SCOPE OF THE REPORT
The mandate of the Task Force included a broad variety of questions to be addressed. It was not feasible to have, in a single Task Force, sufficient representation of all areas of expertise needed to carry out a best evidence synthesis on all clinical questions and on all questions concerning prevention. Consequently, it was decided to focus the full Task Force on clinical issues, specifically risk, diagnosis, treatment and prognosis of whiplash. Issues regarding mechanism of injury and prevention of whiplash were addressed by consensus in a subgroup that included an injury epidemiologist, orthopaedist, and engineer with outside consultants. This group conducted a review of the literature on road safety, biomechanics and injury control with respect to the mechanism of whiplash injury, prevention of collisions and the environment of moving automobiles.
In parallel with the Task Force review of the scientific evidence, a subgroup of clinicians was formed, with experts from the various specialties involved in diagnosis, treatment and rehabilitation of WAD. They reviewed the basic anatomy, physiology and semiology underlying clinical interventions for WAD. This permitted a better elaboration of the treatment algorithm and recommendations for professional education.
Because of the above consensus process, the entire Task Force was better prepared to describe, define and classify the problem of whiplash, a process essential to the evaluation of the literature and to any subsequent recommendations. These results appear in Section 3: Consensus Findings. One of the most important contributions of the Task Force is the Quebec Classification of Whiplash-Associated Disorders. We hope our classification will allow more meaningful discussion of clinical issues and allow comparisons of future research studies, through the adoption of standardized diagnostic criteria for WAD.
Surprisingly little evidence relevant to epidemiology, to clinical decisions, to preventive interventions and to rehabilitation was found. Accordingly, for many aspects covered by its Mandate from the SAAQ, the Task Force was forced to invoke expert opinion to make recommendations in areas where the literature was weak. To supplement this process and to gain a better understanding of the epidemiology of WAD in Quebec, we identified a cohort of whiplash subjects from the injury claim files of the SAAQ and examined prognostic factors in the recovery process. These findings appear in Section 2: The Quebec Whiplash-Associated Disorders Cohort Study.
This Scientific Monograph presents the essential scientific background from relevant clinical, epidemiological, basic science and engineering disciplines, the methods employed, conclusions and recommendations. Given the dearth of valid information in the international literature, it emphasizes research priorities in the near term and the longer term. These can be found in Section 6: Research Priorities for Whiplash-Associated Disorders.