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The perceived relationship between neck symptoms and precedent injury
hjwy Vol. 20, No. I, pp. 17-19, 1995 Copyright (I“ 1995 Elsevier Science Ltd Printed m Great Britain. All rights reserved OOZO-1383195 $lO.OO+ 0.00
The perceived and precedent I’. D. Marshall,
M. O’Connor
relationship injury
between
neck symptoms
and J. P. Hodgkinson
Department of Orthopaedic Surgery, Ancoats Hospital, Manchester, UK
A quesfionnaire survey of 328 hospifal employees was used to establish the general prevalence of neck symptoms related to eveyday activities in a represenfafive population of working society. The response rate was 92 per cent. Of the study population of 302,54 had suffered a neck injury, and of this group, 43 (80 per cent) had some neck discomfort during or after performing normal everyday fasks. Of the symptomatic cases, only seven (16 per cent) admitted that they had sufiered from some neck symptoms before the injury, whilst 36 (84 per cent) attributed all of their neck symptoms to the injury sustained. Of the tofal popuiafion, 248 had nof suffered a neck inju y and of this group 84 (34 per cent) suffered some neck discomfort during or after performing normal everyday tasks. The x2 test was used to test the null hypothesis thaf the sub-group attributing their symptoms to injury, in whom only 16 per cent acknowledged pre-existent neck symptoms, was derived from the same population as the group who had not suffered any definite neck injury, and yet were still troubled with some neck symptoms in 34 per cent of cases. This hypothesis was rejected ip < o.o~, indicafing that there was a significant difference between these two groups. We conclude that some individuals who suffer a neck injury do not recall that they suffered some minor neck symptoms before injuy. The statistical analysis and alternative possible explanations are discussed. Our conclusions may be of medico-legal importance in cases where compensation is being sought.
Injury, 199.5, Vol. 26, 17-19, January
Introduction It is common clinical experience that the incidence of minor
neck symptoms amongst the general population is relatively high, and this has been confirmed by prevalence studies’-’ In medico-legal practice it is not uncommon to find that patients seeking compensation for injury often deny the presence of pre-existing neck symptoms. In order to investigate the relationship between neck symptoms and neck injury we circulated a questionnaire to all NHS employees working at Ancoats Hospital, Manchester.
Methods A questionnaire was designed to gather information regarding neck symptoms before any inquiry was made as to any previous neck injury (Figure I). A significant neck
was defined as one which resulted in neck pain and stiffness for a minimum period of I week afterwards. The final question asked to what degree the respondent considered an injury had contributed to their symptoms, and whether they had experienced any neck symptoms before injury. The questionnaire was sent to the 328 employees working at Ancoats Hospital, Manchester. Those which were returned were subdivided according to the age, sex, and the physical nature of the work undertaken. injury
Results The questionnaire was sent to the 328 employees working at Ancoats Hospital and 302 replies were received, giving a response rate of 92 per cent. We looked at this study population of 302, and sub-divided them into two groups, depending upon whether or not a neck injury had been suffered (Figure 2). The first group of 248 had not suffered a neck injury, and of this number, 84 (34 per cent) had neck discomfort during or after performing normal everyday tasks. The incidence of neck symptoms in this group increased with age, such that whilst 23 per cent of people aged between 30 and 39 years experienced neck symptoms, this increased to 37 per cent for people aged between 40 and 49 years, and increased further to 44 per cent for people aged between 50 and 59 years (Figure.?). There was no significant difference in the incidence of neck symptoms between male and female hospital employees in any of the age ranges studied (x’ test, P> 0.05) and there was also no correlation between the incidence of neck symptoms and the physical nature of the work undertaken (x” test, P> 0.05).
The second group of 54 reported a previous neck injury, and of these 43 (80 per cent) had neck discomfort during or after performing normal everyday tasks. Of the symptomatic cases only seven (16 per cent) reported that they had suffered any neck symptoms before injury, whilst 36 (84 per cent) maintained that they had no neck symptoms before injury, and attributed all of their neck symptoms to the injury. The x” test was used to test the null hypothesis that the group attributing symptoms to injury, in whom only 16 per cent acknowledged pre-existent neck symptoms, was derived from the same population as the group
18
Injury:
International
Journal
of the Care of the Injured
(1995)
Vol. 26/No.
Ancoats Hospital Neck Pain Study
Age.. .
Sex...
Weight.. .
Height.. .
Occupation.. .
