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ABSTRACT: OBJECTIVE:: Coping is shown to affect outcomes in chronic pain patients; however, few studies have examined the role of coping in the course of recovery in whiplash-associated disorders (WAD). The purpose of this study was to determine the predictive value of coping style for 2 key aspects of WAD recovery, reductions in neck pain, and in disability. METHODS:: A population-based prospective cohort study design was used to study 2986 adults with traffic-related WAD. Participants were assessed at baseline, 6 weeks, and 4, 8, and 12 months postinjury. Coping was measured at 6 weeks using the Pain Management Inventory, and neck pain recovery was assessed at each subsequent follow-up, using a 100 mm visual analogue scale (VAS). Disability was assessed at each follow-up using the Pain Disability Index (PDI). Pain recovery was defined as a VAS score of 0 to 10; disability recovery was defined as a PDI score of 0 to 4. Data analysis used multivariable Cox proportional hazards models. RESULTS:: Those using high versus low levels of passive coping at 6 weeks postinjury experienced 28% slower pain recovery and 43% slower disability recovery. Adjusted hazard rate ratios for pain recovery and disability recovery were 0.72 (95% CI, 0.59-0.88) and 0.57 (95% CI, 0.41-0.78), respectively. Active coping was not associated with recovery of neck pain or disability. CONCLUSIONS:: Passive coping style predicts neck pain and self-assessed disability recovery. It may be beneficial to assess and improve coping style early in WAD.
The Clinical journal of pain 02/2013; · 3.01 Impact Factor
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ABSTRACT: Expectations and beliefs are important predictors of outcome following minor head injury. In this paper, the primary purpose is to develop a simple symptom expectation questionnaire for minor head injury for use in future research studies.
An existing database of 179 injury-naive subjects who completed a 56-item checklist of expected symptoms for minor head injury was analyzed to determine which items could correctly identify an a priori case definition of an expecter (a subject who expected at least one of these symptoms would remain chronic following minor head injury). A total of six of the 56 items were found to be discriminatory, and these were tested in additional subject groups against the original questionnaire.
From the original database of 179 subjects completing a 56-item symptom expectation checklist, 135 expected that at least one of the 56 symptoms would be chronic following minor head injury. The 135 expecters, however, all chose at least one of six items: headache, anxious or worried, depressed, difficulty concentrating, dizziness, and neck pain. Using these six items, in two new groups of subjects, all those who endorsed one of the 56 symptoms as likely to be chronic following minor head injury (expecters) could also be identified on the 6-item checklist.
A shortened (6-item) symptom expectation checklist of commonly reported symptoms following minor head injury (headache, anxious or worried, depressed, difficulty concentrating, dizziness, and neck pain) correctly identifies subjects who expect that at least one symptom will be chronic following minor head injury (i.e., an expecter).
Journal of Zhejiang University SCIENCE B 06/2011; 12(6):499-502. · 1.10 Impact Factor
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ABSTRACT: The objective of the study was to determine the odds ratio for compliance with referral to an active treatment program according to coping style in a cohort of acute whiplash-injured subjects. Sixty whiplash patients were assessed within 1 week of their collision for their coping styles and were then questioned 3 weeks later to determine if they had complied with a referral for an active treatment program. Coping style was assessed with the Vanderbilt Pain Management Inventory. Adjusting for age, gender, and initial whiplash disability questionnaire scores, the odds ratio for compliance with therapy for subjects who had a low active/high passive coping style was 0.15 (P=0.03) (95% CI, 0.03-0.86) relative to all other coping style patterns, whose odds ratios did not differ from each other. As a secondary outcome, the odds ratio for reporting prescription medication use for subjects who had a low active/high passive coping style was 6.7 (P=0.038) (95% CI, 1.1-40.4). Those whiplash patients who have a low active/high passive coping style are less likely to attend an active exercise-based rehabilitation program and more likely to use prescription medications in the first 3 weeks following injury. Coping style may affect recovery from whiplash injury through issues of compliance with active therapy and increased reliance on prescription medications.
