Battle Ceri, Driscoll Timothy, Fitzsimmons Deborah, Harris Shaun, Lecky Fiona, O'Neill Claire, Watkins Alan, Barnett Jane, Davies Susan, Hutchings Hayley Anne
Physiotherapy Dept, Morriston Hospital, Swansea, Wales, UK; Swansea Trials Unit. Swansea University Medical School, Swansea University, Swansea, UK.
Swansea Trials Unit. Swansea University Medical School, Swansea University, Swansea, UK.
Injury. 2025 May;56(5):112075. doi: 10.1016/j.injury.2024.112075. Epub 2024 Dec 3.
The aim of this trial was to investigate the impact of early thoracic and shoulder girdle exercises on chronic pain and Health-Related Quality of Life in patients with blunt chest wall trauma, when compared to normal care.
A multi-centre, parallel, randomised controlled trial, in which adult patients presenting to hospital with blunt chest wall trauma were allocated to either control or intervention group. The intervention was an exercise programme consisting of four simple thoracic and shoulder girdle exercises, completed for one week. Outcomes measures included prevalence and severity of chronic pain using the Brief Pain Inventory, health-related quality of life using EQ-5D-5 L, and cost effectiveness, measured at initial presentation and three months post-injury.
360 participants were recruited. Participants' mean age was 63.6 years (standard deviation (SD): 17.9 years) and 213 (59.8 %) were men. After loss-to-follow-up, the survey response rate at three months was 73.0 % (251/344 participants). The primary analysis, for chronic pain prevalence at three months post-injury, found no statistically significant differences between intervention and control groups, with lower rates in the control (intervention: 35/126 (27.8 %), control: 20/117 (17.1 %); adjusted odds ratio 1.862; 95 % CI: 0.892 to 3.893, p = 0.098). There were no statistically significant differences between intervention and control groups for pain severity at three months post-injury, (intervention mean (SD): 2.15 (2.49), control: 1.81 (2.10); adjusted difference 0.196, 95 % CI:0.340 to 0.731; p = 0.473); or Health-Related Quality of Life (intervention mean (SD): 0.715 (0.291), control: 0.704 (0.265); adjusted difference: 0.030; 95 % CI:0.033 to 0.094; p = 0.350). The health economic analysis found the intervention was associated with higher costs compared to normal care.
The results of this trial did not support a 'one-size fits all' simple, early exercise programme for patients with blunt chest wall trauma. Future research should consider the impact of a personalised exercise programme, commenced by the patient at least one week post-injury.
本试验的目的是研究与常规护理相比，早期胸部和肩带运动对钝性胸壁创伤患者慢性疼痛和健康相关生活质量的影响。
一项多中心、平行、随机对照试验，将因钝性胸壁创伤入院的成年患者分为对照组或干预组。干预措施是一个由四项简单的胸部和肩带运动组成的运动计划，持续进行一周。结果指标包括使用简明疼痛量表评估慢性疼痛的患病率和严重程度，使用EQ-5D-5L评估健康相关生活质量，以及在初次就诊时和受伤后三个月测量成本效益。
招募了360名参与者。参与者的平均年龄为63.6岁（标准差（SD）：17.9岁），男性213人（59.8%）。失访后，三个月时的调查回复率为73.0%（251/344名参与者）。对受伤后三个月慢性疼痛患病率的初步分析发现，干预组和对照组之间没有统计学上的显著差异，对照组的患病率较低（干预组：35/126（占27.8%），对照组：20/117（占17.1%）；调整后的优势比为1.862；95%置信区间：0.892至3.893，p = 0.098）。受伤后三个月，干预组和对照组在疼痛严重程度方面没有统计学上的显著差异（干预组平均值（SD）：2.15（2.49），对照组：1.81（2.10）；调整后的差异为0.196，95%置信区间：0.340至0.731；p = 0.473）；在健康相关生活质量方面也没有差异（干预组平均值（SD）：0.715（0.291），对照组：0.704（0.265）；调整后的差异：0.030；95%置信区间：0.033至0.094；p = 0.350）。健康经济分析发现，与常规护理相比，该干预措施成本更高。
本试验结果不支持对钝性胸壁创伤患者采用“一刀切”的简单早期运动计划。未来的研究应考虑个性化运动计划的影响，该计划应由患者在受伤后至少一周开始实施。
