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Objective: The purpose of the study was to determine the prevalence and factors associated with injury in professional ballet and modern dancers, and assess if dancers are reporting their injuries and explore reasons for not reporting injuries. Design: Cross-sectional study. Setting: Participants were recruited from nine professional ballet and modern dance companies in Canada, Denmark, Israel, and Sweden. Participants: Professional ballet and modern dancers. Independent Variables: Sociodemographic variables included age, sex, height, weight, and before-tax yearly or monthly income. Dance specific characteristics included number of years in present dance company, number of years dancing professionally, number of years dancing total, and rank in the company. Main Outcome Measures: Self-reported injury and Self-Estimated Functional Inability because of Pain. Results: A total of 260 dancers participated in the study with an overall response rate of 81%. The point prevalence of self-reported injury in professional ballet and modern dancers was 54.8% (95% CI, 47.7-62.1) and 46.3% (95% CI, 35.5-57.1), respectively. Number of years dancing professionally (OR = 4.4, 95% CI, 1.6-12.3) and rank (OR = 2.4, 95% CI, 1.2-4.8) were associated with injury in ballet dancers. More than 15% of all injured dancers had not reported their injury and their reasons for not reporting injury varied. Conclusions: The prevalence of injury is high in professional dancers with a significant percentage not reporting their injuries for a variety of reasons. Number of years dancing and rank are associated with injury in professional ballet dancers. [ABSTRACT FROM AUTHOR]

A conference paper on a study which identifies the prevalence of bodily pain after traffic injury and describes the bodily pain distribution. It states that a cross-sectional analysis was conducted to a population-based cohort of 6481 residents in Saskatchewan, who undergo treatment or filed an auto insurance claim within 30 days. It determines four major patterns accounted for the 60% pain localization variance, such as low back pain and upper anterior trunk and upper extremity pain.

The article compares the chiropractic and primary care physician (PCP) visits of patients with vertebrobasilar artery (VBA) stroke. According to the authors, patients less than 45 years old were about three times more likely to see a chiropractor or a PCP before their stroke than the control sample. They add that there was no increased link between chiropractic visits and VBA stroke in those older than 45 years. They note positive links between PCP visits and VBA stroke in all age groups.

The article identifies relevant literature on the frequency, determinants, assessment, interventions, course and prognosis of neck pain and its associated disorders, using best evidence synthesis. According to the authors, 46% of 31,878 citations were judged scientifically admissible to inform clinical practice, policy-making and future research. They add that the citations were screened for relevance to the Neck Pain Task Force mandate using a priori criteria.

Abstract: Pain coping strategies are associated with pain severity, psychological distress and physical functioning in populations with persistent pain. However, there is little evidence regarding the relationship between coping styles and recovery from recent musculoskeletal injuries. We performed a large, population-based prospective cohort study of traffic injuries to assess the relationship between pain coping strategies and recovery from whiplash injuries. Subjects were initially assessed within 6 weeks of the injury, with structured telephone interview follow-up at 6 weeks, and 3, 6, 9 and 12 months post-injury. Coping was measured at 6 weeks using the Pain Management Inventory and recovery was assessed at each subsequent follow-up period, using a global self-report question. Multivariable Cox proportional hazards models showed that early use of passive coping strategies was independently associated with slower recovery. Depressive symptomatology (CES-D) was an effect modifier of this relationship. Without depressive symptomatology, those using high levels of passive coping recovered 37% slower than those using low levels of passive coping (HRR=0.63; 95% CI 0.44–0.91). However, in the presence of depressive symptomatology, those using high levels of passive coping recovered 75% more slowly than those who coped less passively (HRR=0.25; 95% CI 0.17–0.39). In other words, those with depressive symptoms but who used few passive coping strategies recovered four times more quickly than those with depressive symptoms who used high levels of passive coping. Active coping showed no independent association with recovery. These findings highlight the importance of early assessment of both coping behaviors and depressive symptomatology. [Copyright &y& Elsevier]

