In contrast to the lack of progress made in the diagnosis of peripheral pathology, much ground has been made in characterising the condition in terms of its physical and psychological presentation, and some of the key findings in this area have implications for the clinical assessment of WAD, and these will be outlined. It is mandatory that pain and disability be measured as the first step of clinical assessment due to their consistent prognostic capacity. Guideline-recommended pain measures include the 11-point visual analogue scale or numeric rating scale, and the recommended measure of disability is the Neck Disability Index due its clinimetric properties.37 However,
other measures are also acceptable, see more and some include the Whiplash Disability Questionnaire and the Patient Specific Functional Scale.37 It is also important to gain an
understanding of any psychological factors that may influence recovery or the effects of physiotherapy interventions. Numerous psychological questionnaires are available so it is often difficult for clinicians to decide on the most appropriate questionnaire/s to use. One suggestion is to select relevant questionnaires based on the patient’s reported symptoms this website in the subjective examination. For example, early symptoms of post-traumatic stress may be suspected in patients who report difficulty sleeping due to thoughts about the accident, flashbacks, or avoidance of driving due to fear. These symptoms can be further evaluated using validated questionnaires, with the Impact of Events Scale recommended for use by physiotherapists.37 A score of 25 or 26 on the Impact of Events Scale indicates a moderate level of symptoms of post-traumatic stress.38 Similarly, if from the patient history and interview, it appears that other psychological factors are present, these can also be further evaluated. Table
2 outlines some questionnaires that may be useful for physiotherapists, the interpretation of scores, and their availability. Management decisions made on the basis of responses on these questionnaires depend on the stage of the condition, whether acute or chronic, and this will be discussed below. The physical examination of the Levetiracetam patient with WAD follows the same general examination procedures usually adopted for the examination of any cervical spine condition but with some additional procedures included based on research findings of WAD. One aim of the physical examination is to determine the grade of the condition using the QTF classification system.32 A Grade II condition will have physical signs of decreased range of neck movement and palpable ‘tenderness’ compared to Grade I, where the patient reports neck pain but with no physical signs.