Handicap after acute whiplash injury - A 1-year prospective study of risk factors

Background: Exposure to a whiplash injury implies a risk for development of chronic disability and handicap, with reported frequencies ranging from 0% to 50% in follow-up studies. The exact risk for development of chronic whi plash syndrome is not known. Objective: To prospectively determine the sens itivity and specificity of five possible predictors for handicap following a whiplash injury. Methods: In a 1-year prospective study of persons with a cute whiplash injury (n = 141) and control subjects who had acute ankle dis tortion (n = 40), pain intensity, number of nonpainful neurologic complaint s, cervical mobility, workload during extension and flexion of the neck, an d results of psychometric assessment were recorded. The consecutively sampl ed injured persons were assessed with structured and semistructured questio nnaires, and underwent neurologic examination after 1 week and 1, 3, 6, and 12 months. After 3 to 4 years, participants with whiplash injury were ques tioned about legal issues. Results: After 1 year, 11 (7.8%) persons with wh iplash injury had not returned to usual level of activity or work. The best single estimator of handicap was the cervical range-of-motion test, which had a sensitivity of 73% and a specificity of 91% (p < 0.01, Cox regression analysis). Accuracy and specificity increased to 94% and 99% when combined with pain intensity and other complaints. This increase was gained at the expense of a reduced sensitivity. Initiation of lawsuit within first month after injury did not influence recovery. Conclusion: The cervical range-of- motion test has a high sensitivity in prediction of handicap after acute wh iplash injury. The value of cervical range-of-motion test is further improv ed by additional recording of symptoms and pain intensity.