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Home / A Review and Methodologic Critique of the Literature Refuting Whiplash Syndrome

A Review and Methodologic Critique of the Literature Refuting Whiplash Syndrome

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Article

Does Pain Extent Predict Ongoing Pain and Disability in Patients with Chronic Whiplash-Associated Disorders?

past ane,2 , 1 , iii , four,5 , 1 , 1 , four,half-dozen , 7 and one,*

i

Eye of Precision Rehabilitation for Spinal Hurting (CPR Spine), School of Sport, Practise and Rehabilitation Sciences, Academy of Birmingham, Birmingham B15 1JN, UK

2

Physical Therapy Section, College of Practical Medical Sciences, Umm Al-Qura University, Makkah 24382, Saudi arabia

iii

Schoolhouse of Sport, Rehabilitation and Exercise Sciences, Faculty of Physiotherapy, University of Essex, Colchester CO4 3WA, Uk

iv

Department of Medical and Wellness Sciences, Linköping Academy, SE-581 83 Linköping, Sweden

5

Occupational and Environmental Medicine Heart, Department of Health, Medicine and Caring Sciences, Unit of Clinical Medicine, Linköping University, SE-581 83 Linköping, Sweden

6

Centre for Clinical Research Sörmland, Uppsala University, SE-751 05 Uppsala, Sweden

7

Rehabilitation Inquiry Laboratory, Department of Business concern Economic science, Wellness and Social Care, University of Applied Sciences and Arts of Southern Switzerland, 6928 Manno, Switzerland

*

Author to whom correspondence should exist addressed.

Academic Editor: Marcus Schiltenwolf

Received: 14 December 2021 / Revised: nineteen January 2022 / Accepted: twenty January 2022 / Published: 22 January 2022

Abstract

This study investigates whether baseline hurting extent, extracted from an electronic pain drawing, is an independent predictive factor of hurting and disability measured 1 year and 2 years later in people with chronic WAD. Participants completed questionnaires assessing neck pain intensity, disability via the Cervix Inability Alphabetize (NDI), psychological features, and work ability. Participants also completed electronic pain drawings from which their pain extent was extracted. A two-step modelling approach was undertaken to identify the rough and adjusted association between pain extent and NDI measured at one-twelvemonth and ii-yr follow-ups. A total of 205 participants were included in the analysis. The univariate analysis showed that pain extent was significantly associated with the NDI score at the one-year (p = 0.006, 95% CI: 0.159–0.909) and 2-twelvemonth (p = 0.029, 0.057–0.914) follow-ups. These associations were not maintained when we introduced perceived disability, psychological wellness, and work ability into the model after i year (p = 0.56, 95%CI: −0.28–0.499) and ii years (p = 0.401, −0.226–0.544). Pain extent, as an contained factor, was significantly associated with perceived pain and disability in patients with chronic WAD for up to 2 years. This association was masked by neck disability, psychological health, and work ability.

1. Introduction

The chief crusade of whiplash-associated disorders (WAD) is motor vehicle collision, which results in a neck injury due to the acceleration–deceleration mechanism [i]. In developed countries, the annual incidence of WAD is estimated to exist >300 per 100,000 inhabitants [2], placing a pregnant annual socioeconomic burden of USD xiii.4 billion and USD three.9 billion on Europe and the United states of america, respectively [three,four]. Improvements in pain and disability are likely to occur in the first three months afterwards the injury but practice not change substantially after this fourth dimension. Approximately l% of patients with WAD keep to experience persistent symptoms one year after the trauma [v,half-dozen].

