Are psychological interventions effective for the management of neck pain and whiplash-associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

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• 作者：Heather M. Shearer ; DC ; MSc^a ; ^b ; ^{heather.shearer@uoit.ca} ; Linda J. Carroll ; PhD^c ; Jessica J. Wong ; BSc ; DC ; FCCS(C)^a ; ^b ; Pierre Cô ; té ; DC ; PhD^d ; ^e ; ^f ; Sharanya Varatharajan ; BSc ; MSc^a ; ^g ; Danielle Southerst ; BScH ; DC ; FCCS(C)^a ; Deborah A. Sutton ; BScOT ; MEd ; MSc^a ; Kristi A. Randhawa ; BHSc ; MPH^a ; ^g ; Hainan Yu ; MBBS ; MSc^a ; Silvano A. Mior ; DC ; PhD^b ; ^e ; Gabrielle M. van der Velde ; DC ; PhD^h ; ⁱ ; ^j ; Margareta C. Nordin ; Dr Med Sci.^k ; Maja Stupar ; DC ; PhD^b ; ^f ; Anne L. Taylor-Vaisey ; MLS^a
• 关键词：Neck pain and associated disorders ; Outcome ; Psychological intervention ; Recovery ; Systematic review ; Whiplash-associated disorders
• 刊名：The Spine Journal
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：16
• 期：12
• 页码：1566-1581
• 全文大小：350 K
• 卷排序：16

文摘

In 2008, the lack of published evidence prevented the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders (Neck Pain Task Force [NPTF]) from commenting on the effectiveness of psychological interventions for the management of neck pain.PurposeThis study aimed to update findings of the NPTF and evaluate the effectiveness of psychological interventions for the management of neck pain and associated disorders (NAD) or whiplash-associated disorders (WAD).Study Design/settingThis study used systematic review and best-evidence synthesis.SampleRandomized controlled trials, cohort studies, and case-control studies comparing psychological interventions to other non-invasive interventions or no intervention were the samples used in this study.Outcome measuresThe outcome measures are (1) self-rated recovery; (2) functional recovery; (3) clinical outcomes; (4) administrative outcomes; and (5) adverse effects.MethodsWe searched six databases from 1990 to 2015. Randomized controlled trials, cohort studies, and case-control studies meeting our selection criteria were eligible for critical appraisal. Random pairs of independent reviewers used the Scottish Intercollegiate Guidelines Network criteria to critically appraise eligible studies. Studies with a low risk of bias were synthesized following best evidence synthesis principles. This study was funded by the Ontario Ministry of Finance.ResultsWe screened 1,919 articles, 19 were eligible for critical appraisal and 10 were judged to have low risk of bias. We found no clear evidence supporting relaxation training or cognitive behavioral therapy (CBT) for persistent grades I–III NAD for reducing pain intensity or disability. Similarly, we did not find evidence to support the effectiveness of biofeedback or relaxation training for persistent grade II WAD, and there is conflicting evidence for the use of CBT in this population. However, adding a progressive goal attainment program to functional restoration physiotherapy may benefit patients with persistent grades I–III WAD. Furthermore, Jyoti meditation may help reduce neck pain intensity and bothersomeness in patients with persistent NAD.ConclusionsWe did not find evidence for or against the use of psychological interventions in patients with recent onset NAD or WAD. We found evidence that a progressive goal attainment program may be helpful for the management of persistent WAD and that Jyoti meditation may benefit patients with persistent NAD. The limited evidence of effectiveness for psychological interventions may be due to several factors, such as interventions that are ineffective, poorly conceptualized, or poorly implemented. Further methodologically rigorous research is needed.