5.1 INTRODUCTION
Interdisciplinary research for the chiropractic profession probably came alive for most members of the chiropractic profession with the involvement in the 1970s of Chung Ha Suh, Ph.D., and his colleagues at the Biomechanics Department of the University of Colorado, when they began a series of studies which have provided an extensive body of chiropractic-related scientific research.
As has been noted previously [See Chapter 4] Dr. Chung Ha Suh, was the first American college professor willing to ‘stick his neck out’ for chiropractic research. He had grown up in Korea, where he had not been subjected to the same life-long anti-chiropractic bias as his American colleagues. In undertaking the Colorado research, he had to withstand intense pressure from powerful forces within the American medical and academic establishments. The medical profession, particularly the AMA used a two pronged approach, namely condemnation for lack of scientific evidence, and preventing chiropractors from getting research funds and collaboration. [1]
Within Europe there was a development of interest in chiropractic and the work of a number of medical practitioners and their writings which are pro chiropractic. Some of the research from Germany which is medical in origin is quite prochiropractic. It is claimed that an American trained chiropractor and a medical doctor working during the war created what has led to on-going interest in chiropractic. As such there is a group of German Physicians known as “Die arztliche Forschungs- und Arbeitsgemeinschaft fur Chiropraktik” (Medical Research and Work Group for Chiropractic). [2]
Weiant and Goldschmidt went on to remark that in the first edition of their book they mentioned that this research group had a membership of some 200. [That was in 1957] By 1966, with their 4th edition they reported that the membership had grown to approximately 1000. [2]
5.2 CURRENT MULTI-DISCIPLINARY RESEARCH IN THE USA
Below are listed research projects funded for both new and ongoing research by the National Center for Complementary and Alternative Medicine. The list includes the project title, principal investigator, institution, and state. [3]
- Chiropractic
Title: Developmental Center for Clinical and Translational Science in Chiropractic
Specialty: Chiropractic
Principal Investigator: Dr. Christine Goertz, D.C.,
Description: This project conducted by the Palmer Centre for Chiropractic Research (PCCR) involved establishing a 4 year multi-disciplinary Developmental Center to assist in building research expertise. It involves 10 researchers from Palmer and investigators from Loyola University, University of Iowa, Mt Sinai Medical centre and Mines VA Hospital. . The main research involves evaluating non-rotary adjustments cervical spine problems through three projects. Project 1 evaluates the effectiveness of upper cervical adjustment for changing blood pressure for person with Stage I hypertension. Project 2 is a study of treating temporomandibular disorders with manipulation. Project 3 aims to develop, then assess a method of sham manipulation for the cervical spine.
5.3 CURRENT MULTI-DISCIPLINARY RESEARCH IN CANADA
In the meantime meaningful research projects are continuing at the Canadian Memorial Chiropractic College in Toronto, Ontario. The Research Agenda, available on the Website of CMCC sets out the parameters for research being conducted under the direction of the Dean of Graduate Education and Research, John J Triano, DC MA PhD FCCS[C] [Hon]. CMCC is recognized around the world for having a strong and innovative research program. [4]
The research agenda for CMCC has seen them create two Centres of Research Excellence. One center is to study treatment mechanics and the other centre is to focus on health policy matters and patient access issues. Although CMCC has over the years conducted both basic and clinical science work, the agenda for the long term is to focus on clinical studies. [4], [5]
1. The Centre for the Study of Mechanobiology, Injury, and Health [5]
This Centre will study the effects of mechanical stress on cell and tissue activity. The main emphasis will be on the issue of tissue mechanotransduction that is the way in which physical treatment is communicated to the tissue and how it to achieves its effect.
Researchers and clinicians at the centre will study injury mechanisms and how to achieve the best treatment results.
2. The Centre for Interprofessional Health Dynamics [5]
The Centre for Interprofessional Health Dynamics will study the dynamics of interprofessional healthcare and how chiropractic incorporates into the total filed of health care. They will also address matters relating to public health, health policy and how patients can benefit best from interprofessional health care.
The chiropractors at CMCC are working with a team at St. Michael’s Hospital, and have found that patient satisfaction and quality of care has improved.
A key role of the centre is become experts on policy development and implementation so that they can advise the important Health care policy makers to ensure patients have better access to quality health care.[5]
Research Chairs and Professorships at Canadian Universities
1. Dr. Greg Kawchuk DC, PhD
He currently holds the Canada Research Chair in Spinal Function and Associate Professorship within the Faculty of Rehabilitation Medicine at the Spinal Function Laboratory of the University of Alberta.
