Predictive Factors for Persistent Pain and Poor Recovery of Health Status 1 Year after Whiplash Injury (Quebec Grade 1 and 2): Results from the ESPARR Cohort


Background: A large number of studies have addressed whiplash injury, and many meta-analyses have sought to highlight chronicity factors; the implicated processes, however, remain a matter of debate. The present study used data from the ESPARR cohort (an on-going prospective study of a representative cohort of road accident victims in the Rh?ne administrative département of France). The objectives were to describe the consequences of whiplash injury and to determine prognostic factors for poor recovery and persistent pain at 1 year post-accident. Methods: The cohort included 255 “pure” whiplash victims, 173 of whom responded to the 1-year follow-up questionnaire. Correlations between explanatory variables and health and pain status were explored by modified Poisson regression to provide adjusted relative risk (RR) values. Results: Half of the victims had not fully recovered health status by 1 year. The main factor associated with non-recovery was pain (RR = 1.3; 1.0-1.7). A birth in the family preceding the accident emerged as another factor (RR=1.5; 1.2-1.9). Victims responsible for their accident were twice as likely to report being free of pain as those not responsible (RR = 0.5; 0.3-0.8). No correlation emerged with accident-related characteristics or PTSD. Conclusions: The present results extend our understand- ing of whiplash injury. Residual pain is the fundamental factor causing whiplash victims to feel that they have not recovered good health. Our findings suggest this may be bound up with physical factors (gender susceptibility); external factors such as having to carry weights (such as a baby) and with perceiving oneself as a victim are not incompatible with this hypothesis.

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Khati, I. , Chossegros, L. , Charnay, P. , Tardy, H. , Perrine, A. , Laumon, B. and Hours, M. (2014) Predictive Factors for Persistent Pain and Poor Recovery of Health Status 1 Year after Whiplash Injury (Quebec Grade 1 and 2): Results from the ESPARR Cohort. Pain Studies and Treatment, 2, 36-49. doi: 10.4236/pst.2014.22008.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Spitzer, W.O., Skovron, M.L., Salmi, L.R., Cassidy, J.D., Duranceau, J., Suissa, S. and Zeiss, E. (1995) Scientific Mo- nograph of the Quebec Task Force on Whiplash-Associated Disorders: Redefining “Whiplash” and Its Management. Spine, 20, 1S-73S.
[2] AAAM, Association for the Advancement of Automotive Medicine (1990) The Abbreviated Injury Scale-1990 Revision (AIS-90). Des Plaines.
[3] Richter, M., Otte, D., Pohlemann, T., Krettek, C. and Blauth, M. (2000) Whiplash-Type Neck Distortion in Restrained Car Drivers: Frequency, Causes and Long-Term Results. European Spine Journal, 9, 109-117.
[4] C?té, P., Cassidy, J.D., Carroll, L.J., Frank, J.W. and Bombardier, C. (2001) A Systematic Review of the Prognosis of Acute Whiplash and a New Conceptual Framework to Synthesize the Literature. Spine, 26, E445-E458.
[5] Scholten-Peeters, G.M., Verhagen, P., Bekkering, G.E., Van Der Windt, D.A., Barnsley, L., Oostendorp, R.A.B. and Hendriks, E.J. (2003) Prognostic Factors of Whiplash-Associated Discorders: A Systematic Review of Prospective Co- hort Studies. Pain, 104, 303-322.
[6] Williams, M., Williamson, E., Gates, S., Lamb, S. and Cooke, M. (2007) A Systematic Literature Review of Physical Prognostic Factors for the Development of Late Whiplash Syndrome. Spine, 32, E764-E780.
[7] Williamson, E., Williams, M., Gates, S. and Lamb, S.E. (2008) A Systematic Literature Review of Psychological Factors and the Development of Late Whiplash Syndrome. Pain, 135, 20-30.
