Protocol of a randomized controlled trial of the effectiveness of physician education and activation versus two rehabilitation programs for the treatment of Whiplash-associated Disorders: The University Health Network Whiplash Intervention Trial

Background: Whiplash injuries are an important public health problem that is associated with significant disability and high health care utilization. Recent cohort studies suggest that physician care may be the most effective treatment for patients with whiplash-associated disorders. However, these findings have not been tested in a randomized controlled trial. The purpose of this study is to determine which of physician care or two rehabilitation programs of care is most effective in improving recovery of patients with recent whiplash associated disorders. Methods and Design: We designed a pragmatic randomized clinical trial. A total of 444 participants (148 in each of three arms) who reside in Southern Ontario, Canada will be recruited from a large insurer. We will include individuals who are 18 years of age or older and who are diagnosed with Grade I or II Whiplash-associated Disorders. Participants will be randomized to physician-based education and activation or one of two rehabilitation programs of care currently in use in Ontario. Our primary outcome, self-rated global recovery and all secondary outcomes (neck pain intensity, whiplash disability, health-related quality of life, depressive symptomatology and satisfaction with care) will be measured at baseline by a trial coordinator and at 6 weeks, 3, 6, 9 and 12 months follow-up by an interviewer who is blind to the participants' baseline characteristics and treatment allocation. We will also collect information on general health status, other injuries, comorbidities, expectation of recovery, work status, pain coping, legal representation, and co-interventions. The primary intention-to-treat analysis will compare time to recovery between the three interventions. This trial will have 90% power at an alpha of 0.05 to detect a 20% difference in the rate of perceived recovery at one year. Secondary analyses will compare the health outcomes, rate of recurrence and the rate of adverse events between intervention groups. Conclusion: The results of this study will provide the public, clinicians and policy makers much needed evidence on the effectiveness of common approaches used to manage whiplash-associated disorders. © 2008 Côté et al; licensee BioMed Central Ltd

Influência do manejo do solo nas propriedades químicas e físicas em topossequência na bacia do rio Araguaia, Estado do Tocantins

A conversão do Cerrado nativo em áreas de exploração agrícola pode modificar os processos de decomposição e síntese da matéria orgânica do solo e, assim, na disponibilidade de nutrientes. Objetivou-se avaliar as propriedades químicas e físicas do solo em topossequência caracterizada por apresentar uso com pastagem cultivada com Brachiaria brizantha ao lado do Cerrado nativo, na camada de 0- 15 cm de profundidade. O estudo foi realizado no município de Colmeia, Estado do Tocantins. Foram determinados 10 pontos de coleta (cinco para Cerrado nativo e cinco para pasto) para cada posição do relevo (topo, encosta e pedimento); em cada ponto amostral, foram coletados solos em três profundidades (0-5, 5-10 e 10- 15 cm), totalizando 90 amostras. Foram realizadas as seguintes análises químicas e físicas: C orgânico, P, K+, Ca2+, Mg2+, H + Al, pH e granulometria. O C orgânico não apresentou diferença (p > 0,05) entre os valores encontrados no Cerrado nativo e pastagem e as posições do relevo avaliadas. A conversão de Cerrado nativo para uso agropecuário reduziu os teores de P. Os teores de K trocável não foram alterados pela retirada da cobertura vegetal original. Observou-se aumento dos teores de areia quando se passou da meia-encosta para o pedimento.The conversion of native vegetation into agricultural areas can modify soil organic matter content and decomposition and synthesis processes and therefore the nutrient avalilability. The aim of this study was to evaluate the chemical and physical soil properties (0-15 cm depth) in a toposequence characterized by planted pasture beside the native Cerrado vegetation cover. The study was carried out in Colméia, State of Tocantins. Ten sampling points were determined (five samples in native vegetation and five samples in pasture) for each relief position (summit, midslope and footslope) and at each point soils were sampled at three depths (0-5, 5-10 and 10-15 cm), totaling 90 samples. The following chemical and physical properties were analyzed: organic C, P, K+, Ca2+, Mg2+, H + Al, pH, and texture. Organic C content found under native vegetation did not differ from pasture and the relief positions. The conversion from native vegetation to livestock use decreased P contents. The removal of native vegetation did not alter available K contents. There was an increase in sand content from midslope to the footslope positions