Prognosis following WAD is multifactorial and may include personal, social, and environmental factors. Indicators of cardinal sensitization appear to influence recovery in people with WAD [7,8,9]. For example, widespread hurting is ofttimes seen in patients with chronic WAD [ten] and has been associated with college pain and disability WAD [11]. Several studies take shown that people with chronic WAD have widespread hypersensitivity [12,xiii], including thermal hyperalgesia [fourteen], mechanical hyperalgesia [14], and hyperexcitability of spinal cord reflexes [xv,xvi]. Initial high scores of neck pain and disability take also been associated with persistent hurting and disability in patients with WAD [17,eighteen], as have psychological factors such as low and feet [19,xx,21], fearfulness of movement [xix], and lower self-efficacy [20]. Nonetheless, the predictive power of pain extent (i.e., the size of the painful area) on cervix pain and inability has non been investigated in people with chronic WAD.

Nosotros hypothesized that individuals with chronic WAD who present with larger hurting extent will report higher pain and inability in the longer term. Therefore, the aim of this study was to investigate whether pain extent, extracted from a pain drawing by individuals with chronic WAD, was an independent predictive factor of pain and disability when measured 1 year and 2 years after.

2. Materials and Methods

A secondary assay of data from a randomized controlled trial (ClinicalTrials.gov, NCT01528579, 1 Febrary 2021) [22] was performed to investigate whether hurting extent was associated with long-term outcome in people with chronic WAD. Pain extent was not extracted from the pain drawings and analyzed in the previously published clinical trial [22].

2.1. Participants

Participants were recruited to the original trial [22] from half-dozen different Swedish regions between February 2011 and May 2012. They were recruited from primary health care centers, orthopedic clinics, and hospital outpatient services. Participants were eligible if they were between 18 and 63 years of historic period and if the cause of the current symptoms was a whiplash injury occurring in the preceding 6 to 36 months. Additionally, the following criteria had to exist met: classified every bit WAD grade 2 or Three [1], at least 10/50 points on the Neck Disability Index (NDI) [23], and average pain intensity of more than 20/100 mm on a visual analogue scale (VAS) [24]. Participants were excluded if they had a previous cervix injury with unresolved symptoms, neck surgery, traumatic brain injury, more than one month'due south absenteeism from work due to neck pain in the twelvemonth preceding the injury, tumor, myelopathy, any other dominant pain complaint, or were non fluent in the Swedish linguistic communication. The original trial investigated the event of exercise interventions in individuals with chronic WAD with 3, 6, 12, and 24 months follow-up. For the original trial [22], participants were randomly allocated to one of three groups to receive: a neck-specific exercise intervention only (NSE); NSE, with the improver of a behavioral arroyo (NSEB); or prescribed physical activity (PPA).

The process of recruiting participants was as follows: 7950 potential participants were invited to participate by letter; of them, 7531 were excluded, every bit baseline self-reporting criteria were non fulfilled or refused to participate. A further 203 participants were excluded subsequently eligibility assessment and physical examination, and the remaining 216 subjects were included in the trial. For further details, meet the original trial written report [22].

The Regional Ethics Committee of Linköping, Sweden approved the study. Written informed consent was obtained from all participants and the study was conducted according to the Declaration of Helsinki.

2.2. Outcome

Neck pain-related disability was the primary outcome, which was measured using the NDI at baseline and at one year and 2 years after the intervention. The NDI is a cervix-specific questionnaire that consists of 10 items related to functional activities of daily life such equally personal intendance, lifting, reading, work, driving, sleeping, and recreation [25]. Each item is scored from 0 (no disability) to 5 (consummate disability) to give a maximum total score of 50, which tin be expressed as a percent (0–100%) with larger scores reflecting higher levels of disability. The NDI is a reliable (intraclass correlation coefficient up to 0.98) and valid measurement of inability in people with neck pain disorders [26].

2.three. Candidate Predictors

Participants completed self-reported questionnaires in society to collect baseline information about personal, demographic, psychological, and other related factors, equally detailed beneath prior to randomization.

2.iv. Pain Extent

Participants were asked to draw their perceived hurting area on 2 trunk charts (frontal and dorsal view of the body). Pain drawings were then digitized and imported into custom-made paradigm assay software, developed with Matlab®. The reliability of this automatic process of digitizing pain drawings has been established in people with chronic cervix hurting (intraclass correlation coefficient (2, one) = 0.92) [27]. The software then quantifies the number of pixels shaded in the pain drawing (frontal and dorsal), expressed as a percentage of the total body chart area [11,27]. Further details are available elsewhere [11].

