"Whiplash associated disorders: redefining whiplash and its management" by the Quebec Task Force. A critical evaluation.
METHODS
The two publications of the Quebec Task Force on Whiplash-Associated Disorders were evaluated by the authors of this report for methodologic error and bias.


OBJECTIVE
To determine whether the conclusions and recommendations of the Quebec Task Force on Whiplash-Associated Disorders regarding the natural history and epidemiology of whiplash injuries are valid.


BACKGROUND
In 1995, the Quebec Task Force authored a text (published by the Societe de l'Assurance Automobile du Quebec) and a pullout supplement in Spine entitled "Whiplash-Associated Disorders: Redefining Whiplash and its Management." The Quebec Task Force concluded that whiplash injuries result in "temporary discomfort," are "usually self-limited," and have a "favorable prognosis," and that the "pain [resulting from whiplash injuries] is not harmful."


METHODS
The authors of the current report reviewed the text and the supplement for methodologic flaws that may have threatened the validity of the conclusions and recommendations of the Quebec Task Force.


RESULTS
Five distinct and significant categories of methodologic error were found. They were: selection bias, information bias, confusing and unconventional use of terminology, unsupported conclusions and recommendations, and inappropriate generalizations from the Quebec Cohort Study.


CONCLUSIONS
The validity of the conclusions and recommendations of the Quebec Task Force regarding the natural course and epidemiology of whiplash injuries is questionable. This lack of validity stems from the presence of bias, the use of unconventional terminology, and conclusions that are not concurrent with the literature the Task Force accepted for review. Although the Task Force set out to redefine whiplash and its management, striving for the desirable goal of clarification of the numerous contentious issues surrounding the injury, its publications instead have confused the subject further.
Freeman
M D
MD
Department of Public Health and Preventive Medicine, Oregon Health Sciences University School of Medicine, Portland, USA.
Croft
A C
AC
Rossignol
A M
AM
D000063:Accidents, Traffic; D015982:Bias; D002574:Cervical Vertebrae / Q000293:injuries*; D015331:Cohort Studies; D015340:Epidemiologic Research Design; D005260:Female; D006801:Humans; D008297:Male; D011792:Quebec / Q000453:epidemiology; D015203:Reproducibility of Results; D014911:Whiplash Injuries / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy