Ritchie Carrie, Ehrlich Carolyn, Sterling Michele
Recover Injury Research Centre, NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, University of Queensland, Herston, QLD, 4006, Australia.
Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, 4131, Australia.
BMC Musculoskelet Disord. 2017 Dec 15;18(1):531. doi: 10.1186/s12891-017-1882-9.
Whiplash associated disorders (WAD) are the most common non-hospitalised injury resulting from a motor vehicle crash. Approximately 50% of individuals with WAD experience on-going pain and disability. Results from intervention trials for individuals with chronic WAD are equivocal and optimal treatment continues to be a challenge. It may be that traditional quantitative measures included in treatment trials have not captured the full benefits patients experience through participation in an intervention. The aim of the present study was to explore participant subjective experiences and perceptions of living with on-going WAD.
Twenty-seven individuals with chronic WAD participated in a one-on-one, semi-structured individual telephone interview. All interviews were audio-taped, transcribed verbatim and data were analysed using an inductive thematic analysis process.
Two themes emerged that described the experience of living with chronic WAD. First, all participants described navigating the healthcare system after their whiplash injury to help understand their injury and interpret therapeutic recommendations. Participants highlighted the need to 'find the right healthcare practitioner (HCP)' to help with this process. Many participants also described additional complexities in navigating and understanding healthcare incurred by interactions with compensation and funding systems. Second, participants described a journey of realisation, and the trial and error used to establish self-management strategies to both prevent and relieve pain. Participants described trying to understand the impact of their initial injury in relation to the gradual realisation that there may be on-going residual deficit. Seeking information from multiple sources, including personal experience gained through trial and error, was important in the search for acceptable management strategies.
Recovery from a whiplash injury is an adaptive process and more than elimination of pain or disability, therefore may be different from common clinical patient reported outcomes. Early identification of patient understandings of pain, expectations of recovery, symptoms and therapy may help merge patient and HCP understandings. Additionally, helping individuals to recognise symptom triggers and develop appropriate strategies to minimise triggers may actively engage patients in their recovery. Finally, acknowledgement and validation of the whiplash injury by HCPs is seen by many as a necessary step in the recovery process.
挥鞭样损伤相关疾病(WAD)是机动车碰撞导致的最常见的非住院性损伤。约50%的WAD患者经历持续性疼痛和残疾。针对慢性WAD患者的干预试验结果并不明确,最佳治疗仍然是一项挑战。可能是治疗试验中纳入的传统定量测量方法未能充分体现患者通过参与干预所获得的全部益处。本研究的目的是探讨参与者对患有持续性WAD的主观体验和认知。
27名慢性WAD患者参与了一对一的半结构化个人电话访谈。所有访谈均进行录音,逐字转录,数据采用归纳主题分析方法进行分析。
出现了两个描述慢性WAD患者生活体验的主题。首先,所有参与者都描述了在挥鞭样损伤后应对医疗保健系统以帮助了解自己的损伤并解读治疗建议的过程。参与者强调需要“找到合适的医疗保健从业者(HCP)”来协助这一过程。许多参与者还描述了与赔偿和资金系统互动在应对和理解医疗保健方面带来的额外复杂性。其次,参与者描述了一个认识过程,以及为建立预防和缓解疼痛的自我管理策略而进行的反复试验。参与者描述了试图理解初始损伤的影响,以及逐渐认识到可能存在持续性残留缺陷的过程。从多个来源获取信息,包括通过反复试验获得的个人经验,对于寻找可接受的管理策略很重要。
挥鞭样损伤的恢复是一个适应性过程,不仅仅是消除疼痛或残疾,因此可能与常见的临床患者报告结局不同。早期识别患者对疼痛的理解、恢复期望、症状和治疗方法,可能有助于融合患者和HCP的理解。此外,帮助个体识别症状触发因素并制定适当策略以尽量减少触发因素,可能会使患者积极参与自身恢复。最后,许多人认为HCP对挥鞭样损伤的认可和确认是恢复过程中的必要步骤。