Head-turning new tool for assessing whiplash patients

 

Physiotherapists looking to increase their knowledge of patient recovery after whiplash injury are now able to access a free digital evidence-based risk prediction tool, WhipPredict.

The tool was developed by Professor Michele Sterling, specialist research fellow by original contribution physiotherapist (as awarded by the Australian College of Physiotherapists in 2009), and colleagues at the RECOVER Injury  Research  Centre at The University of Queensland.

Michele says the public health motivation behind the development of WhipPredict was to help identify, from very soon after receiving a whiplash injury, who is going to recover well and who may be at risk of developing chronic pain and disability, so that the most appropriate treatment for that individual can be delivered.

‘We know that no two whiplash injuries are the same; some people recover very well and very quickly and those people probably don’t need a lot of treatment,’ Michele says. ‘Whereas for others the injury process can be slower and these people will likely need more concerted treatment.

‘WhipPredict is a risk screening tool for use by clinicians. It has good accuracy to predict which individual person is going to recover well and who might have a slower recovery period. Importantly, it takes little time for the injured person to complete and is easy to understand,’ she says.

‘The demands of daily clinical physiotherapy practice make it difficult to be across all prognostic indicators for all conditions. So we have created an online version of WhipPredict for ease of use in the clinic. For those who prefer hard copy, there is also a “prescription pad” format that can be included in patient notes.’

The team at RECOVER has been working on identifying prognostic indicators for recovery after whiplash injury for many years. As a result, there are some consistent prognostic indicators including initial pain intensity, disability, post-traumatic stress symptoms and low expectations of recovery.

However for clinical purposes, it was not clear which combination of factors or their cut off scores the physiotherapists should be looking for. So WhipPredict was created by pooling data from two cohort studies (approximately 280 injured people) to determine the best combination of various factors including measures of pain, disability, sensory measures such as pressure and  cold pain thresholds, psychological factors and measures of movement and motor function.

After these analyses, the combination of factors with the best prognostic capacity were the Neck Disability Index questions about hyperarousal symptoms (adapted from the posttraumatic stress diagnostic scale), age (Ritchie et al 2013), and these from WhipPredict. Subsequently the tool has been validated in different cohorts (Ritchie et al 2015, Griffin et al 2019).

WhipPredict is designed for people with a whiplash injury of less than six weeks. The injured person completes the online or hard copy version, which takes about five to 10 minutes to complete. Online, the tool automatically calculates the patient risk (low, medium or high risk of poor recovery) and this result is emailed to the physiotherapist, not the patient.

The patient is not automatically provided with the result, as this information is best conveyed in a sensitive manner by the treating physiotherapist. In the hard copy version, the risk category is easily scored.

Injured people identified as low risk of poor recovery (ie, they will recover well) generally need simple treatment of reassurance and exercise over a few sessions. Those categorised at medium or high risk need further assessment of factors that may hinder their recovery. Most commonly these are psychological factors such as post-traumatic stress symptoms, poor expectations of recovery, or fear. Michelle says, in conjunction with more customary physiotherapy treatment, we would also aim to target those psychological factors. This approach is currently being tested, with results expected this year (Rebbeck et al 2016).

A recent clinical trial showed that physiotherapists could target stress symptoms in people with acute whiplash associated disorders (WAD) at medium to high risk of poor recovery (based on WhipPredict). This approach, in combination with exercise, was more effective in improving disability and mental health outcomes when compared to exercise alone (Sterling et al 2019). It should be noted that some patients may require referral to a mental health professional if their symptoms are high and do not resolve.

WhipPredict was developed with the intent of making clinical practice more time efficient. While it is not a replacement for clinical reasoning or judgement, WhipPredict has been shown to give clinicians a more accurate picture of a patient’s risk of poor recovery than clinical judgement alone (Kelly et al 2018). It is advised to first risk-screen a person with acute WAD, using WhipPredict, to gauge prognosis and then  conduct further assessment if required.

The WhipPredict tool is available via the RECOVER website in hard copy and online versions (tinyurl.com/thml5hv). RECOVER Injury Research Centre is a joint initiative of the Queensland Motor Accident Insurance Commission (MAIC) and The University of Queensland.

The assessment  and  management of people with WAD will be a focus of Professor Sterling’s invited presentation and post-conference workshop at IFOMPT 2020 (6–8 October at the Melbourne Convention and Exhibition Centre). Professor Michele Sterling is the program leader of the Designing Better Therapies program at RECOVER Injury Research Centre. She is the director of the NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries.

Email inmotion@australian.physio for references.

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