Prognosis in Acute WAD

1. Prognosis in Acute WAD Thesis project of Dave Walton PT, PhD(cand.)

2. Purpose • To develop a new tool for use with acute WAD patients that: • Is clinically feasible • Provides an estimate of the risk that a patient will develop persistent WAD-related morbidity • Indicates the nature of the risk, focusing on modifiable barriers to recovery, that will help in clinical decision-making

3. The process so far… • 2006 – 2007: Systematic review and meta-analysis of existing prognostic literature (JOSPT Fall 2008) • 2007: Construction of multi-dimensional model for the development of chronic WAD • 2007-2008: Development of the prototype tool using the model as a framework for item generation.

4. Development of the tool • Items were generated by 5 physiotherapists with experience in treating WAD (mean clinical experience 12 years, range 8-18) • Well over 1000 items generated • Items reduced through group consensus and theoretical considerations • Items passed by experts from other fields (psychology, physiatry, questionnaire development)

5. Development of the tool • Tool now consists of two parts • 93-item self-report questionnaire • 19-item physical assessment • Self-report questionnaire reviewed and edited by professional technical editor • Pilot testing: • Questionnaire: good acceptability so far, average of 15-20 mins to complete • Physical ax: reliability testing currently underway

6. What are we capturing? • Self-report questionnaire: • Multiple sub-constructs hypothesized to predict multiple outcomes within the spectrum of ‘WAD’ • Symptoms • Coping strategies • Cognitions • Emotions • Past history

7. What are we capturing? • Physical assessment: • ROM (ordinal) • Peripheral key muscle strength (nominal) • Reaction to traction/compression (nominal) • Neck flexion in supine (ordinal) • Sensation (nominal) • Algometry (ratio) • Symptom reproduction (for each)

8. What are we predicting? • Recovery at 3 and 6 months post injury, defined as: • Not all bothered by symptoms over past week • No interference with normal activities over the past week • Very satisfied with current situation • No ongoing medication use for symptoms • Return to full work or school (not included for those unemployed or not in school)

9. Secondary Outcomes • Neck Disability Index (10 items) • Core Whiplash Outcome Measures (5 items) • Patient Health Questionnaire (9-item depression screen) • PTSD Checklist (17-item PTSD screen) • Tampa Scale for Kinesiophobia (11-item fear/avoidance screen) • Other individual items (bothersomeness, ongoing litigation) • 65 items in total at follow-up

10. Methods • Subjects who meet inclusion criteria are presented with the LOI and consent form at their first visit. • Those who consent: • Name and contact info is recorded on a master list, associated with an ID number • Given the prototype self-report questionnaire to complete within 24 hours • Completed forms are sealed in an envelope and returned to clinic staff for storage

11. Methods • Standardized physical assessment is completed after subjective interview but before more targeted assessment techniques. Findings are recorded and stored securely with self-report questionnaire. • Master list must be stored in a locked cabinet with consent forms at night • Completed forms must be stored in a separate locked cabinet

12. Completed forms • After either a) 10 completed forms have been collected OR b) once per month, completed forms (not master list) are sent to Dave Walton at UWO via Purolator (pre-paid). • Once per month master list is faxed to Dave’s private fax machine.

13. Intervention • At therapist’s discretion. • We are not trying to control anything to do with intervention (good external validity, some sacrifice of internal validity) • We will ask you to complete a checklist of the general types of treatment provided, at either D/C or 6 months, whichever is first. This can be mailed or faxed.

14. Follow-up • Arranged by Dave and/or research assistant, you don’t do anything regarding follow-up for the study. The process will be (FYI only): • We will either mail the forms to the patient’s house, or email the patient a link to a secure site with the forms online. • Forms are completed and either mailed back to Dave, or stored on secure server. • This is done 3- and 6-months post-injury (approx. 15-20 minutes to complete)

15. What do we need? • Data! • Clinics who see WAD patients post-MVA within 4 weeks of injury • Clinicians who are willing to learn and perform the standardized assessment on patients at their first visit (pretty straightforward) • Clinics with staff who are willing to: • Screen potential subjects for inclusion criteria (w/i 4 weeks of injury, at least 18, able to read English) • Provide the LOI, consent form and questionnaire • Keep a master list and consent forms in a locked cabinet • Fax the master list to Dave once/month

16. Targets • 530 total subjects • As many clinics as are interested • Ethics approval and data collection to start in May ‘08

17. What will you get? • All the forms, including questionnaires, master list with pre-generated ID numbers, envelopes. • Instructional manual and video for performing physical assessment • A digital algometer and set of monofilaments for sensory testing, for the clinic, as long as you act as a data collection site • Recognition as a data collection site (certificate) • That warm fuzzy feeling that comes from contributing to research in the field

18. The research team • Dave Walton PT, FCAMT, PhD(cand.) • Dr. Joy MacDermid PT, PhD • Dr. Robert Teasell MD • Dr. Warren Nielson, Psychologist, PhD • Jennifer Toland PT, FCAMT, MClSc(cand.) • Hilary Reese PT, FCAMT, MClSc(cand.) • Tamara Nailer PT, MClSc(cand.) • Lenerdene Levesque PT, FCAMT, MClSc(cand.)

19. Want more info? • The forms, including assessment manual, and more information, are available on-line at: http://publish.uwo.ca/~dwalton5/Website Or, contact Dave at: dwalton5@uwo.ca Thanks! Whiplash, the cowboy monkey