The role of the referring primary health professional
The Clinical Prediction Rule (CPR) predicts the patient's recovery and whether they are at low or medium to high risk of poor recovery. In addition, the Australian Guidelines for the management of acute whiplash-associated disorders recommend a number of other assessments that may be undertaken by a primary health professional to assess the risk of poor recovery. You can read more about health professional identification of patients at poor risk of recovery in the clinician whiplash portal.
The role of the specialist
Your role as a specialist is to manage or ‘troubleshoot’ the physical and psychological factors that may be present in your patient and associated with poor recovery.
While some factors will be identified through a patient’s response on the CPR, additional poor prognostic factors may be relevant to your patient’s case.
Factors predictive of poor recovery
Factors predictive of poor recovery
| Factor | Outcome/s | Strength of evidence |
| SYMPTOMS | ||
| Higher initial neck pain levels | Ongoing pain | A |
| Ongoing disability | A | |
| Ongoing psychological symptoms | B | |
| Work disability | C | |
| Other (like muscle function) | D | |
| Higher initial disability | Ongoing disability | A |
| Self-perceived injury severity | Ongoing pain/disability | B |
| Headache | Ongoing pain/disability | D |
| Higher number of symptoms | Ongoing pain/disability | C |
| WAD grade | Ongoing pain/disability | C |
| Back pain | Ongoing pain/disability | C |
| Dizziness | Ongoing pain/disability | C |
| PSYCHOLOGICAL | ||
| Posttraumatic stress symptoms | Ongoing pain/disability | A |
| Negative expectation of recovery | Ongoing pain/disability | A |
| Somatisation | Ongoing pain/disability | B |
| Depression | Ongoing pain/disability | C |
| Pain catastrophising | Ongoing pain/disability | C |
| Coping strategies | Ongoing pain/disability | D |
| CRASH RELATED | ||
| Self-rates collision severity | Ongoing pain/disability | C |
| DEMOGRAPHICS | ||
| Age | Ongoing psychological symptoms | B |
| PHYSICAL | ||
| Cervical range of motion | Ongoing disability | A |
| Cold hyperalgesia | Ongoing disability | A |
| PRE-COLLISION | ||
| Pre-collision bodily pain | Ongoing pain/disability | B |
| Pre-collision psychological health | Ongoing pain/disability | C |
| GRADE OF RECOMMENDATIONS | DESCRIPTION |
| A | Body of evidence can be trusted to guide practice |
| B | Body of evidence can be trusted to guide practice in most situations. |
| C | Body of evidence provides some support for recommendation(s) but care should be taken in its application. |
| D | Body of evidence is weak and recommendations must be applied with caution. |
| E | A graded recommendation could not be made due to lack of evidence. Consensus recommendations are expressed as a clinical practice point which is supported by all members of the working group. |
Factors not predictive of poor recovery
Factors not predictive of poor recovery
| Factor | Outcome/s | Strength of evidence |
| SYMPTOMS | ||
| Shoulder pain | Ongoing pain/disability | A |
| PSYCHOLOGICAL | ||
| Kinesiophobia (fear of movement) | Ongoing pain/disability | C |
| Anxiety | Ongoing pain/disability | D |
| CRASH RELATED | ||
| Seat belt use | Ongoing pain/disability | A |
| Awareness of collision | Ongoing pain/disability | A |
| Position in vehicle | Ongoing pain/disability | A |
| Speed of collision | Ongoing pain/disability | A |
| Head position at impact | Ongoing pain/disability | B |
| Use of head restraints | Ongoing pain/disability | B |
| Direction of impact | Ongoing pain/disability | B |
| Airbag deployment | Ongoing pain/disability | C |
| RADIOLOGICAL FINDINGS | ||
| Radiological findings | Ongoing pain/disability | A |
| DEMOGRAPHICS | ||
| Age | Ongoing pain | B |
| Work disability | A | |
| Living situation | Ongoing pain/disability | B |
| Work status | Ongoing pain/disability | C |
| Income | Ongoing pain/disability | C |
| PHYSICAL | ||
| Lower pressure pain thresholds | Ongoing pain/disability | A |
| Motor/sensory-motor dysfunction | Ongoing pain/disability | A |
| BMI | Ongoing pain/disability | B |
| Cervical range of motion | Ongoing pain/disability | B |
| Sympathetic vasoconstriction | Ongoing pain/disability | B |
| PRE-COLLISION | ||
| Pre-collision neck pain | Ongoing pain/disability | B |
| Pre-collision headache | Ongoing pain/disability | B |
| Pre-collision general health | Ongoing pain/disability | B |
| Pre-collision medication use | Ongoing pain/disability | B |
| Factors with inconsistent evidence (equal numbers of studies both for and against predictive capacity): |
||
| FACTOR | ||
| Gender | ||
| Educational evidence | ||
| Self-perceived general health | ||
| Compensation related factors | ||
| GRADE OF RECOMMENDATIONS | DESCRIPTION |
| A | Body of evidence can be trusted to guide practice |
| B | Body of evidence can be trusted to guide practice in most situations. |
| C | Body of evidence provides some support for recommendation(s) but care should be taken in its application. |
| D | Body of evidence is weak and recommendations must be applied with caution. |
| E | A graded recommendation could not be made due to lack of evidence. Consensus recommendations are expressed as a clinical practice point which is supported by all members of the working group. |
Source: NSW Motor Accident Authority. Guidelines for the management of acute whiplash, 3rd Ed 2014