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Contributions of Physical and Cognitive Impairments to Self-Reported Driving Difficulty in Chronic Whiplash-Associated Disorders

Takasaki, Hiroshi MSc; Treleaven, Julia PhD; Johnston, Venerina PhD; Jull, Gwendolen PhD

Spine:
doi: 10.1097/BRS.0b013e31829adb54
Cervical Spine
Abstract

Study Design. Cross-sectional.

Objective. To conduct a preliminary analysis of the physical, cognitive, and psychological domains contributing to self-reported driving difficulty after adjusting for neck pain, dizziness, and relevant demographics in chronic whiplash-associated disorders (WAD) using hierarchical regression modeling.

Summary of Background Data. Pain is a risk factor for car crashes, and dizziness may affect fitness to drive. Both symptoms are common in chronic WAD and difficulty driving is a common complaint in this group. Chronic WAD is often accompanied by physical, cognitive, and psychological impairments. These impairments may contribute to self-reported driving difficulty beyond neck pain, dizziness, and relevant demographics.

Methods. Forty individuals with chronic WAD participated. Dependent variables were the magnitude of self-reported driving difficulty assessed in the strategic, tactical, and operational levels of the Neck Pain Driving Index. Three models were developed to assess the contributions of independent variables (physical, cognitive, and psychological domains) to each of the 3 dependent variables after adjusting for neck pain intensity, dizziness, and driving demographics. The measures included were: physical domain—range and maximum speed of head rotation, performances during gaze stability, eye-head coordination, and visual dependency tests; cognitive domain—self-reported cognitive symptoms including fatigue and the trail making tests; and psychological domain—general stress, traumatic stress, depression, and fear of neck movements and driving.

Results. Symptom duration was relevant to driving difficulty in the strategic and tactical levels. The cognitive domain increased statistical power to estimate the strategic and operational levels (P < 0.1) beyond other contributors. The physical domain increased statistical power to estimate the tactical level (P < 0.1) beyond other contributors.

Conclusion. Physical and cognitive impairments independently contributed to self-reported driving difficulty in chronic WAD beyond neck pain, dizziness, and symptom duration.

Level of Evidence: 3

In Brief

Driving is a common complaint of people with chronic whiplash-associated disorders. Using hierarchical multiple regression analyses, this study demonstrated that physical and cognitive impairments independently contributed to self-reported driving difficulty after adjusting for neck pain, dizziness, and symptom duration in a group with chronic whiplash-associated disorder.

Author Information

From the NHMRC Centre of Clinical Research Excellence–Spinal Pain, Injury and Health, Division of Physiotherapy, School of Health and Rehabilitation Science, The University of Queensland, Brisbane, Queensland, Australia.

Address correspondence and reprint requests to Hiroshi Takasaki, MSc, CCRE Spine, Division of Physiotherapy, School of Health and Rehabilitation Science, The University of Queensland, Brisbane, Queensland 4072, Australia; E-mail: hiroshi.takasaki@uqconnect.edu.au

Acknowledgment date: March 1, 2013. First revision date: April 26, 2013. Acceptance date: May 6, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: grants pending and royalties.

© 2013 by Lippincott Williams & Wilkins