การจัดการทางกายภาพบำบัดสำหรับผู้ป่วยกลุ่มอาการวิพแลช เกรด 2 ในระยะเฉียบพลัน
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เม.ย. 17, 2018
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บทคัดย่อ
ในปัจจุบันกลุ่มอาการวิพแลซ (whiplash-associated disorders: WAD) ยังไม่ได้รับความสนใจและศึกษาในประเทศไทย ถึงแม้ว่าประเทศไทยมีอัตราการประสบอุบัติเหตุทางท้องถนนค่อนข้างสูง ทั้งที่ประเทศที่พัฒนาแล้วประสบปัญหาเกี่ยวกับการบริหารจัดการกับกลุ่มอาการนี้ ไม่ว่าจะเป็น สวีเดน ฝรั่งเศส เยอรมัน อิตาลี แคนาดา สหรัฐอเมริกา สหราชอาณาจักร และออสเตรเลีย ดังนั้นการสังเกตและเฝ้าระวังสถานการณ์ของกลุ่มอาการวิพแลซในประเทศไทยจึงมีความน่าสนใจว่าทำไมประเทศไทยถึงไม่มีปัญหาเรื่องนี้ โดยส่วนใหญ่นักกายภาพบำบัดมักมีบทบาทในการบริหารจัดการกลุ่มอาการนี้โดยเฉพาะวิพแลช เกรด 2 ซึ่งพบได้อย่างน้อยร้อยละ 70 ของผู้ป่วยกลุ่มนี้ ดังนั้น บทความนี้มีวัตถุประสงค์เพื่อรวบรวมองค์ความรู้ที่เกี่ยวข้องกับกลุ่มอาการวิพแลซในรูปแบบของ ที่มาของกลุ่มอาการดังกล่าว สถานการณ์ในปัจจุบัน อาการและอาการแสดง การจำแนกกลุ่มอาการ และการบริหารจัดการทางกายภาพบำบัดสำหรับผู้ป่วยกลุ่มอาการวิพแลซ II ในระยะเฉียบพลันตลอดจนแนวทางการศึกษาและการจัดการรักษาในอนาคต เพื่อให้นักกายภาพบำบัดของไทยมีความเข้าใจผู้ป่วยกลุ่มนี้เพิ่มมากขึ้นและนำองค์ความรู้นี้ไปใช้ในการบริหารจัดการผู้ป่วยกลุ่มนี้เพื่อป้องกันภาวะเรื้อรังที่อาจจะเกิดขึ้นได้ นอกจากนี้อาจเป็นการกระตุ้นให้นักกายภาพบำบัดหรือนักวิจัยของไทยทำการศึกษาที่เกี่ยวข้องกับกลุ่มอาการวิพแลซ
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References
1. Cote P, Hogg-Johnson S, Cassidy JD, Carroll L, Frank JW, Bombardier C. Early aggressive care and delayed recovery from whiplash: isolated finding or reproducible result? Arthritis Rheum. 2007; 57(5): 861-8.
2. Chappuis G, Soltermann B. Number and cost of claims linked to minor cervical trauma in Europe: results from the comparative study by CEA, AREDOC and CEREDOC. Eur Spine J. 2008; 17(10): 1350-7.
3. Holm LW, Carroll LJ, Cassidy JD, Hogg-Johnson S, Cote P, Guzman J, et al. The burden and determinants of neck pain in whiplash-associated disorders after traffic collisions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine. 2008; 33(4 Suppl): S52-9.
4. Mooney H. Insurance companies are reeling from the number of claims being made by people who say they have whiplash injuries 2012 [cited 14 May 2017]. Available from: http://www.csp.org.uk/frontline/article/what%E2%80%99s-driving-rise-whiplash-injuries.
5. Hyde D. Why Britain is the whiplash capital of Europe. The Telegraph [Internet]. United Kingdom 2013. [cited 23 December 2013]. Available from: http://www.telegraph.co.uk/ finance/personalfinance/insurance/10185382/Why-Britain-is-the-whiplash-capital-of- Europe. html.
