Gross Anita R, Kaplan Faith, Huang Stacey, Khan Mahweesh, Santaguida P Lina, Carlesso Lisa C, Macdermid Joy C, Walton David M, Kenardy Justin, Söderlund Anne, Verhagen Arianne, Hartvigsen Jan
McMaster University, Hamilton, ON, Canada;
Open Orthop J. 2013 Sep 20;7:530-61. doi: 10.2174/1874325001307010530. eCollection 2013.
To conduct an overview on psychological interventions, orthoses, patient education, ergonomics, and 1⁰/2⁰ neck pain prevention for adults with acute-chronic neck pain.
Computerized databases and grey literature were searched (2006-2012).
Systematic reviews of randomized controlled trials (RCTs) on pain, function/disability, global perceived effect, quality-of-life and patient satisfaction were retrieved.
DATA COLLECTION & ANALYSIS: Two independent authors selected articles, assessed risk of bias using AMSTAR tool and extracted data. The GRADE tool was used to evaluate the body of evidence and an external panel to provide critical review.
We retrieved 30 reviews (5-9 AMSTAR score) reporting on 75 RCTs with the following moderate GRADE evidence. For acute whiplash associated disorder (WAD), an education video in emergency rooms (1RCT, 405participants] favoured pain reduction at long-term follow-up thus helping 1 in 23 people [Standard Mean Difference: -0.44(95%CI: -0.66 to -0.23)). Use of a soft collar (2RCTs, 1278participants) was not beneficial in the long-term. For chronic neck pain, a mind-body intervention (2RCTs, 1 meta-analysis, 191participants) improved short-term pain/function in 1 of 4 or 6 participants. In workers, 2-minutes of daily scapula-thoracic endurance training (1RCT, 127participants) over 10 weeks was beneficial in 1 of 4 participants. A number of psychosocial interventions, workplace interventions, collar use and self-management educational strategies were not beneficial.
REVIEWERS' CONCLUSIONS: Moderate evidence exists for quantifying beneficial and non-beneficial effects of a limited number of interventions for acute WAD and chronic neck pain. Larger trials with more rigorous controls need to target promising interventions.
对针对急慢性颈部疼痛成人的心理干预、矫形器、患者教育、人体工程学以及一级/二级颈部疼痛预防进行综述。
检索计算机化数据库和灰色文献（2006 - 2012年）。
检索关于疼痛、功能/残疾、总体感知效果、生活质量和患者满意度的随机对照试验（RCT）的系统评价。
两名独立作者选择文章，使用AMSTAR工具评估偏倚风险并提取数据。使用GRADE工具评估证据体，并由一个外部专家组进行批判性审查。
我们检索到30篇综述（AMSTAR评分为5 - 9分），报告了75项RCT，具有以下中等质量的GRADE证据。对于急性挥鞭样损伤相关疾病（WAD），急诊室的教育视频（1项RCT，405名参与者）在长期随访中有利于减轻疼痛，每23人中就有1人受益[标准化均数差：-0.44（95%CI：-0.66至-0.23）]。长期使用软颈托（2项RCT，1278名参与者）并无益处。对于慢性颈部疼痛，身心干预（2项RCT，1项荟萃分析，191名参与者）使4名或6名参与者中的1名在短期疼痛/功能方面得到改善。在工作人群中，为期10周、每天进行2分钟的肩胛胸廓耐力训练（1项RCT，127名参与者）使4名参与者中的1名受益。一些心理社会干预、工作场所干预、颈托使用和自我管理教育策略并无益处。
对于急性WAD和慢性颈部疼痛的有限数量干预措施的有益和无益效果进行量化，存在中等证据支持。需要开展更严格对照的更大规模试验，以针对有前景的干预措施。
