THE ECONOMIC BURDEN OF WAD

THE ECONOMIC BURDEN OF WAD

Little is known about the individual and societal economic burden of WAD. For instance, little is known about the prevalence of long-lasting work disability due to WAD, which probably the most costly part. This burden is probably largely dependent on the legislation in different countries. In 2002, an independent and temporary Commission on whiplash-related injuries was informed in Sweden, initiated by the four largest motor vehicle insurers. The mandate of the 3-year commission was an examination of the problems of WAD from road safety, medical care, insurance and societal aspects. One of the conclusions of the final report was that the yearly cost for society and for the insurance industry was approximately SEK 1.5 billion (US$201 million), while projected costs (i.e. what new cases of WAD arising in a particular year will cost society and insurers by the time the person reaches retirement age) amounted to SEK 4.6 billion (US$648 million). These calculations were based on an annual incidence of 30,000 WAD cases (324 per 100,000 inhabitants) in the year 2002. Since the report’s publication, the number of WAD cases have decreased dramatically to about 16,000 claims in 2008 (173 per 100,000 inhabitants), which, of course, has an impact on the overall costs.

Comparable data has not been found, but there is some evidence from a study that addressed the incidence of WAD in 10 European countries. The administrative data suggests that the total claims cost in Switzerland was 500 million Swiss francs (US$467 million). Switzerland’s population is 80% that of Sweden. Expenditures in addition to the claims cost was not reported in that study.

SUMMARY

In summary, as in almost all other diseases and injuries, factors that are involved in the risk or prognosis of WAD are multifactorial and constitute a web of biological, psychological and social components.

REFERENCES

1.      Crowe H. A new diagnostic sign in neck injuries. Calif Med 1964; 100:12-13.

2.      Gay J. Abbott K. Common whiplash injuries of the neck. JAMA 1953; 152:1698-704.

3.      Benson BW, Mohtadi NG, Rose MS, Meeuwisse WH. Head and neck injuries among ice hockey players wearing full face shields vs half face shields. JAMA 1999; 282(24):2328-32.

4.      Versteegen GJ, Kingma J, Meijler WJ, ten Duis HJ. Neck sprain not arising from car accidents: a retrospective study covering 25 years. Eur Spine J 1998;7(3):201-5.

5.      Lorish TR, Rizzo TD, Jr., Ilstrup DM, Scott SG. Injuries in adolescent and preadolescent boys at two larger wrestling tournaments. Am J Sports Med 1992;20(2):199-202.

6.      Spitzer WO, Skovron ML, Salmi LR, et al. Scientific Monograph of the Quebec Task Force on whiplash-associated disorders: redefining “whiplash” and its management. Spine 1995;20(8 Suppl):1S-73S.

7.      Holm LW, Carroll LJ, Cassidy JD, Ahlbom A. Factors influencing neck pain intensity in whiplash-associated disorders in Sweden. Clin J Pain 2007;23(7):591-7.

8.      Ferrari R, Russell AS, Carroll LJ, Cassidy JD. A re-examination of the whiplash-associated disorders (WAD) as a systematic illness. Ann Rheum Dis 2005:1337-42.

9.      Berglund A, Alfredsson L, Jensen I, et al. Occupant- and crash-related factors associated with the risk of whiplash injury. Ann Epidemiol 2003;13(1):66-72.

10.   Bylund P-O, Bjornstig U. Sick leave and disability pension among passenger car occupants injured in urban traffic. Spine 1998;23(9):1023-8.

11.   Versteegen GJ,Kingma J, Meijler WJ, ten Duis HJ. Neck sprain in patients injured in car accidents: a retrospective study covering the period 1970-1994. Eur Spine J 1998;7(3):195-200.

Overcoming Chiropractic Fear

If you have never been to a chiropractor before, it is only natural to have some apprehension on your first visit. If you are suffering from neck or back pain, visiting a chiropractor can alleviate and even eliminate pain, and yet some people are simply afraid to go. This is especially true if you don’t know what to expect. Knowledge is power and getting the facts and understanding what will happen can help you overcome your fear.

