Understanding functioning and health in patients with whiplash-associated disorders

Abstract

The phenomenon of Whiplash-Associated Disorders cannot currently be understood from a biomedical perspective. In contrast to disability, which is frequently seen in patients with WAD, cervical tissue lesions or other biomedical sequellae are seldom found. The approach of WAD from a perspective of functioning and health is an alternative for the biomedical model and can be helpful in assessing and understanding the patients complaints, clinical characteristics and the course of the disorder. The characteristics of a conceptual framework related to functioning and health were explored, with help of the International Classification of Functioning, Disability and Health (ICF). For the assessment of functioning and health in patients with WAD, there is a need for brief and clinically applicable, condition specific questionnaires for assessment of functioning in patients with WAD. Currently, the Neck Bournemouth Questionnaire (NBQ) is the only self-assessment questionnaire that meets these criteria. After thorough translation, the construct validity, content validity and reliability of the Dutch NBQ (NBQ-NL) was assessed in respect of assessment of WAD from a perspective of functioning and health. Content validity was assessed in relation to the separate constructs of the ICF, by means of Discriminant Content Validity. Results of the study showed moderate to good correlation coefficients, but arguable limits of agreement in relation to the NBQ questionnaire items and counterpart items of other questionnaires. The NBQ-NL showed excellent test-retest reliability, with an ICC of 0.92 for repeated measurements. The NBQ-NL showed to be a multidimensional questionnaire, but most items measure a mixture of constructs within the theoretical framework of the ICF. In clinical practice, there is a need for a consensus based set of measures for the assessment of functioning and health in patients with WAD. Such a core set, may improve clinical decision-making. A consensus based preliminary core set for assessment of patients with acute, sub acute and chronic WAD was developed, with help of a Delphi-study. The preliminary core set of 27 assessment instruments (questionnaires and physical measures). The preliminary core set contains all ICF constructs. Additionally, a WAD-specific questionnaire was developed. This Whiplash Activity and Participation List (WAL) is a 38 item, condition-specific questionnaire based on clinical experience of experts and on patients’ experience. The WAL measures the ICF construct “activity and participation”. The relative contribution of cervical impairments and psychosocial factors to perceived disability among people with chronic whiplash associated disorders was examined, within a cross sectional design. Results of our study show that depressive symptomatology and catastrophizing explained 61% of the variance in NDI scores. Catastrophizing explained 57% of the variance in NDI scores and 15% of the variance in the sum scores of active cervical rotations.