Expert Services Medicine, If P&C Insurance Company Ltd., PO Box 240, 1326 Lysaker, Norway.
Eur J Pain. 2009 Nov;13(10):1068-75. doi: 10.1016/j.ejpain.2008.12.006. Epub 2009 Jan 31.
Whiplash is the most common type of injury reported in traffic accidents, but the effectiveness of conservative treatment for whiplash lacks evidence.
To assess the effect of early multidisciplinary evaluation and advice on the frequency of chronic neck pain three years post-injury in persons with minor or moderate traffic injuries.
In an insurance setting, we tested the effect by (1) a risk score matched prospective cohort design, (2) a propensity score matched nested case-control design and, (3) a risk and propensity score adjusted multivariate analysis in an unmatched prospective cohort design. We simulated unobserved risk and propensity factors to evaluate the robustness of the results for hidden bias.
All three designs showed a significantly increased risk for chronic neck pain among those who received the intervention compared to those who did not. The relative risks ranged from 1.7 (95% CI: 1.0-2.6) to 2.6 (95% CI: 1.5-4.0). The results were robust to hidden bias.
The consistency of the findings across the different designs strongly suggest that early multidisciplinary evaluation and advice increased the risk of having chronic neck pain three years following a minor or moderate traffic injury. Literally, the intervention may therefore have done more harm than good.
挥鞭伤是交通事故中最常见的损伤类型，但保守治疗挥鞭伤的效果缺乏证据。
评估早期多学科评估和建议对轻微或中度交通事故后 3 年慢性颈痛发生率的影响。
在保险环境中，我们通过（1）风险评分匹配的前瞻性队列设计、（2）倾向评分匹配的嵌套病例对照设计和（3）未匹配的前瞻性队列设计中的风险和倾向评分调整的多变量分析来检验效果。我们模拟了未观察到的风险和倾向因素，以评估结果对隐藏偏差的稳健性。
所有三种设计均表明，与未接受干预的患者相比，接受干预的患者慢性颈痛的风险显著增加。相对风险范围为 1.7（95%可信区间：1.0-2.6）至 2.6（95%可信区间：1.5-4.0）。结果对隐藏偏差具有稳健性。
不同设计结果的一致性强烈表明，轻微或中度交通事故后早期多学科评估和建议增加了 3 年后慢性颈痛的风险。实际上，干预可能弊大于利。
