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Coping and Recovery in Whiplash-associated Disorders: Early use of Passive Coping Strategies is Associated With Slower Recovery of Neck Pain and Pain-related Disability

Carroll, Linda J. PhD*; Ferrari, Robert MD, MSc (Med)†,‡; Cassidy, J. David PhD, DrMedSc§,∥,¶; Côté, Pierre DC, PhD¶,#

The Clinical Journal of Pain: January 2014 - Volume 30 - Issue 1 - p 1–8
doi: 10.1097/AJP.0b013e3182869d50
Original Articles

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.

*Department of Public Health Sciences, Alberta Centre for Injury Prevention and Research

Departments of Medicine

Rheumatic Diseases, University of Alberta, Edmonton, AB

Division of Outcomes and Population Health, Toronto Western Research Institute

Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto

#Faculty of Health Sciences and UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT), Toronto, ON, Canada

§Institute of Sport Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark

The authors declare no conflict of interest. Supported by Saskatchewan Government Insurance Corporation, Regina, Saskatchewan, Canada.

Reprints: Linda J. Carroll, PhD, 4075 Research Transition Facility, 8308-114 Street, Edmonton, AB, Canada T6G 2E1 (e-mail:

Received July 12, 2012

Accepted January 7, 2013

© 2014 by Lippincott Williams & Wilkins