Table car accident injury claim by jolinmilioncherie


									                                                                                               Evidence Tables on Course and Prognostic Factors in WAD

Table 1. Course of WAD.

Author(s), Year, Study Design   Setting and Subjects                       Follow-up                                 Course
                                Number (n) Enrolled
                 1              Adult car drivers, insured by one          Follow-up in at 7 years after collision   39.6% of those with WAD after a
Berglund, 2000
Cohort                          company in Sweden, involved in rear-       by mailed survey                          collision reported a 3-month period
                                end collisions in 1987-1988. N=182                                                   prevalence (often or always) of neck
                                with WAD; N=136 without WAD.                                                         or shoulder pain at 7 years, compared
                                Compared with random sample of                                                       with 14.0% for those not injured 7
                                persons insured by same company, no                                                  years earlier and 11.1% of those who
                                history of collision.                                                                had not been in a collision.

Borchgrevink et al., 1996 2     Patients registered with neck sprain       Follow-up 2.5 to 8.5 years post-          27% of those with WAD were on sick
Cohort                          injury from car collision, 1985-1990,      collision, using administrative Social    leave. 14% had sick leave for less
                                at hospitals in 4 cities in Norway         Security data.                            than 2 weeks immediately after
                                (representing 7.3% of population of        Outcomes: presence, duration and          collision, 8% for more than 2 weeks
                                Norway) (n=473)                            timing of sick leave                      immediately after collision and 5%
                                                                                                                     sometime later over follow-up. At
                                                                                                                     follow-up, 58% reported symptoms
                                                                                                                     and 5% claimed rehabilitation or
                                                                                                                     permanent disability pension.

Boyd et al., 20023              Children aged 4-16 in northwest            Followed until asymptomatic or up to      Mean duration of symptoms was 8.8
Cohort                          England with Grades I and II WAD           56 days via clinical exam followed by     days (range was 3-70 days). None
                                after car crash; consecutive               telephone call to confirm continued       had symptoms lasting more than 2
                                presentations to 3 urban ERs.              asymptomatic status.                      months.
                                Excludes those needing admission.

Bylund et al., 1998 4           Passenger car occupants aged 16-64 y       Follow-up at 2.5 years post-injury and    During the 2.5 years following the car
Cohort                          involved in car accidents in the city of   on January 1, 1996 (4-6 years post-       accident 40% (103) had been on sick
                                Umea Sweden from January 1, 1990           injury), using data from Social           leave totaling 12,500 days for total
                                to December 31, 1991 who were              Insurance Office records (universal       benefits of 0.8 million US dollars.
                                registered by the Accident Analysis        coverage) to assess days on sick          Cervical strains accounted for 75% of
                                Group at the University Hospital           leave, costs of sick leave and            total sick-leave days. Within 2.5
                                (n=255)                                    disability pension.                       years, only 18 (7%) still on sick leave.
                                                                                                                     By 4-6 years after injury, 9 people
                                                                                                   Evidence Tables: Course and Prognosis in WAD

                                                                                                              had been approved for disability
                                                                                                              pension (all with cervical strains) and
                                                                                                              9 others were on full or partial sick
                                                                                                              Disability pension costs estimated
                                                                                                              between $1.1 and 3.8 million (USD).

Cassidy at al., 2000 5     All adults submitting personal injury    Follow-up of time to claim closure by     Median time to claim closure was 433
Cohort                     claims after motor vehicle injury in     administrative database to 1997;          (95% CI 409-457) days under the tort
                           Saskatchewan, Canada, 1994-1995;         claim closure in both tort and no fault   system and 194 (95% CI 182-206)
                           self-reported neck or shoulder pain      system validated against self-reported    days under the subsequent no fault
                           after collision. Excluded reopened       recovery in depression, neck pain and     system.
                           claims, hospitalized for more than 2     physical functioning.
                           days. (n=5,398)

Cassidy et al., 2007 6     All adults submitting personal injury    Follow-up by telephone interview at 6     Median time to recovery was 4
Cohort                     claims after motor vehicle injury in     weeks, 3, 6, 9 and 12 months. Self-       months.
                           Saskatchewan, Canada, 1997-1998;         reported global recovery, as
                           self-reported collision-related neck     determined by endorsement of ‘all
                           pain. Excluded those hospitalized for    better’ or ‘quite a bit of
                           more than 2 days. (n=6,021)              improvement’.

Drottning et al., 2002 7   Patients with possible WAD attending     Initial questionnaire at 4 weeks,         8.2% of patients had cervicogenic
Descriptive                emergency department in Oslo after a     followed by examination for               headache at 6 weeks, 4.4% at 6
                           traffic collision; 1993-1995. (n=587).   cervicogenic headache at 6 weeks and      months and 3.4% at 1 year. At 1 year,
                                                                    follow-up at 6 months and 1 year.         44% of whole sample had neck pain
                                                                                                              (12% had daily neck pain). Of those
                                                                                                              with cervicogenic headache at 1 year,
                                                                                                              90% had concurrent neck pain (35%
                                                                                                              had daily neck pain)

Gargan et al., 1994 8      Patients attending the emergency         Symptoms assessed within 7 days by        82% had neck pain within 7 days of
Cohort                     department in Swindon, England from      examination and after three months,       the collision and another 4% had later
                           May to September, 1991, following a      via temporal records                      symptoms. After 3 months, 66%
                           rear-end collision; most were                                                      reported neck pain.
                           symptomatic. All were given soft
                           collars and non-steroidal medication.
                                                                                                  Evidence Tables: Course and Prognosis in WAD


Holm et al. 1999 9        Swedish population with a permanent       Outcome assessed average of 4 years      In those judged to have permanent
Cross-sectional           medical impairment of 10% or more         after injury.                            medical impairment of 10% or more
                          due to road traffic injury during years   Outcomes: prevalence of medical          due to WAD, 63% had returned to full
                          1989 or 1994. (n=184 impaired due         impairment, reduced or full work         working capacity in 1989 and 69% in
                          to WAD in 1989 and n=481 in 1994).        disability                               1994.

