The association between a lifetime history of a neck injury in a motor vehicle collision and future neck pain: a population-based cohort study Predictors of persistent neck pain after whiplash injury A Randomized Controlled Trial of an Educational Intervention to Prevent the Chronic Pain of Whiplash Associated Disorders Following Rear-End Motor Vehicle Collisions Chronic neck pain and whiplash: a case-control study of the relationship between acute whiplash injuries and chronic neck pain. Can high-risk older drivers be identified through performance-based measures in a Department of Motor Vehicles setting? Reduction in motor vehicle collisions following treatment of sleep apnoea with nasal CPAP Population-based, inception cohort study of the incidence, course, and prognosis of mild traumatic brain injury after motor vehicle collisions.
The objective of this population -based cohort study was to investigate the association between a lifetime history of neck injury from a motor vehicle collision and the development of troublesome neck pain . The current evidence suggests that individuals with a history of neck injury in a traffic collision are more likely to experience future neck pain . However , these results may suffer from residual confounding . Therefore , there is a need to test this association in a large population -based cohort with adequate control of known confounders . We formed a cohort of 919 r and omly sample d Saskatchewan adults with no or mild neck pain in September 1995 . At baseline , participants were asked if they ever injured their neck in a motor vehicle collision . Six and twelve months later , we asked about the presence of troublesome neck pain  ( grade II – IV ) on the chronic pain grade question naire . Multivariable Cox regression was used to estimate the association between a lifetime history of neck injury in a motor vehicle collision and the onset of troublesome neck pain while controlling for known confounders . The follow-up rate was 73.5 % ( 676/919 ) at 6 months and 63.1 % ( 580/919 ) at 1 year . We found a positive association between a history of neck injury in a motor vehicle collision and the onset of troublesome neck pain after controlling for bodily pain and body mass index ( adjusted HRR = 2.14 ; 95 % CI 1.12–4.10 ) . Our analysis suggests that a history of neck injury in a motor vehicle collision is a risk factor for developing future troublesome neck pain . The consequences of a neck injury in a motor vehicle collision can have long lasting effects and predispose individuals to experience recurrent episodes of neck pain Objective : To establish the aetiological influences of  persistent neck pain following a motor vehicle collision and to construct a model for use in the emergency department for identifying patients at high risk of persistent symptoms . Design : Prospect i ve cohort study . Patients recruited from hospital emergency departments were sent a question naire to gather information on various exposures . They were followed up at 1 , 3 , and 12 months to identify those with persistent symptoms . Main outcome measure : Persistent neck pain ( pain at 1 , 3 , and 12 months after collision ) . Results : The baseline survey included 765 patients . Subsequently , 480 completed a question naire at each follow up time point , of whom 128 ( 27 % ) reported neck pain on each occasion . Few collision specific factors predicted persistent neck pain . In contrast , a high level of general psychological distress , pre-collision history of widespread body pain , type of vehicle , whiplash associated symptoms , and initial neck disability best predicted the persistence of symptoms . Furthermore , these factors , in combination , accounted for more than a fivefold increase in the risk of persistent neck pain . Conclusion : The greatest predictors of persistent neck pain following a motor vehicle collision relate to psychological distress and aspects of pre-collision health rather than to various attributes of the collision itself . With these factors , and those relating to initial injury severity , it is possible to identify a subgroup of patients presenting with neck pain with the highest risk of persistent symptoms . Thus , it is possible to identify whiplash patients with a poor prognosis and to provide closer follow up and specific attention to management in these individuals Study Design . Concealed allocation , multicenter , single-blind , r and omized controlled clinical trial . Objective . To assess the efficacy of an educational video in the tertiary prevention of persistent WAD symptoms following rear-end motor vehicle collisions ( MVCs ) . Summary of Background Data . Whiplash-associated disorders ( WAD ) are an