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. Two different courses of impaired cervical kinaesthesia following a whiplash injury. A one-year prospective study. Categorising the severity of neck pain: Establishment of cut-points for use in clinical and epidemiological research Are early MRI findings correlated with long-lasting symptoms following whiplash injury? A prospective trial with 1-year follow-up Availability of Child Passenger Safety Resources to Emergency Physicians Practicing in Emergency Departments Within Pediatric, Adult, and Nontrauma Centers: A National Survey Headache, Neck Pain, and Neck Mobility After Acute Whiplash Injury: A Prospective Study Pain after whiplash: a prospective controlled inception cohort study A prehospital glasgow coma scale score < or = 14 accurately predicts the need for full trauma team activation and patient hospitalization after motor vehicle collisions. Cognitive training decreases motor vehicle collision involvement of older drivers. Potential risk factors for prolonged recovery following whiplash injury An endurance-strength training regime is effective in reducing myoelectric manifestations of cervical flexor muscle fatigue in females with chronic neck pain Environmental factors and the risk for childhood pedestrian-motor vehicle collision occurrence. Risk factors for neck pain: a longitudinal study in the general population Computerized Mobilization of the Cervical Spine for the Treatment of Chronic Neck Pain Natural evolution of late whiplash syndrome outside the medicolegal context Prospective validation of an out-of-hospital decision rule to identify seriously injured children involved in motor vehicle crashes. Social Support and Pain Outcomes After Trauma Exposure Among Older Adults: A Multicenter Longitudinal Study
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 A longitudinal study was conducted to observe persons with neck pain after motor vehicle collisions . The aims were to reveal the prospect i ve development of cervical kinaesthesia and to investigate the association between the test results and self-reported pain and disabilities . Two different cervical kinaesthetic tests , the Fly test and the Head-Neck Relocation test , measured movement control and the relocation accuracy of the cervical spine , respectively . Self- assessment measures included pain intensity ( VAS ) , neck pain and disability ( NDI ) , fear of re-injury ( TAMPA ) and psychological distress ( GHQ-28 ) .  Seventy-four subjects entered the study , but 47 were eligible , as they participated in all 4 measurements at 1 , 3 , 6 and 12 months post-collision . According to the performances on the two kinaesthetic tests , the subjects could be classified into improvement and non-improvement groups , respectively . The result revealed , for the first time , two different courses of deficient cervical kinaesthesia . About half of the participants showed significant deteriorating performances in both kinaesthetic tests throughout the year ( p < 0.002 ) , while the other half improved their performances ( p < 0.02 ) . Generally , the relationships between the kinaesthetic tests and the self- assessment scores were not significant , irrespective of the performances on the two kinaesthetic tests . Accordingly , the results of the question naires correlated poorly or weakly with the kinaesthetic test results at all assessment points . The need for developing a new question naire , capturing the symptoms prevalent in patients with neck pain and cervical sensorimotor impairments is urgent . What determines the two different kinaesthetic courses need to be scrutinised in future research Abstract Grading pain intensity scales into simple categories provides useful information for both clinicians and epidemiologists and methods to classify pain severity for numerical rating scales have been recommended . However , the establishment of cut‐points is still in its infancy and little is known as to whether cut‐points are affected by age or gender . The objectives of this paper were to establish optimal cut‐points in pain severity in individuals with neck pain ( NP ) and to investigate if the cut‐points were influenced by gender , age , and NP duration . Data from the population ‐based ‘ Funen Neck and Chest Pain Study ’ was used . Univariate and multivariate analyses of variance were performed to calculate optimal single and double cut‐points for three different pain intensity scores within the past 2 weeks relative to two neck disability scales ( ‘ global assessment of NP ’ and the ‘ Copenhagen Neck Functional Disability Scale ’ ) . The two disability scales showed small differences in optimal cut‐points . Furthermore , cut‐points changed for each of the three pain intensity scales . Only small gender differences in cut‐points were seen and no specific trend was noted in either single or double cut‐points in different age