title: 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: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Department of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada. pnolet@rogers.com.|School of Kinesiology, Lakehead University, Thunder Bay, ON, Canada. pnolet@rogers.com.|Wellington Orthopaedic and Rehabilitation Associates, 86 Dawson Rd., Unit 3, Guelph, ON, N1H 1A8, Canada. pnolet@rogers.com.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Nolet
authors.affiliation: Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada.|Division of Human Sciences, Northern Ontario School of Medicine, Lakehead University, Thunder Bay, ON, Canada.|Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.|Institute for Work and Health, Toronto, ON, Canada.
authors.forename: Vicki L
authors.initials: VL
authors.lastname: Kristman
authors.affiliation: Department of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada.|Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.|Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada.|UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Toronto, ON, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Côté
authors.affiliation: Department of Public Health Sciences, The Alberta Centre for Injury Control and Research, School of Public Health, University of Alberta, Edmonton, AB, Canada.
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Carroll
authors.affiliation: Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada.|Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.|Department of Sport Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark.
authors.forename: J David
authors.initials: JD
authors.lastname: Cassidy
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000328:Adult; D019567:Back Injuries / Q000150:complications*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012525:Saskatchewan; D011795:Surveys and Questionnaires
keywords: Cohort studies; Low back pain; Risk factors; Traffic accidents; Whiplash injuries