Jónsson et al., 1994 10   Consecutive patients with a WAD-          Questionnaires and physical              At 6 weeks, 26 (52%) had recovered
Cohort (Phase 1)          type injury in automobile collisions      examination at 6 weeks, one year and     and resumed their previous activities
                          presenting to the only available          5 years                                  without restriction; 24 (48%) had
                          emergency primary care trauma                                                      persistent or aggravated neck pain;
                          center in Uppsala, Sweden during a                                                 and of these, 19 had radiating pain.
                          13 month period.                                                                   Of the 26 asymptomatic at 6 weeks,
                          (n=50)                                                                             19 (73%) were asymptomatic at 5
                                                                                                             Of the 24 symptomatic at 6 weeks, 14
                                                                                                             (58%) reported neck pain at 5 years
                                                                                                             (11-point VAS of 1-6) and had
                                                                                                             extensive treatment (physical therapy,
                                                                                                             chiropractic, surgery).

Kasch et al., 2003 11     Consecutive adult patients in Aarhus      Questionnaires, interview and clinical   At 1 month, overall pain decreased
Cohort                    area attending emergency department       examination at 1 week and 1, 3, 6 and    from 23 to 16 on the 100 mm VAS.
                          with neck pain or headache after          12 months.                               Median neck pain fell from 32 at 1
                          exposure to rear collision; January                                                week to 23 at 1 month
                          1997 through January 1998. Excludes
                          those with prior neck or low back
                          disorder or head trauma. (n=141 with

Mayou et al, 2002 12      Patients with WAD attending the           Follow-up questionnaires at 3 months.    3 months after injury, 64% reported
Cohort                    Accident and Emergency Department                                                  ‘minor/major’ problems; 37% had
                          at John Radcliffe Hospital in Oxford,                                              ‘moderate to very severe pain’; 57%
                          England over a 1-year period. No                                                   saw a general practitioner; 24% had
                          date range given for this 1-year                                                   post-traumatic stress disorders; 21%
                          period. Excludes head injuries with >                                              had anxiety or depression; 21% had
                                                                                                       Evidence Tables: Course and Prognosis in WAD

                              15 minutes loss of consciousness.                                                  phobic travel anxiety; 37% had
                              (N=278).                                                                           psychological consequences; 47% had
                                                                                                                 ‘minor/major’ financial problems; 15
                                                                                                                 had ‘moderate to extreme’ limitations
                                                                                                                 of daily activities in the past month;
                                                                                                                 and 62% were claiming

Miettinen et al., 2004 13     Insurance claimants with neck pain        1-year and 3 year follow-ups.            Frequency of sick leave: 61% had no
Cohort                        after a motor vehicle collision in        Outcomes were frequency of sick          sick leave; 12.6% had sick leave less
                              Finland in 1998. (n=312 respondents       leave and health impairment              than 1 week; 14.8% for 1 week to 1
Miettinen et al., 2004 14     at baseline; 182 at one year and 144 at   compared to pre-injury status (judged    month, and 11.5% for more than one
Cohort                        3 years)                                  by participants as due to injury).       month.

Norris et al., 1983 15        Presentation to a British accident        At least 6 months: Mean follow-up        Time to return to work (weeks): 2.4
Cohort                        department with neck injury from          times in months: Group 1 - 19.7;         (s.d. 2) for Group 1; 4.5 (s.d. 3) for
                              rear-end MVC between September            Group 2 – 23.9; Group 3 – 24.7.          Group 2 and 10.3 (s.d. 3.3) for Group
                              1977 and May 1980 (n=61). 3               Follow-up data ascertained at clinic     3.
                              severity groups: Group 1 symptoms         visit through self-report and physical   Free of symptoms at follow-up:
                              but no physical findings (n=27);          examination                              Group 1 (56%); Group 2 (19%) and
                              Group 2 symptoms and reduced range                                                 group 3 (10%).
                              of movement, no neurological signs
                              (n=24); Group 3 symptoms, reduced
                              movement and neurological loss on
                              examination (n=10).

Obelieniene et al., 1999 16   Adults in Kaunas, Lithuania, mid          Follow-up at 2 and 12 months after       Median duration of neck pain was 3
Cohort                        1990’s. Subjects exposed to rear-end      the collision through mailed survey.     days (range < 3 hours to 17 days).
                              collisions, reported to police (n=59
                              with neck pain after the collision)

Partheni et al., 2000 17      Patients from an emergency                Follow-up at 1, 3 and 6 months post-     Proportion reporting neck pain fell
Cohort                        department in Patras, Greece from         collision by questionnaire               from 100% in the first three days
                              July 1995-July 1998, involved in rear,                                             post-injury, to 9.4% at 1 month, 1.7%
                              lateral or frontal motor vehicle                                                   at 3 months and 1.1% at 6 months.
                              collision with WAD Grades I or II
                              with symptom onset within 2 days of
                                                                                                 Evidence Tables: Course and Prognosis in WAD

                             collision (n=180)

Sterling et al., (2003) 18   Volunteers with WAD (n=66; neck      Follow-up at 1, 2 and 3 months by         At three months, 38% recovered; 33%
Cohort                       pain after motor vehicle crash).     examination (ROM, joint position          had mild and 29% had
                             Healthy volunteers (n=20)            error, EMG) and fear of movement          moderate/severe pain. Those with
                                                                  questionnaire (TAMPA).                    moderate/severe pain at three months
                                                                                                            had decreased
                                                                                                            ROM, decreased joint function, more
                                                                                                            EMG activity and high fear of
                                                                                                            movement at each measurement
                                                                                                            point. Mild group became more like
                                                                                                            the recovered group over follow-up.

Suissa et al., 1995 19       All WAD claims from MVC (ICD 9       Follow-up to claim closure,               22% were on benefits for less than 1
Cohort                       code 847.0) receiving compensation   ascertained through administrative        week. Overall, 50% claims closed
                             from SAAQ in Québec in 1987; with    database or May 1993.                     within 1 month, 64% within 60 days,
                             collision-related data from police                                             87% within 6 months and 97% within
                             report. (n=3014).                                                              1 year.

Suissa et al., 2006 20       WAD traffic injury claimants in      Follow-up to claim closure, using         At one year, 40% of patients
Cohort                       Québec presenting to treatment       administrative database, or for 1 year.   attending and over 50% of patients
                             centres between March and                                                      not attending treatment programs
                             September, 2001. Comparison group                                              were still on compensation.
                             was WAD claimants not seen at the
                             centres. (n=2163)
                                                                                                               Evidence Tables: Course and Prognosis in WAD

Table 2. Prognostic factors for recovery after WAD.

