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Daily stressors in patients with acute whiplash associated disorders
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. (Behavioural medicine and physiotherapy - Pernilla Åsenlöf)
Department of Physiotherapy, School of Health, Care and Social wellfare, Vasteras, Sweden .
Division of Psychology, Department of Social Sciences, Mid Sweden University, Östersund, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
2012 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, no 21, 1783-1789 p.Article in journal (Refereed) Published
Abstract [en]

Purpose

Stressors in acute whiplash associated disorders (WAD), as reported on a daily basis, have hitherto been neglected in research. The primary aim of this study was to describe the most stressful daily situation or event reported by individuals with acute WAD within a month of a whiplash trauma. Another aim was to describe the meaning and significance of these daily stressors, i.e. primary appraisal.

Method

A descriptive design with a content analysis approach was used. 260 WAD-daily coping assessments (WAD-DCA) generated during 1 week by 51 participants with acute WAD were included in the study. Stressors were analysed using qualitative content analysis.

 Results

The reported stressors generated 13 categories covering a wide range of stressful situations in daily life related to (i) work, (ii) physical symptoms, (iii) feelings and cognitions, (iv) family and home responsibilities and (v) recreation. The majority of the stressors were appraised as "expected" as well as "disabling". Most threatening stressors were related to work, driving and feelings/cognitions.

Conclusions

The wide variety of stressors indicates that it is not only pain itself that influences daily life in acute WAD. Early identification of individual and situation-specific stressors gives new data regarding what bothers individuals suffering from WAD after a collision and may be helpful in understanding the coping process in relation to specific stressors and stressor appraisals.

Place, publisher, year, edition, pages
2012. Vol. 34, no 21, 1783-1789 p.
Keyword [en]
coping, daily assessments, whiplash associated disorders
National Category
Physiotherapy
Identifiers
URN: urn:nbn:se:uu:diva-174497DOI: 10.3109/09638288.2012.662571ISI: 000307851800003PubMedID: 22512410OAI: oai:DiVA.org:uu-174497DiVA: diva2:527386
Available from: 2012-05-21 Created: 2012-05-21 Last updated: 2017-12-07Bibliographically approved
In thesis
1. A Behavioural Medicine Perspective on Acute Whiplash Associated Disorders: Daily Coping, Prognostic Factors and Tailored Treatment
Open this publication in new window or tab >>A Behavioural Medicine Perspective on Acute Whiplash Associated Disorders: Daily Coping, Prognostic Factors and Tailored Treatment
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to study the daily process of coping, potential prognostic factors for recovery and evaluating an individually tailored behavioural medicine intervention in the acute stage of Whiplash Associated Disorders (WAD). The studies comprised three samples of patients with acute Whiplash Associated Disorders (WAD). All patients were included within the first month after the whiplash occurrence and were recruited from hospital emergency wards in six Swedish communities.

Study I and II included 51 participants generating 260 daily coping diaries (WAD-DCA) during seven days in the acute stage of WAD. In Study I daily stressors and primary appraisal were analysed and in Study II patterns between stressors, appraisals, coping strategy profiles, daily activity level and well-being were described. The results showed a large variety of situations that the individuals perceive as stressful, not only pain itself. High self-efficacy was associated with high degree of physical/mental well-being. Threatening stressors and catastrophic thoughts were associated with low degree of physical and mental well-being. In Study III potential prognostic factors for good as well as poor recovery were studied more closely in a mildly affected sample (MIAS) (n=98) from within the first month after the accident up to one year later. Pain-related disability at baseline emerged as the only indicator of prognosis after 12 months in MIAS. Study IV (n=55) was a randomised control study, were current clinical recommendations of standard self-care instructions (SC) for the management of acute WAD was compared to an individually tailored behavioural medicine intervention delivered via Internet or face-to-face. The results showed that SC was not as effective as the behavioural medicine intervention. By early identification of situation-specific factors and potential behavioural (physical, cognitive and affective) determinants of activity performance, it seems possible to tailor a self-management intervention that decreases pain-related disability, fear of movement and catastrophising and increases self-efficacy. The use of innovative methods such as the Internet of distributing treatment interventions showed to be a good alternative to more traditional forms.

The results of this thesis uncover new insights in understanding the individual’s specific perspective as applied in a behavioural medicine approach in acute WAD.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 66 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 807
Keyword
Behavioural medicine, Acute whiplash associated disorders, Daily coping, Prognostic factors, Tailored treatment, Pain-related disability
National Category
Physiotherapy
Research subject
Physiotherapy; Medical Science
Identifiers
urn:nbn:se:uu:diva-179993 (URN)978-91-554-8458-3 (ISBN)
Public defence
2012-10-12, Sal B41, Ing A11, Biomedicinskt Centrum (BMC), Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2012-09-21 Created: 2012-08-28 Last updated: 2013-01-22Bibliographically approved

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