TABLE 2.
Study characteristics
| Study details | Demographics | Participants | Patient‐reported outcome | Pain | Disability | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Author | Year | Country | Setting (e.g. outpatient, inpatient, emergency department) | Age | Gender | Ethnicity | Sample size | Length of follow‐up | Individuals aged ≥16 years sustaining any physically traumatic event that was reported to result in at least one musculoskeletal injury within 3 months of the baseline assessment | Recorded measure of PTSS at baseline (within 3 months of the traumatic event in which injuries were sustained) definition of PTSS | Outcome measure | Effect measure | Outcome measure | Effect measure |
| Kongsted et al. | 2007 | Denmark | Emergency unit and GP | 18–70 years | M = 35.9%; F = 64.1% | Not reported | 668 | 3, 6 and 12 months | Whiplash injury grade (I–III): Within 3 days after the accident or a maximum of 10 days after the accident | Baseline PTSS collected using the Impact of Event Scale (IES) | SF‐36 | Unadjusted OR = 3.3 [1.8, 5.9, p < 0.001]; adjusted OR for age = 3.0 [1.6, 5.5, p < 0.001], adjusted OR for age and baseline pain intensity = 2.1 [1.1, 4.1, p < 0.05] | 15‐item Copenhagen Neck Functional Disability Scale | Unadjusted OR = 3.2 [1.7, 6.0, p < 0.001]; adjusted OR for age = 3.1 [1.6, 5.8, p < 0.01], adjusted OR for age and baseline pain intensity = 2.1 [1.1, 4.2, p < 0.05] |
| Maujean et al. | 2017 | Australia | Emergency department | 18–65 years | F = 64.4% | Not reported | 146 | 6 months | Acute Whiplash: (grade I–III) Within 1 month of injury | Post‐traumatic stress scale (PDS) within 1 month of injury | Not reported | Not reported | Neck Disability Index (NDI) | PTSS cluster (hyperarousal/numbing) significantly predicted future neck pain–related disability (unstandardized coefficient = 1.15; SE = 0.57, p = 0.043) |
| Pedler et al. | 2016 | Australia | Emergency department | 18–65 years | F = 71 | Not reported | 103 | 3 months | Whiplash‐associated disorder grade (I–III); symptoms less than 6 weeks following injury | The Posttraumatic Stress Diagnostic Scale (PDS) measured 30 days following a motor vehicle accident | (10‐cm visual analogue scale [VAS]) | Pearson correlation r = 0.349; p < 0.01 between PTSS and pain | Neck Disability Index (NDI) | Pearson correlation r = 0.624; p < 0.01 between PTSS and disability |
| Ravn et al. | 2019 | Denmark | Emergency department | ≥18 years | F = 62.9% | Not reported | 229 | 3 and 6 months | Whiplash grade (I–III): within 4 weeks to 6 months post‐injury | Harvard Trauma Questionnaire part IV | Numeric Rating Scale (NRS) | Recovering PTSS (high initial PTSS, then gradually recover): PAIN OR: 1.86 (1.26, 2.76); p = 0.002; Chronic PTSS (persist over 6 months): PAIN OR: 1.86 (1.27, 2.73); p = 0.001 | Pain Disability Questionnaire (PDQ) | MEAN (SD) Chronic PTSS V/S recovering PTSS: CHRONIC: Mean 34.8 (SD:28.7); RECOVERING: Mean: 16.5 (SD:20.4); p = 0.0009; Chronic PTSS V/S no PTSS: Chronic: 34.8 (28.7); no PTSS: 7.1 (13.1), p = 0.003 |
| Ravn et al. | 2018 | Australia | Emergency department; primary care; advertisement in newspaper | 18–65 years | F = 66.4% | Not reported | 253 | 3, 6 and 12 months | Acute Whiplash injury grade (I–III) within 4 weeks of injury | Post‐traumatic stress scale (PDS) | Visual Analogue Scale (VAS) | PTSS predicted an increase in pain from baseline to 3 months; standardized coefficient = (β = 0.24, p < 0.001); 6 months to 12 months = (β = 0.21, p < 0.001) | Not reported | Not reported |
