Enabling change in whiplash management through a clinical pathway of care

Abstract

Best practice recommendations for whiplash management have changed considerably over the past few decades; however, have not been widely adopted in clinical practice. Clinical pathways are a promising strategy to enable practice change. The aim of this thesis was to explore selected aspects of practice change to support the implementation of a clinical pathway of care for whiplash and the administration of a randomised controlled trial that tests the effectiveness of the pathway. This thesis used several research methods, including retrospective audit of insurer files, focus group discussions, process evaluation, and a clinical trial. The audit of files showed that many aspects of practice in whiplash management were inconsistent with the guidelines. Themes generated from the focus groups suggested that recommendations requiring significant change in practice were not well accepted, explaining an important potential barrier to adherence. Other barriers identified included lack of clarity in recommendations and perceived patient expectations about management. The focus groups also supported the potential for wider use of whiplash specialists in a peer review role by better meeting the needs of the referring health professional. This finding supports one of the key components of the clinical pathway of care for whiplash and strongly shaped the further development of the pathway as an intervention in the randomised controlled trial. The thesis delivered a new and acceptable online tool, My Whiplash Navigator, as a resource to promote best practice. Finally, the thesis provided preliminary evidence that implementation of the clinical pathway of care has enabled change in aspects of practice. This thesis generated new knowledge that informed the implementation and evaluation of the clinical pathway of care for whiplash. Further, this thesis identified mechanisms to enable best practice management of whiplash and more broadly other high burden musculoskeletal conditions.