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The aetiology of persistent neck pain after a whiplash injury
Başlık:
The aetiology of persistent neck pain after a whiplash injury
Yazar:
Atherton, Kate, author.
ISBN:
9780355978506
Yazar Ek Girişi:
Fiziksel Tanımlama:
1 electronic resource (233 pages)
Genel Not:
Source: Dissertation Abstracts International, Volume: 76-08C.
Özet:
Aims and objectives: The principal aim of the current study was to identify the most important predictors of persistent neck pain after a whiplash injury. Pre-collision health, collision, psychological and psychosocial factors were investigated for their relative contribution to the persistence of neck pain in order to develop an aetiological understanding of why pain persists. A second objective of the study was to identify, soon after the collision, individuals who were at risk of neck pain persistence. The independent aetiological predictors were used alongside features of the acute whiplash injury to identify individuals at high risk of persistent pain at the time of their presentation to the Emergency Department. Methods: The study was a prospective cohort study that recruited patients attending local Emergency Departments with neck pain within 24 hours of a motor vehicle collision. Risk factors were assessed by postal questionnaire mailed to the participant's home immediately after their hospital attendance. In addition, clinical information from their hospital notes was collected. Responders were followed up one, three and twelve months after their collision by postal questionnaire and their current neck pain assessed. The primary outcome was persistent neck pain, defined as a report of neck pain at the initial and three follow-up assessments. Results: The patient population was relatively young (median age: 32 years; IQR: 24.3, 42.0 years) and evenly split with respect to gender (females- 47.7%). Females and older patients were more likely to participate in the study, however this was not found to affect the validity of the study or the generalisability of the results. In total, 765 patients completed an initial study questionnaire and 480 completed a questionnaire at every stage of follow-up. 27% of respondents reported persistent neck pain in the twelve months following their motor vehicle collision. After accounting for differences in age and gender between respondents and patients who did not participate, this was equivalent to a minimum persistent neck pain prevalence of 19%. Relatively few of the factors assessed for predictive ability were associated with persistent neck pain. Some features of the collision, such as the perceived severity of the collision (RR; 1.58, 95%CI; 1.01-2.47) and type of vehicle (RR; 1.99, 95%CI: 0.96-4.15) were associated with an increase in the risk of persistent neck pain however, both measures of post-collision psychological state included in the study were significantly associated with outcome. A high level of psychological distress, measured by the General Health Questionnaire (RR: 2.13, 95%CI: 1.30-3.49) and a high sensitivity to somatic symptoms, measured by the Modified Somatic Perception Questionnaire (RR: 1.59, 95%CI: 1.08-2.33) were both found to be predictive at a significance level of p=0.10. A multivariable model identified two factors, psychological distress and vehicle type, as independently predictive of persistent neck pain. Self-reported features of the acute whiplash injury were significantly associated with persistent neck pain; two acute injury factors, number of reported WAD symptoms and level of neck disability, best identified individuals at risk of persistent neck pain, with a sensitivity of 60% and a specificity of 66%. Conclusions: The persistence of neck pain amongst individuals presenting to an Emergency Department with neck pain after a motor vehicle collision is not uncommon. This study suggests that, despite being originating from a motor vehicle collision, it is the post-collision psychological state of the individual that is most important in determining the persistence of neck pain after a whiplash injury. Features of the acute injury may provide the best means of identifying individuals at high risk of neck pain persistence. This at risk group may be targeted for preventative management strategies or recruited into randomised trials to maximise the identification of suitable interventions.
Notlar:
School code: 1543
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Yer Numarası | Demirbaş Numarası | Shelf Location | Lokasyon / Statüsü / İade Tarihi |
---|---|---|---|
XX(683886.1) | 683886-1001 | Proquest E-Tez Koleksiyonu | Arıyor... |
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