颈部特定运动联合或不联合行为疗法对慢性挥鞭样损伤相关疾病心理因素的影响：一项为期2年随访的随机对照试验
The effect of neck-specific exercise with or without a behavioral approach on psychological factors in chronic whiplash-associated disorders: A randomized controlled trial with a 2-year follow-up.
作者信息
Overmeer Thomas, Peterson Gunnel, Landén Ludvigsson Maria, Peolsson Anneli
机构信息
Physiotherapy Department, School of Health, Care and Social Welfare, Mälardalen University, Västerås Centre for Health and Medical Psychology, Örebro University, Örebro Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping Centre for Clinical Research Sörmland, Uppsala University, Uppsala Rehab Väst, County Council of Östergötland, Department of Rehabilitation and Department of Medical and Health Sciences, Linköping University, Sweden.
出版信息
Medicine (Baltimore). 2016 Aug;95(34):e4430. doi: 10.1097/MD.0000000000004430.
BACKGROUND
To investigate the effect of neck-specific exercise with (NSEB) or without (NSE) a behavioural approach and prescribed physical activity (PPA) on general pain disability and psychological factors in chronic whiplash-associated disorders (WAD), grade 2 and 3, with a 2-year follow-up.
METHODS
A randomized controlled multi-centre study of 3 exercise interventions (NSE, NSEB or PPA) including a 2-year follow-up. A total of 216 volunteers with chronic WAD were recruited and 194 were analyzed, mean age 40.4 (Standard Deviation [SD] 11.4). Measures of general pain disability, pain catastrophizing, anxiety and depression, and kinesiophobia were evaluated at baseline, and 3, 6, 12 and 24 months with linear mixed models.
RESULTS
General pain disability decreased by 28% in the NSEB group from baseline to 3 months (P < 0.001) and the improvements in disability were maintained over time (6, 12 and 24 months P < 0.01) compared to the NSE (P > 0.42) and PPA groups (P > 0.43). Pain catastrophizing decreased in the NSE group from baseline to 6 and 12 months (P < 0.01) and in the NSEB group from baseline to 3 and 24 months (P < 0.01) compared to the PPA group (P > 0.82) that showed no change over time. The NSE group improved in kinesiophobia over time from baseline to12 months (P < 0.01) compared to the NSEB (P = 0.052) and the PPA groups (P > 0.74). Anxiety decreased over time from baseline to 12 and 24 months in the NSE group (P > 0.02), but not in the NSEB (P > 0.25) or the PPA (P > 0.50) groups. The PPA had no effect on general disability or any of the measured psychological factors.
CONCLUSION
This randomised controlled trial with a 2-year follow-up shows that physiotherapist-led neck-specific exercise with or without the addition of a behavioural approach had superior outcome on general disability and most psychological factors compared to the mere prescription of physical activity.
背景
探讨有（NSEB）或无（NSE）行为方法及规定体育活动（PPA）的颈部特定锻炼对慢性挥鞭样损伤相关疾病（WAD）2级和3级患者一般疼痛残疾及心理因素的影响，并进行为期2年的随访。
方法
一项对3种锻炼干预措施（NSE、NSEB或PPA）进行的随机对照多中心研究，包括为期2年的随访。共招募了216名慢性WAD志愿者，对194名进行分析，平均年龄40.4岁（标准差[SD]11.4）。在基线以及3、6、12和24个月时，采用线性混合模型评估一般疼痛残疾、疼痛灾难化、焦虑和抑郁以及运动恐惧。
结果
与NSE组（P>0.42）和PPA组（P>0.43）相比，NSEB组从基线到3个月一般疼痛残疾下降了28%（P<0.001），且残疾改善情况随时间得以维持（6、12和24个月时P<0.01）。与PPA组（P>0.82，随时间无变化）相比，NSE组从基线到6个月和12个月疼痛灾难化程度降低（P<0.01），NSEB组从基线到3个月和24个月疼痛灾难化程度降低（P<0.01）。与NSEB组（P=0.052）和PPA组（P>0.74）相比，NSE组从基线到12个月运动恐惧随时间改善（P<0.01）。NSE组从基线到12个月和24个月焦虑随时间降低（P>0.02），但NSEB组（P>0.
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