Department of Physical Medicine and Rehabilitation, Parkwood Hospital, London, Ontario, Canada.
Pain Res Manag. 2010 Sep-Oct;15(5):295-304. doi: 10.1155/2010/640164.
Whiplash-associated disorder (WAD) represents a significant public health problem, resulting in substantial social and economic costs throughout the industrialized world. While many treatments have been advocated for patients with WAD, scientific evidence supporting their effectiveness is often lacking. A systematic review was conducted to evaluate the strength of evidence associated with various WAD therapies. Multiple databases (including Web of Science, EMBASE and PubMed) were searched to identify all studies published from January 1980 through March 2009 that evaluated the effectiveness of any clearly defined treatment for acute (less than two weeks), subacute (two to 12 weeks) or chronic (more than 12 weeks) WAD. The present article, the second in a five-part series, evaluates the evidence for interventions initiated during the acute phase of WAD. Twenty-three studies that met the inclusion criteria were identified, 16 of which were randomized controlled trials with 'fair' overall methodological quality (median Physiotherapy Evidence Database score of 5.5). For the treatment of acute WAD, there was strong evidence to suggest that not only is immobilization with a soft collar ineffective, but it may actually impede recovery. Conversely, although exercise programs, active mobilization and advice to act as usual all appeared to improve recovery, it is not clear which of these interventions was the most effective. While there was also evidence supporting the use of pulsed electromagnetic field therapy and methylprednisolone infusion, the evidence was insufficient to establish the effectiveness of either of these treatments. Based on current evidence, activation-based therapy is recommended for the treatment of acute WAD; however, additional research is required to determine the relative effectiveness of various exercise⁄mobilization programs.
颈挥鞭伤相关性疾患(WAD)是一个严重的公共健康问题,在工业化国家造成了巨大的社会和经济成本。尽管有许多治疗方法被推荐用于 WAD 患者,但支持其疗效的科学证据往往缺乏。我们进行了一项系统评价,以评估各种 WAD 治疗方法的证据强度。我们检索了多个数据库(包括 Web of Science、EMBASE 和 PubMed),以确定所有发表于 1980 年 1 月至 2009 年 3 月的研究,这些研究评估了任何明确定义的治疗急性(少于 2 周)、亚急性(2 至 12 周)或慢性(超过 12 周) WAD 的有效性。本文是五部分系列的第二篇,评估了 WAD 急性期干预措施的证据。确定了符合纳入标准的 23 项研究,其中 16 项为总体方法学质量“一般”的随机对照试验(物理治疗证据数据库中位数评分为 5.5)。对于急性 WAD 的治疗,有强有力的证据表明,软颈圈固定不仅无效,而且实际上可能阻碍康复。相反,虽然运动方案、主动活动和照常活动的建议似乎都能改善康复,但不清楚哪种干预措施最有效。虽然也有证据支持脉冲电磁场治疗和甲基强的松龙输注,但证据不足以确定这两种治疗方法的有效性。基于目前的证据,建议对急性 WAD 采用基于激活的治疗;然而,需要进一步的研究来确定各种运动/活动方案的相对有效性。
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