a physical therapist as a result of the injury. Baseline prognostic factors were collected from an injury questionnaire administered by Saskatchewan Government Insurance. The outcome, global self-perceived recovery, was assessed by telephone interviews six weeks, three and six months later. Twenty-five possible baseline prognostic factors were considered in the analyses. A prediction model was built using Cox regression. The predictive ability of the model was estimated with concordance statistics c-index. Internal validity was checked using bootstrapping.

ResultsOur final prediction model included: age, number of days to reporting the collision, neck pain intensity, low back pain intensity, pain other than neck and back pain, headache before collision and recovery expectations. The model had an acceptable level of predictive ability with a c-index of 0.68 95% CI: 0.65, 0.71. Internal validation showed that our model was robust and had a good fit.

ConclusionsWe developed a model predicting recovery from WAD, in a cohort of patients who consulted physical therapists. Our model has adequate predictive ability. However, to be fully incorporated in clinical practice the model needs to be validated in other populations and tested in clinical settings.

KeywordsPrediction Prognosis Whiplash-associated disorders Neck pain Physical therapy Cohort Recovery Regression Discrimination AbbreviationsWADWhiplash-associated disorders

SGIThe Saskatchewan Government Insurance

PTPhysical therapist

MDMedical doctor

NRSNumeric rating scale

CES-DCentre for Epidemiologic Studies Depression Scale

SEStandard error

SDStandard deviation

HRRHazard rate ratio

CIConfidence Interval

LRTLog-rank test.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2474-13-264 contains supplementary material, which is available to authorized users.

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Author: Tony Bohman - Pierre Côté - Eleanor Boyle - J David Cassidy - Linda J Carroll - Eva Skillgate


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