Compensation claim lodgement and health outcome developmental trajectories following whiplash injury: A prospective study

被引:147
作者
Sterling, Michele [1 ]
Hendrikz, Joan [1 ]
Kenardy, Justin [1 ]
机构
[1] Univ Queensland, Ctr Natl Res Disabil & Rehabil Med CONROD, Mayne Med Sch,Div Physiotherapy, Ctr Clin Excellence Spinal Pain Injury & Hlth, Herston, Qld 4006, Australia
基金
英国医学研究理事会; 澳大利亚研究理事会;
关键词
Whiplash injury; Posttraumatic stress; Compensation; POSTTRAUMATIC-STRESS-DISORDER; PROGNOSTIC-FACTORS; SAS PROCEDURE; SYMPTOMS;
D O I
10.1016/j.pain.2010.02.013
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
This study aimed to identify distinctive trajectories for pain/disability and posttraumatic stress disorder (PTSD) symptoms following whiplash injury and to examine the effect of injury compensation claim lodgement on the trajectories. In a prospective study, 155 individuals with whiplash were assessed at < 1 month, 3, 6 and 12 months post injury. Outcomes at each time point were Neck Disability Index (NDI) and the Posttraumatic Stress Diagnostic Scale (PDS). Group-based trajectory analytical techniques were used to identify outcome profiles. The analyses were then repeated after including third party compensation claim lodgment as a binary time-changing covariate. Three distinct NDI trajectories were determined: (1) Mild: mild or negligible pain/disability for the entire 12 months (45%), (2) Moderate: initial moderate pain/disability that decreased to mild levels by 3 months (39%) and (3) Chronic-severe: severe pain/disability persisting at moderate/severe levels for 12 months (16%). Three distinct PTSD trajectories were also identified: (1) Resilient: mild symptoms throughout (40%), (2) Recovering: initial moderate symptoms declining to mild levels by 3 months (43%) and (3) Chronic moderate-severe: persistent moderate/severe symptoms throughout 12 months (17%). Claim submission had a detrimental effect on all trajectories (p < 0.001) except for the Chronic-severe NDI trajectory (p = 0.098). Following whiplash injury, there are distinct pathways of recovery for pain/disability and PTSD symptoms. Management of whiplash should consider the detrimental association of compensation claim with psychological recovery and recovery of those with mild to moderate pain/disability levels. However, claim lodgement has no significant association with a more severe pain and disability trajectory. Crown Copyright (C) 2010 Published by Elsevier B. V. on behalf of International Association for the Study of Pain. All rights reserved.
引用
收藏
页码:22 / 28
页数:7
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