CCRE Spinal Pain, Injury, and Health, Division of Physiotherapy, The University of Queensland, Australia.
Spine (Phila Pa 1976). 2011 Dec 1;36(25 Suppl):S335-42. doi: 10.1097/BRS.0b013e3182388449.
Expert debate and synthesis of research to inform future management approaches for acute whiplash disorders.
To identify a research agenda toward improving outcomes for acute whiplash-injured individuals to lessen the incidence of transition to chronicity.
International figures are concordant, estimating that 50% of individuals recover from pain and disability within 3 to 6 months of a whiplash injury. The remainder report continuing symptoms up to 1 to 2 years or longer postinjury. As no management approach to date has improved recovery rates, new clinical/research directions are required for early management of whiplash-injured patients.
A group of multidisciplinary researchers critically debated evidence and current research concerning whiplash from biological, psychological, and social perspectives toward informing future research directions for management of acute whiplash.
It was recognized that effective treatments for acute whiplash are constrained by a limited understanding of causes of whiplash-associated disorders. Acute whiplash presentations are heterogeneous leading to the proposal that a research priority was development of a triage system based on modifiable prognostic indicators and clinical features to better inform individualized early management decisions. Other priorities identified included researching effective early pain management for individuals presenting with moderate to high levels of pain; development of best education/information for acute whiplash; testing the efficacy of stratified and individualized rehabilitation, researching modes of delivery considering psychosocial modulators of pain and disability; and the timing, nature, and mode of delivery of cognitive-behavioral therapies. Directions were highlighted for future biomechanical research into injury prevention.
The burden of whiplash injuries, the high rate of transition to chronicity, and evidence of limited effects of current management on transition rates demand new directions in evaluation and management. Several directions have been proposed for future research, which reflect the potential multifaceted dimensions of an acute whiplash disorder.
专家辩论和研究综合，以提供急性挥鞭伤管理方法的未来方向。
确定改善急性挥鞭伤患者结局的研究议程，以减少向慢性转化的发生率。
国际数据一致，估计 50%的个体在挥鞭伤后 3 至 6 个月内从疼痛和残疾中恢复。其余的报告持续症状长达 1 至 2 年或更长时间。由于迄今为止没有任何管理方法提高了康复率，因此需要新的临床/研究方向来早期管理挥鞭伤患者。
一组多学科研究人员从生物学、心理学和社会角度批判性地辩论了有关挥鞭伤的证据和当前研究，以告知急性挥鞭伤管理的未来研究方向。
人们认识到，急性挥鞭伤的有效治疗受到对挥鞭伤相关疾病原因的有限理解的限制。急性挥鞭伤表现具有异质性，因此提出了一个研究重点是开发基于可改变的预后指标和临床特征的分诊系统，以更好地为个体化早期管理决策提供信息。确定的其他优先事项包括研究对中度至高度疼痛的个体进行有效的早期疼痛管理；制定急性挥鞭伤的最佳教育/信息；测试分层和个体化康复的疗效，研究考虑疼痛和残疾的心理社会调节因素的交付模式；以及认知行为疗法的时间、性质和交付模式。为未来的生物力学损伤预防研究指明了方向。
挥鞭伤的负担、向慢性转化的高转化率，以及现有管理对转化率影响有限的证据，都要求在评估和管理方面有新的方向。已经提出了几个未来研究的方向，这些方向反映了急性挥鞭伤障碍的潜在多方面维度。
