1
|
Holmes B, Brazauskas R, Cassidy LD, Wiegand RA. Factors in Patient Responsiveness to Directional Preference-Matched Treatment of Neck Pain With or Without Upper Extremity Radiation. J Patient Cent Res Rev 2017; 4:60-68. [PMID: 31413972 DOI: 10.17294/2330-0698.1271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Patient-related predictive factors in responsiveness to directional preference therapy for neck pain with or without upper extremity radiation (NP/R) have not been reported. A directional preference is any neck movement that, when performed repeatedly to end range, results in centralization and/or alleviation of NP/R. It was hypothesized that patient compliance with a prescribed, directional preference-matched home exercise program would improve positive responsiveness to NP/R treatment. METHODS Patient-related factors thought to affect responsiveness to care were collected retrospectively from charts and de-identified for patients with NP/R who underwent chiropractic treatment at a multispecialty spine clinic from January 2014 through June 2015. Responsiveness was measured by calculating the percentage change in Neck Bournemouth Questionnaire (NBQ) scores over treatment time. Multiple linear regression was used to identify factors associated with positive responsiveness. RESULTS Mean percentage change in patient NBQ score from initial intake to discharge was 50% (standard deviation: 32%). Of 104 patients meeting study inclusion criteria, 86 (83%) reported experiencing improvement after the first treatment session. Bivariate analysis of patient characteristics by compliance with directional preference-matched exercise indicated that compliant patients (n=95, 91%) demonstrated significantly greater responsiveness to care than did noncompliant patients, at 55% versus 25% change in NBQ score, respectively (P=0.0041). Four factors were statistically significant predictors of patient responsiveness to directional preference therapy for NP/R: patient compliance with directional preference-matched exercise (P=0.0023), patient age (P=0.0029), condition chronicity (P<0.0001), and whether the patient reported improvement of symptoms following initial treatment session (P=0.0003). CONCLUSIONS The results of this study suggest that patient compliance with directional preference exercise is associated with patient responsiveness to conservative treatment of NP/R, as are age, chronicity and report of immediate symptom improvement.
Collapse
Affiliation(s)
- Benjamin Holmes
- Aurora Sheboygan Clinic Spine Institute, Sheboygan, WI.,Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Ruta Brazauskas
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Laura D Cassidy
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | | |
Collapse
|
2
|
Whibley D, Martin KR, Lovell K, Jones GT. A systematic review of prognostic factors for distal upper limb pain. Br J Pain 2015; 9:241-55. [PMID: 26526466 DOI: 10.1177/2049463715590885] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Musculoskeletal pain in the distal upper limb is relatively common, can be a cause of disability, presents a high cost to society and is clinically important. Previous reviews of prognostic factors have focused on pain in the proximal upper limb, whole upper extremity or isolated regions of the distal upper limb. AIM To identify factors that predict outcome of distal upper limb pain. STUDY DESIGN Systematic review. METHOD Eight bibliographic databases were searched from inception to March 2014. Eligible articles included adults with pain anywhere in the distal upper limb at baseline from randomised controlled trials with a waiting list, expectant policy or usual care group, or observational studies where no treatment or usual care was provided. Data describing the association between a putative prognostic factor and pain or functional outcome at follow-up were required. Quality was assessed using the Quality in Prognostic Studies tool. RESULTS Seven articles reporting on six studies were identified. Heterogeneity of study populations and outcome measures prevented a meta-analysis so a narrative synthesis of results was undertaken. Three factors (being female, a longer duration of the complaint at initial presentation and having musculoskeletal pain in multiple locations) were significantly associated with poor pain outcome in more than one study. Being female was the only factor significantly associated with poor functional outcome in more than one study. CONCLUSIONS A range of sociodemographic, pain-related, occupational and psychosocial prognostic factors for distal upper limb pain outcomes were investigated in studies included in the review. However, due to the lack of commonality of factors investigated and lack of consistency of results across studies, there is limited evidence for predictors of distal upper limb pain outcomes. Further research is required to identify prognostic factors of distal upper limb pain, particularly modifiable factors that may influence management.
