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INTRODUCTION
In January
1995, the Societe de l’assurance Automobile du Quebec (SAAQ)
published a text entitled, Whiplash Associated Disorders (WAD)--Redefining
Whiplash and its Management (referred to, henceforth, as the
“text”). The text was authored by the Quebec Task Force on
Whiplash-Associated Disorders, which was chaired by Walter
O. Spitzer, M.D., M.P.H., F.R.C.P.C., and consisted of an
eminent panel of experts in medicine, epidemiology and biostatistics,
chiropractic, and other disciplines. The reported mandate
of the Task Force was to address a variety of issues concerning
whiplash injuries, including:
- the
prevention of whiplash injuries;
- an
examination of the natural history of the condition;
- the
formulation of practical clinical guidelines for diagnosis
and management of the condition;
- the
development of a strategy for the education of health care
providers regarding whiplash injuries; and,
- the
development of recommendations for occupational and personal
rehabilitation for whiplash-injured individuals.
The Task
Force set out to comprehensively review the literature on
the subject in order to respond to the issues of the mandate.
In addition, a retrospective cohort study was performed on
SAAQ data of whiplash-diagnosed individuals in Quebec who
collected compensation for their injuries in 1987.
The strategy
of the Task Force was to use the “preeminence of evidence”
for developing the guidelines, and that, no matter how eminent
the panel members were in their respective fields of specialty,
their opinions were “always subordinate to evidence” (section
1, page 3).
The Task
Force first set about this task by instructing its members
on the anatomy, pathophysiology, and biomechanics of whiplash
injuries. Then, they examined the existing literature on the
subject, using a technique called “the best synthesis of evidence,”
to determine which literature was scientifically suitable
for inclusion in the study. The Task Force then studied its
cohort and analyzed the resulting data. Lastly, based upon
the results of the literature search and the cohort study,
conclusions and recommendations were made regarding the research
questions that had been asked. In addition to the text, which
was several hundred pages long and available from the SAAQ
(it is self-referred to as the “Official Report”), the Task
Force published a 73-page pull-out supplement in the April
15, 1995 issue of the journal Spine ([i]) (referred to, henceforth,
as the “supplement”). When the text and supplement were published,
synopsized versions of the conclusions and recommendations
were published widely in the popular press, under headlines
such as Whiplash Treatments Found to be Ineffective, and Much
Whiplash Aid is Rated Worthless ([ii], [iii],
[iv]).
It is
our contention that some of the most critical conclusions
and recommendations, as well as the methodology used by the
Task Force in reaching those conclusions, are flawed to the
point that the validity of the document must be questioned.
The purpose of this paper is to describe our findings of the
examination of the text and supplement and to present an analysis
of potential sources of bias and other weaknesses.
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here to read the full article.
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