In my previous columns on whiplash-associated disorders (WAD), I have discussed history-taking and the physical examination of the neck, including nonorganic findings. To follow up, I’d like to provide you with some practical tools to help in your assessment and management of ICBC patients.
The first comprehensive monograph on WAD was published in Spine (1995;20[8 suppl]:S1-73) by the Quebec Task Force (QTF). The members of this task force, considered experts in the field of WAD, screened approximately 10 000 articles and published a synopsis. The QTF classified WAD into the Grades I to IV that we still use today.
Thirteen years later a second task force of more than 50 clinicians and scientists from several countries screened approximately 32000 articles in order to establish “best evidence” information. The results of the work completed by the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and its Associated Disorders also were published in Spine (2008;33[4 suppl]:S1-213).
These supplements are comprehensive, although they do not contain specific, practical tools for medical practice and patient management. In my opinion, they are best used as a starting point for further in-depth research into specific areas of WAD.
The Motor Accidents Authority of New South Wales, Australia, developed comprehensive guidelines for the diagnosis and management of whiplash-associated disorders in 2001 and revised them in 2007. These Guidelines for the Management of Acute Whiplash-Associated Disorders for Health Professionals (2nd edition, 2007) can be downloaded from www.maa.nsw.gov.au.
The guidelines focus on the first 3 months postinjury, although there is also some information on factors that may be associated with a more prolonged recovery. The QTF grades of WAD are used and there is extensive information on the assessment and management of WAD. If you’ve never read anything on WAD, I suggest you read the summary guidelines. They include a management algorithm and a number of assessment tools all contained in 28 pages. Subsequent pages provide patient handouts and detailed exercises, plus educational information.
There were several physiotherapists in the working group. Their information is very helpful in ongoing medical and physiotherapy management and expectations. The material is extremely easy to read and I have found it helps me to be objective and to help patients focus on abilities and limitations—rather than pain—during the period of recovery from injuries.
The Official Disability Guidelines of the Work Loss Data Institute provide brief management and return-to-work guidelines on a best-evidence basis. Their web site is www.odgtreatment.com. Please e-mail Anita.Gill@icbc.com for user ID and password information. The keyword “whiplash” provides a starting point for neck injuries. This site contains information on a very wide variety of medical issues. It provides brief summaries of expectations for recovery, as well as numerous links for further information.
ICBC provided funding for the BC Whiplash Initiative, a multi-agency project on WAD. As a result a comprehensive syllabus was published in 1997. At the time this was widely distributed to physicians, but if you do not have a copy, you may access the syllabus at www.health-sciences.ubc.ca/whiplash.bc. The syllabus is available but the web site is no longer being maintained and the material has not been updated. Nevertheless, it does contain good basic information.
The College of Physicians and Surgeons of BC Library is an excellent source of further articles and literature searches. Many articles are available for instant download and the librarians will assist you in obtaining copies of articles not readily available in full.
Thank you to those of you who have sent me a copy of your MVA patient histories. I look forward to receiving others so that a standardized form may be developed. Please send these along with any other comments or suggestions to Laura.Jensen@ICBC.com or fax to 604 647-6148.
—L.A. Jensen, MD
ICBC Medical Community Liaison
The opinions expressed in this article are those of the author and do not necessarily represent the position of the Insurance Corporation of British Columbia.
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