2.four.1. Neck Pain Intensity

Current neck pain intensity was measured at baseline, utilizing the VAS where 0 = no hurting and 100 = worst imaginable pain [24]. The validity and reliability of the VAS accept previously been established [28].

2.4.2. Pain Disability Index (PDI)

The PDI score of each participant was assessed to evaluate whatever aspects of their lives that were disrupted by hurting. It is divided into seven categories, where each is given a score from 0 (no disability) to x (usual activities take been prevented past pain), producing a total score of seventy (greater disability due to pain). The validity and reliability of the PDI have been established previously [29].

2.four.3. General Wellness

The EuroQol Five Dimension Scale (EQ-5D) was utilized to assess perceived quality of life. EQ-5D comprises 5 dimensions related to a patient's mobility, cocky-care, usual activities, pain or discomfort, and anxiety or low [30]. The EuroQol VAS provides a cocky-interpretation of current health (0 to 100 points scale, with higher scores representing the best imaginable health state).

2.4.4. Psychosocial Features

The Pain Cocky-Efficacy Scale (PSES) evaluated each participant's confidence in managing activities despite pain. Participants scored xx items relating to physical and psychological factors, rating each item 0–10. The last score ranged between 0–200, with highest scores indicating greater confidence [31]. The Hurting Catastrophizing Scale (PCS) was utilized to evaluate testify of rumination, magnification, or frustration regarding the participants' pain control [32]. PCS scores range 0 to 52, where a higher score indicates greater levels of negative pain-related thoughts. The eleven-item Tampa Scale of Kinesiophobia (TSK) was used to evaluate fear of movement, with college scores reflecting a greater fear of movement (score range 11–44) [33]. The Hospital Feet and Depression Calibration (HADS) was utilized to evaluate depression and anxiety and consists of 7 items for anxiety (HADS-A) and vii for depression (HADS-D), producing a score between 0 and 21, with college scores associated with heightened levels of anxiety and depression [34].

two.four.5. Work-Related Factors

To appraise self-perceived work ability, the Work Power Alphabetize (WAI) was used, which consists of seven items considering concrete and mental work demands in conjunction with an individual'south health status [35]. The validity and reliability of the WAI every bit a measure for piece of work disability was confirmed [36].

ii.five. Statistical Analysis

Descriptive summary statistics were performed on the participant'southward baseline characteristics, including full general health, pain, inability, work factors, and psychological factors.

All analyses were performed using R software, version 3.4.2. The analyses included all 205 participants from inception. Missing data were handled using the Multiple Imputation using Chained Equations (MICE) method carried out using R software's "mice" package [37], with five imputations and x iterations per imputation.

To identify the predictive value of pain extent on NDI outcomes after 1 twelvemonth and two years, a two-pace modelling approach was undertaken [38]. Commencement, the number of predictor variables entering the second stage analysis was reduced using a least absolute shrinkage and pick operator (LASSO) regression. LASSO regression was performed on the predictor variables of baseline NDI, PDI, TSK, PCS, HADS-A, HADS-D, EQ-5D, EQ-VAS, PSES, WAI, and VAS on the endpoint NDI beyond the five imputed datasets using a previously published method [38]. 2nd, two simple least-squared regressions were performed. The first regression was performed with only pain extent as the predictor, and the second regression was performed with pain extent, group, and all remaining predictors identified from the LASSO regression [39]. The offset analysis provided a crude association of pain extent with NDI, whilst the second analysis provided an adjusted association of pain extent with NDI. The least-squared regression was performed on all five imputed datasets independently, and the results were pooled using Rubin's rule from across the five analyses [37,40]. A p value of <0.05 was considered statistically significant.

