Clinical Practice Guideline for the Physiotherapy Management of Whiplash Patients Grade I and II Dutch National Institute of Allied Health Professions
Royal Dutch Physical Therapy Association
Vrije Universiteit Brussel, Belgium
Information Wendy Peeters, MSc Dep of Research & Development PO Box 1161 3800 BD Amersfoort The Netherlands
[email protected]
Wendy GM Peeters, MSc1,2,3, Trudy E Bekkering, MSc1,4, Arianne P Verhagen, PhD5, Daniëlle AWM van der Windt, PhD4, Kees Lanser, MT6, Karin WM van der Steen, MSc1, Erik JM Hendriks, PhD1, Rob AB Oostendorp, PhD1,2,7 1Dutch National Institute of Allied Health Professions, Amersfoort, 2Department of Manual Therapy, Vrije Universiteit Brussel, 3Spine and Rehabilitation Center Uden,4Institute for Research in Extramural Medicine, Vrije Universiteit Amsterdam, 5Department of General Practice, University of Rotterdam,6Integral Neck and Back Center, Hardinxveld-Giessendam, 7University Medical Care, Catholic University of Nijmegen
Description: A Clinical Practice Guideline (CPG) is a systematically developed guideline, drafted by experts and directed at the contents of care of (aspects of) health problems. An CPG is based on the different phases of the physiotherapy care process, the available clinical evidence and (multidisciplinary) expert consensus. Authorization: The CPG is reviewed and approved by the Royal Dutch Physiotherapy Association and the Dutch Society of General Practitioners, after consultation and field testing by individual physiotherapists in primary care (n=32) and a multidisciplinary task group. Purpose: To assist physiotherapists in decision-making and to improve the efficacy and uniformity of patient care. Guideline: • Diagnostic process (Table 1) • Therapeutic process (Figure 1) Prognostic factors: To distinguish between patients who are expected to develop either a normal or a delayed recovery. Prognostic factors related to delayed recovery
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Decreased mobility of the cervical spine immediatel y after injury
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Pre-existing neck trauma
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Older gender
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Female gender
Figure 1. Therapeutic process Main treatment goals
Time since the accident
act as ususal without pain - to reduce pain - te provide information and improve insight
phase 1 < 4 days
return to ususal activities - to provide information and improve insight - to improve functions
phase 2 4 days to 3 weeks
no phase 3 3 to 6 weeks
phase 4 6 weeks to 3 months
Treatment - education - training of functions and activities - behavioral treatment
to increase activities gradually and enable positive movement experiences; to improve adaptive coping strategies and self-control
normal recovery? yes
no
build up the level of activities - to provide information and improve insight - to improve functions - to increase activities / participation
to increase activities gradually and enable positive movement experiences; to improve adaptive coping strategies and self-control
normal recovery? yes phase 5 and 6 > 3 months
Evaluation of treatment goals
Termination treatment
build up the level of activities - to provide information and improve insight - to improve functions - to increase activities / participation
Table 1. Diagnostic process to provide insight in patients health problem in terms of functions, activities, participation and prognostic factors
History taking nature, severity and duration of complaint accident specific information rate of recovery coping strategy Visual inspection posture of the neck Physical examination regional active neck examination muscular stability/ propriocepsis Questionnaires Neck Disability Index (NDI) Visual Analogue Scale (VAS) Coping Stategies Questionnaire (CSQ)
Conclusion: • The guideline reflects the current ‘state of knowledge’ on effective and appropriate physiotherapy care • An early active strategy is recommended to improve functions, to increase activities and to prevent chronicity • Active interventions are recommended
