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Table 5: Results based on Disability or Functional Outcome Measures. Cohort Study number 1 Outcome measurement used Time of follow up Factors associated with poor outcome - Test used Factors associated with poor outcome univariate results multivariate results Non-recovered had higher mean BMI Mann(p=0.015), higher initial neck pain intensity Whitney U, (p=0.000), higher TSK scores (p=0.000), Student thigher scores on catastrophising subscale test, chiof PCL-E (p= 0.000), lower isometric square test. muscle activity (p=0.004) and higher initial ROC NDI (p=0.000). curves. Initial NDI>15 is predictive of poor outcome with 54.3% probability. If this is combined with an initial TSK score >40 this increased to 83.3% probability. Initial high pain intensity (r= 0.38, P<0.01) General Low ratings of self-efficacy (r= -0.48, Linear p<0.001). Model Multiple logistic regression Final model included: Nederhand Recovered versus non6 months et al (2004) recovered based on Neck Disability Index. Scores >15 = non-recovered. 3 Kyhlback et Pain Disability Index al (2002) 1 Year 4 7 Henriks et al Functionally recovered 1 Year (2005) versus non-recovered. Functionally recovered = VAS <30mm for neck pain OR VAS >78mm for activities AND no pain medication use during follow-up. Miettinen et Change in health status 3 years al (2004) due to whiplash injury. Self report. Subjects rated the effect of whiplash injury on their health as no change, slightly worse or significantly worse. Slightly worse or significantly worse = a change in health status. Patients with initial high self-efficacy had Age, Sex, WAD Grade, WAD lower disability at follow-up (β= -0.56, grade/sex. P<0.001) Female gender (OR 4.596 [1.507-14.015]), Seen by PT or GP. low level of education (OR 3.511 [1.05411.696]), high initial neck pain intensity (OR 1.020 [1.002-1.038]), higher levels of somatisation (OR 1.110 [1.030-1.195]). Less initial work limitation reduced the risk of poor outcome (OR 0.986 [0.975-0.998]). Age, gender, marital status, condition of health before the accident, symptoms after the accident, scores on Beck's depression inventory, General Health Questionnaire, Neck Disability Index, Work Ability Index. Binomal NDI score (>20) (p<0.05, OR 11.2). linear regression (logistic regression) 8 Sterling et al Neck Disability Index (2005) 6 months 8 Sterling et al Neck Disability Index (2006) 2-3 years Multiple Factors predicting mod/severe disability Age, gender, initial NDI score, logistic (NDI>30) physical measures of motor regression High Initial NDI (B=0.06, p= 0.028, OR=1.06 function, physical measures of CI 1.007-1.12) sensory function, sympathetic Older age (B=0.13, p=0.01, OR=1.13 CI nervous system function, GHQ1.03-1.23) 28, TSK, Impact of events scale. Reduced cold pain threshold (B=0.26, p=0.01, OR=1.29 CI 1.05-1.58) High Impact of Events Scale scores (stress reaction) (B=0.11, p=0.005, OR 1.11 CI 1.031.2). Was able to correctly classify 86.7% of patients as to whether they had severe/moderate symptoms or not using these variables. Factors predictive of mild disability (NDI score 10-18): Initial NDI score (OR 1.15 [1.03-1.28]), GHQ-28 total (OR 1.15 [1.041.28]) and Cervical Extension ROM (OR 1.1 [1.03-1.25]). Multiple Factors predicting NDI Score: Left cervical rotation, logistic Initial NDI (p=0.001) sympathetic nervous system regression Age (p=0.008) function, compensation status, Cold pain thresholds (p=0.026) initial NDI, age, cold pain Impact of Events Scale scores (p=0.018) thresholds, Impact of Events Factors predicting moderate/severe disability Scale. (NDI>30): High initial NDI OR= 1.05 (CI 1-0-1.1) Older age OR=1.1 (CI 1.0-1.13) Reduced cold pain threshold OR=1.1 (1.01.13). High Impact of Events Scale Score OR=1.03 (CI 1.03-1.20) Logistic Patients with a history of previous Age, gender, driver-passenger regression psychological problems were 5 times more status, neuroticism, previous likely to have a poor social outcome (p<0.05) psychological problems, memories of the accident, mood score and neck symptoms immediately following the accident. 11 15 Mayou and Poor social outcome. A 1 year Bryant global social outcome was (1996) determined by an interviewer to estimate changes to work, leisure and other social changes attributable to the injury. Poor social outcome not clearly defined. Kasch et al Disability. Patients 1 year (2001) completed a 6 point scale to rate work capacity and handicap. Patients were considered handicapped (or non-recovered) if they selected items 3, 4, 5 or 6. Cox Reduced total cervical ROM in the first week regression is associated with increased disability analysis (B=2.53 CI 1.26-5.11, p =0.01). ROM was considered to be decreased if it was 2 standard deviation below the total cervical ROM of the control group. Cervical muscle workload, pain (VAS), number of symptoms, gender, speed differences >26km/hr, age>31, BMI>30, lawsuit during first month post injury.
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