Predictors of outcome following a short multimodal rehabilitation program for patients with whiplash associated disorders

Background. Patients with whiplash associated disorders (WAD) may present with physical and psychological symptoms which persist long after the initial onset of pain. Several studies have shown that therapeutic exercise for motor and sensorimotor control combined with manual therapy in a multimodal rehabilitation (MMR) program is effective at improving pain and disability in patients with neck disorders. To date, no studies have investigated which self-reported physical or psychological symptoms are predictive of response to this MMR program. Aim. To determine which baseline features can predict outcome following a 3-week MMR program in patients with WAD. Design. Observational prospective cohort study. Setting. Outpatient rehabilitation clinic. Population. Thirty-seven patients aged >18 years with a diagnosis of WAD grade II or III. Methods. The MMR program included manual therapy, motor control and sensorimotor control training according to the clinical impairments of each patient. Patients were assessed before and after treatment for their physical and psychological symptoms by means of self-reported questionnaires. Regression models were estimated with pain intensity, disability and post-traumatic stress symptoms (PTSS) as outcomes. Results. After treatment, patients exhibited significant improvements in all evaluated outcomes (all P<0.01). Regression models accounting for 35% and 36% of the variance in pain intensity outcomes included average pain intensity over the previous week and pain catastrophizing as significant predictors. Disability and pain catastrophizing were predictors of changes in disability following the MMR program explaining 49% of the variance in the model. Furthermore, higher PTSS at baseline was a significant predictor of PTSS after treatment, explaining 55% of the variance in the model. Conclusion. Improved outcomes on pain intensity, disability and PTSS following a MMR program could be partially predicted based on the patient's initial presentation. Clinical Rehabilitation Impact. This knowledge may assist clinicians in predicting outcome following a MMR program inclusive of specific exercise therapy and manual therapy in patients with WAD.