Cognitive determinants of pain and disability in patients with chronic whiplash-associated disorder: A cross-sectional observational study

Thompson, Dave P.; Oldham, Jacqueline A.; Urmston, Martin; Woby, Steve R.

doi:10.1016/j.physio.2009.11.001

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Volume 96, Issue 2 , Pages 151-159, June 2010

Cognitive determinants of pain and disability in patients with chronic whiplash-associated disorder: A cross-sectional observational study

Dave P. Thompson
- Department of Physiotherapy, Pennine Acute Hospitals NHS Trust, North Manchester General Hospital, Crumpsall, Manchester M8 5RB, UK
- Centre for Rehabilitation Science, ARC Epidemiology Unit, School of Translational Medicine, University of Manchester, Manchester, UK
- Corresponding author at: Department of Physiotherapy, North Manchester General Hospital, Delaunays Road, Crumpsall, Manchester M8 5RB, UK. Tel.: +44 0161 720 2423; fax: +44 0161 720 2435.
Jacqueline A. Oldham
- Centre for Rehabilitation Science, ARC Epidemiology Unit, School of Translational Medicine, University of Manchester, Manchester, UK
Martin Urmston
- Department of Physiotherapy, Pennine Acute Hospitals NHS Trust, North Manchester General Hospital, Crumpsall, Manchester M8 5RB, UK
Steve R. Woby
- Department of Physiotherapy, Pennine Acute Hospitals NHS Trust, North Manchester General Hospital, Crumpsall, Manchester M8 5RB, UK
- Centre for Rehabilitation Science, ARC Epidemiology Unit, School of Translational Medicine, University of Manchester, Manchester, UK

published online 22 January 2010.

Abstract

Objective

To delineate the relative extent to which specific cognitive factors are related to levels of pain and disability in patients with chronic whiplash-associated disorder.

Design

Cross-sectional observation study.

Setting

Three secondary care physiotherapy departments in the Greater Manchester region of the UK.

Participants

All patients with chronic whiplash-associated disorder referred to the participating departments were invited to take part in the study. In total, 124 patients were invited to participate, and 63 (51%) agreed to do so. Complete data were available for 55 (44%) of those invited to participate in the study.

Main outcome measures

Pain and disability, as assessed by the Neck Disability Index.

Results

Cognitive factors were strongly related to levels of disability (R² change=0.39, P<0.001). Specifically, greater catastrophising (β=0.41, P<0.01) and lower functional self-efficacy beliefs (β=−0.47, P<0.001) were significantly related to greater levels of disability. Significant univariate correlations were seen between the cognitive factors and current pain intensity. However, no significant associations were seen between the cognitive factors and current pain intensity in the multivariate analysis.

Conclusions

Interventions which aim to reduce catastrophising and enhance functional self-efficacy beliefs should be included alongside conventional physiotherapy interventions when treating patients with chronic whiplash-associated disorder.

Keywords: Whiplash, Pain, Catastrophising, Self-efficacy, Fear, Vigilance