Predicting Outcomes in Whiplash: Difference between revisions

(added management)
(edit references)
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==Management==
==Management==
Some research exists of the beneficial interventions for the different phases of whiplash but further study is definitely indicated.    Acute (< 2 weeks), subacute (2-12 weeks), chronic (> 12 weeks).  <ref name”:18”>Teasell RW, McClure JA, Walton D, Pretty J, Salter K, Meyer M, Sequeira K, Death B. A research synthesis of therapeutic interventions for whiplash-associated disorder: part 1–overview and summary. Pain Research and Management. 2010;15(5):287-94. [Accessed 19 June 2018] Available from: http://downloads.hindawi.com/journals/prm/2010/106593.pdf </ref>
Some research exists of the beneficial interventions for the different phases of whiplash but further study is definitely indicated.    Acute (< 2 weeks), subacute (2-12 weeks), chronic (> 12 weeks).  <ref name":18”>Teasell RW, McClure JA, Walton D, Pretty J, Salter K, Meyer M, Sequeira K, Death B. A research synthesis of therapeutic interventions for whiplash-associated disorder: part 1–overview and summary. Pain Research and Management. 2010;15(5):287-94. [Accessed 19 June 2018] Available from: http://downloads.hindawi.com/journals/prm/2010/106593.pdf </ref>
Exercise and therapy that includes mobilisation has been studied the most an appears to be superior treatment in terms of acute and chronic WAD. <ref name:”18”/>  Moderate to aggressive mobilisation and exercises should be avoided in the acute and subacute phases. <ref name:”18”/>
Exercise and therapy that includes mobilisation has been studied the most an appears to be superior treatment in terms of acute and chronic WAD. <ref name":18”/>  Moderate to aggressive mobilisation and exercises should be avoided in the acute and subacute phases. <ref name":18”/>
Interdisciplinary treatments are also extensively studied and psychological counselling combined with physiotherapy has better results than physiotherapy alone. <ref name:”18”/>
Interdisciplinary treatments are also extensively studied and psychological counseling combined with physiotherapy has better results than physiotherapy alone. <ref name":18”/>


General treatment strategies will be discussed below.  
General treatment strategies will be discussed below.  
===Acute Phase===
===Acute Phase===


Studies have shown that patients can have a rapid improvement in symptoms within the first 90 days following the injury but then the recovery platos.  A great amount of patients experience ongoing pain and disability. This means that the first 3 months after the injury is crucial in the management of these patients. <ref name”:3”>
Studies have shown that patients can have a rapid improvement in symptoms within the first 90 days following the injury but then the recovery plateaus.  A great amount of patients experience ongoing pain and disability. This means that the first 3 months after the injury is crucial in the management of these patients. <ref name”:3”>
Kamper SJ, Rebbeck TJ, Maher CG, McAuley JH, Sterling M. Course and prognostic factors of whiplash: a systematic review and meta-analysis. Pain. 2008 Sep 15;138(3):617-29. [Accessed 14 June 2018] Available from: http://www.academia.edu/download/41675199/Course_and_prognostic_factors_of_whiplas20160128-23571-1o7c4mo.pdf </ref>
Kamper SJ, Rebbeck TJ, Maher CG, McAuley JH, Sterling M. Course and prognostic factors of whiplash: a systematic review and meta-analysis. Pain. 2008 Sep 15;138(3):617-29. [Accessed 14 June 2018] Available from: http://www.academia.edu/download/41675199/Course_and_prognostic_factors_of_whiplas20160128-23571-1o7c4mo.pdf </ref>
“A multidisciplinary team approach” is advised for patients that fall within in the moderate to high risk for long term pain and disability following a whiplash injury. *This will include physiotherapy to restore ROM, pain treatment and medication for adequate pain relief, and psychology to specifically target the patient’s post traumatic stress reaction. <ref name”:1”/>
“A multidisciplinary team approach” is advised for patients that fall within in the moderate to high risk for long term pain and disability following a whiplash injury. *This will include physiotherapy to restore ROM, pain treatment and medication for adequate pain relief, and psychology to specifically target the patient’s post traumatic stress reaction. <ref name”:1”/>
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*Neuropathic pain - manual therapy, aerobic exercise, local exercise to reduce pain experience. Neuropathic medication
*Neuropathic pain - manual therapy, aerobic exercise, local exercise to reduce pain experience. Neuropathic medication