6. Financial Services Commission of Ontario (FSCO). FSCO, financial services submission to the superintendent: submitted for the review of part VI of the insurance act. Canada: Financial Services Commission of Ontario; 2014.
7. Sterling M. Physiotherapy management of whiplash-associated disorders (WAD). J Physiother. 2014; 60(1): 5-12.
8. Wiangkham T. Development and evaluation of a novel intervention for rehabilitation following whiplash injury: University of Birmingham; 2017.
9. Michaleff ZA, Maher CG, Lin CW, Rebbeck T, Jull G, Latimer J, et al. Comprehensive physiotherapy exercise programme or advice for chronic whiplash (PROMISE): a pragmatic randomised controlled trial. Lancet. 2014; 384(9938): 133-41.
10. Spitzer WO, Skovron ML, Salmi LR, Cassidy JD, Duranceau J, Suissa S, et al. Scientific monograph of the Quebec Task Force on whiplash-associated disorders: redefining "whiplash" and its management. Spine. 1995; 20(8 Suppl): 1s-73s.
11. Cassidy JD, Carroll LJ, Côté P, Lemstra M, Berglund A, Nygren Å. Effect of eliminating compensation for pain and suffering on the outcome of insurance claims for whiplash injury. N Engl J Med. 2000; 342(16): 1179-86.
12. MacNab I. Whiplash injuries of the neck. Proceedings: American Association for Automotive Medicine Annual Conference, 1965: 9: 11-15.
13. Pearson AM, Ivancic PC, Ito S, Panjabi MM. Facet joint kinematics and injury mechanisms during simulated whiplash. Spine. 2004; 29(4): 390-7.
14. Nygren A, Gustafsson H, Tingvall C. Effects of different types of headrests in rear-end collisions. SAE Technical Paper, 1985 Jan 1.
15. Ivancic PC. Mechanisms and mitigation of head and spinal injuries due to motor vehicle crashes. J Orthop Sports Phys Ther. 2016; 46(10): 826-33.
16. Elkin BS, Elliott JM, Siegmund GP. Whiplash injury or concussion? a possible biomechanical explanation for concussion symptoms in some individuals following a rear-end collision. J Orthop Sports Phys Ther. 2016; 46(10): 874-85.
17. Berglund A, Bodin L, Jensen I, Wiklund A, Alfredsson L. The influence of prognostic factors on neck pain intensity, disability, anxiety and depression over a 2-year period in subjects with acute whiplash injury. Pain. 2006; 125(3): 244-56.
18. Siegmund GP, Winkelstein BA, Ivancic PC, Svensson MY, Vasavada A. The anatomy and biomechanics of acute and chronic whiplash injury. Traffic Inj Prev. 2009; 10(2): 101-12.
19. Saari A, Itshayek E, Cripton PA. Cervical spinal cord deformation during simulated head-first impact injuries. J Biomech. 2011; 44(14): 2565-71.
20. Ellman L, Champion S, Dobbin J, Lumley K, McCartney J, McCartney K, et al. Cost of motor insurance: whiplash. In: Committee HoCT, editor. London: The Stationery Office Limited; 2013.
21. Merrick D, Stalnacke BM. Five years post whiplash injury: Symptoms and psychological factors in recovered versus non-recovered. BMC Res Notes. 2010; 3: 190.
22. Jull GA, Sterling M, Curatolo M, Carroll L, Hodges P. Toward lessening the rate of transition of acute whiplash to a chronic disorder. Spine. 2011; 36(25 Suppl): S173-4.
23. Borsbo B, Peolsson M, Gerdle B. Catastrophizing, depression, and pain: correlation with and Influence on quality of life and health - a study of chronic whiplash-associated disorders. J Rehabil Med. 2008; 40(7): 562-9.
24. Borsbo B, Peolsson M, Gerdle B. The complex interplay between pain intensity, depression, anxiety and catastrophising with respect to quality of life and disability. Disabil Rehabil. 2009; 31(19): 1605-13.
25. Jull G, Kenardy J, Hendrikz J, Cohen M, Sterling M. Management of acute whiplash: a randomized controlled trial of multidisciplinary stratified treatments. Pain. 2013; 154(9): 1798-806.
