title: Toward optimal early management after whiplash injury to lessen the rate of transition to chronicity: discussion paper 5.
abstract: METHODS
  Expert debate and synthesis of research to inform future management approaches for acute whiplash disorders.
  
  
  OBJECTIVE
  To identify a research agenda toward improving outcomes for acute whiplash-injured individuals to lessen the incidence of transition to chronicity.
  
  
  BACKGROUND
  International figures are concordant, estimating that 50% of individuals recover from pain and disability within 3 to 6 months of a whiplash injury. The remainder report continuing symptoms up to 1 to 2 years or longer postinjury. As no management approach to date has improved recovery rates, new clinical/research directions are required for early management of whiplash-injured patients.
  
  
  METHODS
  A group of multidisciplinary researchers critically debated evidence and current research concerning whiplash from biological, psychological, and social perspectives toward informing future research directions for management of acute whiplash.
  
  
  RESULTS
  It was recognized that effective treatments for acute whiplash are constrained by a limited understanding of causes of whiplash-associated disorders. Acute whiplash presentations are heterogeneous leading to the proposal that a research priority was development of a triage system based on modifiable prognostic indicators and clinical features to better inform individualized early management decisions. Other priorities identified included researching effective early pain management for individuals presenting with moderate to high levels of pain; development of best education/information for acute whiplash; testing the efficacy of stratified and individualized rehabilitation, researching modes of delivery considering psychosocial modulators of pain and disability; and the timing, nature, and mode of delivery of cognitive-behavioral therapies. Directions were highlighted for future biomechanical research into injury prevention.
  
  
  CONCLUSIONS
  The burden of whiplash injuries, the high rate of transition to chronicity, and evidence of limited effects of current management on transition rates demand new directions in evaluation and management. Several directions have been proposed for future research, which reflect the potential multifaceted dimensions of an acute whiplash disorder.
authors.affiliation: CCRE Spinal Pain, Injury, and Health, Division of Physiotherapy, The University of Queensland, Australia. g.jull@uq.edu.au
authors.forename: Gwendolen A
authors.initials: GA
authors.lastname: Jull
authors.forename: Anne
authors.initials: A
authors.lastname: Söderlund
authors.forename: Brian D
authors.initials: BD
authors.lastname: Stemper
authors.forename: Justin
authors.initials: J
authors.lastname: Kenardy
authors.forename: Anita R
authors.initials: AR
authors.lastname: Gross
authors.forename: Pierre
authors.initials: P
authors.lastname: Côté
authors.forename: Julia
authors.initials: J
authors.lastname: Treleaven
authors.forename: Nikolai
authors.initials: N
authors.lastname: Bogduk
authors.forename: Michele
authors.initials: M
authors.lastname: Sterling
authors.forename: Michele
authors.initials: M
authors.lastname: Curatolo
mesh_terms: D059787:Acute Pain / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D000223:Adaptation, Psychological; D059350:Chronic Pain / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D035881:Compensation and Redress; D018450:Disease Progression; D006801:Humans; D017063:Outcome Assessment, Health Care; D020127:Recovery of Function; D013315:Stress, Psychological / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D014911:Whiplash Injuries / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*