Scholten-Peeters Gwendolijne G M, Neeleman-van der Steen Catharina W M, van der Windt Daniëlle A W M, Hendriks Erik J M, Verhagen Arianne P, Oostendorp Rob A B
Dutch Institute of Allied Health Care, Amersfoort, The Netherlands.
Spine (Phila Pa 1976). 2006 Apr 1;31(7):723-31. doi: 10.1097/01.brs.0000206381.15224.0f.
Randomized clinical trial.
To compare the effectiveness of education and advice given by general practitioners (GPs) with education, advice, and active exercise therapy given by physiotherapists (PTs) for patients with whiplash-associated disorders.
Available evidence from systematic reviews has indicated beneficial effects for active interventions in patients with whiplash-associated disorders. However, it remained unclear which kind of active treatment was most effective.
Whiplash patients with symptoms or disabilities at 2 weeks after accident were recruited in primary care. Eligible patients still having symptoms or disabilities at 4 weeks were randomly allocated to GP care or physiotherapy. GPs and PTs treated patients according to a dynamic multimodal treatment protocol primarily aimed to increase activities and influence unfavorable psychosocial factors for recovery. We trained all health care providers about the characteristics of the whiplash problem, available evidence regarding prognosis and treatment, and protocol of the interventions. The content of the information provided to patients during treatment depended on the treatment goals set by the GPs or PTs. Also, the type of exercises chosen by the PTs depended on the treatment goals, and it was not explicitly necessary that exercise therapy was provided in all patients. Primary outcome measures included neck pain intensity, headache intensity, and work activities. Furthermore, an independent blinded assessor measured functional recovery, cervical range of motion, disability, housekeeping and social activities, fear of movement, coping, and general health status. We assessed outcomes at 8, 12, 26, and 52 weeks after the accident.
A total of 80 patients were randomized to either GP care (n = 42) or physiotherapy (n = 38). At 12 and 52 weeks, no significant differences were found concerning the primary outcome measures. At 12 weeks, physiotherapy was significantly more effective than GP care for improving 1 of the measures of cervical range of motion (adjusted mean difference 12.3 degrees ; 95% confidence interval [CI] 2.7-21.9). Long-term differences between the groups favored GP care but were statistically significant only for some secondary outcome measures, including functional recovery (adjusted relative risk 2.3; 95% CI 1.0-5.0), coping (adjusted mean difference 1.7 points; 95% CI 0.2-3.3), and physical functioning (adjusted mean difference 8.9 points; 95% CI 0.6-17.2).
We found no significant differences for the primary outcome measures. Treatment by GPs and PTs were of similar effectiveness. The long-term effects of GP care seem to be better compared to physiotherapy for functional recovery, coping, and physical functioning. Physiotherapy seems to be more effective than GP care on cervical range of motion at short-term follow-up.
随机临床试验。
比较全科医生（GP）提供的教育与建议，和物理治疗师（PT）提供的教育、建议及主动运动疗法，对挥鞭样损伤相关疾病患者的疗效。
系统评价的现有证据表明，主动干预对挥鞭样损伤相关疾病患者有益。然而，哪种主动治疗最有效仍不清楚。
在初级保健机构招募事故发生2周后有症状或残疾的挥鞭样损伤患者。4周时仍有症状或残疾的符合条件患者被随机分配接受全科医生护理或物理治疗。全科医生和物理治疗师根据动态多模式治疗方案治疗患者，该方案主要旨在增加活动量并影响不利于康复的心理社会因素。我们对所有医疗保健提供者进行了关于挥鞭样损伤问题的特征、预后和治疗的现有证据以及干预方案的培训。治疗期间向患者提供的信息内容取决于全科医生或物理治疗师设定的治疗目标。此外，物理治疗师选择的运动类型也取决于治疗目标，并非所有患者都必须接受运动疗法。主要结局指标包括颈部疼痛强度、头痛强度和工作活动。此外，由一名独立的盲法评估者测量功能恢复、颈椎活动范围、残疾情况、家务和社交活动、运动恐惧、应对方式和总体健康状况。我们在事故发生后的8周、12周、26周和52周评估结局。
共80例患者被随机分配至全科医生护理组（n = 42）或物理治疗组（n = 38）。在12周和52周时，主要结局指标未发现显著差异。在12周时，物理治疗在改善一项颈椎活动范围指标方面比全科医生护理显著更有效（调整后平均差异12.3度；95%置信区间[CI] 2.7 - 21.9）。两组之间的长期差异有利于全科医生护理，但仅在一些次要结局指标上具有统计学意义，包括功能恢复（调整后相对风险2.3；95% CI 1.0 - 5.0）、应对方式（调整后平均差异1.7分；95% CI 0.2 - 3.3）和身体功能（调整后平均差异8.9分；95% CI 0.6 - 17.2）。
我们发现主要结局指标无显著差异。全科医生和物理治疗师的治疗效果相似。在功能恢复、应对方式和身体功能方面，全科医生护理的长期效果似乎比物理治疗更好。在短期随访中，物理治疗在颈椎活动范围方面似乎比全科医生护理更有效。
