The role of patient held beliefs about injury and recovery in the development of late whiplash syndrome following an acute whiplash injury

Abstract

This thesis has investigated the role of patient held beliefs about injury and recovery in the development of late whiplash syndrome (LWS) following an acute whiplash injury. Beliefs about injury and recovery have the potential to influence outcome. These beliefs are potentially modifiable through physiotherapy management and gaining greater understanding into how they influence outcome can potentially improve physiotherapy management of acute whiplash injuries. Mixed methods were used to investigate the role of these beliefs in the development of LWS. Following a systematic literature review, a prospective cohort study was carried out to identify risk factors for LWS as well as Neck Disability Index Scores and participant perceived improvement at follow up. This was complemented by a qualitative study designed to gain greater insight into the patient’s experience of recovering from a whiplash injury. Patients’ expectations of outcome were found to influence the development of LWS, in particular, their expectations of time to recovery. Patients’ expectations of treatment benefit were found to influence outcome to a lesser degree. The patients’ belief about their ability to cope with their neck problem (self-efficacy) was shown to influence outcome in the short term but not long term follow up. The use of passive coping strategies may moderate the influence of these types of beliefs. The qualitative study highlighted the importance of realistic expectations, the value of reassurance from health professionals and how the patient’s understanding of pain are important in identifying potential barriers to recovery. This thesis has also presented detailed information about the clinical presentation of individuals who have sustained a whiplash injury and explored patterns of recovery amongst individuals. This will help clinicians to understand the nature of whiplash injuries and how they impact on patients which has the potential to improve patient management