Term Paper on "Physiotherapy Management of Whiplash Associated Disorders"

Term Paper 40 pages (11600 words) Sources: 0

[EXCERPT] . . . .

Physiotherapy management of whiplash associated disorders: A Literature Review

Biopsychosocial aspects of WAD

Physiotherapy and WAD

Preliminary Literature Review

Physical symptoms following whiplash

Psychological and cognitive aspects of WAD

Social and cultural aspects of WAD

Management aspects of WAD

Methodology / Method

Critical Review

Description of results

Critical review of results

Recent studies in the physiotherapy management of whiplash associated disorders: A Literature Review. Poor Research question.

I am not sure if any of these questions are better. I really need some suggestions for a research question.

What is the new evidence that will inform the CSP guideline review in 2010.

What is new in the Physiotherapy management of whiplash associated disorders: A Literature Review?

What is new in the Physiotherapy management of whiplash associated disorders since the publication of the Whiplash guidelines in 2005: A Literature Review

Is there any new body of evidence that might need to be considered when the whiplash guidelines are reviewed in 2010?

ABSTRACT: Poor research question.The examiner thought the entire abstract was not great.

Aim: This dissertation examines the recent studies on the physiotherapy management of whiplash associated disorders.

Method: The Chartered Society of Physiotherapists (CSP) published the guidelines for the Physiotherapy management of WAD in 2005.It systematically reviewed all whiplash related studies until March 2004 in order to issue the guidelines. Therefore this study only includes studies published after March 2004.It specifically looks at all randomized controlled studies related to the Physiotherapy management in whiplash injuries.

Results: The search produced 10 RCT's that fit the inclusion and exclusion criterion. The two major aspects that the analysis revealed were most of studies done recently in the physiotherapy management of WAD are related to the use of collar and prescription of exercises for whiplash patients.

Discussion: Inspite of various recommendations for research by the CSP in the whiplash guidelines there has been very few RCT's done for Physiotherapy management of WAD. Most of the studies are related to exercise prescription following whiplash injuries and the general consensus is that supervised exercise programme might be more beneficial than no exercises or home exercises. The search has also not revealed any significant studies on the physiotherapy management of psychosocial aspects of WAD but this could be due to the stringent search criterion of the study.

Conclusion: The literature review has revealed the current best evidence in the field of Physiotherapy management of WAD. sweeping statement

INTRODUCTION:

Background:

Whiplash injuries are a major health and economic problem around the world (Lamb et al., 2007).Whiplash is usually defined as an acceleration-deceleration mechanism of energy transfer to the neck that results from rear-end or side-impact motor vehicle collisions, diving accidents, or other mishaps. The impact results in bony or soft tissue injuries which in turn may lead to a variety of clinical manifestations called whiplash-associated disorders (WAD) (Spitzer et al., 1995). WAD's are estimated at 300 -- 600 cases per 100,000 population per year in North America and western Europe (Holm et al., 2008a). They incur a lot of costs to the insurance and medical systems, and may result in long-term disability in the injured person and that includes increased risk of future neck pain and other health complaints (Cote et al., 2001).There is uncertainty about the management of these injuries, and the scale and complexity of whiplash injuries makes it an important public health concern (Ozegovic et al., 2010). Exorbitant health care costs, increasing disability rates and uncertainty about the most effective management of WAD have therefore led governments, insurers and clinicians to develop treatment guidelines and programs of care for its treatment (Cassidy et al., 2007, Moore et al., 2005).

Spitzer et al. (1995) compiled data from numerous sources to describe the course of recovery following whiplash injury. They reported that by 4 weeks post-injury, approximately 50% of individuals had resumed pre-injury activities. At 12 weeks post injury, approximately 75% of individuals had resumed their pre-injury activities. Individuals who remained disabled at 12 weeks post-injury were considered at high risk of becoming permanently disabled. Lamb et al. (2007) remarked that these patients who show signs of long-term disability generate the majority of costs, and prevention of chronic symptoms is therefore a priority in treatment of whiplash injuries. There are different aspects that need to be considered to be able to formulate treatment programmes for WAD.