Clinical Rheumatology 04/2011; 30(9):1221-5. · 2.00 Impact Factor
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ABSTRACT: Cross-sectional cohort study: to examine concurrent expectations and coping style for whiplash injury in injury-naive subjects in Germany. Studies suggest the recovery rate from whiplash injury may be faster in Germany than in Canada. Canadians have a high expectation for chronic pain following whiplash injury and Germans do not. Expectation of recovery not only predicts recovery in whiplash victims but is also known to correlate with coping style. The Vanderbilt Pain Management Inventory was administered to university students and staff in Germany. Subjects who had not yet experienced whiplash injury were given a vignette concerning a neck sprain (whiplash injury) in a motor vehicle collision and were asked to indicate how likely they were to have thoughts or behaviours indicated in the coping style questionnaire. Subjects also completed expectation questionnaires regarding whiplash injury. Sixteen percent of subjects held an expectation of chronic neck or back pain after whiplash injury. The mean active coping style score was 27.4±3.6 (40 is the maximum score for active coping). The mean passive coping style score was 27.0±6.3 (50 is the maximum score for passive coping). Coping style scores and patterns were not different from those previously observed in Canadian studies, but there was no correlation between expectations and coping style among German subjects, a finding that differs from Canadian studies. Although expectations and coping styles may interact or be co-modifiers in the outcomes of whiplash injury in Canadian whiplash victims, in Germany, despite having similar coping styles to Canadians, the lack of expectation for chronic pain may be protective from the effect of passive coping styles. Further studies of coping style as an aetiologic factor in the chronic whiplash syndrome are needed.
Clinical Rheumatology 03/2011; 30(9):1209-14. · 2.00 Impact Factor
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Robert Ferrari
Headache The Journal of Head and Face Pain 01/2011; 51(1):163-5. · 2.52 Impact Factor
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ABSTRACT: In pain conditions, active coping has been found to be associated with less severe depression, increased activity level and less functional impairment. Studies indicate that there is a high expectation for chronic disability following a diagnosis of rheumatoid arthritis. The objective of this study was to compare both the expectations and the coping style for rheumatoid arthritis in disease-naïve subjects.
The Vanderbilt Pain Management Inventory was administered to university students. Subjects who had not yet experienced rheumatoid arthritis (RA) and did not know a person with RA were given a vignette concerning a new onset diagnosis of RA and were asked to indicate how likely they were to have thoughts or behaviours indicated in the coping style questionnaire. Subjects also completed expectations regarding daily functioning according to the Stanford Health Assessment Questionnaire (HAQ) for RA.
The mean active coping style score for RA was 27.3 ± 4.6 (40 is the maximum score for active coping). The mean passive coping style score was 26.2 ± 7.0 (50 is the maximum score for passive coping). Those with high passive coping styles had a higher mean expectation score (higher HAQ score) of disability from rheumatoid arthritis. The correlation between passive coping style score and expectation score was 0.48, while the correlation between active coping style score and expectation was -0.34.
Both expectations and coping styles may interact or be co-modifiers in the outcomes of RA patients. Further studies of coping styles and expectations in RA are required.
Clinical Rheumatology 12/2010; 29(12):1445-8. · 2.00 Impact Factor
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Robert Ferrari
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ABSTRACT: Central sensitisation is associated with chronic pain in whiplash patients. Predicting which patients will develop central sensitisation is difficult but patient expectations of recovery predict a variety of outcomes in whiplash patients.
Ninety-one whiplash patients were assessed within 1 week of their collision in order to ascertain their expectations of recovery and were then re-examined 3 months later with the Brachial Plexus Provocation Test (BPPT) as a sign of central sensitisation.
Adjusting for a number of predictors, patient expectation of recovery was found to predict the results of the BPPT. Subjects who expected 'to get better soon' had a BPPT angle that was 42 degrees less (ie. closer to normal or full range) than any of the subjects who had poor recovery expectations.
Whiplash patients who expect 'never to get better' or 'don't know' have a much higher likelihood of developing at least one sign of central sensitisation 3 months after their collision.
Australian family physician 11/2010; 39(11):863-6. · 0.73 Impact Factor
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ABSTRACT: Symptom and pain diaries are often recommended to or used by patients with chronic pain disorders. Our objective was to examine the effect on recall of symptoms after 14 days of daily symptom diary use in healthy subjects.
Subjects were randomly assigned to 1 of 2 groups: the diary group and the control group. Both subject groups completed an initial symptom checklist composed of headache, neck pain, back pain, fatigue, abdominal pain, elbow pain, jaw pain, and numbness/tingling in arms or legs. Both groups indicated their symptom frequency and their perceived average symptom severity in the last 14 days. The diary group was asked then to examine the symptom checklist daily for 14 days while the control group was not. After 2 weeks, both groups then repeated the symptom checklist for recall of symptoms and symptom severity.
