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Five years after the blow, whiplash casualties nevertheless have poorer quality of life in the physical domain than other mildly injured casualties: analysis of the ESPARR cohort

BMC Public Health volume 16, Article number:13 (2015) Cite this article

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Abstract

Background

This written report aims to compare wellness status and quality of life five years afterwards a road accident between casualties with whiplash versus other mild injuries, to compare development of quality of life at one and five years later on the accident, and to explore the relation between initial injury (whiplash vs. other) and quality of life.

Methods

The study used data from the ESPARR cohort (a representative cohort of road accident casualties) and included 167 casualties with "pure" whiplash and a population of 185 casualties with other mild injuries (MAIS-i). All subjects with lesions classified every bit cervical contusion (AIS code 310402) or neck sprain (AIS lawmaking 640278) were considered as whiplash casualties. Diagnosis was made by physicians, at the commencement of infirmary care, based on interview, clinical findings and X-ray. Whiplash injuries were so classified following the Quebec classification (grades 1 and 2). Quality of life was assessed on the WHOQoL-Bref questionnaire. Correlations between explanatory variables and quality of life were explored past Poisson regression and variance analysis.

Results

Between ane and 5 years, global QoL improved for both whiplash and not-whiplash casualties; merely, considering the two whiplash groups separately, improvement in grade 2 was much less than in form 1. At 5 years, grade-2 whiplash casualties were more dissatisfied with their health (39.4 %; p < 0.05) than not-whiplash (24.iii %) or form-one whiplash casualties (27.0 %). Deteriorated quality of life in the mental, social and ecology domains was mainly related to psychological and socioeconomic factors for both whiplash and other mildly injured road-accident casualties. While PTSD was a major gene for the physical domain, whiplash remained a predictive cistron afterward adjustment on PTSD; unsatisfactory health at five years, with deteriorated quality of life in the physical domain, was observed specifically in the whiplash group, pain playing a predominant intermediate office.

Conclusions

Deteriorated quality of life in the physical domain remained 5 years after the accident, specifically in the form-2 whiplash group, hurting playing a predominant intermediate role, which may be in line with the hypothesis of neuropathic pain.

Peer Review reports

Background

Defined every bit an acceleration-deceleration mechanism in the cervix, whiplash is the most common injury in road accidents, particularly for motorists: over the 2007–2010 period (French road safety database), 35 % of injured car occupants were concerned [one]. The annual incidence charge per unit of casualties suffering from whiplash seems to be of the same gild of magnitude in most countries (annual incidence between 0.04 and 3.two/i,000 inhabitants [ii, 3]). A study of drivers in collisions involving 2 cars found similar results in French (1997–2003) and Castilian databases (2002–2004) [4]: 12.2 % were diagnosed with whiplash in French republic and 12.0 % in Spain.

Although considered a small-scale injury, whiplash is reported to generate both brusk- and long-term consequences, such as neck hurting, headache, dizziness, sensory disorder and reduced neck mobility. These symptoms are often grouped together as "whiplash-associated disorder" (WAD) [five]. Whiplash injury and WAD have been widely described in the international literature: in most studies, more than half of whiplash casualties reported not-recovery 1 year after the blow [6–11]. Many studies also examined the relation betwixt quality of life (QoL) and whiplash [eight, 12, 13], some showing a correlation between mail service-traumatic stress disorder and lower QoL [14]. Psychological factors, such as psychological history …., are oftentimes related to WAD [15, 16]. However, information technology is not articulate if psychological factors are necessary and sufficient for non-recovery or if other sociodemographic or genetic factors may besides play some role.

Yet, just a few studies [17, eighteen] compared chronicity in whiplash casualties versus other types of injury of similar severity. Chronic symptomatology may not be specific to whiplash, simply dependent on personal (eastward.yard., psychological) factors, as reported by the authors. If, still, whiplash casualties (dissimilar those with other comparable injuries) suffer specifically from chronical symptoms, and notably pain, it is necessary to farther explore the possibility of neural lesions in the cervical region which may exist the cause of neuropathic pain, as studied by Sterling and Pedler [xix]. Furthermore, long-term (>1-twelvemonth) follow-upward of whiplash casualties is little documented in the literature [twenty–22].

