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Onset of Neck Pain After a Motor Vehicle Accident:
A Case-Control Study
NICOLA J. WILES, GARETH T. JONES, ALAN J. SILMAN, and GARY J. MACFARLANE
ABSTRACT. Methods. We conducted a case-control study of drivers (ages 17–70 yrs) who reported a motor vehicle accident to their insurance company. A self-report mailed questionnaire retrospectively collected information on the driver's pre- and post-accident health, details of the accident, and other exposure data. Case/control status (post-accident neck pain) was ascertained using a preshaded manikin. Results. In total, 26% of drivers reported post-accident neck pain. Women, younger individuals, and those with a history of neck pain were more likely to report neck pain following their accident (OR 1.50, 95% CI 0.98, 2.28; OR 1.62, 95% CI 0.96, 2.74; OR 1.75, 95% CI 1.09, 2.81, respectively). In addition, a number of accident related and psychosocial factors were independently associated with reporting post-accident neck pain: collision from behind (OR 2.55, 95% CI 1.41, 4.62); vehicle stationary at impact (OR 1.93, 95% CI 1.12, 3.33); collision severity (upper vs lowest tertile: OR 16.1, 95% CI 8.64, 30.1); not being at fault (OR 2.61, 95% CI 1.49, 4.59); and monotonous work (OR 2.19, 95% CI 1.19, 4.04). Based on these 8 factors, the likelihood of having neck pain increased from 7% with ≤ 2 risk factors to 62% with ≥ 5. Conclusion. Development of neck pain after a motor vehicle accident is a complex phenomenon resulting from the combined effects of constitutional, mechanical, and psychosocial factors. Using 8 such variables it is possible to identify those at high risk of developing neck pain. (J Rheumatol 2005;32:1576–83) Key Indexing Terms:
EPIDEMIOLOGY
From the ARC Epidemiology Unit and the Unit of Chronic Disease Epidemiology, Division of Epidemiology and Health Sciences, University of Manchester, Manchester, United Kingdom. Supported by the Association of British Insurers and the Arthritis Research Campaign (ARC), Chesterfield, United Kingdom. N.J. Wiles, PhD, Lecturer in Epidemiology; G.T. Jones, PhD, Lecturer in Rheumatic Disease Epidemiology; A.J. Silman, MD, Professor of Rheumatic Disease Epidemiology, Epidemiology Unit; G.J. Macfarlane, MD, Professor of Epidemiology, Unit of Chronic Disease Epidemiology. Address reprint requests to Prof. G.J. Macfarlane, Aberdeen Pain Research (Epidemiology) Group, Department of Public Health, School of Medicine, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, Scotland. E-mail: g.j.macfarlane@abdn.ac.uk Accepted for publication March 29, 2005. |