Curtis P, Carey T S, Evans P, Rowane M P, Jackman A, Garrett J
Department of Family Medicine, University of North Carolina at Chapel Hill, 27599, USA.
J Fam Pract. 2000 Sep;49(9):786-92.
We examined clinical outcomes and patient perceptions of back care given by physicians before and after an intensive course of training in back care and limited manual therapy techniques.
From a prospective observational cohort study of low back pain involving 208 physicians (115 primary care) and their patients and a subsequent clinical trial of treatment of low back pain given by 31 physicians specially trained in manual therapy and enhanced back care, outcome data from the patients of 13 physicians participating in both studies were compared. In the observational study, the 13 physicians cared for 120 patients. In the manual therapy trial (191 patients) a control group of 94 patients received enhanced back care and an intervention group of 97 patients received enhanced back care plus manual therapy. Pearson's chi-square comparisons and linear and Cox proportional hazard modeling were used to examine effects of variables and recovery time.
Characteristics of the 13 physicians' patients in the cohort group and the manual therapy trial showed some differences in income, workers' compensation, previous employment, and baseline dysfunction. Both control and intervention patients in the manual therapy trial showed more rapid improvement in functional status over time and greater satisfaction with their care than those in the previous cohort study. However, there was no difference between the studies in patient-reported time to return to performing usual daily activities.
A structured clinical approach to low back care may bring modestly improved clinical outcomes and patient satisfaction.
我们研究了在接受背部护理及有限手法治疗技术强化培训前后，医生提供的背部护理的临床结果及患者的看法。
在一项涉及208名医生（115名初级保健医生）及其患者的腰痛前瞻性观察队列研究，以及随后一项由31名接受过手法治疗和强化背部护理专门培训的医生进行的腰痛治疗临床试验中，对参与两项研究的13名医生的患者的结果数据进行了比较。在观察性研究中，这13名医生照料了120名患者。在手法治疗试验（191名患者）中，94名患者的对照组接受强化背部护理，97名患者的干预组接受强化背部护理加手法治疗。使用Pearson卡方比较、线性和Cox比例风险模型来检查变量和恢复时间的影响。
队列组和手法治疗试验中13名医生的患者的特征在收入、工伤赔偿、以前的工作和基线功能障碍方面存在一些差异。手法治疗试验中的对照组和干预组患者随着时间的推移功能状态改善更快，对护理的满意度也高于之前队列研究中的患者。然而，在患者报告的恢复日常活动时间方面，两项研究之间没有差异。
一种结构化的腰痛护理临床方法可能会适度改善临床结果和患者满意度。
