A meta-analysis and systematic review of changes in joint position sense and static standing balance in patients with whiplash-associated disorder

Objective To synthesise and analyse the current evidence regarding changes in joint position sense (JPS) and standing balance in people with whiplash-associated disorder (WAD) taking the presence or absence of dizziness into account. Data sources PubMed, CINAHL Plus, Web of Science, Embase, MEDLINE and APA PsycINFO were searched by two independent reviewers from inception until August 2020 and reference lists of all included studies were also reviewed. Study selection Only cross-sectional studies that measured JPS and/or standing balance between people with WAD vs. healthy controls (HC) or people with WAD complaining of dizziness (WADD) vs. those not complaining of dizziness (WADND) were selected. Data extraction Relevant data were extracted using specific checklists and quality assessment was performed using Downs and Black Scale (modified version). Data synthesis Twenty-six studies were included. For JPS, data were synthesized for absolute error in the primary plane of movement for separate movement directions. For standing balance, data were synthesized for traditional time- and frequency domain sway parameters considering the conditions of eyes open (EO) and eyes closed (EC) separately. For meta-analysis, reduced JPS was observed in people with WAD compared to HC when the head was repositioned to a neutral head position (NHP) from rotation (standardised mean difference [SMD] = 0.43 [95%: 0.24–0.62]) and extension (0.33 [95%CI: 0.08–0.58]) or when the head was moved toward 50° rotation from a NHP (0.50 [0.05–0.96]). Similarly, people with WADD had reduced JPS compared to people with WADND when the head was repositioned to a NHP from rotation (0.52 [0.22–0.82]). Larger sway velocity and amplitude was found in people with WAD compared to HC for both EO (0.62 [0.37–0.88] and 0.78 [0.56–0.99], respectively) and EC (0.69 [0.46–0.91] and 0.80 [0.58–1.02]) conditions. Conclusion The observed changes of JPS and standing balance confirms deficits in sensorimotor control in people with WAD and especially in those with dizziness.

The Need for Three Separate Parallel WAD Ratings of Whiplash Injuries to Cervical, Lumbosacral, and Thoracic Spine in Clinical Assessments of Injured Motorists

Background: The prevailing classification of whiplash associated disorder (WAD) focuses solely on neck injuries, thus implying that injuries to other spinal regions are relatively inconsequential. In fact, some whiplash studies exclude patients with injuries to lower spine. We examined whiplash pain locations of injured motorists and their statistical correlates. Method: De-identified archival data of 158 injured motorists (57 men and 101 women; mean age 39.4 years, SD=12.5) were reviewed statistically. Their motor vehicle accidents (MVAs) occurred 7 to 194 weeks previously (mean=50.7 weeks, SD=38.5), but all still experienced active whiplash symptoms requiring therapy. Results: The most frequently reported locations of whiplash pain were the head (89.9%), neck (88.6%), shoulders (80.4%), and lower back (77.8%). WAD studies that exclude patients with lower back pain might exclude about 82.9% of injured motorists: the remaining 17.1% of patients with whiplash injury only to the neck are presumably those less adversely affected by the MVA than patients with pain in multiple locations. No correlations of high or moderate magnitude were detected among the various pain locations. Furthermore, no high or moderate correlations were observed between clinical variables (including 2 neuropsychological symptoms scales) and reports of headache or pain in the neck or in lower back. Discussion and Conclusions: The prevailing WAD classification system needs to be renamed as specific to neck injury only: WAD-C. Parallel WAD classification systems need to be introduced separately for the lumbosacral spine (as WAD-LS) as well as the thoracic spine (as WAD-T) to improve diagnostic descriptive precision of clinical WAD assessments and of their research applications.