The effectiveness and cost-effectiveness of motion style acupuncture treatment (MSAT) for acute neck pain: A multi-center randomized controlled trial.

BACKGROUND: Neck pain is a common complaint in the general population. Despite the consistent ongoing pain and the resulting economic burden on affected individuals, there have only been a few studies investigating the treatment of acute neck pain. This study aims to evaluate the effectiveness, safety, and cost-effectiveness of the motion style acupuncture treatment (MSAT) and acupuncture treatment for acute neck pain. METHODS: This 2-armed, parallel, multi-centered randomized controlled trial will be conducted at 4 community-based hospitals in Korea. A total of 128 subjects will be randomly assigned, at a 1:1 ratio, to the MSAT and the acupuncture treatment groups. Treatment will be administered 2 to 3 times a week for 2 weeks. The primary outcome will be the visual analog scale of neck pain on movement. The secondary outcomes will be the numeric rating scale of the neck, neck disability index, Northwick Park questionnaire, patient global impression of change, range of motion of the neck, 5-level EuroQol-5 dimension, 12-item Short-Form Health Survey, and EuroQol visual analogue scale. This protocol has been registered at the Clinicaltrials.gov (NCT04539184). DISCUSSION: To our knowledge, this study is the first well-designed multi-centered randomized controlled trial to evaluate the effectiveness, safety, and cost-effectiveness of MSAT on acute neck pain. The results of this study will be useful for clinicians in primary medical institutions that frequently treat acute neck pain patients and for policymakers working with national health insurance.

Chronic Spinal Pain and Financial Worries in the US Adult Population.

STUDY DESIGN: Epidemiological study based on cross-sectional data of a representative sample. OBJECTIVE: To determine whether financial worries are associated with chronic spinal pain in the US adult population. SUMMARY OF BACKGROUND DATA: This study used data from the US 2015 National Health Interview Survey. The sample size was 33,672 and the study population is defined as aged 18 to 85 years. METHODS: To account for the complex sampling design, the Taylor linearized variance estimation method was used. Spinal pain was defined in two ways: chronic low back pain and neck pain, chronic low back pain and/or neck pain. Eight types of financial worries were assessed: paying monthly bills, maintaining standard of living, credit card payments, paying rent/mortgage/housing costs, medical costs for healthcare, money for retirement, medical costs of illness/accident, and paying for children's college. RESULTS: Different types of financial worries were significantly associated with chronic spinal pain, controlling for demographic characteristics and socioeconomic status. These worries included paying monthly bills (odds ratio [OR] 2.5), maintaining standard of living (OR 2.5), credit card payments (OR 2.2), paying rent/mortgage/housing costs (OR 2.2), medical costs for healthcare (OR 2.2), money for retirement, (OR 2.3), medical costs of illness/accident (OR 2.2), and paying for children's college (OR 1.4). CONCLUSION: This study shows that financial worries were significantly associated with chronic spinal pain. Financial worries may be important to be taken into consideration by clinicians managing patients with spinal pain. More future research is needed to explore the association between financial worries and spinal pain. LEVEL OF EVIDENCE: 3.

The impact of patient preferences and costs on the appropriateness of spinal manipulation and mobilization for chronic low back pain and chronic neck pain.