| Ramchand et al. | 2008 | USA | hospitalized for injuries resulting from community violence | Mean = 25 (±5.8) | M = 94% | Seventy‐eight per cent self‐identified as Hispanic, 13% self‐identified as Black; 3% identified as non‐Hispanic Caucasian; 3% identified as Asian; and 4% identified as Native American, multiracial, or other | 413 | 3 and 12 months | Fifty‐nine per cent had sustained gunshot injuries and the remainder was injured from other penetrating or blunt objects. Between October 1998 and June 2000, all consecutively hospitalized young adults who were admitted to a large Level I trauma facility in Los Angeles for treatment of wounds from community violence were screened for eligibility. To be eligible for the study, participants had to (a) have sustained an injury inflicted by a person other than a family member or a former sexual partner, (b) be between 18 and 40 years of age and (c) be able to communicate fluently in English or Spanish. Individuals were screened for eligibility by trained lay interviewers only at such time as potential participants were capable of giving informed consent | Civilian Version of the Posttraumatic Stress Disorder (PTSD) Checklist (PCL) | Not reported | Not reported | Physical health and functioning were derived from 15 items drawn from the physical domain of the RAND‐36 Health Status Inventory. Questions from the physical domain cover four areas: general health perception, physical functioning, physical pain and physical health‐related role limitations | Our longitudinal measurement model including only PTSS and physical functioning fit the data well (χ 2 (174) = 286.7, CFI = 0.98, SRMR = 0.04) |
| Andersen et al. | 2016 | Denmark |
ED register data to define WAD grades. Participants were invited by post and Self‐reported questionnaires were used to measure PTSS and pain and pain‐related outcomes |
mean age for the patients was (M = 36.79, SD = 12.61) | 61.6% were women | Not reported | 198 | 3 months, 6 months | Consecutive patients from a large Danish emergency ward were all contacted by post within 3 weeks after their whiplash injury | To measure the severity of PTSS, we used the Harvard Trauma Questionnaire part IV (HTQ‐IV) The HTQ‐IV consists of 17 items on a 4‐point Likert scale (1 = not at all, 4 = very often) | Pain intensity was measured as the average score of four 11‐point Likert scales (NRS) Each scale measured pain intensity on a numerical rating scale ranging from 0 (no pain) to 10 (the worst possible pain). | The total effect (c) of PTSS symptoms at baseline on 6‐month pain intensity was positive and statistically significant of moderate size (R 2 = 29%), with no mediators in the model | Not reported | Not reported |
| Asenlof et al. | 2013 | Sweden | Ninety‐eight participants were recruited from the emergency wards at two hospitals in Uppsala (University hospital) and Västerås (Regional county hospital) in Sweden between January 2007 and December 2009 | 18 to 65 years | F = 52 (53.1%), M = 46 (46.9%) | Not reported | 98 | 3, 6 and 12 months | Eligibility criteria were; age 18 to 65 years, fulfilled criteria for the diagnosis of WAD grade I and II established by a physician on the emergency ward within 72 h from the accident, satisfactory Swedish language skills and subjective report of not being in need of further treatment due to mild pain and disability 2–4 weeks after the accident | Post‐traumatic stress symptoms were measured with the Impact of Event Scale (IES) | Pain intensity was operationalized as the average pain intensity experienced over the past two weeks, which was scored on a numerical rating scale (NRS) with a score of 0 (no pain) and 10 (worst pain imaginable/unbearable pain) | Not reported | Pain‐related disability was measured with the Swedish version of The Pain Disability Index (PDI) | IES did not predict disability at 6 months in the multivariate linear regression model: B = −0.12 (−0.28, 0.04), p = 0.15 |
Abbreviations: CFI, comparative fit index; HTQ, Harvard Trauma Questionnaire; IES, impact of events scale; NDI, neck disability index; NRS, numeric rating scale; OR, odds ratio; PCL, the posttraumatic stress disorder checklist; PDI, peri‐traumatic distress inventory; PSD, post traumatic diagnostic scale; PTSD, post traumatic stress disorder; PTSS, post traumatic stress symptoms; RMDQ, Roland Morris Disability Questionnaire; SEM, standard error of the mean; SRMR, standardized root mean squared; VAS: visual analogue scale; WAD, whiplash‐associated disorders.