Quebec task force Classification of Grades of WAD

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Original Editor - Kapil Narale

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Whiplash[edit | edit source]

Check out the Whiplash page for detailed information on Whiplash Associated Disorders. The grades of WAD are related to the occurrence of whiplash.

What is the Classification of Grades of WAD[edit | edit source]

The Quebec Task Force on Whiplash-Associated Disorders (WAD) for grading WAD injuries was developed into a classification system in 1995, in Quebec, Canada. [1][2] It was developed as an objective tool to assist clinicians and researchers with diagnosing different types of WADs. It is also used to help clinicians in making treatment decisions for a certain severity of WAD. [2]

In 1995, upon development of the Classification model, the Quebec task force exclaimed that, [3]

"whiplash injuries result in "temporary discomfort," usually "self-limited," and have a "favourable prognosis," and that the "pain is not harmful". [3]

Grades of WAD[edit | edit source]

The following chart outlines the Quebec task force Classification of Grades of WAD: [1]

Grades of WAD
Grade Classification
0 No complaint about the neck.

No physical sign(s).

I Complaint of neck pain, stiffness or tenderness only.

No physical sign(s).

II Neck complaint AND musculoskeletal sign(s).

Musculoskeletal signs include decreased range of motion and point tenderness.

III Neck complaint AND neurological sign(s).

Neurologic signs include decreased or absent deep tendon reflexes, weakness, and sensory deficits.

IV Neck complaint AND fracture or dislocation.

It is shown that the prognosis of the injury worsens with an increase in WAD grade. [1][2]

When considering the different grades, the greatest risk for long term symptoms is seen in a group of patients with a grade II classification. [2]

Here is a brief video outlining the Classification grades of WAD as written in the chart above:


Use of the Classification System[edit | edit source]

This classification system helps categorise the nature and severity of the WAD injury from information collected during the history and physical examination. This incudes the feeling of pain, decreased range of motion (ROM), point tenderness, neurological signs, and fractures or dislocation. [1]

It is used as a prognostic tool, which depends on the signs and symptoms of neck pain and point tenderness presented by the patient. These same signs and symptoms can lead to the development of WAD over the first few weeks after sustaining an injury. [2]

To maximise the usefulness of the predictive tool, the classification should be completed within the first week after injury. [2]

Reliability and Validity[edit | edit source]

The Quebec Classification for WAD has always been criticised. For various reasons outlined in Hartling et al 2001, there is limited objective and quantifiable evidence to support the use of the Classification. [2]

In 1999, a study by Kivioja et al showed that even though the Quebec Classification helps indicate the severity of WAD, there was no available research to indicate that the classification was indicative of long-term WAD outcomes. A study conducted by this group showed that the Classification system had limited prognostic value. [2]

Inter-rater Reliability[edit | edit source]

The inter-rater reliability of the Quebec task force classification is unknown . [1]

It is apparent that the reliability of a well-known classification system can greatly vary between clinicians of different experience level, whether the clinician has 2-3 years of experience or 10-20 years of experience. It is likely that individuals with more experience have a better ability at using the classification system due to more exposure. The raters' understanding of the classification system can be different from one another due to clinical experience. The inter-rater reliability may be affected by the interpreter's background, experience, and training. Classifying individuals based on profiles and descriptions rather than in-person classifications would also have a big difference on the interpreted classification. though the classification is determinant on clinical signs. Also the clinician's understanding of the descriptors within the classification system may have an effect on their selection of grades. [1]

The classification by Spitzer et al. (1995) does not specify how to interpret the grades of classification. [1]

Inter-rater reliability can be improved if the initial patient-physician interaction was video recorded. This owuld allow for analysis of facial expressions and emotions. [1]

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Shergill Y, Côté P, Shearer H, Wong J.J, Stupar M, Tibbles A, Cassidy D.J. Inter-rater reliability of the Quebec Task Force classification system for recent-onset Whiplash Associated Disorders. Journal of the Canadian Chiropractic Association. 2021:65(2):186-192.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Hartling L, Brison R.J, Ardern C, Pickett W. Prognostic Value of the Quebec Classification of Whiplash-Associated Disorders. Spine. 2001:26(1):36–41.,
  3. 3.0 3.1 Freeman M.D, Croft A.C, Rossignol A.M. "Whiplash Associated Disorders: Redefining Whiplash and Its Management" by the Quebec Task Force. Spine. 1998:23(9):1043-1049.
  4. Benchmark Physio. #Benchmarkpeptalks episode 7Classification of Whiplash Injury. Available from: (accessed 30/07/2023).