title: Thoracic dysfunction in whiplash-associated disorders: a systematic review and meta-analysis protocol.
abstract: BACKGROUND
  Whiplash-associated disorder (WAD) research has largely focused on the neck, yet symptoms often include other areas. The prevalence of acute thoracic spine pain is reported ~66 %, which is perhaps unsurprising given the mechanism of injury involves a forceful loading/eccentric contraction of posterior thoracic structures such as the trapezius. Many individuals with WAD experience disability and pain beyond normal tissue healing time, termed chronic WAD. With the thoracic spine contributing to neck mobility, and 23 % of individuals complaining of thoracic pain 1 year post injury, it is time to look beyond the neck to fully understand the anatomical dysfunction in WAD.
  
  
  METHODS
  A systematic review protocol has been designed and will be reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). A sensitive topic-based search strategy is planned from inception to the current date. Databases, grey literature and registers will be searched using terms and keywords derived from a scoping search. Two reviewers will independently search information sources, assess studies for inclusion and extract data. A third reviewer will check for accuracy. Data to be extracted include summary data: sample size and characteristics, timescales to reflect disorder state, patient-reported or performance-based measure and findings. Risk of bias within studies will be assessed using the Newcastle-Ottawa Scale. Quantitative meta-analysis approach will be used for homogenous data and where appropriate presented using subgroups. All other results will be presented using narrative summaries. Subgroups will, where possible, be based on patient-reported or performance-based measure of dysfunction and/or stage of condition (acute/sub-acute or chronic). Strength of the overall body of evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).
  
  
  CONCLUSIONS
  This is the first study to bring together evidence of thoracic dysfunction post whiplash and provide new insights into the scope and nature of thoracic dysfunction in WAD. With current management options being largely focused to a primary neck complaint and many patients going to become chronic in their presentations, this review may stimulate research and clinical interest in a largely under investigated, yet anatomically and kinematically related, spinal region.
  
  
  BACKGROUND
  PROSPERO CRD42015026983.
authors: School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. n.heneghan@bham.ac.uk.
authors: Nicola R
authors: NR
authors: Heneghan
authors: School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. SmithRMW@adf.bham.ac.uk.
authors: Richard
authors: R
authors: Smith
authors: School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. a.b.rushton@bham.ac.uk.
authors: Alison
authors: A
authors: Rushton
mesh_terms: D001416:Back Pain / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D000078202:Systematic Reviews as Topic; D013898:Thoracic Injuries / Q000150:complications / Q000503:physiopathology*; D013904:Thoracic Vertebrae / Q000503:physiopathology*; D014911:Whiplash Injuries / Q000150:complications / Q000503:physiopathology*; D015201:Meta-Analysis as Topic