Two studies on whiplash-associated disorders that were generated by insurance companies were reviewed. The Quebec Task Force (QTF) report was comprised of a cohort study, a best evidence synthesis and consensus recommendations. The British Columbia Whiplash Initiative (BCWI) propagated the QTF recommendations.The Quebec Task Force Cohort Study:This study was designed to determine retrospectively the natural history of whiplash injuries, however, recovery from whiplash injuries was determined by the discontinuation of payments and not by the resolution of symptoms. Patients complaining of 'recurrences', who comprised a substantial percentage of the total number of patients studied, were specifically excluded from the data set. When these patients were included in the data set, the percentage of patients who failed to recover (based on whether they were still receiving compensation) had risen from the reported 2.9% to as high as 12.4% after one year. It is impossible to draw valid conclusions about the natural history of whiplash injuries from this study because it did not study recovery from whiplash symptoms and excluded the majority of patients who were classified as 'recurrences' from the final study analysis.The Quebec Task Force Best Evidence Synthesis Including Interventions:This analysis identified the paucity of conclusive research regarding treatments for whiplash. The paucity of conclusive research limited the number of conclusions that could be drawn.The Quebec Task Force Consensus Recommendations:Despite a recognized lack of quality research, a consensus report that focused on therapeutic interventions was made. This consensus report is of concern because there was limited evidence to support the consensus, the classifications and recommendations were entirely arbitrary, the cohort data that the consensus panel relied upon to identify a natural history was seriously flawed, funding for the study was partisan, there was potential for abuse of guidelines, and there was a failure to deal with chronic whiplash injuries.The British Columbia Whiplash Initiative:This report, which was designed as a set of educational modules, relied heavily on the QTF, particularly the cohort study and the consensus recommendations. As a result, the report was based upon a flawed and overly optimistic picture of the natural history of whiplash disorders, and an arbitrary classification and management system. Both the QTF and the BCWI draw attention to the potential dangers of insurance industry initiatives designed to persuade medical and allied health professionals to accept viewpoints that appear overoptimistic and potentially self-serving.
Natural history of the Queen Charlotte islands, British Columbia. Natural history of the Cook inlet region, Alaska.