Collapse
Affiliation(s)
- Daniel Whibley
- Musculoskeletal Research Collaboration, Epidemiology Group, University of Aberdeen, Aberdeen, UK ; Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK
| | - Kathryn R Martin
- Musculoskeletal Research Collaboration, Epidemiology Group, University of Aberdeen, Aberdeen, UK ; Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Gareth T Jones
- Musculoskeletal Research Collaboration, Epidemiology Group, University of Aberdeen, Aberdeen, UK ; Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
3
|
Jørgensen SH, Ribergaard NE, Al-Kafaji OH, Rasmussen C. Epidural steroid injections in the management of cervical disc herniations with radiculopathy. Scand J Rheumatol 2015; 44:315-20. [DOI: 10.3109/03009742.2014.992950] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
4
|
Nastasia I, Coutu MF, Tcaciuc R. Topics and trends in research on non-clinical interventions aimed at preventing prolonged work disability in workers compensated for work-related musculoskeletal disorders (WRMSDs): a systematic, comprehensive literature review. Disabil Rehabil 2014; 36:1841-56. [PMID: 24472007 DOI: 10.3109/09638288.2014.882418] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This study sought to provide an overview of the main topics and trends in contemporary research on successful non-clinical interventions for preventing prolonged work disability in workers compensated for work-related musculoskeletal disorders (WRMSDs). METHODS A systematic electronic search (English and French) was performed in ten scientific databases using keywords and descriptors. After screening the identified titles and abstracts using specific sets of criteria, categorical and thematic analyses were performed on the retained articles. RESULTS Five main topics appear to dominate the research: (1) risk factors and determinants; (2) effectiveness of interventions (programmes, specific components, strategies and policies); (3) viewpoints, experiences and perceptions of specific actors involved in the intervention process; (4) compensation issues; and (5) measurement issues. A currently widespread trend is early screening to identify risks factors for appropriate intervention and multidisciplinary, multimodal approaches. Morover, workplace-related psychosocial and ergonomic factors are considered vital to the success and sustainability of return-to-work (RTW) interventions. Finally, involving workplace actors, and more specifically, affected workers, in the RTW process appears to be a powerful force in improving the chances of moving workers away from disabled status. CONCLUSIONS The findings of this literature review provide with information about the main topics and trends in research on rehabilitation interventions, revealing some successful modalities of intervention aimed at preventing prolonged work disability. IMPLICATIONS FOR REHABILITATION Successful intervention for preventing prolonged work disability in workers compensated for WRMSDs address workplace issues: physical and psychosocial demands at work, ability of the workers to fill these demands, work organization and support of the worker, and worker' beliefs and attitudes related to work. Successful intervention promotes collaboration, coordination between all actors and stakeholders involved in the process of rehabilitation. Strategies able to mobilize the employees, employers, insurers and health care providers are still needed to be implemented.
Collapse
Affiliation(s)
- Iuliana Nastasia
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST) , Montreal, Quebec , Canada and
| | | | | |
Collapse
|
5
|
Wani S, Raka N, Jethwa J, Mohammed R. Comparative efficacy of cervical retraction exercises (McKenzie) with and without using pressure biofeedback in cervical spondylosis. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2013. [DOI: 10.12968/ijtr.2013.20.10.501] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Surendra Wani
- Department of Musculoskeletal Physiotherapy, MGM's Institute of Physiotherapy, Aurangabad, Maharashtra, India
| | - Neha Raka
- Department of Musculoskeletal Physiotherapy, MGM's Institute of Physiotherapy, Aurangabad, Maharashtra, India
| | - Juhi Jethwa
- Department of Musculoskeletal Physiotherapy, MGM's Institute of Physiotherapy, Aurangabad, Maharashtra, India
| | - Rafi Mohammed
- Musculoskeletal Physiotherapy, MGM's Institute of Physiotherapy, Aurangabad, Maharashtra, India
| |
Collapse
|
6
|
