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 Prediction of Outcome in Whiplash-Associated Disorders Using West Haven–Yale Multidimensional Pain Inventory A Randomized Controlled Trial of an Educational Intervention to Prevent the Chronic Pain of Whiplash Associated Disorders Following Rear-End Motor Vehicle Collisions Can high-risk older drivers be identified through performance-based measures in a Department of Motor Vehicles setting? Polymorphisms in the glucocorticoid receptor co-chaperone FKBP5 predict persistent musculoskeletal pain after traumatic stress exposure Population-based, inception cohort study of the incidence, course, and prognosis of mild traumatic brain injury after motor vehicle collisions. Outcomes at 12 Months After Early Magnetic Resonance Imaging in Acute Trauma Patients With Persistent Midline Cervical Tenderness and Negative Computed Tomography Derivation of a clinical prediction rule to identify both chronic moderate/severe disability and full recovery following whiplash injury Neck Pain in the General Population Chronic neck pain and whiplash: a case-control study of the relationship between acute whiplash injuries and chronic neck pain. Early coping strategies do not influence the prognosis after whiplash injuries. Neck exercises, physical and cognitive behavioural-graded activity as a treatment for adult whiplash patients with chronic neck pain: Design of a randomised controlled trial Prognostic factors for poor recovery in acute whiplash patients Neither the WAD-classification nor the Quebec Task Force follow-up regimen seems to be important for the outcome after a whiplash injury. A prospective study on 186 consecutive patients Expectations for Recovery Important in the Prognosis of Whiplash Injuries Similar factors predict disability and posttraumatic stress disorder trajectories after whiplash injury
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 Objective To investigate the predictive capacity of the West Haven – Yale Multidimensional Pain Inventory ( MPI ) with regard to prolonged pain , using car occupants who had sustained a neck sprain in a traffic accident . Design A prospect i ve cohort study including a one-year follow-up . Patients One hundred thirty adults were examined by a specialized neck-injury team after a first visit to an accident and emergency department . The subjects answered the MPI question naire within one month of the accident . Outcome Measures One year later , the patients answered a question naire about residual neck pain . The main outcome was determined by the question , “ Do you have residual pain which you relate to the accident ? ” Results One hundred twenty-three ( 95 % ) of the subjects completed the study . Ninety-seven reported pain of some degree that they related to the accident . All but one of the MPI variables differed significantly between the group with residual pain and the group without pain . The variable interference had the strongest correlation with the outcome . Its discriminative capacity was 81 % for those with pain and 94 % for those without pain one year later . Conclusions The MPI may be used at an early stage to identify patients who may develop chronic neck-pain after a traffic accident , at least in those who want a follow-up session after an initial visit to an accident and emergency department 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 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 & NA ; An association is demonstrated between genetic polymorphisms in the gene coding for a key regulatory molecule in the hypothalamic‐pituitary‐adrenal axis and persistent pain after trauma . & NA ; Individual vulnerability factors influencing the function of the hypothalamic‐pituitary‐adrenal axis may contribute to the risk of the development of persistent musculoskeletal pain after traumatic stress exposure . The objective of the study was to evaluate the association between polymorphisms in the gene encoding FK506 binding protein 51 , FKBP5 , a glucocorticoid receptor co‐chaperone , and musculoskeletal pain severity 6 weeks after 2 common trauma exposures . The study included data from 2 prospect i ve emergency department‐based cohorts : a discovery cohort ( n = 949 ) of European Americans experiencing motor vehicle collision and a replication cohort of adult European American women experiencing sexual assault ( n = 53 ) .  DNA was collected from trauma survivors  at the time of initial assessment . Overall pain and neck pain 6 weeks after trauma exposure were assessed using a 0–10 numeric rating scale . After adjustment for multiple comparisons , 6 FKBP5 polymorphisms showed significant association ( minimum P < 0.0001 ) with both overall and neck pain in the discovery cohort . The association of rs3800373 , rs9380526 , rs9394314 , rs2817032 , and rs2817040 with neck pain and /or overall pain 6 weeks after trauma was replicated in the sexual assault cohort , showing the same direction of the effect in each case . The results of this study indicate that genetic variants in FKBP5 influence the severity of musculoskeletal pain symptoms experienced during the weeks after motor vehicle collision and sexual assault . These results suggest that glucocorticoid pathways influence the development of persistent posttraumatic pain , and that such pathways may be a target of pharmacologic interventions aim ed at improving recovery after trauma 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 Study Design . A prospect i ve observational cohort study of alert , neurologically intact