groups . The cut‐points were almost identical for acute , subacute , and chronic NP . This paper has implication s for underst and ing the impact of using different pain intensity scales and provides reference cut‐points in NP for use in future clinical and epidemiological research Neck pain is the cardinal symptom following whiplash injuries . The trauma mechanism could theoretically lead to both soft tissue and bone injury that could be visualised by means of MRI . From previous quite small trials it seems that MRI does not demonstrate significant tissue damage . Large prospect ively followed cohorts are needed to identify possible clinical ly relevant MRI findings . The objective of this trial was to evaluate ( 1 ) the predictive value of cervical MRI  after whiplash injuries and ( 2 ) the value of repeating MRI examinations after 3 months including sequences with flexion and extension of the cervical spine . Participants were included after rear-end or frontal car collisions . Patients with fractures or dislocations diagnosed by st and ard procedures at the emergency unit were not included .  MRI scans of the cervical spine were performed at baseline and repeated after 3 months . Clinical follow-ups were performed after 3 and 12 months . Outcome parameters were neck pain , headache , neck disability and working ability .  A total of 178 participants had a cervical MRI scan on average 13 days after the injury . Traumatic findings were observed in seven participants . Signs of disc degeneration were common and most frequent at the C5–6 and C6–7 levels . Findings were not associated with outcome after 3 or 12 months . The population had no considerable neck trouble prior to the whiplash injury and the non-traumatic findings represent findings to be expected in the background population . Trauma-related MRI findings are rare in a whiplash population screened for serious injuries in the emergency unit and not related to a specific symptomatology . Also , pre-existing degeneration is not associated with prognosis Objectives More can be done to eliminate preventable motor vehicle collision (MVC)–related injuries through correct and consistent use of child passenger restraints . This study sought to determine emergency physician awareness of and referral patterns to child passenger safety re sources and to compare awareness and referrals by practice setting . Methods This was a cross-sectional mailed survey of a national r and om sample of 1200 emergency physicians drawn from the American Medical Association Physician Masterfile . Results Responses were returned by 638 ( 64 % ) of 1000 of physicians with a valid mailing address . Fifty-two percent reported working in an emergency department ( ED ) within a pediatric trauma center , 23 % in an adult trauma center , and 25 % in a nontrauma center . Police or fire department car seat installation programs were most frequently available ( 65 % pediatric , 56 % adult , 48 % nontrauma center ) , and free/reduced-price booster seat programs least frequently available ( 46 % pediatric , 30 % adult , 23 % nontrauma center ) ( P < 0.001 ) . Half of pediatric trauma center physicians would always recommend replacement of a 3-year-old ’s car seat following a roll-over MVC compared with one third of adult and nontrauma center physicians ( P < 0.001 ) . There were no significant differences by practice setting for distribution of discharge instructions containing child passenger safety information or referrals to available re sources . Conclusions Availability of child passenger safety re sources for children discharged from EDs following an MVC varies by practice setting . Pediatric injury prevention outreach to general EDs is needed to increase the number of children who are benefiting from existing community child passenger re sources Study Design . A 6-month prospect i ve study of neck mobility in patients with acute whiplash injury and a control group with acute ankle distortion  was conducted . Objectives . To assess active  neck mobility  after acute whiplash and ankle distortion injuries , and to relate neck mobility to headache , neck pain , and speed of car at the time of collision . Summary of background data . A major problem after whiplash injury is restriction of neck mobility immediately subsequent to trauma . It is , however , unclear whether neck mobility changes after the acute injury are related to the associated headache and neck pain . Methods . Cervical range of neck motion , neck pain , and headache were assessed after 1 week , then 1 , 3 , and 6 months after injury in 141 patients with acute whiplash injury , and in 40 patients with acute nonsport ankle distortion .  