There are many risk factors for developing chronic symptoms from a car accident. 50% of crash victims will be pain free within 6 months, while 25% have mild disability and another 25% have moderate to severe disability. Three factors have been recently used to correctly predict who will be a risk for having prolonged symptoms. These factors have been has been validated in an article in the April issue of the Journal of Sport Physical Therapy.
The advantage of the Clinical Prediction Rule is that it can quickly and easily predict who may benefit and should receive earlier care, and who may respond well without extensive care and treatment. As a result, appropriate treatment can be directed to the subgroup that perhaps needs earlier and more intensive care.
The Clinical Prediction Rule for Whiplash Disability is as follows:
Low Risk of Chronicity:
1. Under 35 years of age.
2. Lower score on the Neck Disability Index (<32).
3. No signs of increased arousal or central nervous system sensitivity.
High Risk of Chronicity:
1. Over 35 years of age.
2. High initial disability on the Neck Disability Index (32 or greater).
3. High arousal, including trouble sleeping, irritability, difficulty concentrating, easily started, and overly alert.
For example, an 22 year old patient with low disability and no signs of hyperarousal probably does not need early referral to physical therapy and will likely have no symptoms at 6 months with minimal to no treatment given. However, the 45 year old patient who is moderately disabled and has signs of hyperarousal should perhaps have early intervention from a physical therapist, with the goal of reducing the risk of chronic symptoms and disability.
So what happens to the patient who does not qualify for either category? A “wait and see” approach or “current practice standards” may be appropriate. My personal preference is to have one physical therapy visit within the first six weeks after the accident. The purpose of the visit is to teach the client appropriate ways to manage and protect the cervical spine to maximize the potential for a quick and full recovery.
If the patient does well in the next six weeks, no additional care may be required. But if the client still has remaining symptoms, additional physical therapy may be warranted as primary tissue healing would have been achieved. Manual therapy, therapeutic exercise, vestibular training, and dry needling can help complete recovery.