Whiplash: evidence base for clinical practice.
Author: Bradshaw, Jane
Pub Date: 11/01/2011
Publication: Name: New Zealand Journal of Physiotherapy Publisher: New Zealand Society of Physiotherapists Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 New Zealand Society of Physiotherapists ISSN: 0303-7193
Issue: Date: Nov, 2011 Source Volume: 39 Source Issue: 3
Accession Number: 288538009
Full Text: Whiplash: Evidence Base for Clinical Practice Michelle Sterling, Justin Kenardy. Churchill Livingstone Elsevier, Australia 2011. ISBN: 978-0-7295-3946-3. Soft cover, 196 pages. RRP: AUS $85.00.

This book is a welcomed response to the concern, debate, and controversy regarding rising costs and unsatisfactory treatment outcomes for Whiplash Associated Disorder (WAD), despite a recent increase in published research and clinical guidelines. Usually a consequence of a motor vehicle crash, WAD is a unique, functionally disabling, complex and heterogeneous condition. It can present with diverse, individually varying acute and often chronic physiological, psychological and environmental manifestations. Researcher-clinicians, Michelle Sterling, physiotherapist and Justin Kenardy, psychologist, as authors, have achieved their goal of enhancing understanding by critically evaluating a wide range of perspectives on the WAD evidence base, which can stimulate improved research and clinical outcomes.

Underlying themes of the book are the need for improved research designs and improved clinical management of acute and chronic pain, post traumatic stress disorder, sensory dysfunction and psychological distress and motor dysfunction. The authors contend that WAD is a unique condition which warrants specific assessment and management. Therefore, it can differ from neck and chronic musculoskeletal pain disorders including low back pain. Also highlighted are the complicating compensable and legal problems.

This well written small book clarifies our understandings with easily read text and concise chapter summaries. Comprehensive referencing and explicit tables and figures are useful features. The beginning chapters discuss epidemiology, multiple biopsychosocial risk and prognostic factors emphasizing beneficial early treatment intervention, causal links and classification systems. Chapter 3 outlines motor vehicle crash kinematics, structure theories, metrics and occupant and vehicle impact factors. Chapter 4 explores specific cervical pathoanatomical diagnoses, imaging correlates and persistent symptoms.

Mandatory routine assessment of sensory features reflecting augmented central pain-processing and medication, physical and psychological interventions are recommended. Chapter 6 recommends specific exercise rehabilitation of complex neuromuscular changes. Chapter 7 describes causal relationships and clinical assessment and management of sensorimotor dysfunction particularly cervical afferents, the vertebral artery, vestibular and oculomotor systems responsible for often disabling dizziness, unsteadiness and visual disturbances. Chapters 8--9 provide insight into significant but often inadequately identified and managed post traumatic and psychological stress.

Prognostic indicators of non-recovery are also covered, highlighting initial pain intensity as the most consistent predictor. Chapters 11--13 translate synthesized evidence based knowledge into best clinical management, emphasizing psychological management and fresh options. Varying compensation and legal issues in Australia, the United States and Canada with minimal reference to New Zealand are also outlined. The final chapters evaluate malingering identification and management, present useful clinically relevant case studies and exciting new research and clinical directions.

I strongly recommend this easily read, enlightening evidence-based update on WAD research and clinical best practice, particularly to researchers, educators and clinicians, including physiotherapists. Refreshing insights and take home clinical pearls inspire their integration into routine research and clinical practice, whilst improving patients' outcomes and reducing costly disabilities.

Jane Bradshaw MHealSc(Rehab), Dip HealSc(Rehab), Dip Man T, Dip Phty Physiotherapist, Wellington.
Gale Copyright: Copyright 2011 Gale, Cengage Learning. All rights reserved.