Morphology of Cervical Spine Meniscoids in Individuals With Chronic Whiplash Associated Disorder: A Case-Control Study.
J Orthop Sports Phys Ther. 2016 Sep 3;:1-33
Authors: Farrell SF, Osmotherly PG, Cornwall J, Lau P, Rivett DA
Study Design Case-control study. Background Cervical spine meniscoids are thought to contribute to neck pain and hypomobility in individuals with chronic whiplash associated disorder (WAD), however their morphology has not been studied in a clinical population. Objectives To investigate cervical spine meniscoid morphology in individuals with chronic WAD. Methods Twenty volunteers with chronic WAD (mean [SD] age 39.3 [11.0] years, 10 female) and 20 age and sex-matched controls (39.1 [10.6] years) underwent cervical spine magnetic resonance imaging. Lateral atlantoaxial and zygapophyseal joints (C2/3 to C6/7) were inspected for meniscoids. Length of meniscoid protrusion was measured and composition (adipose/fibrous/fibroadipose) assessed. Data were analyzed using Wilcoxon signed-rank tests and linear and logistic regression (P < .05). Results Meniscoids were identified in the chronic WAD (n = 317) and control (n = 296) groups. At the lateral atlantoaxial joints, median meniscoid length was greater in the control group (ventral 6.07 mm; dorsal 7.24 mm) than WAD group (ventral 5.01 mm, P = .06; dorsal 6.48 mm, P < .01). At the dorsal aspect of zygapophyseal joints, meniscoids were more frequently fibrous in the chronic WAD group (odds ratio 2.38, P < .01; likelihood ratio test [LRT] Chi-square  = 9.02, LRT P = .01). Conclusion In individuals with chronic WAD, lateral atlantoaxial meniscoids were shorter and dorsal cervical zygapophyseal meniscoids were more fibrous, suggesting alterations in meniscoid composition. This may have pathoanatomical implications in chronic WAD. J Orthop Sports Phys Ther, Epub 3 Sep 2016. doi:10.2519/jospt.2016.6702.
PMID: 27594664 [PubMed - as supplied by publisher]
Are People With Whiplash Associated Neck Pain Different to People With Non-Specific Neck Pain?
J Orthop Sports Phys Ther. 2016 Sep 3;:1-30
Authors: Anstey R, Kongsted A, Kamper S, Hancock M
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 2578 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. J Orthop Sports Phys Ther, Epub 3 Sep 2016. doi:10.2519/jospt.2016.6588.
PMID: 27594663 [PubMed - as supplied by publisher]
The Traumatic Injuries Distress Scale: A New Tool That Quantifies Distress and Has Predictive Validity With Patient-Reported Outcomes.
J Orthop Sports Phys Ther. 2016 Sep 3;:1-19
Authors: Walton DM, Krebs D, Moulden D, Wade P, Levesque L, Elliott J, MacDermid JC
Study Design Observational cohort. Background Outcomes for acute musculoskeletal (MSK) injuries are currently suboptimal with an estimated 10 to 50% of injured individuals reporting persistent problems. Early risk-targeted intervention may hold value for improving outcomes. Objectives To describe the development and preliminary concurrent and longitudinal validation of the Traumatic Injuries Distress Scale (TIDS), a new tool intended to provide the magnitude and nature of risk for persistent problems following acute MSK injuries. Methods Two hundred participants recruited from emergency medicine departments or rehabilitation clinics completed the TIDS and a battery of other self-reported questionnaires. A sub-cohort (n = 76) was followed at 1 week and again 12 weeks after the inciting event. Exploratory factor analysis (EFA) and concurrent and longitudinal correlations were used to evaluate the ability of the TIDS to predict acute presentation and 3-month outcomes. Results EFA revealed 3 factors explaining 62.8% of total scale variance. Concurrent and longitudinal associations with established clinical measures supported the nature of each subscale. TIDS scores at baseline were significantly associated with variability in disability, pain intensity, satisfaction, anxiety, and depression at 12 weeks post-injury with adequate accuracy to endorse its use as part of a broader screening protocol. Limitations to interpretation are discussed. Conclusions We present the initial psychometric properties of a new measure of acute post-traumatic distress following MSK injury. The subscales may be useful as stratification variables in subsequent investigations of clinical interventions. J Orthop Sports Phys Ther, Epub 3 Sep 2016. doi:10.2519/jospt.2016.6594.
PMID: 27594662 [PubMed - as supplied by publisher]
Recovery Pathways and Prognosis After Whiplash Injury.