The Government of Canada recently strengthened research excellence by investing $159.1 million to fund 181 Canada Research Chairs newly awarded or renewed in 45 Canadian universities across the country [6]. Dr. Greg Kawchuk has had his “Chair in spinal function” at the University of Alberta renewed with a $500,000 grant.
2. Dr. Mark Erwin DC, PhD
(CCRF Scientist in Disc Biology and Assistant Professor Department of Orthopaedic Surgery, Spine Programme, Faculty of Medicine University of Toronto and Toronto Western Hospital)
’Dr Mark Erwin was appointed to the second chiropractic research Chair in Canada in 2003. This chair was in Disc biology and based at the University of Toronto.
Dr. Erwin’s research addresses degenerative disc and other disorder of connective tissue through investigation at the cellular/ molecular level. [7]
3. Dr. Jean-Sébastien Blouin DC, PhDCCRF/CIHR
Canadian Chiropractic Research Foundation Professorship in Spine Biomechanics and Neuro-Physiology at the University of British Columbia [8]
Dr. Blouin is a 1999 Doctor of Chiropractic graduate degree from the Universite of Quebec. He also holds a M.Sc. and Ph.D. degrees in Kinesiology from Universite Laval. His doctoral research was on forward head posture in sitting and how the head and neck stabilizes the position. He is well published with articles in journals such as Spine and Pain. [8]
Dr. Blouin has won two major awards. They are the renowned Michael Smith Foundation for Health Research Scholar Award and Establishment Grant with a value of $555,000. And the MSFHR Scholar Award of $80,000 per year for a period of 6 years. [9]
Dr. Blouin is presently at the University of British Columbia with the positions of ’CCRF Professorship in Spine Biomechanics and Human Neurophysiology and also the ’CCRF/CIHR Chiropractic Research Chair’ [9].
4. Dr. Martin Descarreaux DC, PhD
(Chair of Chiropractic Research FRCQ Platinum System Chiropractic Associate Professor Department of University of Quebec at Trois-Rivieres)
In late 2008 Dr. Descarreaux was made an Associate Professor after working for 5 years at UQTR. His Neuromuscular Rehabilitation Research Group has qualified for three years of repeat internal funding after attaining “group” status. For the next three years. Working with the French chiropractic association since January 2008 he is active in developing treatment guidelines for neck pain in France. [9]
5. Dr. Jason Busse DC, PhDCCRF/CIHR
Chiropractic Research Chair, McMaster University and Institute for Work & Health [9].
In 2008 Dr. Busse was the recipient of the CCRF/CIHR Chiropractic Research Chair at McMaster University and the Institute for Work and Health. The award is for 5-years with funding of $550,000 from the Canadian Institutes of Health Research (CIHR) and the Canadian Chiropractic Research Foundation (CCRF).
Dr. Busse is well published with 55 articles already in press and works in the Clinical Epidemiology & Biostatistics department at McMaster University.
He is the principal investigator in one project
Exploring Predictors of Prolonged Recovery Following Acceptance 2008 for Disability Benefits: A Systematic Review. with GH Guyatt and funded for $30000 by Great West Life Assurance Company ’
And a co-investigator in 3 projects:
- A Prospective Multicentre Randomized Controlled Trial: 2007-2011 Trial to Evaluate Therapeutic Ultrasound in the Treatment of Tibial Fractures (TRUST).This project is supported by CIHR& Smith and Nephew to a value of $2,025,469.
- Complementary and Alternative Medicine in Back Pain Utilization: 2008-2009 A Systematic Review. This project is supported by the Agency for Health Research and Quality and NCCAM/NIH with Funding of$198,000.
- Evaluating the need for and potential design of a no-fault 2008-2009 compensation program for immunization related injuries. This project is supported by CIHR with Funding of $145,274. [9]
6. Dr. Jill Hayden DC, PhD, CCRF/CIHR
Chiropractic Research Chair Assistant Professor Department of Community Health and Epidemiology Faculty of Medicine Dalhousie University.
Dr Jill Hayden is another recipient of a CCRF/CIHR Chiropractic Research Chair with a 5 year award of $525,000. She is based at Dalhousie University in Halifax and specializes is clinical epidemiology research addressing prognosis and systematic review for musculoskeletal problems.
