Implementation of a risk-stratified, guideline-based clinical pathway of care to improve health outcomes following whiplash injury (Whiplash ImPaCT): a multicentre, randomized, controlled trial.
Implementation of a risk-stratified, guideline-based clinical pathway of care to improve health outcomes following whiplash injury (Whiplash ImPaCT): a multicentre, randomized, controlled trial.
复制标题
实施风险分层、基于指南的临床护理路径，以改善颈椎扭伤后的健康结果（Whiplash ImPaCT）：一项多中心、随机、对照试验。
DOI：
10.1097/j.pain.0000000000002940
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发表时间：
2023
期刊：
影响因子：
7.4
通讯作者：
M. Sterling
中科院分区：
文献类型：
--
作者：
T. Rebbeck;A. Bandong;A. Leaver;C. Ritchie;N. Armfield;M. Arora;I. Cameron;L. Connelly;Roy Daniell;M. Gillett;Rodney Ingram;J. Jagnoor;J. Kenardy;G. Mitchell;K. Refshauge;Simone Scotti Requena;Sarah Robins;M. Sterling
摘要
目前的颈部扭伤护理途径遵循“阶梯式护理模式”，导致治疗效果有限，并且无法提供有效的管理解决方案。本研究旨在评估风险分层临床护理路径 (CPC) 与常规护理 (UC) 相比对急性颈部扭伤患者的有效性。我们在澳大利亚的初级保健领域进行了一项多中心、双臂、平行、随机、对照试验。患有急性颈部扭伤的参与者 (n = 216) 根据不良结果的风险进行分层（低风险与中/高风险），并使用隐藏分配到 CPC 或 UC 进行随机分配。在 CPC 组中，低风险参与者接受了基于指南的建议和由在线资源支持的锻炼，中风险/高风险参与者被转介给颈椎扭伤专家，由他评估可改变的风险因素，然后确定进一步的护理。 UC 组接受了不了解风险状况的主要医疗保健提供者的护理。主要结局是 3 个月时颈部残疾指数 (NDI) 和总体变化评级 (GRC)。对使用意向治疗和线性混合模型的组进行盲法分析。 3 个月时，各组之间的 NDI（平均差 [MD] [95% 置信区间 (CI)] -2.34 [-7.44 至 2.76]）或 GRC（MD 95% CI 0.08 [-0.55 至 0.70]）没有差异。基线风险类别不会改变治疗效果。没有不良事件的报告。对急性颈部扭伤的风险分层护理并不能改善患者的治疗效果，因此不建议以目前的形式实施该 CPC。
ABSTRACT
Current pathways of care for whiplash follow a "stepped care model," result in modest treatment outcomes and fail to offer efficient management solutions. This study aimed to evaluate the effectiveness of a risk-stratified clinical pathway of care (CPC) compared with usual care (UC) in people with acute whiplash. We conducted a multicentre, 2-arm, parallel, randomised, controlled trial in primary care in Australia. Participants with acute whiplash (n = 216) were stratified for risk of a poor outcome (low vs medium/high risk) and randomised using concealed allocation to either the CPC or UC. In the CPC group, low-risk participants received guideline-based advice and exercise supported by an online resource, and medium-risk/high-risk participants were referred to a whiplash specialist who assessed modifiable risk factors and then determined further care. The UC group received care from their primary healthcare provider who had no knowledge of risk status. Primary outcomes were neck disability index (NDI) and Global Rating of Change (GRC) at 3 months. Analysis blinded to group used intention-to-treat and linear mixed models. There was no difference between the groups for the NDI (mean difference [MD] [95% confidence interval (CI)] -2.34 [-7.44 to 2.76]) or GRC (MD 95% CI 0.08 [-0.55 to 0.70]) at 3 months. Baseline risk category did not modify the effect of treatment. No adverse events were reported. Risk-stratified care for acute whiplash did not improve patient outcomes, and implementation of this CPC in its current form is not recommended.