Correlation between expectations of recovery and injury severity perception in whiplash-associated disorders

Abstract

Objective

To assess the correlation between expectations of recovery and whiplash patients’ perceptions of injury severity using a simplified instrument. Expectations of recovery have been shown to predict rate of recovery from whiplash injury in population-based studies. The perception of having more severe pathology or more ominous diagnostic labels has also been associated with a worse prognosis.

Methods

Consecutive patients with whiplash-associated disorder grade 1 or 2, presenting in the acute stage to a primary care centre, were asked “do you think that your injury will…” with response options “get better soon; get better slowly; never get better; don’t know.” Injury severity perception (ISP) was measured with a numerical rating scale which ranged from 0–10, on which subjects were asked to rate how severe (in terms of damage) they thought their injury was. The anchors were labeled “no damage” (0) and “severe, and maybe permanent damage” (10). The primary outcome measure was the correlation between the subject’s ISP score and expectation of recovery.

Results

A total of 94 subjects (34 males, 60 females, and mean age (40.6±10.0) years, range 19–60 years) were included. The initial responses to expectation of recovery were: get better soon (29/94); get better slowly (22/94); never get better (11/94); don’t know (32/94). The mean ISP score was 4.9±1.7 (range 2–9 out of 10). There was a high correlation between expectations and ISP scores (Spearman’s rank correlation coefficient 0.68). Those who expected to recover soon and those who expected to get better slowly had the lowest ISP scores.

Conclusions

The more slowly whiplash patients expect to recover, or the less sure they are of recovery, the more severe their initial perceptions of injury.