Division of Musculoskeletal Physiotherapy, Department of Health Sciences, Artesis University College Antwerp, Belgium.
Pain Physician. 2012 Sep-Oct;15(5):351-61.
Until now, there is no firm evidence for conservative therapy in patients with chronic Whiplash Associated Disorders (WAD). While chronic WAD is a biopsychosocial problem, education may be an essential part in the treatment and the prevention of chronic WAD. However, it is still unclear which type of educative intervention has already been used in WAD patients and how effective such interventions are.
This systematic literature study aimed at providing an overview of the literature regarding the currently existing educative treatments for patients with whiplash or WAD and their evidence.
Systematic review of the literature.
A systematic literature search was conducted in the following databases: Pubmed, Springerlink, and Web of Science using different keyword combinations. We included randomized controlled clinical trials (RCT) that encompass the effectiveness of education for patients with WAD. The included articles were evaluated on their methodological quality.
Ten RCT's of moderate to good quality remained after screening. Both oral and written advice, education integrated in exercise programs and behavioral programs appear effective interventions for reducing pain and disability and enhancing recovery and mobility in patients with WAD. In acute WAD, a simple oral education session will suffice. In subacute or chronic patients broader (multidisciplinary) programs including education which tend to modulate pain behavior and activate patients seems necessary.
Because of limited studies and the broad range of different formats and contents of education and different outcome measures, further research is needed before solid conclusions can be drawn regarding the use and the modalities of these educational interventions in clinical practice.
Based on this systematic literature study is seems appropriate for the pain physician to provide education as part of a biopsychosocial approach of patients with whiplash. Such education should target removing therapy barriers, enhancing therapy compliance and preventing and treating chronicity. Still, more studies are required to provide firm evidence for the type, duration, format, and efficacy of education in the different types of whiplash patients.
到目前为止，慢性挥鞭样损伤（Whiplash Associated Disorders，WAD）患者的保守治疗还没有确凿的证据。虽然慢性 WAD 是一种生物心理社会问题，但教育可能是治疗和预防慢性 WAD 的重要组成部分。然而，目前尚不清楚已经在 WAD 患者中使用了哪种类型的教育干预措施，以及这些干预措施的效果如何。
本系统文献研究旨在概述目前针对挥鞭伤或 WAD 患者的教育治疗方法及其证据。
系统文献回顾。
在 Pubmed、Springerlink 和 Web of Science 等数据库中，使用不同的关键词组合进行了系统的文献搜索。我们纳入了包含 WAD 患者教育有效性的随机对照临床试验（RCT）。对纳入的文章进行了方法学质量评估。
筛选后有 10 项 RCT 具有中等至良好的质量。口头和书面建议、纳入运动计划和行为计划的教育以及行为计划似乎都是有效的干预措施，可以减轻疼痛和残疾，促进 WAD 患者的康复和活动能力。在急性 WAD 中，简单的口头教育课程就足够了。在亚急性或慢性患者中，包括教育在内的更广泛（多学科）的方案似乎是必要的，因为这些方案往往可以调节疼痛行为并激发患者的积极性。
由于研究有限，以及教育的形式和内容以及不同的结局测量指标差异很大，因此在临床实践中使用这些教育干预措施的方式和效果方面，还需要进一步的研究才能得出确凿的结论。
基于本系统文献研究，疼痛医师作为生物心理社会治疗的一部分，为挥鞭伤患者提供教育似乎是合适的。这种教育应该针对消除治疗障碍、提高治疗依从性以及预防和治疗慢性疾病。然而，还需要更多的研究来提供关于不同类型的挥鞭伤患者的教育类型、持续时间、形式和效果的有力证据。