BACKGROUND: Although the delivery of appropriate healthcare is an important goal, the definition of what constitutes appropriate care is not always agreed upon. The RAND/UCLA Appropriateness Method is one of the most well-known and used approaches to define care appropriateness from the clinical perspective-i.e., that the expected effectiveness of a treatment exceeds its expected risks. However, patient preferences (the patient perspective) and costs (the healthcare system perspective) are also important determinants of appropriateness and should be considered. METHODS: We examined the impact of including information on patient preferences and cost on expert panel ratings of clinical appropriateness for spinal mobilization and manipulation for chronic low back pain and chronic neck pain. RESULTS: The majority of panelists thought patient preferences were important to consider in determining appropriateness and that their inclusion could change ratings, and half thought the same about cost. However, few actually changed their appropriateness ratings based on the information presented on patient preferences regarding the use of these therapies and their costs. This could be because the panel received information on average patient preferences for spinal mobilization and manipulation whereas some panelists commented that appropriateness should be determined based on the preferences of individual patients. Also, because these therapies are not expensive, their ratings may not be cost sensitive. The panelists also generally agreed that preferences and costs would only impact their ratings if the therapies were considered clinically appropriate. CONCLUSIONS: This study found that the information presented on patient preferences and costs for spinal mobilization and manipulation had little impact on the rated appropriateness of these therapies for chronic low back pain and chronic neck pain. Although it was generally agreed that patient preferences and costs were important to the appropriateness of M/M for CLBP and CNP, it seems that what would be most important were the preferences of the individual patient, not patients in general, and large cost differentials.

Factors Associated With Return-to-Work Following Cervical Spine Surgery in Non-Worker's Compensation Setting.

STUDY DESIGN: This study retrospectively analyzes prospectively collected data. OBJECTIVE: Here in this study we aim to determine the factors which impact a patient's ability to return to work (RTW) in the setting of cervical spine surgery in patients without worker's compensation status. SUMMARY OF BACKGROUND DATA: Surgical management of degenerative cervical disease has proven cost-effectiveness and shown significant improvement in quality of life. However, the ability to RTW is an important clinical outcome for preoperatively employed patients. METHODS: All adult patients undergoing elective surgery for cervical degenerative disease at our institution are enrolled in a prospective, web-based registry. A multivariable Cox proportional hazards regression model was built for time to RTW. The variables included in the model were age, sex, smoking status, occupation type, number of levels operated on, ASA grade, body mass index, history of diabetes, history of coronary artery disease (CAD), history of chronic obstructive pulmonary disease (COPD), anxiety, depression, myelopathy at presentation, duration of symptoms more than 12 months, diagnosis, type of surgery performed, and preoperative Neck Disability Index, EuroQol Five Dimensions, and Numeric Rating Scale pain scores for neck pain and arm pain scores. RESULTS: Of the total 324 patients with complete 3-month follow-up data 83% (n = 269) returned to work following surgery. The median time to RTW was 35 days (range, 2-90 d). Patients with a labor-intensive occupation, higher ASA grade, history of CAD, and history of COPD were less likely to RTW. The likelihood of RTW was lower in patients with a diagnosis of disc herniation compared with cervical stenosis, patients undergoing cervical corpectomy compared laminectomy and fusion and patient with longer operative time. CONCLUSION: Our study identifies the various factors associated with a lower likelihood of RTW at 3 months after cervical spine surgery in the non-worker's compensation setting. This information provides expectations for the patient and employer when undergoing cervical spine surgery. LEVEL OF EVIDENCE: 3.

Influence of subjective economic hardship on new onset of neck pain (so-called: katakori) in the chronic phase of the Great East Japan Earthquake: A prospective cohort study.

BACKGROUND: Studies have suggested that musculoskeletal symptoms increase after natural disasters. The Great East Japan Earthquake (GEJE) and accompanying tsunami placed a huge financial burden on the local population. This study determined whether subjective economic hardship influenced the new onset of neck pain (katakori) in the chronic phase after the GEJE. METHODS: This study used longitudinal data from 1359 adults who had responded to the self-report questionnaire at 2 and 3 years after the GEJE. New-onset neck pain was defined as neck pain absent at 2 years and present at 3 years. Subjective economic hardship at 2 years after the GEJE was categorized into 4 groups: "normal," "a little bit hard," "hard," and "very hard." Multiple logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI) in order to examine the association between subjective economic hardship and new-onset neck pain. RESULTS: Among the participants, 12.9% (n = 175) reported new-onset neck pain. A significantly higher rate of new-onset neck pain was observed in participants who considered their subjective economic hardship to be "hard" (OR = 2.10, 95% CI = 1.34-3.30) or "very hard" (OR = 3.26, 95% CI = 1.83-5.46; p for trend <0.001) compared with those who considered their hardship to be "normal." CONCLUSIONS: Subjective economic hardship was significantly associated with new-onset neck pain in the chronic phase of the GEJE. (228/300).

