Research into whiplash published in this week's PLoS Medicine has found that an individual's expectation of getting better plays a crucial role in the likelihood of his or her recovery, even after the severity of their physical and psychological symptoms are taken into account. Lena Holm at Karolinska Institutet in Stockholm, Sweden and colleagues from Sweden and Canada investigated the role of individuals' expectation of recovery by using a questionnaire-based study of adult insurance claimants.
Whiplash is the range of injuries caused by sudden distortion of the neck, often occurring during a car crash. It can result in a diverse set of symptoms collectively known as whiplash-associated disorders (WAD), including back, neck and shoulder pain, blurred vision, headache, ringing in the ears, nausea, anxiety and depression. As well as causing patients severe distress, the diversity of the symptoms makes prediction of recovery very difficult and costly for the health system and for employers. Lena Holm and colleagues collected information with a questionnaire from just over 1,000 adult claimants from two insurance companies in Sweden. As well as asking each person for details about their accident, demographic profile, health history, pain and symptoms since the crash, they asked how likely they thought they were to recover from their injuries. For those who said they had WAD, the authors followed up with a second questionnaire asking ab out any disability, pain or other symptoms they were experiencing because of the injury.
Only a quarter of the people with WAD said they expected to make a full recovery. Those who stated that they were less likely to make a full recovery were more likely to have a high disability six months after the questionnaire, compared to individuals who stated that they were likely to make a full recovery. This association remained even after taking into account the severity of individuals' symptoms, and how well the person was coping psychologically.
The findings suggest that expectation of recovery has an important prognostic value: the authors argue an "early assessment of expectations of recovery" should be made because it can help predict a patient's progress or his or her chance of eventual recovery from WAD. It may also help explain why some patients with initially mild WAD symptoms go on to develop longer-term problems. Given the influence of the initial expectation a patient has of recovery, healthcare providers and educational campaigns could help patients by aiming to increase their positive feeling towards recovery. The authors call for more studies into these interventions, citing a recent media campaign about back pain as an example, to see if they could be of benefit.
Citation: Holm LW, Carroll LJ, Cassidy JD, Skillgate E, Ahlbom A (2008) Expectations for recovery important in the prognosis of whiplash injuries. PLoS Med 5(5): e105.
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