The association between a lifetime history of low back injury in a motor vehicle collision and future low back pain: a population-based cohort study

Abstract

Purpose

This population-based cohort study investigated the association between a lifetime history of a low back injury in a motor vehicle collision (MVC) and future troublesome low back pain. Participants with a history of a low back injury in a motor vehicle collision who had recovered (no or mild low back pain) were compared to those without a history of injury. Current evidence from two cross-sectional and one prospective study suggests that individuals with a history of a low back injury in a MVC are more likely to experience future LBP. There is a need to test this association prospectively in population-based cohorts with adequate control of known confounders.

Methods

We formed a cohort of 789 randomly sampled Saskatchewan adults with no or mild LBP. At baseline, participants were asked if they had ever injured their low back in a MVC. Six and 12 months later, participants were asked about the presence of troublesome LBP (grade II–IV) on the Chronic Pain Grade Questionnaire. Multivariable Cox proportional hazards regression analysis was used to estimate the association while controlling for known confounders.

Results

The follow-up rate was 74.8% (590/789) at 6 months and 64.5% (509/789) at 12 months. There was a positive crude association between a history of low back injury in a MVC and the development of troublesome LBP over a 12-month period (HRR = 2.76; 95% CI 1.42–5.39). Controlling for arthritis reduced this association (HRR = 2.25; 95% CI 1.11–4.56). Adding confounders that may be on the casual pathway (baseline LBP, depression and HRQoL) to the multivariable model further reduced the association (HRR = 2.20; 95% CI 1.04–4.68).

Conclusion

Our analysis suggests that a history of low back injury in a MVC is a risk factor for developing future troublesome LBP. The consequences of a low back injury in a MVC can predispose individuals to experience recurrent episodes of low back pain.

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Acknowledgments

The authors would like to acknowledge the Chiropractors’ Association of Saskatchewan for funding the Saskatchewan Health and Back Pain Survey and the assistance of Saskatchewan Health in sampling the Saskatchewan population. Dr. Kristman is supported by the Canadian Institutes of Health Research through a New Investigator Award in Community-based Primary Health Care.

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Correspondence to Paul S. Nolet.

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Nolet, P.S., Kristman, V.L., Côté, P. et al. The association between a lifetime history of low back injury in a motor vehicle collision and future low back pain: a population-based cohort study. Eur Spine J 27, 136–144 (2018). https://doi.org/10.1007/s00586-017-5090-y

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Keywords

  • Low back pain
  • Traffic accidents
  • Whiplash injuries
  • Risk factors
  • Cohort studies