Toward optimal early management after whiplash injury to lessen the rate of transition to chronicity: discussion paper 5. Spine (Phila Pa 1976) 2011 Dec 01;36(25 Suppl):S335-42
Date
12/30/2011Pubmed ID
22101753DOI
10.1097/BRS.0b013e3182388449Scopus ID
2-s2.0-84859385758 (requires institutional sign-in at Scopus site) 26 CitationsAbstract
STUDY DESIGN: Expert debate and synthesis of research to inform future management approaches for acute whiplash disorders.
OBJECTIVE: To identify a research agenda toward improving outcomes for acute whiplash-injured individuals to lessen the incidence of transition to chronicity.
SUMMARY OF BACKGROUND DATA: International figures are concordant, estimating that 50% of individuals recover from pain and disability within 3 to 6 months of a whiplash injury. The remainder report continuing symptoms up to 1 to 2 years or longer postinjury. As no management approach to date has improved recovery rates, new clinical/research directions are required for early management of whiplash-injured patients.
METHODS: A group of multidisciplinary researchers critically debated evidence and current research concerning whiplash from biological, psychological, and social perspectives toward informing future research directions for management of acute whiplash.
RESULTS: It was recognized that effective treatments for acute whiplash are constrained by a limited understanding of causes of whiplash-associated disorders. Acute whiplash presentations are heterogeneous leading to the proposal that a research priority was development of a triage system based on modifiable prognostic indicators and clinical features to better inform individualized early management decisions. Other priorities identified included researching effective early pain management for individuals presenting with moderate to high levels of pain; development of best education/information for acute whiplash; testing the efficacy of stratified and individualized rehabilitation, researching modes of delivery considering psychosocial modulators of pain and disability; and the timing, nature, and mode of delivery of cognitive-behavioral therapies. Directions were highlighted for future biomechanical research into injury prevention.
CONCLUSION: The burden of whiplash injuries, the high rate of transition to chronicity, and evidence of limited effects of current management on transition rates demand new directions in evaluation and management. Several directions have been proposed for future research, which reflect the potential multifaceted dimensions of an acute whiplash disorder.
Author List
Jull GA, Söderlund A, Stemper BD, Kenardy J, Gross AR, Côté P, Treleaven J, Bogduk N, Sterling M, Curatolo MAuthor
Brian Stemper PhD Professor in the Biomedical Engineering department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Acute PainAdaptation, Psychological
Chronic Pain
Compensation and Redress
Disease Progression
Humans
Recovery of Function
Stress, Psychological
Time Factors
Whiplash Injuries