期刊
MUSCULOSKELETAL SCIENCE AND PRACTICE
卷 55, 期 -, 页码 -出版社
ELSEVIER
DOI: 10.1016/j.msksp.2021.102426
关键词
Neck pain; Whiplash; WAD; Acute; Subacute; Soft-collar
资金
- Fund for research, quality and education in physiotherapy practice (Fysioterapipraksisfonden)
- Lundbeck Foundation for Health Care Research
- Motor Accident Insurance Commission of Queensland
- Region Zealand (Exercise First)
- European Research Council (ERC) under the European Union [801790]
In treating Whiplash Associated Disorders, four RCTs showed that an active approach or act-as-usual was more effective than soft-collar treatment, but due to low quality evidence, further research is needed to investigate the combination of soft collar use with an active rehabilitation strategy for acute/subacute WAD.
Background: Active rehabilitation of Whiplash Associated Disorders (WAD) is favoured over passive modalities such as soft-collars. However, the effectiveness of soft-collar use remains unclear. Objective: To investigate the effectiveness of soft-collar use on pain and disability in WAD. Design: Systematic review. Method: Databases (AMED, CINAHL Complete, Cochrane Library, Embase, Medline, PEDro, PsycINFO, PubMed, SPORTDiscus) were searched for guidelines, reviews and RCTs on soft-collar use as part of WAD treatment. Reference lists of reviews and guidelines were screened for additional RCTs. Study quality was rated using the PEDro-scale and overall quality of evidence with GRADE. Results: Four RCTs (n = 409) of fair-good quality (PEDro-scores) were included with three using a soft collar in addition to other conservative treatment while one study compared soft-collar use to act-as-usual. All studies found that an active or act-as-usual approach was more effective in reducing pain intensity compared to softcollar use, confirmed by meta-analysis (two RCTs with data: SMD of -0.80 (-1.20, -0.41)). No studies reported disability outcomes while contrasting results were found between groups regarding total cervical range of motion (two RCTs with data: SMD of 0.16 (-0.21, 0.54)) or rotation (two RCTs with data: SMD of 0.54 (-0.19, 1.27)). Overall quality of the evidence was low to very low. Conclusion: All four RCTs favoured an active approach/act-as-usual over soft-collar treatment. However, due to methodological concerns and low certainty of evidence, future studies investigating soft collar use in combination with an active rehabilitation strategy for acute/subacute WAD are needed.
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