[8] Walton, D., Pretty, J., Macdermid, J. and Teasell, R. (2009) Risk Factors for Persistent Problems Following Whiplash Injury: Results of a Systematic Review and Meta-Analysis. Journal of Orthopaedic & Sports Physical Therapy, 39, 334-350.
[9] Carroll, L.J., Holm, L.W., Hogg-Johnson, S., et al. (2008) Course and Prognostic Factors for Neck Pain in Whiplash- Associated Disorders (WAD): Results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine, 33, S83-S92.
[10] Revel, M. (2003) Whiplash Injury of the Neck from Concepts to Facts. Annales de Réadaptation et de Médecine Physi- que, 46, 158-170.
[11] Binder, A. (2007) The Diagnosis and Treatment of Nonspecific Neck Pain and Whiplash. Eura Medicophysics, 43, 79- 89.
[12] Hours, M., Bernard, M., Charnay, P., et al. (2010) Functional Outcome after Road-Crash Injury: Description of the ESPARR Victims Cohort and 6-Month Follow-Up Results. Accident Analysis & Prevention, 42, 412-421.
[13] Laumon, B., Martin, J.L., Collet, P., Chiron, M., Verney, M.P., Ndiaye, A. and Vergnes, I. (1997) A French Road Ac- cident Trauma Registry : First Results. 41st AAAM Conference, 1997, AAAM, Orlando.
[14] Charnay, P. and Laumon, B. (2002) Le registre des victimes d’accidents de la circulation routière du Rh?ne: Modalités de mise en place, de recueil, d’informatisation et de gestion. Rapport UMRESTTE, 1-119.
[15] The Whoqol Group (1998) Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment. Psychological Medicine, 28, 551-558.
[16] Weathers, F.W., Litz, B.T., Herman, D.S., Huska, J.A. and Keane, T.M. (1993) The PTSD Checklist: Reliability, Vali- dity and Diagnostic Utility. IXth Annual Meeting of the International Society for Traumatic Stress Studies, 1993, San Antonio.
[17] Ventureyra, V., Yao, S.-N., Cottraux, J., Note, I. and De Mey-Guillard, C. (2002) The Validation of the Posttraumatic Stress Disorder Checklist Scale in Posttraumatic Stress Disorder and Nonclinical Subjects. Psychotherapy Psychosom, 71, 47-53.
[18] Sullivan, M.J., Stanish, W., Sullivan, M.E. and Tripp, D. (2002) Differential Predictors of Pain and Disability in Patients with Whiplash Injuries. Pain Research Managing, 7, 68-74.
[19] Hendriks, E.J.M., Scholten-Peeters, G.G., Van Der Windt, D.A.W.M., Neeleman-Van Der Steen, C.W.M., Oostendorp, R.A.B. and Verhagen, A.P. (2005) Prognostic Factors for Poor Recovery in Acute Whiplash Patients. Pain, 114, 408- 416.
[20] Carstensen, T., Frostholm, L., Oernboel, E., Kongsted, A., Kasch, H., Jensen, T. and Fink, P. (2012) Are There Gender Differences in Coping with Neck Pain Following Acute Whiplash Trauma? A 12-Month Follow-Up Study. European Journal of Pain, 16, 49-60.
[21] Merrick, D. and St?lnacke, B.M. (2010) Five Years Post Whiplash Injury: Symptoms and Psychological Factors in Re- covered versus Non-Recovered. BMC Research Notes, 3, 190.
[22] Stemper, B., Derosia, J., Yogananan, N., Pintar, F., Shender, B. and Paskoff, G. (2009) Gender Dependent Cervical Spine Anatomical Differences in Size-Matched Volunteers-Biomed 2009. Biomedical Sciences Instrumentation, 45, 149- 154.
[23] Stemper, B.D., Yoganandan, N., Pintar, F.A., Maiman, D.J., Meyer, M.A., DeRosia, J., Shender, B.S. and Paskoff, G. (2008) Anatomical Gender Differences in Cervical Vertebrae of Size-Matched Volunteers. Spine, 33, E44-E49.