In this study, the current guidelines for estimating sample size required for creating prognostic models were employed [41]. Several criteria should be specified, including the expected R2 of the model, the hateful outcome value together with the standard deviation of the hateful in the target population, and the number of potential predictors [41]. These data were derived from a similar study including individuals with chronic WAD in which R2 is 0.56, with mean NDI scores of 15.57 and standard deviation of xiv.1 after ii to 3 years post-accident [viii]. Finally, seven potential candidate predictors were selected to be included in this written report at the 1-year follow-upwards with six predictors at ii years. This resulted in a sample size of 241 and 240 participants after 1 and two years, respectively. Sample size calculations were handled using the pmsampsize bundle, carried out using R software [41].

iii. Results

The data from 205 participants were included in the analysis of this written report, following the multiple imputation process. Forty-five (22%) and ninety-i (44%) of the participants' data were missing an NDI score at i and ii years, respectively. The characteristics of the individuals, including their sex activity, age, and other baseline measures, are presented in Table one. Farther details on participant characteristics tin exist found in the written report of the randomized controlled trial [22].

three.1. Predictor Variable Selection (i.due east., Shrinking the Number of Predictors)

The baseline covariates with nonzero coefficients to the NDI outcome were NDI, HADS-D, PSES, and WAI at one twelvemonth and NDI, TSK, and WAI at 2 years (Table 2 and Table 3).

iii.2. Prediction of Outcome at One Year

A i-pct increase in pain extent significantly increased NDI by 0.5 units (t = 2.88, p = 0.006, 95% CI: 0.159–0.909) (Table 4). When the human relationship between pain extent and NDI was adjusted by the baseline effects of NDI, group allotment, HADS-D, PSES, and WAI, a one-percent increase in pain extent non-significantly increased NDI by 0.11 units (t = 0.586, p = 0.56, 95% CI: −0.28–0.499) (Table 5).

3.3. Prediction of Outcome at Two Years

A one-percent increase in pain extent significantly increased NDI by 0.49 units (t = 2.383, p = 0.029, 95% CI: 0.057–0.914) (Table 6). When the relationship between pain extent and NDI was adjusted by the baseline effects of NDI, group allocation, TSK, and WAI, a i-percent increase in pain extent non-significantly increased NDI by 0.16 units (t = 0.856, p = 0.401, 95%CI: −0.226–0.544) (Tabular array seven).

4. Discussion

This is the offset study to investigate whether the reported spatial extent of pain is a predictive factor of consequence in chronic WAD. The results suggest that patients with chronic WAD who present with more widespread pain are expected to have increased ongoing pain and disability at one year and two years, fifty-fifty after participating in an exercise program. Yet, this association was not maintained when we adjusted for other factors. This finding therefore only partially supports our assertion that patients with chronic WAD reporting widespread pain proceed to demonstrate higher persistent pain and disability at least 2 years subsequently.

Pain extent explained 5% and 4% of the variance in the NDI in this population at i yr and 2 years, respectively. A one-percent increase in baseline pain extent predicted a meaning increment in NDI by 0.5 and 0.49 at one twelvemonth and ii years, respectively. Thus, patients who presented with more than widespread pain were more than likely to have ongoing neck pain and disability at to the lowest degree 2 years later on. This result is consistent with earlier research confirming a human relationship between larger area of pain and college neck disability in patients with chronic WAD [xi] and patients with chronic neck pain [27]. These results are likewise supported by earlier findings that a 10-calendar week rehabilitation programme, including exercises, resulted in a 37% reduction in neck pain intensity in people with WAD and signs of mechanical hyperalgesia, whereas the response to the aforementioned intervention was only a sixteen% reduction in cervix pain intensity in people with WAD with signs of widespread mechanical and common cold hyperalgesia, suggesting an up-regulation of central nociception processing and/or a loss of descending inhibition [42].

