Physiotherapy management of acute whiplash-associated disorder II

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Taweewat Wiangkham


Whiplash-associated disorders (WAD) are not reported as a health problem in Thailand although the incidence of road traffic accidents in Thailand is quite high. Interestingly, the developed countries (e.g. Sweden, France, Canada, Italy, USA, UK and Australia) have reported the problems of the WAD management. It is interesting to observe and monitor the patients with WAD in Thailand in order to explore why WAD are not an issue. The interesting grade is WAD grade II which can be classified at least 70% of patients with WAD and commonly managed by physiotherapists. Therefore, the aim of this review was to update the evidence and knowledge regarding WAD in the acute stage to Thai physiotherapists in order to assist them in preventing their patients from chronicity. Additionally, this review could encourage Thai physiotherapists and researchers in conducting whiplash studies in the future. This review consists of the definition of WAD, the situation of WAD, the presentation of WAD, the classification of WAD, the management of WAD II and its future study.



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Wiangkham T. Physiotherapy management of acute whiplash-associated disorder II. Thai Journal of Physical Therapy [Internet]. 17Apr.2018 [cited 21Oct.2018];40(1):31-0. Available from:
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1. Cote P, Hogg-Johnson S, Cassidy JD, Carroll L, Frank JW, Bombardier C. Early aggressive care and delayed recovery from whiplash: isolated finding or reproducible result? Arthritis Rheum. 2007; 57(5): 861-8.

2. Chappuis G, Soltermann B. Number and cost of claims linked to minor cervical trauma in Europe: results from the comparative study by CEA, AREDOC and CEREDOC. Eur Spine J. 2008; 17(10): 1350-7.

3. Holm LW, Carroll LJ, Cassidy JD, Hogg-Johnson S, Cote P, Guzman J, et al. The burden and determinants of neck pain in whiplash-associated disorders after traffic collisions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine. 2008; 33(4 Suppl): S52-9.

4. Mooney H. Insurance companies are reeling from the number of claims being made by people who say they have whiplash injuries 2012 [cited 14 May 2017]. Available from:

5. Hyde D. Why Britain is the whiplash capital of Europe. The Telegraph [Internet]. United Kingdom 2013. [cited 23 December 2013]. Available from: finance/personalfinance/insurance/10185382/Why-Britain-is-the-whiplash-capital-of- Europe. html.

6. Financial Services Commission of Ontario (FSCO). FSCO, financial services submission to the superintendent: submitted for the review of part VI of the insurance act. Canada: Financial Services Commission of Ontario; 2014.

7. Sterling M. Physiotherapy management of whiplash-associated disorders (WAD). J Physiother. 2014; 60(1): 5-12.

8. Wiangkham T. Development and evaluation of a novel intervention for rehabilitation following whiplash injury: University of Birmingham; 2017.

9. Michaleff ZA, Maher CG, Lin CW, Rebbeck T, Jull G, Latimer J, et al. Comprehensive physiotherapy exercise programme or advice for chronic whiplash (PROMISE): a pragmatic randomised controlled trial. Lancet. 2014; 384(9938): 133-41.

10. Spitzer WO, Skovron ML, Salmi LR, Cassidy JD, Duranceau J, Suissa S, et al. Scientific monograph of the Quebec Task Force on whiplash-associated disorders: redefining "whiplash" and its management. Spine. 1995; 20(8 Suppl): 1s-73s.

11. Cassidy JD, Carroll LJ, Côté P, Lemstra M, Berglund A, Nygren Å. Effect of eliminating compensation for pain and suffering on the outcome of insurance claims for whiplash injury. N Engl J Med. 2000; 342(16): 1179-86.

12. MacNab I. Whiplash injuries of the neck. Proceedings: American Association for Automotive Medicine Annual Conference, 1965: 9: 11-15.

13. Pearson AM, Ivancic PC, Ito S, Panjabi MM. Facet joint kinematics and injury mechanisms during simulated whiplash. Spine. 2004; 29(4): 390-7.

