Overview of evidence: Prognostic factors following whiplash injury

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1 Overview of evidence: Prognostic factors following whiplash injury Confidence in conclusions (that an association exists) are presented in both text and graphical format, using the following legend: = confidence, = confidence, = confidence, = very low confidence Table s1a: Parameters of the accident Predictor Confidence in conclusions / Impact direction: rear Impact direction: front Impact direction: side Seating position: front passenger Seating position: driver Vehicle stationary when hit Aware of impending collision Head rest in place Head rotated at impact No seat belt in use speed of vehicles Accident occurred on a highway Velocity change > 10km/h (self-reported) Velocity change (crash recorder) Severe collision (self-report)

2 Table s1b: Psychological and behavioral factors Predictor Confidence in conclusions / Anxiety at inception Depression at inception General psychological distress at inception Post-traumatic stress symptoms at inception Perceived threat / helplessness Cognitive function Personality traits (e.g. Neuroticism, Nervousness) Catastrophizing Coping strategies Fear-avoidance General stress unrelated to accident Blame & Anger Social function Self-Efficacy Life Control Insomnia Irritability Familiarity with symptoms of whiplash

3 Somatisation Well-being Expectation, amplification and attribution

4 Table s1c: Self-reported symptoms or interference at inception Predictor Confidence in conclusions / pain intensity number of different symptoms neck-related disability Shoulder or upper extremity pain WAD grade Presence of any headache intensity headache Back pain Radicular / peripheral neurological symptoms Early onset of symptoms after accident Disturbed sleep Dizziness Blurred vision Fatigue Sensitivity to noise or light Auditory disturbance Quality of life Difficulty swallowing

5 Feeling of neck stiffness

6 Table s1d: Biological and/or clinical assessment Predictor Confidence in conclusions / Restricted cervical range of motion Cold hypersensitivity / hyperalgesia Mechanical hyperalgesia Reduced superficial neck muscle recruitment / altered muscle recruitment patterns (EMG) Abnormalities on diagnostic imaging (MRI, X-ray) Angular deformity of the neck (scoliosis, flattened cervical lordosis) Anthropometrics: Height Anthropometrics: Body Mass Index Joint Position Error Motor-evoked potentials Cranial nerve or brainstem disturbance Muscle spasm workload in cervical muscles

7 Table s1e: Medicolegal context Predictor Confidence in conclusions / Compensation system (tort vs. no fault) Receiving compensation Lawyer involvement Table s1f: Other social influences Predictor Confidence in conclusions / Type of work* Psychosocial work factors (undefined) Social support Table s1g: Demographics Predictor Confidence in conclusions / Female Older age* er education

8 Table s1h: Treatment-related factors Predictor Confidence in conclusions / Consulting a general physician, chiropractor or physiotherapist in the acute stage Frequent medical or rehabilitation visits Initial treatment received in hospital Need for a cervical collar >12 weeks post-injury Attendance at community-based rehabilitation clinics Early return to pre-accident activities Need to resume physiotherapy after initial treatment Over-medicalization (not defined) Table s1i: Pre-injury history Predictor Confidence in conclusions / Pre-injury neck pain (self-report) Pre-injury headache (self-report) Pre-existing findings (e.g. degeneration) on diagnostic imaging Pre-injury mental health problems Pre-injury back pain Pre-injury widespread pain

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