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GWENLLIAN WYNNE-JONES, GARETH T. JONES, NICOLA J. WILES, ALAN J. SILMAN, and GARY J. MACFARLANE ABSTRACT. Objective. To determine, in a group of persons involved in a motor vehicle collision, the contributions of pre-collision health and psychological factors, the social environment, collision-specific factors, and post-collision symptoms, to the new onset of widespread pain (WP). Methods. A prospective cohort study of persons, registered with an insurance company, who had recently experienced a motor vehicle collision. Participants were sent a questionnaire to assess pre-collision health, collision-specific factors, post-collision health, and WP. Those reporting WP prior to the collision were excluded from followup. At 12 months, participants were sent a followup questionnaire to ascertain one-month period prevalence of (new onset) WP. Results. In total 957 individuals took part in the baseline survey and were eligible for followup. Subsequently, 695 (73%) completed a questionnaire at 12 months, of whom 54 (7.8%) reported new WP. Few collision-specific factors predicted the onset of WP. In contrast, post-collision physical symptoms (rate ratio 2.5, 95% confidence interval 1.2–5.1), pre-collision health-seeking behavior (RR 3.6, 95% CI 1.6–7.9), pre-collision somatization (RR 1.7, 95% CI 0.99–2.8), and perceived initial injury severity (RR 1.7, 95% CI 0.9–3.3), in addition to older age (RR 3.3, 95% CI 1.5–7.1), were all independently predictive of new onset WP. In combination, these factors accounted for about a 20-fold difference in the risk of new onset WP. Conclusion. We identified 5 factors that independently predict the onset of WP following a motor vehicle collision. Early identification of this "at-risk" group may allow the targeting of preventive management in those at highest risk of developing future symptoms. (First Release Mar 15 2006; J Rheumatol 2006;33:968–74) Key Indexing Terms: EPIDEMIOLOGY
From the Primary Care Sciences Research Centre, Keele University, Keele; Aberdeen Pain Research Collaboration, Epidemiology Group, University of Aberdeen, Aberdeen; Academic Unit of Psychiatry, Department of Community Based Medicine, University of Bristol, Bristol; and the ARC Epidemiology Unit, The University of Manchester, Manchester, United Kingdom. Supported by the Association of British Insurers and the Arthritis Research Campaign. However, the opinions in this report, content, and choice of words are those of the authors alone. G. Wynne-Jones was funded by a Medical Research Council PhD studentship. G. Wynne-Jones, RN, BSc (Hons), Post-doctoral Research Fellow, Primary Care Sciences Research Centre, Keele University; G.T. Jones, BSc (Hons), MSc Econ, PhD, Senior Lecturer in Epidemiology, Epidemiology Group, Department of Public Health, University of Aberdeen; N.J. Wiles, BSc (Hons), PhD, Lecturer in Epidemiology, Academic Unit of Psychiatry, Department of Community Based Medicine, University of Bristol; A.J. Silman, MD, FRCP, Professor of Rheumatic Disease Epidemiology, ARC Epidemiology Unit, The University of Manchester; G.J. Macfarlane, BSc (Hons), MBChB, PhD, MD (Hons), Professor of Epidemiology, Epidemiology Group, Department of Public Health, University of Aberdeen. Address reprint requests to Dr G.T. Jones, Epidemiology Group, Department of Public Health, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK. E-mail:gareth.jones@abdn.ac.uk Accepted for publication November 15, 2005.
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