Hawk C, Long C R, Boulanger K T
Palmer Center for Chiropractic Research, Davenport, Iowa 52803, USA.
J Manipulative Physiol Ther. 2001 Mar-Apr;24(3):157-69.
To identify patient and practice characteristics that might contribute to people's seeking chiropractic care for nonmusculoskeletal complaints.
This was a cross-sectional study conducted through the methods of practice-based research.
Data were collected in 1998--1999 in chiropractic offices in the United States, Canada, and Australia; data were managed by a practice-based research office operating in a chiropractic research center.
The subjects were new and established patients of all ages who visited the participating offices during a designated data collection week.
Multiple logistic regression was used to examine factors associated with patients' presenting for nonmusculoskeletal chief complaints. Pearson's chi(2) test was used to examine associations among practice variables and the proportion of patients with nonmusculoskeletal chief complaints.
A total of 7651 patients of 161 chiropractors in 110 practices in 32 states and 2 Canadian provinces participated; data from 2 Australian practices were included in the totals but not in the analysis. Nonmusculoskeletal complaints accounted for 10.3% of the chief complaints. The following characteristics made patients more likely to present with nonmusculoskeletal chief complaints: being less than 14 years of age (adjusted odds ratio [AOR], 6.9; 95% CI, 5.2--9.1); being female (AOR, 1.5; CI, 1.3--1.8); presenting in a small town/rural location (AOR, 1.9; CI, 1.3--2.7); reporting more than 1 complaint, especially nonmusculoskeletal complaints (AOR, 4.9; CI, 3.9--6.0); having received medical care for the chief complaint (AOR, 3.4; CI, 2.9--4.1); and having first received chiropractic care before 1960 (AOR, 1.7; CI, 1.1--2.4). Practices with the highest proportion of patients with nonmusculoskeletal chief complaints (>17%) were less likely to accept insurance and more likely to be in locations with populations greater than 100,000. They used the most common chiropractic adjustive techniques less frequently and used more nonadjustive procedures, especially diet/nutrition counseling, nutritional supplementation, herbal preparations, naturopathy, and homeopathy.
Drawing on practices with the patient and practice characteristics identified in this study to conduct outcomes studies on nonmusculoskeletal conditions is a possible direction for future research.
确定可能促使人们因非肌肉骨骼疾病而寻求脊椎按摩治疗的患者及治疗机构特征。
这是一项通过基于实践的研究方法进行的横断面研究。
数据于1998 - 1999年在美国、加拿大和澳大利亚的脊椎按摩治疗诊所收集；数据由一家在脊椎按摩治疗研究中心运作的基于实践的研究办公室管理。
研究对象为在指定数据收集周期间就诊于参与研究的诊所的各年龄段新患者和老患者。
采用多元逻辑回归分析与患者因非肌肉骨骼主要症状就诊相关的因素。采用Pearson卡方检验分析治疗机构变量与非肌肉骨骼主要症状患者比例之间的关联。
来自32个州和2个加拿大省份的110家诊所的161名脊椎按摩治疗师共7651名患者参与研究；来自2家澳大利亚诊所的数据计入总数但未纳入分析。非肌肉骨骼疾病占主要症状的10.3%。以下特征使患者更有可能因非肌肉骨骼主要症状就诊：年龄小于14岁（调整优势比[AOR]，6.9；95%可信区间[CI]，5.2 - 9.1）；女性（AOR，1.5；CI，1.3 - 1.8）；在小镇/农村地区就诊（AOR，1.9；CI，1.3 - 2.7）；报告超过1种症状，尤其是非肌肉骨骼症状（AOR，4.9；CI，3.9 - 6.0）；因主要症状接受过医疗护理（AOR，3.4；CI，2.（此处原文有误，应为2.9 - 4.1））；1960年前首次接受脊椎按摩治疗（AOR，1.7；CI，1.1 - 2.4）。非肌肉骨骼主要症状患者比例最高（>17%）的治疗机构接受保险的可能性较小，且更可能位于人口超过10万的地区。这些机构较少使用最常见的脊椎按摩调整技术，且更多地使用非调整程序，尤其是饮食/营养咨询、营养补充、草药制剂、自然疗法和顺势疗法。
借鉴本研究中确定的患者及治疗机构特征开展针对非肌肉骨骼疾病的疗效研究是未来研究的一个可能方向。