‘’’Advice/education’’’ <ref name:”18”/> oral and video education might be more effective than handing out a pamphlet for the patient to read. <ref name”:17”> Teasell RW, McClure JA, Walton D, Pretty J, Salter K, Meyer M, Sequeira K, Death B. A research synthesis of therapeutic interventions for whiplash-associated disorder (WAD): part 2–interventions for acute WAD. Pain Research and Management. 2010;15(5):295-304.  [Accessed 19 June 2018] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2975532/pdf/prm15295.pdf </ref>
‘’’Advice/education’’’ <ref name":18”/> oral and video education might be more effective than handing out a pamphlet for the patient to read. <ref name”:17”> Teasell RW, McClure JA, Walton D, Pretty J, Salter K, Meyer M, Sequeira K, Death B. A research synthesis of therapeutic interventions for whiplash-associated disorder (WAD): part 2–interventions for acute WAD. Pain Research and Management. 2010;15(5):295-304.  [Accessed 19 June 2018] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2975532/pdf/prm15295.pdf </ref>




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- cognitive restructuring - list/document/discuss pain related thoughts. Draw out negative thoughts to make them aware of them. Do you think this is helpful? What use is that? Replace with positive thoughts.  
- cognitive restructuring - list/document/discuss pain related thoughts. Draw out negative thoughts to make them aware of them. Do you think this is helpful? What use is that? Replace with positive thoughts.  
#Fear of movement and reinjury - controlled/supported exposure to feared activities. Support and coach them.  
#Fear of movement and re-injury - controlled/supported exposure to feared activities. Support and coach them.  
‘’’Psychological factors/Post traumatic stress’’’
‘’’Psychological factors/Post traumatic stress’’’
*Early specific treatments for post traumatic stress is more effective than general cognitive behavioural therapy.  <ref name=":1"/>
*Early specific treatments for post traumatic stress is more effective than general cognitive behavioural therapy.  <ref name=":1"/>
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Gentle desensitization techniques to treat widespread tenderness, exposure to aerobic exercise, slow and graded.  
Gentle desensitization techniques to treat widespread tenderness, exposure to aerobic exercise, slow and graded.  
‘’’Mobilisation programs’’’ includes activities that are aimed at improving or maintaining mobility <ref name:”17”/>
‘’’Mobilisation programs’’’ includes activities that are aimed at improving or maintaining mobility <ref name":17”/>
There exists strong evidence that active mobilisation is linked to less pain and some evidence that it might improve range of motion in acute WAD. <ref name:”17”/>
There exists strong evidence that active mobilisation is linked to less pain and some evidence that it might improve range of motion in acute WAD. <ref name":17”/>
*Neck Specific Exercise
*Neck Specific Exercise
**Physiotherapist guided neck specific exercises has been shown to decrease disability after 3 months when compared to physical activity prescription <ref name=":7">Ludvigsson ML, Peterson G, O’Leary S, Dedering A, Peolsson A. The Effect of Neck-specific Exercise With, or Without a Behavioral Approach, on Pain, Disability, and Self-Efficacy in Chronic Whiplash-associated Disorders. Clin J Pain. 2015 Apr;31(4):294-303. [Accessed 14 June 2018] Available from: http://www.academia.edu/download/43630977/The_Effect_of_Neck-specific_Exercise_Wit20160311-20625-1cp7azf.pdf </ref>
**Physiotherapist guided neck specific exercises has been shown to decrease disability after 3 months when compared to physical activity prescription <ref name"=:7">Ludvigsson ML, Peterson G, O’Leary S, Dedering A, Peolsson A. The Effect of Neck-specific Exercise With, or Without a Behavioral Approach, on Pain, Disability, and Self-Efficacy in Chronic Whiplash-associated Disorders. Clin J Pain. 2015 Apr;31(4):294-303. [Accessed 14 June 2018] Available from: http://www.academia.edu/download/43630977/The_Effect_of_Neck-specific_Exercise_Wit20160311-20625-1cp7azf.pdf </ref>
**Cervical range of motion was shown to improve with physiotherapy guided and a self administered program with low load exercises but only the physiotherapy approach produced improvement in motor control. <ref name:”4”/>  
**Cervical range of motion was shown to improve with physiotherapy guided and a self administered program with low load exercises but only the physiotherapy approach produced improvement in motor control. <ref name":4”/>  
**Active mobilisation <ref name:”18”/>
**Active mobilisation <ref name":18”/>