Book a Consultation

One of the best things you can do to overcome your fear of the chiropractor is to book a consultation appointment. Make sure when you book the appointment you let them know about your concerns. A good chiropractor will sit down with you and explain to you about chiropractic care, what it is and what will happen during your first adjustment. They will let you know that being adjusted does not cause any pain and in fact relieves it. They should be able to answer any questions you might have and may even have additional brochures or short movies for you to watch.

Ask Friends, Family and Co-Workers About Their Chiropractic Experiences

Another way to help alleviate your fear is to talk to others who have been treated by a chiropractor in the past or who are currently under chiropractic care. They will be able to tell you their stories of chiropractic success and let you know there is nothing to worry about. This is also a great way to get a referral and just knowing you are seeing a chiropractor that has been recommended can help.

Focus On Pain Relief

The most common reason people visit chiropractors is for back or neck pain relief. If this is you, try to stay focused on the pain relief. So many people continually suffer from neck and back pain that could so easily be alleviated and even eliminated through chiropractic care. Especially if you are seriously suffering, in the end, pain relief should outweigh fear.

Memorial Day Tips & Safety

Each year, thousands of people are involved in traffic accidents during the Memorial Day Weekend. If you are one of these unfortunate people, will you know what to do in the aftermath of a collision? How you react can prevent further injuries, reduce costs and accelerate the clean-up and repair process.

Action Plan to Deal with Accidents:

1. Keep an Emergency Kit in Your Glove Compartment. Drivers should carry a cell phone, as well as pen and paper for taking notes, a disposable camera to take photos of the vehicles at the scene, and a card with information about medical allergies or conditions that may require special attention if there are serious injuries. Also, keep a list of contact numbers for law enforcement agencies handy. Drivers can keep this free fill-in-the-blanks accident information form in their glove compartment. The DocuDent™ Auto Accident Kit ($19.95), supported by AAA and insurance companies, offers a comprehensive kit that includes a flashlight, reusable camera and accident documentation instructions. A set of cones, warning triangles or emergency flares should be kept in the trunk.

2. Keep Safety First. Drivers involved in minor accidents with no serious injuries should move cars to the side of the road and out of the way of oncoming traffic. Leaving cars parked in the middle of the road or busy intersection can result in additional accidents and injuries. If a car cannot be moved, drivers and passengers should remain in the cars with seatbelts fastened for everyone's safety until help arrives. Make sure to turn on hazard lights and set out cones, flares or warning triangles if possible.

3. Exchange Information. After the accident, exchange the following information: name, address, phone number, insurance company, policy number, driver license number and license plate number for the driver and the owner of each vehicle. If the driver's name is different from the name of the insured, establish what the relationship is and take down the name and address for each individual. Also make a written description of each car, including year, make, model and color — and the exact location of the collision and how it happened. Finally, be polite but don't tell the other drivers or the police that the accident was your fault, even if you think it was.

4. Photograph and Document the Accident. Use your camera to document the damage to all the vehicles. Keep in mind that you want your photos to show the overall context of the accident so that you can make your case to a claims adjuster. If there were witnesses, try to get their contact information; they may be able to help you if the other drivers dispute your version of what happened.

5. File An Accident Report. Although law enforcement officers in many locations may not respond to accidents unless there are injuries, drivers should file a state vehicle accident report, which is available at police stations and often on the Department of Motor Vehicles Web site as a downloadable file. A police report often helps insurance companies speed up the claims process.

6. Know What Your Insurance Covers. The whole insurance process will be easier following your accident if you know the details of your coverage. For example, don't wait until after an accident to find out that your policy doesn't automatically cover costs for towing or a replacement rental car. Generally, for only a dollar or two extra each month, you can add coverage for rental car reimbursement, which provides a rental car for little or no money while your car is in the repair shop or if it is stolen. Check your policy for specifics.

