BC Whiplash Initiative

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					                                        RESOURCES *: RESSOURCES


BC Whiplash                                 Banff, Alta, in 1995, during which the
                                            Physical Medicine Research Foun-
                                                                                               evidence or consensus as recommend-
                                                                                               ed by the Quebec Task Force. The
Initiative                                  dation concluded that the Quebec                   Grand Round Syllabus' warns that the
Primrose Ketchum
                                            Task Force on Whiplash-Associated                  strategies do not apply to chronic
                                            Disorders presented the best evidence-             whiplash-associated disorders and
T    he BC Whiplash Initiative              based synthesis to date. The Physical              should not be considered clinical prac-
     (BCWI) is a multi-agency project       Medicine Research Foundation com-                  tice guidelines.
dedicated to developing a continuing        mitted itself to disseminate the findings
medical education (CME) program for         of the Quebec report for the benefit               Recommended. For grade 1 injuries,
physicians on diagnosis and treatment       of patients in British Columbia.                   treatment options are normal activity;
of whiplash-associated disorders.           Organizations participating in the                 reassurance; education; neck range-of-
Management is predicated on evi-            BCWI include the BC College of Family              motion exercises (self-conducted or
dence-based- guidelines wherever            Physicians and UBC's Department of                 supervised); and use of mobilization or
possible. The BCWI's guidelines, how-       Family Practice (Rural Education                   manipulation, analgesics, possibly
ever, are for educational purposes only     Training), Family Practice Residency               NSAIDs, and traction only for short
and are not formal clinical practice        Program, Under-                                                      periods. For grade 2
guidelines.                                 graduate Medi-                                                       and 3 injuries, modi-
                                            cal Association,                                                     fied activity; realistic
Family physicians can play                  and Division of                                                      reassurance with
a key role                                  CME. The Insu-                                                       guidance and educa-
Patients with whiplash-associated dis-      rance Corpor-                                                        tion; neck range-of-
orders tend to drift along with pain        nfinn VI  RC( filn-
                                            aLlUll nf "%- lU11-                                                          an
                                                                                                                     mntinn         rprri q
wondering when to go back to work           ded the project through an educa-                  activity, and mobility at first; use of
and whether to rest or stay active to       tional grant to the Physical Medicine              analgesics and possibly NSAIDs for
promote healing. "Family physicians         Research Foundation.                               the first weeks; short-term manipula-
can offer practical advice," says              The Quebec Task Force on Whiplash-              tion or mobilization as part of overall
Dr Stan Lubin, a member of the              Associated Disorders reviewed evidence             activity-treatment strategy; short-term
Initiative's Curriculum Committee,          in the literature on the risk, diagnosis,          traction; a collar for no more than
who presented a workshop on the             management, and prognosis of whiplash-             72 hours; and possibly surgery for spe-
BCWI at the British Columbia Annual         associated disorders. An exhaustive                cific indications, such as progressive
Scientific Assembly in Vancouver.           search through more than 10000 publi-              neurologic deficit, are recommended.
    "Family physicians can play a key       cations turned up only 346 worth study-
role in promoting activity, exercise,       ing and only 62 of these met the rigours           Evidence inconclusive. Passive
and mobility, and recommending a            of excellence. The Task Force found fun-           treatments, such as cervical pillows,
graduated increase in activity; in sug-     damental gaps in information on patho-             heat or ice, massage, acupuncture,
gesting multidisciplinary clinics for       physiology, diagnosis, treatment, clinical         transcutaneous electrical stimulation,
various types of therapy; in doing care-    course, and prevention of the disorders.           diathermy, ultrasound and laser thera-
ful assessment and reassessment; and        Their synthesis and research findings              py, and electromagnetic therapy for
in reassuring patients that most people     led to a new classification of whiplash-           grade 1 injuries are neither supported
get better," he said. According to the      associated disorders. (Injuries are grad-          nor ruled out by evidence. For grade 2
BCWI's Grand Round Syllabus,' 30% of        ed from 0 to 4 where 0 indicates no neck           and 3 injuries, passive treatments; pro-
patients with whiplash-associated dis-      complaints and no physical signs; 1 indi-          longed use of tranquilizers, sedatives,
orders return to usual activity within      cates neck complaints of pain, stiffness,          muscle relaxants, or analgesics; and
2 weeks of injury, 50% of patients          or tenderness only, but no physical signs;         long-term manipulative treatment
return to usual activity within 6 weeks     2 indicates neck complaints and muscu-             have not been proved beneficial.
of injury, and almost all patients return   loskeletal signs; 3 indicates neck com-            Investigational joint or tissue injection
to usual activity by 1 year after injury.   plaints and neurologic signs; and                  might be useful for diagnosis. These
                                            4 indicates neck complaints and fracture           treatments should be reassessed regu-
Beginnings                                  or dislocation.)                                   larly and should not be used instead of
The BCWI grew out of the eighth                                                                any of the recommended treatments.
International Symposium on "Musculo- Management strategies
skeletal Pain Emanating from the Head The BCWI recommends strategies                           Not recommended. Prolonged use
and Neck," and is the result of the asso- for early management of whiplash-                    of passive treatments or opiate or
ciated Consensus Conference held in associated disorders based on current                      sedative drugs, stopping work, surgery,

                                                       VOL44: JUNE * JUIN   19984 Canadian Family Physician Le Medecin defamille canadien 1329
                                                                                                                                      RESOURCES *. RESSOURCES


and rest are not thought to be therapeu-                                                                                                                    Topics include the following.                                  Epple, Program Secretary, Division of
tic for whiplash-associated disorders.                                                                                                                   * New classification of whiplash based                            Continuing Medical Education,
                                                                                                                                                           on results of the Quebec Task Force                             University of British Columbia, Room
Whiplash roadshow                                                                                                                                          on Whiplash-Associated Disorders                                105, 2194 Health Sciences Mall,
Sessions entitled "Comprehensive                                                                                                                         * Guidelines for treatment                                        Vancouver, BC V6T 1Z3; telephone
Management of Whiplash: When,                                                                                                                            * How to write a medical-legal report                             (604) 822-2043; fax (604) 822-4835;
Why, and How" are offered as a post-                                                                                                                     * Dos and don'ts of management                                    e-mail lori@cehs.ubc.ca. All requests
graduate program by the Division of                                                                                                                      * Hints on physical examinations                                  should be made by the CME coordina-
Continuing Medical Education at                                                                                                                          * Warning flags of chronicity and                                 tor for your community. More informa-
the University of British Columbia to                                                                                                                      strategies to prevent or minimize it                            tion is available on the BCWI website
communities in British Columbia.                                                                                                                         * Management of difficult chronic cases                           at http://www.healthsciences.ubc.ca/
Programs vary from half a day to a                                                                                                                       * Discussion of case histories                                    whiplash.bc/home.html.             *
full day in length and are structured                                                                                                                    * Impact dynamics and the patho-
to meet a region's specific needs.                                        Reference                                                                        physiology of injury
Because   all topics cannot be covered                                    1. BC Whiplash Initiative. Whiplash-associated
at every session,  selection of topics is How to sign up                    disorders. Grand round syllabus. Vancouver:
made following discussion with the Requests for these postgraduate Physical Medicine Research Foundation; 1997.
region's CME coordinator.                 programs should be made to Lori
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1330 Canadian Family Physician . Le Medecin defamille canadien e VOL44: JUNE * JUIN 1998

				
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