Author(s), Year, Study          Setting and Subjects            Prognostic Factors                Follow-up and Outcomes          Key Findings
Design                          Number (n) Enrolled             Considered                        Measured
Berglund et al, 200121          Adult car drivers, insured by   Exposure to rear-end              Follow-up in at 7 years after   Compared to unexposed
Cohort (Phase II)               one company in Sweden,          collision, with or without        collision by mailed survey.     subjects, exposed subjects
                                involved in rear-end            claim for WAD adjusted for        Outcomes: 3-month period        with WAD were more likely
                                collisions in 1987-1988.        age, gender                       prevalence of general health,   to experience headache (OR-
                                N=232 exposed to rear-end                                         fatigue, depressive mode,       =3.7, 95% CI 2.6-5.3),
                                collision. N=157 with neck                                        sleep disturbance, headache,    thoracic pain (OR= 3.1, 95%
                                injuries alone; N=75 with                                         thoracic pain, low back pain    CI 2.0-4.8), low back pain
                                neck and other injuries;                                          and stomach ache.               (OR= 1.7, 95% CI 1.3-2.4),
                                N=204 without neck injuries;                                                                      ill health (OR= 3.3, 95% CI
                                N=3688 unexposed subjects.                                                                        2.2-5.0), sleep disturbance
                                                                                                                                  (OR= 2.4, 95% CI 1.5-3.9)
                                                                                                                                  and fatigue (OR= 1.6, 95% CI
                                                                                                                                  Exposed subjects without
                                                                                                                                  WAD and unexposed subjects
                                                                                                                                  equally likely to experience
                                                                                                                                  symptoms at 7 years.

Berglund et al., 200622         Swedish adults with acute       Gender, age, income,              Follow-up by mailed             At 2 years, higher intensity of
Cohort (Phase II)               WAD from a car collision,       education, position in vehicle,   questionnaire at 1 month, 6     neck pain was predicted by
                                1993-94, and making an          direction of collision,           months, 1 year, 2 years post-   higher initial neck pain
                                injury claim. (n=2280           awareness of collision, use of    injury.                         (severe pain OR=8.4, 95% CI
                                enrolled)                       headrest, use of seat belt,       Outcomes: neck pain             6.5-10.9), being female
                                                                head position, broken car         intensity, disability           (OR=1.3, 95% CI 1.0-1.6),
                                                                seat, initial neck pain           (Disability Rating Index),      higher (self-rated) WAD
                                                                intensity, initial headache,      anxiety and depression          grade (WAD II OR=1.5, 95%
                                                                self-reported WAD severity,       (HADS), sick leave              CI 1.1-1.9; for WAD III,
                                                                helplessness (to control          exceeding 14 days.              OR=2.4, 1.8-3.2), initial
                                                                consequences of pain), health                                     headache (OR=1.3, 95% CI
                                                                locus of control (latter two                                      1.1-1.7), high helplessness
                                                                measured at one month).                                           (OR=2.7, 95% CI 2.1-3.4)
                                                                                                                                  and low education (OR=1.8,
                                                                                                            Evidence Tables: Course and Prognosis in WAD

                                                                                                                              95% CI 1.3-2.4). Greater
                                                                                                                              disability was predicted by
                                                                                                                              higher initial neck pain
                                                                                                                              (severe pain OR=6.4, 95% CI
                                                                                                                              4.9-8.4), being female
                                                                                                                              (OR=1.3, 95% CI 1.1-1.6),
                                                                                                                              higher self-rated WAD grade
                                                                                                                              (WAD II OR=1.6, 95% CI
                                                                                                                              1.2-2.1; for WAD III,
                                                                                                                              OR=3.4, 95% CI 2.5-4.5),
                                                                                                                              initial headache (1.7, 95%CI
                                                                                                                              1.4-2.1), high helplessness
                                                                                                                              (OR=2.2, 1.7-2.8) and low
                                                                                                                              education (OR=1.4, 95% CI

Borchgrevink et al., 19962   Patients registered with neck    Presence and duration of sick   Follow-up 2.5 to 8.5 years      Chronic symptoms associated
Cohort (Phase I)             sprain injury from car           leave for neck problems in      post-collision using Social     with female gender (neck
                             collision, 1985-1990, at         the 2-8 years prior to          Security data.                  pain RR=1.2; dizziness
                             hospitals in 4 cities in         collision, gender               Outcomes: presence,             RR=1.5; nausea RR=2.5),
                             Norway (representing 7.3%                                        duration and timing of sick     longer or later sick leave
                             of population of Norway)                                         leave (Social Security data);   associated with past history
                             (n=473)                                                          symptoms; quality of life,      of sick leave for neck pain.
                                                                                              analgesic use; rehabilitation
                                                                                              or permanent disability

Boyd et al., 2002 3          Children aged 4-16 in            WAD severity: Grade I           Followed until asymptomatic     Symptoms lasted longer for
Cohort (Phase I)             northwest England with           (n=40) and Grade II (n=9)       or up to 56 days via clinical   Grade II than for Grade I
                             WAD after car crash;                                             exam followed by telephone      (19.7 days vs. 6.4 days).
                             consecutive presentations to 3                                   call to confirm continued
                             urban ERs. Excludes those                                        asymptomatic status.
                             needing admission.                                               Outcome: time to recovery
                             (n=49)                                                           (defined as no neck pain).

Bylund et al., 19984         WAD injuries in traffic          Gender, mechanism of injury     Days of sick leave              Women had a longer average
Cohort (Phase 1)             collisions in Umea, Sweden;                                                                      sick leave than did men,
                                                                                                                Evidence Tables: Course and Prognosis in WAD

                                January 1, 1990 to December                                                                         (RR=2.9) and a higher
                                31 1991; ages 16-64;                                                                                proportion of women took
                                registered by the Accident                                                                          sick leave (RR= 2.4). Those
                                Analysis Group at the                                                                               in rear-end collisions had the
                                University Hospital. (n=255)                                                                        longest average sick leave

Carroll et al., 200623          Traffic injuries in             Pain coping strategies             Follow-up to recovery or up      Passive coping predicted
Cohort (Phase III)              Saskatchewan, Canada            measured at 6-weeks post-          to one year.                     slower recovery (OR=0.45,
                                between December 1997-          injury (controlling for            Outcome: Time to self-           95% CI 0.36-0.56), especially
                                November 1999, aged 18 and      demographic and                    reported global recovery.        in the presence of concurrent
                                over; with self-reported neck   socioeconomic factors, initial                                      depression (OR =0.25, 95%
                                pain after the collision.       pain intensity and extent,                                          CI 0.17-0.39). Depression at
                                (n=2320)                        post-injury symptoms, prior                                         six weeks predicted slower
                                                                health)                                                             recovery (HRR=0.68, 95% CI
                                                                                                                                    0.62-0.76). Active coping did
                                                                                                                                    not predict time to recovery
                                                                                                                                    (OR=1.08, 95% CI 0.87-

