Freeman M D, Croft A C, Rossignol A M
Department of Public Health and Preventive Medicine, Oregon Health Sciences University School of Medicine, Portland, USA.
Spine (Phila Pa 1976). 1998 May 1;23(9):1043-9. doi: 10.1097/00007632-199805010-00015.
The two publications of the Quebec Task Force on Whiplash-Associated Disorders were evaluated by the authors of this report for methodologic error and bias.
To determine whether the conclusions and recommendations of the Quebec Task Force on Whiplash-Associated Disorders regarding the natural history and epidemiology of whiplash injuries are valid.
In 1995, the Quebec Task Force authored a text (published by the Societe de l'Assurance Automobile du Quebec) and a pullout supplement in Spine entitled "Whiplash-Associated Disorders: Redefining Whiplash and its Management." The Quebec Task Force concluded that whiplash injuries result in "temporary discomfort," are "usually self-limited," and have a "favorable prognosis," and that the "pain [resulting from whiplash injuries] is not harmful."
The authors of the current report reviewed the text and the supplement for methodologic flaws that may have threatened the validity of the conclusions and recommendations of the Quebec Task Force.
Five distinct and significant categories of methodologic error were found. They were: selection bias, information bias, confusing and unconventional use of terminology, unsupported conclusions and recommendations, and inappropriate generalizations from the Quebec Cohort Study.
The validity of the conclusions and recommendations of the Quebec Task Force regarding the natural course and epidemiology of whiplash injuries is questionable. This lack of validity stems from the presence of bias, the use of unconventional terminology, and conclusions that are not concurrent with the literature the Task Force accepted for review. Although the Task Force set out to redefine whiplash and its management, striving for the desirable goal of clarification of the numerous contentious issues surrounding the injury, its publications instead have confused the subject further.
本报告的作者对魁北克鞭打相关疾病工作组的两份出版物进行了方法学错误和偏差评估。
确定魁北克鞭打相关疾病工作组关于鞭打损伤自然史和流行病学的结论及建议是否有效。
1995年，魁北克工作组撰写了一篇文章（由魁北克汽车保险协会出版）以及发表在《脊柱》杂志上的一篇名为“鞭打相关疾病：重新定义鞭打及其管理”的插页增刊。魁北克工作组得出结论，鞭打损伤会导致“暂时不适”，“通常为自限性”，且“预后良好”，并且“（鞭打损伤所致的）疼痛并无危害”。
本报告的作者审查了该文章和增刊，以查找可能影响魁北克工作组结论及建议有效性的方法学缺陷。
发现了五个不同且显著的方法学错误类别。它们是：选择偏倚、信息偏倚、术语使用混乱且不规范、无依据的结论和建议，以及对魁北克队列研究的不恰当归纳。
魁北克工作组关于鞭打损伤自然病程和流行病学的结论及建议的有效性值得怀疑。这种有效性的缺乏源于存在偏倚、使用不规范术语以及与工作组所接受审查的文献不一致的结论。尽管工作组着手重新定义鞭打及其管理，力求实现澄清围绕该损伤的众多有争议问题这一理想目标，但其出版物反而使该主题更加混乱。
