Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Australia School of Psychology, Centre of National Research on Disability and Rehabilitation Medicine, The University of Queensland, Australia Centre of National Research on Disability and Rehabilitation Medicine, The University of Queensland, Australia Specialist Pain Medicine Physician and Rheumatologist, St Vincent's Clinical School, University of New South Wales, Australia.
Pain. 2013 Sep;154(9):1798-1806. doi: 10.1016/j.pain.2013.05.041. Epub 2013 May 29.
Acute whiplash is a heterogeneous disorder that becomes persistent in 40% to 60% of cases. Estimates of recovery have not changed in recent decades. This randomized, single-blind, controlled trial tested whether multidisciplinary individualized treatments for patients with acute whiplash (<4 weeks postinjury) could reduce the incidence of chronicity at 6 mo by 50% compared to usual care. Participants (n=101) were recruited from accident and emergency centres and the community. It was hypothesized that better recovery rates were achievable if the heterogeneity was recognised and patients received individualised interventions. Patients randomized to pragmatic intervention (n=49) could receive pharmaceutical management (ranging from simple medications to opioid analgesia), multimodal physiotherapy and psychology for post-traumatic stress according to their presentations. The treatment period was 10 wks with follow-up at 11 weeks and 6 and 12-months. The primary outcome was neck pain and disability (Neck Disability Index (NDI)). Analysis revealed no significant differences in frequency of recovery (NDI ≤ 8%) between pragmatic and usual care groups at 6 months (OR 95%, CI=0.55, 0.23-1.29), P=0.163) or 12 mo (OR 95%, CI=0.65, 0.28-1.47, P=0.297). There was no improvement in current nonrecovery rates at 6 mo (63.6%, pragmatic care; 48.8%, usual care), indicating no advantage of the early multiprofessional intervention. Baseline levels of pain and disability had a significant bearing on recovery both at 6 and 12 mo in both groups, suggesting that future research focus on finding early effective pain management, particularly for the subgroup of patients with initial high levels of pain and disability, towards improving recovery rates.
急性颈扭伤是一种异质性疾病，在 40%至 60%的病例中持续存在。近几十年来，对恢复的估计并没有改变。这项随机、单盲、对照试验测试了对于急性颈扭伤（受伤后<4 周）患者，与常规护理相比，多学科个体化治疗是否能将慢性疾病的发生率在 6 个月时降低 50%。参与者（n=101）从急诊中心和社区招募。研究假设，如果能识别异质性并为患者提供个体化干预，就能获得更好的恢复率。随机分配到实用干预组（n=49）的患者可以根据自己的表现接受药物管理（从简单的药物到阿片类镇痛药）、多模式物理治疗和创伤后应激的心理治疗。治疗期为 10 周，随访时间为 11 周、6 个月和 12 个月。主要结局是颈部疼痛和残疾（颈部残疾指数（NDI））。分析显示，在 6 个月（NDI≤8%）或 12 个月（NDI≤8%）时，实用干预组和常规护理组的恢复频率（NDI≤8%）无显著差异（OR95%CI=0.55,0.23-1.29,P=0.163）或 12 个月（OR95%CI=0.65,0.28-1.47，P=0.297）。6 个月时，当前非恢复率没有改善（实用护理组为 63.6%，常规护理组为 48.8%），这表明早期多专业干预没有优势。在两组中，6 个月和 12 个月时，疼痛和残疾的基线水平对恢复有显著影响，这表明未来的研究重点是寻找早期有效的疼痛管理方法，特别是针对初始疼痛和残疾水平较高的患者亚组，以提高恢复率。