Abstract: Although neck pain is a common source of disability, little is known about its incidence and course. We conducted a population-based cohort study of 1100 randomly selected Saskatchewan adults to determine the annual incidence of neck pain and describe its course. Subjects were initially surveyed by mail in September 1995 and followed-up 6 and 12 months later. The age and gender standardized annual incidence of neck pain is 14.6% (95% confidence interval: 11.3, 17.9). Each year, 0.6% (95% confidence interval: 0.0–1.1) of the population develops disabling neck pain. The annual rate of resolution of neck pain is 36.6% (95% confidence interval: 32.7, 40.5) and another 32.7% (95% confidence interval: 25.5, 39.9) report improvement. Among subjects with prevalent neck pain at baseline, 37.3% (95% confidence interval: 33.4, 41.2) report persistent problems and 9.9% (95% confidence interval: 7.4, 12.5) experience an aggravation during follow-up. Finally, 22.8% (95% confidence interval: 16.4, 29.3) of those with prevalent neck pain at baseline report a recurrent episode. Women are more likely than men to develop neck pain (incidence rate ratio=1.67, 95% confidence interval 1.08–2.60); more likely to suffer from persistent neck problems (incidence rate ratio=1.19, 95% confidence interval 1.03–1.38) and less likely to experience resolution (incidence rate ratio=0.75, 95% confidence interval 0.63–0.88). Neck pain is a disabling condition with a course marked by periods of remission and exacerbation. Contrary to prior belief, most individuals with neck pain do not experience complete resolution of their symptoms and disability. [Copyright &y& Elsevier]

The objective of this study is to determine whether depression is an independent risk factor for onset of an episode of troublesome neck and low back pain. There is growing evidence that pain problems increase the risk of depression. However, the evidence about the role of depression as a risk factor for onset of pain problems is contradictory. This lack of consistency in research findings may be due in part to methodological weaknesses in existing studies, for example, use of an inappropriate study design and inadequate consideration of confounding. A population-based random sample of adults was surveyed and followed at 6 and 12 months. Individuals at risk of troublesome (intense and/or disabling) neck or low back pain are the subjects of this report (n=790). We used Cox proportional hazards models to measure the time-varying effect of depressive symptoms on the onset of troublesome neck and low back pain. Our multivariable analysis considered the possible confounding effects of demographic and socio-economic factors, health status, co-morbid medical conditions and injuries to the neck or low back. We found an independent and robust relationship between depressive symptoms and onset of an episode of pain. In comparison with the lowest quartile of scores (the least depressed), those in the highest quartile of depression scores had a four-fold increased risk of troublesome neck and low back pain (adjusted HRR 3.97; 95% CI 1.81–8.72). Depression is a strong and independent predictor for the onset of an episode of intense and/or disabling neck and low back pain. [Copyright &y& Elsevier]

A letter to the editor is presented in response to the article "Risk of vertebrobasilar stroke and chiropractic care: results of a population based case control and case-crossover," by J. D. Cassidy et al, published in a 2008 issue, along with the response of the authors.

Presents a commentary on a study on chronic neck pain after whiplash. Other factors that must be considered; Differences in social reactions to rear-end collisions; Recommendations.

Objectives: The aim of this cohort study was to investigate the association between self-reported cardiovascular disorders (CVD) and recovery from whiplash-associated disorder (WAD) after a traffic collision., Materials and Methods: This study was based on the Saskatchewan Government Insurance cohort, including individuals over 18 years of age, who made a traffic-injury claim or received health care after a traffic injury, between 1997 and 1999. Participants completed a baseline questionnaire and were followed up by telephone interviews at 6 weeks, 3 months, 6 months, 9 months, and 12 months after injury. Our sample includes a subcohort of 6011 participants who reported WAD (defined as answering "yes" to the question "Did the accident cause neck or shoulder pain") at baseline. The outcome, self-perceived recovery, was measured at all follow-up interviews. The presence of CVD and its effect on health was classified into 3 exposure categories: (1) CVD absent, (2) CVD present with no or mild effect on health, and (3) CVD present with moderate or severe effect on health. The association between CVD and recovery from WAD was assessed with Cox regression, and adjusted for potential confounders., Results: We found a crude association between comorbid CVD with moderate or severe effect on health in women. However, the adjusted association was weak and potentially affected by residual confounding. We found no association in men., Discussion: Our results suggest that CVD does not have an impact on the recovery of individuals with WAD.

