Psychological factors (notably distress, depressive mood, and somatization) are implicated in the transition to chronic low back pain. The development and testing of clinical interventions specifically targeting these factors is indicated. In view of the importance attributed to other psychological factors (particularly coping strategies and fear avoidance) there is a need to clarify their role in back-related disability through rigorous prospective studies.

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Objectives: To review the literature and provide an evidence based framework for patient centred information and advice on whiplash associated disorders. Methods: A systematic literature search was conducted, which included both clinical and non-clinical articles to encompass the wide range of patients' informational needs. From the studies and previous reviews retrieved, 163 were selected for detailed review. The review process considered the quantity, consistency, and relevance of all selected articles. These were categorised under a grading system to reflect the quality of the evidence, and then linked to derived evidence statements. Results: The main messages that emerged were: physical serious injury is rare; reassurance about good prognosis is important; over-medicalisation is detrimental; recovery is improved by early return to normal pre-accident activities, self exercise, and manual therapy; positive attitudes and beliefs are helpful in regaining activity levels; collars, rest, and negative attitudes and beliefs delay recovery and contribute to chronicity. These findings were synthesised into patient centred messages with the potential to reduce the risk of chronicity. Conclusions: The scientific evidence on whiplash associated disorders is of variable quality, but sufficiently robust and consistent for the purpose of guiding patient information and advice. While the delivery of appropriate messages can be both oral and written, consistency is imperative, so an innovative patient educational booklet, The Whiplash Book, has been developed and published. W hiplash injuries and in particular the development of chronic pain and disability, are an increasing clinical and social problem. During treatment, clinicians typically provide patients with some information and advice but its form, content, and possible value vary considerably.The concept of evidence based health care has fostered an increasing interest in patient information. The quantity of patient information material, covering most medical conditions, is now vast and available in multi-media format including pamphlets, books, videos, and internet sites. However, this material is of widely varying quality, 1 much of it simply representing the views of individuals or interest groups without any firm evidence base. The Toronto Statement on the Relationship Between Communication and Practice and Outcomes 2 recognised that: communication problems in medicine are both important and common; suitable explanations can diminish anxiety and psychological distress; the quality of information is related to positive health outcomes. There is emerging evidence that appropriate written material can be an effective component in the management of musculoskeletal conditions, 3 while poor information, or misinformation, can adversely affect health behaviour and health outcomes. 4 The Quebec Task Force (QTF) on whiplash associated disorders (WAD), 5 suggested that information is an essential part of an active management approach. It recommended that information should ...

Objectives: This study aimed to develop and evaluate an evidence based educational booklet on whiplash associated disorders. Methods: A comprehensive review of the available scientific evidence produced a set of unambiguous patient centred messages that challenge unhelpful beliefs about whiplash and promote an active approach to recovery. These messages were incorporated into a novel booklet, which was then evaluated qualitatively for end user acceptability and its ability to impart the intended messages, and quantitatively for its ability to improve beliefs about whiplash and what to do about it. The subjects comprised people attending accident and emergency or manipulative practice with a whiplash associated disorder, along with a sample of workers without a whiplash associated disorder (n = 142). Results: The qualitative results showed that the booklet was considered easy to read, understandable, believable, and conveyed its key messages. Quantitatively, it produced a substantial statistically significant improvement in beliefs about whiplash among accident and emergency patients (mean 6.5, 95% CI 3.9 to 9.1, p,0.001), and among workers (mean 9.4, 95% CI 7.9 to 10.9, p,0.001), but the shift in the more chronic manipulation patients was substantially smaller (mean 3.3, 95% CI 0.5 to 6.1, p,0.05). Conclusions: A rigorously developed educational booklet on whiplash (The Whiplash Book) was found acceptable to patients, and capable of improving beliefs about whiplash and its management; it seems suitable for use in the accident and emergency environment, and for wider distribution at the population level. A randomised controlled trial would be required to determine whether it exerts an effect on behaviour and clinical outcomes. W hiplash associated disorders (WAD) after road traffic accidents remain a substantial clinical and social problem. Although many cases of WAD seem to recover within days or weeks with no lasting effects, 1 UK figures indicate that around 50% of patients do not recover by three months, 2 and 25% have residual disability at six months; 3 many of these patients remain symptomatic for two years or more.