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Chiropractic Research Review

Predicting Whiplash Disability: The CROM Test

Acute whiplash injury results from sudden movements of the head and neck during collision that cause damage to the soft tissues of the neck. Acute whiplash may progress into the chronic injury known as late whiplash syndrome.



The goal of this study was to evaluate five possible predictors for a patient developing late whiplash syndrome. Danish researchers studied 141 subjects who had been involved in a rear-end vehicle collision; subjects had no history of prior neck, head, or low-back injuries. The authors evaluated active cervical range of motion (CROM) using a CROM instrument; pain intensity; number of non-painful neurologic complaints; workload during flexion and extension of the neck; and psychometric variables. Participants with whiplash injury were also questioned about legal issues. Forty acute-ankle-distortion patients were used as a control in the one-year study. Of the whiplash patients, 8% did not return to daily activity and 4% returned to modified job functions after one year.

The results show that a reduction in total CROM measurements was the single most sensitive and specific test of the five used to predict late whiplash syndrome, with 73% sensitivity and 91% specificity. Predictability increased to 94% accuracy and 99% specificity once pain intensity measures and nonpainful symptoms were factored in.

The authors conclude that this study shows a poor prognosis for whiplash patients who have reduced mobility and high initial pain intensity.

Kasch H, Bach FW, Jensen TS. Handicap after acute whiplash injury. Neurology June 26, 2001:56, pp. 1637-1643.

Chiropractic Research Review

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