Clinical practice guideline for the physiotherapy of patients with whiplash-associated disorders.
METHODS
A clinical practice guideline.


OBJECTIVE
To assist physiotherapists in decision making and to improve the efficacy and uniformity of care for patients with whiplash-associated disorders Grades I and II.


BACKGROUND
Whiplash constitutes a considerable problem in health care. Many interventions are used in physiotherapy practice, despite increasing evidence for the use of active interventions. There is still no clinical practice guideline for the management of patients with whiplash-associated disorders. METHOD OF DEVELOPMENT: A computerized literature search of Medline, Cinahl, Cochrane Controlled Trial Register, Cochrane Database of Systematic Reviews, and the Database of the Dutch National Institute of Allied Health Professions was performed to search for information about the diagnostic process and the therapeutic process in whiplash patients. When no evidence was available, consensus between experts was achieved to develop the guideline. Practicing physiotherapists reviewed the clinical applicability and feasibility of the guideline, and their comments were used to improve it.


CONCLUSIONS
The diagnostic process consists of systematic history taking and a physical examination supported by reliable and valid assessment tools to document symptoms and functional disabilities. The primary goals of treatment are a quick return to normal activities and the prevention of chronicity. Active interventions such as education, exercise therapy, training of functions, and activities are recommended according to the length of time since the accident and the rate of recovery. The biopsychosocial model is used to address the consequences of whiplash trauma.


CONCLUSIONS
Scientific evidence for the diagnosis and physiotherapeutic management of whiplash is sparse; therefore, consensus is used in different parts of the guideline. The guideline reflects the current state of knowledge of the effective and appropriate physiotherapy in whiplash patients. More and better research is necessary to validate this guideline in the future.
Scholten-Peeters
Gwendolijne G M
GG
Center for Quality of Care Research, University Medical Center, Catholic University of Nijmegen, The Netherlands. npi.oo.wendy@planet.nl
Bekkering
Geertruida E
GE
Verhagen
Arianne P
AP
van Der Windt
Daniëlle A W M
DA
Lanser
Kees
K
Hendriks
Erik J M
EJ
Oostendorp
Rob A B
RA
D000054:Acceleration / Q000009:adverse effects; D000223:Adaptation, Psychological; D003657:Decision Making; D003663:Decision Trees; D004185:Disability Evaluation; D018450:Disease Progression; D019317:Evidence-Based Medicine; D005081:Exercise Therapy / Q000592:standards; D006040:Goals; D006287:Health Planning Guidelines; D006801:Humans; D026761:Physical Therapy Specialty / Q000379:methods / Q000592:standards*; D011379:Prognosis; D020127:Recovery of Function; D012196:Review Literature as Topic; D011795:Surveys and Questionnaires; D014911:Whiplash Injuries / Q000145:classification / Q000175:diagnosis / Q000628:therapy*