‘’’Electromagnetic field therapy’’’ - some limited research has shown this to be effective <ref name:”18”/>
‘’’Electromagnetic field therapy’’’ - some limited research has shown this to be effective <ref name":18”/>
‘’’Treatments deemed not effective’’’
‘’’Treatments deemed not effective’’’
*Soft collar immobilization - may impede recovery <ref name:”18”/>
*Soft collar immobilization - may impede recovery <ref name":18”/>
*Laser acupuncture<ref name:”18”/>
*Laser acupuncture<ref name":18”/>
*Education alone<ref name:”18”/>
*Education alone<ref name":18”/>
*Exercise programs purely focussed on strength and endurance and not on mobility <ref name:”17”/>
*Exercise programs purely focused on strength and endurance and not on mobility <ref name":17”/>
‘’’Medication’’’
‘’’Medication’’’
Some evidence show that methylprednisolone infusion is effective in acute WAD <ref name:”17”/>
Some evidence show that methylprednisolone infusion is effective in acute WAD <ref name":17”/>
===Sub-acute Phase=== <ref name:”18”/>
===Sub-acute Phase=== <ref name:"18”/>
“‘Interdisciplinary treatment’’’
“‘Interdisciplinary treatment’’’
‘’’Manual therapy’’’ - joint manipulation has shown some benefit
‘’’Manual therapy’’’ - joint manipulation has shown some benefit
Line 139: Line 139:


===Chronic Phase===
===Chronic Phase===
Rehabilitation done by physiotherapist can produce meaningful changes in the symptoms of a patient with chronic pain after a whiplash.<ref name:”4”/>  Exercises seems to be the most effective non-invasive treatment in this phase. <ref name:”18”/>
Rehabilitation done by physiotherapist can produce meaningful changes in the symptoms of a patient with chronic pain after a whiplash.<ref name":4”/>  Exercises seems to be the most effective non-invasive treatment in this phase. <ref name":18”/>
When treating chronic whiplash patients the focus should be on the following:  <ref name”:2”/>
When treating chronic whiplash patients the focus should be on the following:  <ref name”:2”/>
*improving the impaired physical movements and activities
*improving the impaired physical movements and activities
*working on the patient’s psychosocial abilities and activities  
*working on the patient’s psychosocial abilities and activities  
‘’’Manual therapy’’’ - joint manipulation has shown to be helpful as well as myofeedback training. <ref name:”18”/>
‘’’Manual therapy’’’ - joint manipulation has shown to be helpful as well as myofeedback training. <ref name":18”/>
A multi-model physiotherapy approach was compared to a patient self-management program.  Both groups improved with their NDI scores but more so in the physiotherapy group. The physiotherapy group also had a greater improvement in NPI scores.  <ref name:”4”/> The following treatments were included in the physiotherapy group:<ref name:”4”/>
A multi-model physiotherapy approach was compared to a patient self-management program.  Both groups improved with their NDI scores but more so in the physiotherapy group. The physiotherapy group also had a greater improvement in NPI scores.  <ref name":4”/> The following treatments were included in the physiotherapy group:<ref name":4”/>
*specific low load exercises for the neck flexor and extensor muscles as well as the scapular and postural muscles.   
*specific low load exercises for the neck flexor and extensor muscles as well as the scapular and postural muscles.   
*kinesthetic exercises
*kinesthetic exercises
Line 150: Line 150:
*education on ergonomics, ADL, and work settings
*education on ergonomics, ADL, and work settings
*assurance
*assurance
Physiotherapy can aggravate some patients with chronic WAD and therefore the authors of this study chose only low load interventions.  <ref name:”4”/>
Physiotherapy can aggravate some patients with chronic WAD and therefore the authors of this study chose only low load interventions.  <ref name":4”/>
However, when a patient has widespread mechanical and thermal hypersensitivity then physiotherapy should not be the only treatment these patients receive.  <ref name:”4”/>
However, when a patient has widespread mechanical and thermal hypersensitivity then physiotherapy should not be the only treatment these patients receive.  <ref name":4”/>


== References ==
== References ==

Revision as of 21:01, 18 June 2018

Original Editor - Tarina van der Stockt

Top Contributors - Tarina van der Stockt, Tony Lowe, Habibu Salisu Badamasi, Jess Bell and Robin Tacchetti

Whiplash is an acceleration-deceleration mechanism of energy transfer to the neck. It may result from rear-end or side-impact motor vehicle collisions, but can also occur during sport (diving, snowboarding) and other types of falls. The impact may result in bony or soft-tissue injuries affecting the ligaments, muscles, and nerves and may lead to other clinical manifestations call whiplash associated disorders (WAD). [1] [2] WAD is a term used to describe a collection of symptoms following a whiplash injury. [3] WAD symptoms range from neck pain, stiffness and tenderness, to loss of motor function and mental as well as stress reactions. [3] Usually patients recovery within 3 months after a whiplash injury but ½ of the patients with acute WAD go on to develop chronic pain and or disability. [2] To learn more about WAD you can click on the following link: Whiplash Associated Disorders

Early identification of the individuals that might have long term pain and disability will help clinicians to spend the correct resources in prevention and treatment., [4] This subject is continually being researched and therapists should stay up to date with the current research on predicting factors. [4]

Factors that predict poor outcomes[edit | edit source]

High levels of initial pain and a high score on the neck disability index are considered the strongest predictors of pain and disability after 6 months. [4] Other strong predictors include cold hyperalgesia, older age, and acute post-traumatic stress. [5]

1. High level of initial pain[edit | edit source]

Level of pain on Visual Analogue Scale 5.5/10 is considered high [4] High levels of initial pain is considered a very strong predictor of poor outcome in the long term[2] [4]

It is an easy scale for therapists and doctors to use in practices, and can be used to measure initial pain and pain levels with activities of daily living or work activities. [6]

2. Characteristics of pain[edit | edit source]

Presence of Neuropathic pain (listen to descriptors used by patient in history taking - burning, electrical, mind of its own, area extra tender to touch, Allodynia, mottled appearance to the skin) pain from nerve tissue

Neck Disability Index (NDI) [4]

  • 10-item questionnaire, filled out by the patient asking the patient to rate activities of dailing living for e.g. personal care, reading, driving, concentration, pain intensity, lifting, sleeping, recreation, and headache on a 0-5 scale indicating disability in these activities. [7]
  • Along with pain intensity it is considered a very strong predictor of poor outcome in terms of chronic pain and disability
  • greater than 14.5/100 [4]

3. Psychological factors[edit | edit source]

Catastrophization

  • “Catastrophizing refers to an exaggerated negative orientation toward noxious stimuli” [8]
  • It is considered multidimensional and consists of the following: [9]
    • Rumination - when a person can’t stop thinking about the pain, especially how much it hurts
    • Magnification - fearful thoughts that something serious might happen
    • Helplessness - a feeling that there is nothing that can be done to alleviate the pain
  • In general these patients have a negative mindset on pain. They have passive coping skills like lying down, drinking pain medication, and expecting the clinician to fix them. They sometimes even look ill.
  • “Most robust and reliable psychological predictor of pain experience” [1]
  • Pain Catastrophizing Scale is a 13-item questionnaire where patients can rate the frequency of certain thoughts and feelings when they experience pain. [1]
  • Catastrophizing is considered a significant risk factor [6]
  • When reducing catastrophization in a patient the patient (acute/chronic) will have a decrease in pain severity and in disability [6]

Fear of movement

  • TAMPTA scale of kinesiophobia (TSK) is a 17-item questionnaire. It measures fear (re)injury due to movement. The scores range from 17 to 68 and a score of 37 is considered high. [7]
  • Ask the patient what are they concerned about, what fears do they have. For e.g. do they think that their spine is fragile and can easily be damaged? What movements or exercises are they avoiding?

Post traumatic stress reaction

A combination of high levels of pain plus post traumatic stress are considered a high predictor of poor outcome after whiplash.

