Whiplash Associated Disorders and Psychological Problems

In 1995, the Quebec Task Force proposed a controversial classification system for whiplash associated disorders (WAD), that was to be used immediately following an accident. It rates injuries on a scale that ranges from 0-3:

0- No complaint, no physical signs
1- Neck pain, stiffness, no physical signs
2- Neck complaint and musculoskeletal signs
3- Neck complaint, musculoskeletal signs, and neurological signs

This current study evaluated 104 WAD patients over 2.5 years. The authors evaluated subjects' quality of life, in terms of pain-related disability, anxiety, depression, and pain intensity. By assessing the physical and psychological functioning of the patients and comparing the long-term outcome to the initial diagnosis, the authors hoped to test the Quebec classifications and determine if they accurately reflect a patient's well being or level of functioning.

Overall, subjects had more difficulty with the psychosocial aspects of their injury than with the physical problems. 80% of the patients reported that they had more problems with concentration than they did at the time of the collision, and 71% stated that they had more trouble with memory.

There were significant physical symptoms as well: 52% reported worse neck pain, 56% had worse headache pain, and 61% claimed to have more numbness.

There was no relationship between initial symptoms and later symptoms, so the WAD classifications did not predict quality of life, or functioning for these patients. The authors conclude:

"WAD should be viewed in the same way as physical illness in general, which was suggested by Mayou and Radanov. It was further shown that the medical assessment of symptoms in the acute phase is a poor predictor of future levels of dysfunction, disability, and emotional distress. Other types of measures are therefore needed as complements to the medical diagnosis."

Soderlund A and Lindberg P. Long-term functional and psychological problems in whiplash associated disorders. International Journal of Rehabilitation Research 1999;22:77-84.