Migraines and Chiropractic Care

The pain of a migraine can be so searing you may as well drill a hole through your head. Then again this was the remedy of choice 3,000 years ago when evil spirits were thought to be the culprit behind migraines. While modern-day treatments have changed, the mystery behind the condition remains.

One popular theory: Migraines result from a chemical imbalance in the brain. Often a trigger, such as certain foods or hormones, can cause blood vessels to dilate in the brain. The vessels become inflamed, thus irritating surrounding nerve fibers. The nerve fibers then send messages back to control centers in the brain, which continues vessel dilation, thus kicking off a vicious cycle of violent pain.

There are plenty of drugs that combat migraines, though no magic bullet exists. Some studies, however, show that alternative treatments can complement mainstream medicine. A study from Northwestern College of Chiropractic in Bloomington, Minnesota, compared chiropractic manipulation with amitriptyline, an antidepressant commonly used to treat migraines. The study found that chiropractic healing was about as successful as the drug.

Chiropractors believe that some migraines originate in the spine. Often a misalignment of the vertebrae, or subluxation, can irritate the nerves that travel the length of the spine to the brain. This misalignment makes a person more prone to chemical imbalances in the brain. Some researchers say that realigning the vertebrae—a chiropractor's specialty—relieves the pressure against inflamed nerves and can in turn relieve the headaches.

For migraines caused by subluxation, chiropractors recommend gently stretching the neck—rolling and sudden movements should be avoided. To prevent subluxations, pay attention to your posture. For example, if you sit for long periods in front of a computer, move your body around frequently. Also, sleep on your side or back, and use a firm pillow that supports your neck.

Whiplash

What causes whiplash?

Whiplash occurs when the soft tissue in the spine is stretched and strained after the body is thrown in a sudden, forceful jerk. The injury most commonly occurs in car crashes involving sudden deceleration, but the injury can also occur in other strenuous physical activities such as diving.

What does whiplash feel like?

The most frequent complaints are headaches and stiffness in the neck and the back of the head. These symptoms appear within the first couple of days after the accident and usually pass after a few days to a few weeks.

Chiropractic Care for Whiplash

Whiplash Chiropractic

Pain and stiffness in the neck which may not come on immediately, but develop over the following 24 to 48 hours. You may have reduced range of movement in the cervical spine (neck). You may have headaches, dizziness, blurred vision (this should go within 24 hours, if they persist consult your doctor), pain and stiffness may last a few days, to a few weeks, depending on the severity.

The primary whiplash treatment for joint dysfunction, spinal manipulation involves the chiropractor gently moving the involved joint into the direction in which it is restricted.

Whiplash is common in car accidents, due in part to the fact that the muscles do not have enough time to brace during impact.

Simple cases of whiplash are the result of strain or sprained or dysfunction of ligaments in the neck. The muscles of the neck naturally spasm as a protective mechanism after an injury has occurred. This in turn can cause spinal misalignment which can irritate nerves reducing the body’s ability to heal itself.

Returning Patients to Work

Returning Patients to Work

                This study investigated what nonphysical factors were associated with patients not returning to work after soft-tissue injury. As the authors state, “Nonphysical factors, the nature of which may be social, economical, or psychological, may also influence the success of work hardening and may act as barriers to successful work return.”

                One hundred patients were involved in this study. The mean injury duration of the participants was 13 months; the mean time absent from work was 7.5 months. Many of these patients had undergone surgery for their injuries -- 20% of cervical spine patients, and 35% of low back patients. Fifty-one percent of the participants were using medications. Eighty-eight per cent of the patients had a diagnosis related to the spine. 

                The patients attended a “work hardening: program daily for 7.5 hours and for an average of 17.3 days. The average treatment lasted 4.3 weeks. The program consisted of “physical therapy conditioning, work simulation, and a psychological education group.” At the end of the intervention, 50% had returned to work. The author reports that there were three non-physical factors associated with returning to work:

1. Having a high school education. Less educated patients were less likely to return to work. This could be due to the fact that, “most heavy labor and blue collar jobs are performed by the less educated persons and that these jobs may be more difficult to return to than lighter jobs.”

