Correlation of clinical findings, collision parameters, and psychological factors in the outcome of whiplash associated disorders.

OBJECTIVE: To determine prognostic factors for the duration and severity of acute symptoms in subjects with grade 1 or 2 whiplash injuries. METHODS: Collision victims presenting to a trauma centre with spinal pain or stiffness were assessed clinically (including a visual analogue scale (VAS)), radiologically, and psychologically (short form 36 (SF36), everyday life quality (EDLQ), pain control questionnaire (FSR)). Collision type and estimated DeltaV (change in velocity of the occupant's vehicle) were also assessed. Assessment at six months involved VAS symptom rating, SF36, EDLQ, depression scale (CES-D), and impact of event scale (IES). RESULTS: 43 consecutive collision victims (22 male, 21 female; mean age 29 years (range 19 to 72) with grade 1 or 2 whiplash associated disorders were assessed. Mean DeltaV, available for 36 of 43 collisions, was 13.9 (5 to 30) km/h. Thirty two (74%) of the subjects were available for follow up at six months. The mean duration of symptoms was 28 (1 to 180) days in this group. No correlation was found between severity and duration of symptoms and the DeltaV of collision or other collision parameters. Patients with initial pain VAS >5 or with duration of symptoms more than 28 days had significant changes in SF36, EDLQ, CES-D, and IES scores at six months, and had initial scores that were predictive of these outcomes. CONCLUSIONS: Psychological factors were found to be more relevant than collision severity in predicting the duration and severity of symptoms in collision victims with grade 1 or 2 whiplash associated disorders.

Validity study for the stigmatization experience in atopic dermatitis and psoriatic patients.

A central experience of patients with atopic dermatitis and psoriasis is the feeling of stigmatization. This can be estimated by the "Questionnaire on Experience with Skin Complaints" (QES), based on the "Feelings of Stigmatization Questionnaire" by Ginsburg & Link. This study was designed to evaluate the psychometric properties of the QES, especially the validity of this questionnaire, and to supply more information about the stigmatization experiences of patients with atopic dermatitis and psoriasis. Three groups of patients were analysed: 76 with atopic dermatitis, 81 and 217 with psoriasis, respectively. The comparison of subgroups with different affected regions revealed that the genital region is especially relevant for the stigmatization experience in these patients. In addition, the feeling of stigmatization (estimated by the QES) is relatively independent of the different dimensions of the "Trier Scales of Coping with Diseases", except for the depressive coping style "Rumination" measuring a high amount of inner concern with the afflicting disease. It can be concluded that the QES is a valid and reliable instrument for examining the stigmatization experience of patients with atopic dermatitis and psoriasis.

Dimensions of stigmatization in patients with psoriasis in a "Questionnaire on Experience with Skin Complaints'.

BACKGROUND: Stigmatization is a central experience of patients with psoriasis with a broad psychic and social impact. OBJECTIVE: The purpose of this study is to identify the dimensions of stigma experience by a Questionnaire on Experience with Skin Complaints (QES; 'Fragebogen zum Erleben von Hautbeschwerden'). METHODS: 187 in-patients with psoriasis were examined with the QES, an adopted and extended (German) version of the Feeling of Stigmatization Questionnaire by Ginsburg and Link. A factor analysis of the questionnaire was conducted and the construct validity was evaluated. RESULTS: Five factors were found: 'self-esteem', 'retreat', 'rejection', 'composure' and 'concealment'. Self-esteem, retreat and rejection are mainly influenced by 'problematic regions' affected by psoriasis, rejection also by 'visible parts' and retreat also by 'invisible regions'. The influences of age, age at onset and sex on the stigma experience are small but significant. CONCLUSIONS: The QES proved to be an economical and reliable psychometric instrument to differentiate the stigma experience of psoriasis patients.