Management of whiplash-associated disorder in the Italian emergency department: the feasibility of an evidence-based continuous professional development course provided by physiotherapists

Abstract

Purpose: The management of whiplash and associated disorders (WAD) in the Italian Health System is still empirical and influenced by a single professional's expertise. Therefore, the purpose of our study is to describe a structured management changes in an Italian emergency department (ED) after an evidence based continuous professional development (CPD) course. Methods: A CPD course was organized by Orthopedic Manipulative Physical Therapists (OMPT) for personnel of ED in the hospital Girolamo Fracastoro (San Bonifacio, Verona, Italy), based on latest scientific evidence. Data regarding the number of X-Rays, computed tomography (CT) scan, orthopaedic referrals, neck collars and WAD IV (i.e., severe diagnosis) before and after the course were compared. Results: 3066 cases of WAD have been analyzed in 2016 and 2185 in 2017/2018. The number of X-Rays dropped down from 15.1% to 13.5%; the CT scans increased from 1.3% to 1.9%; the WAD IV diagnosis increased from 0.7% to 1.6%; the orthopaedic referrals dropped from 1.5% to 1.1%; the collars prescription dropped from 8.8% to 2.5%. Conclusion: An updated framework increased the efficiency of ED's maintaining the same level of safety (i.e., WAD IV diagnosis). Given that, it can also be argued that, in line with other countries, the implementation of an OMPT role within the ED multidisciplinary team is advised also in Italy. ä IMPLICATIONS FOR REHABILITATIONPhysiotherapists were commissioned to organize a management change of patients in an Italian Emergency Department clinical setting for the management of whiplash; Guidelines and other appropriate clinical rules facilitate the delivery of an evidence-based and more appropriate management and care plan; An inter-disciplinary continuous professional development course has the potential to positively influence patients' journey and to optimize the use of departmental resources; The involvement of other health professionals (e.g., Physiotherapists) within the Italian Emergency Department organizational chart might lead to further improvement of service provided.

Use of Soft Cervical Collar among Whiplash Patients in Two Italian Emergency Departments Is Associated with Persistence of Symptoms: A Propensity Score Matching Analysis

“…Providing updated evidence-based interventions requires a cultural shift in how clinicians may better influence WAD patients' outcomes [80]. Accordingly, there is a need to inform the health providers, in order to implement the current guidelines routinely, with the final goal to promote early access to active treatment approaches for WAD patients (e.g., exercises), as well as to objectivize the associated impairments [81] and address the negative prognostic factors (e.g., fear avoidance, maladaptive beliefs) [82,84]. However, for certain well-selected patients with WAD [85][86][87][88], and, accordingly, for patient clinical presentations and preferences, an intermittent use of the collar for a short period and during the acute stage could be potentially indicated when appropriately combined with education and active approaches [24,53,70].…”

“…However, for certain well-selected patients with WAD [85][86][87][88], and, accordingly, for patient clinical presentations and preferences, an intermittent use of the collar for a short period and during the acute stage could be potentially indicated when appropriately combined with education and active approaches [24,53,70]. To encourage Italian public administrators and national council representatives, we created and implemented, in the article, an infographic based on the latest guidelines for public use (Supplement 1 in Supplementary Materials), where we suggest a road map based on our previous experience in an Italian ED, where musculoskeletal specialized physical therapists were commissioned to train the staff and organize a management change in patients with WAD [84].…”

“…Furthermore, the selected outcome, restricted to "emergency departments return", does not allow all those patients who seek treatment outside of the ED (e.g., private settings, clinics) to be identified. Finally, the patient sample collected was dated (years 2013-2014) and, although WAD management in Italy is widely based on a single clinician's expertise, guidelines and local laws have been changed [84,91].…”

Assessing cardiovascular parameters and risk factors in physical therapy practice: findings from a cross-sectional national survey and implication for clinical practice

“…Given the absence of Italian guidelines, we have produced and implemented in the article three infographics for public use, which have the dual objective of raising awareness among Italian physiotherapists and provides practical resources for everyday practice [84]. Two infographics explain the correct procedure for measuring the parameters both at rest and during exercises (Additional file 3 and 4).…”

Comparative Effectiveness and Safety of Concomitant Treatment with Chuna Manual Therapy and Usual Care for Whiplash Injuries: A Multicenter Randomized Controlled Trial

“…Most treatment takes place in the subacute phase for whiplash patients [ 5 ] and it is important to early appropriate management is of paramount importance. Inappropriate management at an early stage can cause persistent pain and over-commit resources [ 6 ]. Fast management of early-stage pain through active and diverse treatment is necessary.…”