2. Absence of “pain behaviors.” These were defined as “overt behaviors that are not in proportion to physical findings, such as facial grimacing, emotional lability, positive Waddell’s signs, constant holding of the injured area, and antalgic limping.” Unfortunately, the studies criteria for low back pain “physical findings” was reduced to :simple and severe,” and the criteria for these was evidence of “radiographically-determined injury to the disc or bony structures.” If there were no radiological findings, the injury was classified as “simple.” Thus, if a patient was not considered to have a real injury, but behaved as if he or she did have pain, these were determined as “pain behaviors!” The patients with pain behaviors were less likely to return to work than those without and were less likely to complete the program, but this could be related to the fact that “Work hardening tends to further aggravate pain…” That these patients were in real pain, despite signs on radiologic exams, seems to not be considered in this paper.

3. Absence of attorney representation. Those patients that retained an attorney were less likely to return to work, showed more pain behaviors, and were more likely to be discharged from the programs for lack of compliance. The study did not provide data regarding attorney representation and severity of injury, or length of time off work.

Chiropractic Treatment in Whiplash Injury

The Role of Chiropractic Treatment in Whiplash Injury

                Whiplash or whiplash-associated disorders (WADs) commonly involve the cervical spine. The natural history of neck pain is poorly understood, and little research about its causes or treatments has been performed. The severity of symptoms and the severity of trauma are not always directly related. Few objective findings are correlated with the symptoms reported in the head, neck, or upper quarter. The duration of symptoms are signs associated with whiplash are reported by numerous authors to be between 2 to 6 months. However, the magnitude of this problem cannot be overestimated. In a survey of more than 10,000 cases of WAD pain, it persisted in 25% of the cases for 5 years after the accident.

                Neck pain is not only common following an automobile accident but is common independently of traumatic origin as well. The incidence of neck and shoulder pain is quite high in the general population. The point prevalence (number of individuals suffering at a given point in time) of neck and shoulder pain is between 10% to 22%. The 1-year prevalence is 16% to 40% (number of individuals who will have discomfort during a 1-year period). The lifetime prevalence falls between 50% and 70%.

Keys to Recovery: The 5 R’s

1. Reassurance that no serious disease is present and that improvement is likely to begin rapidly

2. Relief of pain with medication or manipulation

3. Reactivation advice that normal activities can be resumed (walking, swimming, biking) and education    about simple activity modifications to reduce biomedical strain (ie, Brugger relief position, chin tucks)

4. Reevaluation of those entering the subacute phase for structural, functional, or psychosocial factors

5. Rehabilitation/reconditioning/reeducation of muscles with McKenzie, stabilization, progressive strengthening, or cognitive-behavioral (indicated if high “yellow flags” score) approaches.

Injury Resources

There are many risk factors related to the POTENTIAL of a trauma to cause an injury. 

Each patient and traumatic event must be individually evaluated. Evaluation should be broken up into pre injury factors, collision specific factors, and post collision factors. 

 

Based on scientific and medical literature there are two major factors that determine the occupants risk for injury. These factors are:

 1. Human risk factors or variables (age, general health, diseases that slow healing, long thin neck, prior injuries, degenerative spine disease, history of pain before the accident, osteoporosis, diabetic, muscle mass and various other conditions that would be specific for the occupant. But it must make clinical sense why it would increase the risk for injury.)

 2. Forces imposed on the occupant. (Vehicle specifics, position in the car, type of bumper, distance from the head to the seat back, surprise of the occupant, type of seat belt used, angle of collision, if the breaks we applied during collision, surprised by the collision, multiple collisions or if the occupants head was turned during impact. There are literally hundreds of other factors that can increase or decrease the risk of injury, and again they must make clinical sense.)

The Insurance Institute for Highway Safety is an independent, nonprofit, scientific, and educational organization dedicated to reducing the losses; deaths, injuries, and property damage. On its website is information concerning deaths, injuries, and property damage on most make, model and year of vehicles since 1990. http://www.iihs.org  Simply go to their website click on research, then insurance loss to view statistical information on injury & vehicle damage.