A previous analysis of the mildly injured subjects of the ESPARR route-accident casualties cohort (ESPARR: Étude et Suivi d'une Population d'Accidentés de la Road dans le Rhône) showed that, ane year after a low-severity road accident, subjects suffering from whiplash had recovered poorly compared to subjects with other minor injuries, that but QoL did non differ betwixt whiplash and non-whiplash casualties [23]. The present study aimed to report the consequences of whiplash injury in the ESPARR cohort five years subsequently the blow, in terms of pain, sequelae and QoL, and to compare them with those observed in the other mildly injured subjects. A secondary objective was to expect for factors (notably whiplash status) associated with poorer quality of life in mildly injured subjects 5 years later on the accident. 2 underlying hypotheses were that psychological factors are significantly associated with persistent complaints, whatsoever the type of mild injury (not only whiplash) and that, in WAD, persistent pain accounts for complaints even in the absenteeism of contributory psychological factors.

Materials and methods

The ESPARR cohort

The ESPARR projection is a prospective cohort report of route accident casualties, which seeks to place long-term consequences and to ameliorate ascertain what constitutes serious injury. Information technology is based on the Rhône Registry of Road Traffic Casualties [24], which, since 1995, has recorded all casualties receiving medical care in public or individual health facilities in the Rhône authoritative area of France. The inclusion criteria are: (1) having had a road traffic accident in the Rhône administrative area involving at least one mechanical means of transport; (two) living in the Rhône authoritative area; (3) having survived the accident at to the lowest degree upwardly to infirmary access; and (4) having received care in one of the surface area's hospitals. The injured are followed up for 5 years subsequently the accident. All subjects have provided written consent.

Each individual lesion is coded using the Abbreviated Injury Scale (AIS) [25]: from 1 (minor injury) to 6 (fatal injury). The Maximum-AIS (M.AIS) is the injury's highest AIS score and defines overall initial injury severity.

The inclusion period for road accidents was initially from October 1st, 2004 to Dec 31st, 2005, afterward extended to July 31st, 2006 for the virtually seriously injured (G.AIS ≥ iii). The protocol has been described in detail in a previous publication [26].

The accomplice comprises 1,168 adults, aged ≥16 years at the time of the accident. At inclusion, the injured were asked to answer a questionnaire specifically drawn upwards for the ESPARR study, administered in a face-to-face up interview.

The questionnaire gathered data on the accident and previous familial, occupational and wellness status. In addition, initial lesion assessment and other medical data (radiology, intensive care, etc.) were collected from medical records. Lesions were coded past the trained physician of the Registry from which the cohort was derived.

Written report population

The present study selected the 546 adults in the ESPARR cohort who had sustained only mild injury, divers as maximum AIS level 1 (MAIS-ane), excluding cases with associated AIS ≥ 2 lesions in other body regions; 253 of these subjects had sustained whiplash injury and the other 293 had whatever other type of MAIS-i lesion, such every bit ankle or shoulder sprain, superficial wounds or contusions, tendon tear, etc. In all, 352 subjects (64.five %) responded to the 5-year follow-upwards questionnaire (between Oct 2009 and December 2010): 167 of the 253 whiplash cases (66.0 %), comprising 63 course-1 and 104 grade-2 injuries, and 185 of the 293 other mild injury casualties (63.1 %). 16 % of non-whiplash and 20 % of whiplash casualties failed to respond to the 1-year questionnaire.

Clinical definition of whiplash

In the nowadays study, all subjects with lesions classified as cervical contusion (AIS code 310402) or cervix sprain (AIS code 640278) were considered as whiplash casualties. Diagnosis was made by physicians, at the outset of hospital care, based on interview, clinical findings and X-ray. In the AIS classification, Lawmaking 310402 is attributed to neck pain following a road accident with painful neck on palpation without other objective signs, and corresponds to grade 1 in the Quebec classification; Code 640278 is attributed to cervix pain associated with cervical stiffness and radiologic loss of cervical lordosis, and corresponds to grade ii in the Quebec nomenclature [23]. Cervical spine lesions graded AIS-one (code 640278) only with associated neurologic abnormality (Quebec form iii) (n = 2) were excluded.