Widespread pain is characteristic of central sensitization, a miracle idea to contribute to the maintenance of pain and disability in people with WAD [10]. To appointment, all the same, at that place has been very piddling investigation of the relationship between pain extent and directly measures of central sensitization. In one study investigating individuals with chronic knee arthritis, larger hurting extent was significantly associated with lower-force per unit area pain thresholds measured both over the knee and at a remote site [43]. Thus, pain extent, extracted from pain drawings, may be clinically useful when investigating bear witness of central sensitization, an aspect that ought to exist considered when determining prognoses. Farther studies are needed to extend this work to a WAD population.

Earlier research measuring pressure level pain thresholds over cervical, elbow, and tibialis anterior muscle sites showed a meaning clan between pressure hurting threshold and poorer outcomes on the NDI upwardly to 2–three years following treatments by a physiotherapist or a chiropractor after a whiplash injury [viii]. Although moderate correlations betwixt pressure pain thresholds and disability have been found in people with WAD when measured simply at cervical spine sites [44,45], the results from a meta-analysis plant that patients with chronic WAD prove higher pressure pain sensitivity at multiple sites in the body [46], suggesting that augmented primal processing is present in this population. Moreover, a systematic review by Williams et al. [47], which explored prognostic factors in patients with WAD, plant moderate evidence supporting the theory that cold hyperalgesia predicts higher neck disability in people with WAD. Further studies are required to explore the utilise of pain extent as an indicator of central sensitization in the prediction of effect following physical interventions in patients with chronic WAD.

4.ane. Adjusted Pain Extent

Pain extent was not predictive of NDI once we adjusted for NDI, HADS-D, PSES, and WAI afterward 1 year and NDI, TSK, and WAI after 2 years. Introducing these factors into the model lowered the beta coefficient (β) of pain extent from 0.53 to 0.11 and 0.48 to 0.fifteen at 1 and ii years, respectively, suggesting that function of the clan between pain extent and disability is explained by other factors such as perceived disability or psychosocial factors. Additionally, this could signal that these elements may have a potential confounding result on pain extent, blurring its clan with the NDI when introduced into the model [48]. For a cistron to be considered every bit a potential confounder, it must accept an association with both the exposure and outcome [49]. In our study, and based on the proposed properties [49], we hypothesized that NDI, HADS-D, TSK, PSES, and WAI should exist associated with widespread pain, given that the association betwixt them and the overall outcomes in WAD have been established in earlier studies [17,18,19,xx,21].

At that place is prove of associations between the presence of psychological factors and widespread pain in patients with WAD. A study by Holm et al. [50] aimed to investigate whether psychological features and other injury-related factors were associated with the development of widespread pain, measured by the number of painful body areas, in patients with WAD; depressive mood was strongly associated with widespread pain, compared to those who present with localized pain (adjusted OR = 3.ii). Similarly, in patients with chronic WAD, widespread hurting was institute to be associated with higher depression and lower self-efficacy [11]. Some other study investigating psychological factors in cohorts other than whiplash plant that the presence of psychological impairments were associated with the evolution of chronic widespread pain [51]. Psychological distress could be a consequence of widespread pain; this is supported past a randomized controlled trial that found psychological distress resolved in patients with WAD after elimination of hurting [52].

In addition to psychological factors, the current literature indicates that the evolution of widespread pain might be associated with perceived disability and work ability. Widespread pain was shown to be significantly associated with the NDI in patients with chronic WAD [11], likewise as in another chronic WAD populations, in which the aforementioned meaning correlation was plant between hurting area and NDI [53]. Besides inability, poor work ability was associated with those who have multi-site hurting (OR = ii.41) in a cohort of wellness intendance providers [54]. Nonetheless, no direct measure has been conducted between work ability and widespread pain in patients with WAD. Future research may investigate such association prospectively, which might help in decision making with work capacity in WAD patients.

4.2. Methodological Considerations

This written report has many strengths. At to the lowest degree 10 participants were used for each predictor variable when developing the predictive factors, which minimizes the hazard of overestimating the results [55]. Moreover, allocated treatments were taken into consideration when developing the predictive factors equally recommended to avert poor functioning of pain extent [56]. Finally, this study considers other potential confounders which were included in the final multivariable analysis.