In 2008 Dr. Hayden won a grant from the Cochrane Collaboration of $48,000 for project named “Approaches to Estimate and Present Baseline Risks: Recommendations for Cochrane Review Summary of Findings Tables.’
.Dr. Hayden is involved with two major peer review committees:
1. The CIHR Allied Health Professionals Peer Review Committee for New Investigators, and
2. The Nova Scotia Health Research Foundation Knowledge Transfer/Exchange Peer Review Committee.
Apart from the Committees Dr Hayden is also collaborating on a number of other projects. [9]
7. Dr. John Z Srbely DC, PhD, CCRF
Professorship in Spine Mechanics and Human Neurophysiology Assistant Professor College of Biological Sciences Department of Human Health and Nutritional Sciences University of Guelph, Ontario [9].
Dr Srbely has been holding the CCRF Professorship in Neurophysiology and Spine Biomechanicsat the University of Guelph since 2008. Funding for the post came from CCRF, Ontario Chiropractic Association and the University itself.
Dr. Srbely’s is an expert on myofascial pain. With specific knowledge of central sensitization of pain and how it shows clinically. His research will seek to expand on the knowledge of chiropractic’s role for the treatment of chronic and myofascial pain. The Professorship at the University excitingly gives access to the laboratories of neurophysiology and spine biomechanics, both of which are modern and headed by expert researchers.
Dr. Srbely has been recognized in the past through winning the CCA Young Investigator Award in 2005 and a Graduate Scholarship Award at the University of Guelph in 2006. Dr. Srbely completed his PhD in 2008. [9]
5.4 BONE AND JOINT DECADE 2000-2010 TASK FORCE ON NECK PAIN AND ITS ASSOCIATED DISORDERS
In December 2008 the Motor Accident Authority [MAA] in the Australian State of New South Wales hosted a seminar for health professionals and insurers to discuss and review the findings of the Bone and Joint Decade 2000-2010 ‘Task Force on Neck Pain and its Associated Disorders.’
One of the important associated disorders is ‘Whiplash injury’. It is useful to visit the MAA Web-site and review the material presented. A number of useful publications have been developed and although some may be controversial in their presentation they should be of interest to any person who has sustained such an unfortunate injury. The main items of interest are publications for professionals and publications for injured persons. The ‘injured persons” piece provides information about whiplash and the expected recovery over a 12 week post accident period. The publication is non-technical and written for the consumer. The professional items include guidelines, insurance claims guide and a technical report which discusses how the guidelines were created. [10]
The appropriate URL is: http://www.maa.nsw.gov.au/default.aspx?MenuID=115
5.4.1 HISTORY OF BONE AND JOINT DECADE 2000-2010 [10]
The Bone and Joint Decade was focused on improving the quality of life for people suffering from musculo-skeletal problems throughout the world. Specifically, the Bone and Joint Decade seeks to empower patients, promote research, enhance patient diagnosis, prevention and treatment and attempt to decrease the financial and social cost to society of musculo-skeletal disorders. The Bone and Joint decade was presented at the WHO Head office in January 2000 after being endorsed at the UN in late 1999. Many professional organisations are participants along with 61 countries.
5.4.2 About the Quebec Task Force [10]
The Quebec Task Force (QTF) on Whiplash Associated Disorders (WAD) was established in 1995. At that time only Whiplash was studied. Neck pain in general and occupation- related neck pain was not included. QTF suggested a second Task Force by formed by 2000.
Throughout the period from 1995 -1999 there were many good quality studies published including controlled trials and prognostic studies. In 1999 the Neck pain Task force was formally proposed with formation occurring in 2000. The task force was known as ’The WHO Collaborating Center Task Force on Neck Pain and Its Associated Disorders.’ Various administration posts were filled and some original research was developed. In 2002 the Task Force becomes known as “The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.” In 2005, the five year program of the Task force is extended by one year. The final meeting of the Task force occurs in October 2006 with proceedings finalized in 2007. The results appear in the Journal “Spine” in February 2008 with republication in the European Spine Journal.
5.4.3 COMPOSITION OF THE TASK FORCE [10]
a) The Administrative Committee
The administrative committee was headed by Dr. Scott Haldeman (president) with two Vice-Presidents namely Dr. Åke Nygren and Jon Schubert. The Scientific Secretary posts were held by Dr Linda J. Carroll and Dr J. David Cassidy.
b) The Scientific Secretariat [10]
The Scientific Secretariat was composed of 13 researchers with backgrounds in various fields such as chiropractic, orthopedic surgery and epidemiology among others.