[24] Bell, D.R., Blackburn, J.T., Norcorss, M.F., Ondrak, K.S., Hudson, J.D., Hackney, A.C. and Padua, D.A. (2012) Estrogen and Muscle Stiffness Have a Negative Relationship in Females. Knee Surgery, Sports Traumatology, Arthroscopy, 20, 361-367.
[25] Vibert, N., Hoang, T., Gilchrist, D.P., MacDougall, H.G., Burgess, A.M., Roberts, R.D., Vidal, P.P. and Curthoys, I.S. (2006) Psychophysiological Correlates of the Inter-Individual Variability of Head Movement Control in Seated Humans. Gait & Posture, 23, 355-363.
[26] Sterner, Y., Toolanen, G., Gerdle, B. and Hildingsson, C. (2003) The Incidence of Whiplash Trauma and the Effects of Different Factors on Recovery. Journal of Spinal Disorders & Techniques, 16, 195-199.
[27] Richter, M., Ferrari, R., Otte, D., Kuensebeck, H.W., Blauth, M. and Krettek, C. (2004) Correlation of Clinical Findings, Collision Parameters, and Psychological Factors in the Outcome of Whiplash Associated Disorders. Journal of Neu- rology, Neurosurgery & Psychiatry, 75, 758-764.
[28] Carroll, L.J., Holm, L.W., Hogg-Johnson, S., et al. (2009) Course and Prognostic Factors for Neck Pain in Whiplash- Associated Disorders (WAD). Results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its As- sociated Disorders. Journal of Manipulative and Physiological Therapeutics, 32, S97-S107.
[29] Ferrari, R. (2004) The Clinical Relevance of Symptom Amplification. Pain, 107, 276-277.
[30] Buitenhuis, J., De Jong, P., Jaspers, J. and Groothoff, J. (2008) Catastrophizing and Causal Beliefs in Whiplash. Spine (Phila Pa 1976), 33, 2427-2433.
[31] B?rsbo, B., Peolsson, M. and Gerdle, B. (2008) Catastrophizing, Depression, and Pain: Correlation with and Influence on Quality of Life and Health—A Study of Chronic Whiplash-Associated Disorders. Journal of Rehabilitation Medi- cine, 40, 562-569.
[32] Chossegros, L., Hours, M., Charnay, P., et al. (2011) Predictive Factors of Chronic Post-Traumatic Stress Disorder 6 Months after a Road Traffic Accident. Accident Analysis & Prevention, 43, 471-477.
[33] Sterling, M., Hendrikz, J. and Kenardy, J. (2010) Compensation Claim Lodgement and Health Outcome Developmental Trajectories Following Whiplash Injury: A Prospective Study. Pain, 150, 22-28.
[34] Ferrari, R. and Russell, A.S. (2001) Why Blame Is a Factor in Recovery from Whiplash Injury. Medical Hypotheses, 56, 372-375.
[35] Fice, J.B., Cronin, D.S. and Panzer, M.B. (2011) Cervical Spine Model to Predict Capsular Ligament Response in Rear Impact. Annals of Biomedical Engineering, 39, 2152-2162.
[36] Robinson, J.P., Burwinkle, T. and Turk, D.C. (2007) Perceived and Actual Memory, Concentration, and Attention Pro- blems after Whiplash-Associated Disorders (Grades I and II): Prevalence and Predictors. Archives of Physical Medicine and Rehabilitation, 88, 774-779.
[37] Amoros, E., Martin, J.L. and Laumon, B. (2006) Under-Reporting of Road Crash Casualties in France. Accident Analysis & Prevention, 38, 627-635.
[38] Ngo, T., Stupar, M., C?té, P., Boyle, E. and Shearer, H. (2010) A Study of the Test-Retest Reliability of the Self-Perceived General Recovery and Self-Perceived Change in Neck Pain Questions in Patients with Recent Whiplash-Associated Dis- orders. European Spine Journal, 19, 957-962.

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