Predictors of Neck Disorders

This study hoped to determine what factors influenced the prognosis of neck disorders (ND) in 568 subjects (294 in the intervention and 274 in the control). The patients were four different types of workers—hospital, airport, warehouse, and office. The predictive factors that were evaluated were: a disorder for more than 30 days, any treatments the patient sought, and a specific visit to a healthcare professional for ND. The authors used Langer's questionnaire that evaluates psychosomatic and psychological aspects, and the Nordic questionnaire, which assesses musculoskeletal symptoms over six months. The subjects took the Nordic again after 12 months.

During the initial evaluation, 40.5% complained of ND in the previous 6 months. The rate was more frequent among women and those with psychological distress. Nurses reported a higher incident rate than did warehouse workers. Women were also more likely to seek medical treatment.

Statistically, the follow-up did not differ significantly—40.8% still reported ND—but the authors claim there were differences on an individual level. They write, "The situation at the time of the first questionnaire was predictive of the situation at the time of the second questionnaire." Here's how:

• Subjects who didn't have symptoms, but did have a history of ND at the first questionnaire were more at risk than patients without a history.
• Subjects without symptoms at the first questionnaire were less at risk than subjects with a prevalent disorder at the first questionnaire.

52 subjects reported ND for more than 30 days at the first evaluation. A year later, 6 completely recovered, 19 reported they suffer less than 30 days, 27 reported the pain persisted for more than 30 days. But there were no major changes; for instance, if a subject did not report ND initially, there were no new chronic problems reported.

Gender and age predicted the occurrence of any ND and patients seeking treatment. Also psychological distress, psychosomatic disorders, and headaches heavily predicted neck disorders. The authors also state that psychological distress plays a role in various dimensions of the neck disorder:

"There may be several underlying mechanisms between psychological distress and musculoskeletal disorders: increase of muscle tension, increase of the perception of pain, less control on occupational constraints, and less compliance with treatment."

Occupation did not emerge as a predictor. Work satisfaction, however, seemed to protect the patient from the incidence of ND, but it did not protect the persistence of ND.

Leclerc A, Niedhammer I, Landre M, et al. One-year predictive factors for various aspects of neck disorders. Spine 1999;24(14):1455-1462.