The psychometric properties of the cervical nonorganic signs in patients with neck pain: an assessment of pain expression.

PURPOSE: Neck pain is a common cause of disability. This study investigated the psychometric properties of the cervical nonorganic signs (CNOS), a tool for assessing abnormal illness behaviors in patients with neck pain. METHODS: The CNOS was administered on patients with neck pain. Reliability and validity analyses were used to evaluate the psychometric properties. Exploratory factor analysis was used to investigate the dimensionality. Correlations with the Short Form-36 were used to investigate the convergent validity. RESULTS: The results supported the reliability (inter-rater reliability intra-class correlation: 0.920), validity (correlated with body pain (|ρ|=0.31) and vitality (|ρ| =0.30), and two-factor dimensionality (χ2= 5.904, p= 0.66; χ2/df = 0.738; RMSEA< 0.001; CFI = 1.000; TLI = 1.024; SRMR = 0.047) of the scale. The two factors were pain (severe pain) and vitality (poor vitality) expressed by the patients. CONCLUSION: The CNOS is a reliable and valid instrument for assessing pain and vitality problems. It helps patients to express severe pain and lack of vitality. The rehabilitation discipline could use the scale to understand pain expression and to design proper rehabilitation programs. Implications for Rehabilitation The cervical nonorganic signs has two domains (pain and vitality). The scale is reliable and valid for patients with neck pain. Patients with high scores on the pain domain have severe body pain that may interfere with normal social activities. Clinicians should understand their suffering and try to help them to alleviate the pain.

Validation of a measure of health-related production loss: construct validity and responsiveness - a cohort study.

BACKGROUND: The aim of this study is to evaluate the construct validity and responsiveness of a Swedish measure of health-related production loss as well as to investigate if there is a difference in the level of production loss within a population suffering from persistent back/neck pain and CMDs. METHODS: The sample was drawn from a study that assessed employees' health and working capacity in 74 health care units before and after intervention. The study included 692 patients who reported working the previous six months at baseline measurement, and who were also asked to answer questions related to health-related production loss. Health-related measures were general health derived from Short Form-12, health-related quality of life derived from EQ-5D, and work ability derived from the Work Ability Index (WAI). Convergent validity and external responsiveness were assessed using Spearman's Rank Correlation Coefficient and a linear regression model, respectively. RESULTS: The different measures of health showed a moderate-to-strong correlation with the measure of health-related production loss and fulfilled the criteria for construct validity. Changes in health and work ability led to significant changes in health-related production loss, which demonstrates external responsiveness. This result is valid for both the total population and for the two different subgroups that were evaluated. CONCLUSIONS: The present study shows that this measure of health-related production loss is a valid measure for capturing production loss due to illness, and that work ability is more strongly correlated with health-related production loss than people's general health is. The result shows an average of about 50 % reduced production due to illness, with back pain being the most costly.

Late bedtimes weaken school performance and predispose adolescents to health hazards.

STUDY OBJECTIVES: Our study explored if bedtimes influenced school performance and motivation, as well as the odds ratio (OR) for health-related concerns in adolescents. METHODS: The School Health Promotion Study was based on an anonymous self-report questionnaire conducted in 90% of the municipalities in Finland. The study was conducted during 2008 and 2010 in Southern Finland, Eastern Finland, and Lapland, and during 2009 and 2011 in Western Finland, Northern Finland, and Åland. Several indicators were used to measure school performance and motivation. Accidents and health-related complaints, such as depressive symptoms, sleep quality, neck or shoulder pains, lower back pains, stomachaches, anxiety or nervousness, irritation or tantrums, headaches, and tiredness or dizziness were analyzed in relation to the usual bedtime. Our study had a relatively large sample size (N=384,076), consisting of students in the eighth and the ninth grades of secondary schools and the first and the second grades of upper secondary and vocational schools (ages 14-20 years) in Finland. RESULTS: All of the various indicators used to assess school performance and motivation suggest that the later the bedtime of adolescents, the lower their school performance and their motivation. Similarly later bedtimes increase the OR for depressive symptoms and other negative health consequences in adolescents as well as a tendency towards accidents. All of these problems were emphasized in students with bedtimes of 11:30 PM and later. CONCLUSIONS: Late bedtimes, especially those after 11:30 PM, indicate poor sleep which deteriorates school performance and motivation and increases the OR for depressive symptoms and other health-related issues in adolescents.