Cassidy at al., 2000; Côté et   All personal injury claimants   Compensation system (tort or       Follow-up by administrative      Longer time to claim closure
al., 20015;24                   after motor vehicle injury in   no fault), age, gender, marital    database up to 1997 (n=5398)     in tort than no fault system.
Cohort (Phase II)               Saskatchewan, Canada, July      status, education,                 and at 6 weeks, 4, 8 and 12      For all claims, longer claim
                                1994 to December 1995; 18       employment, characteristics        months by mailed self-report     duration associated with
                                years or older; self-reported   of collision, seat belt use,       questionnaire (n=2783).          female gender (HRR=0.84
                                neck or shoulder pain after     headrest, initial pain intensity   Outcomes: time to claim          (0.77-0.91), more neck pain
                                collision. Excluded reopened    and extent, prior health, other    closure (n=5,398). Outcome       (HRR=0.63, 0.52-0.76 for
                                claims, hospitalized for more   associated injuries and            of claim closure validated       VAS 80-100 in tort system) ,
                                than 2 days. Population-        symptoms, at fault for             against self-reported recovery   higher % of body in pain
                                based. (total n=5,398)          collision, lawyer retained,        in depression, neck pain and     (HRR=0.59 for 40-100% in
                                                                type of care provider.             physical functioning.24          tort system), retaining a
                                                                                                                                    lawyer (HRR=0.60, 0.53-0.68
                                                                                                                                    in tort system, 0.61, 0.49-0.75
                                                                                                                                    in no fault system), type of
                                                                                                                                    initial health care provider
                                                                                                                                    (HRR=0.61 for MD +
                                                                                                                                    Chiropractor in tort system,
                                                                                                            Evidence Tables: Course and Prognosis in WAD

                                                                                                                                  and 0.61 for Chiropractor in
                                                                                                                                  no fault system). Shorter
                                                                                                                                  duration of claims in low
                                                                                                                                  education (HRR=1.56, 95%
                                                                                                                                  CI 1.27-1.92 for < grade 8).
                                                                                                                                  For tort claims only, longer
                                                                                                                                  claim duration in those with
                                                                                                                                  painful jaw (HRR=0.80, 0.70-
                                                                                                                                  0.92) and those not at fault
                                                                                                                                  for collision (HRR=0.70,
                                                                                                                                  0.61-0.80). For no fault
                                                                                                                                  claims only, longer duration
                                                                                                                                  in those with arm pain
                                                                                                                                  (HRR=0.84, 0.77-0.92) or
                                                                                                                                  fractures (0.70, 0.55-0.89).

Cassidy et al., 2007 6   All adults submitting personal   Prognostic actors: Type and        Follow-up by telephone               Attendance at rehabilitation
Cohort (Phase III)       injury claims after motor        timing of rehabilitation           interview at 6 weeks, 3, 6, 9        programs predicted slower
                         vehicle injury in                program compared to usual          and 12 months. Self-reported         recovery. Rehabilitation
                         Saskatchewan, Canada, 1997-      care; controlling for              global recovery, as                  type, Fitness training:
                         1998; self-reported collision-   demographic and                    determined by endorsement            Attended before 70 days of
                         related neck pain. Excluded      socioeconomic factors,             of ‘all better’ or ‘quite a bit of   injury (HRR= .68, 95% CI
                         those hospitalized for more      collision factors, initial pain    improvement’.                        .54-.86). Outpatient
                         than 2 days. (n=6,021)           and symptoms, initial health                                            Rehabilitation: Attended
                                                          care providers                                                          before 120 days of injury,
                                                                                                                                  (HRR=. 50, 95% CI .33-.77).

Côté et al., 200525      All personal injury claimants    Prognostic factors: Type and       Follow-up to claim closure by        Fastest recovery times in
Cohort (Phase III)       after motor vehicle injury in    intensity of health care during    administrative database.             those with 1-2 visits to
                         Saskatchewan, Canada, July       the first 30 days after traffic-   Outcome of claim closure             general practitioners in the
Côté et al., 200726      1994 to December 1995; 18        related neck injury (WAD),         validated against self-              first month post-injury.
Cohort (Phase III)       years or older; self-reported    controlled for demographics,       reported recovery in                 Longer claim duration in
                         neck or shoulder pain after      injury severity, prior health,     depression, neck pain and            those with more frequent
                         collision; excludes those        pre-collision health care          physical functioning.24              health care and those seen by
                         making a personal injury         utilization, lawyer retained                                            chiropractors; general
                         claim later than 30 days post-   and collision characteristics.                                          practitioners plus
                         injury, and those whose          Administrative health data                                              chiropractors; and general
                                                                                                         Evidence Tables: Course and Prognosis in WAD

                          patterns of post-injury health   used for pre- and post-injury                                    practitioners plus specialists.
                          care did not fit into one of 8   health care utilization.                                         Findings were consistent over
                          pre-determined patterns (n=                                                                       both insurance systems.
                          1693 in the Tort cohort and                                                                       GP (1-2 days): 1.00
                          n=2486 in the no fault cohort)                                                                    GP (>2 visits): 0.73, (95% CI
                                                                                                                            DC ( >6 visits): 0.61, (95%
                                                                                                                            CI .46-.81).
                                                                                                                            GP and Specialist: 0.69, (95%
                                                                                                                            CI .55-.87)
                                                                                                                            Gen.Med: 0.78, (95% CI .64-

Drottning et al., 20027   Patients with possible WAD       Prognostic factors: Initial       Follow-up at 6 months and 1    Cervicogenic headache at one
Descriptive (Phase I)     attending emergency              clinical exam; prior injuries     year. Outcome:                 year is predicted by prior car
                          department in Oslo after a       and headaches; symptoms at        Cervicogenic headache, range   collisions (RR= 1.55), pre-
                          traffic collision; 1993-1995.    4 weeks, intensity of             of motion                      existing headaches (RR=
                          (n=587).                         headaches and neck pain at 4                                     2.70) and neck pain (RR=
                                                           weeks, neurological exam for                                     2.9), stiffness (RR= 3.4), and
                                                           those with headaches at 6                                        initial reduced range of
                                                           weeks.                                                           motion (1.58).