  • Occurs in about 25% of people who sustain a whiplash in a motor vehicle accident [10]
  • Characterized by 3 major symptom groups (clusters): [10]
    • Re-experiencing of symptoms - intrusive thoughts about the accident coming to mind during the day, nightmares
    • Symptom avoidance - social withdrawal, avoiding any stimulus or thoughts that remind of the accident
    • Hyper aroused state - hyper vigilant, jumpy, irritable, high respiration rate
  • Ask the patient how often do they think about the accident. Do they keep telling you about the accident?
  • Measured by the Impact of Events Scale (IES). It is a 15-item questionnaire and screens for post-traumatic stress as it measures the current subjective stress regarding the specific life event. [11]
  • The EIS was revised include questions about hyper-arousal. It is called the Impact of Events Scale - Revised (IES)-R and is a 22-item questionnaire. Link to the revised scale: (IES)-R
  • IES should only be done 6 weeks after the injury as it is normal to have these intrusive thoughts before that.

Perception of injustice has been shown as a predictor of long term disability and pain after a whiplash injury[10]

4. Physical factors[edit | edit source]

Widespread tenderness in areas not affected by the injury

  • front of the shins
  • widespread hypersensitivity - tested with blunt pressure [12]

Cold pain threshold alteration (hyperalgesia) - is associated with higher pain and disability 6 months after the whiplash. [5]

  • (touched by metal at 15-20 degrees C feels like burning)
  • if the cold pain threshold decreases with even 1 degree compared to normal then the person have a high chance of developing moderate/severe symptoms in the long term [5]
  • Considered a strong sensory predictor along with impaired sympathetic vasoconstriction [5]
  • Thermal hyperalgesia (heat/cold) is seen soon after the whiplash injury in those individuals who develop ongoing moderate to severe pain/disability [12]
  • Could be indicative of peripheral nerve damage[5], “changes in the central mediation of pain”[12], or changes in the sympathetic nervous system [12].

Positive Upper limb tension test 1 (ULTT1) or brachial plexus provocation test [12]

  • A positive or heightened reaction is seen soon after the whiplash injury in those individuals who develop ongoing moderate to severe pain/disability
  • In patients with chronic the WAD the presence of a decrease in bilateral elbow extension with this test is indicative of motor and sensory changes due to central sensitisation
  • For more information on this test follow the link to Neurodynamic Assessment


Additional factors to consider[edit | edit source]

Weaker predictors of risk - can help with the prognosis and intervention decision making but cause and effect cannot be shown [4]

  • Female sex -- robust risk predictor [4]
  • Report of low back pain with evaluation after the incident [4]

Poor predictors

  • Range of motion of the cervical spine and changes in neck muscle activation after whiplash is not considered a significant predictor of long term pain and disability. [2]
  • Accident parameters as recalled by the patient is not considered a predictor for recovery. This might change in the future with more data as technology in vehicles improve. [4]
  • Past medical history [4]

Management[edit | edit source]

Some research exists of the beneficial interventions for the different phases of whiplash but further study is definitely indicated. Acute (< 2 weeks), subacute (2-12 weeks), chronic (> 12 weeks). [13] Exercise and therapy that includes mobilisation has been studied the most an appears to be superior treatment in terms of acute and chronic WAD. Cite error: The opening <ref> tag is malformed or has a bad name Moderate to aggressive mobilisation and exercises should be avoided in the acute and subacute phases. Cite error: The opening <ref> tag is malformed or has a bad name Interdisciplinary treatments are also extensively studied and psychological counseling combined with physiotherapy has better results than physiotherapy alone. Cite error: The opening <ref> tag is malformed or has a bad name

General treatment strategies will be discussed below.

