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一项针对挥鞭伤后恢复的特定颈部引导式运动疗法的效果:系统评价与荟萃分析。

Effects of a Guided Neck-Specific Exercise Therapy on Recovery After a Whiplash: A Systematic Review and Meta-analysis.

作者信息

Muñoz Lazcano Pablo, Rojano Ortega Daniel, Fernández López Isidro

机构信息

From the Residencia y Centro de Día Montehermoso, Madrid, Spain (PML); Department of Informatics and Sports, Universidad Pablo de Olavide, Sevilla, Spain (DRO); Holystic Centro de Recuperación, Madrid, Spain (IFL); and Faculty of Nursery, Physiotherapy and Podiatry, Universidad Complutense, Madrid, Spain (IFL).

出版信息

Am J Phys Med Rehabil. 2024 Nov 1;103(11):971-978. doi: 10.1097/PHM.0000000000002460. Epub 2024 Feb 29.

Abstract

OBJECTIVE

To analyze the effects on pain and disability recovery after a whiplash of a guided neck-specific exercise therapy, compared to a different or an unguided neck-specific exercise therapy.

DESIGN

A literature search was conducted from inception to May 31, 2023, in three electronic databases: PubMed, ScienceDirect, and Web of Science. Eleven randomized controlled trials were included. Meta-analyses were performed with Review Manager software. The standardized mean difference with a 95% confidence interval was used to measure the effect sizes and only short-term time points were considered.

RESULTS

Not all studies reported a significant decrease of pain and disability in the neck-specific exercise group compared to controls. However, meta-analyses demonstrated a significantly greater decrease in neck pain (standardized mean difference: -0.25; 95% confidence interval: [-0.38, -0.12]; P = 0.0002) and neck-disability index (standardized mean difference: -0.35; 95% confidence interval: [-0.54, -0.15]; P = 0.0005) in the neck-specific exercise group.

CONCLUSIONS

In addition to the benefits that a guided neck-specific exercise therapy has on motivation and program adherence, it provides greater benefits in pain and disability than a different or unguided neck-specific exercise therapy. Positive results are observed primarily with intervention periods of more than 6 wks and at least two sessions per week.

TO CLAIM CME CREDITS

Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME.

CME OBJECTIVES

Upon completion of this article, the reader should be able to: (1) Determine the impact that whiplash-associated disorders have on a patient's life; (2) Identify and recognize the greater benefits of a supervised exercise therapy on recovery after a whiplash injury; and (3) Differentiate between the different exercise protocols conducted (types of exercises and duration) and incorporate therapy appropriately as part of an effective treatment plan.

LEVEL

Advanced.

ACCREDITATION

The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

摘要

目的

与不同的或非指导性的颈部特定运动疗法相比,分析指导性颈部特定运动疗法对挥鞭样损伤后疼痛和功能障碍恢复的影响。

设计

从创刊至2023年5月31日,在三个电子数据库(PubMed、ScienceDirect和Web of Science)中进行文献检索。纳入了11项随机对照试验。使用Review Manager软件进行荟萃分析。采用95%置信区间的标准化均差来衡量效应大小,且仅考虑短期时间点。

结果

并非所有研究都报告与对照组相比,颈部特定运动组的疼痛和功能障碍有显著降低。然而,荟萃分析表明,颈部特定运动组的颈部疼痛(标准化均差:-0.25;95%置信区间:[-0.38, -0.12];P = 0.0002)和颈部功能障碍指数(标准化均差:-0.35;95%置信区间:[-0.54, -0.15];P = 0.0005)有显著更大程度的降低。

结论

除了指导性颈部特定运动疗法对动机和方案依从性有好处外,与不同的或非指导性的颈部特定运动疗法相比,它在疼痛和功能障碍方面有更大益处。主要在干预期超过6周且每周至少两次治疗时观察到阳性结果。

如需申请继续医学教育学分

请登录http://www.physiatry.org/JournalCME在线完成自我评估活动和评价。

继续医学教育目标

读完本文后,读者应能够:(1)确定挥鞭样损伤相关疾病对患者生活的影响;(2)识别并认识到监督下的运动疗法对挥鞭样损伤后恢复的更大益处;(3)区分所采用的不同运动方案(运动类型和持续时间),并将该疗法作为有效治疗计划的一部分进行适当整合。

级别

高级。

认证

学术物理医学与康复医师协会经继续医学教育认证委员会认可,可为医生提供继续医学教育。学术物理医学与康复医师协会将此基于期刊的继续医学教育活动指定为最多1.0个美国医学协会医师认可奖第1类学分™。医生应仅根据其参与活动的程度申请相应学分。

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