The presence and predictive capacity of altered cervical kinematics, neuromuscular, and psychological features in individuals with whiplash associated disorders at different stages of pain

Alalawi, Ahmed ORCID: 0000-0001-5667-8150 (2023). The presence and predictive capacity of altered cervical kinematics, neuromuscular, and psychological features in individuals with whiplash associated disorders at different stages of pain. University of Birmingham. Ph.D.

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Abstract

Neck pain is a significant source of disability and is associated with reduced quality of life and reduced work productivity. Besides the burden of current neck pain, neck pain disorders are commonly recurring conditions, with episodes of pain reoccurring over the course of months or years. Individuals with Whiplash Associated Disorders (WAD) are more likely to present with higher pain severity and greater physical and psychological impairments than individuals with idiopathic neck pain.

This thesis presents an investigation of features related to cervical kinematic, neuromuscular, and psychological function in individuals with acute, recurrent, and chronic neck pain (CNP) following a whiplash trauma, and assesses their relevance for the presence of persistent pain and disability. Four studies were conducted to investigate this aim.

Study 1 assessed cervical kinematic features in people with acute WAD and assessed their correlations with self-reported outcomes. Compared to healthy participants, cervical range of motion, velocity of movement, and smoothness of movement were altered in people with acute WAD and the extent of these features were associated with the level of neck pain and disability.

Study 2 comprised a systematic review to assess whether the cervical kinematic features identified in Study 1 were predictive of ongoing pain and disability after a whiplash trauma. Low to very low-quality evidence indicates that high levels of pain and disability at baseline as well as a higher WAD grade were associated with poor outcomes. Inconclusive evidence was found on the predictive capacity of neck range of motion, joint position error, activity of the superficial neck muscles, muscle strength/endurance, and perceived functional capacity. No primary studies investigated the association between more contemporary kinematic features such as velocity of neck movement, smoothness of movement, and variability of neck motion with ongoing disability following a whiplash injury. Findings from this review prompted the need for Study 3.

The initial aim of Study 3 was to investigate the predictive ability of cervical kinematic features on pain and disability six months following a whiplash injury. However, this aim was modified due to the small sample of recruited participants as a consequence of the COVID-19 pandemic. The modified aim was to assess the correlation between baseline measures of cervical kinematics and ongoing pain and disability six months later, instead of assessing the predictive ability of such features. Preliminary findings suggest that cervical kinematics in extension were correlated with ongoing pain and disability six months following the injury.

The final study, Study 4, of the thesis investigated similar features that were assessed in the other studies within this thesis, but in individuals with recurrent neck pain (RNP), or CNP following a whiplash injury, and healthy participants. All three groups had been assessed at baseline, with only the RNP group had been followed for up to a 12-months. The existence of altered cervical kinematic features, neuromuscular, and psychological function in individuals with RNP compared to CNP and healthy participants was assessed (cross-sectional design), with their predictive ability investigated in those with RNP (longitudinal design). The results indicated that people with RNP and CNP presented with higher neck disability, greater kinesiophobia, lower quality of life, slower and irregular neck movements, and less neck strength compared to healthy controls. Moreover, a higher number of previous pain episodes within the last 12 months along with lower neck flexion strength were predictive of higher neck disability at a six-month follow-up in those with RNP. These findings have significant implications for rehabilitation and prevention of patients with WAD; this work has identified features which could be targeted in a rehabilitation programme with the aim of preventing recurrent episodes of neck pain.

Overall, this thesis found that altered cervical kinematics together with impaired psychological function are present soon after a whiplash injury and can remain present in people with CNP, and in people with RNP even when assessed during a pain-free period. Furthermore, preliminary findings highlighted the association between altered cervical extension with ongoing pain and disability following a whiplash trauma, and that the number of previous episodes of neck pain over a 12-month period together with lower neck muscle strength were predictive of higher neck disability at a six-month follow up in people with RNP. Greater understanding of the physical and psychological manifestations at different stages of pain and their relevance to ongoing poor outcomes has potential to influence rehabilitation programmes to ensure better patient recovery.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):