Results . Patients with whiplash injury had significantly reduced flexion , extension , lateral flexion , and rotation of the neck immediately after injury , as compared with patients with ankle distortion injury . Neck mobility , however , was similar in the two groups after 3 months . In patients with whiplash injury , neck pain and neck mobility were found to be related inversely to reported headache and neck mobility . Neck mobility was not significantly related to a difference in car speed at the time of collision . Conclusions . Neck mobility is reduced immediately after , but not 3 months after , a whiplash trauma . Headache and neck mobility are related inversely and neck pain and neck mobility are related inversely during the first 6 months after acute whiplash injury OBJECTIVES In Lithuania , there is little awareness of the notion that chronic symptoms may result from rear end collisions via the so-called whiplash injury . After most such collisions no contact with the health service is established . An opportunity therefore exists to study post-traumatic pain without the confounding factors present in western societies . METHODS In a prospect i ve , controlled inception cohort study , 210 victims of a rear end collision were consecutively identified from the daily records of the Kaunas traffic police .  Neck pain and headache were evaluated by mailed question naires shortly after the accident , after 2 months , and after 1 year . As controls , 210 sex and age matched subjects were r and omly taken from the population register of the same geographical area and evaluated for the same symptoms immediately after their identification and after 1 year . RESULTS Initial pain was reported by 47 % of accident victims ; 10 % had neck pain alone , 18 % had neck pain together with headache , and 19 % had headache alone . The median duration of the initial neck pain was 3 days and maximal duration 17 days . The median duration of headache was 4.5 hours and the maximum duration was 20 days . After 1 year , there were no significant differences between the accident victims and the control group concerning frequency and intensity of these symptoms . CONCLUSIONS In a country were there is no preconceived notion of chronic pain arising from rear end collisions , and thus no fear of long term disability , and usually no involvement of the therapeutic community , insurance companies , or litigation , symptoms after an acute whiplash injury are self limiting , brief , and do not seem to evolve to the so-called late whiplash syndrome BACKGROUND Trauma team activation protocol s should ideally minimize the undertriage of seriously injured patients and eliminate unnecessary activations for those patients that do not require hospitalization . This study examined which physiologic parameter(s ) most reliably predicted the need for hospitalization after motor vehicle collisions ( MVCs ) . METHODS A prehospital triage tool using st and ard physiologic parameters was developed and prospect ively analyzed for reliability in predicting subsequent patient admission at a Level II trauma center after MVCs . Data were collected on 4,014 consecutive patients , 2,880 ( 72 % ) of whom had all of the physiologic parameters reported and recorded . Patients who arrived in extremis , who were dead on arrival , or who died shortly after arrival despite appropriate trauma team activation were ineligible for the study . Multivariate stepwise logistic regression analysis was used to determine which parameters were associated with hospital admission . RESULTS The Glasgow Coma Scale ( GCS ) score was the only prehospital physiologic parameter providing a clinical ly identifiable difference between those patients admitted ( 13 + /- 4 ) and those discharged to home ( 15 + /- 0.5 ) ( mean + SD ) ( relative risk for hospitalization , 2.24 ; 95 % confidence interval , 1.86 - 2.70 for GCS score < 14 ) . CONCLUSION The prehospital GCS score is a reliable physiologic parameter for predicting hospital admission after MVC . When obvious indicators ( hypoxemia , multiple long bone fractures , focal neurologic deficits ) for trauma team activation are lacking , the prehospital GCS score may be used to reduce overtriage and undertriage rates OBJECTIVES To test the effects of cognitive training on subsequent motor vehicle collision ( MVC ) involvement of older drivers . DESIGN R and omized , controlled , multisite , single-blind clinical trial . SETTING Community-dwelling seniors at four U.S. sites : Birmingham , Alabama ; Baltimore , Maryl and ; Indianapolis , Indiana ; and State College , Pennsylvania . PARTICIPANTS Nine hundred eight older drivers ( mean age 73.1 ; 18.6 % African American ) who were r and omized to one of three cognitive interventions or a control condition .  INTERVENTIONS Up to 10 sessions of cognitive training for memory , reasoning , or speed of processing .  