important and costly health problem . There is a lack of high quality evidence surrounding efficacy of treatments for WAD . Existing research supports active interventions and early return to regular activities . Methods . Consecutive patients presenting to four tertiary care emergency departments following rear-end MVCs were eligible . Following informed consent , patients were allocated , using central r and omization , to receive an educational video plus usual care or usual care alone . The video provided reassurance , and advice about posture , return to regular activities , exercises , and pain-relief methods . Data were collected by telephone using st and ardized question naires . The primary outcome was presence of Persistent WAD Symptoms at 24 weeks postinjury , based on the frequency and severity of neck , shoulder , or upper back pain . The absolute difference in proportion of patients with persistent WAD symptoms and rate ratios were calculated . Changes in pain scores were compared using the Mann-Whitney U test . Results . The  intervention ( n = 206 ) and control ( n = 199 ) groups were similar at baseline ( mean age 38.4 years ; 64 % female ) . Overall , the proportion of subjects with Persistent WAD Symptoms decreased from 89.1 % at baseline to 33.6 % at 24 weeks after injury . At 24 weeks , the proportion of subjects with persistent WAD symptoms in the intervention group was 7.9 % ( 95 % CI , −2.0 , 17.8 ) lower than the control group . The median improvement in pain score at 24 weeks was 3 for the intervention group and 2 for the control group ( P = 0.016 ) . Conclusion . The presence of persistent WAD symptoms following simple rear-end MVCs was high in this sample . The video group demonstrated a trend toward less severe WAD symptoms . We recommend evaluating other educational interventions that could reduce WAD symptoms The authors undertook a case-control study of chronic neck pain and whiplash injuries in nine states in the United States to determine whether whiplash injuries contributed significantly to the population of individuals with chronic neck and other spine pain . Four hundred nineteen patients and 246 controls were r and omly enrolled . Patients were defined as individuals with chronic neck pain , and controls as those with chronic back pain . The two groups were surveyed for cause of chronic pain as well as demographic information . The two groups were compared using an exposure-odds ratio . Forty-five per cent of the patients attributed their pain to a motor vehicle accident . An OR of 4.0 and 2.1 was calculated for men and women , respectively . Based on the results of the present study , it reasonable to infer that a significant proportion of individuals with chronic neck pain in the general population were originally injured in a motor vehicle accident OBJECTIVES To evaluate the relationship between performance-based risk factors and subsequent at-fault motor vehicle collision ( MVC ) involvement in a cohort of older drivers . DESIGN Prospect i ve cohort study . SETTING Motor Vehicle Administration ( MVA ) field sites in Maryl and . PARTICIPANTS Of the 4,173 older drivers invited to participate in the study , 2,114 individuals aged 55 to 96 agreed to do so . These analyses focus on 1,910 individuals recruited through MVA field sites . MEASUREMENTS  Gross Impairment Screening Battery  , which included  Rapid Pace Walk , Head/Neck Rotation , Foot Tap , Arm Reach , Cued Recall , Symbol Scan , Visual Closure subtest of the Motor Free Visual Perception Test ( MVPT ) , Delayed Recall , and Trail Making Test with an Abbreviated Part A and  st  and ard Part B ; Useful Field of View ( UFOV ) subtest 2 ; a Mobility Question naire ; and MVC occurrence . RESULTS In drivers aged 55 and older with intact vision ( 20/70 far visual acuity and 140 degrees visual field ) , age , sex , history of falls , and poorer cognitive performance , as measured using Trails B , MVPT , and UFOV subtest 2 , were predictive of future at-fault MVC involvement . After adjusting for annual mileage , participants aged 78 and older were 2.11 as more likely to be involved in an at-fault MVC , those who made four or more errors on the MVPT were 2.10 times as likely to crash , those who took 147 seconds or longer to complete Trails B were 2.01 times as likely to crash , and those who took 353 ms or longer on subtest 2 of the UFOV were 2.02 times as likely to incur an at-fault MVC . Older adults , men , and individuals with a history of falls were more likely to be involved in subsequent at-fault MVCs . CONCLUSION Performance-based cognitive measures are predictive of future at-fault MVCs in older adults . Cognitive performance , in particular , is a salient predictor