Faculty of Health Sciences, The University of Sydney, 75 East St, Lidcombe, NSW, Australia.
John Walsh Centre for Rehabilitation Research, The University of Sydney, Kolling Institute, St Leonards, NSW, Australia.
BMC Health Serv Res. 2019 Nov 6;19(1):806. doi: 10.1186/s12913-019-4623-y.
Studies aimed at improving the provision of evidence-based care (EBC) for the management of acute whiplash injuries have been largely successful. However, whether EBC is broadly provided and whether delivery of EBC varies based on risk of non-recovery, is uncertain. Receiving EBC should improve recovery, though this relationship has yet to be established. Further, mitigating the effect of EBC is the relationship with the practitioner, a phenomenon poorly understood in WAD. This study aimed to determine the proportion of individuals with whiplash, at differing baseline risk levels, receiving EBC. This study also aimed to determine whether receiving EBC and the therapeutic relationship were associated with recovery at 3 months post injury.
Participants with acute whiplash were recruited from public hospital emergency departments, private physiotherapy practices, and State Insurance Regulatory Authority (SIRA) databases. Participants completed questionnaires at baseline (demographics, risk of non-recovery) and 3-months (treatment received, risk identification, therapeutic relationship) post injury. Primary health care providers (HCPs) treating these participants also completed questionnaires at 3-months. Recovery was defined as neck disability index ≤4/50 and global perceived effect of ≥4/5.
Two-hundred and twenty-eight people with acute whiplash, and 53 primary care practitioners were recruited. The majority of the cohort reported receiving EBC, with correct application of the Canadian C-spine rule (74%), and provision of active treatments (e.g. 89% receiving advice) high. Non-recommended (passive) treatments were also received by a large proportion of the cohort (e.g. 50% receiving massage). The therapeutic relationship was associated with higher odds of recovery, which was potentially clinically significant (OR 1.34, 95% CI 1.18-1.62). EBC was not significantly associated with recovery.
Guideline-based knowledge and practice has largely been retained from previous implementation strategies. However, recommendations for routine risk identification and tailored management, and reduction in the provision of passive treatment have not. The therapeutic relationship was identified as one of several important predictors of recovery, suggesting that clinicians must develop rapport and understanding with their patients to improve the likelihood of recovery.
旨在提高管理急性颈扭伤循证护理（EBC）提供的研究已取得了很大成功。然而，EBC 是否广泛提供，以及是否根据非恢复风险提供 EBC，尚不确定。接受 EBC 应该会改善康复，尽管这种关系尚未建立。此外，减轻 EBC 的影响是与从业者的关系，这在 WAD 中尚未得到很好的理解。本研究旨在确定在不同基线风险水平的颈扭伤患者中接受 EBC 的比例。本研究还旨在确定接受 EBC 和治疗关系是否与受伤后 3 个月的恢复相关。
从公立医院急诊部、私人物理治疗诊所和州保险监管局（SIRA）数据库招募急性颈扭伤患者。参与者在基线（人口统计学、非恢复风险）和受伤后 3 个月（接受的治疗、风险识别、治疗关系）完成问卷。治疗这些参与者的初级保健提供者（HCP）也在 3 个月时完成了问卷。康复定义为颈部残疾指数≤4/50 和全球感知效果≥4/5。
共招募了 228 名急性颈扭伤患者和 53 名初级保健医生。大多数患者报告接受了 EBC，正确应用加拿大颈椎规则（74%）和提供主动治疗（例如，89%接受建议）的比例很高。未推荐（被动）治疗也被很大一部分患者接受（例如，50%接受按摩）。治疗关系与更高的康复几率相关，这可能具有临床意义（OR 1.34，95%CI 1.18-1.62）。EBC 与康复无显著相关性。
基于指南的知识和实践很大程度上保留了以前实施策略的内容。然而，常规风险识别和针对性管理的建议，以及减少被动治疗的建议并未得到保留。治疗关系被确定为康复的几个重要预测因素之一，这表明临床医生必须与患者建立融洽关系并加深理解，以提高康复的可能性。
