Nyiendo J, Haas M, Goldberg B, Sexton G
Western States Chiropractic College, Division of Research, Center for Outcomes Studies, Portland, Ore 97230, USA.
J Manipulative Physiol Ther. 2001 Feb;24(2):92-100. doi: 10.1067/mmt.2001.112565.
Chronic low back pain sufferers are among those who account for the greatest usage of health care resources. Primary care medical (MD) physicians and chiropractic (DC) physicians treat most of these patients.
To study patient characteristics and physician practice activities for patients with chronic low back pain treated by DC physicians and MD physicians.
A longitudinal, practice-based observational study was undertaken in 14 general practice and 51 DC community-based clinics. A total of 2945 consecutive patients with ambulatory low back pain of mechanical origin were enrolled; 835 patients were in the chronic subgroup. Patients were followed for 12 months. Data were obtained on all of the following: patient demographics, health status, and psychosocial characteristics; history, duration, and severity of low back pain and disability; physicians' practice activities; and low back complaint status at 1 year.
Patients treated by MD physicians were younger and had lower incomes; their care was more often paid for by a third party; their baseline pain and disability were slightly greater. In addition, patients treated by MD physicians had one fourth as many visits as patients treated by DC physicians. Utilization of imaging procedures by enrolling physicians was equivalent for the two provider groups. Medications were prescribed for 80% of the patients enrolled by MD physicians; spinal manipulation was administered to 84% of patients enrolled by DC physicians. Physical modalities, self-care education, exercise, and postural advice characterized low back pain management in both provider groups. Patients' care-seeking was not exclusive to one provider type. Most patients experienced recurrences (patients treated by MD physicians, 59.3%; patients treated by DC physicians, 76.4%); 34.1% of patients treated by MD physicians and 12.7% of patients treated by DC physicians reported 12 months of continuous pain. Only 6.7% of patients treated by MD physicians and 10.9% of patients treated by DC physicians reported 1 resolved episode during the year.
Differences in sociodemographics, present pain intensity, and functional disability may distinguish patients with chronic low back pain seeking care from primary care medical physicians from those seeking care from DC physicians. Although the primary treatment modality differs, the practice activities of MD physicians and DC physicians have much in common. Long-term evaluation suggests that chronic back pain is persistent and difficult to treat for both provider types.
慢性下腰痛患者是医疗保健资源使用量最大的群体之一。初级保健医生（MD）和脊椎按摩治疗师（DC）治疗了大多数此类患者。
研究由DC医生和MD医生治疗的慢性下腰痛患者的特征以及医生的诊疗活动。
在14家全科诊所和51家社区DC诊所进行了一项基于实践的纵向观察性研究。共纳入2945例连续性非卧床机械性下腰痛患者；其中835例患者属于慢性亚组。对患者进行了12个月的随访。收集了以下所有数据：患者的人口统计学特征、健康状况和社会心理特征；下腰痛和残疾的病史、持续时间和严重程度；医生的诊疗活动；以及1年后的下腰痛状况。
由MD医生治疗的患者更年轻且收入更低；他们的治疗费用更多由第三方支付；他们的基线疼痛和残疾程度略高。此外，由MD医生治疗的患者就诊次数仅为DC医生治疗患者的四分之一。两组医生对影像检查的使用情况相当。MD医生登记的患者中有80%被开了药；DC医生登记的患者中有84%接受了脊柱推拿治疗。物理治疗方法、自我护理教育、锻炼和姿势建议是两组医生治疗下腰痛的主要方式。患者寻求治疗并不局限于某一种医生类型。大多数患者出现了复发（MD医生治疗的患者中复发率为59.3%；DC医生治疗的患者中复发率为76.4%）；MD医生治疗的患者中有34.1%以及DC医生治疗的患者中有12.7%报告有12个月的持续疼痛。MD医生治疗的患者中只有6.7%以及DC医生治疗的患者中只有10.9%报告在这一年中有一次症状缓解。
社会人口统计学、当前疼痛强度和功能残疾方面的差异可能会区分寻求初级保健医生治疗的慢性下腰痛患者和寻求DC医生治疗的患者。尽管主要治疗方式不同，但MD医生和DC医生的诊疗活动有很多共同之处。长期评估表明，对于这两类医生来说，慢性背痛都是持续且难以治疗的。
