Measuring psychological distress for people with whiplash

5 October 2022

Study title

A systematic review shows minimal evidence for measurement properties of psychological functioning outcomes in whiplash.

What is the research about?

The impact of psychological distress for people with whiplash associated disorder (WAD) has been shown to be comparable to more severe injuries including spinal cord and traumatic brain injury. Thus, it is important to include measures of psychological functioning in clinical trials of treatment for WAD. An International Committee of experts in the assessment of WAD selected seven psychological functioning constructs that are important to evaluate in WAD. Selection of instruments to measure these constructs should be based on the instruments measurement properties (e.g., validity, reliability) in the population of interest. The aim of the present systematic review was to comprehensively identify, synthesize and appraise existing studies on measurement properties of outcome measures for the assessment of anxiety, depression, fear of movement, pain catastophizing, posttraumatic stress symptoms, self-efficacy and stress in people with WAD. 

What did the researchers do?

Seven research databases were systematically searched and the measurement properties of each patient reported outcome measure were evaluated using recommended criteria.  

What you need to know:

Measurement properties of 10 outcome measures were evaluated in WAD: to assess fear of movement - the Pictorial Fear of Activity Scale-Cervical (PFActS-C), and Tampa Scale of Kinesiophobia – 11; to assess pain catastrophizing - the Pain Catastrophizing Scale (PCS); to assess self-efficacy - the Pain Self-efficacy Questionnaire (PSEQ), PSEQ-4 item, PSEQ-2a, PSEQ-2b, and Self-Efficacy Scale; to assess posttraumatic stress symptoms - the Harvard Trauma Questionnaire and Posttraumatic Stress Diagnostic Scale. Content validity (e.g., the extent to which the outcome measures the intended behaviour) was not examined in any of these in whiplash. Moderate/high quality evidence showed adequate internal structure for the PSEQ, PCS and PFActS-C. Whereas, the original structures of the remaining seven PROMs were not confirmed in whiplash. Furthermore, no studies were identified that evaluated the measurement properties of an outcome measure to assess depression, anxiety, or stress in WAD.

What did the researchers find?

The psychometric properties of patient-reported outcome measures to assess the psychological constructs of anxiety, depression, fear of movement, pain catastrophizing, posttraumatic stress symptoms, self-efficacy and stress have not been adequately evaluated for whiplash associated disorders.

How can you use this research?

Given the impact of psychological distress in whiplash, there is a need for further research to evaluate the measurement properties (e.g., validity, reliability) of psychological outcome measures in WAD, with priority given to evaluation of content validity. Until this occurs, we found adequate internal structure for three outcome measures: the Pain Self-Efficacy Questionnaire to assess the construct self-efficacy, the Pain Catastrophizing Scale to assess pain catastrophizing, and the Pictorial Fear of Activity Scale-Cervical to assess fear of movement. These three outcome measures could be used in clinical trials if the research aims align with these constructs.

About the researchers

Carrie Ritchie is a Senior Research Fellow with RECOVER Injury Research Centre, UQ, Australia

Tonny Elmose Andersen is an Associate Professor of Psychology at the University of Southern Denmark, Denmark

Sophie Lykkegaard Ravn is an Associate Professor of Psychology at the University of Southern Denmark, Denmark

Anne Soderlund is a Professor of Physiotherapy at Malardalen University, Sweden

Michele Sterling is the Program Leader for Improving health outcomes after musculoskeletal injury at RECOVER Injury Research Centre, UQ, Australia

CATWAD co-authors: Linda Carroll, Luke B. Connelly, Pierre Cote, Michele Curatolo, Genevieve Grant, Gwendolen Jull, Helge Kasch, Joy MacDermid, Eva Maj Malmström, Trudy Rebbeck, Julia Treleaven, David Walton, Hans Westergren

Citation

Ritchie, C., Andersen, T., Ravn, S., Soderlund, A., Sterling, M., & CATWAD co-authors. A systematic review shows minimal evidence for measurement properties of psychological functioning outcomes in whiplash. Journal of Clinical Epidemiology, 151 (2022), 29-44.

Keywords

Whiplash; Psychometrics; Psychological functioning; Patient-reported outcome measure; Internal structure; Measurement property

Contact information, acknowledgements

Carrie Ritchie, c.ritchie@uq.edu.au, RECOVER Injury Research Centre and NHMRC Centre of Research Excellence: Better Health Outcomes for Compensable Injury

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