Chiropractic Management of WAD Continued from Page 34 STUDY METHODS, STRENGTHS AND WEAKNESSES This was a systematic review including a comprehensive literature search, re-view of evidence, selection for relevance, quality assessment, evidence synthesis, quantity/consistency of evidence and in-terpretation of knowledge for advancing the management of WAD. In my opinion the authors presented a balanced summary of the existing lit-erature and integrated it quite well into a model for advancing the management of Whiplash Associated Disorders and fur-ther research in this area. This study method is generally used in guiding health-care decision-making processes and considered a reasonable approach in developing best-evidence practice guidelines. 24 The participatory action research (PAR) method used in this study embod-ied the process of systematic review and its application in general practice. 25 This incorporates the process of: 1. Defining the Problem – in this case the need to establish baseline evidence on chiropractic care in the 2. • model. However, the WAD-Plus Model takes further steps to con-sider the elapsed time since the ac-cident, the pain experience and po-tential chronicity factors. The WAD-plus model is an expanded model of care that includes the con-ventional dimensions of patient care plus three other important dimen-sions discussed earlier: time since in-jury, pain experience and chronicity factors. The practitioner should incor-porate into his/her clinical manage-ment model the time since injury (i.e., acute, sub-acute and chronic), the pain experience (psychosocial factors, etc.); and potential chronicity factors (demographic, socioeconomics, prior health status, symptom severity, com-pensation and legal factors, and health behaviours). The GDC advises that all of these factors have a bearing on the frequency, duration and scope of chi-ropractic intervention. 3. 4. 5. 6. management of WAD injuries; Planning – the process for review and analysis of information using source evidence review and best evi-dence synthesis (including literature search, selection for relevance, qual-ity assessment and synthesis); 26 Data Generation – by way of systemat-ic review, data extraction and analysis; Analysis and Interpretation – best evidence synthesis relevant to chiro-practic treatment; Action – GDC recommendations and the WAD-plus model; and Evaluation – feedback from stake-holders and practitioners. • For article with references, diagram of WAD-plus model, and list of additional readings, please visit www.canadianchiropractor.ca Author Affiliations: Canadian Memorial Chiropractic College (CMCC); University of Québec – Trois Riv-ieres: Department of Chiropractic; Univer-sity of Western Ontario – Faculty of Health Sciences, School of Occupational Therapy Guidelines Development Committee (GDC). 38 • CaNaDIaN CHIROPRaCTOR | DECEMBER 2010 www.canadianchiropractor.ca
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