26. Lamb SE, Gates S, Williams MA, Williamson EM, Mt-Isa S, Withers EJ, et al. Emergency department treatments and physiotherapy for acute whiplash: a pragmatic, two-step, randomised controlled trial. Lancet. 2013; 381(9866): 546-56.
27. Jull G. Whiplash continues its challenge. J Orthop Sports Phys Ther. 2016; 46(10): 815-17.
28. Leth-Petersen S, Rotger GP. Long-term labour-market performance of whiplash claimants. J Health Econ. 2009; 28(5): 996-1011.
29. Jennum P, Kjellberg J, Ibsen R, Bendix T. Health, social, and economic consequences of neck injuries: a controlled national study evaluating societal effects on patients and their partners. Spine. 2013; 38(5): 449-57.
30. Eck JC, Hodges SD, Humphreys SC. Whiplash: a review of a commonly misunderstood injury. Am J Med. 2001; 110(8): 651-6.
31. Galasko CSB, Murray P, Stephenson W. Incidence of whiplash-associated disorder. BCMJ. 2002; 44(5): 237-40.
32. Tanaboriboon Y. Road accidents in Thailand: changes over the past decade. IATSS Research. 2004; 28(1): 119-22.
33. Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med. 1996; 335(23): 1721-6.
34. Thompson DP, Oldham JA, Urmston M, Woby SR. Cognitive determinants of pain and disability in patients with chronic whiplash-associated disorder: a cross-sectional observational study. Physiotherapy. 2010; 96(2): 151-9.
35. Hartling L, Brison RJ, Ardern C, Pickett W. Prognostic value of the Quebec classification of whiplash-associated disorders. Spine. 2001; 26(1): 36-41.
36. Prushansky T, Gepstein R, Gordon C, Dvir Z. Cervical muscles weakness in chronic whiplash patients. Clinical biomechanics (Bristol, Avon). 2005; 20(8): 794-8.
37. Sterling M, Chadwick BJ. Psychologic processes in daily life with chronic whiplash: relations of posttraumatic stress symptoms and fear-of-pain to hourly pain and uptime. Clin J Pain. 2010; 26(7): 573-82.
38. Buitenhuis J, de Jong PJ. Fear avoidance and illness beliefs in post-traumatic neck pain. Spine. 2011; 36(25 Suppl): S238-43.
39. Carroll LJ. Beliefs and expectations for recovery, coping, and depression in whiplash-associated disorders: lessening the transition to chronicity. Spine. 2011; 36(25 Suppl): S250-6.
40. Sterling M, Hendrikz J, Kenardy J. Similar factors predict disability and posttraumatic stress disorder trajectories after whiplash injury. Pain. 2011; 152(6): 1272-8.
41. Sterling M. A proposed new classification system for whiplash associated disorders--implications for assessment and management. Man Ther. 2004; 9(2): 60-70.
42. Williamson E, Williams MA, Gates S, Lamb SE. Risk factors for chronic disability in a cohort of patients with acute whiplash associated disorders seeking physiotherapy treatment for persisting symptoms. Physiotherapy. 2015; 101(1): 34-43.
43. Jagnoor J, Cameron I, Harvey L, Ierano J, Nicholson K, Rebbeck T, et al. Motor Accidents Authority: guidelines for the management of acute whiplash-associated disorders - for health preofessionals. third ed. Sydney: New South Wales Government; 2014.
44. Wiangkham T, Duda J, Haque S, Madi M, Rushton A. The effectiveness of conservative management for acute whiplash associated disorder (WAD) II: a systematic review and meta-analysis of randomised controlled trials. PLoS One. 2015; 10(7): e0133415.
45. Wiangkham T, Duda J, Haque MS, Madi M, Rushton A. Effectiveness of conservative treatment in acute whiplash associated disorder (WAD) II: a systematic review and meta-analysis of randomised controlled trials. Physiotherapy. 2015; 101, Supplement 1(0): e1623-e4.