Assessment of physical activity in patients with chronic low back or neck pain.

AIM: To investigate physical activity level in patients with chronic low back and neck pain. MATERIAL AND METHODS: 32 preoperative patients, 32 outpatients with low back or neck pain and 32 healthy controls were included in study. The physical activity level of the participants was evaluated with the International Physical Activity Questionnaire. The Oswestry Disability Index and Neck Pain Disability Index, Short Form-36, Pittsburgh Sleep Quality Index and Beck Depression Inventory were used for assessment of disability, quality of life, sleep quality and depression. RESULTS: Statistical significant differences was found in disability, sleep quality, depression, physical activity level and quality of life scores between three groups (p < 0.05). All scores of preoperative patients were significantly lower than outpatients except sleep parameter (p < 0.05). Sleep quality, disability and depression scores of patients with chronic neck pain were significantly lower and physical activity level and quality of life scores were significantly higher than patients' with chronic low back pain (p < 0.05). CONCLUSION: Physical activity modification was found in patients with chronic low back and neck pain. Physical activity level, disability, sleep, depression and quality of life scores of preoperative patients with low back pain more affected than neck patients.

Simple neck pain questions used in surveys, evaluated in relation to health outcomes: a cohort study.

BACKGROUND: The high prevalence of pain reported in many epidemiological studies, and the degree to which this prevalence reflects severe pain is under discussion in the literature. The aim of the present study was to evaluate use of the simple neck pain questions commonly included in large epidemiological survey studies with respect to aspects of health. We investigated if and how an increase in number of days with pain is associated with reduction in health outcomes. METHODS: A cohort of university students (baseline age 19-25 years) were recruited in 2002 and followed annually for 4 years. The baseline response rate was 69% which resulted in 1200 respondents (627 women, 573 men). Participants were asked about present and past pain and perceptions of their general health, sleep disturbance, stress and energy levels, and general performance. The data were analyzed using a mixed model for repeated measurements and a random intercept logistic model. RESULTS: When reporting present pain, participants also reported lower prevalence of very good health, higher stress and sleep disturbance scores and lower energy score. Among those with current neck pain, additional questions characterizing the pain such as duration (categorized), additional pain sites and decreased general performance were associated with lower probability of very good health and higher amounts of sleep disturbance. Knowing about the presence or not of pain explains more of the variation in health between individuals, than within individuals. CONCLUSION: This study of young university students has demonstrated that simple neck pain survey questions capture features of pain that affect aspects of health such as perceived general health, sleep disturbance, mood in terms of stress and energy. Simple pain questions are more useful for group descriptions than for describing or following pain in an individual.

Prevalence of chronic head, neck and low back pain and associated factors in women residing in the Autonomous Region of Madrid (Spain).