Have you ever suffered from neck pain? If so: For how many years? How often do you suffer from neck pain? How long doeseachepisodelast? Have you ever suffered from neck pain or stiffnessduring or following theseactivities: Reachingto a high shelf Hanging curtains Long car journey Prolongedwatching of television Exerciseor sportingactivity Looking up Have you ever injured your neck? If so: When? How did the injury occur? If the injury occurred as a result of a road traffic accident(whiplash type injury) was the vehic.lein which you were travelling damagedbeyondrepair? For how long after this injury were you troubled with pain and stiffnessin your neck. (How many days/weeks/months?) Did you receiveany compensationfor the injury or is there a claim still in process? Did you have any problemswith neck pain or stiffnessbefore the injury? If so: what particular activities causedpain or stiffness? Do you considerthat the neck injury which you suffered is the causeof your present neck problems? Figure
I. Neck symptom
questionnaire
sent to all staff at Ancoats Hospital, Manchester.
1
Marshall
et al.: Neck symptoms
and precedent
19
injury
% suffering neck symptoms
Neck
injury
No neck
injury
2. The incidence of neck symptoms related to previous neck injury.
Figure
% suffering
45 40 35 25 20
23
normal everyday tasks, If such direct questions had not been asked, then such information may not have been volunteered. We consider that direct questioning techniques were appropriate for this study, given that questions such as ‘Do you ever suffer from neck discomfort after driving for long distances, or after looking up for long periods?’ are often asked in the preparation of medical reports, and affirmative responses given. This study has highlighted the high incidence of minor neck symptoms amongst the general working population, if direct questions are asked. The aetiology of neck pain is clearly multifactorial, but with increasing age cervical spondylosis becomes a major factor. Some injuries do result in permanent neck symptoms in patients who previously had asymptomatic cervical spondylosis, and from a legal standpoint, it is usually held that the injury resulted in the spondylosis becoming symptomatic earlier than it would otherwise have done so. However, as a result of this study, we consider that in some cases of so-called ‘asymptomatic’ spondylosis, the presence of neck discomfort after normal activities could have been elicited before, if direct questions had been asked. Patients who suffer neck symptoms following an injury often do not recall that they suffered with some minor neck symptoms before the incident.
15
neck symptoms
i - 8 5 0 I--- O .in .ln 20-29 IU-IJ
Conclusion
10 30
30-39 40-49
50-59
80-85
3. Incidence of neck symptoms related to age in subjects who have not suffered a previous neck injury.
Figure
who had not suffered any definite neck injury, and yet were still troubled with some neck symptoms in 34 per cent of cases. This hypothesis was rejected (P-C O.Ol), indicating that there was a significant difference between these two groups.
Discussion In spite of relatively small numbers in this study, the results are such as to be of statistical significance. We consider that there are two possible explanations for the statistically significant difference observed. Firstly, that the subpopulation who suffer a neck injury is, in fact, constitutionally different from the rest of the population. Secondly, that the two groups are derived from the same population, but those individuals who suffer a neck injury do not recall that they suffered with some minor neck symptoms before their injury. As it is intrinsically unlikely that patients who suffer neck injury are in any way different from those who do not suffer injury, we feel that it is reasonable to reject the first explanation, and favour the second. The results confirm the clinical observation that the incidence of neck symptoms increases with age. The study has also revealed a high incidence of neck symptoms (23 per cent) in the relatively young age group of 30-39 years (Figure2). This may be due to the fact that in the questionnaire direct questions were asked regarding the occurrence of neck symptoms during or after performing
We conclude that some individuals who suffer a neck injury sometimes do not recall that they suffered with some minor neck symptoms before their injury. This finding may be of medico-legal importance in cases in which compensation is being sought for a previous neck injury.
Acknowledgements We would like to thank all of the staff of Ancoats Hospital, Manchester, who took part in this study. We would particularly like to thank our medical secretaries, Ruth Costigan and Judith Garside, for their help with the distribution and collection of the questionnaires.
References 1 Makela M, Heliovaara M, Sievers K et al. Prevalence, determinants, and consequences of chronic neck pain in Finland. Am J Epidemiol 1991; 134: 1356. 2 Stock SR. Workplace ergonomic factors and the development of musculoskeletal disorders of the neck and upper limbs: a meta analysis. Am ] Ind Med 1991; 19: 87. 3
Takala EP, Viikari-Juntura E, Moneta GB et al. Seasonal variation in neck and shoulder symptoms. S’ca~zI ] Work Envirorz Health
1992;
18: 257.
