Josh Walker

Thesis Name

Thesis Abstract

Whiplash-associated disorders (WAD) are a significant public health problem, characterised by neck pain, disability, and psychological sequelae. Approximately half of the individuals who suffer an acute whiplash injury fail to fully recover within three months, often developing chronic pain and long-term functional limitations (Kamper et al., 2008). In fact, the annual costs of WAD in Australia exceed $950 million (Bandong et al., 2018). WAD, therefore, poses a substantial health and economic burden. Clinical practice guidelines (CPG) in Australia and abroad emphasise evidence-based, conservative management of WAD; thorough triage, limited use of imaging, and a focus on active rehabilitation over passive modalities (Bandong et al., 2018; Griffin et al., 2019). As primary neuromusculoskeletal practitioners, chiropractors are well-positioned to help relieve the burden of WAD within this conservative framework.

Unfortunately, the scientific evidence for chiropractic treatment of WAD remains inconclusive. The most recent Cochrane review on the conservative management of whiplash found that available randomised trials were heterogeneous and of low quality, such that the evidence neither supports nor refutes the effectiveness of any specific active or passive conservative treatment for WAD (Verhagen et al., 2007). Subsequent research suggests that active interventions may yield better medium- to long-term outcomes than passive approaches; however, the overall confidence in the evidence remains very low (Wiangkham et al., 2015). Moreover, while chiropractors often treat WAD with manual therapy, the supporting evidence for these treatments is limited. A chiropractic-specific systematic review noted that chiropractic care may improve pain and cervical range of motion in WAD, but this conclusion was based on low-level evidence and consensus (Shaw et al., 2010). There is a recognised need for high-quality updated evidence in this area.

In practice, variability also exists in the management of WAD. Guidelines advocate active management and psychosocial support, yet not all clinicians consistently follow these recommendations (Bandong et al., 2018). Many providers give exercises and advice, but the use of outcome measures, risk stratification tools, and avoidance of ineffective passive treatments is suboptimal (Bandong et al., 2018; Griffin et al., 2019). Little is known about Australian chiropractors’ approaches to WAD or the barriers they face in implementing guideline-based care. Additionally, patient perspectives, such as why those with WAD seek chiropractic care and their satisfaction or outcomes, remain underexplored.

Research questions:

1. What is the current evidence on the effectiveness of conservative interventions for whiplash-associated disorders?
2. What are the current practices of Australian chiropractors in assessing and managing patients with WAD, and what are the perceived barriers and facilitators to implementing evidence-based care for WAD?
3. How do chiropractors describe their clinical decision-making and treatment approaches for WAD?
4. Why do patients with WAD seek chiropractic care, and what are their experiences and expectations of chiropractic management?
5. Is it feasible to implement an evidence-based chiropractic treatment program for WAD in a real-world setting, and what are the preliminary outcomes?
6. What insights can be gained from existing data about WAD outcomes? 

Why My Research is Important/Impacts

Initially, an updated systematic review will compile high-quality evidence from the past two decades to further enhance the understanding of conservative treatments for whiplash. This could directly inform future clinical guidelines and practitioner education globally. Subsequent studies focusing on Australian chiropractors will provide the first comprehensive picture of how WAD is currently managed in chiropractic settings and what barriers exist to best practice. This work can guide targeted interventions to improve guideline adherence and patient care by identifying gaps between guideline recommendations and real-world practice.

Importantly, the qualitative components will uncover their experiences, beliefs, and needs of both chiropractors and patients. Understanding the patient perspective on seeking chiropractic care for WAD can help tailor services to meet patient expectations and improve satisfaction. Exploring chiropractors’ perspectives can reveal challenges in managing WAD and opportunities for professional development.

Finally, the feasibility trial and secondary data analyses will lay the groundwork for future research in the chiropractic management of whiplash. A successful feasibility study will demonstrate that evidence-based chiropractic care for WAD is achievable in practice, supporting progression to a larger clinical trial. The analysis of existing trial and insurance data will leverage real-world evidence to identify factors influencing recovery that can be directly addressed.