I hope all you Rehabhub readers are enjoying life and enjoying reading Rehabhub. As promised here is the second installment of our article about Whiplash Associated Disorders. Last week we looked at the Quebec Task Force and the classification system it came up with for Whiplash Associated disorders.
There were some criticisms of the Quebec Task force. The main critism was that the recommendations were based more on concensus of the experts involved in the process rather than on the outcome of a review of literature. The reason for this was that the literature avialable at the time was not sufficient to make recommendations and the concensus of the task group members was required to provide useful recommendations.
The recommendations were also critised as exhibiting bias. It was agued that the task force selected for the study only reports which involved cases which fitted certain distinct criteria and excluded those cases which may add complexity to the study. This meant that some of the real presentations of WAD were systematically excluded from the research and from the resultant recommendations. The recommendations, it was argued, would therefore by biased and only apply to particular cases of WAD. (See Teasell, R. and Merskey, H. The Quebec Task Force on shiplash-associated disorders and the British columbia Whiplash Initiative: A study of insurance industry initiatives. Pain Research & Management 1999;4(3):1141-149 )
Despite these criticisms 2001 the Australian researchers developed new guidelines for the management of Whiplash Associated Disorders. This set of Guidelines was based on the Quebec Task Force findings and included the use research which had been done since the Task Force released it recommneations. This review had international standing. In 2007 these guidelines were updated again to include a systematic review of relevant more recent literature. The 2007 NSW Motor Accident Authority Guidelines focus on the 12 weeks after the injury. The research showed, and the guidelines recommended, that certain forms of treatment were better than other forms of treatment. For example evidence was found to support the use of prescibed exercises and advice to stay active. However, some commonly used treatments were found to have no supporting evidence such as the use of cervical collars and prescribed rest. The full guidelines are available on the NSW MAA website. You can find the full details of the Technical Report Guidelines for the Management of Acute Whiplash-Associated Disorders (2nd edition 2007) on www.maa.nsw.gov.au and following the links to Whiplash guidelines – Technical Report Guidelines for the Management of Acute Whiplash-Associated Disorders 2nd Edition 2007. This includes the research methods used, the literature used and details of how the guidelines came about. You will notice that there are a number of other guidelines resulting from the MAA research which include guidelines for treating professionals, for injured people etc. Different insurance bodies of each State in Australia have their own versions of these more practical guides and build on the research of the NH&MRC and various other bodies in ways that are relevant for their state. For example, the South Australian Motor Accident Commission’s Clinical Resource Guide includes some useful details on the management of chronic WAD, that is, past the first 12 weeks from the date of injury.
The Quebec Task Force provided a starting point for a more systematic approach to Whiplash Associated Disorders. Further research including the MAA Guidelines have built on this and, as always, further research is required.
I hope this article is helpful for those of you dealing with whiplash associated disorders. Please feel free to comment if you have anything to add or you disagree with anything I have said.