Fritz Julie M, Whitman Julie M, Flynn Timothy W, Wainner Robert S, Childs John D
Department of Physical Therapy, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 15260, USA.
Phys Ther. 2004 Feb;84(2):173-90.
Although spinal manipulation is one of the few interventions for low back pain supported by evidence, it appears to be underutilized by physical therapists, possibly due to therapists' concerns that a patient may not benefit from the intervention. The purpose of this study was to identify factors that are associated with an inability to benefit from manipulation.
Seventy-five people with nonradicular low back pain (mean age=37.6 years, SD=10.6, range=19-59; mean duration of symptoms=41.7 days, SD=54.7, range=1-252) participated.
Subjects underwent a standardized examination that included history-taking; self-reports of pain, disability, and fear-avoidance beliefs; measurement of lumbar and hip range of motion; and use of various tests. All subjects received a spinal manipulation intervention for a maximum of 2 sessions. Subjects who did not show greater than 5 points of improvement on the modified Oswestry Low Back Pain Disability Questionnaire were considered to have shown no improvement with the manipulation. Baseline variables were tested for univariate relationship with the outcome of the manipulation. Variables showing a univariate relationship were entered into a logistic regression equation, and adjusted odds ratios were calculated.
Twenty subjects (28%) did not improve with manipulation. Six variables were identified as being related to inability to improve with manipulation: longer symptom duration, having symptoms in the buttock or leg, absence of lumbar hypomobility, less hip rotation range of motion, less discrepancy in left-to-right hip medial rotation range of motion, and a negative Gaenslen sign. The resulting logistic regression model explained 63% of the variance in manipulation outcome.
The majority of subjects improved with manipulation. Baseline variables could be identified that were predictive of which subjects would not improve.
尽管脊柱推拿是少数有证据支持的用于治疗腰痛的干预措施之一，但物理治疗师对其使用似乎不足，这可能是因为治疗师担心患者无法从该干预措施中获益。本研究的目的是确定与无法从推拿中获益相关的因素。
75名非根性腰痛患者参与研究（平均年龄 = 37.6岁，标准差 = 10.6，年龄范围 = 19 - 59岁；平均症状持续时间 = 41.7天，标准差 = 54.7，范围 = 1 - 252天）。
受试者接受了标准化检查，包括病史采集；疼痛、残疾和恐惧回避信念的自我报告；腰椎和髋关节活动范围的测量；以及各种测试的应用。所有受试者均接受了最多2次的脊柱推拿干预。在改良的奥斯维斯特里腰痛残疾问卷上改善未超过5分的受试者被认为推拿后无改善。对基线变量与推拿结果进行单变量关系测试。将显示单变量关系的变量纳入逻辑回归方程，并计算调整后的优势比。
20名受试者（28%）推拿后无改善。确定了6个与推拿后无法改善相关的变量：症状持续时间较长、臀部或腿部有症状、腰椎活动度未降低、髋关节旋转活动范围较小、左右髋关节内旋活动范围差异较小以及Gaenslen征阴性。所得的逻辑回归模型解释了推拿结果中63%的方差。
大多数受试者推拿后有改善。可以确定预测哪些受试者不会改善的基线变量。