Hartling et al., 200227   Patients presenting to two       Prognostic factors: age,          Follow-up at 6 months by       Older age (OR= 3.21, 95% CI
Cohort (Phase II)         emergency departments in         gender, BMI, height, prior        telephone contact. Outcome     1.62-2.18), larger number of
                          Ontario, Canada with traffic-    neck pain, characteristics of     was WAD, defined as regular    initial symptoms (OR= 6.71,
                          related WAD; between             the collision, initial pain and   or daily moderate pain or      95% CI 2.39- 18.81- 22.67,
                          October 1995 and March           symptoms (type, frequency,        occasional, regular or daily   95% CI 5.21- 98.72), and
                          1998. (n=380)                    intensity).                       severe pain.                   early development of upper
                                                                                                                            back pain (OR= 2.91, 95% CI
                                                                                                                            1.65-5.12), upper extremity
                                                                                                                            numbness/weakness (OR=
                                                                                                                            2.18, 95% CI 1.22-3.87), and
                                                                                                                            disturbance in vision (OR=
                                                                                                                            1.96, 95% CI 1.00-3.86)
                                                                                                                            predicted persistent WAD at
                                                                                                                            6 months.
                                                                                                            Evidence Tables: Course and Prognosis in WAD

Holm et al., 1999 9      Population based. Swedish      Prognostic factors: type of           Outcome assessed average of       Older age (OR= 2.9, 95 % CI
Cohort (Phase II)        population with a permanent    injury (WAD, WAD plus                 4 years after injury.             1.8-4.8), greater medical
                         medical impairment of 10%      other, other injury), year of         Outcomes: medical                 impairment (OR= 8.1, 95%
                         or more due to WAD.            impairment judgment, age,             impairment, reduced or full       CI 4.9-13.4) and lower
                         (n=184 in 1989 and n=481 in    gender, professional status,          work disability                   professional status (OR= 3.6,
                         1994).                         and (with work disability                                               95% CI 1.9-96.9) associated
                                                        outcome only) medical                                                   with partial/full work
                                                        impairment rating                                                       disability at follow-up.

Kasch et al., 200128     Patients presenting to         Prognostic factors for return         Follow-up at 1, 3, 6 and 12       Decreased range of motion
Cohort (Phase II)        emergency units in Aarhus,     to work or daily activities:          months post injury by             predicted handicap (HRR=
                         Denmark, within 2 days of a    gender, age, BMI, initial pain        interview and examination.        2.53, 95% CI 1.26-5.11),
                         WAD in a rear-end collision.   intensity, number of                  Outcome: time to return to        especially in the presence of
                         (n=141). Controls: patients    symptoms, active cervical             work or daily activities; and     high pain intensity and non-
                         with ankle injuries. (n=40)    range of motion, speed                work capacity or handicap.        painful complaints.
                                                        difference of cars; and               Handicap defined as self-         Decreased range of motion
                                                        workload.                             report of reduced hours and       plus high initial pain
                                                        Prognostic factors for                work capacity, job dismissal      predicted failure to recover.
                                                        handicap: same as above plus          or change in job due to injury,   More intense pain, greater
                                                        lawsuit within 1 month of             in job training due to injury     number of symptoms, and
                                                        injury, type of therapy chosen        or application/receiving          lawsuit during the first month
                                                        at first visit (soft collar, active   disability pension.               showed a trend toward
                                                        or passive physiotherapy,                                               predicting handicap, but
                                                        manipulation, weak                                                      precision was poor.
                                                        analgesics), health behavior
                                                        (assessed by the Millon
                                                        Behavioral Health Inventory)

Kivioja et al., 200529   Patients presenting to         Coping (catastrophizing, as           1-year follow-up.                 When all predictors were
Cohort (Phase II)        emergency room in              assessed by CSQ)                      Outcome: neck pain (‘Do           included in multivariable
                         Stockholm with WAD             administered within 1 week            you have neck pain now’:          analysis, only prior neck pain
                         (December 1996-June 1997);     of injury, prior neck pain,           yes/no).                          predicted neck pain at one
                         18-65 years old. (n=96)        initial neck pain intensity,                                            year (OR=4.5, 95% CI 1.11-
                                                        age, gender.                                                            8.76).

Krafft et al., 200030    Insurance claimants with       Prognostic factors were tow-          One year follow-up.               Presence of tow-bars on cars
Cohort (Phase I)         Folksam, Sweden; AIS 1         bar presence on the stricken          Outcome was medical               is associated with long term
                                                                                                          Evidence Tables: Course and Prognosis in WAD

                           neck injuries after rear          vehicle and peak               assessment of pain, function      consequences (RR= 1.22), but
                           impact; random sample of          accelerations in the crash.    and/or mental dysfunction.        not short-term consequences.
                           injuries between 1990 and
                           1993. For long-term portion
                           of study, at least one
                           passenger sustained loss of
                           function, pain and/or mental
                           dysfunction assessed at one
                           year. (n=659 for short term
                           and 501 for long term

Krafft et al., 200231      Insurance (Folksam, Sweden)       Prognostic factor was crash    At least 6 month follow-up.       Symptoms had longer
Cohort (Phase I)           claimants with Grades 0-III       pulse readings                 Outcomes: duration of             duration with greater mean
                           WAD after a rear impact                                          symptoms (less than one           acceleration.
                           involving car models with                                        month vs. more than one
                           crash recorders; crashes                                         month; more than 6 months),
                           occurred after 1996, car                                         recorded on medical notes.
                           models were 1995 and later.
                           (n=66 crashes with 94 WAD

Miettinen et al., 200413   Insurance claimants with          Age, gender, education,        1-year follow-up:                 At one year, low education
Cohort (Phase I)           neck pain after a motor           marital status, collision      Outcomes: self-reported           predicted impaired health
                           vehicle collision in Finland in   factors, WAD classification,   change in health due to the       (OR for primary school = 4.6,
                           1998. (n=330)                     self-reported depression       collision, length of sick leave   95% CI 1.3-15.9), being
                                                             (BDI), general distress        due to the collision.             divorced or widowed
                                                             (GHQ).                                                           (OR=3.5, 95% CI 0.8-15.9,
                                                                                                                              n.s.). GHQ and BDI each
                                                                                                                              predicted impaired health in
                                                                                                                              crude analyses.
                                                                                                                              Predictors of longer sick
                                                                                                                              leave (unadjusted) were being
                                                                                                                              female and
                                                                                                                              marital status.
                                                                                                                              At 3 years, WAD
                                                                                                     Evidence Tables: Course and Prognosis in WAD

                                                                                                                        classification predicted
                                                                                                                        change in health. For
                                                                                                                        significant change in health
                                                                                                                        (compared with no change)
                                                                                                                        RR=3.28 (95% CI 1.07-
                                                                                                                        10.03) for WAD III compared
                                                                                                                        with WAD I.

