Cognitive Determinants of Pain and Disability in Patients with Chronic Whiplash-associated Disorder: a Cross-sectional Observational Study

Objective: To delineate the relative extent to which specific cognitive factors are related to levels of pain and disability in patients with chronic whiplash-associated disorder.

Design: Cross-sectional observation study.

Setting: Three secondary care physiotherapy departments in the Greater Manchester region of the UK.

Participants: All patients with chronic whiplash-associated disorder referred to the participating departments were invited to take part in the study. In total, 124 patients were invited to participate, and 63 (51%) agreed to do so. Complete data were available for 55 (44%) of those invited to participate in the study.

Main Outcome Measures: Pain and disability, as assessed by the Neck Disability Index.

Results: Cognitive factors were strongly related to levels of disability (R(2) change=0.39, P<0.001). Specifically, greater catastrophising (beta=0.41, P<0.01) and lower functional self-efficacy beliefs (beta=-0.47, P<0.001) were significantly related to greater levels of disability. Significant univariate correlations were seen between the cognitive factors and current pain intensity. However, no significant associations were seen between the cognitive factors and current pain intensity in the multivariate analysis.

Conclusions: Interventions which aim to reduce catastrophising and enhance functional self-efficacy beliefs should be included alongside conventional physiotherapy interventions when treating patients with chronic whiplash-associated disorder.