The biopsychosocial aspects of WAD:

There have been many studies to understand the concept of chronic pain. A study (Millard, 1995 cited in Soderlund and Lindburg, 2001 p .436) described chronic pain as a multi-component phenomenon with associations between injury, pain experience, impairment, physical maintaining factors, emotional and cognitive factors, as well as environmental and socioeconomic influences.(Busse et al., 2004, Ferrari 2002 and Olsson et al., 2002) looked at the bio psychosocial model of musculoskeletal chronic pain and used the model to identify factors that determine chronicity in WAD and consequently assess interventions that are most likely to be effective.

Biological and cognitive factors: Yogananadan et al. In 2001 used conventional spine imaging and cryomicrotomy to conclude that neck pain in the acute stage following whiplash incident result from soft tissue injuries to the cervical region that was caused by the acceleration/deceleration force occurring at the time of the accident. However Melzack and Wall in 1965 suggested that the nociception of pain caused by the activation of peripheral sensory fibres and the emotional experience of pain are not one and the same needs more expansion. Kall (2009) suggests that this might be the reason why patients react differently to the same extent of physical pathology. There are several cognitive, affective and behavioural factors that can influence the perception of pain, maintenance of pain and disability, exacerbation of pain and consequently response to treatment (Bunkertorp et al., 2006, Turk 2002).Individuals beliefs and responses to perceived pain plays an important role. Negative reaction to pain might cause fear of movement thus preventing the individual from performing daily activities which in turn can lead to negative self-image and reduced self-efficacy (Lethem et al., 1983, Philips 1987).Vlaeyen and Linton (2000) suggested that catastrophic thinking following injury can also result in development of fear of pain which in turn can cause avoidance of activity or escape behaviour. The above points are general to any chronic pain. Link this entire section to WAD.

Psychological factors: A study done by Carroll et al. In 2006 found that almost 45% of those with traffic-related whiplash injuries showed depressive symptoms in the early weeks post-collision, and they suggested that, like neck pain, depressed symptomatology is an important component in the cluster of WAD symptoms and can be considered a traffic-related psychological injury. Another psychological factor found to be prevalent in individuals with whiplash injuries is post-traumatic stress symptoms. Studies have suggested that as many as 1 in 4 individuals who sustain whiplash injuries in road traffic accidents might show evidence of clinically significant post traumatic stress symptoms (Blanchard et al., 2004, Jaspers 1998, Kuch, Swinson and Kirby, 1985).Expand .impact on daily life and function.

Social and environmental factors: There are some social or environmental factors that have been studied and found to have an influence on chronicity in WAD. Buitenhuis and colleagues in 2009 did a study on work disability after whiplash and found that 58.8% of the studied population with neck complaints was work-disabled after the accident. Out of this group 78.3% recovered from work disability in the first year leaving 21.7% participants with persistent work disability after 1 year.This study clearly showed that work disability due to post-whiplash syndrome was not only a common problem but also that in a considerable number of cases work disability took a chronic course.

It has been suggested in some studies that cultural differences may explain the chronicity of symptoms following whiplash injuries. Buitenhuis et al. In 2008 commented that dysfunctional causal beliefs could be caused by culturally embedded beliefs regarding the course and severity of whiplash. Ferrari and Russell (2008) also proposed that late whiplash with chronic pain and disability is a result of unrealistic cultural expectations. They found that in countries like Germany, Greece and Lithuania chronic WAD was rare or nonexistent in contrast to its frequent occurrence in other European countries and North America, where the population is conditioned to expect worse outcomes.

Looking at the various biological, psychological and social factors associated with WAD we will not be mistaken in saying that management of people with WAD is intellectually and clinically demanding, requiring high level of clinical reasoning skills (Moore et al., 2005).Evidence suggests that the type, intensity and timing of health care delivery are strongly and independently associated with recovery time in WAD (Cote et al. 2005, Cassidy et al. 2007).

Physiotherapy and WAD:

WAD is a common injury that is treated in physiotherapy clinics in the United Kingdom and beyond (Moore et al., 2005).What are the presenting problems of WAD. Typically, physiotherapy approaches to chronic WAD are concerned with movement and function (Soderlund and Lindberg 2001).Various treatment techniques such as manipulation and mobilization (Cassidy et… READ MORE

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