A total 35 of 40 initially recruited subjects completed all the questionnaires, 18 in the diary group and 17 in the control group. At the outset, both groups had similar frequencies and intensities of symptoms. After 2 weeks of symptom diary use, diary group subjects had an increased frequency (doubled) of recalled symptoms, and significantly increased intensity of symptoms compared with the control group, which had not changed its mean frequency or intensity of symptoms.
The use of a symptom diary for 2 weeks, even in generally healthy subjects, results in increased recall of daily symptoms and increased perception of symptom severity.
The Journal of Rheumatology 10/2010; 37(11):2387-9. · 3.69 Impact Factor
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Robert Ferrari
Journal of General Internal Medicine 05/2010; · 2.83 Impact Factor
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ABSTRACT: In pain conditions, active coping has been found to be associated with less severe depression, increased activity level, and less functional impairment. Studies indicate that Canadians have a high expectation for chronic pain following whiplash injury. Expectation of recovery has been shown to predict recovery in whiplash victims. The objective of this study was to compare both the expectations and the coping style for whiplash injury in injury-naive subjects. The Vanderbilt Pain Management Inventory was administered to university students. Subjects who had not yet experienced whiplash injury were given a vignette concerning a neck sprain (whiplash injury) in a motor vehicle collision and were asked to indicate how likely they were to have thoughts or behaviors indicated in the coping style questionnaire. Subjects also completed expectation questionnaires regarding whiplash injury. Subjects (57%) held an expectation of chronic pain after whiplash injury. The mean active coping style score was 28.5±6.6 (40 is the maximum score for active coping). The mean passive coping style score was 28.5±6.6 (50 is the maximum score for passive coping). Those with high passive coping styles had a higher mean expectation score. The correlation between passive coping style score and expectation score was 0.62, while the correlation between active coping style score and expectation was -0.48. Both expectations and coping styles may interact or be co-modifiers in the outcomes of whiplash injury in whiplash victims. Further studies of coping style as an etiologic factor in the chronic whiplash syndrome are needed.
Clinical Rheumatology 04/2010; 29(11):1245-9. · 2.00 Impact Factor
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Journal of psychosomatic research 03/2010; 68(3):311-2. · 2.91 Impact Factor
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ABSTRACT: Quasi-experimental before-and-after design with control group.
We evaluated a back pain mass media campaign's impact on population back pain beliefs, work disability, and health utilization outcomes.
Building on previous campaigns in Australia and Scotland, a back pain mass media campaign (Don't Take it Lying Down) was implemented in Alberta, Canada. A variety of media formats were used with radio ads predominating because of budget constraints.
Changes in back pain beliefs were studied using telephone surveys of random samples from intervention and control provinces before campaign onset and afterward. The Back Beliefs Questionnaire (BBQ) was used along with specific questions about the importance of staying active. For evaluating behaviors, we extracted data from governmental and workers' compensation databases between January 1999 and July 2008. Outcomes included indicators of number of visits to health care providers, use of diagnostic imaging, and compensation claim incidence and duration. Analysis included time series analysis and ANOVA testing of the interaction between province and time.
Belief surveys were conducted with a total of 8566 subjects over the 4-year period. Changes on BBQ scores were not statistically significant, however, the proportion of subjects agreeing with the statement, "If you have back pain you should try to stay active" increased in Alberta from 56% to 63% (P = 0.008) with no change in the control group (consistently approximately 60%). No meaningful or statistically significant effects were seen on the behavioral outcomes.
A Canadian media campaign appears to have had a small impact on public beliefs specifically related to campaign messaging to stay active, but no impact was observed on health utilization or work disability outcomes. Results are likely because of the modest level of awareness achieved by the campaign and future campaigns will likely require more extensive media coverage.
Spine 03/2010; 35(8):906-13. · 2.08 Impact Factor
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ABSTRACT: Objective: To ascertain the prevalence of symptoms of temporomandibular disorders [TMD] in whiplash victims in Lithuania versus healthy controls. Methods: In a controlled, retrospective cohort study in Lithuania, 210 rear-end collision victims [at 14–27 months following the collision] were surveyed for TMD symptoms. Results were compared to an age-and sex-matched control group, sampled randomly from the local population register. Results: In the accident group, 2.4% [4/165] reported jaw pain for one day or more per month compared to 3.3% [6/180] of controls. One [0.6%] accident victim and two [1.1%] controls had daily jaw pain. In both groups there was a low prevalence of jaw sounds, pain in or near the ear[s], jaw locking, tinnitus, and facial pain. Conclusion: Lithuanian accident victims do not appear to report chronic symptoms of TMD in association with an acute whiplash injury.
01/2010; 8(1-2):133-142.