OBJECTIVE: To compare the prevalence of chronic headache (CH), chronic neck pain (CNP) and chronic low back pain (CLBP) in the autonomous region of Madrid by analyzing gender differences and to determine the factors associated with each pain location in women in 2007. METHODS: We analyzed data obtained from adults aged 16 years or older (n = 12,190) who participated in the 2007 Madrid Regional Health Survey. This survey includes data from personal interviews conducted in a representative population residing in family dwellings in Madrid. The presence CH, CNP, and CLBP was analyzed. Sociodemographic features, self-perceived health status, lifestyle habits, psychological distress, drug consumption, use of healthcare services, the search for alternative solutions, and comorbid diseases were analyzed by using logistic regression models. RESULTS: The prevalence of CH, CNP and CLBP was significantly higher (P<0.001) in women (7.3%, 8.4%, 14.1%, respectively) than in men (2.2%, 3.2%, 7.8%, respectively). In women, CH, CNP and CBLP were significantly associated with having ≥3 chronic diseases (OR 7.1, 8.5, 5.8, respectively), and with the use of analgesics and drugs for inflammation (OR: 3.5, 1.95, 2.5, respectively). In the bivariate analysis, the factors associated with pain in distinct body locations differed between men and women. CONCLUSIONS: This study found that CH, CNP and CLBP are a major public health problem in women in central Spain. Women have a higher overall prevalence of chronic pain than men. Chronic pain was associated with a higher use of analgesics and healthcare services.

Complexities in understanding the role of compensation-related factors on recovery from whiplash-associated disorders: discussion paper 2.

STUDY DESIGN: Focused discussion. OBJECTIVE: To present some of the complexities in conducting research on the role of compensation and compensation-related factors in recovery from whiplash-associated disorders (WAD) and to suggest directions for future research. SUMMARY OF BACKGROUND DATA: There is divergence of opinion, primary research findings, and systematic reviews on the role of compensation and/or compensation-related factors in WAD recovery. METHODS: The topic of research of compensation/compensation-related factors was discussed at an international summit meeting of 21 researchers from diverse fields of scientific enquiry. This article summarizes the main points raised in that discussion. RESULTS: Traffic injury compensation is a complex sociopolitical construct, which varies widely across jurisdictions. This leads to conceptual and methodological challenges in conducting and interpreting research in this area. It is important that researchers and their audiences be clear about what aspect of the compensation system is being addressed, what compensation-related variables are being studied, and what social/economic environment the compensation system exists in. In addition, summit participants also recommended that nontraditional, sophisticated study designs and analysis strategies be employed to clarify the complex causal pathways and mechanisms of effects. CONCLUSION: Care must be taken by both researchers and their audiences not to overgeneralize or confuse different aspects of WAD compensation. In considering the role of compensation/compensation-related factors on WAD and WAD recovery, it is important to retain a broad-based conceptualization of the range of biological, psychological, social, and economic factors that combine and interact to define and determine how people recover from WAD.

Another study showing that two preference-based measures of health-related quality of life (EQ-5D and SF-6D) are not interchangeable. But why should we expect them to be?

OBJECTIVES: Studies have shown that preference-based measures of health-related quality of life (utility measures) fail to provide interchangeable values, which raises concerns for the cross-study comparability of cost-effectiveness estimates. This study offers generalizable and condition-specific insight into why (rather than if) there are discrepancies between two widely used measures, the EQ-5D and SF-6D. METHODS: Comparisons focused on practical considerations and the respective descriptive and valuation components of the measures, addressing empirical and conceptual issues. More specifically, we addressed instrument-completion, item-completion, contextual framing of questions, dimension-to-dimension correlations, floor and ceiling effects, and construct validity. Data came from randomized controlled trial participants with nonspecific neck pain (n = 346). RESULTS: The descriptive classification systems do not permit respondents to describe their health state in the same manner, due, primarily, to contextual differences and the number of available response options. Specific to neck pain populations, "vitality" was a unique contributor to the SF-6D, although both measures identified the same significant linear trends across theoretical constructs. Rates of instrument completion were significantly better for the EQ-5D over the course of the randomized controlled trial. CONCLUSIONS: The EQ-5D and SF-6D do not provide interchangeable utility estimates for patients with nonspecific neck pain-a finding that is common to other clinical areas. However, this result, and the results from previous studies, should not be surprising given the extent of between-measure differences relating to the descriptive content of health dimensions across the two measures. Given the consistent messages emerging from method comparison studies for the EQ-5D and SF-6D, new and/or novel approaches are necessary to drive this research area forward.