14. Nygren A, Gustafsson H, Tingvall C. Effects of different types of headrests in rear-end collisions. SAE Technical Paper, 1985 Jan 1.

15. Ivancic PC. Mechanisms and mitigation of head and spinal injuries due to motor vehicle crashes. J Orthop Sports Phys Ther. 2016; 46(10): 826-33.

16. Elkin BS, Elliott JM, Siegmund GP. Whiplash injury or concussion? a possible biomechanical explanation for concussion symptoms in some individuals following a rear-end collision. J Orthop Sports Phys Ther. 2016; 46(10): 874-85.

17. Berglund A, Bodin L, Jensen I, Wiklund A, Alfredsson L. The influence of prognostic factors on neck pain intensity, disability, anxiety and depression over a 2-year period in subjects with acute whiplash injury. Pain. 2006; 125(3): 244-56.

18. Siegmund GP, Winkelstein BA, Ivancic PC, Svensson MY, Vasavada A. The anatomy and biomechanics of acute and chronic whiplash injury. Traffic Inj Prev. 2009; 10(2): 101-12.

19. Saari A, Itshayek E, Cripton PA. Cervical spinal cord deformation during simulated head-first impact injuries. J Biomech. 2011; 44(14): 2565-71.

20. Ellman L, Champion S, Dobbin J, Lumley K, McCartney J, McCartney K, et al. Cost of motor insurance: whiplash. In: Committee HoCT, editor. London: The Stationery Office Limited; 2013.

21. Merrick D, Stalnacke BM. Five years post whiplash injury: Symptoms and psychological factors in recovered versus non-recovered. BMC Res Notes. 2010; 3: 190.

22. Jull GA, Sterling M, Curatolo M, Carroll L, Hodges P. Toward lessening the rate of transition of acute whiplash to a chronic disorder. Spine. 2011; 36(25 Suppl): S173-4.

23. Borsbo B, Peolsson M, Gerdle B. Catastrophizing, depression, and pain: correlation with and Influence on quality of life and health - a study of chronic whiplash-associated disorders. J Rehabil Med. 2008; 40(7): 562-9.

24. Borsbo B, Peolsson M, Gerdle B. The complex interplay between pain intensity, depression, anxiety and catastrophising with respect to quality of life and disability. Disabil Rehabil. 2009; 31(19): 1605-13.

25. Jull G, Kenardy J, Hendrikz J, Cohen M, Sterling M. Management of acute whiplash: a randomized controlled trial of multidisciplinary stratified treatments. Pain. 2013; 154(9): 1798-806.

26. Lamb SE, Gates S, Williams MA, Williamson EM, Mt-Isa S, Withers EJ, et al. Emergency department treatments and physiotherapy for acute whiplash: a pragmatic, two-step, randomised controlled trial. Lancet. 2013; 381(9866): 546-56.

27. Jull G. Whiplash continues its challenge. J Orthop Sports Phys Ther. 2016; 46(10): 815-17.

28. Leth-Petersen S, Rotger GP. Long-term labour-market performance of whiplash claimants. J Health Econ. 2009; 28(5): 996-1011.

29. Jennum P, Kjellberg J, Ibsen R, Bendix T. Health, social, and economic consequences of neck injuries: a controlled national study evaluating societal effects on patients and their partners. Spine. 2013; 38(5): 449-57.

30. Eck JC, Hodges SD, Humphreys SC. Whiplash: a review of a commonly misunderstood injury. Am J Med. 2001; 110(8): 651-6.

31. Galasko CSB, Murray P, Stephenson W. Incidence of whiplash-associated disorder. BCMJ. 2002; 44(5): 237-40.

32. Tanaboriboon Y. Road accidents in Thailand: changes over the past decade. IATSS Research. 2004; 28(1): 119-22.

33. Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med. 1996; 335(23): 1721-6.

34. Thompson DP, Oldham JA, Urmston M, Woby SR. Cognitive determinants of pain and disability in patients with chronic whiplash-associated disorder: a cross-sectional observational study. Physiotherapy. 2010; 96(2): 151-9.

