Rossignol M, Abenhaim L, Séguin P, Neveu A, Collet J P, Ducruet T, Shapiro S
Montreal Department of Public Health, Quebec, Canada.
Spine (Phila Pa 1976). 2000 Jan 15;25(2):251-8; discussion 258-9. doi: 10.1097/00007632-200001150-00018.
A randomized controlled trial comparing usual care with a program for the coordination of primary health care (CORE) for the treatment of subacute low-back pain patients.
To measure the effectiveness of the CORE program as a mean for implementing clinical practice guidelines for low-back pain in an urban community.
Clinical practice guidelines have been developed for primary care physicians and patients on the clinical management of low-back pain. The implementation of the guidelines in a large community is difficult with the multiplicity of medical and nonmedical back care providers and products. The CORE program was designed to make the guidelines fit in this complex environment.
One hundred ten workers compensated for low-back pain for 4 to 8 weeks in metropolitan Montreal were randomized in two groups: usual care (N = 56) and the CORE program (N = 54). Coordination of primary health care was performed by two primary care physicians and a nurse in liaison with the treating physicians, and included a complete examination, recommendations for the clinical management, and support to carry out the recommendations. All workers were followed for 6 months. Back pain and functional status were assessed at baseline, 3 months, and 6 months.
In the 6-month follow-up, the CORE group returned to work 6.6 days (standard error = 8.9) quicker than the control group, a difference that was not statistically significant. However, the CORE group showed a sustained improvement in pain and functional status with two-fold differences at the end of the 6 months of follow-up. This represented nine points on the Oswestry scale (P = 0.02) and 12 points on the Quebec Back Pain Disability Scale (P = 0.01). The CORE group also used three times less specialized imaging tests of the spine at 3 months (P < 0.01) and exercised twice as much at 6 months (P < 0.05) than the controls.
The therapeutic results for workers with low-back pain could be improved by implementing the clinical practice guidelines with primary care physicians in a large community, without delaying the return to work. The CORE intervention for back pain patients is highly relevant to primary care practice. It is simple in its application, flexible to accommodate physicians' and- patients' preferences in health care, and it is effective on patients' clinical outcome.
一项随机对照试验，比较常规护理与初级卫生保健协调项目（CORE）对亚急性下背痛患者的治疗效果。
评估CORE项目作为在城市社区实施下背痛临床实践指南手段的有效性。
已为初级保健医生和患者制定了下背痛临床管理的临床实践指南。由于医疗和非医疗背部护理提供者及产品众多，在大型社区实施这些指南很困难。CORE项目旨在使这些指南适用于这种复杂环境。
在蒙特利尔大都市，110名因下背痛获得4至8周赔偿的工人被随机分为两组：常规护理组（N = 56）和CORE项目组（N = 54）。由两名初级保健医生和一名护士与治疗医生联络进行初级卫生保健协调，包括全面检查、临床管理建议以及对执行建议的支持。所有工人随访6个月。在基线、3个月和6个月时评估背痛和功能状态。
在6个月随访中，CORE组比对照组提前6.6天（标准误 = 8.9）恢复工作，差异无统计学意义。然而，CORE组在疼痛和功能状态方面持续改善，在6个月随访结束时差异达两倍。这在奥斯维斯特里量表上相当于9分（P = 0.02），在魁北克背痛残疾量表上相当于12分（P = 0.01）。CORE组在3个月时使用的脊柱专科影像检查也比对照组少三倍（P < 0.01），在6个月时锻炼量是对照组的两倍（P < 0.05）。
在大型社区与初级保健医生一起实施临床实践指南可改善下背痛工人的治疗效果，且不延迟恢复工作。针对背痛患者的CORE干预与初级保健实践高度相关。其应用简单，灵活以适应医生和患者在医疗保健方面的偏好，且对患者临床结局有效。