MEASUREMENTS State-recorded MVC involvement up to 6 years after study enrollment . RESULTS Speed-of-processing and reasoning training result ed in lower rates of at-fault collision involvement over the subsequent approximately 6-year period than controls . After adjusting for age , sex , race , education , mental status , health , vision , depressive symptoms , and testing site , participants r and omized to the speed-of-processing and reasoning interventions had an approximately 50 % lower rate ( per person-mile ) of at-fault MVCs than the control group ( rate ratio ( RR ) = 0.57 , 95 % confidence interval ( CI ) = 0.34 - 0.96 for speed of processing ) , and ( RR = 0.50 , 95 % CI = 0.27 - 0.92 for reasoning ) . There was no significant difference observed for the memory group . CONCLUSION Cognitive speed-of-processing and reasoning training result ed in a lower at-fault MVC rate in older drivers than in controls . Considering the importance of driving mobility , the costs of crashes , and the benefits of cognitive training , these interventions have great potential to sustain independence and quality of life of older adults . More research is needed to underst and the effects of different types and quantities of training A retrospective analysis of insurance data was made of 600 individuals cl aim ing compensation for whiplash following motor vehicle accidents . Three hundred r and omly selected cl aim ants who had settled their injury cl aims within 9 months of the accident were compared with 300 who had settled more than 24 months after the accident . We compared the two groups to identify possible risk factors for prolonged recovery , for which settlement time greater than 24 months was a marker . Variables considered included demographic factors , type of collision , degree of vehicle damage , workers compensation , prior cl aim or neck disability , treatment and time to settlement .  Consulting a solicitor was associated with a highly significant , four-fold increase of late settlement of the cl aim . A concurrent workers ’ compensation cl aim , prior neck disability and undergoing physiotherapy or chiropractic treatment were weakly associated with late settlement . The degree of damage to the vehicle ( as indicated by cost of repairs ) was not a significant predictor of late settlement . Late settlement may be the direct effect of legal intervention , independent of the severity of the injury . Whilst the financial benefit to the cl aim ant of consulting a solicitor is apparent , the benefit of prolonged disability is not . It may be to the advantage of both insurers and cl aim ants if those likely to proceed to late settlement could be recognised early and their cl aims settled expeditiously OBJECTIVE The purpose of this study was to investigate whether an endurance-strength training program is effective in reducing myoelectric manifestations of sternocleidomastoid ( SCM ) and anterior scalene ( AS ) muscle fatigue which have been found to be greater in people with chronic neck pain . METHODS Fifty-eight female patients with chronic non-severe neck pain were r and omized into one of two 6-week exercise intervention groups : an endurance-strength training regime for the cervical flexor muscles or a referent exercise intervention involving low load retraining of the cranio-cervical flexor muscles . The primary outcomes were a change in maximum voluntary contraction ( MVC ) force and change of the initial value and rate of change of the mean frequency , average rectified value and conduction velocity detected from the SCM and AS muscles during sub-maximal isometric cervical flexion contractions at 50 , 25 and 10 % MVC . RESULTS At the 7th week follow-up assessment , the endurance-strength training group revealed a significant increase in MVC force and a reduction in the estimates of the initial value and rate of change of the mean frequency for both the SCM and AS muscles ( P<0.05 ) . Both exercise groups reported a reduced average intensity of neck pain and reduced neck disability index score ( P<0.05 ) . CONCLUSIONS An endurance-strength exercise regime for the cervical flexor muscles is effective in reducing myoelectric manifestations of superficial cervical flexor muscle fatigue as well as increasing cervical flexion strength in a group of patients with chronic non-severe neck pain . SIGNIFICANCE Provision of load to challenge the neck flexor muscles is required to reduce the fatigability of the SCM and AS muscles in people with neck pain . Improvements in cervical muscle strength and reduced fatigability may be responsible for the reported efficacy with this type of exercise program In King County , Washington , during 1985 - 1986 , 98 children aged less than 15 years involved in pedestrian-motor vehicle collisions result ing in death or injuries severe enough to require hospitalization were identified through the Trauma Registry at the Regional Trauma Center and the Medical Examiner 's Office . Two age- and sex-matched controls were selected for each case , one through r and om digit dialing and the other from children undergoing appendectomy .  