Variables and measurements

Effect measurements at 5 years

QoL was evaluated on the World Wellness System Quality of Life (Cursory) (WHOQoL-Bref) questionnaire [27]. This tool contains 26 questions. The kickoff 2 assess perception of overall QoL and perception of overall wellness, respectively. The other questions are categorized in 4 domains: physical, psychological, social and environmental [28]. Responses to each question are graded on a five-indicate Likert scale for intensity, chapters, frequency or evaluation, equally the case may be (from 1 = poor QoL, to 5 = adept QoL). Each of the four scores (one per domain) ranges from 4 to twenty, modified in the present written report to 0–100 for comparison with WHOQOL-100 scores used in other studies. A high score indicates proficient QoL.

For analysis, the 2 generic questions (overall QoL and general wellness status) of the WHOQoL-Bref were coded as dichotomous variables: good or very good versus neither proficient nor bad, bad, very bad or no reply for overall QoL; and satisfied or very satisfied versus neither satisfied nor dissatisfied, dissatisfied, very dissatisfied or no reply for perception of overall wellness.

Variable of interest

The variable of interest for analysis was whiplash status, in iii categories: non-whiplash, class-1 whiplash, and grade-2 whiplash.

Exploratory variables

At inclusion, the questionnaire collected sociodemographic and accident-related data, plus some medical information and psychological history. Specifically, sociodemographic information comprised age, gender, family state of affairs, educational level and socio-occupational category. Accident-related data comprised type of road-user with position inside the vehicle and impact direction, antagonist, reason for travel at time of accident, subjective responsibility for accident (admitting existence at error in the accident or not), friend or family unit member as well injured in the same accident, and intention to lodge a complaint Footnote one. Financial problems (job loss, fiscal difficulties, failure) in the year before the accident and psychological history (sleep disorder, consumption of antidepressants/anxiolytics, regular appointments with a psychologist) in the year before the accident were likewise considered in this analysis.

Post-traumatic stress disorder (PTSD) at vi months and/or 1 year subsequently the blow was also taken into account and was assessed using the Postal service-traumatic CheckList Scale (PCLS) [29]. The PCLS includes 17 items relating to the three dimensions of the disorder (re-experiencing, avoidance and hyper-arousal), and has been shown to have proficient specificity for the diagnosis of PTSD; validation studies of the PCLS [29–32] have shown practiced psychometric properties. The validation of the French version [31] showed that PCLS score ≥ 44 indicates presence of PTSD and the being of disturbances which will necessarily affect lifestyle.

The presence of pain and sequelae of accident-related injuries was collected in the 5-year questionnaire. A free text nigh pain location allowed information to be classified according to trunk region (head, neck, face, spine, thorax, abdomen, upper limbs, and lower limbs); a dichotomous variable was created for each region (pain vs. no pain).

Statistical analysis

The representativeness of the study population (whiplash and non-whiplash subjects) was assessed by comparing sociodemographic and accident data betwixt respondents and non-respondents at 5 years' follow-upwards. Descriptive statistics were used to describe the distribution of variables. Chiii test (significance level, 5 %) or Fisher'south exact examination (pocket-size samples) were used for categoric variables; Student's test (normal data distribution) or Kruskal-Wallis test (non-normal data distribution) were used for continuous variables.

QoL data (the 2 generic questions and mean scores in the iv domains) collected at 1 and 5 years after the accident were compared for subjects responding at the both follow-up steps. Thus, it was possible to observe a meaning improvement or deterioration in QoL for each group, using McNemar's examination (significance level, five %) or Student's test for matched data.

The side by side footstep was to identify factors for impaired QoL, with whiplash status as the variable of interest. Two modified Poisson regression models were built for each of the beginning 2 variables of the QoL scale: i.e., poor overall QoL and unsatisfactory overall health. Variance analysis was used to study each of the four QoL domains. Analysis strategy was identical in all models. Historic period and gender, considered as adjustment variables, were included in the multivariate analysis regardless of their significance level. The variable of involvement (not-whiplash, grade-ane whiplash, course-2 whiplash) and explanatory factors at time of accident or at 1-year follow-upward significantly associated (≥x %) with outcome on univariate assay were included in the multivariate analysis, after checking for collinearity between explanatory variables. Stepwise selection with backward emptying was applied, with p > 0.05 for exclusion (model i). For each outcome, the final model was built from model ane, to which the variable "hurting at v years" was added (model 2).

QoL was as well analyzed separately for casualties with and without PTSD, and interactions between whiplash and pain were investigated.

Statistical Assay Arrangement software, version 9.3 for Windows (SAS Establish Inc., Cary, NC, Us) (proc genmod and proc glm) was used for all analyses.

