Hurwitz Eric L, Carragee Eugene J, van der Velde Gabrielle, Carroll Linda J, Nordin Margareta, Guzman Jaime, Peloso Paul M, Holm Lena W, Côté Pierre, Hogg-Johnson Sheilah, Cassidy J David, Haldeman Scott
Department of Public Health Sciences, John A. Burns School of Medicine, University of Hawaii at Mānoa, Honolulu, HI, USA.
J Manipulative Physiol Ther. 2009 Feb;32(2 Suppl):S141-75. doi: 10.1016/j.jmpt.2008.11.017.
Best evidence synthesis.
To identify, critically appraise, and synthesize literature from 1980 through 2006 on noninvasive interventions for neck pain and its associated disorders.
No comprehensive systematic literature reviews have been published on interventions for neck pain and its associated disorders in the past decade.
We systematically searched Medline and screened for relevance literature published from 1980 through 2006 on the use, effectiveness, and safety of noninvasive interventions for neck pain and associated disorders. Consensus decisions were made about the scientific merit of each article; those judged to have adequate internal validity were included in our best evidence synthesis.
Of the 359 invasive and noninvasive intervention articles deemed relevant, 170 (47%) were accepted as scientifically admissible, and 139 of these related to noninvasive interventions (including health care utilization, costs, and safety). For whiplash-associated disorders, there is evidence that educational videos, mobilization, and exercises appear more beneficial than usual care or physical modalities. For other neck pain, the evidence suggests that manual and supervised exercise interventions, low-level laser therapy, and perhaps acupuncture are more effective than no treatment, sham, or alternative interventions; however, none of the active treatments was clearly superior to any other in either the short- or long-term. For both whiplash-associated disorders and other neck pain without radicular symptoms, interventions that focused on regaining function as soon as possible are relatively more effective than interventions that do not have such a focus.
Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain; this was also true of therapies which include educational interventions addressing self-efficacy. Future efforts should focus on the study of noninvasive interventions for patients with radicular symptoms and on the design and evaluation of neck pain prevention strategies.
最佳证据综合分析。
识别、严格评价并综合1980年至2006年间关于颈部疼痛及其相关疾病的非侵入性干预措施的文献。
在过去十年中，尚未发表关于颈部疼痛及其相关疾病干预措施的全面系统文献综述。
我们系统检索了Medline，并筛选了1980年至2006年间发表的关于颈部疼痛及相关疾病非侵入性干预措施的使用、有效性和安全性的相关文献。对每篇文章的科学价值达成共识；那些被判定具有足够内部效度的文章被纳入我们的最佳证据综合分析。
在359篇被认为相关的侵入性和非侵入性干预文章中，170篇（47%）被认为具有科学可接受性，其中139篇与非侵入性干预措施相关（包括医疗保健利用、成本和安全性）。对于挥鞭样损伤相关疾病，有证据表明教育视频、松动术和运动似乎比常规护理或物理治疗方式更有益。对于其他颈部疼痛，证据表明手法和有监督的运动干预、低强度激光治疗以及可能的针灸比不治疗、假治疗或替代干预更有效；然而，在短期或长期内，没有一种积极治疗方法明显优于其他方法。对于挥鞭样损伤相关疾病和无神经根症状的其他颈部疼痛，专注于尽快恢复功能的干预措施相对比不专注于此的干预措施更有效。
我们的最佳证据综合分析表明，对于颈部疼痛患者，涉及手法治疗和运动的疗法比替代策略更有效；对于包括解决自我效能感的教育干预措施的疗法也是如此。未来的研究应集中于对有神经根症状患者的非侵入性干预措施的研究以及颈部疼痛预防策略的设计和评估。