The effect of intimate partner violence and other forms of violence against women on health.

BACKGROUND: There are many studies concerning the health consequences of intimate partner violence (IPV). However, little research has been done on the health consequences of other forms of violence against women (VAW) such as the violence perpetrated by male relatives, friends or strangers. The aims of this paper were: (i) to analyze the prevalence of different forms of VAW perpetrated by males at home, workplace and other social environments in Spain and (ii) to analyze whether IPV and other forms of VAW have a different or similar negative impact on women's health. METHODS: A sample of 13 094 women interviewed in the Spanish National Health Survey 2006 was included. Outcomes were physical and mental health indicators. Predictor variables were IPV and other VAW forms. Logistic regression models were fitted. RESULTS: The likelihood of coronary heart disease [OR: 5.28 (1.45-19.25)], chronic neck [OR: 2.01 (1.35-2.97)] and back pain [OR: 2.34 (1.53-3.57)] was higher among women who reported IPV than among those who did not. Similar associations were found in the case of women affected by other forms of VAW. Mental health problems, with the exception of psychotropic drug use, were more frequent and more strongly associated with IPV than with other forms of VAW. CONCLUSION: There are health inequities between battered and non-battered women, which may be related to exposure to not only IPV but also other forms of VAW.

Assessment of a traditional acupuncture therapy for chronic neck pain: a pilot randomised controlled study.

OBJECTIVE: This study is aimed to assess the efficacy of traditional acupuncture for chronic neck pain in patients by comparing the differences in symptoms, dysfunctions and quality of life. METHODS: The study used a two-arm, single-blinded, randomised controlled design. The patients were randomised to the study group and control group, who respectively received traditional acupuncture and placebo treatment. The Northwick Park Neck Pain Questionnaire (NPQ), visual analogue scale (VAS), Short Form (36) Health Survey (SF-36) and doctor's judgement were applied for measuring effectiveness. The patients' effectiveness outcome was assessed, respectively, before the intervention, immediately after the intervention, at the end of the first month of follow-up and at the end of the third month of follow-up. The statistical analysis was done on Statistical Package for Social Sciences (SPSS) v13, which included comparison of demographic and clinical homogeneity, the repeated measures approach based on the general linear model (GLM) for effectiveness assessment and the sum rank test for doctors' subjective efficacy judgement. RESULTS: Totally, 190 patients were recruited and 178 patients (88 in the study group and 90 in the control group) completed the intervention and follow-up assessment. The scores of NPQ, VAS and SF-36 were improved after the intervention and during follow-up (P<0.01 vs. before the intervention). The patients in the study group had better effectiveness outcome in NPQ, VAS and in the VT, SF and MH domains of SF-36 (P<0.05). CONCLUSION: Traditional acupuncture can relieve pain intensity and improve the quality of daily life with a relative long-term clinical efficacy in patients with chronic neck pain.

Measuring practitioner/therapist effects in randomised trials of low back pain and neck pain interventions in primary care settings.

In psychological health treatment studies it has been shown that differences between therapists account for some of the non-specific effect of treatment but this phenomenon has not so far systematically been investigated in musculoskeletal disorders. In this study we evaluated and compared the size and potential influence of the 'practitioner effect' (or 'therapist effect') in three randomised treatment trials of low back pain and neck pain patients in primary care. We calculated the proportion of variance in outcomes attributable to differences across practitioners, i.e. the practitioner-variance partition coefficient (p-vpc). As measures of outcome, we focused on self-reported disability as the primary outcome, but we also investigated assessed psychological outcomes. The p-vpc for the disability measures ranged from 2.6% to 7.1% across trials and time points (post treatment and follow up). Estimates differed between treatment subgroups within trials; being highest in treatment subgroups assigned to psychosocial-based interventions. A 'practitioner effect' does exist and is more pronounced in treatments involving greater psychosocial emphasis. This has implications for both practice and research in this clinical area. It highlights the importance of patient-practitioner interactions, and the need to address practitioner effects in designing and analysing outcome studies in low back pain and neck pain in primary care.