Nederhand et al., 200332   Admissions to general        Prognostic factors assessed an   24 week follow-up. Outcome     Mean baseline NDI score for
Cohort (Phase I)           hospital emergency           average of 8 days post-injury:   was non-disabled (defined as   non-disabled, 14.2 (10th, 90th
                           department between July      disability (Neck Disability      NDI score ≤ 15) vs. disabled   %ile, 4.6-25.4) vs. disabled,
Nederhand et al., 200433   1999 and December 2001       Index), pain intensity (VAS)     (NDI score >15).               27.9 (15.4-40.0); mean
Cohort (Phase I)           with neck pain after motor   fear of movement (Tampa                                         baseline neck pain VAS for
                           vehicle collision. (N=82)    Scale), catastrophizing (Pain                                   non-disabled, (33.6, s.d. 20.5)
                                                        cognition List – Experimental                                   vs. disabled, ( 60.7s.d. 19.4);
                                                        version), surface                                               mean baseline fear of
                                                        electromyography.                                               movement for non-disabled,
                                                                                                                        35.0 (10th, 90th %ile 26.0-
                                                                                                                        45.0) vs. disabled, 41.5 (33.8-
                                                                                                                        50.4); mean baseline
                                                                                                                        catastrophizing for non-
                                                                                                                        disabled vs. disabled (28.6s.d.
                                                                                                                        22.2 vs. 53.2s.d. 24.4)
                                                                                                                        No elevated muscle reactivity
                                                                                                                        (hyper reactivity) at baseline
                                                                                                                        or follow-up. Isometric
                                                                                                                        muscle activity, disabled
                                                                                                                        (141.2 s.d. 70.3) vs. non-
                                                                                                                        disabled (96 s.d. 50.1) No
                                                                                                                        changes over time. All
                                                                                                                        individually predicted
                                                                                                                        recovery. Combining
                                                                                                                        baseline neck disability with
                                                                                                                        fear of movement improves
                                                                                                                        the prediction of outcome.

Norris et al., 1983 15     Presentation to a British    WAD severity: Group 1            Average follow-up times in     Severity of injury at baseline
                                                                                                      Evidence Tables: Course and Prognosis in WAD

Cohort (Phase I)          accident department with     symptoms but no physical          months: Group 1: 19.7;           predicted poorer recovery of
                          neck injury from rear-end    findings (n=27); Group 2          Group 2: 23.9; Group 3: 24.7.    neck pain (Grp1 vs. Grp2,
                          MVC between September        symptoms and reduced range        Follow-up data at clinic visit   RR=1.84, Grp2 vs. Grp3, rr=
                          1977 and May 1980 (n=61).    of movement, no neurological      through self-report and          1.11, Grp1 vs. Grp3, RR=
                                                       signs (n=24); Group 3             physical examination.            2.05). Group membership
                                                       symptoms, reduced                 Outcomes: symptoms, time         also predicted headaches,
                                                       movement and neurological         off work, neurological           parasthesias; more time off
                                                       loss on examination (n=10).       abnormalities.                   work and interference with
                                                       These groups were similar to                                       leisure activities at follow-up.
                                                       the subsequent WAD Grades

Richter et al.; 200434    Patients with WAD            Gender, collision factors,        6 month follow-up.               Initial SF-36 scores and
Cohort Study (Phase II)   presenting to the Hanover    medical history, symptoms         Outcomes: Duration and           initial anxiety predicted
                          trauma centre in Germany.    (presence, location, time of      severity of symptoms (11-        duration and severity of neck
                          N= 43                        onset and severity of neck        point VAS). Other outcomes       pain (no effect sizes
                                                       stiffness, neck restriction,      were changes in SF-36,           available). Age, gender,
                                                       presence of vertigo, nausea,      everyday quality of life,        clinical, radiological findings
                                                       dysphagia, auditory and/or        depression and impact of         and collision parameters did
                                                       visual disturbance), clinical     event.                           not predict severity and
                                                       findings (neck or occipital                                        duration of symptoms.
                                                       tenderness or pain, spinous
                                                       processes, axial compression
                                                       pain, active/passive range of
                                                       motion), radiological and
                                                       neurological findings,
                                                       treatment, psychological
                                                       factors (SF36, depression,
                                                       impact of event, everyday life
                                                       quality), collision factors
                                                       (change in velocity, time and
                                                       location of collision, position
                                                       in vehicle, airbag
                                                       deployment, restraint use,
                                                       collision type, vehicles
Sterner et al., 200335    All persons seeking health   Rear-end vs. other collision;     16-month follow-up through       Predictors of WAD-related
                                                                                                         Evidence Tables: Course and Prognosis in WAD

Cohort (Phase II)        care from physicians in Umeå     prior headache, prior neck        questionnaire.                   disability were: female
                         (Sweden) after WAD in            and prior low back pain (none     Outcomes: disability:            gender (OR= 2.02, 95% CI
                         MVC. Population-based            vs. sometimes/often), age,        none/minor or major affecting    1.13-3.63), lower education
                         Excludes those on sick leave     gender, marital status,           work or leisure. (296            (OR= 2.08, 95% CI 1.09-
                         for neck pain prior to injury.   university vs. lower              responded to follow-up)          3.98), more severe WAD
                         (n=356)                          education, occupation, WAD                                         Grades II-III) (OR=2.03, 95%
                                                          severity (WAD 0-1 vs. 2-3).                                        CI 1.08-3.88) and prior neck
                                                                                                                             complaints (OR= 3.17, 95%
                                                                                                                             CI 1.34-7.46).

