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The Role of Illness Perceptions in Predicting Outcome After Acute Whiplash Trauma: A Multicenter 12-month Follow-up Study

Gehrt, Tine B. BSc*; Wisbech Carstensen, Tina Birgitte PhD*; Ørnbøl, Eva MSc*; Fink, Per K. PhD*; Kasch, Helge PhD; Frostholm, Lisbeth PhD*

doi: 10.1097/AJP.0000000000000085
Original Articles

Objectives: To examine (1) whether the patients’ perceptions of their symptoms immediately after the accident and at 3-month follow-up predict working ability and neck pain at 12-month follow-up and (2) the possible changes in patients’ illness perceptions during the follow-up period.

Materials and Methods: A total of 740 consecutive patients exposed to acute whiplash trauma consulting emergency units and general practitioners in 4 Danish counties from 2001 to 2003. The patients completed questionnaires at baseline, 3-, and 12-month follow-up. Illness perceptions were measured using a condensed version of the Illness Perception Questionnaire and a 1-item question concerning return to work expectation. Neck pain was measured using an 11-point box scale, and working ability was measured by self-report at 12-month follow-up. Multiple logistic regression analyses were applied controlling for possible confounders.

Results: Patients with pessimistic illness perceptions at baseline and 3-month follow-up were more likely to experience neck pain and affected working ability at 12 months compared with patients with optimistic illness perceptions. Negative return-to-work expectation predicted affected working ability at 12 months. Furthermore, patients with high neck pain intensity or affected working ability report more changes in their illness perceptions during follow-up than patients with low neck pain intensity or unaffected working ability.

Discussion: The findings are in line with the common-sense model of illness and previous research demonstrating that patient’s expectations for recovery and illness perceptions might influence the course after whiplash injury. Illness perceptions and expectations may provide a useful starting point for future interventions and be targeted in the prevention of chronicity.

*The Research Clinic for Functional Disorders and Psychosomatics

Department of Neurology, Aarhus University Hospital, Aarhus, Denmark

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Supported by Insurance and Pensions in Denmark, Philip Heymans Allé 1, DK-2900 Hellerup, Denmark, The Health Insurance Foundation, Fondenes Hus, Otto Mønsteds Gade 5, 1571 København V, Danmark The Research Foundation of Aarhus University, Finlandsgade 14, DK-8200 Aarhus N, Denmark, The Tryg Foundation, Lyngby Hovedgade 4, 2.sal, DK-2800 Kgs. Lyngby, Denmark, The Illum Foundation, Valkendorfsgade 16, 1151 København K, Denmark, The Lippmann Foundation, Copenhagen, Denmark, The Foundation of The Family Hede Nielsen, Holmboes Allé 1, 11. etage. DK 8700 Horsens, Denmark, and The Danish Rheumatism Association, Gentoftegade 118, DK-2820 Gentofte, Denmark. The authors declare no conflict of interest.

Reprints: Lisbeth Frostholm, PhD, The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Barthsgade 5, 1, DK-8200 Aarhus N, Denmark (e-mail:

Received September 10, 2013

Received in revised form March 3, 2014

Accepted February 3, 2014

© 2015 by Lippincott Williams & Wilkins