What are people's perspectives on different labels for neck pain after a motor vehicle crash? A content analysis of randomized study data

BACKGROUND: Labels for neck pain after a motor vehicle crash (MVC) influenced recovery expectations and management preferences. Research is needed to understand why these expectations and preferences varied based on the label given. AIM: To explore how people perceive different labels for neck pain after an MVC. METHODS: We performed a content analysis of qualitative data from a randomised controlled study. 2229 participants with and without neck pain read a vignette describing a patient with neck pain after an MVC, using one of five labels: whiplash injury, whiplash-associated disorder, post-traumatic neck pain, neck pain, or neck strain. Participants provided free-text responses on the label's meaning, associated words/feelings, required health services/treatments, and any confusion about the label. RESULTS: Compared to neck strain, post-traumatic neck pain, whiplash-associated disorder, and neck pain more commonly evoked negative feelings about symptom severity and prognosis (4.7 % for neck strain versus 7.2 %-16.0 % for other labels) and psychological distress (7.3 % versus 13.0 %-30.3 %). Regarding treatment preference, neck pain most commonly promoted need for passive physical therapies (21.6 %) and imaging (9.8 %), whereas neck strain most often promoted need for exercise (11.6 %) and rarely imaging (3.4 %). Neck pain was the most confusing label (39.9 %), while whiplash injury was the least (14.8 %), with confusion arising from vagueness or a mismatch with diagnostic expectations. CONCLUSION: The meanings, feelings and confusions evoked by neck pain labels after an MVC may explain their impact on recovery expectations and management preferences. Clinicians may consider avoid labels associated with negative feelings and lower preferences for guideline-recommended treatments.