Gross A R, Aker P D, Goldsmith C H, Peloso P
School of Rehabilitation Science, McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada, L8N 3Z5.
Cochrane Database Syst Rev. 2000;1998(2):CD000962. doi: 10.1002/14651858.CD000962.
To track down the best estimate of efficacy of the various conservative management strategies for mechanical neck disorders, a four-part systematic review was prepared. Part four investigates the efficacy of patient education strategies as the therapeutic intervention.
This review of patient education is one of four reviews of conservative management of mechanical neck disorders. The other reviews address manual, physical and drug therapies. The objective of this review was to assess the effects of patient education for pain in adults with mechanical neck disorders.
We searched Medline, Embase, Chirolars, Index to Chiropractic Literature, Cinahl, Science Citation Index, Conference Proceedings Index, National Technical Information Services from 1985 to December 1993, reference lists of the retrieved articles and we contacted experts in the field.
Randomised trials or controlled clinical trials of patient educational strategies for adults with mechanical neck disorders.
Three reviewers independently assessed trial quality and two reviewers independently extracted data. Investigators were contacted to obtain data that could not be found in the published reports.
Three trials were included. Their methodological quality varied from weak to strong. One trial did not find a significant reduction in pain using group instructional strategies (neck school) and exercise with or without psychological counselling compared to no treatment (standardised mean difference 0.07, 95% confidence interval -0.51 to 0.66, and -0.37, 95% confidence interval -0.95 to 0.22, respectively). Another trial did not find a significant reduction in pain using individualised patient education (advice), anti-inflammatories and analgesics compared with placebo (standardised mean difference 0.24, 95% confidence interval -0.58 to 1.07). The third trial found that advice which included demonstrated mobilization exercises, verbal and written instruction on posture correction, the use of a collar, heat sources, muscle relaxation and analgesics gave significant pain relief compared with general advice about mobilisation after a period of rest and use of analgesics at 4 weeks of treatment (standardised mean difference -0.62, 95% confidence interval -1.05 to -0.19) but at 6 weeks of treatment there was no longer any difference (s.m.d. -0.37, 95% confidence interval -0.8 to 0.05). The first two trials lacked statistical power and the third was methodologically weak.
REVIEWER'S CONCLUSIONS: Patient education utilising individualised or group instructional strategies has not been shown to be beneficial in reducing pain for mechanical neck disorders.
为探寻各种保守治疗策略对颈部机械性疾病的最佳疗效评估，我们开展了一项分为四个部分的系统评价。第四部分研究患者教育策略作为治疗干预措施的疗效。
本次对患者教育的评价是颈部机械性疾病保守治疗四项评价之一。其他评价涉及手法治疗、物理治疗和药物治疗。本评价的目的是评估患者教育对患有颈部机械性疾病的成年人疼痛的影响。
我们检索了1985年至1993年12月期间的医学文献数据库（Medline）、荷兰医学文摘数据库（Embase）、脊椎按摩疗法文献索引数据库（Chirolars）、脊椎按摩疗法文献索引（Index to Chiropractic Literature）、护理学与健康领域数据库（Cinahl）、科学引文索引（Science Citation Index）、会议论文索引（Conference Proceedings Index）、国家技术信息服务处数据库（National Technical Information Services），检索了所获文章的参考文献列表，并联系了该领域的专家。
针对患有颈部机械性疾病的成年人的患者教育策略的随机试验或对照临床试验。
三名评价员独立评估试验质量，两名评价员独立提取数据。联系研究者以获取发表报告中未找到的数据。
纳入了三项试验。其方法学质量从弱到强不等。一项试验发现，与不治疗相比，采用小组指导策略（颈部学校）以及进行有或没有心理咨询的锻炼，疼痛没有显著减轻（标准化均数差值分别为0.07，95%置信区间为-0.51至0.66，以及-0.37，95%置信区间为-0.95至0.22）。另一项试验发现，与安慰剂相比，采用个体化患者教育（建议）、抗炎药和镇痛药，疼痛没有显著减轻（标准化均数差值为0.24，95%置信区间为-0.58至1.07）。第三项试验发现，包含示范松动练习、关于姿势矫正的口头和书面指导、使用颈托、热源、肌肉放松和镇痛药的建议，与关于休息一段时间后进行松动以及在治疗4周时使用镇痛药的一般建议相比，能显著减轻疼痛（标准化均数差值为-0.62，95%置信区间为-1.05至-0.19），但在治疗6周时不再有差异（标准化均数差值为-0.37，95%置信区间为-0.8至0.05）。前两项试验缺乏统计学效力，第三项试验在方法学上存在不足。
尚未证明采用个体化或小组指导策略的患者教育对减轻颈部机械性疾病的疼痛有益。
