Chiropractic Management of WAD Recommendations for practice and research This article is a review of the recently published study titled: A Systematic Review of Chiroprac-tic Management of Whiplash Associated Disorders: Recommendations for Advancing Evidence-Based Practice and Research Authors : Shaw L., Descarreaux M., Bryans R., et al. Publication Information: Work 2010; 35: 369-394 feature Shawn Thistle, BKin (Hons), DC, CSCS Stanley N. Bacso, DC, FaCO, FCCO(C) Dr. Stanley Bacso received his DC in 1997 from Parker College of Chiropractic, and his Fellowship from the College of Chiropractic Orthopedics (Canada) and acad-emy of Chiropractic Orthopedics (US) in 2005. He also completed his post-doctoral diplomat and neurol-ogy (DaCNB) in 2002. Recently, he has conducted research on digital videofluoroscopy and its useful-ness in diagnosis and treatment of musculoskeletal injuries and does research review work for Dr. Thistle and Research Review Service. Dr. Shawn Thistle graduated from CMCC and holds an Honours De-gree in Kinesiology from McMaster University. He also holds a certificate in Contemporary Medical acupunc-ture from McMaster University, and is a Certified active Release Tech-niques (aRT®) Provider and the founder and he is president of Research Review Service Inc. (www.researchreviewservice.com). BACKGROUND INFORMATION This paper outlines the process and systematic review conducted to create clinical guide-lines for the chiropractic management of whiplash associated disorders (WAD) injuries. A participatory action research (PAR) approach was used to engage the chiropractic com-munity and stakeholders in order to answer the question, “Does chiropractic manage-ment of WAD clients have an effect on improving health status?” Additionally, the best clinical management for acute, sub-acute and chronic WAD was outlined according to the review of current literature and the development of the WAD-Plus model. WAD is a clinical condition that occurs with acceleration or deceleration of the head and neck in relation to other parts of the body. This typically occurs during motor ve-hicle collisions or other mishaps. These incidents can create major health concerns that have a disruptive effect on the daily lives of many people around the world. 1 The chi-ropractic community has provided leadership with respect to interventions that support the recovery and clinical management for those suffering from WAD injuries. 2, 3 Over the past several years, there has been a paradigm shift in the body of knowledge that is used to guide management of WAD injuries (the Neck Pain Task Force comes to mind and readers are encouraged to review that material as well). Specifically, evidence-based knowledge is being used more vehemently to guide treatment management and decision-making practices in the profession. As part of the process in developing such guidelines, the Clinical Practice Guidelines Task Force (CPGTF) and the Guidelines Development Committee (GDC) reviewed vari-ous evidence-based management and knowledge models to develop protocols for treat-ing WAD. They also provided recommendations with respect to the management of WAD injuries in the acute, sub-acute and chronic phases. The literature relevant to the treatment of WAD injuries is extensive and diverse. The most common intervention reviewed and discussed in the chiropractic community is spinal manipulation. 5 This paper reviews the clinical definition of WAD and their grades. The definition includes (but is not limited to) the prevalence and/or severity of the following factors: neck pain, musculoskeletal signs (i.e., hyperalgesia, movement loss, stiffness, kinesthetic deficits, balance loss), deafness, dizziness, tinnitus, headache, memory loss, dyspha-sia, temporomandibular (TMJ) pain, radiating symptoms, neurological and orthopaedic sequelae. 2,4 PERTINENT RESULTS Overview of findings: Chiropractic care has been shown to improve cervical range-of-motion (cROM) and pain management in WAD cases. Methods were identified to overcome deficiencies in the research and the current (tra-ditional) WAD model. Clinical practice guidelines were outlined, as well as the development of a proposed care model (the WAD-plus Model – see below) The WAD-Plus Model was described – its goal is to advance evidence-based care and www.canadianchiropractor.ca 32 • CaNaDIaN CHIROPRaCTOR | DECEMBER 2010
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