Acute Phase[edit | edit source]

Studies have shown that patients can have a rapid improvement in symptoms within the first 90 days following the injury but then the recovery plateaus. A great amount of patients experience ongoing pain and disability. This means that the first 3 months after the injury is crucial in the management of these patients. [14] “A multidisciplinary team approach” is advised for patients that fall within in the moderate to high risk for long term pain and disability following a whiplash injury. *This will include physiotherapy to restore ROM, pain treatment and medication for adequate pain relief, and psychology to specifically target the patient’s post traumatic stress reaction. Cite error: The opening <ref> tag is malformed or has a bad name ‘’’Manage initial pain’’’

  • Reduce pain experience
  • Neuropathic pain - manual therapy, aerobic exercise, local exercise to reduce pain experience. Neuropathic medication

‘’’Advice/education’’’ Cite error: The opening <ref> tag is malformed or has a bad name oral and video education might be more effective than handing out a pamphlet for the patient to read. [15]


‘’’Catastrophization’’’

  • The intervention will change according to the goal set for this patient [8]
    • If the goal is return to work then the focus should be on graded activity and exposure
    • If reducing pain levels is the goal then monitoring thoughts and restructuring cognitive behavior will be the objective
  • Should be combined with other management techniques[8]

- cognitive restructuring - list/document/discuss pain related thoughts. Draw out negative thoughts to make them aware of them. Do you think this is helpful? What use is that? Replace with positive thoughts.

  1. Fear of movement and re-injury - controlled/supported exposure to feared activities. Support and coach them.

‘’’Psychological factors/Post traumatic stress’’’

  • Early specific treatments for post traumatic stress is more effective than general cognitive behavioural therapy. [5]
  1. PTS reaction - outside PT domain/expertise (clinical psychologist, CBT, EMDR - eye movement desensitization reprocessing)

It has been shown that psychological factors in chronic WAD could be due to ongoing pain and disability. Patients with increased psychological problems one week following the accident is related to the decrease in neck movement. Thus the longer the symptoms are present the greater the psychological impact becomes. and that as the pain and disability improves the psychological factors also improve. [7]


Gentle desensitization techniques to treat widespread tenderness, exposure to aerobic exercise, slow and graded. ‘’’Mobilisation programs’’’ includes activities that are aimed at improving or maintaining mobility Cite error: The opening <ref> tag is malformed or has a bad name There exists strong evidence that active mobilisation is linked to less pain and some evidence that it might improve range of motion in acute WAD. Cite error: The opening <ref> tag is malformed or has a bad name

  • Neck Specific Exercise
    • Physiotherapist guided neck specific exercises has been shown to decrease disability after 3 months when compared to physical activity prescription [16]
    • Cervical range of motion was shown to improve with physiotherapy guided and a self administered program with low load exercises but only the physiotherapy approach produced improvement in motor control. Cite error: The opening <ref> tag is malformed or has a bad name
    • Active mobilisation Cite error: The opening <ref> tag is malformed or has a bad name


‘’’Electromagnetic field therapy’’’ - some limited research has shown this to be effective Cite error: The opening <ref> tag is malformed or has a bad name ‘’’Treatments deemed not effective’’’

  • Soft collar immobilization - may impede recovery Cite error: The opening <ref> tag is malformed or has a bad name
  • Laser acupunctureCite error: The opening <ref> tag is malformed or has a bad name
  • Education aloneCite error: The opening <ref> tag is malformed or has a bad name
  • Exercise programs purely focused on strength and endurance and not on mobility Cite error: The opening <ref> tag is malformed or has a bad name

‘’’Medication’’’ Some evidence show that methylprednisolone infusion is effective in acute WAD Cite error: The opening <ref> tag is malformed or has a bad name ===Sub-acute Phase=== Cite error: The opening <ref> tag is malformed or has a bad name “‘Interdisciplinary treatment’’’ ‘’’Manual therapy’’’ - joint manipulation has shown some benefit


Chronic Phase[edit | edit source]

Rehabilitation done by physiotherapist can produce meaningful changes in the symptoms of a patient with chronic pain after a whiplash.Cite error: The opening <ref> tag is malformed or has a bad name Exercises seems to be the most effective non-invasive treatment in this phase. Cite error: The opening <ref> tag is malformed or has a bad name When treating chronic whiplash patients the focus should be on the following: Cite error: The opening <ref> tag is malformed or has a bad name

  • improving the impaired physical movements and activities
  • working on the patient’s psychosocial abilities and activities

‘’’Manual therapy’’’ - joint manipulation has shown to be helpful as well as myofeedback training. Cite error: The opening <ref> tag is malformed or has a bad name A multi-model physiotherapy approach was compared to a patient self-management program. Both groups improved with their NDI scores but more so in the physiotherapy group. The physiotherapy group also had a greater improvement in NPI scores. Cite error: The opening <ref> tag is malformed or has a bad name The following treatments were included in the physiotherapy group:Cite error: The opening <ref> tag is malformed or has a bad name