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The Journal of Rheumatology 07/2009; 36(6):1347-8; author reply 1348. · 3.69 Impact Factor
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ABSTRACT: Positive expectations predict better outcome in a number of health conditions, but the role of expectations in predicting health recovery after injury is not well understood. We investigated whether early expectations of recovery in whiplash associated disorders (WAD) predict subsequent recovery, and studied the role of "expectations" to predict recovery as determined by pain cessation and resolution of pain-related limitations in daily activities.
A cohort of 6,015 adults with traffic-related whiplash injuries was assessed, using multivariable Cox proportional hazards analysis, for association between these expectations and self-perceived recovery over a 1-year period following the injury. Recovery was assessed using 3 indices: self-perceived global recovery (primary outcome); resolution of neck pain severity; and resolution of pain-related limitations in daily activities.
After adjusting for the effect of sociodemographic characteristics, post-crash symptoms and pain, prior health status and collision-related factors, those who expected to get better soon recovered over 3 times as quickly (hazard rate ratio = 3.62, 95% confidence interval 2.55-5.13) as those who expected that they would never get better. Findings were similar for resolution of pain-related limitations and resolution of neck pain intensity, although the effect sizes for the latter outcome were smaller.
Patients' early expectations for recovery are an important prognostic factor in recovery after whiplash injury, and are potentially modifiable. Clinicians should assess these expectations in order to identify those patients at risk of chronic whiplash, and future studies should focus on the effect of changing these early expectations.
The Journal of Rheumatology 03/2009; 36(5):1063-70. · 3.69 Impact Factor
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The Journal of Rheumatology 01/2009; 35(12):2300-2. · 3.69 Impact Factor
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Spine 11/2008; 33(22):2434. · 2.08 Impact Factor
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ABSTRACT: Beliefs about pain conditions appear to influence recovery in a variety of musculoskeletal conditions. Little is known about population beliefs about neck and arm pain.
To evaluate population beliefs of three common musculoskeletal conditions: work-related neck and arm pain and whiplash injury (WAD).
Mail-out surveys were delivered to 2000 adult residents of two Canadian provinces cross-sectionally. To evaluate beliefs about the three conditions, the back beliefs questionnaire was modified yielding three comparable 10-item measures. In addition, we inquired about the belief about how quickly the condition settles. Respondents indicated their level of agreement on a 5-point Likert scale with lower scores interpreted as negative or pessimistic. Overall and item specific descriptive statistics are reported. A one-way repeated measures ANOVA was performed to compare beliefs across conditions.
Three hundred (15%) surveys were returned. Overall belief scores were different across conditions (p<0.001). Post-hoc tests revealed beliefs about whiplash injury were more negative compared to the other conditions (p<0.017). There were moderate levels of uncertainty in the responses, especially in regard to whiplash injury. For items related to active coping, over 55% of respondents agreed that remaining active and exercising was important. The sample was pessimistic in regard to recovery and resuming usual activities for all conditions, but more so in the case of WAD.
Population beliefs related to neck pain, arm pain, and WAD in the two Canadian provinces sampled were consistent with the literature in regard to remaining active, but appeared misinformed relating to the prognosis of these conditions. Strategies for reeducating the public are indicated.
European journal of pain (London, England) 05/2008; 13(3):300-4. · 3.37 Impact Factor
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ABSTRACT: Review of newspaper articles.
To assess the content of newspaper articles in 2 provinces in Canada to determine if rest or avoidance of activity is being recommended for back pain.
Inaccurate back pain beliefs in the general public may arise due to messages in the mass media. One persisting belief in Canada is that rest or activity avoidance is needed until back pain resolves.
We searched newspapers in 2 Canadian provinces via an electronic database for articles discussing back pain. Two trained raters used an article review template to indicate whether the article's main recommendation was to stay active, rest, was neutral (indicating a balance between rest and activity), or did not provide advice on level of activity during an episode of back pain.
One hundred 29 articles were identified. The primary advice provided related to level of activity during an episode of back pain was stay active in 24% of articles, whereas no articles primarily recommended rest or avoidance of activity. Sixteen percent of articles were rated as neutral, indicating the authors suggested a balance between rest and activity.
Back-pain-related newspaper articles do not carry messages that advocate rest or avoidance of activity, but rather highlight the importance of staying active during an episode or participating in exercise.
Journal of Spinal Disorders & Techniques 03/2008; 21(1):1-3. · 1.50 Impact Factor
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The Journal of Rheumatology 03/2007; 34(2):450; author reply 450-1. · 3.69 Impact Factor
