Identifying predictors of early non-recovery in a compensation setting: The Whiplash Outcome Study

Context: People with Whiplash Associated Disorder (WAD) often experience pain and disability for extended periods of time. A large proportion of these people will seek treatment through a compensation process. Rarely is data related to people's health collected within the compensation process making it difficult to identify those that are at risk of delayed recovery and appropriately direct interventions. Study objective: To compare people with WAD who have recovered with those that have not, within 3 months of injury and identify potential predictors of poorer health and non-recovery to inform claim screening processes. Study design: Cross-sectional analysis of a cohort study. Participants: People who sustained a WAD and claimed compensation within an Australian Motor Accidents Compensation Scheme between November 2007 and June 2009. Measure of recovery: Functional Rating Index (FRI) score (<= 25). Health outcome measures: Short Form 36 (SF36), FRI, and the Pain Catastrophising Scale (PCS). Methods: 246 people who had lodged a claim for compensation were enrolled in the Whiplash Outcome Study within 3 months of sustaining a WAD injury. Participants were assigned to a recovered or non-recovered group and analysed for differences between the two groups. Multiple linear regression models were used to identify potential predictors of poorer health and non-recovery. Results: Overall 23% of the study population had recovered within 3 months of sustaining a WAD, whilst only 9% had finalised their insurance claim. The recovered group had significantly better scores on all health outcome measures; SF36 Physical Component Score, SF36 Mental Component Score and the PCS (p < 0.001). The significant independent predictors of poorer health and non-recovery were helplessness (p < 0.001), older age (p < 0.001) and pre-injury work status being affected (p < 0.001) (r(2) = .624). Regardless of the health outcome measure used, helplessness was significantly associated with poorer reported health. Conclusion: Including additional information at claim notification, specifically the PCS and information on the effect the injury has on the working population could significantly improve claim screening processes, identifying those with poorer health and risk of non-recovery. (C) 2010 Elsevier Ltd. All rights reserved.