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)
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
Somatisation Well-being Expectation, amplification and attribution
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
Feeling of neck stiffness
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
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
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