Over a period of three years, the Québec Task Force sought to demarcate the borders of the body of evidence on the risk, diagnosis, management and prognosis of Whiplash-Associated Disorders (WAD). We found very little scientifically admissible data, as documented extensively in this Scientific Monograph and in the Official Report submitted to the sponsor, la Societé d'assurance automobile du Québec. The void, unfortunately, about what is known in prevention, diagnosis and rehabilitation is particularly noteworthy.

Nevertheless, we are confident that this Scientific Monograph is a major milestone in the struggle to improve our understanding of WAD and to improve the management of patients affected by this disorder. Despite the paucity of scientific evidence, we redefined and formally classified WAD. We established that most persons with WAD have a relatively benign disorder that resolves spontaneously in days or a few weeks and requires very little treatment. The benefits of early return to usual activities of daily living and normal work after whiplash injury have been emphasized throughout this monograph. We have proposed formal but flexible plans to improve the clinical care and management of WAD. Also, we have identified research priorities addressed to the welfare of injured persons, to the needs of clinicians attempting optimum care and to a better understanding of the pathogenesis and the evolution of WAD.

Ultimately, society as a whole must become better empowered to deal with the complex determinants of WAD and with the correction of its effects. The necessary multifaceted strategies required to address this problem are too daunting for any one clinical discipline, for any one sector of society, for any one state or province and for any one agency to take on with any chance of making significant progress. The partners in future quests will be disparate and diverse. Without attempting to be exhaustive, we should create teams with imaginative combinations of primary care physicians, physiotherapists, chiropractors, physiatrists, orthopedists, occupational therapists, ergonomists, neurosurgeons, radiologists, psychologists, psychiatrists, rheumatologists, epidemiologists, biostatisticians, computer experts, health policy analysts and engineers. At a different level, the resources and expertise of governments, research-funding agencies, insurance societies, patient associations and professional associations must be marshaled in a cohesive manner. The heterogeneous and complementary groups must pursue better care, relevant research and improved societal interventions simultaneously, and, in our view, urgently. Large gaps in our knowledge reinforce the need for better focused education, not only in disorders of the spine but musculoskeletal disease in general.

The governmental no-fault Québec Society of Automobile Insurance (SAAQ) sponsored the scholarly effort now diffused through this monograph. Having honored the members and President of the Task Force through scrupulous respect for its scientific independence, the SAAQ now endorses the Official Report they have received. More importantly, they now join the Task Force members in recognizing the starting point for the next phase. The SAAQ and the government of Québec will continue to be involved with important, meaningful inputs. For the challenges of WAD, the SAAQ has been a major catalyst; for the future it can be expected to stimulate and conduct developmental activities. But any progress will depend on a concerted international effort. We are optimistic that collaborative efforts will materialize and hopeful that the chief beneficiary will be the patient with WAD.