Tang ML, Poon WY, Ling L, Liao Y, Chui HW. Approximate unconditional test procedure for comparing two ordered multinomials. Comput Stat Data Anal 2011. [DOI: 10.1016/j.csda.2010.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
7
|
Hestbaek L, Rasmussen C, Leboeuf-Yde C. Financial compensation and vocational recovery: a prospective study of secondary care neck and back patients. Scand J Rheumatol 2009; 38:481-7. [DOI: 10.3109/03009740902895735] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
8
|
Petersen TT, Fonager K, Bøggild H, Pedersen L, Mortensen JT. Application for disability pension and change in use of prescribed drugs. A regional Danish cohort study. Scand J Public Health 2009; 37:380-6. [PMID: 19324925 DOI: 10.1177/1403494809103908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To investigate if a pending application for disability pension had an influence on the applicant's purchase of medical drugs, with a particular focus on musculoskeletal disorders and the use of painkillers. METHODS We performed a registry-based follow-up study including 12,020 applicants for disability pension in a Danish county from 1995 to 2000 and linked this information to a database of drug prescriptions. Purchase of drug was calculated for the 6-month period just before the decision and for the 6-month period 2 years later. Changes in a 2-year time period were estimated by differences in purchase rates. Furthermore, the proportion of applicants with an increased purchase of drugs and the proportion of applicants who ceased buying drugs were estimated. The results were stratified by diagnosis and result of application (awarded/rejected). The analyses were furthermore restricted to musculoskeletal disorders and the use of painkillers. RESULTS AND CONCLUSIONS At baseline 81% had a purchase and after the 2-year time period 11% ceased buying prescribed drugs. Half of all applicants increased the purchase of drugs. For musculoskeletal disorders one third had an increased purchase rate of painkillers while one fourth ceased purchase of drugs with variations in different diagnostic subgroups. The major changes of drug purchase after a pending application for disability pension are probably ascribed to characteristics of the diseases underlying the disability.
Collapse
Affiliation(s)
- Thomas T Petersen
- Department of Social Medicine, Aalborg Hospital, Aarhus University Hospital, DK-9000 Aalborg, Denmark.
| | | | | | | | | |
Collapse
|
9
|
Rasmussen C, Leboeuf-Yde C, Hestbaek L, Manniche C. Poor outcome in patients with spine-related leg or arm pain who are involved in compensation claims: a prospective study of patients in the secondary care sector. Scand J Rheumatol 2008; 37:462-8. [PMID: 18819041 DOI: 10.1080/03009740802241709] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate whether poor outcome after spinal pain episodes is linked with the claim process and, if so, whether this link is independent of other potential risk factors of chronic pain and disability in patients with spine-related leg or arm pain. METHODS A 1-year prospective outcome study with internal control groups in two Danish secondary care, public, multidisciplinary, non-surgical spine clinics. Patients with low back pain (LBP) radiating to the leg (n = 1243) or with neck and arm pain thought to emanate from the neck (n = 202) were referred to the clinics by their general practitioners. Rheumatologists, physiotherapists, and nurses examined, treated, and informed the patients based on cognitive principles. Follow-up data were collected with a postal questionnaire. Claim, defined as seeking some sort of financial compensation or filing any sort of financial claim, such as workers' compensation, was the main independent variable. Potential confounders examined were: age, sex, social class, smoking, duration and severity of pain and disability. The main outcome measures were: global assessment (main outcome variable), pain, disability, and intake of analgesics. RESULTS Financial claims were registered by 31% of patients. After adjustment for covariates, the odds ratio for claim and no improvement was calculated to be 4.2 (95% CI 2.8-6.2) for the LBP/leg patients and 17.4 (95% CI 5.1-60.1) for the neck/arm patients. CONCLUSION A claim for financial compensation is strongly and independently linked with a poor prognosis for Danish patients with pain radiating from the low-back or neck.
Collapse
Affiliation(s)
- C Rasmussen
- Spine Clinic, Department of Rheumatology, Vendsyssel Hospital, Hjørring, Denmark.
