Neuromuscular Mechanisms Underlying Poor Recovery From Whiplash Injuries

Study Overview
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Brief Summary
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This study is investigating whether changes in the shape and size of bodily muscles and spinal cord anatomy can influence recovery rates following a motor vehicle collision (MVC). The objective is to demonstrate that the presence of muscle and spinal cord degeneration and associated muscle weakness is the consequence of a mild MVC-related injury involving the cervical spinal cord.

Detailed Description
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Whiplash is a condition that consists of patients that display varying degrees of pain and disability. Most patients should expect full-recovery within the first 2-3 months post injury. At the other end of the spectrum is a group of patients (  25%) who continue to have moderate-severe pain-related disability in the long-term. Reasons for this transition to chronicity are largely unknown. The situation would benefit if there were radiological findings of the disorder. However, clear and consistent findings of injured tissues on standard radiological exams remain elusive. As part of this study, the investigators will innovatively investigate measures to 1) quantify the temporal development of widespread muscle degeneration, 2) identify quantifiable markers of altered cervical spinal cord physiology, 3) quantify reductions in central activation and fatigue 4) evaluate potential genetic variants that may be associated with chronic pain after a MVC and 5) determine the mediational influence of psychosocial factors on recovery rates following whiplash injury, as a potential mechanism underlying the transition to chronic pain.

Official Title
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Neuromuscular Mechanisms Underlying Poor Recovery From Whiplash Injuries

Conditions
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Whiplash, WAD, Whiplash Associated Disorders

Intervention / Treatment
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* Device: Pedometer
* Device: MRI


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Males and Females (18 - 65 years of age) Individuals less than one week post MVA with a primary complaint of neck pain. Able to give written informed consent and complete interviews in English Exclusion Criteria: Individuals with a spinal fracture from the MVA, or spinal surgeries History of one or more MVAs or previous diagnosis of cervical or lumbar radiculopathy History of neurological disorders (e.g. Multiple Sclerosis, previous stroke, myelopathy), inflammatory diseases (e.g. Hepatitis, Systemic Lupus Erythematosus, Rheumatoid Arthritis or Osteoarthritis, Alzheimers, Ankylosing Spondylitis, Crohn's disease, Fibromyalgia) or metabolic disorders (e.g. Diabetes, hyper- and hypo-thyroidism) Standard contraindications to MRI: claustrophobia, metallic implants, pacemaker and pregnancy.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Procedures<br>RNA/DNA blood sample will be collected. Participant will complete questionnaires, MRI and strength and reflex testing. | Device: Pedometer<br> <br> Device: MRI<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| MRI to assess the changes in markers of altered cervical spinal cord physiology and muscle degeneration. |  | < 1 week; 2 weeks; 3 months; 1 year of MVC | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Neck Disability Index (NDI) Questionnaire | This questionnaire will access the influence of psychosocial factors on recovery rates over a period of time. | <1 week; 2 weeks, 3 months; 1 year of MVC | 
| Coping Strategy Questionnaire-C | This questionnaire will access the influence of psychosocial factors and recovery rates over a period of time. | < 1 week; 2 weeks; 3 months; 1 year of MVC | 
| Pain Management Inventory (PMI) Questionnaire | This questionnaire will access the influence of psychosocial factors and recovery rates over a period of time. | < 1 week; 2 weeks; 3 months; 1 year of MVC | 
| Tampa Questionnaire | This questionnaire will access the influence of psychosocial factors and recovery rates over a period of time. | < 1 week; 2 weeks, 3 months; 1 year of MVC | 
| Post-traumatic Diagnostic Scale (PDS) Questionnaire | This questionnaire will access the influence and psychosocial factors and recovery rates over a period of time. | < 1 week; 2 weeks; 3 months; 1 year of MVC | 
| Impact of Events Scale Questionnaire | This questionnaire will access the influence of psychosocial factors and recovery rates over a period of time. | < 1 week; 2 weeks; 3 months; 1 year of MVC | 
| Center for Epidemiological Studies - Depression Scale Questionnaire | This questionnaire will access the influence of psychosocial factors and recovery rates over a period of time. | < 1 week; 2 weeks; 3 months; 1 year of MVC | 
| Hospital Anxiety and Depression Scale Questionnaire | This questionnaire will access the influence of psychosocial factors and recovery rates over a period of time. | < 1 week; 2 weeks; 3 months; 1 year of MVC | 
| Traumatic Injuries Distress Scale and a Symptom Index | This questionnaire will access the influence of psychosocial factors and recovery rates over a period of time. | < 1 week; 2 weeks; 3 months; 1 year after MVC | 
| Prediction of Post-MVC Chronic Axial Pain Assessment | This questionnaire will access the influence of psychosocial factors and recovery rates over a period of time. | Baseline visit | 
| Follow-Up Data Collection Form for clinical prediction | This questionnaire will access the influence of psychosocial factors and recovery rates over a period of time. | 2 week; 3 month; 1 year of MVC | 
| Pedometer: wear for 2 consecutive weeks | The pedometer will record changes in activity level. | 2 weeks; 3 months after MVC | 
| RNA and DNA blood collection | The samples will evaluate potential genetic variants that may be associated with chronic pain after a MVC. | within a week of MVC | 
| Strength and reflex testing in the lower leg | This testing will demonstrate changes in central activation and fatigue. | 2 weeks; 3 months; 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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MRI, whiplash, neck pain, chronic pain, motor vehicle accident, car accident, DNA, RNA