The Task Force also incorporates numerous other individuals within its’ various committees and research projects.
Link:For review of biography of the administrative committee and scientific members URL: http://www.nptf.ualberta.ca/bios.htm
5.4.4 The Processes and Methods of the Task Force [10]
- The “Mandate” of the Task Force was to make reports on the evidence for neck pain. They looked for the best currently available research on risk, prognosis, diagnosis, effectiveness and safety. They were also tasked with identifying gaps or problems in the published literature.
- A “Best Evidence Synthesis” approach was used with all chapters being reviewed and debated by the Secretariat. Topics were put together by writing teams that summarized evidence and presented conclusions. The overall clinical, research policy statements of the group was formulated through discussion and consensus.
- A number of original Research Projects have been completed as part of the study. Amongst them are those listed below:
- Epidemiology of Vertebrobasilar Stroke in Two Canadian Provinces by Eleanor Boyle, Pierre Cote and J. David Cassidy.
- Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-based Case Control and Case-crossover Study. By J. David Cassidy, Eleanor Boyle, Pierre Côté, Helen He, Sheilah Hogg-Johnson, Frank Silver, Susan Bondy.
- Decision analysis of non-steroidal anti-inflammatory drug, exercise, and manual therapies: a comparison of the health outcomes associated with common therapies for troublesome neck pain. By Gabrielle van der Velde, Sheilah Hogg-Johnson, J. David Cassidy, Pierre Côté
- The Prevalence and Incidence of Work Absenteeism Associated with Neck Pain: A Cohort of Ontario Workers’ Compensation Claimants. By Pierre Côté, Vicki Kristman, Marjan Vidmar, Dwayne Van Eerd, Sheilah Hogg-Johnson, Dorcas Beaton. [10]
5.4.5 TWO STUDIES FROM BONE AND JOINT DECADE 2000-2010
1. The Conceptual Model from the Decade of the Bone and Joint 2000-2010 Task Force on Neck Pain & Its Associated Disorders.
Background of the Neck pain task force.
The Neck Pain Task Force was formed to study research evidence about neck pain. The task force needed to establish a single organizing model to review the literature.
The original proposal was developed in 2000 with separation into risk, diagnosis, prognosis and treatment factors.
In 2004 a link was established with the International Classification of Functioning Disability and Health (ICF).
The Twofold Purpose of the Task Force was to formulate an integrated model neck pain that linked epidemiological factors (incidence, prevalence) and neck pain treatment. They also sort to aggregate and review the present knowledge base and determine any gaps.
The conceptual elements used to develop the model included pain classification, functional disability classification, items from the WAD task force and admissible studies among others.
In 2006 the model was simplified to become focused on persons with neck pain and those at risk.
A new conceptual model for neck pain dealing with onset, course, care and consequences was presented by The Task Force. The model is patient centred (those with neck pain and those at risk), describes neck pain as episodic; is used to examine scientific data; defines manage options, choices and consequences; shows the short-and long-term impacts of neck pain episodes; discusses the multiple factors that influence neck pain, and establishes a “five-axis classification” for reviewing neck pain publications. [12]
2. Course and Prognostic Factors for Neck Pain in Whiplash-Associated Disorders (WAD)
This study was a best evidence synthesis project about the course and prognostic factors for neck pain and its associated disorders in Grades I–III whiplash-associated disorders (WAD).
Background data about the topic.
WAD Knowledge on recovery helps to guide patient recovery expectations. In order to decrease the cost burden of WAD the key prognostic factors of WAD need to be identified. Appropriate identification will aid planning, deciding necessary interventions and effective compensation plans.
A critical review of the literature published from 1980 to 2006 was the method chosen by the Task Force. Studies had to meet validity criteria to be included in the study.
Results
Following the literature review, the Task Force identified 226 articles on the course and prognostic factors for neck pain. These articles were subjected to critical review, following which 70 articles that
meet scientific merit criteria were accepted. Of the 70, 47 of the papers were on WAD. From the evidence it could be seen that about 50% of people diagnosed with WAD will have neck pain at 1 year post- injury. The predictive factors for slower recovery were more initial pain and symptoms, and more initial disability. Some collision factors are prognostic such as headrest type. Post-injury depression, fear of movement and other psychological factors were prognostic for slower or incomplete recovery.
