The nosologic status of the whiplash syndrome: A critical review based on a methodological approach

Study design. Empirical studies concerning the Whiplash syndrome are reviewed from the point of view of epidemiologic methodology. Objective. To assess the nosologic status of the whiplash syndrome. Summary of background data. Although a large number of studies concerning the syndrome exist, there is still controversy concerning the existence of the syndrome. Methods. The manner in which each study contributes to the validity of the syndrome is determined on the basis of the methodologic design (descriptive, case-control, cohort, and intervention/experimental) of the study. Results. Whereas the face validity of the syndrome is excellent, the descriptive, construct, and predictive validity are rather poor. In particular, convincing empirical evidence for a causal link (construct validity) between the trauma mechanism and chronic symptoms is sparse. Conclusions. Carefully conducted studies designed to assess the degree to which head and neck trauma contribute to the development of chronic pain, particularly head and neck pain, are urgently needed.