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Chiropractic Research Review

Physiotherapy Guidelines for Treating Whiplash

It has been estimated that the total monetary costs of whiplash are approximately $29 billion per year in the U.S. Despite these costs, a set of clinical practice guidelines for the physiotherapeutic management of patients with this condition is unavailable.

The objective of this review was to describe a recently created "best evidence" guideline for whiplash patients from the Netherlands, to aid clinicians in decision making and improve and standardize care for whiplash-associated disorders (WAD) Grades I and II.

The authors conducted a computerized literature search for information on the diagnosis and treatment of WAD; an expert consensus was used to develop guidelines when no literature was available. The recommendations of the guidelines are summarized below:

* The diagnostic process should consist of history taking and physical examination supplemented with valid assessment tools to record functional limitations and symptomology.
* The major goals of treatment should be: quick return to normal activity levels, pain reduction, and avoidance of chronicity.
* Active interventions (including education, exercise, increasing activity, and training of functions) are recommended at varying stages after injury and based on recovery rate. Rest may not be a successful form of treatment.
* Chronic whiplash should be treated like other chronic syndromes, addressing psychosocial factors in addition to physical limitations. For patients with WAD lasting over three months, clinicians should focus on promoting self-control and positive recovery outlook.

A field test of the guidelines showed that 84% of users felt they were "clear and easy to understand," and that the language was straightforward. "This guideline may be considered as a state-of-the-art document that assists physiotherapists to make diagnostic conclusions and therapeutic decisions," the authors conclude. They warn that not all of the interventions recommended in these guidelines are evidence-based; thus the guidelines may be biased.

Scholten-Peeters GGM, Bekkering GE, Verhagen AP, et al. Clinical practice guideline for the physiotherapy of patients with whiplash-associated disorders. Spine 2002:27(4), pp. 412-422.

Chiropractic Research Review

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