35. Hartling L, Brison RJ, Ardern C, Pickett W. Prognostic value of the Quebec classification of whiplash-associated disorders. Spine. 2001; 26(1): 36-41.

36. Prushansky T, Gepstein R, Gordon C, Dvir Z. Cervical muscles weakness in chronic whiplash patients. Clinical biomechanics (Bristol, Avon). 2005; 20(8): 794-8.

37. Sterling M, Chadwick BJ. Psychologic processes in daily life with chronic whiplash: relations of posttraumatic stress symptoms and fear-of-pain to hourly pain and uptime. Clin J Pain. 2010; 26(7): 573-82.

38. Buitenhuis J, de Jong PJ. Fear avoidance and illness beliefs in post-traumatic neck pain. Spine. 2011; 36(25 Suppl): S238-43.

39. Carroll LJ. Beliefs and expectations for recovery, coping, and depression in whiplash-associated disorders: lessening the transition to chronicity. Spine. 2011; 36(25 Suppl): S250-6.

40. Sterling M, Hendrikz J, Kenardy J. Similar factors predict disability and posttraumatic stress disorder trajectories after whiplash injury. Pain. 2011; 152(6): 1272-8.

41. Sterling M. A proposed new classification system for whiplash associated disorders--implications for assessment and management. Man Ther. 2004; 9(2): 60-70.

42. Williamson E, Williams MA, Gates S, Lamb SE. Risk factors for chronic disability in a cohort of patients with acute whiplash associated disorders seeking physiotherapy treatment for persisting symptoms. Physiotherapy. 2015; 101(1): 34-43.

43. Jagnoor J, Cameron I, Harvey L, Ierano J, Nicholson K, Rebbeck T, et al. Motor Accidents Authority: guidelines for the management of acute whiplash-associated disorders - for health preofessionals. third ed. Sydney: New South Wales Government; 2014.

44. Wiangkham T, Duda J, Haque S, Madi M, Rushton A. The effectiveness of conservative management for acute whiplash associated disorder (WAD) II: a systematic review and meta-analysis of randomised controlled trials. PLoS One. 2015; 10(7): e0133415.

45. Wiangkham T, Duda J, Haque MS, Madi M, Rushton A. Effectiveness of conservative treatment in acute whiplash associated disorder (WAD) II: a systematic review and meta-analysis of randomised controlled trials. Physiotherapy. 2015; 101, Supplement 1(0): e1623-e4.

46. Rushton A, Wright C, Heneghan N, Eveleigh G, Calvert M, Freemantle N. Physiotherapy rehabilitation for whiplash associated disorder II: a systematic review and meta-analysis of randomised controlled trials. BMJ open. 2011; 1(2): e000265.

47. Wiangkham T, Duda J, Haque MS, Rushton A. Development of an active behavioural physiotherapy intervention (ABPI) for acute whiplash-associated disorder (WAD) II management: a modified Delphi study. BMJ open. 2016; 6(9): e011764.

48. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655.

49. Wiangkham T, Duda J, Haque MS, Price J, Rushton A. Acute Whiplash Injury Study (AWIS): a protocol for a cluster randomised pilot and feasibility trial of an active behavioural physiotherapy intervention in an insurance private setting. BMJ open. 2016; 6(7): e011336.

50. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977; 84(2): 191-215.

51. Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther. 1991; 14(7): 409-15.

52. MacDermid JC, Walton DM, Avery S, Blanchard A, Etruw E, McAlpine C, et al. Measurement properties of the neck disability index: a systematic review. J Orthop Sports Phys Ther. 2009; 39(5): 400-17.

53. TRACsa. Clinical guidelines for best practice management of acute and chronic whiplash associated disorders: clinical resource guide. Adelaide: TRACsa: Trauma and Injury Rocovery; 2008.

54. Press MJ, Howe R, Schoenbaum M, Cavanaugh S, Marshall A, Baldwin L, et al. Medicare payment for behavioral health integration. N Engl J Med. 2017; 376(5): 405-7.