Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.
PLoS One. 2018 Jun 12;13(6):e0198352. doi: 10.1371/journal.pone.0198352. eCollection 2018.
Globally, road transport accidents contribute significantly to mortality and burden of disability. Up to 50 million people suffer a transport-related non-fatal injury each year, which often leads to long-term disability. A substantial number of people with minor injuries struggle to recover and little is known about the factors leading to poor or non-recovery. The aim of this paper is to present a systematic review of biopsychosocial factors related to poor or non-recovery after a minor transport-related injury.
Studies were selected through searches of PubMed, Medline, Embase, and Cochrane library. Methodological quality was assessed using a Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklist for quantitative cohort studies and Standards for Reporting Qualitative Research (SRQR) checklist for qualitative articles. Data were extracted using the Cochrane data extraction tool based on the biopsychosocial model of health (BPS). In total, there were 37 articles included. However, heterogeneity of the techniques and tools used to assess factors and outcomes across studies meant that pooling of results to determine biopsychosocial factors most predictive of poor or non-recovery was not possible. Hence, a narrative synthesis was conducted and shown multiple factors to be associated with poorer outcomes or non-recovery, most being identified in the biological and psychological domain of the BPS model. Factors that were the most representative across studies and have shown to have the strongest associations with poor or non-recovery were high initial pain intensity, pain duration and severity, pre-accident physical and mental health status and pain catastrophising.
This review demonstrates the complexity of recovery and a challenge in reporting on predictors of recovery. It is evident that a range of multi-factorial biopsychosocial factors impact recovery. These factors are often inter-connected and multi-faceted and therefore, it was not feasible to select or focus on one single factor. In defining the most predictive factors, further research is required, yet the consensus around which tools to use to measure recovery outcomes is needed and is highly recommended. Regardless of the descriptive nature, the review demonstrated that high levels of post-injury pain are associated with poorer outcomes such as chronic pain and physical and mental disability. Therefore, early targeting of modifiable factors such as pain, pain catastrophizing and arising comorbidities such as PTSD, depression and anxiety may assist in reducing chronic pain and ongoing related disabilities.
Systematic review protocol was registered in International Prospective Register for Systematic Reviews (PROSPERO) on 14 December 2016. Registration number CRD42016052276.
在全球范围内，道路交通伤害对死亡率和残疾负担的影响很大。每年有多达 5000 万人遭受与交通相关的非致命伤害，这往往导致长期残疾。相当多的轻伤患者难以康复，而对于导致康复不良或无法康复的因素知之甚少。本文旨在系统综述与轻微交通相关损伤后康复不良或无法康复相关的生物心理社会因素。
通过对 PubMed、Medline、Embase 和 Cochrane 图书馆的检索，选择了研究。使用苏格兰校际指南网络 (SIGN) 对定量队列研究进行了批判性评估清单和对定性文章的标准报告定性研究 (SRQR) 清单评估方法学质量。使用基于健康的生物心理社会模型 (BPS) 的 Cochrane 数据提取工具提取数据。共有 37 篇文章入选。然而，由于研究之间用于评估因素和结果的技术和工具的异质性，无法对结果进行汇总以确定对康复不良或无法康复最具预测性的生物心理社会因素。因此，进行了叙述性综合，并显示出多种因素与较差的结果或无法康复相关，这些因素大多在 BPS 模型的生物学和心理学领域被确定。在研究中最具代表性并与康复不良或无法康复关系最密切的因素是初始疼痛强度高、疼痛持续时间和严重程度、事故前的身体和心理健康状况以及疼痛灾难化。
本综述表明康复的复杂性以及报告康复预测因素的挑战。显然，一系列多因素生物心理社会因素会影响康复。这些因素通常相互关联且多方面，因此不可能选择或专注于一个单一因素。在确定最具预测性的因素时，需要进一步研究，但需要就用于测量康复结果的工具达成共识，这是高度推荐的。无论描述性如何，该综述表明，受伤后高水平的疼痛与慢性疼痛和身体及精神残疾等较差的结果相关。因此，早期针对可改变的因素，如疼痛、疼痛灾难化以及出现 PTSD、抑郁和焦虑等合并症，可能有助于减少慢性疼痛和持续相关残疾。
系统评价方案于 2016 年 12 月 14 日在国际前瞻性系统评价注册库（PROSPERO）中注册。注册号 CRD42016052276。
