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Biomedical subjects

A Schnidrig

Publications and source records attributed to A Schnidrig.

9 recordsLinked to original sources
PubMed1994

Relationship between early somatic, radiological, cognitive and psychosocial findings and outcome during a one-year follow-up in 117 patients suffering from common whiplash.

To analyse the significance of the interplay between somatic and psychosocial factors in influencing the course of recovery a non-selected well defined group of 117 whiplash patients was investigated. Initial examination was performed, on average, 7.2 +/- 4.2 days after trauma and follow-ups were carried out at 3, 6 and 12 months. At the initial investigation all patients were given a neurological examination, cognitive and psychosocial factor assessment and cervical spine X-rays. At each follow-up stepwise regression was performed to evaluate the relationship between initial findings and the course of recovery. Fifty-one (44%), 36 (31%) and 28 (24%) patients were symptomatic at 3, 6 and 12 months respectively. Poor improvement at all examinations was significantly correlated with factors associated with severity of injury such as initial symptoms of radicular irritation and intensity of neck pain. Moreover, results indicate that poor recovery is related to severity of injury in addition to some pre-traumatic factors (previous history of head trauma and headache) and initial injury-related reaction (i.e. sleep disturbances, reduced speed of information processing and nervousness). However, psychosocial factors did not prove predictive at any follow-up examination. These results indicate that symptoms suggesting a more severe neck injury appear to be particularly related to delayed recovery from common whiplash. Moreover these results may be of value in the objective evaluation of potentially difficult claims for compensation, which may in some cases be falsely based.

Adult↗
PubMed1994

Common whiplash: psychosomatic or somatopsychic?

One hundred and seventeen randomly selected patients were assessed for different psychological variables (personality traits, wellbeing, and cognitive ability) in relation to somatic symptoms after common whiplash. Patients were investigated at an average of 7.4 (SD 4.2) days after trauma and again at three and six months. The course of recovery could not be explained by the patients' disposition. The results indicated that improvement in wellbeing was associated with recovery from somatic symptoms. There was, however, cognitive impairment in patients who suffered from symptoms. These findings support the view that the psychological and cognitive problems of patients with common whiplash are mainly related to somatic symptoms.

Adult↗
PubMed1994

Presenting symptoms and signs after whiplash injury: the influence of accident mechanisms.

OBJECTIVE: To assess the relationship between accident mechanisms and initial findings after whiplash injury. DESIGN: Cohort study. SETTING: Outpatient department, Department of Neurology, University of Berne, Switzerland. PATIENTS: A population-based sample of 137 consecutive patients referred by primary care physicians. Fractures or dislocations of the cervical spine, head trauma, and preexisting neurologic disorders were exclusion criteria. MAIN OUTCOME MEASURES: Patients were interviewed and examined within 7.2 days (SD, 3.9 days) after trauma. Analyzed accident features were position in the car, use of seat belt, head restraint and its point of head contact, damage to seat, head position and state of preparedness at the moment of impact, and type of collision. Analyzed symptoms were intensity and onset delay of post-traumatic head and neck pain; pain in the shoulders, back, and anterior neck; symptoms of neurologic dysfunction according to presumed origin--cranial nerve or brainstem, radicular or myelopathic; and a score of multiple symptoms. Analyzed signs were neck muscle tenderness and restricted neck movement, and signs of cranial nerve, brainstem, or radicular dysfunction. RESULTS: Passenger position in the car, use of seat belt, and the presence of a head restraint showed no significant relationship with findings. Rotated or inclined head position at the moment of impact was associated with a higher frequency of multiple symptoms (p = 0.045 and 0.008) with more severe symptoms and signs of musculoligamental cervical strain (p = 0.048 and 0.038) and of neural, particularly radicular (p = 0.031 and 0.019), damage. Unprepared occupants had a higher frequency of multiple symptoms (p = 0.031) and more severe headache (p = 0.046). Rear-end collision was associated with a higher frequency of multiple symptoms (p = 0.006), especially of cranial nerve or brainstem dysfunction (p = 0.00003). CONCLUSION: Three features of accident mechanisms were associated with more severe symptoms: an unprepared occupant; rear-end collision, with or without subsequent frontal impact; and rotated or inclined head position at the moment of impact.

Accidents, Traffic↗
PubMed1993

Factors influencing recovery from headache after common whiplash.