trauma patients presenting to the emergency department with midline cervical tenderness . Screening cervical magnetic resonance imaging ( MRI ) had been conducted after negative computed tomography ( CT ) when tenderness was persistent . Objective . To determine the association of acute findings and demographic characteristics with any long-term neck disability , and with time to return to work in such patients . Summary of Background Data . The relationship between acute findings and outcomes in these patients is unknown , and we hypothesized that outcomes at 12 months would correlate with acute clinical signs and symptoms , MRI findings , and mechanisms of injury . Methods . Patients at a Level 1 trauma center with persistent midline cervical tenderness in the absence of evidence of intoxication , painful distracting injury , persistently abnormal neurology , or acute CT findings , who underwent early cervical MRI under the institutional protocol , were review ed in the outpatient spine clinic after discharge . In addition , the factors associated with neck disability and time to return to work were examined at follow-up at 12 months after presentation . Results . There were 162 of 178 patients available for follow-up at 12 months ( 91 % ) . Of these , 46 % had MRI-identified cervical spine injury at their initial examination , and 22 % had required clinical management , including 2.5 % with operative stabilization . Neck disability was present in 43 % of patients and was associated with depressive symptoms , workers ' compensation , and low annual income . Delay in return to work was associated with the presence of minor limb/other fractures and depressive symptoms , whereas patients on high annual incomes were found to return to work more quickly . Conclusion . Surprisingly in these acute trauma patients , MRI-detected injury , clinical factors , and injury mechanism were not found to be associated with long-term patient outcomes . As a result , a trial of a more targeted , individual return to work plan , including strategies aim ed at improving physical and psychological function , may now be justified to optimize long-term recovery , reduce health re source costs , and maximize economic productivity through early return to work Summary A clinical prediction rule comprising relevant biopsychosocial factors was derived to predict both  chronic moderate/severe disability and full recovery following whiplash injury . Abstract Recovery following a whiplash injury is varied : approximately 50 % of individuals fully recover , 25 % develop persistent moderate/severe pain and disability , and 25 % experience milder levels of disability . Identification of individuals likely to develop moderate/severe disability or to fully recover may help direct therapeutic re sources and optimise treatment . A clinical prediction rule ( CPR ) is a research ‐generated tool used to predict outcomes such as likelihood of developing moderate/severe disability or experiencing full recovery from whiplash injury . The purpose of this study was to assess the plausibility of developing a CPR . Participants from 2 prospect i ve , longitudinal studies that examined prognostic factors for poor functional recovery following whiplash injury were used to derive this tool . Eight factors , previously identified as predictor variables of poor recovery , were included in the analyses : initial neck disability index ( NDI ) , initial neck pain ( visual analogue scale ) , cold pain threshold , range of neck movement , age , gender , presence of headache , and posttraumatic stress symptoms ( Posttraumatic Diagnostic Scale [ PDS ] ) . An increased probability of developing chronic moderate/severe disability was predicted in the presence of older age and initially higher levels of NDI and hyperarousal symptoms ( PDS ) ( positive predictive value [ PPV ] = 71 % ) . The probability of full recovery was increased in younger individuals with initially lower levels of neck disability ( PPV = 71 % ) . This study provides initial evidence for a CPR to predict both chronic moderate/severe disability and full recovery following a whiplash injury . Further research is needed to vali date the tool , determine the acceptability of the proposed CPR by practitioners , and assess the impact of inclusion in practice Study Design A r and omized cross-sectional question naire was used to determine the prevalence of neck pain in Norwegian adults . Objectives The frequency and duration of neck pain were assessed . Summary of Background Data Reliable epidemiologic studies on the prevalence of neck pain in the general population have been sparse . Methods A question naire that inquired about neck pain within the last year was sent to a r and om sample of 10,000 adult Norwegians . Results Overall , 34.4 % of the responders had experienced neck pain within the last year . A total of 13.8 % reported neck pain that lasted for more than 6 months . Conclusions Chronic neck pain is a frequent symptom in the general population , particularly in women . Although reservations have to be taken as to the interpretation , the reported prevalence of persisting pain after whiplash injuries is of the same magnitude as the prevalence of chronic neck pain in the general population 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 This is a 1-year prospect i ve study to investigate the prognostic value of coping strategies such as catastrophising for persistent pain after a whiplash injury . A consecutive series of 96 patients who were seen in the emergency