The Neck Pain Task Force was able to formulate a baseline for the course and prognosis for WAD based on current evidence and also concluded that. Recovery from WAD appears to be multifactorial. [10]
5.4.6 QUÉBEC TASK FORCE ON WHIPLASH-ASSOCIATED DISORDERS
The Québec Task Force (QTF) was established to study and submit a report on whiplash-associated disorders. The QTF was funded by the Quebec province public auto insurer and in 1995 they reported their findings. The QTF put forward specific recommendations for WAD in the areas of prevention, diagnosis and treatment. The recommendations have been used to create a guideline for claims management, classification and treatment of WAD. The QTF report “Redefining “Whiplash” was released in the April 15, 1995 issue of the journal Spine. [11]
Dr. J. David Cassidy, DC, PhD, FCCS(C), at that time an Assistant Professor and Director of Research within the Department of Surgery at the Division of Orthopedics at the Royal University Hospital of the University of Saskatchewan, Saskatoon, Canada was a member of the editorial board of the QTF of WAD and also represented Chiropractic. THE QTF was composed predominantly of individuals from other health-related fields.
Link: Members of the Quebec Task Force of WAD
URL: http://www.chiro.org/LINKS/FULL/Quebec_Task_Force/members.htm
The Scientific Monograph of the Quebec Task Force on Whiplash-Associated Disorders is an abridged version of the Official Report entitled Whiplash-Associated Disorders (WAD) of the Quebec Task Force on Whiplash-Associated Disorders, also entitled in French Les Troubles Associés à l’Entorse Cervicale (TAEC). Throughout the Monograph one can refer to the Official Report (Official Report of the Quebec Task Force on Whiplash-Associated Disorders) and the Scientific Monograph (Scientific Monograph of the Quebec Task Force on Whiplash-Associated Disorders). The Official Report is the authorized and endorsed report of the Task Force.
The most important contribution of the Task Force may be the Quebec Classification of Whiplash-Associated Disorders. The classification provides categories that are jointly exhaustive and mutually exclusive, clinically meaningful, stand the test of common sense and are ’user-friendly‘ to investigators, clinicians and patients. Future research will decide whether refinement is required to enhance the discriminating properties of the classification and to establish the validity of the categories proposed.
Links:
Report of Quebec Task Force of WAD Scientific Monograph of the Quebec Task Force on Whiplash-Associated Disorders
URL: http://www.chiro.org/LINKS/FULL/Quebec_Task_Force/Quebec_Task_Force_on_WAD.html [13]
Treatment Recommendations
The recommendations of the Quebec Task Force for treatment for individuals with whiplash associated disorders are:
Grade 1-3: patient can be treated with manipulation or mobilization and range of motion exercises. Traction and posture advice can be used alongside other treatments.
Rest is not accepted for grade 1, but up to 4 days is allowed for Grade 2 and 3.
Grade WAD 2-3 can include drugs such as non-narcotic pain killers and non-steroidal anti-inflammatory drugs. Drug prescription is restricted to a maximum period of 3 weeks.
Cervical collars are not used for Grade 1 but can be used for up to 72 hours for Grade 2 and 3. . Encouraging normal activities to start as soon as possible is also recommended to ensure faster recovery. [11], [12]
The Grading Classification of the Québec Task Force on WAD
Five grades of Whiplash-Associated Disorder were defined by the Quebec Task Force on Whiplash-associated Disorders (WADs) [11]:
- Grade 0: no neck pain, stiffness, or any physical signs are noticed
- Grade 1: neck complaints of pain, stiffness or tenderness only but no physical signs are noted by the examining physician.
- Grade 2: neck complaints and the examining physician finds decreased range of motion and point tenderness in the neck.
- Grade 3: neck complaints plus neurological signs such as decreased deep tendon reflexes, weakness and sensory deficits.
- Grade 4: neck complaints and fracture or dislocation, or injury to the spinal cord.
The findings of the QTF on WAD have also been subject to review by others. The review paper by Teasell and Merskey [14] claims that the information on natural history of WAD is flawed due to recovery data being based on discontinuation of insurance payments rather than on physical recovery. They also claim that the classification and management system is arbitrary and there is insufficient quality evidence to make treatment recommendations. [14]
5.5 OUTCOME ON THE BONE AND JOINT DECADE
A Medical Opinion
The observations made by a well respected medical practitioner [15] who has taken the time to study the full details of this massive study as presented in Spine and then report his opinion may save the less studious practitioner considerable time, but if any serious clinician takes his advice and truly looks at the evidence brought together in this study then they should be well rewarded for their efforts. Among his observations are that neck pain is a common problem but not so widely studied as lower back pain. He notes that the task force has put together much information that can be used to help patients suffering from neck pain and that clinicians should use the information.