Ethics and consent

The report protocol was submitted to and canonical by the French Ministry of Research (CCTIRS: Informational Commission on Data Processing in Material Research in the Field of Health) (CCTIRS Number 04.159). Data collection and assay were approved by the national data protection potency (CNIL: CNIL Number 04–1417). Lastly, simply patients (or their family) who gave written consent for follow-up were included in the cohort. At any fourth dimension during the follow-upward period, subjects were gratuitous to cease participation, and, in that example, to exist totally withdrawn from the study files and analyses.

Availability of information

Data are available from the authors upon request (CNIL's requirement).

Results

Representativeness of the study population

Respondents in the reference population (MAIS1, non-whiplash group) were, on average, older than non-respondents (34.0 ± 14.8 years vs. 30.ane ± 14.vii years at time of accident; p < 0.03). Their educational level was more frequently college than school-leaving document (29.seven % vs. 16.7 %; p < 0.03). There was no pregnant departure in terms of gender, family unit situation, occupation at time of accident, type of road user, reason for travel or body region involved (caput, confront, neck, thorax, belly, spine, upper limbs, or lower limbs).

Mean age at time of accident was not significantly different betwixt respondents and non-respondents in the whiplash grouping. However, respondents were more numerous in the 35–45 years age-group (25.vii % vs. 8.1 %) and less numerous in the 16–25 years age-grouping (27.5 % vs. 43.0 %) (chi2 exam; p < 0.01). They were also more oftentimes in work at the time of the blow (71.9 % vs. 58.1 %; p < 0.03). There was no significant departure in terms of gender, family state of affairs, educational level, type of route user, reason for travel or body region involved.

There was no significant difference between the 2 grades of whiplash (grades ane and two) for respondents and not-respondents on sociodemographic, accident-related or injury characteristics.

Characteristics of the populations

Comparison betwixt whiplash and not-whiplash casualties revealed several significant differences (Table 1). In particular, females were more numerous in the whiplash group; whiplash casualties were more frequently four-cycle motor-vehicle drivers, with accidents involving another motor vehicle, and with rear affect; subjective responsibleness was less frequently reported in the whiplash grouping, while financial difficulties in the year before the accident were more frequent. By contrast, there were no significant differences between the whiplash and not-whiplash casualties in terms of psychological history or intention to society a complaint.

Table 1 Sociodemographic and accident-related characteristics at inclusion for whiplash victims and non-whiplash victims

Full size table

The reference population (n = 185) included 337 distinct lesions distributed betwixt the 8 torso regions (head, face, neck, thorax, abdomen, spine, upper limbs, and lower limbs): i.e., 1.8 minor lesions per casualty. The lower and upper limbs were the most frequently affected regions (35.0 and 23.1 %, respectively). The most frequent lesions were: lower-limb pare contusion (hematoma) (AIS code 810402; n = 32), knee contusion (AIS code 850802; n = 31), and shoulder contusion (AIS code 751010; north = 21).

In the year following the accident, sixteen.8 % of whiplash casualties presented PTSD (course 1: 17.five %; grade 2: xvi.3 %; non-whiplash casualties: 12.4 %), with no significant difference between groups (Table i). Class 1 and 2 whiplash casualties were compared on all analyses; no significant differences were establish.

Consequences at five years

Pain and sequelae

Five years after the blow, whiplash casualties (in item, grade ii) were twice as likely to report pain equally non-whiplash casualties (40.7 % vs. 22.ii %) (Table two). Whiplash casualties suffered from cervix pain (form ane, 22.two; grade ii, 33.vii) and spine pain (other than cervical spine) (12.vii % and 20.two %, respectively). Non-whiplash casualties complained of spine pain (vii.0) and lower-limb pain (ix.7 %). Only one in five of those reporting pain at 5 years had suffered from PTSD during the first year after the accident, whichever the group (53/68 whiplash and 33/41 non-whiplash casualties).

Tabular array 2 Description of pain and sequelae for whiplash and non-whiplash victims, at five year post-route-accident

Full size table

1 in four whiplash casualty suffered from headache related to the accident (grades 1 and 2, 26.9 %; ten % for non-whiplash casualties; p < 0.0001). Psychological sequelae were frequent in all three groups (grade 1, xx.6 %; grade 2, 27.9 %; non-whiplash, 17.3 %; not-significant difference).