Objective: Psychological factors such as depression affect recovery after whiplash-associated disorders. This study examined the prevalence of pain-related emotions, such as frustration, anger, and anxiety, and their predictive value for postcrash pain recovery during a 1-year follow-up., Methods: A population-based prospective cohort study design was used. Self-reported pain-related depression, anxiety, fear, anger, and frustration were assessed using 100-mm visual analog scales (VASs) at 6 weeks after crash in 2986 persons with traffic-related whiplash-associated disorder. Multivariable logistic regression was used to assess the relationship between the intensity of these pain-related emotions and pain recovery at 4 and 12 months after crash. Pain was measured at all time points on a 100-mm VAS, and pain recovery was defined as a score of 10 or lower., Results: Pain-related frustration was the most intense, with a mean score of 52. Only 3% of the cohort reported having no pain-related frustration, and 4% reported no pain-related anxiety. Multivariable logistic regression models revealed that each pain-related emotion increased the risk of failing to recover (odds ratios for each point increase on the 100-mm VAS), ranging from 1.011 to 1.015. Specifically, with each 10-point increase in pain-related emotion, the odds of failing to achieve pain recovery at 4 months was increased by 14% (p < .001) for depression, 15% (p < .001) for anxiety, 11% (p < .001) for fear, 12% (p < .001) for anger, and 11% (p < .001) for frustration., Conclusions: These findings suggest that it may be beneficial for health care providers to address emotional status related to pain in the first few weeks after a whiplash injury.

Study Design: Best evidence synthesis., Objective: To perform a best evidence synthesis on the course and prognostic factors for neck pain and its associated disorders in Grades I-III whiplash-associated disorders (WAD)., Summary of Background Data: Knowledge of the course of recovery of WAD guides expectations for recovery. Identifying prognostic factors assists in planning management and intervention strategies and effective compensation policies to decrease the burden of WAD., Methods: The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and its Associated Disorders (Neck Pain Task Force) conducted a critical review of the literature published between 1980 and 2006 to assemble the best evidence on neck pain and its associated disorders. Studies meeting criteria for scientific validity were included in a best evidence synthesis., Results: We found 226 articles related to course and prognostic factors in neck pain and its associated disorders. After a critical review, 70 (31%) were accepted on scientific merit; 47 of these studies related to course and prognostic factors in WAD. The evidence suggests that approximately 50% of those with WAD will report neck pain symptoms 1 year after their injuries. Greater initial pain, more symptoms, and greater initial disability predicted slower recovery. Few factors related to the collision itself (for example, direction of the collision, headrest type) were prognostic; however, postinjury psychological factors such as passive coping style, depressed mood, and fear of movement were prognostic for slower or less complete recovery. There is also preliminary evidence that the prevailing compensation system is prognostic for recovery in WAD., Conclusion: The Neck Pain Task Force undertook a best evidence synthesis to establish a baseline of the current best evidence on the course and prognosis for WAD. Recovery of WAD seems to be multifactorial.

Study Design: Survey, subgroup analysis, Q-analysis, and analysis of e-mail exchanges., Objective: To assess what influences the choice of priorities for interventions to prevent back-related disability., Summary of Background Data: Back-related disability results from interaction of physical, psychological, occupational, and social factors. However, opinions differ on which factors should be targeted by interventions aimed at preventing disability., Methods: A Delphi panel (14 researchers and 19 occupational health stakeholders) attempted to reach consensus about the relative impact and modifiability of 32 factors involved in back-related disability. Data gathered during the panel were analyzed using 4 methods: (1) a survey asking panel members what influenced their rankings, (2) subgroup analysis to compare differences in rankings according to members' backgrounds and affiliations, (3) Q-analysis to identify views shared by members, and (4) qualitative analysis of e-mail exchanges during the panel process., Results: Besides research evidence about a factor, we found that the greatest influence was the personal experience of panel members, which included diverse views about the nature of back disability, expectations about how interventions would be implemented, the typical workers or patients seen by them, and their values and principles. The member's educational background and current affiliation played a lesser role in their choice of priorities. The choice of priorities was also influenced by difficulties in separating the impact of a factor from its modifiability, whether the panel member considered occupational or nonoccupational disability, and the intricate linkages between the factors., Conclusions: This study suggests the choice of priorities is primarily influenced by different views about disability and other components of personal experience. Secondary influences included process difficulties in making a choice. The person's background and affiliation had a weak association with the views and choice of priorities.