of subsequent crash involvement in older adults . High-risk older drivers can be identified through brief , performance-based measures administered in a MVA setting BACKGROUND Patients with untreated obstructive sleep apnoea ( OSA ) have increased motor vehicle collisions ( MVCs ) . When successfully treated , they report improved driving and fewer mishaps , but there are few objective data to confirm this . A study was therefore undertaken to examine actual MVC data in a large group of patients with OSA before and after treatment with continuous positive airway pressure ( CPAP )  compared with a control group matched for age , sex , and type of driver 's licence ( commercial or non-commercial ) . METHODS Two hundred and ten patients of mean ( SD ) age 52 ( 11 ) years , body mass index ( BMI ) 35.5 ( 10 ) kg/m2 , apnoea/hypopnoea index ( AHI ) 54 ( 29 ) events/h were treated with CPAP for at least 3 years .  MVC records were obtained from the Ontario Ministry of Transportation ( MTO ) data base for patients and an equal number of r and omly selected control drivers . MVC rates were compared for 3 years before and after CPAP therapy for patients and for the corresponding time frames for controls . RESULTS Untreated patients with OSA had more MVCs than controls ( mean ( SD ) MVCs/driver/year 0.18 ( 0.29 ) v 0.06 ( 0.17 ) , p<0.001 ) . Following CPAP treatment the number of MVCs/driver/year fell to normal ( 0.06 ( 0.17 ) ) while , in controls , the MVC rate was unchanged over time ( 0.06 ( 0.17 ) v 0.07 ( 0.18 ) , p = NS ) . Thus , the change in MVCs over time between the groups was very significant ( change = –0.12 ( 95 % CI –0.17 to –0.06 ) , p<0.001 ) ) . The MVC rate in untreated patients ( n=27 ) remained high over time . Driving exposure was not different following CPAP . CONCLUSIONS The risk of MVCs due to OSA is removed when patients are treated with CPAP . As such , any restrictions on driving because of OSA could be safely removed after treatment OBJECTIVE To determine the incidence , course , and prognosis of adult mild traumatic brain injury ( MTBI ) caused by motor vehicle collisions . DESIGN Prospect i ve , population -based , inception cohort study . SETTING The province of Saskatchewan , Canada , with a population of about 1,000,000 inhabitants . PARTICIPANTS All adults ( N=1716 ) incurring an MTBI in a motor vehicle collision between November 1997 and December 1999 in Saskatchewan . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Age- and sex-stratified incidence rates , time to self-reported recovery , and prognostic factors over a 1-year follow-up . RESULTS Of 7170 adults injured in a motor vehicle collision over the 2-year inception period , 1716 ( 24 % ) met our cohort definition of MTBI . There were more women affected ( 53 % ) , and MTBI was most common in the 18- to 23-year-old group . Most were not hospitalized ( 73 % ) , but 28 % reported loss of consciousness and 23 % reported posttraumatic amnesia . The annual incidence of MTBI per 100,000 adults was 106.1 ( 95 % confidence interval [ CI ] , 98.9 - 113.6 ) in the first year and 118.3 ( 95 % CI , 110.8 - 126.3 ) in the second year of the study . The 1-year follow-up rate was 84 % . The median time to recovery was 100 days ( 95 % CI , 97 - 103 ) , and about 23 % reported not having recovered by 1 year . Factors associated with delayed recovery included being older than 50 years , having less than a high school education , having poor expectations for recovery , having depressive symptoms , having arm numbness , having hearing problems , having headaches , having low back pain , and having thoracic back pain . Loss of consciousness and posttraumatic amnesia were not associated with recovery . CONCLUSIONS MTBI affects almost a quarter of persons reporting an injury after a traffic collision . The median time to recovery is 100 days , but 23 % have still not recovered by 1 year . A mix of biopsychosocial factors is associated with recovery , including a strong effect of poor expectations for recovery
CONCLUSIONS There was a consistent positive association among studies that have examined the association between MVC-related neck injury and future NP .
OBJECTIVE To summarize the literature that has examined the association between a motor vehicle collision ( MVC ) related neck injury and future neck pain ( NP )  in comparison with the population that has not been exposed to neck injury from an MVC .
LITERATURE SURVEY Neck injury result ing from an MVC is associated with a high rate of chronicity .
Prognosis studies indicate 50 % of injured people continue to experience NP a year after the collision .
This is difficult to interpret due to the high prevalence of NP in the general population .