Over the next few months I will go over each of the many factors that are involved in evaluation an injury case, general personal injury topics, impairment, disability, report writing and where ever the topic takes us.  This blog is for doctors, patients, attorneys, claims adjusters and who ever else may be interested in injury cases. But remember this blog is not medical, legal or claim advise, use this blog at your own risk (gotta get the disclaimer in).

The blogs are scheduled for once a week. Feel free to sign up / "follow" my blog and please comment or ask questions!

Thanks, Dr. Chris Connelly, DC

Whiplash / Neck Pain Atlanta

There are many factors and symptoms associated with whiplash injury with neck pain being the most common.

Whiplash and whiplash associated disorders describe a range of neck injuries related to sudden disorders of the neck in rear-end crashes. The most common symptom reported after whiplash injury is neck muscle strain or tearing of soft tissues which include muscles and ligaments. According to the Insurance Research Council, 2003, Neck sprain or strain is the most serious injury reported in more than 33% of automobile injury insurance claims, with back sprain or strain accounting for another 20%.

Neck PainFactors influencing neck injury risk to occupants of whiplash collisions include gender, seating position and design. Women are more likely to sustain neck injuries than men. Front seat occupants, especially drivers are more likely to sustain neck injuries than rear seat occupants. Seats with poor headrest design and placement allow an occupant's head to whip back and forth during a rear impact are more likely to experience neck injuries.

According to Traffic Injury Prevention, 9:561-567, 2008, Effective head restraints help to limit the whipping motion responsible for damage to the neck. Driver neck injury rates were 15% lower for vehicles with good ratings as compared to poor. Importantly, driver neck injuries lasting 3 months or more were 35% lower for vehicles with seat/head restraints rated good than for those rated as poor. The authors state, "The majority of neck sprain symptoms clear up within a month, but some can last for years." Relating importance, they additionally relate, "Preventing these long term injuries should be a high priority". They further note, "Encouraging automakers to design seats that earn good safety ratings should greatly lessen the problem of whiplash injuires".

Preventing chronic neck pain (lasting 3 months or more) is essential. High pain intensity in the neck and head, signs and symptoms of radiating pain (radicular signs/symptoms), older age, female gender, and tort insurance systems are associated with delayed recovery in whiplash neck injuries as indicated in Spine Journal 26: E445–E458, 2001. Additionally, studies also indicate that psychological and psychosocial factors such as general psychological distress, early depressive symptoms, passive coping strategies, and perceived helplessness are also associated with poor prognosis in whiplash.

Whiplash Injury To Neck

The Spine Journal, 2006 Feb 15;31(4):E98-104 noted, fair or poor health before the collision was associated with severe neck pain in females along with low education and prior neck pain. The article further states, low family income was associated with severe neck pain in males, as was prior headache and being unaware of the head position at the time of collision. In the Public Library of Science article; PLoS Med 5(5): e105, they noted the following factors which complicate whiplash recovery; gender, age, education, family status, general health prior to injury including prior neck pain and headache, prior injuries, memory loss after the injury, number of pain areas, severity of eight pain-associated symptoms, pain intensity in the neck, head, low back and other body parts, anxiety and depression, post traumatic stress symptoms and passive coping strategies.

Whiplash Neck PainAccording to the Results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders, "The preponderance of evidence indicates that, in adults, recovery of WAD [whiplash associated disorders] is prolonged, with approximately half of those affected reporting neck pain symptoms 1 year after the injury." Their inquiry indicated, "Most studies examining recovery from WAD in adult populations suggest a prolonged recovery." Initial pain levels and symptoms are directly related to persistance of neck pain symptoms. The Task Force indicated, "Symptom reporting was greater among those who presented with neck pain accompanied by neurologic signs (equivalent to WAD III): 90% of these patients reported being symptomatic a year after their injury."