Study Design: Population-based, incidence cohort., Objectives: To evaluate a government policy of funding community and hospital-based fitness training and multidisciplinary rehabilitation for whiplash., Summary of Background Data: Although insurance benefits commonly include rehabilitation for whiplash, its effectiveness is unknown., Methods: All Saskatchewan adults treated for whiplash (n = 6,021) over a 2-year period were followed up at 6 weeks, 3, 6, 9, and 12 months. Recovery was defined by self-report of improvement. Recovery times were compared between those attending fitness training at health clubs (n = 833), multidisciplinary outpatient rehabilitation (n = 468), and multidisciplinary inpatient rehabilitation (n = 135) to those receiving usual insured individual care., Results: Recovery was 32% slower in those receiving fitness training within 69 days of injury (P = 0.001) and 19% slower when received within 119 days of injury (P = 0.041). Recovery was 50% slower in those receiving outpatient rehabilitation within 119 days of injury (P = 0.001). Attending inpatient rehabilitation did not influence recovery rates during the follow up (P = 0.131). Multivariable adjustment for important prognostic factors did not change these results., Conclusions: We found no evidence to support the effectiveness of a population-based program of fitness training and multidisciplinary rehabilitation for whiplash. Rehabilitation programs should be tested in randomized trials before being recommended to injured populations.

Study Design: Retrospective clinical cohort study., Objective: To identify the prognostic factors associated with a poor response to treatment in the early stages of a whiplash-associated disorder (WAD)., Summary of Background Data: Several demographic and clinical factors related to recovery following acute WADs have been identified. However, few longitudinal studies have investigated a multivariable model of recovery that includes socio-demographic, treatment, clinical, and nonclinical factors., Methods: A study cohort of 2,185 patients with acute or subacute WADs presenting to 48 rehabilitation clinics in 6 Canadian provinces were investigated for factors associated with failure to demonstrate a minimally important clinical change (10%) in the Canadian Back Institute Questionnaire (CBIQ) score between the initial and discharge rehabilitation visits., Results: Multivariable analysis revealed eight prognostic factors associated with a negative outcome: 1) older age, 2) female gender, 3) increasing lag time between injury date and presentation for treatment, 4) initial pain location, 5) province of injury, 6) higher initial pain intensity, 7) lawyer involvement, and 8) at work at entry to the clinic. The effect of lawyer involvement was stronger for patients with less intense pain on initial visit (odds ratio = 2.97; 95% confidence interval, 1.77-4.99). Similarly, the effect of work status was stronger for patients with less intense pain on initial visit (odds ratio = 2.02; 95% confidence interval, 1.18-3.46)., Conclusions: Researchers and clinicians should be aware of the potential for non-injury-related factors to delay recovery, and be aware of the interaction between the initial intensity of a patient's pain and other covariates when confirming these results.

Study Design: Population-based incidence cohort., Objective: To report the incidence, timing, and course of depressive symptoms after whiplash., Summary of Background Data: Evidence is conflicting about the frequency, time of onset, and course of depressive symptoms after whiplash., Methods: Adults making an insurance claim or seeking health care for traffic-related whiplash were followed by telephone interview at 6 weeks, and 3, 6, 9, and 12 months post-injury. Depressive symptoms were assessed at baseline and at each follow-up., Results: Of the 5,211 subjects reporting no pre-injury mental health problems, 42.3% (95% confidence interval, 40.9-43.6) developed depressive symptoms within 6 weeks of the injury, with subsequent onset in 17.8% (95% confidence interval, 16.5-19.2). Depressive symptoms were recurrent or persistent in 37.6% of those with early post-injury onset. Pre-injury mental health problems increased the risk of later onset depressive symptoms and of a recurrent or persistent course of early onset depressive symptoms., Conclusions: Depressive symptomatology after whiplash is common, occurs early after the injury, and is often persistent or recurrent. This suggests that, like neck pain and headache, depressed symptomatology is part of the cluster of acute whiplash symptoms. Clinicians should be aware of both physical and psychologic injuries after traffic collisions.

Study Design: Cohort study of subjects with whiplash-associated disorders (WAD)., Objective: To assess the association between preinjury factors and neck pain intensity within 30 days after a motor vehicle collision., Summary of Background Data: Neck pain is the main symptom in WAD. There are studies of nonspecific musculoskeletal pain suggesting that pain intensity can be modified by psychologic, personal, or social factors, but, to our knowledge, no studies have investigated the association between such factors and neck pain intensity in WAD., Methods: The subjects (n = 5970) either filed a claim or were treated for neck pain within 30 days after a collision. Neck pain intensity was measured on the visual analog scale., Results: Fair or poor health before the collision was associated with severe neck pain in females (odds ratio 4.0, 95% confidence interval 1.8-8.9). Other associated factors in females included low education and prior neck pain. Low family income was associated with severe neck pain in males (odds ratio 2.3, 95% confidence interval 1.5-3.4), as was prior headache and being unaware of the head position at the time of collision., Conclusion: The results suggest that neck pain intensity in WAD seems to be influenced by several factors other than characteristics related to the injury event itself.

