J Orthop Sports Phys Ther. 2016 (Oct); 46 (10):
Ricci Anstey, DPT, Alice Kongsted, PhD,
Steven Kamper, PhD, Mark Hancock, PhD
Faculty of Medicine and Health Science,
Sydney, NSW, Australia.
Study Design Secondary analysis of a prospective cohort study with cross sectional and longitudinal analyses.
Background   The clinical importance of a history of whiplash associated disorder (WAD) in people with neck pain remains uncertain.
Objective To compare people with WAD to people with non-specific neck pain, in terms of their baseline characteristics, and pain and disability outcomes over 1 year.
Methods Consecutive patients with neck pain presenting to a secondary care spine centre answered a comprehensive self-report questionnaire and underwent a physical examination. Patients were classified into either WAD or non-specific neck pain groups. We compared the outcomes of baseline characteristics of the 2 groups, as well as pain intensity and activity limitation at 6 and 12-month follow-up.
Results 2,578 participants were included in the study. Of these 488 (19%) were classified as having WAD. At presentation patients with WAD were statistically different to patients without WAD for almost all characteristics investigated. While most differences were small (1.1 points on an 11-point pain rating scale and 11 percentage points on the Neck Disability Index) others including the presence of dizziness and memory difficulties were substantial. The between group differences in pain and disability increased significantly (P<.001) over 12 months. At 12-month follow-up the patients with WAD on average had approximately 2 points more pain and 16 percentage points more disability than those with non-specific neck pain.
Conclusion People referred to secondary care with WAD were typically more severely affected on self-reported health than those with non-specific neck pain, and also experienced worse outcomes. Caution is required interpreting the longitudinal outcomes due to lower than optimal follow-up rates.
Level of Evidence Prognosis, level 2.