OBJECTIVE: To assess the relation between pretraumatic and trauma related headache in patients suffering from whiplash. DESIGN: Follow up study of patients examined a mean (SD) of 7.4 (4.2) days after trauma and again at three and six months. SETTING: Patients referred from primary care. SUBJECTS: 117 patients (mean age 30.8 (9.5) years. MAIN OUTCOME MEASURES: Prevalence of trauma related headache and the predictive relation by multiple logistic regression between different somatic and psychological variables and trauma related headache at each examination. RESULTS: Prevalence of trauma related headache decreased from 57% to 27%. History of pretraumatic headache proved a significant risk factor for presenting with trauma related headache. A significant relation between trauma related headache and the following variables was found: at seven days the initial wellbeing score, early onset of neck pain, depression scale from the personality inventory, and the initial intensity of neck pain; at three months, intensity of neck pain, and history of pretraumatic headache; and at six months neck pain, pain intensity, and history of pretraumatic headache. CONCLUSIONS: History of pretraumatic headache significantly increases the likelihood of presenting with trauma related headache but only in combination with findings indicative of clinically important injury to the cervical spine.

Adult↗
PubMed1993

[Results of a 1-year follow-up study of whiplash injury].

Based on a strict definition of whiplash injury, a sample of 117 non-selected patients was examined 7.2 +/- 4.2 days and at 3, 6 and 12 months after trauma. Initially all patients underwent a neurological examination, cognitive and psychosocial factor assessment and cervical spine x-rays. 56%, 70% and 76% of patients had completely recovered at 3, 6 and 12 months respectively. The results indicated that impairment of patients' well-being and cognitive ability was closely associated with somatic symptoms. No major impairment of attentional functioning was found, but some change in cognitive equilibrium was observed which may be related to the type of medication utilized. Delayed recovery at 12 months could be predicted by the following initial variables: higher age, intensity of initial neck pain and headache, symptoms of radicular irritation, sleep disturbances, pretraumatic headache, history of head trauma, nervousness score and--significantly inversely proportional--initial concentration problems and neuroticism score. These results suggest that a more severe neck injury may in particular account for delayed recovery from whiplash.

Adult↗
PubMed1993

Cognitive functioning after common whiplash. A controlled follow-up study.

A random sample of 98 patients with common whiplash was examined early after trauma (mean +/- SD, 7.3 +/- 3.9 days) and again 6 months later. Cognitive functioning was assessed in conjunction with complaints, pain intensity, well-being, subjective cognitive impairment, neuroticism, and medication. At 6 months, 67 patients had fully recovered (asymptomatic group), while 31 were still symptomatic (symptomatic group). Symptomatic patients who were older at baseline, had a greater variety of symptoms, higher neck pain intensity, and greater subjective cognitive impairment. At baseline, both groups scored poorly on tests requiring complex attentional processing. All neuropsychological functions improved to normal at 6 months in both groups. This improvement cannot be explained by a practice effect, as shown by the results of normal volunteers. The symptomatic group showed delayed recovery regarding complex attentional functioning, which may be related to adverse effects of medication.

Adult↗
PubMed1993

Psychosocial stress, cognitive performance and disability after common whiplash.

The relationship between psychosocial stress, cognitive performance and disability was assessed in 97 randomly selected common whiplash patients. Patients were investigated early after injury (mean 7.2 days, SD = 3.8) and again at 6 months. Assessment included different aspects of psychosocial stress, negative affectivity, personality traits and attentional functioning. At 6 months six patients (7%) showed partial or complete disability (disabled group) while 91 patients went back to work at pre-injury levels (non-disabled group). However, 26 patients from the latter group at 6 months were still symptomatic. The disabled and non-disabled groups did not differ with respect to psychosocial stress, negative affectivity and personality traits as assessed at baseline. At 6 months no significant differences were found between the disabled group and 26 symptomatic patients from the non-disabled group with respect to any of the assessed factors. The disabled group showed a combination of the following variables as assessed at baseline: greater age, initial neck pain intensity, initial back pain, blurred vision, and anxiety but less dizziness, sensitivity to noise and neurotic or behavioural problems in childhood.

Adult↗
PubMed1991

Role of psychosocial stress in recovery from common whiplash [see comment].

It is widely accepted that psychosocial factors are related to illness behaviour and there is some evidence that they may influence the rate of recovery from post-traumatic disorders. The abilities of psychosocial stress, somatic symptoms, and subjectively assessed cognitive impairment to predict delayed recovery from common whiplash were investigated in a follow-up study. 78 consecutive patients referred 7.2 (SD 4.5) days after they had sustained common whiplash in car accidents were assessed for psychosocial stress, negative affectivity, personality traits, somatic complaints, and cognitive impairment by semistructured interview and by several standardised tests. On examination 6 months later 57 patients were fully recovered and 21 had persisting symptoms. The groups' scores for the independent variables assessed at the baseline examination were compared. Stepwise regression analysis showed that psychosocial factors, negative affectivity, and personality traits were not significant in predicting the outcome. However, initial neck pain intensity, injury-related cognitive impairment, and age were significant factors predicting illness behaviour. This study, which was based on a random sample and which considered many other possible predictive factors as well as psychosocial status, does not support previous findings that psychosocial factors predict illness behaviour in post-trauma patients.

Follow-Up Studies↗