Study Design: Population-based, prospective cohort., Objectives: To estimate incidence and course of severity-graded low back pain (LBP) episodes in adults., Summary of Background Data: Past studies report variable estimates that do not differentiate LBP severity., Methods: An incidence cohort of 318 subjects free of LBP and a course cohort of 792 prevalent cases was formed from respondents to a mailed survey. Incident, recurrent, persistent, aggravated, improved, and resolved episodes were defined by the Chronic Pain Questionnaire. The follow-up at 6 and 12 months was 74% and 62%, respectfully. Annual estimates were age and sex standardized., Results: The cumulative incidence was 18.6% (95% confidence interval [CI], 14.2%-23.0%). Most LBP episodes were mild. Only 1.0% (95% CI, 0.0%-2.2%) developed intense and 0.4% (95% CI, 0.0%-1.0%) developed disabling LBP. Resolution occurred in 26.8% (95% CI, 23.7%-30.0%), and 40.2% (95% CI, 36.7%-43.8%) of episodes persisted. The severity of LBP increased for 14.2% (95% CI, 11.5%-16.8%) and improved for 36.1% (95% CI, 29.7%-42.2%). Of those that recovered, 28.7% (95% CI, 21.2%-36.2%)had a recurrence within 6months,and 82.4% of it was mild LBP. Younger subjects were less likely to have persistent LBP (incidence rate ratio, 0.88; 95% CI, 0.80-0.97) and more likely to have resolution (incidence rate ratio, 1.26; 95% CI, 1.02-1.56)., Conclusions: Most new and recurrent LBP episodes are mild. Less than one third of cases resolve annually, and more than 20% recur within 6 months. LBP episodes are more recurrent and persistent in older adults.

Study Design: A background literature, supported by discussion and outcomes on the subject of Health Policy and Back Pain, from the Fifth International Forum on Low Back Pain Research in Primary Care, in Montreal in May 2002., Summary of Background Data: A multitude of randomized controlled trials and systematic reviews have been completed in the field of back pain research. There has been limited health policy research in the field of back pain but a greater amount of health policy research in other medical fields., Methods: The focus of the workshop was on the contribution health policy could make in the area of back pain, the methodologies that are appropriate to research in back pain, and the barriers to back pain health policy research. The workshop was supported by the workshop coordinators' literature review., Results: There was consensus about the lack of improved outcomes from randomized controlled trials and individual treatments and general agreement on the importance supporting current research initiatives with health policy research. That policy-makers were developing policy in this area was agreed, and study methodology to support evidence based policy development was explored., Conclusions: Health policy research is a relatively underdeveloped area of research in back pain. Back pain as a public health problem may be supported by a broader research approach and a collaborative association with policy-makers in this area.

Study Design: Historical cohort study., Objectives: We examined the validity of the Isernhagen Work Systems' Evaluation in predicting timely return to work., Summary of Background Data: Functional Capacity Evaluations are used commonly to determine readiness for return to work, yet little is known of their validity., Methods: Workers' compensation claimants undergoing Functional Capacity Evaluations following work-related low back injury were studied. Two cohorts were formed, one on which exploratory analyses were conducted and a second for confirmation. Evaluation indicators were the number of tasks in the protocol rated as failed and performance during the floor-to-waist lift task. The primary outcome investigated was time receiving total temporary disability benefits (as a surrogate of return to work) and a secondary outcome was time until claim closure in the year following Evaluation. Cox proportional-hazards regression was used to determine the prognostic effect of Evaluation crudely and after controlling for potential confounders., Results: Few patients (4%) were found to pass all Evaluation tasks, yet most experienced total temporary disability suspension and claim closure within 1 year following Functional Capacity Evaluations. Better Evaluation performance was related to faster time to suspension of total temporary disability benefits and claim closure after controlling confounding factors, but explained little of the variation in these outcomes (approximately 10%). Performance on the floor-to-waist lift was as predictive as the number of failed tasks in the entire Functional Capacity Evaluations protocol., Conclusions: Better performance on Evaluation was weakly associated with faster recovery; however, the amount of variation explained was small. One task in the Evaluation was as predictive as the entire protocol.