46. Rushton A, Wright C, Heneghan N, Eveleigh G, Calvert M, Freemantle N. Physiotherapy rehabilitation for whiplash associated disorder II: a systematic review and meta-analysis of randomised controlled trials. BMJ open. 2011; 1(2): e000265.
47. Wiangkham T, Duda J, Haque MS, Rushton A. Development of an active behavioural physiotherapy intervention (ABPI) for acute whiplash-associated disorder (WAD) II management: a modified Delphi study. BMJ open. 2016; 6(9): e011764.
48. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655.
49. Wiangkham T, Duda J, Haque MS, Price J, Rushton A. Acute Whiplash Injury Study (AWIS): a protocol for a cluster randomised pilot and feasibility trial of an active behavioural physiotherapy intervention in an insurance private setting. BMJ open. 2016; 6(7): e011336.
50. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977; 84(2): 191-215.
51. Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther. 1991; 14(7): 409-15.
52. MacDermid JC, Walton DM, Avery S, Blanchard A, Etruw E, McAlpine C, et al. Measurement properties of the neck disability index: a systematic review. J Orthop Sports Phys Ther. 2009; 39(5): 400-17.
53. TRACsa. Clinical guidelines for best practice management of acute and chronic whiplash associated disorders: clinical resource guide. Adelaide: TRACsa: Trauma and Injury Rocovery; 2008.
54. Press MJ, Howe R, Schoenbaum M, Cavanaugh S, Marshall A, Baldwin L, et al. Medicare payment for behavioral health integration. N Engl J Med. 2017; 376(5): 405-7.
2. Chappuis G, Soltermann B. Number and cost of claims linked to minor cervical trauma in Europe: results from the comparative study by CEA, AREDOC and CEREDOC. Eur Spine J. 2008; 17(10): 1350-7.
3. Holm LW, Carroll LJ, Cassidy JD, Hogg-Johnson S, Cote P, Guzman J, et al. The burden and determinants of neck pain in whiplash-associated disorders after traffic collisions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine. 2008; 33(4 Suppl): S52-9.
4. Mooney H. Insurance companies are reeling from the number of claims being made by people who say they have whiplash injuries 2012 [cited 14 May 2017]. Available from: http://www.csp.org.uk/frontline/article/what%E2%80%99s-driving-rise-whiplash-injuries.
5. Hyde D. Why Britain is the whiplash capital of Europe. The Telegraph [Internet]. United Kingdom 2013. [cited 23 December 2013]. Available from: http://www.telegraph.co.uk/ finance/personalfinance/insurance/10185382/Why-Britain-is-the-whiplash-capital-of- Europe. html.
6. Financial Services Commission of Ontario (FSCO). FSCO, financial services submission to the superintendent: submitted for the review of part VI of the insurance act. Canada: Financial Services Commission of Ontario; 2014.
7. Sterling M. Physiotherapy management of whiplash-associated disorders (WAD). J Physiother. 2014; 60(1): 5-12.
8. Wiangkham T. Development and evaluation of a novel intervention for rehabilitation following whiplash injury: University of Birmingham; 2017.
9. Michaleff ZA, Maher CG, Lin CW, Rebbeck T, Jull G, Latimer J, et al. Comprehensive physiotherapy exercise programme or advice for chronic whiplash (PROMISE): a pragmatic randomised controlled trial. Lancet. 2014; 384(9938): 133-41.
10. Spitzer WO, Skovron ML, Salmi LR, Cassidy JD, Duranceau J, Suissa S, et al. Scientific monograph of the Quebec Task Force on whiplash-associated disorders: redefining "whiplash" and its management. Spine. 1995; 20(8 Suppl): 1s-73s.
11. Cassidy JD, Carroll LJ, Côté P, Lemstra M, Berglund A, Nygren Å. Effect of eliminating compensation for pain and suffering on the outcome of insurance claims for whiplash injury. N Engl J Med. 2000; 342(16): 1179-86.
12. MacNab I. Whiplash injuries of the neck. Proceedings: American Association for Automotive Medicine Annual Conference, 1965: 9: 11-15.
