1. Duration of absence from usual activities when compensated (number of days between the collision and the last payment of compensation for income replacement). Because of the method of compensation by SAAQ, those subjects who experienced recurrence were excluded (and of course these are the patients that we have trouble getting back to work).

2. Frequency of recurrence or relapse. Recurrence was defined as the "return of apparently resolved symptoms after a single motor vehicle collision". The recurrence had to be in those subjects diagnosed with whiplash as their sole injury.

3. Medical financial cost of whiplash to SAAQ.

The task force's term's of reference included Grades 1-3

Three obvious problems with this classification is that first, Grade 2 is too broad, the spectrum of injuries that this group may contain varies from the quite mild to the very severe injury. Secondly, the presence of non-radiographic (radiotranslucent) fractures, has not been addressed. These should properly belong in the Grade 4 but because they are not seen on X-ray and may not produce neurological signs they are clumped in the Grade 2 group. Thirdly, central neurological damage such as mild brainstem and cerebral lesions have not been included and there is evidence that vestibulospinal reflex changes may affect the recovery rate of the patient.

RESULTS

Duration of Absence

(If many of these duration of absence seem to better what you see, consider that those patients experiencing recurrence were excluded from this statistic and further that the population we see and especially that which we have difficulty with is the more severely injured. Consequently, the above numbers are the average for all levels of injury excluding overt fracture/dislocations and as many of these will be Grade 1 and mild Grade 2, the population is not the same as the one which we see and have most difficulty with. JM)

"The improvement in the physiotherapy group was equivalent to that of subjects who received advice on posture, on early activation, a program of home exercises, and a prescription of soft collars and analgesics with advice to limit use of both."

"There were no studies found regarding cervical pillows for WAD"

"There were no studies found regarding spray and stretch"

"There was no research found regarding postural alignment."

"There was no research found regarding postural alignment."

"There was no research found regarding postural alignment."

"There were no accepted studies regarding ultrasound in WAD"

(This is getting embarrassing! JM)

"The cumulative evidence suggests that prolonged periods of rest are detrimental to recovery from WAD."

"The cumulative evidence suggests that prolonged periods of rest are detrimental to recovery from WAD."

"...there were no clinically or statistically significant differences in outcome (change in pain by the McGill Pain Questionnaire and range of motion at 6 weeks) between any of the traction types and the control treatment."

"In a RCT (randomized controlled trial) comparing the efficacy of a single manipulation with a single mobilization, Cassidy et al found that after controlling for pretreatment differences, there equivalent immediate (less than 5 minutes) improvements in pain and range of motion in neck pain patients. There were no other accepted studies regarding the short or long term effectiveness or efficacy of manipulation."

"The cumulative evidence suggests that mobilization techniques can be used as an adjunct to strategies that promote activation. In combination with activating interventions, they appear beneficial in the short term, but long term benefit has not been established."

"The cumulative evidence suggests that active exercise as part of a multimodal intervention may be beneficial in the short and long term."

"Collars may be promote inactivity, which can delay recovery."

From the above extracts, it is apparent that whiplash (or whatever euphemism or piece of jargon is currently in vogue) is still not well understood. The Quebec study which is probably the largest and most comprehensive of its type is calling for much more research in almost all aspects of whiplash then is currently available. Certainly many professions are realizing this need and just as importantly realizing that it is urgent. We may well find that many of our traditional treatment modalities, protocols and perhaps even physiotherapy itself will be de-insured because of want of appropriate research.

Here is a check sheet that I sometimes use (I'm not as consistent as I should be) for my traumatic cervical patients.

Post-Traumatic Examination of the Neck

Name: .................................................................................... DOB:........................

ACTION:

To physician []

Treat []

Signed ............................................................. Date ............................