Background
Methods/Design
University Health Network Whiplash Intervention Trial Protocol
Grade | Clinical Presentation |
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0 | No neck symptoms, no physical sign(s) |
I | Neck pain, stiffness or tenderness only, no physical sign(s) |
II | Neck symptoms and musculoskeletal sign(s)* |
III | Neck symptoms and neurologic sign(s)† |
IV | Neck symptoms and fracture or dislocation |
Inclusion criteria |
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18 years of age or older. Reside or work in the Greater Toronto Area, Mississauga, Burlington, Cambridge, Kitchener, Ajax, Pickering, or the Durham region in the province of Ontario, Canada. Make an insurance claim for physical injury to Aviva Canada* between February 1, 2008 to March 31, 2012 within 21 days of the traffic collision. |
Report an average neck pain since the accident of at least 3 on a 0-10 numerical rating scale. |
Are injured in a motor vehicle collision with clinician-assessed Grade I or II WAD. Are able to provide written informed consent and complete interviews in English (translators will be available to assist the participant if the claimant experiences difficulty understanding specific items on the questionnaire). |
Exclusion criteria
|
Fracture/dislocation of the spine or any major bone. |
Head trauma associated with loss of consciousness. |
Past whiplash or work-related neck injury within the year prior to current WAD injury. |
Active systemic diseases (cancer, inflammatory arthritis, disorders of central nervous system). |
Previous neck surgery. |
Received treatment from a physiotherapist or chiropractor for neck pain in the three months preceding the motor vehicle collision. |
Does not reside or work in Greater Toronto Area, Mississauga, Burlington, Cambridge, Kitchener, Ajax, Pickering, or the Durham region in the province of Ontario, Canada. |
Physician-based Education and Activation
Pre-approved Framework Guideline for Grade I and II Whiplash-associated Disorders
Soft Tissue Injury Care Model
Quality Control
Data Collection, Follow-up, and Outcomes
Measures | Baseline | 6 Weeks | 3 Months | 6 Months | 9 Months | 12 Months |
---|---|---|---|---|---|---|
Socio-demographic characteristics | x | |||||
Accident information | x | |||||
Past history of neck pain and whiplash | x | |||||
Health care after accident | x | |||||
Co-morbidity questionnaire | x | |||||
Neck pain intensity | x | x | x | x | x | X |
Whiplash disability questionnaire | x | x | x | x | x | X |
SF-36 (acute, v2) | x | x | x | x | x | x |
CES - Depression scale | x | x | x | x | x | x |
Health state preference (rating scale) | x | x | x | x | x | x |
Expectation of recovery | x | x | x | x | x | x |
Global self-perceived recovery question | x | x | x | x | x | x |
Work status | x | x | x | x | x | x |
Lawyer or paralegal involvement | x | x | x | x | x | x |
Satisfaction with care | x | x | x | x | x | |
Co-interventions | x | x | x | x | x |
Statistical Analysis of Trial Effectiveness Data
Economic Evaluation alongside the UHN WIT
Resource Use (Costs)
Costs | Examples |
---|---|
Health care provider fees | Initial assessment, follow-up visits. |
Fees for completing standardized automobile insurance claims forms | Treatment Plan (OCF-18), Discharge and Status Report (OCF-24). |
Health services (block fees) | In-home assessment, functional evaluation, job site assessment, home exercise prescription, multidisciplinary evaluation, workplace/home modification assessment, home exercise prescription, multidisciplinary evaluation, workplace/home/vehicle modification assessment, return to work support, education programs, life skills and job retraining, counseling and coaching, stress management, relaxation therapy, family counseling, cognitive behavioral therapy, pain management. |
Patient out-of-pocket expenses | Over-the-counter medications, prescription drugs, portable electrotherapy devices, orthotics, assistive devices, health care supplies, treatment-related expenses. |
Diagnostic imaging | Radiography, magnetic resonance imaging, ultrasound. |
Benefits | Non-earner, dependent care, caregiver, housekeeping and home maintenance, income replacement, attendant care, lost educational expenses, expense of visitors, long-term care, excess economic loss. |
Independent health examination | Chiropractic, medical, occupational therapy, physical therapy, psychological. |