room in the acute phase after the injury were followed prospect ively for 1 year . Age , gender and whether or not pain in the neck preceded the accident was recorded . Cases involving fractures or dislocations of the cervical spine , head trauma or pre-existing neurological disorders were not included . The mean interval between the accident and the initial examination was 3+/-2(S.D. ) days . Coping was measured using the  Coping Strategies Question naire ( CSQ ) . The outcome parameter was self-reported neck pain at 1 year after the motor vehicle accident . At 1 year , 34 % of the patients had neck pain . Women developed chronic neck pain more often than men ( 71 % versus 29 % ) ; they also had significantly higher coping activity , such as diverting attention , praying or hoping ( p<0.05 ) ,  catastrophising and increasing behavioural activities ( p<0.0001 ) . Women reported pain in the neck or shoulder more often before the accident and this was the only statistically significant predictor of chronic symptoms when analysed by logistic regression ( odds ratio 4.5 ) . To conclude , we found no evidence that the different coping patterns during the early phase after a whiplash injury influenced the prognosis Background Many patients suffer from chronic neck pain following a whiplash injury . A combination of cognitive , behavioural therapy with physiotherapy interventions has been indicated to be effective in the management of patients with chronic whiplash-associated disorders . The objective is to present the design of a r and omised controlled trial ( RCT ) aim ed at evaluating the effectiveness of a combined individual physical and cognitive behavioural- grade d activity program on self-reported general physical function , in addition to neck function , pain , disability and quality of life in patients with chronic neck pain following whiplash injury compared with a matched control group measured at baseline and 4 and 12 months after baseline . Methods / Design The design is a two-centre , RCT - study with a parallel group design . Included are whiplash patients with chronic neck pain for more than 6 months , recruited from physiotherapy clinics and an out-patient hospital department in Denmark . Patients will be r and omised to either a pain management ( control ) group or a combined pain management and training (intervention)group . The control group will receive four educational sessions on pain management , whereas the intervention group will receive the same educational sessions on pain management plus 8 individual training sessions for 4 months , including guidance in specific neck exercises and an aerobic training programme . Patients and physiotherapists are aware of the allocation and the treatment , while outcome assessors and data analysts are blinded . The primary outcome measures will be Medical Outcomes Study Short Form 36 ( SF36 ) , Physical Component Summary ( PCS ) . Secondary outcomes will be Global Perceived Effect ( -5 to + 5 ) , Neck Disability Index ( 0 - 50 ) , Patient Specific Functioning Scale ( 0 - 10 ) , numeric rating scale for pain bothersomeness ( 0 - 10 ) , SF-36 Mental Component Summary ( MCS ) , TAMPA scale of Kinesiophobia ( 17 - 68 ) , Impact of Event Scale ( 0 - 45 ) , EuroQol ( 0 - 1 ) , craniocervical flexion test ( 22 mmHg - 30 mmHg ) , joint position error test and cervical range of movement . The SF36 scales are scored using norm-based methods with PCS and MCS having a mean score of 50 with a st and ard deviation of 10 . Discussion The perspectives of this study are discussed , in addition to the strengths and weaknesses . Trial registration The study is registered in http://www . Clinical Trials.gov identifier NCT01431261 & NA ; The objective of our prospect i ve inception cohort study was to identify prognostic factors for poor recovery in patients with whiplash‐associated disorders grade 1 or 2 who still had neck pain and accompanying complaints 2 weeks after the accident . The study was carried out in a primary health care setting in The Netherl and s and included 125 patients . The primary outcome measure was functional recovery defined in terms of neck pain intensity or work disability without medication use . The secondary outcome measures included neck pain intensity , work disability and sick leave . The outcomes were assessed at 4 , 12 and 52 weeks after the accident . Prognostic factors were identified by logistic regression analyses . One year after the injury , 64 % of the patients were recovered . Factors related to poor recovery were female gender , a low level of education , high initial neck pain , more severe disability , higher levels of somatisation and sleep difficulties . Neck pain intensity and work disability proved to be the most consistent predictors for poor recovery . The accuracy of the predictions of the prognostic models was high , meaning that the models adequately distinguished patients with poor recovery from those regarded as recovered . These findings add to the growing body of evidence , indicating that socio‐demographic , physical and psychological factors affect short‐ and long‐term outcome after whiplash injury . Our findings also indicate that care providers can easily identify patients at risk for poor recovery with a visual analogue scale for initial pain intensity and work‐related activities A classification of injury and a follow-up schedule were proposed by the Quebec Task Force ( QTF ) in 1995 . No general agreement about the clinical usefulness of the WAD-classification or of the