In that location are limitations to this study that should be considered. From 205 participants, the NDI data were bachelor from only 160 and 114 participants at one and ii years, respectively; this could lead to a possible attrition bias. However, we used multivariable imputation to supersede missing values with imputed values, which enables all information to exist included in the concluding regression model. Another limitation is that the study includes patients who received a neck-specific exercise intervention with or without a behavioral approach, and this could limit the external validity of the findings when practical to other WAD populations who receive other types of exercise programs. Additionally, the concluding multivariable analysis may exist express by the included covariates of our analysis. Other significant covariates to hurting extent and WAD upshot should be identified. Finally, the sample size of this report was slightly lower than the required number, which may have resulted in the study beingness underpowered. All the same, considering this study was based on a previously published trial [22], sample size could not be increased.

5. Conclusions

This is the first study to evaluate the predictive ability of pain extent in individuals with chronic WAD, which, on its own, was plant to be significantly associated with poor long-term outcomes. Pain extent was no longer a significant predictor once we included other predictors such as disability, psychological health, and work ability into multivariate analyses.

Author Contributions

A.A., D.F. and M.B. formulated the study idea. A.A. is a PhD student with D.F. as Pb Supervisor. A.A. drafted the initial study with guidance from D.F., D.W.Eastward. and B.50. at all stages. Thousand.P. and A.P. performed information collection. D.F., B.L, D.W.E., G.P., A.P., N.H., A.R. reviewed and provided feedback on the manuscript. D.F. is the guarantor. All authors accept read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Lath Statement

The study was conducted in accordance with the Declaration of Helsinki, and canonical past the Institutional Review Lath (or Ideals Committee) of The Regional Ideals Committee of Linköping, Sweden.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Raw data that back up the findings of this study are available from the corresponding author, upon reasonable request.

Conflicts of Interest

The authors declare no disharmonize of interest.

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Table 1. Baseline characteristics of the included participants with chronic WAD (n = 205).

Table i. Baseline characteristics of the included participants with chronic WAD (n = 205).

Variables Value
Sex
Male person, N (%) 72 (35%)
Female, N (%) 133 (65%)
Grouping
NSE 72 (35%)
NSEB 68 (33%)
PPA 65 (32%)
Historic period
Years (range) SD 40.two (63–eighteen) 11.5
Disability
NDI, hateful (range) SD 33.ii (76–4) 13.01
PDI, mean (range) SD twenty.five (58–0) 13.nine
Pain extent
Mean percent (range) SD vii.0 (57.3–0.00) vii.33
Neck pain intensity
VAS, mean (range) SD 41.vii (97–0) 24.half-dozen
Quality of life
EQ-5D, mean (range) SD * 0.6 (1–(−0.2)) 0.3
EQ-VAS, mean (range) SD ** 62.viii (95–11) 18.0
Self-Efficacy
SES, mean (range) SD 150.v (200–47) 36.ix
Fear of movement
TSK, mean (range) SD 22.1 (41–12) 6.0
Hurting catastrophizing
PCS, mean (range) SD 18.half-dozen (51–0) eleven.two
Low and anxiety
HADS-A, mean (range) SD *** six.9 (18–0) 4.3
HADS-D, mean (range) SD **** iv.8 (19–0) 4.2
Work-related factors
WAI, mean (range) SD 35.4 (49–10) 6.9
ESES
ESES, mean (range) SD ***** 33.5 (60–6) thirteen.6

Table 2. Selected predictor variables for response variable of NDI at 1 year.

Table 2. Selected predictor variables for response variable of NDI at 1 year.

