Rydman Eric, Ponzer Sari, Brisson Rosa, Ottosson Carin, Pettersson-Järnbert Hans
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Department of Orthopedics, Södersjukhuset, 118 83, Stockholm, Sweden.
Eur Spine J. 2018 Jun;27(6):1255-1261. doi: 10.1007/s00586-018-5507-2. Epub 2018 Feb 10.
The long-term outcome of Whiplash-associated disorder (WADs) has been reported to be poor in populations from medical settings. However, no trials have investigated the long-term prognosis of patients from medico-legal environment. For this group, the "compensation hypothesis" suggests financial compensation being associated with worsened outcome. The aims of this study were to describe long-term (2-4 years) non-recovery rates in participants with WAD recruited from insurance companies and to investigate the association between self-reported non-recovery and financial compensation.
144 participants, reporting neck pain after a motor vehicle accident, were recruited from two major insurance companies in Sweden. Self-reported recovery was measured at 6 months and 2-4 years. Those who received financial compensation from an insurance company were compared with those who received no compensation.
The overall non-recovery rate after 2-4 years was 55.9% (66/118). In the non-compensated group, the non-recovery rate was 51.0% (25/49) and in the compensated group 73% (27/37) (p = 0.039). Adjusted OR was 4.33 (1.37-13.66). High level of pain at baseline was a strong predictor of non-recovery [OR 46 (4.7-446.0)]. However, no association was found between pain level at baseline and financial compensation.
The non-recovery rate among patients making insurance claims is high, especially among those receiving financial compensation even if causal relationship cannot be determined based on this study. However, lack of association between baseline level of pain and compensation supports the compensation hypothesis.
在医疗环境人群中，挥鞭样损伤相关疾病（WADs）的长期预后据报道较差。然而，尚无试验研究来自法医学环境患者的长期预后。对于该群体，“补偿假说”表明经济补偿与更差的预后相关。本研究的目的是描述从保险公司招募的WAD参与者的长期（2 - 4年）未恢复率，并调查自我报告的未恢复与经济补偿之间的关联。
从瑞典两家主要保险公司招募了144名报告机动车事故后颈部疼痛的参与者。在6个月和2 - 4年时测量自我报告的恢复情况。将从保险公司获得经济补偿的参与者与未获得补偿的参与者进行比较。
2 - 4年后的总体未恢复率为55.9%（66/118）。在未获补偿组中，未恢复率为51.0%（25/49），在获补偿组中为73%（27/37）（p = 0.039）。调整后的比值比为4.33（1.37 - 13.66）。基线时的高水平疼痛是未恢复的有力预测因素[比值比46（4.7 - 446.0）]。然而，未发现基线疼痛水平与经济补偿之间存在关联。
提出保险索赔的患者中未恢复率较高，尤其是在那些获得经济补偿的患者中，即使基于本研究无法确定因果关系。然而，基线疼痛水平与补偿之间缺乏关联支持了补偿假说。
