Soft-collar use in rehabilitation of whiplash-associated disorders - A systematic review and meta-analysis,Musculoskeletal Science and Practice

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Soft-collar use in rehabilitation of whiplash-associated disorders - A systematic review and meta-analysis
Musculoskeletal Science and Practice ( IF 2.2 ) Pub Date : 2021-07-07 , DOI: 10.1016/j.msksp.2021.102426
Steffan Wittrup McPhee Christensen ₁ , Michael Bo Rasmussen ₂ , Christoffer Lund Jespersen ₂ , Michele Sterling ₃ , Søren Thorgaard Skou ₄

Affiliation

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 soft-collar 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.

中文翻译：

软领在鞭打相关疾病康复中的应用——系统评价和荟萃分析

背景

鞭打相关疾病 (WAD) 的主动康复优于软领等被动方式。然而，软领使用的有效性仍不清楚。

客观的

调查使用软领对 WAD 疼痛和残疾的有效性。

设计

系统审查。

方法

在数据库（AMED、CINAHL Complete、Cochrane Library、Embase、Medline、PEDro、PsycINFO、PubMed、SPORTDiscus）中搜索了关于作为 WAD 治疗一部分的软领使用的指南、评论和 RCT。为额外的 RCT 筛选了评论和指南的参考列表。使用 PEDro 量表和 GRADE 的整体证据质量对研究质量进行评级。

结果

包括四项质量较好（PEDro 评分）的 RCT（n = 409），其中三项除其他保守治疗外还使用软领，而一项研究比较了使用软领与照常行事。所有研究都发现，与软领使用相比，积极或照常的方法在减轻疼痛强度方面更有效，经荟萃分析证实（两项 RCT 数据：SMD 为 -0.80 (-1.20, -0.41)） . 没有研究报告残疾结果，而在总颈椎活动度（两个 RCT 数据：SMD 为 0.16（-0.21，0.54））或旋转（两个 RCT 数据：SMD 为 0.54（-0.19，1.27） ))。证据的总体质量从低到非常低。