Variables Imputed Dataset
i		 Imputed Dataset
2		 Imputed Dataset
3		 Imputed Dataset
4		 Imputed Dataset
5
NDI 0.346 0.378 0.397 0.404 0.400
EQ5D 0 0 0 0 0
EQ-VAS 0 0 0 0 0
ESES 0 0 0 0 0
HADS-A 0 0 0 0 0
HADS-D 0.007 0.007 0.008 0.006 0.008
PCS 0 0 0 0 0
PDI 0 0 0 0 0
SES −0.008 −0.007 −0.012 −0.008 −0.009
TSK 0 0 0 0 0
VAS 0 0 0 0 0
WAI −0.283 −0.216 −0.260 −0.198 −0.281

Tabular array 3. Selected predictor variables for response variable of NDI at 2 years.

Table 3. Selected predictor variables for response variable of NDI at ii years.

Variables Imputed Dataset
1		 Imputed Dataset
2		 Imputed Dataset
3		 Imputed Dataset
four		 Imputed Dataset
5
NDI 0.329 0.380 0.370 0.275 0.437
EQ5D 0 0 0 0 0
EQ-VAS 0 0 0 0 0
ESES 0 0 0 0 0
HADS-A 0 0 0 0 0
HADS-D 0 0 0 0 0
PCS 0 0 0 0 0
PDI 0 0 0 0 0
SES 0 0 0 0 0
TSK 0.090 0.085 0.041 0.036 0.072
VAS 0 0 0 0 0
WAI −0.004 −0.002 −0.001 −0.001 −0.003

Table 4. Crude clan betwixt baseline pain extent to 1 year NDI effect.

Tabular array four. Rough association between baseline pain extent to 1 year NDI consequence.

β SE T Value df p Value Low 95%CI Upper 95% CI Adjusted Rii
(Intercept) 24.004 one.712 14.02 106.709 0 20.61 27.398 0.05
Pain Extent 0.534 0.186 2.88 39.717 0.006 0.159 0.909

Table v. Adapted associations between baseline pain extent to 1 year NDI consequence.

Tabular array 5. Adjusted associations betwixt baseline pain extent to 1 year NDI outcome.

β SE T-Value df p Value Low 95%CI Upper 95% CI Adj R2
(Intercept) 24.516 15.147 1.618 25.561 0.118 −6.646 55.678 0.31
Pain Extent 0.eleven 0.187 0.586 21.34 0.564 −0.28 0.499
NSEB Group 1.319 3.059 0.431 23.442 0.67 −5.003 7.64
PPA Grouping 7.82 2.857 2.737 38.859 0.009 two.04 thirteen.six
HADS-D 0.302 0.324 0.933 143.995 0.353 −0.339 0.943
NDI 0.401 0.143 two.809 29.079 0.009 0.109 0.693
SES −0.023 0.046 −0.509 42.047 0.613 −0.115 0.069
WAI −0.332 0.266 −1.249 31.169 0.221 −0.873 0.21

Table six. Crude association between baseline pain extent to 2 years NDI outcome.

Tabular array 6. Crude association between baseline pain extent to two years NDI outcome.

Predictor β SE T Value df p Value Low 95%CI Upper 95% CI Adjusted Rii
(Intercept) 24.916 ane.926 12.937 25.715 0 20.955 28.877 0.04
Pain Extent 0.485 0.204 2.383 17.731 0.029 0.057 0.914

Table vii. Adjusted associations between baseline pain extent to 2 years NDI upshot.

Table 7. Adjusted associations between baseline pain extent to two years NDI outcome.

Predictors β SE T Value df p Value Low 95%CI Upper 95% CI Adapted R2
(Intercept) vii.462 xvi.296 0.458 xi.963 0.655 −28.056 42.981 0.25
Pain Extent 0.159 0.186 0.856 22.178 0.401 −0.226 0.544
NSEB Group 2.154 3.818 0.564 ix.858 0.585 −vi.37 ten.678
PPA Grouping viii.518 3.899 two.185 9.513 0.055 −0.229 17.266
NDI 0.387 0.178 two.173 9.493 0.056 −0.013 0.787
TSK 0.3 0.265 1.132 14.927 0.276 −0.266 0.866
WAI −0.089 0.331 −0.269 9.554 0.793 −0.832 0.654

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