Various environmental and traffic characteristics were ascertained from visits to the neighborhoods of all subjects . Children living in multifamily dwellings had a risk for injury that was 5.5 times greater than children living in single family homes ( 95 % confidence interval 2.5 - 12.3 ) . In general , areas with busier streets ( greater posted vehicle speeds and /or greater traffic volumes ) were associated with increased risk for pedestrian injuries . The lack of pedestrian crossing devices , crosswalks , or sidewalks , however , was not associated with an increased risk . When the analysis was restricted to the 23 cases injured in front of their homes and their controls , risks were not elevated for any of the street or traffic characteristics . The small size of the study and the lack of relevant information for many subjects limited our ability to adjust for the likely confounding influence of other household/environmental factors . Thus , these results should be viewed as suggestions for future investigations of the causes of childhood pedestrian injuries & NA ; The objective of the study was to examine the 1‐year cumulative incidence of episodic neck pain and to explore its associations with individual risk factors , including a history of previous neck injury . A baseline cross‐sectional survey of an adult general population sample made up of all 7669 adults aged 18–75 years , registered with two family practice s in South Manchester , United Kingdom , identified the study population of adults with no current neck pain . This study population was surveyed again 12 months later to identify all those who had experienced neck pain during the follow‐up period . At follow‐up , cumulative 1‐year episode incidence of neck pain was estimated at 17.9 % ( 95 % confidence interval 16.0–19.7 % ) . Incidence was independent of age , but was more common in women . A history of previous neck injury at baseline was a significant risk factor for subsequent neck pain in the follow‐up year ( risk ratio 1.7 , 95 % confidence interval 1.2–2.5 ) , independent of gender and psychological status . Other independent baseline risk factors for subsequent neck pain included number of children , poor self‐assessed health , poor psychological status and a past history of low back pain . We have carried out a prospect i ve study in a general population sample and demonstrated that established risk factors for chronic pain predict future episodes of neck pain , and shown that in addition a history of neck injury is an independent and distinct risk factor . This finding may have major public health and medicolegal implication Background : Manual therapies for chronic neck pain ( NP ) are imprecise , inconsistent , and brief because of therapist fatigue . Objective : Investigate the safety and efficacy of computerized mobilization of the cervical spine in the sagittal plane for the treatment of chronic NP . Design : Pilot open trial . Setting : Physical therapy outpatient department . Participants : Ten patients with chronic NP . Interventions : A computerized cradle capable of 3-dimensional neck mobilization was utilized . However , in the present trial the cradle was only utilized in the sagittal plane . Treatment sessions lasted 20 minutes , biweekly , for 6 weeks . Main Outcome Measures : Numerical rating scale for pain , Neck Disability Index question naire , muscle algometry , cervical range of motion ( CROM ) , surface electromyography , and 36-item Short Form Health Survey question naire . Results : Treatment was not associated with any significant adverse effects . Pain scores reduced by 2±0.5 numerical rating scale points . CROM showed significant improvement at the end of the study ( P<0.05 ) . Neck Disability Index showed marked improvement by the fourth week , end of study , and 2 weeks after treatment ( P<0.05 ) ; headache subscale showed marked reduction . Conclusions : These preliminary results demonstrate the safety of a novel computerized mobilization of the cervical spine . In addition , the data suggest that this method is effective in increasing CROM and in alleviating NP and associated headache BACKGROUND In Lithuania , few car drivers and passengers are covered by insurance and there is little awareness among the general public about the potentially disabling consequences of a whiplash injury . We took this opportunity to study the natural course of head and neck symptoms after rear-end car collisions . METHODS In a retrospective question naire-based cohort study , 202 individuals ( 157 men ; 45 women ) were identified from the records of the traffic police department in Kaunas , Lithuania . These individuals were interviewed 1 - 3 years after experiencing a rear-end car collision . Neck pain , headache , subjective cognitive dysfunction , psychological disorders , and low back pain in this group were compared with the same complaints in a sex-matched and age-matched control