suggested follow-up regimen exists . A series of 186 consecutive cases seen in the emergency room during the acute phase after a whiplash injury was prospect ively studied for 1 year . All findings including history and physical findings were recorded using st and ardized QTF protocol s. In one group follow-up visits were done according to the QTF regimen : at 1 , 3 , 6 , 12 weeks and 1 year after the accident ; in a control group no visit was scheduled . The outcome variable was neck pain at 1 year after the accident . After 1 year , 18 % of the total number of patients had significant neck pain . Risk factors for chronic neck pain at 1 year after whiplash injury were : neck pain before the accident and a high degree of emotional distress at the time of the accident ; both factors independently associated with a tenfold increased risk of developing chronic neck pain . Neither the WAD classification nor the QTF follow-up regimen could be linked to a better outcome . In this study the outcome was associated with patient-specific characteristics and not with physical signs of injury , the depth of the initial evaluation or the follow-up regimen Background Individuals ' expectations on returning to work after an injury have been shown to predict the duration of time that a person with work-related low back pain will remain on benefits ; individuals with lower recovery expectations received benefits for a longer time than those with higher expectations . The role of expectations in recovery from traumatic neck pain , in particular whiplash-associated disorders ( WAD ) , has not been assessed to date to our knowledge . The aim of this study was to investigate if expectations for recovery are a prognostic factor after experiencing a WAD . Methods and Findings We used a prospect i ve cohort study composed of insurance cl aim ants in Sweden . The participants were car occupants who filed a neck injury cl aim ( i.e. , for WAD ) to one of two insurance companies between 15 January 2004 and 12 January 2005 ( n = 1,032 ) .  Postal question naires were completed shortly ( average 23 d ) after the collision and then again 6 mo later . Expectations for recovery were measured with a numerical rating scale ( NRS ) at baseline , where 0 corresponds to “ unlikely to make a full recovery ” and 10 to “ very likely to make a full recovery . ” The scale was reverse coded and trichotomised into NRS 0 , 1–4 , and 5–10 . The main outcome measure was self-perceived disability at 6 mo postinjury , measured with the Pain Disability Index , and categorised into no/low , moderate , and high disability . Multivariable polytomous logistic regression was used for the analysis . There was a dose response relationship between recovery expectations and disability . After controlling for severity of physical and mental symptoms , individuals who stated that they were less likely to make a full recovery ( NRS 5–10 ) , were more likely to have a high disability compared to individuals who stated that they were very likely to make a full recovery ( odds ratio [ OR ] 4.2 [ 95 % confidence interval ( CI ) 2.1 to 8.5 ] . For the intermediate category ( NRS 1–4 ) , the OR was 2.1 ( 95 % CI 1.2 to 3.2 ) . Associations between expectations and disability were also found among individuals with moderate disability . Conclusions Individuals ' expectations for recovery are important in prognosis , even after controlling for symptom severity . Interventions design ed to increase patients ' expectations may be beneficial and should be examined further in controlled studies & NA ; Distinct developmental trajectories for neck disability and posttraumatic stress disorder ( PTSD ) symptoms after whiplash injury have recently been identified . This study aim ed to identify baseline predictors of membership to these trajectories and to explore their dual development . In a prospect i ve study , 155 individuals with whiplash were assessed at < 1 month , 3 , 6 , and 12 months postinjury . Outcomes at each time point were assessed according to the Neck Disability Index and the Posttraumatic Stress Diagnostic Scale . Baseline predictor variables were age , gender , initial pain ( based on a visual analogue scale [ VAS ] ) , pressure pain thresholds ( PPT ) , cold pain thresholds ( CPT ) , and sympathetic vasoconstrictor responses . Group‐based trajectory analytical techniques were used to parameterise the optimal trajectories and to identify baseline predictors . A dual trajectory analysis was used to explore probabilities of conditional and joint trajectory group membership . CPT ⩾ 13 ° C ( OR = 26.320 , 95 % CI = 4.981–139.09 ) , initial pain level ( VAS ) ( OR = 4.3 , 95 % CI = 4.98–139.1 ) , and age ( OR = 1.109 , 95 % CI = 1.043–1.180 ) predicted a chronic/severe disability trajectory . The same baseline factors also predicted chronic moderate/severe PTSD ( CPT ⩾ 13 ° C , OR = 9.7 , 95%CI = 2.22–42.44 ; initial pain level [ VAS ] : OR = 2.13 , 95 % CI = 1.43–3.17 ; age : OR = 1.07 , 95 % CI = 1.01–1.14 ) . There was good correspondence of trajectory group for both disability and PTSD . These findings support the proposal of links between the development of chronic neck related disability and PTSD after whiplash injury . Developmental trajectories of disability and posttraumatic stress disorder ( PTSD ) after whiplash injury are mostly in synchrony , and similar factors predict their membership . This suggests links between the development of chronic neck pain‐related disability and PTSD
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 .