The tutor suggested that I should put this entire section on the whiplash guidelines in the preliminary literature review chapter. It should also include discussion about my thoughts on the guidelines. she suggested that as this entire project is about studies done after the publication of the guidelines a large part of the prelimnary literature review should have a discussion and critique of the guidelines. The Clinical Guidelines for the Management of WAD: In 2002 physiotherapists identified whiplash injury as a priority area for clinical guidelines. The Chartered Society of Physiotherapists (CSP) responded to this by forming a Guidelines Development Group (GDG) to develop the document. A systematic review of the literature was carried out so that recommendations for practice could be based on relevant, high quality research evidence and the central focus was to understand which physiotherapy interventions are most effective in assisting people with WAD to return to normal activity (Moore et al., 2005). Finally the CSP published the clinical guidelines for the physiotherapy management of Whiplash associated disorders in 2005. The recommendations in these guidelines were intended to assist physiotherapists and patients in making decisions about physiotherapeutic options for interventions, following an individual's assessment (Moore et al., 2005). The guidelines looked at all aspects of physiotherapy assessment and treatment and provided recommendations. During the development of these guidelines, areas for future research were identified, based on the current gaps in existing high quality research evidence, and the clinical importance of particular research questions (Moore et al., 2005). These included evaluating the effect of exercise and advice given to people with WAD and treatments commonly used by physiotherapists, such as manual mobilisation, manipulation and physical agents. The guidelines suggested further studies to examine the relative benefits of individual or combined use of these physiotherapeutic interventions, issues relating to service delivery, and prioritizing patients for treatment. Another important aspect that the guidelines looked at was the factors affecting the prognosis following injury. It was found that in addition to factors like pretrauma neck pain, neurological problems and chronic headaches, psychosocial factors need to be considered when assessing barriers to recovery following whiplash (Moore et al., 2005). Some of the psychosocial factors identified in the guidelines were high fear of pain and movement, low self-efficacy, severe anxiety and depression (Moore et al., 2005). Other factors were unrealistic expectations of treatment, poor understanding of the healing mechanism and occupational barriers like patients perception of work and working conditions. Family issues like overprotection and compensation were also identified. Although a significant number of psychosocial factors were identified most of these were based on the Delphi process which indicates that directly applicable clinical studies of good quality were absent (Moore et al., 2005).The examiner wanted more of my thoughts on the guidelines. wanted other research contributions to guidelines.feels relying heavily on Moore et al. 2005.

Aims of the study:wanted bullet points of the aims and objectives of the study

The aims of the study are as follows:

Deliver a critical review of the relevant juried and scholarly literature concerning the physiotherapeutic management of WAD.

Identify current best practices within this body of evidence.

Provide a summary and synthesis of the research.

Based on the synthesis of the research, provide a series of recommendations for the physiotherapeutic management of WAD.

Generally, then, the study aims to find out if there is any new research that can be used by practising physiotherapists to provide better standard of care to patients with WAD.

Has any of the recommendation that came out of the whiplash guidelines been used to look at new research.

Any new studies that might contradict all that has been stated in the WAD guidelines.

Also describe your own profession.what you do and why are you looking at this as a research .implications for own practice for doing this study.and then after the study in the conclusion chapter write about what have you gained as a practitioner from the study.

The study begins with a preliminary literature review which looks at recent studies pertaining to the pathophysiology and symptoms of whiplash injuries. It explores the biological as well as the psychosocial aspects of WAD and then moves on to discuss the management issues related to whiplash injuries. It then moves on to the methods and results of the literature search and screening. The critical review chapter then explicitly looks at recent randomized controlled studies related to the physiotherapy management of WAD. The study then attempts to identify specific themes or ideas that emerge from the analysis...

The study then concludes with a discussion on the findings, its use in daily clinical practice, limitations of the study and recommendations.
PRELIMINARY LITERATURE REVIEW:

Background and Overview:

Whiplash injuries remain a highly debated clinical entity for a number of reasons, including its higher incidence in countries with free medical care and generous worker's compensation laws in place, as well as the nebulous character of some of the symptoms that are typically associated with the disorder. what do you mean, expand (Poorbaugh et al., 2008, Davidson & Tung 2008, Walker & Hefner 2006, Morris 2000), but the effects of these injuries represent a substantial public healthcare issue that has a number of important socioeconomic implications (Block, Kremer & Fernandez 1999) and that a broad spectrum of psychosocial factors could have some effect on the perception of whiplash injuries by victims as well as the healthcare professionals who treat them. In this regard, Coudeyre, et al. (2007) reported that whiplash and its consequences remain an alarming clinical and social problem, and psychosocial factors could play a role, making the disorder especially relevant for further study because of the enormous amount of resources that are being directed at its treatment as well as the research that is attempting to better understand it. This point is made by Rasmussen and his colleagues who recently emphasized that, "The sequelae following whiplash injuries entail considerable human costs and expenses for both treatment and social services, especially public income benefits" (2010, p.1815)the entire paragraph above lacks clarity. Walton (2009) places the annual incidence of whiplash related disorders in North America at between 70 and 320 per 100,000 population (comparable figures are not available for the UK for the reasons discussed further below). what about uk figures

Other annual incidence rate estimates include:

1. 106 cases per 100,000 in Australia;

2. 302 cases per 100,000 in Canada; and,

3. 94 -- 188 cases per 100,000 in the Netherlands (Moore et al., 2005).

In their Clinical Guidelines for the Physiotherapy Management of Whiplash Associated Disorder, Moore et al. add that, "In the UK, while the numbers of insurance claims and the number of WAD cases seen in accident and emergency departments are increasing the number of UK road accidents remains static" (2005, p.12). These authors also note annual incidence rate information for whiplash associated disorders is not routinely collected in the UK but that it is possible that these disparities in annual incidence rates in different countries may be attributable to non-organic factors such as the growing compensation culture (Moore et al., 2005).

There also remains a dearth of timely and relevant studies concerning both the effects of whiplash and efficacious treatments, with much of the literature being anecdotal in nature, some authorities doubting the legitimacy of the diagnosis and subsequent disabled conditions in the first place, while yet other researchers merely repeat what other authorities have reported in the past (pers. obs.). (Mine-AW) whose words .Therefore, there remains a profound need for additional research in this area. Some of them as identified by Rasmussen et al. are:

1. To identify evidence-based prophylaxis and treatment,

2. To monitor medical diagnoses in relation to social benefits to support research opportunities; and,

3. To assess whether other social solutions comprise alternatives superior to current treatment and compensation options (Rasmussen et al. 2010, p.1815).

There have been a few on-point studies what are these to date, though, but even these report mixed findings. For example, the results of a study by Rebbeck, Refshauge and Maher (2006) reported that health outcomes for whiplash are poor, with over 60% of whiplash sufferers unrecovered after the acute phase (3 months) of their injury. In fact, Michaleff et al. (2009) place the rates even higher and the recovery periods required longer. According to Michaleff and his associates, "Whiplash is the most common injury following a motor vehicle accident. Approximately 60% of people suffer persistent pain and disability six months post injury" (2009, p.149). By contrast, Jensen and his colleagues (2010) note that the prognosis is favourable with recovery in over 90% of the injured subjects within a year time scale. They say that only in a fraction of patients, long-term symptoms with pain and cognitive and emotional symptoms may occur, causing long-term disability. Also the reasons for this smaller percentage remaining disabled for the long-term remain understudied, but the research to date is largely in agreement with findings of other chronic pain conditions. In this regard, Jensen et al. (2010) add that for this smaller percentage of patients with long-term symptoms and pain the pathophysiology is unclear. Most research…