There was no difference in terms of the bear upon of the blow on occupation or social and familial relations between whiplash and not-whiplash casualties (information not shown).

Quality of life – comparison between data at i and 5 years subsequently the accident

In the whole group of respondents to the 5-year follow-upwards, 1 in four casualties reported less than good QoL. There was no pregnant departure between whiplash and non-whiplash casualties overall; yet, grade-2 whiplash casualties were more dissatisfied with their health (39.iv %; p < 0.05) than non-whiplash (24.three %) or grade-1 whiplash casualties (27.0 %); whiplash casualties' mean scores were lower in the physical (grade 2, 75.ii; grade 1, 76.5; vs. non-whiplash, 81.1; p < 0.01) and psychological domains (respectively: 67.half dozen, 67.ane, and 71.ii; p < 0.05).

Restricting assay to respondents at both follow-upwardly steps (ane and 5 years), results were fairly comparable for the non-whiplash and whiplash groups (Table iii). Global QoL improved for both whiplash and non-whiplash casualties; but, considering the 2 whiplash groups separately, improvement in grade 2 was much less. In terms of overall health at 5 years, improvement was less in the whiplash (grades 1 and two) than the not-whiplash group; taking the ii whiplash groups separately, yet, course-one casualties showed similar improvement to non-whiplash casualties, whereas grade-ii casualties reported a status quo (not-significant decline) in health status (Table 3).

Table three Comparison of the evolution of quality of life between 1 and 5 twelvemonth after the accident

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For not-whiplash casualties, scores in the physical, psychological and ecology domains were significantly higher (p < 0.001) at v years than ane year (Table 3); for the course-1 whiplash group, the improvement was meaning for the psychological and environmental domains (p = 0.03), whereas at that place was no significant comeback for the grade-two whiplash grouping. Scores in the psychological, social and environmental domains were quite similar at five years in the various groups, but the concrete score remained lower in the whiplash group.

Multivariate models: factors for impaired quality of life at 5 years after accident

Perception of overall quality of life and of overall health

Later aligning on age and gender, whiplash status (Table four) did non appear as a predictive factor for poorer overall QoL, just was related to unsatisfactory overall health, especially for grade-ii whiplash [RR = 1.48; 95%CI = one.05–ii.08]); other factors (educational level, psychological history, intention to order a complaint and PTSD) seemed also to be associated with poorer overall QoL and unsatisfactory overall health. Interestingly, the results for the two whiplash groups were inversed at the 1-yr follow-up: RR was college in grade 1 than grade ii.

Table 4 Factors related to "non adept quality of life" and "unsatisfactory health" at 5 years

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When pain at 5 years was entered in the two previous models, it emerged every bit an intermediate factor for whiplash status (RR for whiplash status shifted from 1.43 to 1.24 (i.e., >ten % for overall QoL) and from 1.48 to i.xix (i.e., 20 % for overall wellness)). Pain was significantly associated with poorer overall QoL (RR = 1.96; 95 % CI = [one.27–3.03]) and unsatisfactory wellness (RR = 2.75; 95%CI = [ane.98–3.83]). Intention to order a complaint and educational level ceased to be significant for "health status" outcome in the last model.

At that place was no interaction betwixt pain and PTSD in the relation between whiplash and unsatisfactory health, in spite of higher relative risk for hurting in the whiplash than in the non-whiplash group (Table five).

Table 5 Assay of interactions between pain and PTSD related to unsatisfactory wellness

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Scores on the four domains of quality of life

One time adjusted for age and gender, presence of whiplash showed no relation to QoL in iii domains (mental: β = − 1.82 for grade 1 and β = − two.14 for class 2; social: respectively β = −1.00 and β = −1.12; or environmental: respectively β = +one.99 and β = −2.06)], and a borderline relation in the physical domain (β = −1.46 for grade ane and β = − three.71 for grade 2; p = 0.06). Psychological history and PTSD were predictive factors for impaired QoL in all iv domains. Intention to society a complaint immediately later on the accident was predictive in the physical domain, while educational level was not related to the social domain score.

