A prospective cohort study of health outcomes following whiplash associated disorders in an Australian population.

Whiplash associated disorders (WAD) were first defined by the Quebec Task Force (QTF) in 1995.1 Health outcomes for WAD have been reported to vary widely in the literature.2,3 Recovery in the short term is reported to vary from between 29%4 to 90%.5 Studies reporting long term follow up show that 76%6 to 97%7 are recovered by 12 months. Differences in health outcomes reported may arise from the difference in cohorts (for example, participants recruited from emergency clinics or insurer databases) and the participant's insurance compensation status (compensation eligible versus ineligible).3 In addition, studies report health outcomes using different measures. Higher recovery rates are reported when outcome measures are based on finalization of the claim,1,8 and lower recovery rates when outcomes are reported in terms of symptoms or disability.9,10 Health outcomes reported according to more comprehensive and consistent outcome measures may allow for a more complete understanding of health outcomes following WAD. Identifying WAD sufferers who are less likely to recover is important, in order to try to address the poor health outcomes of WAD. Factors associated with poor prognosis from WAD have differed over time. In Australia, clinical guidelines were released with poor prognostic indicators identified as sociodemographic, psychosocial, compensation, and symptom related factors.11 This categorization was based on the QTF findings1 and updated by a systematic review of research published since then. Subsequently published systematic reviews conclude that the consistent factor in determining poor recovery is initial symptom intensity, with psychosocial and compensation based factors concluded by these authors not to predict outcome.3,12 However, more recent prospective studies challenge this again, finding psychological factors such as the initial health status using the SF‐3613 and acute post traumatic stress9 to be predictive of poor outcome in WAD. Clearly there is a need for further research to examine all of these potential prognostic indicators in order to determine which are more predictive of poor outcome in WAD. This paper seeks to define the health outcomes of a prospective cohort of people with WAD using a comprehensive set of health outcome measures. In addition, we aim to examine relationships between poor outcome and the identified potential prognostic indicators,11 in order to present a more complete understanding of recovery and therefore assist in the prevention of chronic disability following WAD.