Kongsted Alice, Qerama Erisela, Kasch Helge, Bach Flemming Winther, Korsholm Lars, Jensen Troels Staehelin, Bendix Tom
The Back Research Center Part of Clinical Locomotion Science, Backcenter Funen, University of Southern Denmark, Ringe, Denmark.
Spine (Phila Pa 1976). 2008 Oct 15;33(22):E843-8. doi: 10.1097/BRS.0b013e318182bee2.
Randomized parallel-group trial with 1-year follow-up.
To evaluate whether education of patients communicated orally by a specially trained nurse is superior to giving patients a pamphlet after a whiplash injury.
Long-lasting pain and physical disability after whiplash injuries are related to both serious personal suffering and huge socio-economic costs. Pure educational interventions after such injuries seem generally as effective as more costly interventions, but it is unknown if the way advice is communicated is of any importance.
Participants with relatively mild complaints after car collisions were recruited from emergency departments and GPs. A total of 182 participants were randomized to either: (1) a 1 hour-educational session with a specially trained nurse, or (2) an educational pamphlet. Outcome parameters were neck pain, headache, disability, and return to work. Recovery was defined as scoring pain 0 or 1 (0-10 point scale) and not being off sick at the time of the follow-ups.
After 3, 6, and 12 months 60%, 58%, and 66%, respectively of the participants had recovered. Group differences were nonsignificant on all outcome parameters, even though the outcome tended to be better for the group receiving personal advice.
Prognosis did not differ between patients who received personal education and those who got a pamphlet. However, a systematic tendency toward better outcome with personal communicated information was observed and the question how patients should be educated to reduce the risk of chronicity after whiplash is worth further investigation, since no treatment have been proven to prevent long-lasting symptoms, and all forms of advice or educational therapy are so cheap that even a modest effect justifies its use.
为期1年随访的随机平行组试验。
评估由经过专门培训的护士进行口头教育的患者与在挥鞭样损伤后给予患者宣传手册相比是否更具优势。
挥鞭样损伤后的长期疼痛和身体残疾既关乎严重的个人痛苦，也涉及巨大的社会经济成本。此类损伤后的单纯教育干预似乎通常与成本更高的干预同样有效，但尚不清楚建议的传达方式是否重要。
从急诊科和全科医生处招募车祸后症状相对较轻的参与者。总共182名参与者被随机分为：(1) 接受经过专门培训的护士进行的1小时教育课程，或 (2) 一份教育宣传手册。结果参数包括颈部疼痛、头痛、残疾状况和重返工作情况。恢复定义为在随访时疼痛评分为0或1（0 - 10分制）且未因病缺勤。
在3个月、6个月和12个月时，分别有60%、58%和66%的参与者康复。尽管接受个人建议的组的结果往往更好，但两组在所有结果参数上的差异均无统计学意义。
接受个人教育的患者与收到宣传手册的患者的预后没有差异。然而，观察到个人传达信息的结果有系统地倾向于更好的趋势，并且鉴于尚无治疗方法被证明可预防长期症状，且所有形式的建议或教育疗法成本低廉，即使效果不显著也值得使用，因此关于如何教育患者以降低挥鞭样损伤后慢性化风险的问题值得进一步研究。
