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A Behavioural Medicine Perspective on Acute Whiplash Associated Disorders: Daily Coping, Prognostic Factors and Tailored Treatment
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to study the daily process of coping, potential prognostic factors for recovery and evaluating an individually tailored behavioural medicine intervention in the acute stage of Whiplash Associated Disorders (WAD). The studies comprised three samples of patients with acute Whiplash Associated Disorders (WAD). All patients were included within the first month after the whiplash occurrence and were recruited from hospital emergency wards in six Swedish communities.

Study I and II included 51 participants generating 260 daily coping diaries (WAD-DCA) during seven days in the acute stage of WAD. In Study I daily stressors and primary appraisal were analysed and in Study II patterns between stressors, appraisals, coping strategy profiles, daily activity level and well-being were described. The results showed a large variety of situations that the individuals perceive as stressful, not only pain itself. High self-efficacy was associated with high degree of physical/mental well-being. Threatening stressors and catastrophic thoughts were associated with low degree of physical and mental well-being. In Study III potential prognostic factors for good as well as poor recovery were studied more closely in a mildly affected sample (MIAS) (n=98) from within the first month after the accident up to one year later. Pain-related disability at baseline emerged as the only indicator of prognosis after 12 months in MIAS. Study IV (n=55) was a randomised control study, were current clinical recommendations of standard self-care instructions (SC) for the management of acute WAD was compared to an individually tailored behavioural medicine intervention delivered via Internet or face-to-face. The results showed that SC was not as effective as the behavioural medicine intervention. By early identification of situation-specific factors and potential behavioural (physical, cognitive and affective) determinants of activity performance, it seems possible to tailor a self-management intervention that decreases pain-related disability, fear of movement and catastrophising and increases self-efficacy. The use of innovative methods such as the Internet of distributing treatment interventions showed to be a good alternative to more traditional forms.

The results of this thesis uncover new insights in understanding the individual’s specific perspective as applied in a behavioural medicine approach in acute WAD.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. , 66 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 807
Keyword [en]
Behavioural medicine, Acute whiplash associated disorders, Daily coping, Prognostic factors, Tailored treatment, Pain-related disability
National Category
Physiotherapy
Research subject
Physiotherapy; Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-179993ISBN: 978-91-554-8458-3 (print)OAI: oai:DiVA.org:uu-179993DiVA: diva2:547550
Public defence
2012-10-12, Sal B41, Ing A11, Biomedicinskt Centrum (BMC), Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2012-09-21 Created: 2012-08-28 Last updated: 2013-01-22Bibliographically approved
List of papers
1. Daily stressors in patients with acute whiplash associated disorders
Open this publication in new window or tab >>Daily stressors in patients with acute whiplash associated disorders
2012 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, no 21, 1783-1789 p.Article in journal (Refereed) Published
Abstract [en]

Purpose

Stressors in acute whiplash associated disorders (WAD), as reported on a daily basis, have hitherto been neglected in research. The primary aim of this study was to describe the most stressful daily situation or event reported by individuals with acute WAD within a month of a whiplash trauma. Another aim was to describe the meaning and significance of these daily stressors, i.e. primary appraisal.

Method

A descriptive design with a content analysis approach was used. 260 WAD-daily coping assessments (WAD-DCA) generated during 1 week by 51 participants with acute WAD were included in the study. Stressors were analysed using qualitative content analysis.

 Results

The reported stressors generated 13 categories covering a wide range of stressful situations in daily life related to (i) work, (ii) physical symptoms, (iii) feelings and cognitions, (iv) family and home responsibilities and (v) recreation. The majority of the stressors were appraised as "expected" as well as "disabling". Most threatening stressors were related to work, driving and feelings/cognitions.

Conclusions

The wide variety of stressors indicates that it is not only pain itself that influences daily life in acute WAD. Early identification of individual and situation-specific stressors gives new data regarding what bothers individuals suffering from WAD after a collision and may be helpful in understanding the coping process in relation to specific stressors and stressor appraisals.

Keyword
coping, daily assessments, whiplash associated disorders
National Category
Physiotherapy
Identifiers
urn:nbn:se:uu:diva-174497 (URN)10.3109/09638288.2012.662571 (DOI)000307851800003 ()22512410 (PubMedID)
Available from: 2012-05-21 Created: 2012-05-21 Last updated: 2017-12-07Bibliographically approved
2. Coping Patterns and Their Relation to Daily Activity, Worries, Depressed Mood, and Pain Intensity in Acute Whiplash-Associated Disorders
Open this publication in new window or tab >>Coping Patterns and Their Relation to Daily Activity, Worries, Depressed Mood, and Pain Intensity in Acute Whiplash-Associated Disorders
Show others...
2013 (English)In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 20, no 2, 293-303 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND

There is a lack of knowledge regarding how individuals with acute whiplash-associated disorders (WAD) appraise and cope with situation-specific stressors.

