Format

Send to

Choose Destination
Musculoskelet Sci Pract. 2018 Nov 19;39:73-79. doi: 10.1016/j.msksp.2018.11.003. [Epub ahead of print]

Agreement is very low between a clinical prediction rule and physiotherapist assessment for classifying the risk of poor recovery of individuals with acute whiplash injury.

Author information

1
Menzies Health Institute Queensland, Griffith University, G05, 3.20E Parklands Drive, Southport, 4222, Australia. Electronic address: joan.kelly@griffithuni.edu.au.
2
Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Level 7 Oral Health Centre, 288 Herston Road, Herston, Queensland, 4006, Australia. Electronic address: c.ritchie@uq.edu.au.
3
Menzies Health Institute Queensland, Griffith University, G05, 3.20E Parklands Drive, Southport, 4222, Australia; Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Level 7 Oral Health Centre, 288 Herston Road, Herston, Queensland, 4006, Australia. Electronic address: m.sterling@uq.edu.au.

Abstract

BACKGROUND:

A prognostic clinical prediction rule (whiplash CPR) has been validated for use in individuals with acute whiplash associated disorders (WAD). The clinical utility of this tool is unknown.

OBJECTIVES:

To investigate: 1) the level of agreement between physiotherapist- and whiplash CPR-determined prognostic risk classification of people with acute WAD; 2) which clinical findings are used by physiotherapists to classify prognostic risk; and 3) whether physiotherapists plan to differ the number of treatment sessions provided based on prognostic risk classification.

DESIGN:

Pragmatic, observational.

METHOD:

38 adults with acute WAD were classified as low, medium, or high risk of poor recovery by their treating physiotherapist (n = 24) at the conclusion of the initial consultation. A weighted Cohen's kappa examined the agreement between physiotherapist estimated risk classification and the whiplash CPR. Physiotherapists' reasons for classification were provided and summarised descriptively. Kruskal-Wallis and post-hoc Dunn's tests compared projected number of treatment sessions between risk subgroups.

RESULTS:

Physiotherapist agreement with the whiplash CPR occurred in 29% of cases (n = 11/38), which was less than what is expected by chance (K = -0.03; 95%CI -0.17 to 0.12). Physiotherapists most frequently considered range of movement (n = 23/38, 61%), a premorbid pain condition (n = 14/38, 37%), response to initial physiotherapy treatment (n = 12/38, 32%), and pain intensity (n = 12/38, 32%) when classifying prognostic risk. The projected number of treatment sessions was not different between risk groups using classifications provided by the physiotherapists (χ2(2) = 2.69, p = 0.26).

CONCLUSIONS:

Physiotherapists should consider incorporating the whiplash CPR into current assessment processes to enhance accuracy in prognostic decision-making.

KEYWORDS:

Clinical decision making; Decision support techniques; Prognosis; Whiplash injuries

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center