| | | | | | | |
Collapse
|
10
|
Lysgaard AP, Fonager K, Nielsen CV. Effect of financial compensation on vocational rehabilitation. J Rehabil Med 2005; 37:388-91. [PMID: 16287672 DOI: 10.1080/16501970510040948] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To examine how financial compensation affects the outcome of vocational rehabilitation. DESIGN A registry-based follow-up study. SUBJECTS A total of 1397 rehabilitees discharged from the 5 local rehabilitation agencies in Aarhus County, Denmark from 1 July 2000 to 31 December 2001. METHODS At submission demographic data was obtained as well as data on financial compensation, i.e. compensation for industrial injury, indemnity for off-duty injury and application for disability pension. Rehabilitation outcomes were recorded at discharge. Renouncing further attempts at rehabilitation was defined as a negative outcome; education, further rehabilitation or return-to-work on normal or less demanding terms were defined as a positive outcome. Rehabilitees with and without financial compensation were compared. RESULTS Rehabilitees with involvement of financial compensation had an increased risk of a negative outcome compared with those without involvement of financial compensation. Adjustment for potential confounders did not change the association between financial compensation and negative outcome. The risk of a negative outcome rose with increasing age, with less than 1 year of labour market experience and with rented housing. Previous occupation as a skilled worker reduced the risk. CONCLUSION Financial compensation was associated with an increased risk of a negative vocational rehabilitation outcome.
Collapse
Affiliation(s)
- Anne Pernille Lysgaard
- Unit of Social Medicine, Dept. of Public Health, Aarhus County, Valdemarsgade 19 V, DK-8000 Aarhus C, Denmark.
| | | | | |
Collapse
|
11
|
Busse JW, Dufton JA, Kilian BC, Bhandari M. The impact of non-injury-related factors on disability secondary to whiplash associated disorder type II: a retrospective file review. J Manipulative Physiol Ther 2004; 27:79-83. [PMID: 14970807 DOI: 10.1016/j.jmpt.2003.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is evidence to suggest that Whiplash Associated Disorders (WADs) are influenced by physical trauma and psychosocial factors, as well as by medicolegal and compensation systems. OBJECTIVE To investigate the impact of noninjury related variables on self-reported disability at initial assessment among patients presenting with WAD type II injuries. DESIGN AND SETTING We reviewed a total of 1101 consecutive files of patients presenting to a single chiropractor's office in British Columbia, Canada. We included those who met the inclusion criteria. We extracted demographic variables and noninjury related information from 33 eligible patient files. We calculated correlations between variables and created a multivariable linear regression model to evaluate their relative associations with Neck Disability Index (NDI) scores on presentation. RESULTS Higher NDI scores on initial assessment correlated with female sex (r = 0.40, P =.02), a greater number of subsequent treatments (r = 0.44, P =.01), a higher number of providers seen before presentation (r = 0.40, P =.02), and most strongly with the involvement of a lawyer (r = 0.73, P <.01). A multivariable linear regression model found that only female sex (P =.03) and the involvement of a lawyer (P =.01) remained significantly associated with higher NDI scores on presentation (adjusted R2 = 0.68 for the model). Female sex was associated with a 10-point increase in NDI scores on presentation (beta coefficient = 10.5; 95% confidence interval [CI] 2.8-18.2), and involvement of a lawyer was associated with a 15-point increase in NDI scores on presentation (beta coefficient = 14.9; 95% CI 5.0-24.7). CONCLUSION Our analysis of WAD type II patients in receipt of compensation found that higher self-reported disability on initial assessment was associated with female sex and in particular by retaining a lawyer. Large prospective studies are needed to establish the validity of these findings.
Collapse
Affiliation(s)
- Jason W Busse
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
| | | | | | | |
Collapse
|
12
|
Luo X, Edwards CL, Richardson W, Hey L. Relationships of clinical, psychologic, and individual factors with the functional status of neck pain patients. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2004; 7:61-69. [PMID: 14720131 DOI: 10.1111/j.1524-4733.2004.71264.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE The objective of this study was to use both generic and disease-specific functional measures examining relationships of clinical, psychologic, and individual factors with the functional status of neck pain patients. METHODS Patients who visited a university-based spine clinic and reported neck pain were included in this study. A comprehensive computerized survey questionnaire was used to collect the information related to this study. The questionnaire also contained a generic measure, short form 12-item survey (SF-12), and a disease-specific measure, neck disability index (NDI). Correlation and multiple regression analysis were conducted to examine the relationships. RESULTS A range of clinical, psychologic, and individual factors emerged to be significant predictors of the NDI or physical component of the SF-12 (PCS). The predictors of higher NDI included higher levels of neck pain, higher levels of back pain, higher levels of pain in arm or shoulder areas, not working, lower education, higher stress, the presence of depression or anxiety, and smoking. The predictors of lower PCS included not working, higher levels of back pain, higher levels of neck pain, lower education, female sex, the presence of cardiovascular disorders, the absence of cervical disk disorders, and older age. CONCLUSIONS The predictors of the NDI or PCS appear to be multidimensional. Interventions designed to maximally improve the functional status of neck pain patients should be multifaceted and involve multidisciplinary teams. Selection of the most appropriate functional measures for an intervention study should consider differences between the generic and disease-specific measures in terms of their respective relationships with targeted factors. Prospective studies are needed to confirm the relationships observed in this study.