Suissa et al., 1995 19   Population based: all motor      Age, gender, number of            Followed until time of claim     From Harder et al 1998:
Cohort (Phase I)         vehicle crash subjects who       dependents, marital status,       closure or one year and seven    Longer time on benefits
                         sustained WAD (ICD-9             employment status, severity       years post-crash, via            predicted by: female gender
Harder et al., 199836    diagnosis code of 847.0) in      of collision, vehicle type,       administrative records of        (RR= .86, 95% CI .77-.96),
Cohort (Phase II)        1987 in Québec and who           driver/passenger, collision       SAAQ in Québec. For one-         older age (RR for > 50 years=
                         were compensated by the          with stationary/moving            year follow-up, subjects         .86, 95% CI .83-.90), having
Suissa et al., 200337    Société d’assurance              object, direction of collision,   recovering within 7 days         dependents (RR= .84, 95% CI
Cohort (Phase II)        automobile du Québec.            seatbelt use, speed limit, neck   were assigned a median           .74-.96), not being employed
                         Recurrences excluded.            pain, tenderness on palpation,    recovery time of 3.5 days.       full time (RR= .86, 95% CI
Suissa 200138            N=2843 for analyses of signs     decreased neck mobility,          For 7 year follow-up, injuries   .76-.98), being injured in a
Cohort (Phase II)        and symptoms at 1 year;          neck pain on mobilization,        not eligible for compensation    truck or bus (RR= .48 ,95%
                         N=2810 with an available         muscle pain, stiffness,           were assigned a mean             CI .39-.59), being a passenger
                         police accident report for       spasms, radiating numbness,       recovery time of 305 days.       (RR= .85, 95% CI .74-.97),
                         analyses of crash                dizziness/vertigo, loss of        Outcome: time in days            collision other than rear-end
                         characteristics. N=2627 at 7     consciousness, vision or ENT      between collision and last       (RR= .85, 95% CI .76-.95)
                         years.                           problems, anxiety or              date of compensation.            and collision with a moving
                                                          insomnia                                                           object (RR= .84, 95% CI .72-

                                                                                                                             From Suissa 2003: Signs and
                                                                                                                             symptoms associated with
                                                                                                                             slower recovery were neck
                                                                                                                             pain on palpation (RR= .86,
                                                                                                                             95% CI .77-.99), muscle pain
                                                                                                                             (RR= .76, 95% CI .76-.1.00),
                                                                                                                             radiating pain or numbness
                                                                                                                             and headache (RR= .55, 95%
Evidence Tables: Course and Prognosis in WAD

                 CI .55-.98) and (RR=.82,
                 95% CI .72-.94). Greater
                 number of risk factors
                 associated with greater time
                 on benefits.

                 From Suissa 2001: At 7 years
                 follow -up, Neck pain on
                 palpation (RR= .85, 95% CI
                 .76-.96), muscle pain (RR=
                 .85, 95% CI .74-.97), Pain or
                 numbness radiating from
                 neck to arms or hands (RR=
                 .64, 95% CI .55-.76) and
                 shoulders (RR= .83, 95% CI
                 .71-.97) and headache (RR=
                 .82, 95% CI .73-.92)
                 associated with slower
                 recovery (adjusted for age
                 and gender.)
                                                                                                              Evidence Tables: Course and Prognosis in WAD

Table 3. Prognostic factors for other outcomes after WAD

Author(s), Year, Study         Setting and Subjects              Prognostic Factors               Follow-up and Outcomes         Key Findings
Design                         Number (n) Enrolled               Considered                       Measured
Buskila et al., 199739         Adults with soft tissue injury    Prognostic factor: soft-tissue   Follow-up 6-18 months post-    At follow-up, neck injury
Cohort (Phase I)               to the neck reporting to an       neck injury or leg fracture;     trauma                         patients had a higher
                               occupational clinic between       making an insurance claims.      Outcomes: tender point count   prevalence of poor
                               July 1994 and December                                             and tenderness threshold,      concentration, blurred vision,
                               1995. Excluded fractures,                                          symptoms of pain, anxiety,     dizziness, sleep disturbance,
                               dislocations, subluxations and                                     depression, fatigue, morning   headaches, parasthesias and
                               repetitive strain injuries.                                        stiffness and global well      subjective joint swelling;
                               (n=102, of whom 74 injuries                                        being (11-point scale);        greater severity of fatigue,
                               were traffic related and 28                                        presence of other symptoms;    anxiety, depression, pain,
                               were work related). Controls                                       Quality of Life; physical      morning stiffness and poor
                               were patients with leg                                             functioning from               global well-being; more
                               fractures (n=59).                                                  Fibromyalgia Impact            tender points, lower pain
                                                                                                  Questionnaire.                 threshold, greater prevalence
                                                                                                                                 of fibromyalgia syndrome (13
                                                                                                                                 times greater), poorer quality
                                                                                                                                 of life and poorer physical
                                                                                                                                 functioning. Neck injury
                                                                                                                                 patients with fibromyalgia
                                                                                                                                 syndrome had more
                                                                                                                                 symptoms. Neck injured
                                                                                                                                 patients making insurance
                                                                                                                                 claims had lower quality of
                                                                                                                                 life (5.6 vs. 5.0 on an 11point
                                                                                                                                 VAS, p= 0.039).

Carroll et al., 200640         Adults with traffic injuries in   Self-reported prior mental       Follow-up at 6 weeks and 3,    42% developed depressive
Cohort (Phase I)               Saskatchewan, Canada              health problems, age, gender.    6, 9 and 12 months by          symptoms within 6 weeks of
                               between December 1997 and                                          telephone interview.           WAD injury, with 38% of
                               November 1999; reporting                                           Outcomes: Timing and           these having recurrent or
                               neck pain after the collision.                                     frequency of depressive        persistent depression
                               (n=6013)                                                           symptoms (measured by          throughout follow-up. Self-
                                                                                                  CES-D); course of depressive   reported prior mental health
                                                                                                  symptomatology                 problems predict persistent
                                                                                                     Evidence Tables: Course and Prognosis in WAD

                                                                                                                        (17.5%; 95% CI, 14.1-21.3)
                                                                                                                        and recurrent (25.6%; 95%
                                                                                                                        CI, 21.6-29.9) depressive
                                                                                                                        symptoms, as well as later
                                                                                                                        onset of depressive