  • specific low load exercises for the neck flexor and extensor muscles as well as the scapular and postural muscles.
  • kinesthetic exercises
  • low velocity manual therapy techniques
  • education on ergonomics, ADL, and work settings
  • assurance

Physiotherapy can aggravate some patients with chronic WAD and therefore the authors of this study chose only low load interventions. Cite error: The opening <ref> tag is malformed or has a bad name However, when a patient has widespread mechanical and thermal hypersensitivity then physiotherapy should not be the only treatment these patients receive. Cite error: The opening <ref> tag is malformed or has a bad name

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 Spitzer WO. et al. (1995). Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining "whiplash" and its management. Spine (Phila Pa 1976)., 20(8 Suppl), pp. 1-73.
  2. ↑ 2.0 2.1 2.2 2.3 Daenen L, Nijs J, Raadsen B, Roussel N, Cras P, Dankaerts W. Cervical motor dysfunction and its predictive value for long-term recovery in patients with acute whiplash-associated disorders: a systematic review. Journal of rehabilitation medicine. 2013 Feb 5;45(2):113-22. [Accessed 14 June 2018] Available from: http://www.ingentaconnect.com/contentone/mjl/sreh/2013/00000045/00000002/art00001?crawler=true&mimetype=application/pdf
  3. ↑ 3.0 3.1 Golbakhsh MR, Mirbolook G, Mirbolook AR, Noughani F, Siavashi B, Gholizadeh A. Effect of Mental and Behavioral Factors on Severity of Whiplash Injury Disability. [Accessed 14 June 2018] Available from: http://traumamon.portal.tools/71693.pdf
  4. ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 Walton DM, MacDermid JC, Giorgianni AA, Mascarenhas JC, West SC, Zammit CA. Risk factors for persistent problems following acute whiplash injury: update of a systematic review and meta-analysis. journal of orthopaedic & sports physical therapy. 2013 Feb;43(2):31-43. [Accessed 14 June 2018] Available from: https://scholar.google.com/scholar_url?url=http://www.jospt.org/doi/pdfplus/10.2519/jospt.2013.4507&hl=en&sa=T&oi=gsb-gga&ct=res&cd=0&ei=z48iW5iCN8OOygTTnLfgDA&scisig=AAGBfm2vfvPVzZoOSqUFSR19jsevoaEIkQ
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Sterling M, Jull G, Vicenzino B, Kenardy J, Darnell R. Physical and psychological factors predict outcome following whiplash injury. Pain. 2005 Mar 1;114(1-2):141-8. [Accessed 14 June 2018] Available from: https://scholar.google.com/scholar_url?url=http://www.academia.edu/download/46453352/Sterling_M_Jull_G_Vicenzino_B_et_al._Phy20160613-23878-ftxn8w.pdf&hl=en&sa=T&oi=gsb-gga&ct=res&cd=0&ei=FI0iW9mYJo_-yQTEtJ-gCQ&scisig=AAGBfm3nqbcO77XbvxRcJiBocwgLwu5aGg
  6. ↑ 6.0 6.1 6.2 Hendriks EJ, Scholten-Peeters GG, van der Windt DA, Neeleman-van der Steen CW, Oostendorp RA, Verhagen AP. Prognostic factors for poor recovery in acute whiplash patients. Pain. 2005 Apr 1;114(3):408-16. [Accessed 14 June 2018] Available from: http://www.academia.edu/download/41859453/Prognostic_factors_for_poor_recovery_in_20160201-7069-15o997z.pdf Cite error: Invalid <ref> tag; name ":2" defined multiple times with different content
  7. ↑ 7.0 7.1 7.2 Golbakhsh MR, Mirbolook G, Mirbolook AR, Noughani F, Siavashi B, Gholizadeh A. Effect of Mental and Behavioral Factors on Severity of Whiplash Injury Disability. [Accessed 14 June 2018] Available from: http://traumamon.portal.tools/71693.pdf
