Whiplash associated disorders: a review of the literature to guide patient information and advice

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.