The elimination of compensation for pain and suffering is associated with a decreased incidence and improved prognosis of whiplash injury.

PurposeLean is a widely used quality improvement methodology initially developed and used in the automotive and manufacturing industries but recently expanded to the healthcare sector. This systematic literature review seeks to independently assess the effect of Lean or Lean interventions on worker and patient satisfaction, health and process outcomes, and financial costs.Data sourcesWe conducted a systematic literature review of Medline, PubMed, Cochrane Library, CINAHL, Web of Science, ABI/Inform, ERIC, EMBASE and SCOPUS.Study selectionPeer reviewed articles were included if they examined a Lean intervention and included quantitative data. Methodological quality was assessed using validated critical appraisal checklists. Publically available data collected by the Saskatchewan Health Quality Council and the Saskatchewan Union of Nurses were also analysed and reported separately.Data extractionData on design, methods, interventions and key outcomes were extracted and collated.Results of data synthesisOur electronic search identified 22 articles that passed methodological quality review. Among the accepted studies, 4 were exclusively concerned with health outcomes, 3 included both health and process outcomes and 15 included process outcomes. Our study found that Lean interventions have: (i) no statistically significant association with patient satisfaction and health outcomes; (ii) a negative association with financial costs and worker satisfaction and (iii) potential, yet inconsistent, benefits on process outcomes like patient flow and safety.ConclusionWhile some may strongly believe that Lean interventions lead to quality improvements in healthcare, the evidence to date simply does not support this claim. More rigorous, higher quality and better conducted scientific research is required to definitively ascertain the impact and effectiveness of Lean in healthcare settings.

Objective.—To test the effectiveness of a multidisciplinary management program for migraine treatment in a group, low cost, nonclinical setting. Design.—A prospective, randomized, clinical trial. Background.—Although numerous studies document the efficacy of pharmacological migraine management, it is unclear whether an effective long‐term management approach exists. Methods.—Eighty men and women were randomly assigned to 1 of 2 groups. The intervention group consisted of a neurologist and physical therapist intake and discharge, 18 group‐supervised exercise therapy sessions, 2 group stress management and relaxation therapy lectures, 1 group dietary lecture, and 2 massage therapy sessions. The control group consisted of standard care with the patient's family physician. Outcome measures included self‐perceived pain intensity, frequency, and duration; functional status; quality of life; health status; depression; prescription and nonprescription medication use; and work status. Outcomes were measured at the end of the 6‐week intervention and at a 3‐month follow‐up. Results.—Forty‐one of 44 patients from the intervention group and all 36 patients from the control group completed the study. There were no statistically significant differences between the 2 groups before intervention. Intention to treat analysis revealed that the intervention group experienced statistically significant changes in self‐perceived pain frequency (P  =  .000), pain intensity (P  =  .001), pain duration (P  =  .000), functional status (P  =  .000), quality of life (P  =  .000), health status (P  =  .000), pain related disability (P  =  .000), and depression (P  =  .000); these differences retained their significance at the 3‐month follow‐up. There were no statistically significant changes in medication use or work status. Conclusions.—Positive health related outcomes in migraine can be obtained with a low cost, group, multidisciplinary intervention in a community based nonclinical setting.

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Positive health-related outcomes in this mostly unresponsive condition can be obtained with a low-cost, group multidisciplinary intervention in a community-based, nonclinical setting.