Carroll Linda J, Holm Lena W, Ferrari Robert, Ozegovic Dejan, Cassidy J David
Department of Public Health Sciences, School of Public Health, and Alberta Centre for Injury Control and Research, University of Alberta, Edmonton, Alberta, Canada.
J Rheumatol. 2009 May;36(5):1063-70. doi: 10.3899/jrheum.080680. Epub 2009 Feb 17.
Positive expectations predict better outcome in a number of health conditions, but the role of expectations in predicting health recovery after injury is not well understood. We investigated whether early expectations of recovery in whiplash associated disorders (WAD) predict subsequent recovery, and studied the role of "expectations" to predict recovery as determined by pain cessation and resolution of pain-related limitations in daily activities.
A cohort of 6,015 adults with traffic-related whiplash injuries was assessed, using multivariable Cox proportional hazards analysis, for association between these expectations and self-perceived recovery over a 1-year period following the injury. Recovery was assessed using 3 indices: self-perceived global recovery (primary outcome); resolution of neck pain severity; and resolution of pain-related limitations in daily activities.
After adjusting for the effect of sociodemographic characteristics, post-crash symptoms and pain, prior health status and collision-related factors, those who expected to get better soon recovered over 3 times as quickly (hazard rate ratio = 3.62, 95% confidence interval 2.55-5.13) as those who expected that they would never get better. Findings were similar for resolution of pain-related limitations and resolution of neck pain intensity, although the effect sizes for the latter outcome were smaller.
Patients' early expectations for recovery are an important prognostic factor in recovery after whiplash injury, and are potentially modifiable. Clinicians should assess these expectations in order to identify those patients at risk of chronic whiplash, and future studies should focus on the effect of changing these early expectations.
在多种健康状况下，积极期望预示着更好的结果，但期望在预测受伤后健康恢复中的作用尚未得到充分理解。我们调查了挥鞭样损伤相关疾病（WAD）患者早期的恢复期望是否能预测随后的恢复情况，并研究了“期望”在通过疼痛停止和日常活动中疼痛相关限制的解决来确定恢复情况时预测恢复的作用。
对6015名因交通相关事故导致挥鞭样损伤的成年人进行队列研究，采用多变量Cox比例风险分析，评估这些期望与受伤后1年内自我感知恢复之间的关联。使用3个指标评估恢复情况：自我感知的总体恢复（主要结局）；颈部疼痛严重程度的缓解；以及日常活动中疼痛相关限制的缓解。
在调整了社会人口学特征、事故后症状和疼痛、既往健康状况以及碰撞相关因素的影响后，那些期望很快好转的人恢复速度比那些认为自己永远不会好转的人快3倍多（风险率比 = 3.62，95%置信区间2.55 - 5.13）。对于疼痛相关限制的缓解和颈部疼痛强度的缓解，结果相似，尽管后一结局的效应量较小。
患者对恢复的早期期望是挥鞭样损伤后恢复的一个重要预后因素，并且可能是可改变的。临床医生应评估这些期望，以识别那些有慢性挥鞭样损伤风险的患者，未来的研究应关注改变这些早期期望的效果。
