Issue link: https://www.massageandbodyworkdigital.com/i/68175
The guideline for determining if the textbook is secondary or tertiary requires us to look at the references provided in the back of the textbook. Do we stop there? Malleson, Brian Grottkau, MD, writing in the New England Journal of Medicine (348, no. 14 (April 3, 2003): 1413–14) about Andrew Malleson's Whiplash and Other Useful Illnesses. As an educator on whiplash and massage since 1988, I am familiar with much of the literature on whiplash. I recognized the theory that litigation hinders recovery and have found it controversial at best. Many studies have successfully demonstrated the opposing theory—that litigation and recovery have no bearing on each other. I also know that many studies that support the former theory cite something known as the "Lithuanian study," a project with suspect methods that have been criticized for more than a decade, although I did not know if that study had any influence on the statement made by Mr. Luchau. I decided to investigate this citation. Using the previously proposed structure for evaluating citations, this is what I found. PRIMARY, SECONDARY, AND TERTIARY SOURCES The first step in researching the research is to plug the citation into a research database like PubMed and see if it is available. Using the citation above, I went directly to the New England Journal of Medicine and discovered that the reference is a book review. The good news is that it is a book review in a peer-reviewed journal, which gives it good marks. The bad news is that a book review of a textbook is far removed from the original source and is therefore considered a tertiary source of information. The guideline for determining if the textbook is secondary or tertiary requires us to look at the references provided in the back of the textbook. I found Andrew Malleson's book, Whiplash and Other Useful Illnesses, almost page for page, on Google books.18 In searching the 62 pages of references, many are primary sources, but some are newspaper articles, magazine articles, and nonfiction.19, 20, 21 The textbook is not an original account of information, and it does not exclusively cite primary sources of information. Therefore, the textbook itself is a tertiary source. More importantly, we find it would have been relatively easy to go to a more direct source and quote the book and not a book review. 120 massage & bodywork july/august 2010 the author of the textbook, took the information about litigation hindering recovery from an original research study. The textbook is 544 pages long, potentially making it difficult to find the original research study where the quote was sourced. Luckily, Google books provides a search engine, allowing for a search of the text. I typed in the keywords "litigation hinders recovery" and got exactly what I was looking for. Three short pages were highlighted, and after a quick read I had all the information I needed. I was just steps away from quoting the original source: the infamous Lithuanian study, as suspected. From here, I went to PubMed, typed in "Schrader H and whiplash" and read the abstract of the original research, including his most recent study.22 LEVELS OF EVIDENCE Once we get our hands on the original research, we can assess the level of evidence of the study methods. In PubMed, I discovered that the original study was written in Norwegian, but the abstract was available in English. There is enough information available in the abstract, however, to assess the level of evidence. The sample size was 202, a moderate number of subjects, but had disproportionately more men than women, more than most whiplash studies. It was a retrospective study, taking place up to three years post- accident, and data was collected by a questionnaire. A control group was identified. The study was reproduced three years later with similar results. Strictly on the merits of its study design, I would place this study in the mid-range level of evidence. DUE DILIGENCE Mr. Luchau exercised full disclosure in stating that there is widespread disagreement on diagnosis, treatment, and even terminology of injuries referred to as whiplash. But he did