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Additional file 1.

Objectives: A core outcomes set (COS) for whiplash-associated disorders (WADs) has been proposed to improve consistency of outcome reporting in clinical trials. Patient-reported disability was one outcome of interest within this COS. The aim of this review was to identify the most suitable tools for measuring self-reported disability in WAD based on clinimetric performance. Methods: Database searches took place in 2 stages. The first identified outcome measures used to assess self-reported disability in WAD, and the second identified studies assessing the clinimetric properties of these outcome measures in WAD. Data on the study, population and outcome measure characteristics were extracted, along with clinimetric data. Quality and clinimetric performance were assessed in accordance with the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN). Results: Of 19,663 records identified in stage 1 searches, 32 were retained following stage 2 searches and screening. Both the Whiplash Disability Questionnaire and Neck Disability Index performed well in reliability (intraclass correlation coefficient=0.84 to 0.98), construct validity (74% to 82% of hypotheses accepted), and responsiveness (majority of correlations in accordance with hypotheses). Both received Category B recommendations due to a lack of evidence for content validity. Discussion: This review identified the Neck Disability Index and Whiplash Disability Questionnaire as the most appropriate patient-reported outcome measures (PROMs) for assessing self-reported disability in WAD based on moderate to high-quality evidence for sufficient reliability, construct validity and responsiveness. However, the content validity of these PROMs has yet to be established in WAD, and until this is undertaken, it is not possible to recommend 1 PROM over the other for inclusion in the WAD COS.

Additional file 1. CONSORT extension for Pilot and Feasibility Trials Checklist.

Appendix 1. Insurer and health professional data collected based on recommendations of the guidelines. Appendix 2. Quebec Task Force classification of grades of WAD. Appendix 3. Flow diagram of claimant files included in the study. (DOCX 37 kb)

Survey questionnaire. (PDF 2893Â kb)

筆者はオーストラリア (以下豪州) に長期在外研究員として派遣期間中に,日本にはない P.C. (Physiotherapy Consultant) という職種を見聞した.この職種はセカンド・オピニオンを用いることにより理学療法サービスの経済的,時間的効率と質の向上を推進していた。本稿ではこの P.C. という職種を紹介し、日本での理学療法士のセカンド・オピニオンについての検討をおこなった.P.C. は治療する理学療法士、患者および保険会社のための第2の見解の一つであり,その主たる役割はすべての当事者にとって満足できる理学療法サービスを推奨することである.豪州の P.C. が果たすセカンド・オピニオンとしての役割の特徴は、推奨される理学療法サービスを担当理学療法士に提供する事である。P.C. という職種はわずかではあるが職域を拡大することが可能である.また,この職種は患者の利益を最大限追求するという社会における理学療法士の責務も果たす可能性があると考える., During a long-term research secondment to Australia, the writer observed the role of Physiotherapy Consultants (PC), a profession which does not exist in Japan. These consultants promote efficiencies of time and economy and improvement of quality of the physiotherapy sespnndo through offering a second opinion. This paper introduces the role of the PC and examines the second opinion of physiotherapists' work in Japan. PCs provide a different point of view on behalf of the physiotherapist, patient, and insurance company, and their main role is the promotion of a physiotherapy service which is satisfactory for all concerned. A characteristic of the Australian PC's role of providing a second opinion is giving the physiotherapist in charge access to the physiotherapy service endorsed. Although there are few PCs, there is potential for the occupation to expand. This role allows physiotherapists to successfully fulfil their obligations in a society where the patient's interests are pursued to the utmost extent.

Introduction Whiplash-associated disorders (WAD) are a huge worldwide health and economic burden. The propensity towards developing into chronic, disabling conditions drives the rise in health and economic costs associated with treatment, productivity loss and compulsory third party insurance claims. Current treatments fail to address the well-documented heterogeneity of WAD and often result in poor outcomes. A novel approach is to evaluate whether the care provided according to the estimated risk of poor prognosis improves health outcomes while remaining cost-effective. Research questions (1) Does a guideline-based clinical pathway of care improve health outcomes after whiplash injury compared to usual care? (2) Does risk of recovery have a differential effect on health outcomes for the clinical pathway of care? (3) Is the clinical pathway of care intervention cost-effective? (4) What are the variations in professional practice between usual care and the clinical pathway of care? Design Multi-centre, randomised, controlled trial conducted over two Australian states: Queensland and New South Wales. Participants and setting 236 people with WAD (grade I-III, within 6 weeks of injury) and their primary healthcare providers. Intervention A clinical pathway of care, with care matched to the predicted risk of poor recovery. Participants at low risk of ongoing pain and disability (hence, predicted to fully recover) will receive up to three sessions of guideline-based advice and exercise with their primary healthcare provider. Participants at medium/high risk of developing ongoing pain and disability will be referred to a specialist (defined as a practitioner with expertise in whiplash) who will conduct a more in-depth physical and psychological assessment. As a result, the specialist will liaise with the original primary healthcare provider and determine one of three further pathways of care. Control Usual care provided by the primary healthcare provider that is based on clinical judgment. Measurements Primary (global rating of change and neck-related disability) and secondary (self-efficacy, pain intensity, general health and disability and psychological health) outcomes will be collected using validated scales. Direct (eg, professional care, transportation costs, time spent for care, co-payments) and indirect (eg, lost economic productivity) costs will be obtained through an electronic cost diary. Health and cost outcomes will be assessed at baseline, 3, 6 and 12 months after randomisation. Professional practice outcomes will be evaluated through questionnaires completed by healthcare providers and their patients at 3 months. Procedure Potential participants (patients) will be identified through emergency departments, primary health clinics and advertisements. Eligible participants will complete baseline assessments and will be categorised into low or medium/high risk of poor recovery using a clinical prediction rule. After this assessment, participants will be randomly allocated to either a control group ( n =118) or intervention group ( n =118), stratified by risk subgroup and treatment site. The participants' nominated primary healthcare providers will be informed of their involvement in the trial. Consent will be obtained from the primary healthcare providers to participate and to obtain information about professional practice. Participants in the intervention group will additionally have access to an interactive website that provides information about whiplash and recovery relative to their risk category. Analysis Analysis will be conducted on an intention-to-treat basis. Outcomes will be analysed independently through cross-sectional analyses using generalised linear models methods, with an appropriate link function, to test for an intervention effect, adjusted for the baseline values. The risk category will be tested for its association with treatment effect by adding risk group to the regression equation. Cost-effectiveness will be calculated using utility weights and the resulting measure will be cost per quality-adjusted life year (QALY) saved. Professional practice outcomes will be analysed using descriptive statistics. Discussion This research is significant as it will be the first study to address the heterogeneity of whiplash by implementing a clinical pathway of care that matches evidence-based interventions to projected risk of poor recovery. The results of this trial have the potential to change clinical practice for WAD, thereby maximising treatment effects, improving patient outcomes, reducing costs and maintaining the compulsory third party system.