Integrating pain into the iv previous predictive models, whiplash status was non-significant in all 4 domains. Pain was a major factor for diminished QoL score, mainly in the physical and environmental domains: the regression coefficient (β) characterizing presence of pain v years after the blow was −13.55 (standard error (SE) = i.79) for the physical domain, −4.35 (SE = 1.70) for the psychological domain, −v.85 (SE = i.92) for the social domain and −8.55 (SE = i.79) for the environmental domain. Pain was a major intermediate factor between whiplash and QoL.

Discussion

Estimation of results

Few studies have been published on the long-term quality of life of mildly injured road-accident casualties. The present written report focused on pocket-size injury (M.AIS = 1) and tried to establish whether those suffering from whiplash (Quebec grades one and ii) differed in QoL five years after the accident. A farther objective was to explore risk factors for impaired QoL. Results showed that, v years after mild road-crash injury, a significant number of patients still showed deteriorated quality of life, any the initial lesion. Furthermore, grade-2 whiplash subjects were more often dissatisfied with their wellness in terms of persistence of hurting, and this was non explained past psychological history or evolution of PTSD.

Pain, headache and psychological sequelae related to the accident were strongly present in whiplash casualties v years after the blow, who were twice as probable to report pain every bit non-whiplash casualties (whiplash, twoscore.seven %; non-whiplash, 22.ii %), whereas pain was non more than frequent in the whiplash group at 1 year [23]. This high percentage of residue pain is in agreement with literature reports. For example, Mayou et al. [17] showed that whiplash casualties were more often in pain than other prey groups three years afterwards the accident (whiplash injury, 30 %; other soft-tissue injury, 15 %; os injury, 25 %; and no injury, 17 %), although these figures are much lower those reported by Stålnacke (63 % residual pain in whiplash casualties v years afterward the blow) [33]. Whiplash casualties in the present written report well-nigh often reported hurting located in the cervix (29.three %; 49 out of 167), compared to less than v % of non-whiplash casualties; these figures are lower than in a Swedish study [21] (39.six % of whiplash and 14.0 % of non-whiplash casualties suffering from cervix hurting seven years after rear-end collision).

While overall QoL was not related to whiplash condition, satisfaction with overall health was negatively correlated with whiplash, which is consistent with the analysis by domain: the just domain which was affected by whiplash was the concrete domain. This was true even when gender, age, educational level, baseline psychological problems and post-accident PTSD were controlled for. Rebbeck et al. [8] also found a big proportion of subjects with whiplash not satisfied with their health status: near one-half had not recovered 2 years afterwards injury. Likewise, a contempo Lithuanian written report showed that whiplash casualties had worse full general health status than matched controls [34].

Furthermore, comparison between information at one and v years showed an improvement in QoL in all groups (with or without whiplash) but, in grade-2 whiplash, QoL remained poorer than in the non-whiplash group v years after the blow; indeed, the mean physical score for the class-ii whiplash group decreased at five years. Schwerla et al. [fourteen] showed a significant improvement in the concrete and mental component summary (SF-36) between the beginning and stop of osteopathic treatment in subjects suffering from whiplash injuries. Rebbeck et al. [8] also showed pregnant improvement over time (follow-up at three and six months and two years) for the physical score (SF-36).

Psychological factors are often put forward equally explaining the chronification of whiplash injury [11, 35]. In understanding with Holm [36], we call back that non-recovery after a mild accident may exist multifactorial and that psychological factors can be a contributing cause of WAD: in the present study, previous psychological factors were related to QoL in whiplash casualties. Similarly, PTSD is often suggested to exist a predictive factor for poor QoL in the showtime years following an accident [37]: for example, in the nowadays study, sixteen.eight % of the whiplash group were suffering from PTSD at the one-year follow-up (12.four % for non-whiplash casualties; non-significant deviation). Similar results were reported by Mayou17 at 3 years, whiplash casualties disposed to show a higher rate of PTSD (17 %) than other groups (not-pregnant deviation). In the present written report, PTSD was a major predictor of lower scores for all three domains (mental, social, environmental), whereas whiplash status was not; only, while PTSD was a major factor for the physical domain, whiplash remained a predictive factor after adjustment on PTSD.

