临床预测规则与物理治疗师评估之间的一致性非常低，无法准确分类急性颈扭伤患者的不良恢复风险。

Agreement is very low between a clinical prediction rule and physiotherapist assessment for classifying the risk of poor recovery of individuals with acute whiplash injury.

机构信息

Menzies Health Institute Queensland, Griffith University, G05, 3.20E Parklands Drive, Southport, 4222, Australia.

Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Level 7 Oral Health Centre, 288 Herston Road, Herston, Queensland, 4006, Australia.

出版信息

Musculoskelet Sci Pract. 2019 Feb;39:73-79. doi: 10.1016/j.msksp.2018.11.003. Epub 2018 Nov 19.

DOI:10.1016/j.msksp.2018.11.003

PMID:30522090

Abstract

BACKGROUND

A prognostic clinical prediction rule (whiplash CPR) has been validated for use in individuals with acute whiplash associated disorders (WAD). The clinical utility of this tool is unknown.

OBJECTIVES

To investigate: 1) the level of agreement between physiotherapist- and whiplash CPR-determined prognostic risk classification of people with acute WAD; 2) which clinical findings are used by physiotherapists to classify prognostic risk; and 3) whether physiotherapists plan to differ the number of treatment sessions provided based on prognostic risk classification.

DESIGN

Pragmatic, observational.

METHOD

38 adults with acute WAD were classified as low, medium, or high risk of poor recovery by their treating physiotherapist (n = 24) at the conclusion of the initial consultation. A weighted Cohen's kappa examined the agreement between physiotherapist estimated risk classification and the whiplash CPR. Physiotherapists' reasons for classification were provided and summarised descriptively. Kruskal-Wallis and post-hoc Dunn's tests compared projected number of treatment sessions between risk subgroups.

RESULTS

Physiotherapist agreement with the whiplash CPR occurred in 29% of cases (n = 11/38), which was less than what is expected by chance (K = -0.03; 95%CI -0.17 to 0.12). Physiotherapists most frequently considered range of movement (n = 23/38, 61%), a premorbid pain condition (n = 14/38, 37%), response to initial physiotherapy treatment (n = 12/38, 32%), and pain intensity (n = 12/38, 32%) when classifying prognostic risk. The projected number of treatment sessions was not different between risk groups using classifications provided by the physiotherapists (χ(2) = 2.69, p = 0.26).

CONCLUSIONS

Physiotherapists should consider incorporating the whiplash CPR into current assessment processes to enhance accuracy in prognostic decision-making.

摘要

背景

已验证一种预测性临床预测规则（挥鞭伤 CPR）可用于诊断急性挥鞭伤相关疾病（WAD）患者。但该工具的临床实用性尚不清楚。

目的

调查：1）物理治疗师和挥鞭伤 CPR 确定的急性 WAD 患者预后风险分类之间的一致性水平；2）物理治疗师用于分类预后风险的临床发现；3）物理治疗师是否计划根据预后风险分类来改变治疗次数。

设计

实用的，观察性的。

方法

38 名急性 WAD 患者在初始咨询结束时，由治疗物理治疗师（n=24）将其分为预后恢复不良的低危、中危或高危人群。采用加权 Cohen's kappa 检验评估物理治疗师估计的风险分类与挥鞭伤 CPR 的一致性。提供并描述性总结了物理治疗师分类的原因。采用 Kruskal-Wallis 和事后 Dunn 检验比较风险亚组之间计划的治疗次数。

结果

物理治疗师与挥鞭伤 CPR 的一致性仅出现在 29%的病例中（n=11/38），低于预期的随机一致性（K=-0.03；95%CI -0.17 至 0.12）。物理治疗师在分类预后风险时最常考虑活动范围（n=23/38，61%）、预发病痛情况（n=14/38，37%）、对初始物理治疗的反应（n=12/38，32%）和疼痛强度（n=12/38，32%）。使用物理治疗师提供的分类，治疗次数的预计值在风险组之间没有差异（χ(2)=2.69，p=0.26）。