Paper accepted 20 July 19%.
reprints should be addressed to: Mr J.P. Hodgkinson, Gartside Street, Manchester M3 3EL, UK. Requests@
76
The perceived and precedent I’. D. Marshall,
M. O’Connor
relationship injury
between
neck symptoms
and J. P. Hodgkinson
Department of Orthopaedic Surgery, Ancoats Hospital, Manchester, UK
A quesfionnaire survey of 328 hospifal employees was used to establish the general prevalence of neck symptoms related to eveyday activities in a represenfafive population of working society. The response rate was 92 per cent. Of the study population of 302,54 had suffered a neck injury, and of this group, 43 (80 per cent) had some neck discomfort during or after performing normal everyday fasks. Of the symptomatic cases, only seven (16 per cent) admitted that they had sufiered from some neck symptoms before the injury, whilst 36 (84 per cent) attributed all of their neck symptoms to the injury sustained. Of the tofal popuiafion, 248 had nof suffered a neck inju y and of this group 84 (34 per cent) suffered some neck discomfort during or after performing normal everyday tasks. The x2 test was used to test the null hypothesis thaf the sub-group attributing their symptoms to injury, in whom only 16 per cent acknowledged pre-existent neck symptoms, was derived from the same population as the group who had not suffered any definite neck injury, and yet were still troubled with some neck symptoms in 34 per cent of cases. This hypothesis was rejected ip < o.o~, indicafing that there was a significant difference between these two groups. We conclude that some individuals who suffer a neck injury do not recall that they suffered some minor neck symptoms before injuy. The statistical analysis and alternative possible explanations are discussed. Our conclusions may be of medico-legal importance in cases where compensation is being sought.
Injury, 199.5, Vol. 26, 17-19, January
Introduction It is common clinical experience that the incidence of minor
neck symptoms amongst the general population is relatively high, and this has been confirmed by prevalence studies’-’ In medico-legal practice it is not uncommon to find that patients seeking compensation for injury often deny the presence of pre-existing neck symptoms. In order to investigate the relationship between neck symptoms and neck injury we circulated a questionnaire to all NHS employees working at Ancoats Hospital, Manchester.
Methods A questionnaire was designed to gather information regarding neck symptoms before any inquiry was made as to any previous neck injury (Figure I). A significant neck
was defined as one which resulted in neck pain and stiffness for a minimum period of I week afterwards. The final question asked to what degree the respondent considered an injury had contributed to their symptoms, and whether they had experienced any neck symptoms before injury. The questionnaire was sent to the 328 employees working at Ancoats Hospital, Manchester. Those which were returned were subdivided according to the age, sex, and the physical nature of the work undertaken. injury
Results The questionnaire was sent to the 328 employees working at Ancoats Hospital and 302 replies were received, giving a response rate of 92 per cent. We looked at this study population of 302, and sub-divided them into two groups, depending upon whether or not a neck injury had been suffered (Figure 2). The first group of 248 had not suffered a neck injury, and of this number, 84 (34 per cent) had neck discomfort during or after performing normal everyday tasks. The incidence of neck symptoms in this group increased with age, such that whilst 23 per cent of people aged between 30 and 39 years experienced neck symptoms, this increased to 37 per cent for people aged between 40 and 49 years, and increased further to 44 per cent for people aged between 50 and 59 years (Figure.?). There was no significant difference in the incidence of neck symptoms between male and female hospital employees in any of the age ranges studied (x’ test, P> 0.05) and there was also no correlation between the incidence of neck symptoms and the physical nature of the work undertaken (x” test, P> 0.05).
The second group of 54 reported a previous neck injury, and of these 43 (80 per cent) had neck discomfort during or after performing normal everyday tasks. Of the symptomatic cases only seven (16 per cent) reported that they had suffered any neck symptoms before injury, whilst 36 (84 per cent) maintained that they had no neck symptoms before injury, and attributed all of their neck symptoms to the injury. The x” test was used to test the null hypothesis that the group attributing symptoms to injury, in whom only 16 per cent acknowledged pre-existent neck symptoms, was derived from the same population as the group
18
Injury:
International
Journal
of the Care of the Injured
(1995)
Vol. 26/No.
Ancoats Hospital Neck Pain Study
Age.. .
Sex...
Weight.. .
Height.. .
Occupation.. .
