Thesis project of Dave Walton PT, PhD(cand.)

To develop a new tool for use with acute WAD patients that:1. Is clinically feasible2. Provides an estimate of the risk that a patient

will develop persistent WAD-related morbidity3. Indicates the nature of the risk, focusing on

modifiable barriers to recovery, that will help in clinical decision-making

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.

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)

Tool now consists of two parts1. 93-item self-report questionnaire2. 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

Self-report questionnaire:◦ Multiple sub-constructs hypothesized to predict

multiple outcomes within the spectrum of ‘WAD’ Symptoms Coping strategies Cognitions Emotions Past history

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)

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)

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

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

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

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.

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.

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)

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

530 total subjects As many clinics as are interested Ethics approval and data collection to start

in May ‘08

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

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.)

The forms, including assessment manual, and more information, are available on-line at:

http://publish.uwo.ca/~dwalton5/WebsiteOr, contact Dave at:dwalton5@uwo.ca

Thanks!

Whiplash, the cowboy monkey