J Orthop Sports Phys Ther. 2016 Sep 3;:1-30
Authors: Ritchie C, Sterling M
Synopsis Recovery from a whiplash injury is varied and complex. Some individuals recover quickly and fully, while others experience on-going pain and disability. Three distinct patterns of predicted recovery (trajectories) have been identified using disability and psychological outcome measures. These trajectories are not linear, and show that recovery, if it is going to occur, tends to happen within the first 3 months of the injury with little improvement after this period. Identification of factors associated with poor recovery is accumulating, and since 2000, there have been at least 10 published systematic reviews on prognostic factors for whiplash associated disorder (WAD). Poor recovery has been consistently reported to be associated with high initial neck pain intensity and neck-related disability, post-traumatic stress symptoms, pain catastrophizing, and to a lesser extent low self-efficacy and cold hyperalgesia. Evidence regarding factors including compensation status, some psychological factors, structural pathology, and pre-injury health status remain equivocal. Given the huge number of predictive factors and various interpretations of recovery, adapting these data for use in clinical practice is difficult. Tools such as clinical prediction rules (CPRs) may help by statistically quantifying relevant data to predict the probability of diagnosis, prognosis, or response to treatment. Numerous CPRs have been derived for individuals with whiplash, however to date, only 3 prognostic CPRs have undergone external validation and none have yet undergone impact analysis, a necessary step in providing information about the rules' ability to improve clinically relevant outcomes. J Orthop Sports Phys Ther, Epub 3 Sep 2016. doi:10.2519/jospt.2016.6918.
PMID: 27594661 [PubMed - as supplied by publisher]
Pharmacological and Interventional Management of Pain After Whiplash Injury.
J Orthop Sports Phys Ther. 2016 Sep 3;:1-17
Authors: Curatolo M
Synopsis Whiplash-associated disorder (WAD) is a group of symptoms and clinical manifestations resulting from rear-end or side impact. Despite the wide use of medications in WAD, the published research does not allow recommendations based on high evidence level. It may be meaningful to use non-steroidal anti-inflammatory drugs (NSAIDs) in the acute post-traumatic phase. In chronic WAD, the use of NSAIDs is more concerning due to potential gastrointestinal and renal complications with prolonged use and lack of evidence for long-term benefits. Antidepressants can be used in patients with clinically relevant hyperalgesia, sleep disorder associated with pain, or depression. Anticonvulsants are unlikely first choice medications, but can be considered if other treatments fail. The use of opioids in patients with chronic pain has become the object of severe concerns, due to the lack of evidence for long-term benefits and the associated risks. Extreme caution in prescribing and monitoring opioid treatment is mandatory. Nerve blocks of the zygapophysial (facet) joints have validity for the diagnosis of facet joint pain, which is one of the possible manifestations of WAD. One randomized sham-controlled trial and several high quality prospective studies support the efficacy of radiofrequency neurotomy for the treatment of facet joint pain. The efficacy of trigger-point treatments is uncertain. They can be offered due to possible efficacy and limited risks. Any medication or procedure has to be considered in the frame of a comprehensive patient evaluation. As for any chronic pain condition, concomitant consideration of rehabilitation and psychosocial interventions are mandatory. J Orthop Sports Phys Ther, Epub 3 Sep 2016. doi:10.2519/jospt.2016.6906.
PMID: 27594660 [PubMed - as supplied by publisher]
Mechanisms and Mitigation of Head and Spinal Injuries Due to Motor Vehicle Crashes.
J Orthop Sports Phys Ther. 2016 Sep 3;:1-28
Authors: Ivancic PC
Synopsis Head and spinal injuries commonly occur during motor vehicle crashes (MVCs). The goal of this clinical commentary is to discuss real-life versus simulated MVCs and present clinical, biomechanical, and epidemiological evidence of MVC-related injury mechanisms. We also address how this knowledge helps guide and inform design of injury mitigation devices and could assist clinical decision making. Evidence indicates that there exists no universal injury tolerance applicable to the entire population of MVC occupants. Occupant injuries are dependent upon a number of factors, including: occupant characteristics (age, height, weight, sex, bone mineral density, and pre-existing medical and musculoskeletal conditions); pre-MVC factors (awareness of the impending crash, occupant position, usage of and position of the seatbelt and head restraint, and vehicle specifications); and MVC-related factors (crash orientation, vehicle dynamics, type of active or passive safety systems, and occupant kinematic response). Injuries resulting from a MVC occur due to blunt impact and/or inertial loading. An S-shaped curvature of the cervical spine and associated injurious strains have been documented during rear, frontal, and side impact MVCs. Injury mechanism data and quantification of spinal instability help guide and inform emergent and subsequent conservative or surgical care when: choosing optimal patient position during transport, determining which injuries may be treated conservatively, performing reduction, choosing optimal positioning intraoperatively, and determining if bracing should be worn prior to and/or following surgery. Continued improvement of traditional injury mitigation systems, such as seats, seatbelts, airbags, and head restraints, together with research of newer collision avoidance technologies will lead to safer motor vehicles and ultimately more effective injury-management strategies. J Orthop Sports Phys Ther, Epub 3 Sep 2016. doi:10.2519/jospt.2016.6716.
PMID: 27594659 [PubMed - as supplied by publisher]