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Two Key Predictors of Work Disability After Whiplash Injury

Posted on: 02/19/2009
Researchers say the cost of whiplash injuries is far more than ever imagined. It turns out that long-term sick leave and disability pensions for chronic pain from whiplash associated disorder (WAD) cost much more than acute medical care. This could mean that routine medical care right after a rear-end collision could save a lot of money in medical costs later.

Other studies show that as many as four out of every 10 people develop chronic neck pain after a car accident. In this study, work disability after whiplash is assessed. This is a fairly new area of study as it relates to neck pain after motor vehicle accidents (MVA).

The results of studies done so far in this area have had mixed results. Some showed full return-to-work for the majority of patients included. Others reported work disability after whiplash was a major problem. How is it possible to have such different results after studying the same thing?

The authors suggest that perhaps there were different types of patients included in each study -- too different to really compare. And it's possible that the way researchers defined the terms return-to-work and work disability can vary considerably.

Of all the studies done, some showed that being an older woman, performing heavy manual work, or being self-employed were risk factors for poor recovery. Patients with these characteristics were more likely to be permanently disabled after a motor vehicle accident.

To help better understand work limitations on post-whiplash patients, the authors of this study looked at neck pain after whiplash injury and specific work-related factors. Subjects for the study came from a Dutch insurance company. Anyone who filed a compensation claim for personal injury because of neck pain after a car accident was invited to participate.

Surveys were used to ask patients questions about the accident, neck complaints, injuries, past history of neck pain, and work-related disability. Each person was contacted one month after the accident and again six months and 12-months after the accident. Information about the subjects included whether they were white or blue-collar workers, level of education, and whether they were self-employed or paid employees of a company.

The first finding reported by the authors was the large number of people who were affected at work by postwhiplash syndrome after a motor vehicle accident (59 per cent of the entire group). So, in keeping with results reported from other studies, it's fair to say that work disability after car accidents is, indeed, a common problem.

Over time, neck complaints diminished. At first (after one month), 83 per cent still had pain. But by the end of a year, only about half of this number (44 per cent) still reported neck pain. The results did not differ between blue and white collar workers. As might be expected, people with the greatest amount of pain had the most work disability. Older adults were most likely to still have neck pain a full year after the accident.

They also found that work disability is usually accompanied by restricted neck movements, increased use of pain medication, and impaired concentration. This last factor, cognitive function (concentration), was affected in both blue and white collar workers and especially in higher age groups. The link between impaired concentration and work disability in whiplash-associated disorder is unknown. Anxiety and/or depression may be part of the picture. Further study is needed to understand this connection.

In summary, the authors point out that 1) work disability is a common problem in people with whiplash associated disorders, 2) older age is a predictor of work disability in this group, 3) cognitive impairment is a second preditive factor of long-term work disability, and 4) these findings are true regardless of work or education level (white versus blue collar workers).

These findings suggest that physical treatment may not be as important after whiplash injury as interventions for mental functioning. Age is not a modifiable risk factor, but it is a tip off to watch out for problems. Older adults should be screened carefully after motor vehicle accidents to help identify problems and prevent an acute injury from becoming a chronic and costly one.

J. Buitenhuis, MD, et al. Work Disability After Whiplash. In Spine. February 1, 2009. Vol. 34. No. 3. Pp. 262-267.

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