A systematic review of chiropractic management of adults with whiplash-associated disorders: Recommendations for advancing evidence-based practice and research

Issue title: 20th Anniversary Issue

Article type: Research Article

Authors: Shaw, Lynn | Descarreaux, Martin | Bryans, Roland | Duranleau, Mireille | Marcoux, Henri | Potter, Brock | Ruegg, Rick | Watkin, Robert | White, Eleanor

Affiliations: Faculty of Health Sciences, School of Occupational Therapy, University of Western Ontario, London, ON, Canada | Département de Chiropratique, Université du Québec à Trois Rivières, Trois Rivières, QC, Canada | Chairman, Guidelines Development Committee (GDC), Chiropractor, Clarenville, NL, Canada | Chiropraticienne, Montréal, QC, Canada | Chiropractor, Winnipeg, MB, Canada | Chiropractor, North Vancouver, BC, Canada | Canadian Memorial Chiropractic College, Toronto, ON, Canada | HIV and Aids Legal Clinic Ontario, Toronto, ON, Canada | Chiropractor, Markham, ON, Canada

Note: [] Address for correspondence: Dr. Roland Bryans, The CCA/ CFCREAB Clinical %Practice Guidelines Project, 39 River Street, Toronto, Ontario, Canada, M5A 3P1. E-mail: rbryans@nfld.net

Abstract: The literature relevant to the treatment of Whiplash-Associated Disorders (WAD) is extensive and heterogeneous. Methods: A Participatory Action Research (PAR) approach was used to engage a chiropractic community of practice and stakeholders in a systematic review to address a general question: 'Does chiropractic management of WAD clients have an effect on improving health status?' A systematic review of the empirical studies relevant to WAD interventions was conducted followed by a review of the evidence. Results: The initial search identified 1,155 articles. Ninety-two of the articles were retrieved, and 27 articles consistent with specific criteria of WAD intervention were analyzed in-depth. The best evidence supporting the chiropractic management of clients with WAD is reported. Further review identified ways to overcome gaps needed to inform clinical practice and culminated in the development of a proposed care model: the WAD–Plus Model. Conclusions: There is a baseline of evidence that suggests chiropractic care improves cervical range of motion (cROM) and pain in the management of WAD. However, the level of this evidence relevant to clinical practice remains low or draws on clinical consensus at this time. The WAD-Plus Model has implications for use by chiropractors and interdisciplinary professionals in the assessment and management of acute, subacute and chronic pain due to WAD. Furthermore, the WAD-Plus Model can be used in the future study of interventions and outcomes to advance evidence-based care in the management of WAD.

Keywords: Pain, neck, treatment, manipulation, assessment

DOI: 10.3233/WOR-2010-0996

Journal: Work, vol. 35, no. 3, pp. 369-394, 2010