Prognosis in whiplash

What we are doing

This project is part of the research thesis component of David Walton, PhD candidate in Health and Rehabilitation Sciences at The University of Western Ontario.  The purpose of the project is to develop a tool that can be easily administered in a clinical setting, and can provide rehabilitation professionals with an estimate of the risk that a patient will go on to develop chronic WAD-related problems.  For those patients deemed to be at risk of a poor outcome, the tool will also provide the nature of the risk.  It is this second purpose that will help guide clinicians in deciding the most appropriate mode of intervention to minimize the risk of chronic problems.

 

Why is a new tool needed?

Currently, the most widely used classification system for patients with whiplash-related symptoms is the system developed by the Quebec Task Force in 1995¹.  This system is clinician-friendly in that it classifies patients into one of 4 categories based on a simple assessment of presenting signs and symptoms.  However, scientific support for the prognostic ability of the system is lacking².  Further, the system does not suggest the optimal direction for intervention for the patient.

Subsequent tools have been developed in an effort to improve the accuracy of prognosis^3,4,5.  To date, none of these tools have garnered widespread acceptance, nor have they demonstrated consistent predictive ability.

Beyond prognosis, much of the literature pertaining to WAD has been directed at finding the optimal intervention that will prevent the transition to a state of chronic pain or disability.  To date, many of these attempts have met with sub-optimal results, leading to suggestions that the best approach to whiplash is to educate the patient to stay active, and otherwise take a wait-and-see approach.

The researchers on this study, along with others in the field, have opined that several of the novel interventions that have recently been evaluated might find better results when applied to a more targeted sub-set of the acute whiplash population.  Unfortunately, no system of classifying patients with whiplash based on the nature of risk has yet been developed.  We hope that this project is the first step in developing a comprehensive risk assessment tool for this purpose.

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