Takasaki Hiroshi, Treleaven Julia, Johnston Venerina, Jull Gwendolen
School of Health and Rehabilitation Science, The University of Queensland, Brisbane, Queensland, Australia.
Spine (Phila Pa 1976). 2013 Aug 15;38(18):1554-60. doi: 10.1097/BRS.0b013e31829adb54.
Cross-sectional.
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.
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.
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.
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.
Physical and cognitive impairments independently contributed to self-reported driving difficulty in chronic WAD beyond neck pain, dizziness, and symptom duration.
横断面研究。
采用分层回归模型，在对慢性挥鞭样损伤相关疾病（WAD）中的颈部疼痛、头晕及相关人口统计学因素进行校正后，对导致自我报告的驾驶困难的身体、认知和心理领域进行初步分析。
疼痛是车祸的一个危险因素，头晕可能影响驾驶适宜性。这两种症状在慢性WAD中都很常见，驾驶困难是该群体的常见主诉。慢性WAD常伴有身体、认知和心理损伤。这些损伤可能导致除颈部疼痛、头晕及相关人口统计学因素之外的自我报告的驾驶困难。
40名慢性WAD患者参与研究。因变量是在颈部疼痛驾驶指数的战略、战术和操作层面评估的自我报告的驾驶困难程度。建立了三个模型，以评估在对颈部疼痛强度、头晕和驾驶相关人口统计学因素进行校正后，自变量（身体、认知和心理领域）对三个因变量各自的影响。所纳入的测量指标包括：身体领域——头部旋转范围和最大速度、注视稳定性测试、眼头协调测试和视觉依赖测试中的表现；认知领域——自我报告的认知症状，包括疲劳和连线测验；心理领域——一般应激、创伤后应激、抑郁以及对颈部运动和驾驶的恐惧。
症状持续时间与战略和战术层面的驾驶困难相关。认知领域比其他因素更能增加估计战略和操作层面驾驶困难的统计学效力（P < 0.1）。身体领域比其他因素更能增加估计战术层面驾驶困难的统计学效力（P < 0.1）。
除颈部疼痛、头晕和症状持续时间外，身体和认知损伤独立导致慢性WAD患者自我报告的驾驶困难。
3级。