The role of compensation has often been raised [11, xv, 38–41]. Sterling et al., however, found no association between lodging a merits and the persistence of moderate/severe symptoms for twelve months in whiplash casualties [42]. Several points should be noted: the present results were adjusted for the intention to lodge a complaint, and there was no correlation between PTSD and intention to lodge a complaint. Furthermore, in France, the fiscal costs of intendance are covered by national health insurance for everybody, and merely a small fraction of the mildly injured society a compensation claim against a private insurance company; furthermore, lodging a complaint with the court is not mandatory for a bounty claim to be lodged against an insurance company. Interestingly, in our models, in spite of adjustment on these various factors, the relation betwixt whiplash and lower satisfaction with overall wellness remained statistically significant. The difference in rate of pain after whiplash between the present written report and many others may be explained by the general frequency of bounty claims in the diverse countries; but other factors may too interfere, such every bit truthful neurophysiological disturbance.

In fact, in the causal chain between the accident and lower satisfaction with health-related quality of life, the chief question is the exact role of pain in the relation between whiplash and impaired long-term QoL. It is suggested that hurting is strongly correlated with astringent PTSD [43], but in some traumas this relation is not so articulate [44]. Like Egloff et al., comparing psychological conditions in patients with chronic hurting disorder with and without not-dermatomal somatosensory deficit [45], we establish no difference in baseline psychological condition between report groups. Analyzing overall health in whiplash and non-whiplash casualties plant no interaction betwixt PTSD and pain.

Considering that the only significant difference between the two whiplash groups concerned the circumstances of the accident, and notably that psychological conditions were similar, the lack of improvement in the form-2 group, in marked contrast to the grade-1 group, which profoundly improved, tin just exist explained by pain, possibly neuropathic, related to a more than severe initial neck injury; this could explain the perception of poorer overall wellness in the grade-two group, whereas the other domains were non related to whiplash. This bespeak needs to be further investigated in hereafter analyses.

Strengths and limitations of the written report

Few studies bargain with the long-term consequences of mild injury. The nowadays report was based on the ESPARR cohort, which prospectively follows up a population of 1,168 road-accident casualties for 5 years. The ESPARR cohort is not specific to whiplash injury, then it tin exist expected that in that location is no selection bias: all patients managed in a public or individual-sector hospital in a well-defined geographical area are included, whatever the severity and type of route accident [26]. The present analysis focused on the mildly injured (MAIS-ane) members of the cohort, which explains the relatively minor number of whiplash casualties. On the i hand, as the cohort does not focus on whiplash, no specific whiplash scale assay, such as the Cervix Disability Index (NDI) [46] or Neck Pain and Disability Calibration (NPDS) [47], was used; furthermore, the questions on pain were not specific to any particular trunk region (e.g., neck), and subjects were gratis to specify whatsoever body regions affected past pain, thus enabling comparison between the two groups of mild injury without specifically focusing on neck hurting. We thereby avoided introducing an information bias, whereas numerous whiplash studies analyzed simply cohorts of whiplash casualties challenge compensation [48] or under treatment for chronic pain [49]. The nowadays pain cess was based on subjective response; this precluded investigating the beingness of a neuropathic component equally proposed by Sterling and Pedler [19]. On the other manus, equally discussed by Carlesso et al. [50], not using a specific neck-pain questionnaire may accept hidden some disabilities specifically related to whiplash; finally, Skevington et al. [51] pointed out that the use of WHOQoL-Bref may lead to poor detection of subtle differences, notably in the social domain. WHOQOL was congenital up from a long procedure of work, word and validation between specialists from a number of countries; in detail, the mental facet was framed by the definitions given by the DSM-IV [52].

At v years, information was obtained through a self-administered questionnaire for all patients, and very few items were not answered; it is unlikely that bias could have been introduced in the analyses between the various groups, merely it is possible.

Another point to be discussed is the possibility of an information bias related to non-respondents: the charge per unit of not-response was quite similar in the whiplash and non-whiplash groups, and it is unlikely that this could have introduced whatever bias in the analysis. It seems that subjects who responded but to the five-year follow-up had slightly lower wellness status than those who responded to both follow-ups; but analysis restricted to the latter did non alter the pattern of results. The same percentage of subjects participated in both follow-ups (one and five years) in the two groups of whiplash casualties (grade i: 79.3 % and form 2: 79.8 %), so the difference observed between the two grades was unrelated to response bias.

Decision

Deteriorated quality of life in the mental, social and ecology domains was mainly related to psychological and socioeconomic factors for both whiplash casualties and other mildly injured route-accident casualties. However, unsatisfactory health at five years, with deteriorated quality of life in the physical domain, was observed specifically in the whiplash group, pain playing a predominant intermediate role, which was not plant at the one-year follow-up. Class-2 whiplash casualties were particularly affected. The hypothesis of neuropathic pain might usefully be further explored.

