Evaluation of an evidence based patient educational booklet for management of whiplash associated disorders

Abstract

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.

Pain neurophysiology education improves cognitions, pain thresholds, and movement performance in people with chronic whiplash: A pilot study

“…Patients with acute WAD showed a substantial improvement in beliefs after reading the book. In contrast, patients with WAD attending a private practice for manipulation showed only a small change in beliefs, and the authors argued that this may have been due to the chronicity of their symptoms [70]. Changing inappropriate pain beliefs should be the initial phase of rehabilitation in those with chronic WAD.…”

“…In cases of hypervigilance, catastrophizing, or avoidance behavior, intensive education about the exact nature of chronic whiplash pain is likely to facilitate effective rehabilitation. McClune et al developed an evidence-based educational booklet, The Whiplash Book [69][70]. The content emphasizes the positive prognosis of whiplash injuries and promotes activity [69].…”

Managing Injuries of the Neck Trial (MINT): a randomised controlled trial of treatments for whiplash injuries

“…The booklet was formatted by design experts, and tested for proof of concept. 19 The results were promising in so far as patient's beliefs about pain and poor recovery were modified, and the potential for modifying behaviours on the causal pathway to disability suggested. 19 Disability outcomes were not investigated.…”

“…19 The results were promising in so far as patient's beliefs about pain and poor recovery were modified, and the potential for modifying behaviours on the causal pathway to disability suggested. 19 Disability outcomes were not investigated. Experience gained in back pain research emphasised the importance of practitioner training in using The Whiplash Book to ensure that verbal consultations and written material were consistent.…”

An update on the management of post-traumatic headache

“…Even though both studies were not intended to investigate post-traumatic headache specifically, they are still interesting with regard to overall treatment of these complex and demanding patients. In the MINT study [McClune et al 2003], the standard treatment, including simple treatment of symptoms and brief information about the condition as it corresponds to the usual extent in an emergency room, was compared with an active treatment and more detailed information including an information booklet ('The Whiplash Book'). In a second step of the study, patients were able to report back after 3 weeks when they did not show satisfactory improvement in symptoms and were then randomized in a group with physical therapy (up to 6 sessions within 8 weeks) and a group with only one physical therapy session and a refresher of the already given advice.…”