We studied 50 consecutive patients presenting at an accident departmen
t after rear-end vehicle collisions and recorded symptoms and psycholo
gical test scores within one week of injury, at three months and at tw
o years. The range of neck movement was noted at three months. Within
one week of injury, psychological test scores were normal in 82% of th
e group but became abnormal in 81% of the patients with intrusive or d
isabling symptoms at over three months (p<0.001) and remained abnormal
in 69% at two years. The clinical outcome after two years could be pr
edicted at three months with 76% accuracy by neck stiffness, 74% by ps
ychological score and 82% by a combination of these variables. The sev
erity of symptoms after a whiplash injury is related both to the physi
cal restriction of neck movement and to psychological disorder, The la
tter becomes established within three months of the injury.