Background & Aims

Whiplash refers to a sudden, strong oscillating movement of the cervical spine, which can occur, for example, in motor vehicle crashes or in fall or diving injuries. People with whiplash-associated disorder (WAD) experience a wide range of diverse symptoms and dysfunctions, such as neck pain, headache, dizziness, and a wide range of muscular dysfunctions (1-5). Furthermore, they may experience diverse social, activity and participation limitations not captured by commonly used disability measures such as the Neck Disability Index and Whiplash Disability Questionnaire (6-9). However, a condition-specific symptom profile and outcome measures provide the basis for accurate assessment, correct diagnosis, and treatment targeting.

We aimed to identify the symptoms, impairments, activity limitations and participation restrictions in patients with WAD to determine an adequate representative sample for developing a condition-specific and clinically relevant questionnaire.

Methods

We performed item generation in three steps: 1) we performed a systematic review, and 2) experts and 3) patients with WAD and nonspecific neck pain (NSNP) were interviewed.

We formed the survey according to the International Classification of Functioning, Disability and Health (ICF) classification based on the systematic review and opinions of the authors. Experts independently rated the relevance of all items for patients with WAD on a 4-point Likert scale (not relevant to very relevant), while patients answered the same questions as experts but evaluated the magnitude of current symptoms and impairments on a 5-point Likert scale (no impairment to complete impairment).

The experts’ answers were evaluated by content validity index, content validity ratio (CVR) and modified ??(10-11). The magnitudes of symptoms and impairments experienced by patients were reported as averages, and standard deviations and comparisons between patient groups were analyzed using a two-sample t-test.

Results

The expert panel included eight specialists in neurosurgery, neurology, and physical and rehabilitation medicine, as well as six physiotherapists. According to preliminary results, the experts considered 31 out of 98 items relevant for patients with WAD. The experts considered the most important symptoms and disorders related to Sensory functions and pain, Movement-related functions, and Mobility in the ICF subcategories.

These subcategories also seemed to be emphasized in patients with NSNP (n=44). However, patients with WAD (n=92) experienced the most significant impairments in Major life areas, Mental functions, Sensory functions and pain, and General activities in the ICF subcategories. When analyzing the items of the questionnaire causing the most significant impairment in patients with WAD, there was a statistically significant difference between the patient groups in the extent or magnitude of symptoms and impairments, except for pain.

Conclusions

According to our preliminary results, the responses of experts and patients seem to contain only a few items that are assessed in commonly used outcome measures in patients with WAD. Our results of the most relevant and most disabling symptoms and impairments can be used to evaluate the symptom profile and select an appropriate outcome measure for patients with WAD, as well as to develop a new WAD-specific outcome measure.

References

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Presenting Author

Niklas Särkilahti

Poster Authors

Niklas Särkilahti

MSc

University of Turku

Lead Author

Jani Takatalo

PhD MD

Oulu University Hospital

Lead Author

Olli Tenovuo

Prof PhD MD

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Neck Pain