Whiplash-associated disorders are a common result of motor vehicle accidents and often lead to complex and prolonged recovery journeys for those affected.

To address the challenges that patients, healthcare providers and insurers face in managing whiplash, researchers from The University of Queensland and The University of Sydney, in collaboration with Motor Accident Insurance Commission and State Insurance Regulatory Authority, developed an innovative e-resource called MyWhiplashNavigator. 

This article summarises a presentation given by Professor Trudy Rebbeck and Dr Ana Paula Carvalho-e-Silva from The University of Sydney’s John Walsh Centre for Rehabilitation Research at the Research to Real World for Compensable Injury Symposium in June 2024, in which they explored the development and implementation of this tool and its potential impact on improving outcomes for people with whiplash-associated disorders. 

How it all started — a patient's journey

The impetus for developing MyWhiplashNavigator came from the typical experiences of patients with whiplash-associated disorders.

A case example illustrates the complex pathway of care. A 45-year-old woman involved in a rear-end motor vehicle accident 12 months ago navigates through emergency care, GP visits, physiotherapy, multiple medical referrals and imaging before eventually returning to physiotherapy. This circuitous journey, involving 8 steps over a year, highlighted the need for more efficient and effective strategies to manage this condition.

Current practice and outcomes

Research shows that around 40% of people with grade 2 whiplash-associated disorders receive MRI scans, despite their limited utility in diagnosis and prognosis. 

Referral pathways often lead to surgeons, even though few patients need surgical intervention. While most clinicians provide appropriate advice and exercise, they often do so irrespective of the prognostic risk. 

That means patients receive the same type and amount of care, regardless of whether they might do well or not so well. And that might be important to differentiate, because when we look at outcomes we see that people who are at low risk of a poor outcome do reasonably well, but those at medium or high risk don't recover well, suggesting they might need something a little different.

Guidelines to improve health outcomes
 
Clinical guidelines are developed to improve the quality and consistency of care, leading to better health outcomes, safety and cost-effectiveness. However, when implementing guidelines, it’s important to provide the key messages that address the existing gaps in practice. 

Here the gaps are:

• assessing the risk of poor prognosis using validated tools
• providing differential treatment based on risk stratification, and 
• ensuring that allied health practitioners and insurers receive bespoke implementation strategies.

Professor Rebbeck and Dr Carvalho-e-Silva developed a study that aimed to improve patient outcomes through a 3-phase approach:

Phase 1 — pre-implementation and mapping 

Insurers play a vital role in implementing the MyWhiplashNavigator, as they’re often the first point of contact for people with whiplash-associated disorders. Improving insurers' knowledge of key messages can positively influence patient outcomes. 

Phase 1 involved focus groups with 19 insurance personnel across New South Wales, Queensland and South Australia. That work revealed that 50% were aware of the guidelines and found them helpful in managing whiplash-associated disorders claims. But challenges they identified included:

• patients not engaging with the recommended treatment
• managing imaging requests
• dealing with differing medical opinions, and 
• the involvement of legal representatives. 

What resources did they use? 

When asked about their familiarity with MyWhiplashNavigator as a resource for claimants, 50% of the insurance personnel were aware of the website and acknowledged its usefulness as a resource for claimants. 

What resources did they need?

They highlighted the need for injury-grade explanations and treatment resources or links to relevant specialist providers.

How did they determine a claimant's risk of a poor outcome?

When asked how they determine a claimant's risk of a poor outcome, the responses revealed different approaches. And when it came to the matching of poor outcomes with treatment, 50% said they did match, some said they didn’t and others were unsure.

Referrals 

The participants commonly referred claimants to medical specialists, rehabilitation providers and primary healthcare. Most thought that referrals would be appropriate if the patient wasn’t improving within 6 weeks. However, some patients might not be referred for several months.

Scenario-based assessment

When presented with a case study of a young woman at low risk of recovering well whose GP requested an MRI, most said that they would support and approve the referral for imaging, even though the guidelines don’t recommend imaging for low-risk individuals

The insurance component in MyWhiplashNavigator

A dedicated component for insurers within the MyWhiplashNavigator website was developed. This component, which is not publicly accessible, provides insurers with:

• information on whiplash guidelines, including prognosis and recommendations for low-risk claimants
• injury-grade explanations
• treatment resources, and 
• links to relevant specialist providers.

Phase 2 — implementation 

This phase focused on these implementation strategies:

For insurers

• Three half-day workshops with insurers focused on the guidelines, key messages and education that challenged current beliefs about identifying individuals at risk of poor recovery.
• To promote more favourable communication strategies, case studies were used to encourage insurers to reflect on the language they currently use and consider alternative language that could positively influence outcomes. 
• Integrating evidence-based guidelines and resources into insurer’s daily workflow practice to promote better communication, risk assessment and timely intervention for claimants with whiplash-associated disorders. This includes a stepped process:

• • Day 1: Encouraging the claimant to complete the whiplash prediction tool.
  • Week 3: Inquiring about the claimant's recovery progress.
  • Week 6: Assessing if the claimant needs extra support based on their risk level (medium or high) and considering referral to a whiplash specialist.

For healthcare professionals 

Implementing MyWhiplashNavigator with healthcare professionals involved addressing their identified need for risk assessment resources, guidance on when to refer high-risk patients and access to whiplash specialists. 

The e-resource provides a stepped process for assessing risk domains and offers exercises to rehabilitate specific impairments. Case studies guide clinicians through the clinical reasoning process, from diagnosis and prognosis to treatment.

Phase 3 — Evaluation and next steps

MyWhiplashNavigator has been integrated into postgraduate education with the Australian Physiotherapy Association and undergraduate education at the University of Sydney.

Early data indicates promising engagement, with around 500 views of MyWhiplashNavigator pages in the last month. Students have reported that the case studies have helped them classify whiplash, identify impairments and develop appropriate treatment plans.

Ongoing evaluation will continue to assess outcomes such as reach, adoption and effectiveness.

The takeaway messages

MyWhiplashNavigator is an important step towards improving the management of whiplash-associated disorders. 

By engaging insurers, healthcare professionals and patients through tailored implementation strategies, this e-resource aims to streamline the patient journey, promote evidence-based practice and ultimately enhance outcomes for people with these disorders.

As evaluation continues, the insights gained will inform future refinements and expansions of this promising tool.

You can find more information about the tool here.

If you’d like to be involved

If you have any questions or would like to be involved in this and other projects (especially as a PhD candidate) you can contact Trudy.rebbeck@sydney.edu.au