The efficacy of multimodal physiotherapy and usual care in chronic whiplash-associated disorders with facet-mediated pain undergoing platelet rich plasma (PRP) treatment: a series of single case experimental designs (SCEDs)

Chronic whiplash-associated disorders (WAD) is a heterogeneous condition with limited effective treatment options available. This study evaluated the efficacy of multimodal physiotherapy and usual care in chronic WAD with facet-mediated pain receiving platelet-rich plasma (PRP) injections to determine if pain interference and confidence completing activities in the presence of neck pain could be improved. A multiple-baseline, single-case experimental design was used to evaluate the 6-week effect of physiotherapy or usual care in two groups of three participants each. All six participants demonstrated a significant reduction in pain interference, and three participants showed improved confidence to perform daily activities when in pain. Weighted Tau-<i>U</i> demonstrated a significant reduction of pain interference with large to very large effect sizes (&gt; 0.75) for both interventions in all participants irrespective of treatment allocation with no significant group difference demonstrated. Similar effects were demonstrated for the confidence to perform daily activities with neck pain (ES &gt; 0.46), although this was only evident in three participants (two PT and one UC). Generalisation measures also showed improvements in pain and disability, psychological and quality of life outcomes. No adverse events were reported. Both physiotherapy and usual care demonstrated improvements in pain interference and confidence to perform activities of daily living with neck pain in people with chronic WAD following cervical facet joint PRP. The trial was registered with ClinicalTrials.gov (Protocol Number: NCT03949959).

慢性鞭打相关障碍（whiplash-associated disorders, WAD）是一类异质性疾病，目前有效治疗手段有限。本研究针对接受富血小板血浆（platelet-rich plasma, PRP）注射的关节突介导性疼痛慢性WAD患者，评估多模式物理治疗与常规护理的疗效，旨在明确干预能否改善疼痛干扰程度以及颈痛状态下完成日常活动的自信心。本研究采用多基线单病例实验设计，对两组各3名受试者分别评估物理治疗或常规护理的6周干预效果。全部6名受试者的疼痛干扰程度均显著降低，其中3名受试者在颈痛状态下完成日常活动的自信心得到提升。加权Tau-U分析显示，无论受试者的治疗分组如何，两种干预方式均能显著降低疼痛干扰程度，效应量介于0.75以上（大至极大效应量），且两组间未观察到显著差异。针对颈痛状态下完成日常活动的自信心，研究也观察到了类似效应（效应量>0.46），但该效应仅在3名受试者中显现（2名物理治疗组受试者与1名常规护理组受试者）。泛化性评估指标亦显示，受试者的疼痛与残疾程度、心理健康状态及生活质量均得到改善。本研究未报告任何不良事件。对于接受颈椎关节突PRP注射的慢性WAD患者，物理治疗与常规护理均能改善其疼痛干扰程度以及颈痛状态下完成日常活动的自信心。本试验已在美国临床试验数据库（ClinicalTrials.gov）注册（协议编号：NCT03949959）。