PURPOSE

The aim of the study was to describe the daily process of coping reported in a daily coping assessment by individuals with acute WAD within 1 month after the accident. More specifically, profiles of coping strategies were identified and patterns between stressors, primary and secondary appraisals, and coping strategy profiles were described in relation to reported level of activity, worries, depressed mood and pain intensity during the day.

METHOD

A descriptive and exploratory design was applied. Two hundred and twenty-nine whiplash-associated disorders-daily coping assessment (WAD-DCA) collected during seven consecutive days from 51 participants with acute WAD in Sweden, were included. Cluster analysis was used to obtain coping strategy profiles and data were graphically visualised as patterns through the coping process.

RESULTS

When measuring coping as a daily process relating to the specific stressful situation, different coping pocess patterns appeared. During days with a high degree of physical and mental well-being, high self-efficacy beliefs seemed to be working as an important secondary appraisal, whereas during days with a low degree of physical and mental well-being primary appraisals of the stressor as a threat and catastrophic thoughts were present in the coping process.

CONCLUSIONS

Early identification of situational- and individual-specific stressors, appraisals and coping efforts as measured by the WAD-DCA may contribute to the understanding of the coping process in the acute stage of WAD and its possible impact on recovery and adjustment.

Keyword
Coping, Daily assessments, Whiplash-associated disorders, Physical well-being, Emotional well-being
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:uu:diva-174498 (URN)10.1007/s12529-012-9220-y (DOI)000318505900017 ()22382932 (PubMedID)
Available from: 2012-05-21 Created: 2012-05-21 Last updated: 2017-12-07Bibliographically approved
3. The clinical course of pain-related disability over the first year in whiplash associated disorders: Description and prediction of outcome in an initially mildly affected sample
Open this publication in new window or tab >>The clinical course of pain-related disability over the first year in whiplash associated disorders: Description and prediction of outcome in an initially mildly affected sample
2013 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 14, 361- p.Article in journal (Refereed) Published
Abstract [en]

Background: Different recovery patterns are reported for those befallen a whip-lash injury, but little is known about the variability within subgroups. The aims were (1) to compare a self-selected mildly affected sample (MILD) with a self-selected moderately to severely affected sample (MOD/SEV) with regard to background characteristics and pain-related disability, pain intensity, functional self-efficacy, fear of movement/(re) injury, pain catastrophising, post-traumatic stress symptoms in the acute stage (at baseline), (2) to study the development over the first year after the accident for the above listed clinical variables in the MILD sample, and (3) to study the validity of a prediction model including baseline levels of clinical variables on pain-related disability one year after baseline assessments. Methods: The study had a prospective and correlative design. Ninety-eight participants were consecutively selected. Inclusion criteria; age 18 to 65 years, WAD grade I-II, Swedish language skills, and subjective report of not being in need of treatment due to mild symptoms. A multivariate linear regression model was applied for the prediction analysis. Results: The MILD sample was less affected in all study variables compared to the MOD/SEV sample. Pain-related disability, pain catastrophising, and post-traumatic stress symptoms decreased over the first year after the accident, whereas functional self-efficacy and fear of movement/(re) injury increased. Pain intensity was stable. Pain-related disability at baseline emerged as the only statistically significant predictor of pain-related disability one year after the accident (Adj r(2) = 0.67). Conclusion: A good prognosis over the first year is expected for the majority of individuals with WAD grade I or II who decline treatment due to mild symptoms. The prediction model was not valid in the MILD sample except for the contribution of pain-related disability. An implication is that early observations of individuals with elevated levels of pain-related disability are warranted, although they may decline treatment.

Keyword
acute whiplash associated disorders, whiplash injury, disease progression, recovery of function, risk factors
National Category
Physiotherapy
Identifiers
urn:nbn:se:uu:diva-180048 (URN)10.1186/1471-2474-14-361 (DOI)000329852100002 ()24359208 (PubMedID)
Available from: 2012-08-28 Created: 2012-08-28 Last updated: 2017-12-07Bibliographically approved
4. Individually tailored behavioural medicine intervention delivered via Internet or Face to face in acute Whiplash Associated Disorders: A randomized controlled trial
Open this publication in new window or tab >>Individually tailored behavioural medicine intervention delivered via Internet or Face to face in acute Whiplash Associated Disorders: A randomized controlled trial
(English)Article in journal (Other academic) Submitted
Keyword
whiplash associated disorders, whiplash injury, cognitive behavioural, physical therapist, randomized control trial, acute pain, Internet intervention, physiotherapy
National Category
Physiotherapy
Identifiers
urn:nbn:se:uu:diva-180049 (URN)
Available from: 2012-08-28 Created: 2012-08-28 Last updated: 2013-01-30Bibliographically approved

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