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A Systematic Review of the Prognosis of Acute Whiplash and a New Conceptual Framework to Synthesize the Literature

Côté, Pierre, DC, MSc*†; Cassidy, J. David, DC, PhD; Carroll, Linda, PhD; Frank, John W., MD, MSc*†§∥; Bombardier, Claire, MD, FRCP*¶#**

Literature Review

Study Design.  Systematic review of prognostic studies of acute whiplash.

Objectives. To update the systematic review on the prognosis of acute whiplash published by the Quebec Task Force on Whiplash-Associated Disorders and to propose a new conceptual framework to conduct systematic reviews on prognosis.

Summary of Background Data.  In 1995, the Quebec Task Force published a systematic review of the literature on whiplash and concluded that its prognosis is favorable. However, few prognostic factors were identified. Recent studies have added to this knowledge, and there is a need to update the review conducted by the Quebec Task Force.

Methods. A bibliographic search of four electronic databases was performed to identify prognostic studies of acute whiplash published after 1995. The literature was appraised with standard review criteria. The consistency of evidence across studies was assessed. A conceptual framework was designed to classify the literature according to methodologic quality, target population, and phases of investigation.

Results. Thirteen cohort studies were included in the review. The framework used in this study demonstrates that most of the recent prognostic studies are descriptive in nature. The prognosis of acute whiplash varies according to the population sampled and the insurance/compensation system under which individuals are allowed to claim benefits. Besides age, gender, baseline neck pain intensity, baseline headache intensity, and baseline radicular signs and symptoms, there is little consistency in the literature about the prognostic factors for the recovery of whiplash.

Conclusions. Scant knowledge about the prognosis of whiplash has been gained since the release of the Quebec Task Force report. However, it is becoming obvious that the insurance and compensation systems have a large impact on recovery from acute whiplash injuries. The conceptual framework used in this study demonstrates that large cohort studies investigating a wide range of prognostic factors are necessary to improve the understanding of this problem.

From the *Institute for Work and Health, Toronto, Ontario, the †Department of Public Health Sciences, Toronto, Ontario, the ‡Epidemiology Program, Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada, the §School of Public Health, University of California, Berkeley, Berkeley, California, the ∥Population Health Program, Toronto, Ontario, Canadian Institute for Advanced Research, the ¶Arthritis and Autoimmunity Research Center, University Health Network, University of Toronto, Toronto, Ontario, the #Clinical Epidemiology and Health Care Research Program, Department of Medicine, and Department of Health Administration, University of Toronto, and the **Department of Medicine, Mt. Sinai Hospital and University Health Network, Toronto, Ontario.

This project was sponsored by Health Canada through the National Health Research and Development Program (grant No. 6606-6599-004). The Institute, an independent, not-for-profit research organization, receives support from the Ontario Workplace Safety & Insurance Board. The participation of Pierre Côté was made possible by a Doctoral Fellowship Training Award from Health Canada through the National Health Research and Development Program and through the Institute for Work and Health by the Workplace Safety and Insurance Board of Ontario.

Acknowledgment date: January 5, 2001.

First revision date: March 5, 2001.

Acceptance date: April 24, 2001.

Device status category: 1.

Conflict of interest category: 14.

Address reprint requests to

Pierre Côté, DC, MSc

Institute for Work and Health

481 University Avenue

Suite 800

Toronto, Ontario

Canada, M5G dE9


© 2001 Lippincott Williams & Wilkins, Inc.