Have you ever suffered from neck pain? If so: For how many years? How often do you suffer from neck pain? How long doeseachepisodelast? Have you ever suffered from neck pain or stiffnessduring or following theseactivities: Reachingto a high shelf Hanging curtains Long car journey Prolongedwatching of television Exerciseor sportingactivity Looking up Have you ever injured your neck? If so: When? How did the injury occur? If the injury occurred as a result of a road traffic accident(whiplash type injury) was the vehic.lein which you were travelling damagedbeyondrepair? For how long after this injury were you troubled with pain and stiffnessin your neck. (How many days/weeks/months?) Did you receiveany compensationfor the injury or is there a claim still in process? Did you have any problemswith neck pain or stiffnessbefore the injury? If so: what particular activities causedpain or stiffness? Do you considerthat the neck injury which you suffered is the causeof your present neck problems? Figure
I. Neck symptom
questionnaire
sent to all staff at Ancoats Hospital, Manchester.
1
Marshall
et al.: Neck symptoms
and precedent
19
injury
% suffering neck symptoms
Neck
injury
No neck
injury
2. The incidence of neck symptoms related to previous neck injury.
Figure
% suffering
45 40 35 25 20
23
normal everyday tasks, If such direct questions had not been asked, then such information may not have been volunteered. We consider that direct questioning techniques were appropriate for this study, given that questions such as ‘Do you ever suffer from neck discomfort after driving for long distances, or after looking up for long periods?’ are often asked in the preparation of medical reports, and affirmative responses given. This study has highlighted the high incidence of minor neck symptoms amongst the general working population, if direct questions are asked. The aetiology of neck pain is clearly multifactorial, but with increasing age cervical spondylosis becomes a major factor. Some injuries do result in permanent neck symptoms in patients who previously had asymptomatic cervical spondylosis, and from a legal standpoint, it is usually held that the injury resulted in the spondylosis becoming symptomatic earlier than it would otherwise have done so. However, as a result of this study, we consider that in some cases of so-called ‘asymptomatic’ spondylosis, the presence of neck discomfort after normal activities could have been elicited before, if direct questions had been asked. Patients who suffer neck symptoms following an injury often do not recall that they suffered with some minor neck symptoms before the incident.
15
neck symptoms
i - 8 5 0 I--- O .in .ln 20-29 IU-IJ
Conclusion
10 30
30-39 40-49
50-59
80-85
3. Incidence of neck symptoms related to age in subjects who have not suffered a previous neck injury.
Figure
who had not suffered any definite neck injury, and yet were still troubled with some neck symptoms in 34 per cent of cases. This hypothesis was rejected (P-C O.Ol), indicating that there was a significant difference between these two groups.
Discussion In spite of relatively small numbers in this study, the results are such as to be of statistical significance. We consider that there are two possible explanations for the statistically significant difference observed. Firstly, that the subpopulation who suffer a neck injury is, in fact, constitutionally different from the rest of the population. Secondly, that the two groups are derived from the same population, but those individuals who suffer a neck injury do not recall that they suffered with some minor neck symptoms before their injury. As it is intrinsically unlikely that patients who suffer neck injury are in any way different from those who do not suffer injury, we feel that it is reasonable to reject the first explanation, and favour the second. The results confirm the clinical observation that the incidence of neck symptoms increases with age. The study has also revealed a high incidence of neck symptoms (23 per cent) in the relatively young age group of 30-39 years (Figure2). This may be due to the fact that in the questionnaire direct questions were asked regarding the occurrence of neck symptoms during or after performing
We conclude that some individuals who suffer a neck injury sometimes do not recall that they suffered with some minor neck symptoms before their injury. This finding may be of medico-legal importance in cases in which compensation is being sought for a previous neck injury.
Acknowledgements We would like to thank all of the staff of Ancoats Hospital, Manchester, who took part in this study. We would particularly like to thank our medical secretaries, Ruth Costigan and Judith Garside, for their help with the distribution and collection of the questionnaires.
References 1 Makela M, Heliovaara M, Sievers K et al. Prevalence, determinants, and consequences of chronic neck pain in Finland. Am J Epidemiol 1991; 134: 1356. 2 Stock SR. Workplace ergonomic factors and the development of musculoskeletal disorders of the neck and upper limbs: a meta analysis. Am ] Ind Med 1991; 19: 87. 3
Takala EP, Viikari-Juntura E, Moneta GB et al. Seasonal variation in neck and shoulder symptoms. S’ca~zI ] Work Envirorz Health
1992;
18: 257.
Paper accepted 20 July 19%.
reprints should be addressed to: Mr J.P. Hodgkinson, Gartside Street, Manchester M3 3EL, UK. Requests@
76