SPECIFIC CLINICAL RECOMMENDATIONS

After reviewing a total of nearly 300 articles addressing risk, diagnosis, treatment, and prognosis of Whiplash-associated disorders (WAD), the Task Force accepted 62 studies. Although accepted, these studies, because of methodologic limitations, constituted at best weak evidence to support recommendations regarding appropriate diagnosis and treatment, and regarding prognostic factors. Therefore, in the absence of strong scientific evidence, the recommendations for clinical practice that follow have largely been developed by the Task Force based upon their clinical judgment and practice. They must be viewed as provisional, until the recommended research is completed. Indeed, the research recommendations should have a high priority, as they are critical to the establishment of evidence-based treatment recommendations.

The recommendations regarding diagnosis and treatment that follow are presented in tabular summary. They are grouped by type of diagnostic method or treatment modality. In the left-most columns the accepted evidence is summarized. For each statement in the table, a more detailed description in the text of chapter three is given. In the middle columns, the recommendations for clinical practice can be found. The last column presents the recommendations for research. Because the accepted studies provided so little evidence to guide clinical practice, we emphasize the importance of the recommendations for research regarding the specific diagnostic and treatment modalities considered.

The tabular presentation of recommendations regarding prognosis follows the same form as those for diagnosis and treatment. Because the accepted studies provided such weak evidence regarding prognostic factors, recommendations for clinical management are also largely practice-based, and indicate what information should be recorded at each visit. It should be emphasized here that the expectations of recovery under optimum management are based on the review of pathophysiology of soft-tissue healing. These expectations reflect the consensus of the Task Force that the prognosis of WAD, as developed in the accepted studies, can be altered by optimum management.