Verbesserte Rehabilitation bei chronischem Schleudertrauma

Zusammenfassung

Eine 30-jährige Frau litt seit einem 3 Jahre zurückliegenden Unfall an chronischem Schleudertrauma, als sie eine spezialisierte Physiotherapiepraxis aufsuchte. Sie war damit ein typisches Beispiel für die allgemein bekannte Prognose, dass 50 % der Schleudertraumen lange Zeit undiagnostiziert bleiben. Die Patientin wies zudem verschiedene Symptome wie leichte Bewegungseinschränkung, posttraumatische Belastung und eine Kältehyperalgesie, die alle als ungünstige prognostische Faktoren für eine Gesundung gelten. Dennoch erholte sie sich mithilfe eines physiotherapeutisch geleiteten Trainingsprogramms, das mit vorgegebenen spezifischen Übungen begann, die eine sofortige Symptomlinderung bewirkten. Es folgte ein abgestuftes funktionelles Training, um sie wieder fit für ihren Sport als Leistungsruderin zu machen.

Bisher konnten randomisierte kontrollierte Studien (RCT) nur geringe oder keine Effekte eines solchen Therapieansatzes nachweisen, und auch eine jüngere hochwertige Studie konnte keine Probanden identifizieren, die auf ein physiotherapeutisch ausgerichtetes Training ansprachen.

Der vorliegende Fall stellt eine Situation dar, in der das Clinical Reasoning und die direkte Reaktion der Patientin auf das Training diesen Ansatz rechtfertigten. Er trägt zur Forderung bei, dass für diese Patientengruppe vielleicht jenseits der aktuellen Forschung bestehende Lösungen gefunden werden müssen, um bessere Heilungsraten zu erzielen.

Abstract

A 30 year old female with chronic whiplash-associated disorders (WAD) was unrecovered at 3 years post injury when she presented to a specialist physiotherapy practice. As such, she was an example of the widely accepted prognostic data, where 50 % of people with WAD remain unrecovered in the long term. Furthermore, she had several factors such as moderate disability, post-traumatic stress and cold hyperalgesia which are all known adverse prognostic factors for non-recovery.

Despite this, she recovered with a physiotherapy-led exercise programme beginning with prescribing specific exercises that had an immediate effect on reducing symptoms. This approach morphed into a functional graded exercise approach to return her to her patient-nominated goal of elite rowing.

To date, randomised controlled trials have demonstrated small or no effects for such an approach, and a recent, high quality randomised controlled trial could not identify responders to physiotherapy-led exercise.

This case presents a situation where clinical reasoning and immediate responsiveness to exercise justified such an approach. It responds to the call that solutions need to be found for this patient group, perhaps outside current research, in order for improved recovery rates to occur.

Schlüsselwörter

chronisches Schleudertrauma - Responder - Heilung - klinischer Behandlungspfad

Keywords

chronic whiplash - responders - recovery - clinical pathway

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