  8. ↑ 8.0 8.1 8.2 Scott W, Wideman TH, Sullivan MJ. Clinically meaningful scores on pain catastrophizing before and after multidisciplinary rehabilitation: a prospective study of individuals with subacute pain after whiplash injury. The Clinical journal of pain. 2014 Mar 1;30(3):183-90. [Accessed 14 June 2018] Available from: https://scholar.google.com/scholar_url?url=http://sullivan-painresearch.mcgill.ca/pdf/abstracts/2014/Scottetal2014.pdf&hl=en&sa=T&oi=gsb-gga&ct=res&cd=0&ei=BZIiW6rcGpLWygT11bHQCQ&scisig=AAGBfm0IwFurhAKGQz_pvBETeDEzxtLb6A
  9. ↑ Sullivan MJ, Rodgers WM, Kirsch I. Catastrophizing, depression and expectancies for pain and emotional distress. Pain. 2001 Mar 1;91(1-2):147-54. [Accessed 15 June 2018] Available from: http://sullivan-painresearch.mcgill.ca/pdf/abstracts/sullivanmar2001.pdf
  10. ↑ 10.0 10.1 10.2 Sullivan MJ, Thibault P, Simmonds MJ, Milioto M, Cantin AP, Velly AM. Pain, perceived injustice and the persistence of post-traumatic stress symptoms during the course of rehabilitation for whiplash injuries. Pain. 2009 Oct 1;145(3):325-31. [Accessed 15 June 2018] Available from: http://www.academia.edu/download/43075568/Pain_perceived_injustice_and_the_persist20160225-28621-1vu0w2l.pdf
  11. ↑ Jull G, Sterling M, Kenardy J, Beller E. Does the presence of sensory hypersensitivity influence outcomes of physical rehabilitation for chronic whiplash?–A preliminary RCT. Pain. 2007 May 1;129(1-2):28-34. [Accessed 14 June 2018] Available from: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.611.9615&rep=rep1&type=pdf
  12. ↑ 12.0 12.1 12.2 12.3 12.4 Sterling M, Jull G, Vicenzino B, Kenardy J. Sensory hypersensitivity occurs soon after whiplash injury and is associated with poor recovery. Pain. 2003 Aug 1;104(3):509-17. [Accessed 15 June 2018] Available from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=11&ved=0ahUKEwjmhuWX0dbbAhUCVK0KHVlgDRQQFghdMAo&url=https%3A%2F%2Fpdfs.semanticscholar.org%2F07ff%2F7e81af852a6dcba56b5dba0f3fc9dba724e5.pdf&usg=AOvVaw0fCGn5gYPGxrzb1aFIs9SX
  13. ↑ Teasell RW, McClure JA, Walton D, Pretty J, Salter K, Meyer M, Sequeira K, Death B. A research synthesis of therapeutic interventions for whiplash-associated disorder: part 1–overview and summary. Pain Research and Management. 2010;15(5):287-94. [Accessed 19 June 2018] Available from: http://downloads.hindawi.com/journals/prm/2010/106593.pdf
  14. ↑ Kamper SJ, Rebbeck TJ, Maher CG, McAuley JH, Sterling M. Course and prognostic factors of whiplash: a systematic review and meta-analysis. Pain. 2008 Sep 15;138(3):617-29. [Accessed 14 June 2018] Available from: http://www.academia.edu/download/41675199/Course_and_prognostic_factors_of_whiplas20160128-23571-1o7c4mo.pdf
  15. ↑ Teasell RW, McClure JA, Walton D, Pretty J, Salter K, Meyer M, Sequeira K, Death B. A research synthesis of therapeutic interventions for whiplash-associated disorder (WAD): part 2–interventions for acute WAD. Pain Research and Management. 2010;15(5):295-304. [Accessed 19 June 2018] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2975532/pdf/prm15295.pdf
  16. ↑ Ludvigsson ML, Peterson G, O’Leary S, Dedering A, Peolsson A. The Effect of Neck-specific Exercise With, or Without a Behavioral Approach, on Pain, Disability, and Self-Efficacy in Chronic Whiplash-associated Disorders. Clin J Pain. 2015 Apr;31(4):294-303. [Accessed 14 June 2018] Available from: http://www.academia.edu/download/43630977/The_Effect_of_Neck-specific_Exercise_Wit20160311-20625-1cp7azf.pdf
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