Li L C, Bombardier C
Health Care Research Division, Arthritis & Autoimmunity Research Centre, University Health Network, 610 University Ave, 16th Floor, Toronto, Ontario, Canada M5G 2M9.
Phys Ther. 2001 Apr;81(4):1018-28.
Since the release of acute low back pain management guidelines in 1994, little was known about the effect of these guidelines on clinical practice. The purpose of this study was to examine physical therapists' reported management of acute and subacute lumbar impairment.
One in 10 registered physical therapists who were randomly selected from southern Ontario, Canada, (n=454) and all registered physical therapists from northern Ontario (n=331) were surveyed.
In the questionnaire, case scenarios covered 3 areas related to the management of lumbar impairment: (1) physical examination, (2) treatment and recommendations, and (3) therapists' beliefs regarding its management.
Five hundred sixty-nine questionnaires were returned (response rate=72.5%). Only data obtained for therapists (n=274) whose weekly workload included more than 10% of people with lumbar impairment were used in the analysis. Overall, patient education, exercise, and electrotherapeutic and thermal modalities were the preferred interventions for acute lumbar impairment (symptom onset of less than 5 weeks) with or without sciatica, whereas exercise and work modification were preferred for subacute lumbar impairment (symptom onset of 5 weeks or longer). There was a trend of using electrotherapeutic and thermal modalities with uncertain effectiveness. Only 46.3% of the therapists agreed or strongly agreed that practice guidelines were useful for managing lumbar impairment.
Although the physical therapists surveyed, in general, followed the guidelines in managing acute lumbar impairment, they felt uncertain regarding the value of practice guidelines. Future research should focus on identifying effective treatment approaches and exploring the effectiveness of practice guidelines.
自1994年发布急性腰痛管理指南以来，对于这些指南对临床实践的影响知之甚少。本研究的目的是调查物理治疗师报告的急性和亚急性腰椎损伤的管理情况。
从加拿大安大略省南部随机抽取十分之一的注册物理治疗师（n = 454）以及安大略省北部的所有注册物理治疗师（n = 331）参与调查。
在问卷中，病例场景涵盖与腰椎损伤管理相关的3个领域：（1）体格检查，（2）治疗与建议，以及（3）治疗师对其管理的看法。
共返回569份问卷（回复率 = 72.5%）。分析仅采用每周工作量中腰椎损伤患者占比超过10%的治疗师（n = 274）的数据。总体而言，对于有或无坐骨神经痛的急性腰椎损伤（症状出现少于5周），患者教育、运动以及电疗和热疗是首选干预措施，而对于亚急性腰椎损伤（症状出现5周或更长时间），运动和工作调整是首选。存在使用疗效不确定的电疗和热疗的趋势。只有46.3%的治疗师同意或强烈同意实践指南对管理腰椎损伤有用。
尽管接受调查的物理治疗师总体上在管理急性腰椎损伤时遵循了指南，但他们对实践指南的价值感到不确定。未来的研究应侧重于确定有效的治疗方法并探索实践指南的有效性。
