Ergebnisse der frühfunktionellen krankengymnastischen übungsbehandlung nach HWS-Distorsion

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Abstract
Fragestellung. Effektivität der frühfunktionellen Physiotherapie im Vergleich zur Standardtherapie mittels weicher Zervikalstütze nach HWS-Distorsion. Methodik. Prospektiv-randomisierte Therapievergleichsstudie an 168 Patienten mit den Hauptzielvariablen Schmerzen und Beeinträchtigung, die mittels numerischer Ratingskalen (0–10) gemessen wurden. Ergebnisse. In der Standardtherapiegruppe betrugen die gemittelten Werte für Schmerzen initial 4,75 und für Beeinträchtigung 4,76, in der Physiotherapiegruppe 4,50 für Schmerzen und 4,39 für Beeinträchtigung. Nach 6 Wochen hatten sich in der Standardtherapiegruppe die Werte für Schmerzen auf 2,66 und für Beeinträchtigung auf 2,40 reduziert. Die Werte in der Physiotherapiegruppe waren mit 1,40 für Schmerzen und 1,29 für Beeinträchtigung signifikant niedriger als in der Standardtherapiegruppe. Schlussfolgerung. Die frühfunktionelle krankengymnastische Übungsbehandlung der akuten HWS-Distorsion ist der Therapie mit der weichen Zervikalstütze signifikant überlegen. Background. Diagnostic evaluation and therapeutic management of acute neck pain after whiplash is a frequent but unsolved clinical problem. Long-lasting symptoms and disability are common. Former studies proposed beneficial effects of physiotherapy in the early management of whiplash injury. The purpose of this study was to assess the effects of early active mobilization versus standard treatment with a soft cervical collar. Methods. Between August 1997 and February 2000 a prospective randomized clinical trial with a total of 168 patients was performed. Of these patients 81 (31 male, 50 female; average age 28,78 years) were randomly assigned to the standardtherapy group, which received a soft cervical collar, and 87 (31 male, 56 female; average age 29,62 years) to the early mobilization group, treated by physiotherapy. Study participants documented pain and disability twice (baseline and six week follow-up) during a one week period by diary, using numeric rating scales ranging from 0 to 10. Results. The initial mean pain intensity (4,75) reported by the standard therapy group was similar to disability (4,76). There were no significant differences to initial pain (4,50) and disability (4,39) reported by the early mobilization group. The mean pain intensity reported by the standard therapy group after 6 weeks was 2,66 and disability was 2,40. The mean pain intensity indicated by physiotherapy group was 1,44 and mean disability was 1,29. The differences between the groups were both significant. Conclusions. Early mobilization is superior to the standardtherapy regarding pain intensity and disability. We conclude that mobilization should be recommended as the new adequate standard-therapy in the acute management of whiplash injury.

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