Further investigation by the Task Force inciated, "At 7 years post injury, almost 40% of those making a claim for traffic-related WAD reported often or always having neck pain, compared with less than 15% of a matched cohort who had been in a car crash with no WAD. This latter figure is consistent with the prevalence of 'frequent' neck pain or neck pain which 'interferes with activities' in the general population. Persons with a history of WAD were also more likely to have pain in other parts of their body and to report general ill health, sleep disturbance, and fatigue at 7 years post injury. Furthermore, 30 months after the injury, 7% of WAD patients seen in emergency departments in Umea, Sweden, were still on sick leave; and 5% of WAD patients seen in emergency departments in Norway were on rehabilitation or permanent disability pension."

The Québec Classification of Whiplash Associated Disorders (WAD) is a clinical classification system which grades symptoms as follows:

* Grade 0 WAD refers to no neck complaints and no physical signs.

* Grade I WAD refers to injuries involving complaints of neck pain, stiffness or tenderness, but no physical signs.

* Grade II WAD refers to neck complaints accompanied by decreased range of motion and point tenderness (musculoskeletal signs).

* Grade III WAD refers to neck complaints accompanied by neurologic signs such as decreased or absent deep tendon reflexes, weakness and/or sensory deficits.

* Grade IV WAD refers to injuries in which neck complaints are accompanied by fracture or dislocation.

* Other symptoms related to whiplash besides neck pain; deafness, dizziness, tinnitus, headache, memory loss, dysphagia, and temporomandibular joint pain can be present in all grades.

In the Journal of Rheumatology. 2007 Jan;34(1):193-200, the authors indicate those with whiplash injury who report early depressive symptoms and more severe neck injury symptoms are at risk of developing wide spread pain (9 or more painful areas).

Who Pays Your Medical Bills When Someone Hits Your Car?

WHO PAYS YOUR MEDICAL BILLS WHEN ANOTHER DRIVER HITS YOU? YOU DO!!

As ridiculous as it may sound, when someone hits your car and is at fault, hospitals, medical doctors, chiropractors, and physical therapists CAN NOT bill the responsible party’s insurance company for direct payment. There is no State of Georgia law that requires the responsible party’s insurance company [the liability carrier] to pay your medical bills. The bills first have to go through an optional automobile coverage you can buy [and should have] called medical payments coverage [med pay]. If you don’t have this coverage you can turn to any other health insurance you have — with it’s built in deductibles, copayments, exclusions, and restrictions on who you can see, how often, and for how long. Some health insurance will not pay if treatment is due to a car accident.

What the liability carrier will do is tell you to let them know when you are through with treatment; then they will offer you a lump sum settlement. Many times, particularly from one company that advertises a lot, what is offered is less than the sum of your medical bills, which could exceed the policy limits the responsible driver had in effect at the time of the accident.

Of course the person who hit you may have no insurance. Then if you don’t have collision or uninsured motorist coverage [called UM] you are going to lose the value of the car as well. You can sue the other driver — if they didn’t hit and run, and if they have any assets. If there is no insurance, the settlement process is protracted [it can take over a year sometimes], you have missed income due to injury, or other issues, you could end up filing bankruptcy. This happens to people regularly.

There are additional scenarios I don’t have the space to cover — like in the case you or a family member doesn’t make a complete recovery and needs ongoing care. Or using your health insurance after an injury, getting a settlement from the liability carrier, and finding out your health insurance company has a legal right to be paid back what they spent in medical bills out of your settlement [subrogation rights].

All of the information above has been reviewed for accuracy by three attorneys who specialize in, and have years of experience in this field.

The best advice is:

1. Buy medical payments coverage [med pay] from your auto insurance agent.
2. Discuss other optional coverage like uninsured motorist coverage [UM]
3. Have high liability limits, particularly if you have a teenage driver!

SOME PEOPLE TELL ME THEY HAVE “FULL COVERAGE” ON THEIR CAR BUT DO NOT HAVE MEDICAL PAYMENTS COVERAGE, OR HAVE A MINIMAL AMOUNT. Emergency room care and hospitalization with fractures or worse can go through tens of thousands in coverage!!