Notes

  1. In France, medical costs are payed past the national health insurance scheme; financial compensation is obtained through the driver'southward compulsory insurance. Lodging a complaint is essentially a manner to obtain adjudication well-nigh responsibility, rather than financial compensation.

Abbreviations

AIS:

Abbreviated Injury Scale

95%CI:

95 % confidence interval

DSM-IV:

Diagnostic and Statistical Transmission of Mental Disorders, quaternary Edition

ESPARR:

Etude et Suivi d'une Population d'Accidentés de la Route dans le Rhône (Follow-upwards study of road-crash casualties in the Rhône authoritative area)

MAIS:

Maximum abbreviated injury scale

PTSD:

Post-traumatic stress disorder

QoL:

Quality of life

RR:

Relative risk

WAD:

Whiplash-associated disorder

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Acknowledgments

The authors are grateful to the blow casualties for their cooperation in information collection.

The authors would like to thank all those who assisted in carrying out this study: Nadia Baguena, Jean-Yves Bar, Amélie Boulanger, Elodie Paquelet, Stuart Nash and Véronique Sotton for collecting the data; Irène Vergnes for organizing the databases; Anne-Marie Bigot, Nathalie Demangel and Geneviève Boissier for subject database direction; Blandine Gadegbeku, Amina Ndiaye and The Association for the Rhône Route Trauma Registry (ARVAC) for their help in collecting and providing medical data; the Scientific Commission (Daniel Floret, Bernard Laumon, Jean-Michel Mazaux, Jean-Louis Martin and Etienne Javouhey); Dominique Boisson and Jacques Luauté for their participation in the ESPARR scientific direction team; and all the hospital staff who accepted the interviewers' presence and referred casualties.

Special thanks to Iain McGill for comments and manuscript editing.

Funding sources

Nosotros admit funding from the French Ministry of Equipment, Send, Housing, Tourism and the Sea (Program Predit 3 "New Knowledge in the Field of Route Safety": N° SU0400066), from the National Bureau for Research (Programme Predit "Prophylactic, reliable and adapted transport" No. ANR-07-TSFA-007–01), from the French Ministry of Health (Plan PHRC 2003: PHRC-N03 and PHRC 2005: PHRC- N051) and from the Road Safety Foundation (2010/MP/01/).

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Author notes

    Affiliations

    1. Unité Mixte de Recherche Epidémiologique et de Surveillance Transport Travail Environnement (UMRESTTE UMR_T 9405), Université Lyon 1, Université de Lyon, Lyon, French republic

      Charlène Tournier, Martine Hours, Pierrette Charnay, Laetitia Chossegros & Hélène Tardy

    Corresponding author

    Correspondence to Martine Hours.

    Additional information

    Competing interest

    The private authors have no competing interests, financial or not-fiscal, to declare.

    The current paper and the data have neither been published nor are under review elsewhere.

    Authors' contributions

    MH and PC made substantial contributions to conception and blueprint, and data acquisition; CT, LC, HT and MH made substantial contributions to data assay and interpretation; CT and MH performed the literature search and data analysis and wrote the initial manuscript; LC and HT were involved in revising the manuscript critically for of import intellectual content. All authors gave concluding blessing of the version to exist published, and agree to exist accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of whatsoever part of the work are appropriately investigated and resolved.

    Authors' information

    MH is a senior researcher (MD and PhD in epidemiology)

    PC is an epidemiological researcher (MSc).

    CT, LC and HT are statisticians (MSc).

    Charlène Tournier and Martine Hours contributed equally to this piece of work.

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    Tournier, C., Hours, M., Charnay, P. et al. Five years subsequently the blow, whiplash casualties still take poorer quality of life in the physical domain than other mildly injured casualties: analysis of the ESPARR cohort. BMC Public Health sixteen, xiii (2015). https://doi.org/ten.1186/s12889-015-2647-viii

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    • DOI : https://doi.org/10.1186/s12889-015-2647-eight

    Keywords

    • Whiplash
    • Quality of life
    • Comparison
    • ESPARR Cohort
    • Prospective report
    • five twelvemonth follow-up
    • Mild injury
    • Route-accident injury

    Source: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-2647-8

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