Do maladaptive beliefs delay whiplash associated disorders (WAD): A systematic review

Abstract

The purpose of the study is to try to establish if maladaptive beliefs effect recovery times and poor outcomes in whiplash associated disorders (WAD). In May 2017 the following databases were searched from their inception until June 2017: SPORT Discuss, CINAHL, PsycINFO, MEDLINE, Ovid MEDLINE, Cochrane, AMED, Embase. A combination of sensitive search strategies was used for locating articles on maladaptive beliefs and WAD. Hand-searching of relevant journals and citation tracking were used to maximise the identified study pool. A total of 189 references were retrieved and an additional three studies were identified through different sources, 178 remained after the removal of duplicates. For 43 references, the full text was assessed, and 7 studies were included. The methodological quality was assessed independently by two assessors. Data extraction was carried out using a standardised data extraction form. Most articles scored a high overall quality and fourteen percent (14%) of articles (1 out of 7) were rated with moderate overall quality. Meta-analysis was not undertaken due to the heterogeneity of prognostic factors, outcome measures and methods used. Four out of the seven studies presented a correlation between catastrophising and disability in at least one follow-up time point (3, 6 or 12 months) whilst three studies found a correlation between fear-avoidance and disability. Four of the studies showed an association between maladaptive beliefs (catastrophising or fear avoidance) and pain and two found a negative effect. Our findings show that outcomes, such as pain and disability, were found to be associated with maladaptive beliefs (catastrophising and fear avoidance).