Collapse
Affiliation(s)
- Xuemei Luo
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
| | | | | | | |
Collapse
|
13
|
Cassidy JD, Carroll L, Côté P, Berglund A, Nygren A. Low back pain after traffic collisions: a population-based cohort study. Spine (Phila Pa 1976) 2003; 28:1002-9. [PMID: 12768138 DOI: 10.1097/01.brs.0000061983.36544.0d] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A population-based, incidence cohort study was conducted. OBJECTIVE To measure the incidence and prognosis for collision-related low back pain before and after a change in the insurance compensation system. SUMMARY OF BACKGROUND DATA Low back pain is a common and costly occupational injury. It also occurs after traffic collisions, but less is known about its frequency and recovery in this setting. METHODS An incidence cohort of 4473 low back pain injury claims was formed between July 1, 1994 and December 31, 1995 in Saskatchewan. On January 1, 1995 the public insurance system changed from a tort system to a no-fault system, eliminating compensation for pain and suffering. The incidence of claims and the time to claim closure were calculated before and after this change. Prognostic models were built using baseline and follow-up data. RESULTS The 6-month incidence of claims decreased from 256 to 176 per 100,000 after the insurance change. The median time to claim closure dropped from 505 days for tort claims to 210 days and 216 days for claims made during the first and second 6 months of the no-fault period. Improvements in bodily pain and physical functioning and the absence of depressive symptoms were associated with faster claim closure. High pain intensity, female gender, full-time employment, concentration problems, and lawyer involvement early in the claim process delayed claim closure. CONCLUSIONS Low back pain is a common traffic injury with a prolonged recovery. Its incidence and prognosis are affected by multiple factors, including the type of compensation system. Our study suggests that biopsychosocial factors are important in determining prognosis.
Collapse
Affiliation(s)
- J David Cassidy
- Epidemiology Program and the Alberta Centre for Injury Control and Research, Department of Public Health Sciences, University of Alberta, Edmonton, Canada.
| | | | | | | | | |
Collapse
|
14
|
McClune T, Burton AK, Waddell G. Whiplash associated disorders: a review of the literature to guide patient information and advice. Emerg Med J 2002; 19:499-506. [PMID: 12421771 PMCID: PMC1756324 DOI: 10.1136/emj.19.6.499] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To review the literature and provide an evidence based framework for patient centred information and advice on whiplash associated disorders. METHODS A systematic literature search was conducted, which included both clinical and non-clinical articles to encompass the wide range of patients' informational needs. From the studies and previous reviews retrieved, 163 were selected for detailed review. The review process considered the quantity, consistency, and relevance of all selected articles. These were categorised under a grading system to reflect the quality of the evidence, and then linked to derived evidence statements. RESULTS The main messages that emerged were: physical serious injury is rare; reassurance about good prognosis is important; over-medicalisation is detrimental; recovery is improved by early return to normal pre-accident activities, self exercise, and manual therapy; positive attitudes and beliefs are helpful in regaining activity levels; collars, rest, and negative attitudes and beliefs delay recovery and contribute to chronicity. These findings were synthesised into patient centred messages with the potential to reduce the risk of chronicity. CONCLUSIONS The scientific evidence on whiplash associated disorders is of variable quality, but sufficiently robust and consistent for the purpose of guiding patient information and advice. While the delivery of appropriate messages can be both oral and written, consistency is imperative, so an innovative patient educational booklet, The Whiplash Book, has been developed and published.
Collapse
Affiliation(s)
- T McClune
- Spinal Research Unit, University of Huddersfield, UK.
| | | | | |
Collapse
|