Article title: The Bone and Joint Decade (2000–2010) Task Force on Neck Pain and Its Associated Disorders: A Clinician’s Perspective by Dr Federico Balagué, MD [15]:
REFERENCES
- Sito Chiropractic. Chiropractic research: Dr. Suh and the University of Colorado project [Online]. 2010 [cited 2010 Apr]; Available from: URL:http://www.sitochiropractic.com/nrp.html
- Wieant CW, Goldschmodt S. Medicine and chiropractic. Gluckstadt (Germany): J.J. Augustin; 1966. p.91.
- RePORTER Project information (5U19AT004663-03) Developmental center for clinical and translational science in chiropractic: an introduction; [cited 2012 May] Available from URL: http://projectreporter.nih.gov/project_info_description.cfm?aid=7896671&icde=12504656&ddparam=&ddvalue=&ddsub=&cr=7&csb=default&cs=ASC
- Canadian Memorial Chiropractic College. CMCC research overview [Online]. 2010 [cited 2010 Apr]; Available from: URL: http://www.cmcc.ca/RESEARCH/Overview/tabid/290/Default.aspx
- CanadianMemorialChiropracticCollege. CMCC research agenda [Online]. 2010 [cited 2010 Apr]; Available from: URL:http://www.cmcc.ca/RESEARCH/ResearchAgenda/tabid/194/Default.aspx
- Canada Research Chairs. Government of Canada strengthens research excellence by investing $159.1 million to fund 181 Canada research chairs across the country [Online]. 2009 Sep 23 [cited Apr 2010]; Available from: URL:http://www.chairs-chaires.gc.ca/media-medias/releases-communiques/2009/september-septembre-eng.aspx
- UHNOrthopaedicsTorontoWesternHospital Scientists. Surgeons & faculty: Mark Erwin, DC, PhD [Online]. 2010 [cited 2010 April]; Available from:URL: http://www.tgwhf.ca/mha/scientists_erwin.asp
- BC Chiropractic Association. Chiropractic research professorship awarded at UBC, 2006, Oct 12 Press Release [online] http://www.bcchiro.com/bcca/news-and-events/documents/0610-news_ubcprofessorship.pdf
- Canadian Chiropractic Research Bulletin #15. Recent research awards [Online]. 2008 Oct 15 [cited 2010 Apr]; Available from: URL: http://files.chiropracticcanada.ca/pdf/researchbulletinno15.pdf
- Carroll L. History (Composition-Process) [Online]. 2008 Dec 1 Australia [cited 2010 Apr]; p.1-37.Available from:URL:http://www.maa.nsw.gov.au/default.aspx?MenuID=115
- Carroll. Bone and joint task force conceptual model: should we change the way we look at neck pain? A proposal for a new paradigm.p.1-39.
- Carroll L, Holm L, Hogg-Johnson S,Côté P, Cassidy D, Haldeman S, et al. Course and prognostic factors for neck pain in whiplash-associated disorders (WAD). Eur Spine J [Serial online] 2008 Apr [cited 2010 Apr];17)1):83-92. Available from: URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2271101/
- Report of Quebec Task Force of WAD Scientific Monograph of the Quebec Task Force on Whiplash-Associated Disorders Available from: URL:http://www.chiro.org/LINKS/FULL/Quebec_Task_Force/Quebec_Task_Force_on_WAD.html
- Pulsus: Pain research & Management. The Quebec Task Force in whiplash-associated disorders and the British Columbia Initiative: a study of insurance industry initiatives [Online]. 1999 Autumn [cited 2010 Apr]; 4(3):141-149. Available from: URL:http://www.pulsus.com/journals/abstract.jsp?jnlKy=7&atlKy=2666&isuKy=532&isArt=t&HCtype=Consumer
- Balagué, F. Bone and Joint Decade (2000–2010) Task Force on neck pain and its associated disorders: a clinician’s perspective. JMPT [serial online] 2009 Feb [cited 2010 Apr];32:2. Available from: URL:http://www.jmptonline.org/issues?Vol=32
