Addendum 1

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Mar 11, 2018 - Addendum 1. Quality indicators for physiotherapy care process of patients with Whiplash-Associated Disorders (WAD). Flowchart of steps of ...
Addendum 1 Quality indicators for physiotherapy care process of patients with Whiplash-Associated Disorders (WAD) Flowchart of steps of clinical reasoning Rob A.B. Oostendorp, Hans Elvers, Emiel Van Trijffel, Emilia Mikolajewska, Geert Rutten, Han Samwel, Jo Nijs, Marcel Heijmans, Margot De Kooning, Marijn Scholte, Marjan Laekeman, Nathalie Roussel, Wendy Scholten-Peeters Nijmegen, The Netherlands - March 11, 2018

Flowchart Clinical Reasoning Process Whiplash Associated Disorders I. Administration. Name . Year of referral . Referring physician - self referral . Medical information . Period since accident . Request for help ... .

II. History Taking

Yes

IIa Sociodemographic characteristics

IIb. Accident related information

IIc. Pre-existent functioning and health status before injury

IId. Previous diagnostics and treatment

IIe. Current health status and recovery rate since accident

III. Objectives of clinical examination Objectives musculoskeletal examination

Objectives neurological examination

Objectives otoneurological examination

Objectives psychological examination

IV. Clinical examination Musculoskeletal examination

Neurological examination

Otoneurological examination

Psychological examination

V. Analysis and conclusion of diagnostic process

Classification WAD 1, 2, 3

Time phase since accident

Recovery since accident Prognostic factors related to recovery after accident Determination of profile A, B or C

Presence of signs of central sensitization Consultation GP in case of insufficiently expected treatment result

Indication physiotherapy

VI. Treatment plan Time phase after accident

Treatment goals

Phase 1 (>=7 days)

Profile A/B/C

Reducing pain; providing information and explaining the functioning consequences and underlying pain mechanisms

Phase 2 (1 - 3 weeks)

Profile A/B/C

See Phase 1 + improving functions

Phase 3a (4 - 6 weeks) normal recovery

Profile A/B/C

See Phase 2 + increasing activities and participation

Phase 3b (4 - 6 weeks) delayed recovery

Profile A/B/C

Explaining underlying pain mechanisms, improving active coping, decreasing fear avoidance, increasin g physical loadability, increasing activities and participation

Phase 4a (7 - 12 weeks) normal recovery

Profile A/B/C

See Phase 3a + minimizing delay in work participation

Phase 4b (7 - 12 weeks) delayed recovery

Profile A/B/C

See Phase 3b

Phase 5 (3 - 6 months)

Profile A/B/C

See Phase 4b

Phase 6 (>6 months)

Profile A/B/C

See Phase 3b

Prognostic duartion of treatment period Prognostic number of treatment sessions Pre-treatemnt outcome measures pain VAS (0-100) and functioning NDI (0-50)

Treatment plan agreement with patient

VII. Treatment Phase 1

Profile A/B/C

Goals

Education, coaching, active exercise therapy

Phase 2

Profile A/B/C

Goals

See Phase 1 + cervical soft collar (< 1 week), massage therap y (< 2 weeks)

Phase 3a

Profile A/B/C

Goals

See Phase 1 + physical loading exercise therapy

Phase 3b

Profile A/B/C

Goals

Pain education, exercise therapy based on cognitive and physi cal principles,

Phase 4a

Profile A/B/C

Goals

See Phase 3a + graded activity

Phase 4b

Profile A/B/C

Goals

See Phase 3b + graded exposure

Phase 5

Profile A/B/C

Goals

See Phase 4b

Phase 6

Profile A/B/C

Goals

See Phase 5

Check for side effects and negative treatment effects

VIII. Evaluation Process evaluation

End evaluation

Treatment goals

Outcomes . Post-treatment outcome measures: . Pain (VAS 0 - 100) . Functioning (NDI 0 - 50) . Global Perceived Effect (GPE 0 - 7)

..

Treatment period (duration) treatment sessions (number)

Returned to work

IX. Discharge Reason for discharge Written report

Post-treatment care