Research papersCourse and prognostic factors of whiplash: A systematic review and meta-analysis☆Kamper, Steven J.a,*; Rebbeck, Trudy J.b; Maher, Christopher G.a; McAuley, James H.a; Sterling, MichelecAuthor Information aThe George Institute, University of Sydney, NSW, Australia bBack Pain Research Group, University of Sydney, NSW, Australia cCentre for National Research on Disability and Rehabilitation Medicine (CONROD), University of Queensland, Australia *Corresponding author. The George Institute for International Health, University of Sydney, PO Box M201, Missenden Road, Sydney NSW 2050, Australia. Tel.: +61 2 8238 2413; fax: +61 2 9657 0301. E-mail: [email protected] Submitted October 19, 2007; received in revised form January 23, 2008; accepted February 20, 2008. ☆Funding: S.J.K.’s scholarship is funded by an Australian Research Council Discovery Grant and the National Health and Medical Research Council of Australia, and part of the production of this paper was funded by The Trauma Injury and Recovery Council of South Australia (TRACsa). C.G.M.’s fellowship is funded by the National Health and Medical Research Council of Australia. T.J.R. performs paid contract work for TRACsa, which is an initiative of the South Australian government. Pain: September 15, 2008 - Volume 138 - Issue 3 - p 617-629 doi: 10.1016/j.pain.2008.02.019 Buy Metrics Abstract We conducted a systematic review and meta-analysis of prospective cohort studies of subjects with acute whiplash injuries. The aim was to describe the course of recovery, pain and disability symptoms and also to assess the influence of different prognostic factors on outcome. Studies were selected for inclusion if they enrolled subjects with neck pain within six weeks of a car accident and measured pain and/or disability outcomes. Studies were located via a sensitive search of electronic databases; Medline, Embase, CINAHL, Cochrane database, ACP Journal club, DARE and Psychinfo and through hand-searches of relevant previous reviews. Methodological quality of all studies was assessed using a six item checklist. Sixty-seven articles, describing 38 separate cohorts were included. Recovery rates were extremely variable across studies but homogeneity was improved when only data from studies of more robust methodological quality were considered. These data suggest that recovery occurs for a substantial proportion of subjects in the initial 3 months after the accident but after this time recovery rates level off. Pain and disability symptoms also reduce rapidly in the initial months after the accident but show little improvement after 3 months have elapsed. Data regarding the prognostic factors associated with poor recovery were difficult to interpret due to heterogeneity of the techniques used to assess such associations and the way in which they are reported. There was also wide variation in the measurement of outcome and the use of validated measures would improve interpretability and comparability of future studies. © 2008 Lippincott Williams & Wilkins, Inc.