Holm et al, 200741     All personal injury claimants    Prognostic factors: gender,     Follow-up at 6 weeks, 4, 8      21% developed widespread
Cohort (Phase I)       after motor vehicle injury in    age, education, prior health,   and 12 months.                  body pain at some point
                       Saskatchewan, Canada, July       prior neck pain, prior          Outcome: onset of               during the one year follow-
                       1994 to December 1995; 18        headache, post-injury           widespread body pain (using     up. 64% of these
                       years or older; self-reported    symptoms, neck pain             a liberal case definition for   subsequently improved, and
                       neck or shoulder pain after      intensity, number of areas in   widespread body pain)           of these, 22% had
                       collision, and localized neck    pain, depressive symptoms                                       recurrences. Onset of
                       injury with or without head or   (CES-D)                                                         widespread pain was more
                       back pain. (n=266)                                                                               common in women (OR= 1.6,
                                                                                                                        95% CI 1.1-2.1), greater
                                                                                                                        number of painful body areas
                                                                                                                        initially (OR= 2.6, 95% CI
                                                                                                                        1.3-5.4), greater initial neck
                                                                                                                        pain intensity (OR= 3.2, 95%
                                                                                                                        CI 1.3-8.0), and more
                                                                                                                        depressive symptoms (OR=
                                                                                                                        3.2, 95% CI 1.6-6.3).

Kasch et al, 200142    Patients presenting to           Prognostic factors: type of     Follow-up at 1 week, 3 and 6    At 1 week to 3 months, WAD
Cohort (Phase II)      emergency units in Aarhus,       injury.                         months.                         patients had greater focal
                       Denmark, within 2 days of                                        Outcome: Musculoskeletal        sensitization (lower pressure
                       neck injury in a rear-end                                        sensitization, determined by    pain thresholds, mean
                       collision. (n=123). Controls:                                    pressure-pain-detection         difference = -.3, p=.008 and
                       patients with ankle injuries.                                    thresholds and palpation-       greater tenderness, mean
                       (n=36).                                                          score.                          difference = 1.6, p = <.05)
                                                                                                                        than controls. No differences
                                                                                                                        were present by 6 months.

Kasch et al., 200543   Adult WAD patients               Type of injury (WAD vs.         Follow-up at 1, 3, 6 and 12     No differences in time to
Cohort (Phase II)      attending emergency units in     ankle)                          months post-injury.             peak pain between recovered
                                                                                                              Evidence Tables: Course and Prognosis in WAD

                             Aarhus after rear-end                                              Outcome: pain (VAS,               WAD and ankle injuries at
                             collision, with initial                                            numeric scale and McGill          baseline or follow-up.
                             complaints. (n=141 at                                              Pain Questionnaire); self-        Unrecovered WAD had
                             baseline, 99 by 1 year).                                           reported work capacity; and       reduced time to peak pain at
                             Comparison Group: Adult                                            time to pressure pain             baseline (59.1 ± 30.8 vs.
                             patients with non-sport ankle                                      tolerance in cold pressure        29.15 ± 10.5, p<.001) and 6
                             injuries. (n=40 at baseline,                                       test. Outcomes stratified by      months (55.1 ± 30.2 vs. 26.5
                             21 by 1 year. Initial                                              recovered WAD; non-               ± 14.9, p< .001) but not at 12
                             assessment 1 week after                                            recovered WAD; and ankle          months. Unrecovered WAD
                             injury.                                                            injury.                           had higher pain than
                                                                                                                                  recovered WAD at all time
                                                                                                                                  points (no adjustment for
                                                                                                                                  initial pain analysis).
Nederhand et al., 200332     Admissions to general            Time since injury, baseline       Follow-up at 1, 4, 8, 12 and      No elevated muscle reactivity
Cohort (Phase I)             hospital emergency               neck disability (measured by      24 weeks. Outcomes were           at any point. Surface EMG of
                             department between July          NDI), fear of movement            upper trapezius EMG (muscle       upper trapezius muscle
                             1999 and December 2001           (Tampa Scale for                  reactivity to exercise,           inversely related to neck pain
                             with neck pain after motor       Kinesiophobia).                   isometric and dynamic             disability, but no time-related
                             vehicle collision. (N=92                                           muscle activity) and disability   changes in EMG. Baseline
                             completing both baseline and                                       status. Disability status         neck disability predicts EMG
                             follow-up for EMG and                                              assessed by Neck Disability       findings at 24 weeks. Effect
                             disability portion; n=82 for                                       Index (NDI), categorized into     sizes not provided.
                             fear of movement study)                                            recovered, mild, moderate
                                                                                                and severe/complete.

Richter et al.,200434        Patients with WAD                Gender, collision factors,        6 month follow-up.                Initial pain intensity score >5,
Cohort (Phase II)            presenting to the Hanover        medical history, symptoms,        Outcomes: SF36, everyday          duration of symptoms more
                             trauma centre in Germany.        clinical findings, radiological   quality of life (EDLQ),           than 28 days had significant
                             N= 43                            and neurological findings,        depression (CES-D), and           changes in SF36, EDLQ,
                                                              treatment, psychological          impact of event (IES).            CES-D, and IES scores at 6
                                                              factors, collision mechanism                                        months. Initial scores on
                                                                                                                                  these predicted later scores.
                                                                                                                                  Effect sizes not provided.

Wynne-Jones et al., 200644   Adult traffic-injury claimants   Gender; age; prior health,        12-month follow-up of pain        54 (7.8%) had widespread
Cohort (Phase II)            to one UK based insurance        prior psychological health,       data. Outcome: New onset          body pain at one year. After
                             company; with no widespread      collision factors, post-          of widespread body pain           adjusting for age and gender,
                                                                             Evidence Tables: Course and Prognosis in WAD

body pain in the month before   collision symptoms, pain and   (same definition as at         in comparison with no neck
the collision. Widespread       health.                        baseline)                      pain, pre-collision only neck
pain defined as pain both                                                                     pain RR=2.0 (95% CI 0.7-
above and below the waist, in                                                                 5.5); post-collision only neck
both sides of body and in the                                                                 pain RR=2.8 (95% CI 1.6-
axial skeleton. N=957                                                                         5.0); pre- and post-collision
enrolled and 695 at follow-up                                                                 neck pain RR=3.3 (95% CI
(39 had pre-collision neck                                                                    1.5-6.8). Neck pain was not
pain, 153 had post-collision                                                                  associated with onset after
neck pain and 37 had both).                                                                   also adjusting for all other
                                                                                              potential prognostic factors.
                                              Evidence Tables: Course and Prognosis in WAD

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