13. Pearson AM, Ivancic PC, Ito S, Panjabi MM. Facet joint kinematics and injury mechanisms during simulated whiplash. Spine. 2004; 29(4): 390-7.
14. Nygren A, Gustafsson H, Tingvall C. Effects of different types of headrests in rear-end collisions. SAE Technical Paper, 1985 Jan 1.
15. Ivancic PC. Mechanisms and mitigation of head and spinal injuries due to motor vehicle crashes. J Orthop Sports Phys Ther. 2016; 46(10): 826-33.
16. Elkin BS, Elliott JM, Siegmund GP. Whiplash injury or concussion? a possible biomechanical explanation for concussion symptoms in some individuals following a rear-end collision. J Orthop Sports Phys Ther. 2016; 46(10): 874-85.
17. Berglund A, Bodin L, Jensen I, Wiklund A, Alfredsson L. The influence of prognostic factors on neck pain intensity, disability, anxiety and depression over a 2-year period in subjects with acute whiplash injury. Pain. 2006; 125(3): 244-56.
18. Siegmund GP, Winkelstein BA, Ivancic PC, Svensson MY, Vasavada A. The anatomy and biomechanics of acute and chronic whiplash injury. Traffic Inj Prev. 2009; 10(2): 101-12.
19. Saari A, Itshayek E, Cripton PA. Cervical spinal cord deformation during simulated head-first impact injuries. J Biomech. 2011; 44(14): 2565-71.
20. Ellman L, Champion S, Dobbin J, Lumley K, McCartney J, McCartney K, et al. Cost of motor insurance: whiplash. In: Committee HoCT, editor. London: The Stationery Office Limited; 2013.
21. Merrick D, Stalnacke BM. Five years post whiplash injury: Symptoms and psychological factors in recovered versus non-recovered. BMC Res Notes. 2010; 3: 190.
22. Jull GA, Sterling M, Curatolo M, Carroll L, Hodges P. Toward lessening the rate of transition of acute whiplash to a chronic disorder. Spine. 2011; 36(25 Suppl): S173-4.
23. Borsbo B, Peolsson M, Gerdle B. Catastrophizing, depression, and pain: correlation with and Influence on quality of life and health - a study of chronic whiplash-associated disorders. J Rehabil Med. 2008; 40(7): 562-9.
24. Borsbo B, Peolsson M, Gerdle B. The complex interplay between pain intensity, depression, anxiety and catastrophising with respect to quality of life and disability. Disabil Rehabil. 2009; 31(19): 1605-13.
25. Jull G, Kenardy J, Hendrikz J, Cohen M, Sterling M. Management of acute whiplash: a randomized controlled trial of multidisciplinary stratified treatments. Pain. 2013; 154(9): 1798-806.
26. Lamb SE, Gates S, Williams MA, Williamson EM, Mt-Isa S, Withers EJ, et al. Emergency department treatments and physiotherapy for acute whiplash: a pragmatic, two-step, randomised controlled trial. Lancet. 2013; 381(9866): 546-56.
27. Jull G. Whiplash continues its challenge. J Orthop Sports Phys Ther. 2016; 46(10): 815-17.
28. Leth-Petersen S, Rotger GP. Long-term labour-market performance of whiplash claimants. J Health Econ. 2009; 28(5): 996-1011.
29. Jennum P, Kjellberg J, Ibsen R, Bendix T. Health, social, and economic consequences of neck injuries: a controlled national study evaluating societal effects on patients and their partners. Spine. 2013; 38(5): 449-57.
30. Eck JC, Hodges SD, Humphreys SC. Whiplash: a review of a commonly misunderstood injury. Am J Med. 2001; 110(8): 651-6.
31. Galasko CSB, Murray P, Stephenson W. Incidence of whiplash-associated disorder. BCMJ. 2002; 44(5): 237-40.
32. Tanaboriboon Y. Road accidents in Thailand: changes over the past decade. IATSS Research. 2004; 28(1): 119-22.
33. Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med. 1996; 335(23): 1721-6.
34. Thompson DP, Oldham JA, Urmston M, Woby SR. Cognitive determinants of pain and disability in patients with chronic whiplash-associated disorder: a cross-sectional observational study. Physiotherapy. 2010; 96(2): 151-9.