group of uninjured individuals selected r and omly from the population register of the same geographic area . FINDINGS Neck pain was reported by 71 ( 35 % [ 95 % CI 29 - 42 ] ) accident victims and 67 ( 33 % [ 27 - 40 ] ) controls . Headache was reported by 107 ( 53 % [ 46 - 60 ] ) accident victims and 100 ( 50 % [ 42 - 57 ] ) controls . Chronic neck pain and chronic headache ( more than 7 days per month ) were also reported in similar proportions ( 17 [ 8.4 % ; 5 - 13 ] vs 14 [ 6.9 % ; 4 - 12 ] and 19 [ 9.4 % ; 6 - 15 ] vs 12 [ 5.9 % ; 3 - 10 ] ) by the two groups . Of those who reported chronic neck pain or daily headache after the accident , substantial proportions had had similar symptoms before the accident ( 7/17 for chronic neck pain ; 10/12 for daily headache ) . There was no significant difference found . No one in the study group had disabling or persistent symptoms as a result of the car accident . There was no relation between the impact severity and degree of pain . A family history of neck pain was the most important risk factor for current neck symptoms in logistic regression analyses . INTERPRETATION Our results suggest that chronic symptoms were not usually caused by the car accident . Expectation of disability , a family history , and attribution of pre-existing symptoms to the trauma may be more important determinants for the evolution of the late whiplash syndrome OBJECTIVES To prospect ively vali date a previously published out-of-hospital clinical decision rule to identify seriously injured children involved in motor vehicle crashes ( MVCs ) . METHODS The authors selected 20 Los Angeles County Fire Department fire stations , based on pediatric MVC call volume and geographic diversity , and 21 associated hospitals for participation in the study . Immediately following an MVC call involving a pediatric patient aged 0 - 14 years , each engine/paramedic squad completed a data form ( 15 variables , including vital signs , Glasgow Coma Scale score , and vehicular and crash characteristics ) . This study was conducted over a 24-month period . Outcomes included : 1 ) " serious injury " as defined by an Injury Severity Score ( ISS ) > or = 16 ( primary outcome ) , and 2 ) need for specialized trauma care ( emergent intubation , major nonorthopedic operative intervention or death in the first 24 hours , or pediatric intensive care unit stay longer than 48 hours ) , as assessed by retrospective chart review . Accuracy measures and binominal confidence intervals ( CIs ) were calculated for the decision rule validation . RESULTS One hundred seventy-five children were prospect ively enrolled in the study ; 36 children were excluded due to lack of hospital participation or missing hospital charts . There were four children with ISS > or = 16 ( 3 % ) and six children requiring specialized trauma care ( 4 % ) . The sensitivities and specificities of the rule were : 100 % ( 95 % CI = 40 % to 100 % ) and 73 % ( 95 % CI = 65 % to 81 % ) for serious injury , and 83 % ( 95 % CI = 36 % to 100 % ) and 74 % ( 95 % CI = 65 % to 81 % ) for specialized trauma care , respectively . CONCLUSIONS Although definitive conclusions are limited by the sample size , the decision rule identified all seriously injured children involved in MVCs and had moderate specificity . The decision rule was less sensitive for identifying children requiring specialized trauma care . Larger validation studies are needed to adequately assess the utility of this rule before implementation Objectives : Certain forms of social support have been shown to improve pain-coping behaviors and pain outcomes in older adults with chronic pain , but little is known about the effect of social support on pain outcomes in older adults following trauma exposure . Methods : We analyzed data from a prospect i ve longitudinal study of adults aged 65 years and older presenting to an emergency department after a motor vehicle collision ( MVC )  to characterize the relationship between perceived social support and MVC-related pain after trauma overall and by subgroups based on sex , depressive symptoms , and marital status . Results : In our sample ( N=176 ) , patients with low perceived social support had higher pain severity 6 weeks after MVC than patients with high perceived social support after adjustment for age , sex , race , and education ( 4.2 vs. 3.2 , P=0.04 ) . The protective effect of social support on pain severity at 6 weeks was more pronounced in men and in married individuals . Patients with low social support were less likely to receive an opioid prescription in the emergency department ( 15 % vs. 32 % , P=0.03 ) , but there was no difference in opioid use at 6 weeks ( 22 % vs. 20 % , P=0.75 ) . Discussion : Among older adults experiencing trauma , low perceived social support was associated with higher levels of pain at 6 weeks
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 .