De Hertogh Willem J, Vaes Peter H, Devroey Dirk, Truijen Steven, Duquet William, Oostendorp Rob
Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium.
BMC Musculoskelet Disord. 2007 Apr 26;8:38. doi: 10.1186/1471-2474-8-38.
Treatment of headache disorders is not always optimal. Patients are treated in multiple ways, and the lack of scientific arguments for referral and the insufficient implementation of guidelines result in unclear treatment strategies. The coexistence of headache and neck pain can lead to the referral to a musculoskeletal physiotherapist. This treatment can only be successful if an underlying cervical segmental dysfunction is present. In such cases a physical treatment can be a valuable option that should be considered. The aim of this study is to identify prognostic therapeutic patient characteristics and to increase the number of correct physiotherapy referrals.
METHODS/DESIGN: This trial is designed to identify patient characteristics which can influence the prognosis of the patient. Patients with recurrent headache and co-existent neck pain are recruited via a multicenter setup. After screening for eligibility, subjects are tested at baseline and randomly allocated to one of two treatment groups. Testing includes the administering of questionnaires (a Headache Diagnosis Questionnaire, Headache Inventory List and the Headache Impact Test (HIT-6)) and physical tests (Thermal Stimuli, Manual Cervical Spine Examination and Pressure Algometry). Treatment groups are a usual care group (UC) administered by the General Practitioner (GP) and a usual care plus musculoskeletal physiotherapy treatment group (UCMT). UC is based on the Dutch GP Guideline for Headache. UCMT consists of the UC plus a combination of exercises and spinal cervical mobilisations. Follow-up measurements consist of the completion of the Headache Inventory List, the HIT-6 and scoring of the global perceived effect (GPE). The latter allowing the distinction between responders (positive effect) and non-responders (no effect or worse). Logistic regression analysis will be used to identify the specific patient characteristics of the responders and the non-responders. The additional value of the musculoskeletal physiotherapy will be examined. Follow-up measurements up to 52 weeks are scheduled.
This trial aims to identify prognostic patient characteristics, in order to supply a useful diagnostic tool for all health care workers, dealing with headache sufferers.
头痛疾病的治疗效果并非总是最佳。患者接受多种治疗方式，而转诊缺乏科学依据且指南执行不充分导致治疗策略不明确。头痛与颈部疼痛并存可能导致患者被转诊至肌肉骨骼物理治疗师处。只有存在潜在的颈椎节段性功能障碍时，这种治疗才可能成功。在这种情况下，物理治疗可以是一种值得考虑的有价值的选择。本研究的目的是确定预后性治疗患者特征，并增加正确的物理治疗转诊数量。
方法/设计：本试验旨在确定可能影响患者预后的患者特征。通过多中心设置招募复发性头痛且伴有颈部疼痛的患者。在筛选合格后，受试者在基线时接受测试，并随机分配到两个治疗组之一。测试包括问卷调查（头痛诊断问卷、头痛清单和头痛影响测试（HIT-6））和体格检查（热刺激、手动颈椎检查和压力痛觉测定）。治疗组分为由全科医生（GP）实施的常规护理组（UC）和常规护理加肌肉骨骼物理治疗组（UCMT）。UC基于荷兰全科医生头痛指南。UCMT包括UC以及运动和颈椎松动术的组合。随访测量包括完成头痛清单、HIT-6以及对总体感知效果（GPE）进行评分。后者可区分有反应者（积极效果）和无反应者（无效果或更差）。将使用逻辑回归分析来确定有反应者和无反应者的具体患者特征。将检查肌肉骨骼物理治疗的附加价值。计划进行长达52周的随访测量。
本试验旨在确定预后性患者特征，以便为所有治疗头痛患者的医护人员提供一种有用的诊断工具。
