Report numberRA-2005-60
TitleThe impact of whiplash, caused by a traffic accident, on the quality of life
SubtitleA pilot study for ' the impact of traffic accidents on the quality of life '
AuthorsEls Inghelbrecht
Bert Willems
Jan Bernheim
Published byPolicy Research Centre for Traffic Safety 2002-2006
Number of pages203
Document languageDutch
Partner(s)LUC (nu UHasselt)
Work packageOther: Knowledge traffic unsafety

That the impact of traffic accidents on public health can be considerable was shown in a previous report by the Traffic Policy Research Centre (Lammar & Hens, 2003). In this study further attention is given to this impact. Because it is important that not only technical-medical factors are considered, a measurement of the subjective quality of life will be used: a global judgement about the quality of life taking physical, psychological and social aspects into account. Not only the short term consequences are important, the long term consequences are just as important. It is decided to select whiplash patients as the population of interest in this study. Whiplash injuries are  considered as injuries with a primarily low severity grade. However, previous research has shown that these patients can have severe and invalidating complaints, in many cases persisting after several months or years.


The term whiplash is used in different contexts with different meanings. The definitions used in this study are:

  1. Whiplash event is an event leading to a whiplash injury (often at the occasion of a head-to-tail traffic accident)
  2. Whiplash refers to the pathophysiological mechanism leading to the whiplash injury.
  3. The Whiplash injury refers to an injury to the neck (for example a sprain or a strain of the neck).
  4. WAD (whiplash associated disorders) refers to the symptoms as a consequence of the whiplash injury.

A review of the international literature shows that people who had a whiplash injury can have several symptoms that quickly disappear but in many casese persist. When the pain and/or the complaints persist 6 months and longer the term chronic WAD is used. There is no consensus on the fraction of people undergoing a whiplash trauma who go on to belong to this second group or about the factors that put these people at risk. This lack of agreement is on the one hand caused by non scientific factors (medico-legal factors or secondary gain) but is on the other hand a consequence of scientific disagreements within the health-care community itself. The epidemiological studies which try to formulate answers to these questions differ in several methodological aspects (definition of recovery, study design, method of recruitment, …), giving rise to different conclusions. 


Moreover, at the level of theories of pathogenesis there are several models that explain why a considerable part of the whiplash patients can have long term complaints even after a long time while most of them do not. These models can be categorised by the relative importance they give to physical, psychological and social factors. Another important theoretical model, the biopsychosocial model, was developed to take into account all of these factors (physical, psychological and social factors together). By stressing the importance of the influence of traffic accidents on the global subjective quality of life (an approach which considers physical, psychological and social factors) the present study can be framed within this biopsychosocial model.


This study aims to formulate an answer to three main research questions:

  1. Which factors have an influence on the recovery of a whiplash injury in the long term? For this part, recovery is on the one hand defined in terms of physical, psychological and functional aspects and on the other hand in terms of global quality of life.
  2. What is the relative importance of different factors (physical, psychological and social) influencing the global judgement of the quality of life? Because it can be assumed that the relative importance of these different factors is influenced by the recovery of the patient, this variable was included as well in this part of the study (recovery defined in functional terms).
  3. What is the influence of a whiplash injury on the global subjective quality of life? Again, this influence will be determined as a function of recovery (recovery in terms of physical, psychological and functional aspects).

Two populations are studied within this study. Persons from the first population are recruited from the comprehensive archives of the emergency department of the AZ VUB university hospital who had a whiplash injury due to a traffic accident 10 to 26 months before the time the study was conducted. Many had recovered. Persons of the second population are recruited through the Whiplash Association (a self-aid group) and consist of subjects who are members of this association. Almost all are chronicallt affected.


The subjects of both populations are asked to fill in a questionnaire. The information that is collected in this way is categorised in information concerning the recovery of the patient (outcome variables) and information concerning possible associations with this recovery (explaining variables). The outcome variables contain the physical, the psychological and the social situation of the patient and a global judgement about their quality of life. The explaining variables contain socio-demographic variables, accident-related variables, the biopsychosocial situation at the moment of the study, personality factors and dimensions contributing to the global quality of life.


The results concerning the first research question (factors contibuting to recovery) show rather weak or even non-existing associations between recovery of the whiplash patients and the possible risk factors. Moreover, these associations depend on the population condidered (first or second population) and the way recovery is defined (physical recovery, psychological recovery, functional recovery, or recovery in terms of global quality of life).


The results concerning the second research question (respective importance of physical, functional and psychological factors in recovery) show that the relative importance of the different factors that determine the global subjective quality of life again differs according to the population recruited and the definition of recovery.


The results concerning the third research question (impact of a whiplash injury on the global subjective quality of life) show that a whiplash injury can have profound effects on the global quality of life. This effect depends on the degree of recovery of the patient. This negative impact of a whiplash injury on global quality of life (i.e; when global quality of life is judged higher in the period before the injury, compared with the global quality of life at the moment of the study) is strong for the subjects of the self-aid group. However, a decrease in global quality of life was also found within the first population in the subjects who had not fully recovered in terms of psychological recovery.


Finally the results are discussed in the light of the existing epidemiological studies and this within the global framework of the biopsychosocial model. Furthermore, based on this study with a selected pathology, some recommendations are formulated on which measures are likely to be the most suitable to assess the influence of traffic accidents with other injuries on public health. Especially the importance of the global quality of life as a measurement of this public health is stressed as well as the importance of the long-term consequences.

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The Policy Research Centre for Traffic Safety carries out policy relevant scientific research under the authority of the Flemish Government. The Centre is the result of a

cooperation between Hasselt University, KU Leuven and VITO, the Flemish Institute for Technological Research.


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