35. Hartling L, Brison RJ, Ardern C, Pickett W. Prognostic value of the Quebec classification of whiplash-associated disorders. Spine. 2001; 26(1): 36-41.
36. Prushansky T, Gepstein R, Gordon C, Dvir Z. Cervical muscles weakness in chronic whiplash patients. Clinical biomechanics (Bristol, Avon). 2005; 20(8): 794-8.
37. Sterling M, Chadwick BJ. Psychologic processes in daily life with chronic whiplash: relations of posttraumatic stress symptoms and fear-of-pain to hourly pain and uptime. Clin J Pain. 2010; 26(7): 573-82.
38. Buitenhuis J, de Jong PJ. Fear avoidance and illness beliefs in post-traumatic neck pain. Spine. 2011; 36(25 Suppl): S238-43.
39. Carroll LJ. Beliefs and expectations for recovery, coping, and depression in whiplash-associated disorders: lessening the transition to chronicity. Spine. 2011; 36(25 Suppl): S250-6.
40. Sterling M, Hendrikz J, Kenardy J. Similar factors predict disability and posttraumatic stress disorder trajectories after whiplash injury. Pain. 2011; 152(6): 1272-8.
41. Sterling M. A proposed new classification system for whiplash associated disorders--implications for assessment and management. Man Ther. 2004; 9(2): 60-70.
42. Williamson E, Williams MA, Gates S, Lamb SE. Risk factors for chronic disability in a cohort of patients with acute whiplash associated disorders seeking physiotherapy treatment for persisting symptoms. Physiotherapy. 2015; 101(1): 34-43.
43. Jagnoor J, Cameron I, Harvey L, Ierano J, Nicholson K, Rebbeck T, et al. Motor Accidents Authority: guidelines for the management of acute whiplash-associated disorders - for health preofessionals. third ed. Sydney: New South Wales Government; 2014.
44. Wiangkham T, Duda J, Haque S, Madi M, Rushton A. The effectiveness of conservative management for acute whiplash associated disorder (WAD) II: a systematic review and meta-analysis of randomised controlled trials. PLoS One. 2015; 10(7): e0133415.
45. Wiangkham T, Duda J, Haque MS, Madi M, Rushton A. Effectiveness of conservative treatment in acute whiplash associated disorder (WAD) II: a systematic review and meta-analysis of randomised controlled trials. Physiotherapy. 2015; 101, Supplement 1(0): e1623-e4.
46. Rushton A, Wright C, Heneghan N, Eveleigh G, Calvert M, Freemantle N. Physiotherapy rehabilitation for whiplash associated disorder II: a systematic review and meta-analysis of randomised controlled trials. BMJ open. 2011; 1(2): e000265.
47. Wiangkham T, Duda J, Haque MS, Rushton A. Development of an active behavioural physiotherapy intervention (ABPI) for acute whiplash-associated disorder (WAD) II management: a modified Delphi study. BMJ open. 2016; 6(9): e011764.
48. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655.
49. Wiangkham T, Duda J, Haque MS, Price J, Rushton A. Acute Whiplash Injury Study (AWIS): a protocol for a cluster randomised pilot and feasibility trial of an active behavioural physiotherapy intervention in an insurance private setting. BMJ open. 2016; 6(7): e011336.
50. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977; 84(2): 191-215.
51. Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther. 1991; 14(7): 409-15.
52. MacDermid JC, Walton DM, Avery S, Blanchard A, Etruw E, McAlpine C, et al. Measurement properties of the neck disability index: a systematic review. J Orthop Sports Phys Ther. 2009; 39(5): 400-17.
53. TRACsa. Clinical guidelines for best practice management of acute and chronic whiplash associated disorders: clinical resource guide. Adelaide: TRACsa: Trauma and Injury Rocovery; 2008.
54. Press MJ, Howe R, Schoenbaum M, Cavanaugh S, Marshall A, Baldwin L, et al. Medicare payment for behavioral health integration. N Engl J Med. 2017; 376(5): 405-7.