Added value of qualitative studies in the development of health related patient reported outcomes such as the Pain Coping and Cognition List in patients with sub-acute neck pain.

Psychometric analyses, such as factor analysis, internal consistency and construct validity analysis, are well known and frequently applied methods in the development of health related patient reported outcomes. These statistical indexes shed very little light on how respondents interpret individual items, or on the meaning of their responses. In this study, the Pain Coping and Cognition List (PCCL), a quantitatively validated psychological questionnaire developed to assess chronic pain, has been subjected to a qualitative research method: the Three Step Test Interview (TSTI), an observational technique that aims to identify problems with self reported questionnaires. It consists of three phases: 1) concurrent thinking aloud; 2) a retrospective interview; 3) a semi-structured interview. Participants with sub-acute neck pain distinguished six different types of problems: long complicated formulations, composite questions, irrelevant questions, lacking frame of reference, problematic words, and wrongly interpreted questions. This study illustrates that qualitative methods have an added value when developing self-report questionnaires because some of the problems that were highlighted that cannot be identified using quantitative methods only. Therefore, we recommend that a full qualitative study should be an integral part of the development of questionnaires. The TSTI method is very useful for this purpose.

A 7-year follow-up of multidisciplinary rehabilitation among chronic neck and back pain patients. Is sick leave outcome dependent on psychologically derived patient groups?

A valid method for classifying chronic pain patients into more homogenous groups could be useful for treatment planning, that is, which treatment is effective for which patient, and as a marker when evaluating treatment outcome. One instrument that has been used to derive subgroups of patients is the Multidimensional Pain Inventory (MPI). The primary aim of this study was to evaluate a classification method based on the Swedish version of the MPI, the MPI-S, to predict sick leave among chronic neck and back pain patients for a period of 7 years after vocational rehabilitation. As hypothesized, dysfunctional patients (DYS), according to the MPI-S, showed a higher amount of sickness absence and disability pension expressed in days than adaptive copers (AC) during the 7-years follow-up period, even when adjusting for sickness absence prior to rehabilitation (355.8days, 95% confidence interval, 71.7; 639.9). Forty percent of DYS patients and 26.7% of AC patients received disability pension during the follow-up period. However, this difference was not statistically significant. Further analyses showed that the difference between patient groups was most pronounced among patients with more than 60days of sickness absence prior to rehabilitation. Cost-effectiveness calculations indicated that the DYS patients showed an increase in production loss compared to AC patients. The present study yields support for the prognostic value of this subgroup classification method concerning long-term outcome on sick leave following this type of vocational rehabilitation.

Early multidisciplinary evaluation and advice was ineffective for whiplash-associated disorders.

BACKGROUND: Whiplash is the most common type of injury reported in traffic accidents, but the effectiveness of conservative treatment for whiplash lacks evidence. AIMS: To assess the effect of early multidisciplinary evaluation and advice on the frequency of chronic neck pain three years post-injury in persons with minor or moderate traffic injuries. METHODS: In an insurance setting, we tested the effect by (1) a risk score matched prospective cohort design, (2) a propensity score matched nested case-control design and, (3) a risk and propensity score adjusted multivariate analysis in an unmatched prospective cohort design. We simulated unobserved risk and propensity factors to evaluate the robustness of the results for hidden bias. RESULTS: All three designs showed a significantly increased risk for chronic neck pain among those who received the intervention compared to those who did not. The relative risks ranged from 1.7 (95% CI: 1.0-2.6) to 2.6 (95% CI: 1.5-4.0). The results were robust to hidden bias. CONCLUSION: The consistency of the findings across the different designs strongly suggest that early multidisciplinary evaluation and advice increased the risk of having chronic neck pain three years following a minor or moderate traffic injury. Literally, the intervention may therefore have done more harm than good.