临床预测规则在初级保健中的实际应用，以识别在接受简短脊柱推拿干预后预后良好的腰痛患者。
Pragmatic application of a clinical prediction rule in primary care to identify patients with low back pain with a good prognosis following a brief spinal manipulation intervention.
作者信息
Fritz Julie M, Childs John D, Flynn Timothy W
机构信息
Division of Physical Therapy, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108, USA.
出版信息
BMC Fam Pract. 2005 Jul 14;6(1):29. doi: 10.1186/1471-2296-6-29.
BACKGROUND
Patients with low back pain are frequently encountered in primary care. Although a specific diagnosis cannot be made for most patients, it is likely that sub-groups exist within the larger entity of nonspecific low back pain. One sub-group that has been identified is patients who respond rapidly to spinal manipulation. The purpose of this study was to examine the association between two factors (duration and distribution of symptoms) and prognosis following a spinal manipulation intervention.
METHODS
Data were taken from two previously published studies. Patients with low back pain underwent a standardized examination, including assessment of duration of the current symptoms in days, and the distal-most distribution of symptoms. Based on prior research, patients with symptoms of <16 days duration and no symptoms distal to the knee were considered to have a good prognosis following manipulation. All patients underwent up to two sessions of spinal manipulation treatment and a range of motion exercise. Oswestry disability scores were recorded before and after treatment. If >or= 50% improvement on the Oswestry was achieved, the intervention was considered a success. Sensitivity, specificity, and positive likelihood ratio were calculated for the association of the two criteria with the outcome of the treatment.
RESULTS
141 patients (49% female, mean age = 35.5 (+/- 11.1) years) participated. Mean pre- and post-treatment Oswestry scores were 41.9 (+/- 10.9) and 24.1 (+/- 14.2) respectively. Sixty-three subjects (45%) had successful treatment outcomes. The sensitivity of the two criteria was 0.56 (95% CI: 0.43, 0.67), specificity was 0.92 (95% CI: 0.84, 0.96), and the positive likelihood ratio was 7.2 (95% CI: 3.2, 16.1).
CONCLUSION
The results of this study demonstrate that two factors; symptom duration of less than 16 days, and no symptoms extending distal to the knee, were associated with a good outcome with spinal manipulation.
背景
初级保健中经常会遇到腰痛患者。虽然大多数患者无法做出明确诊断，但在非特异性腰痛这一较大范畴内可能存在亚组。已确定的一个亚组是对脊柱推拿反应迅速的患者。本研究的目的是探讨两个因素（症状持续时间和症状分布）与脊柱推拿干预后预后之间的关联。
方法
数据取自两项先前发表的研究。腰痛患者接受了标准化检查，包括评估当前症状的持续天数以及症状最远端的分布。根据先前的研究，症状持续时间<16天且膝部远端无症状的患者被认为推拿后预后良好。所有患者均接受了最多两次脊柱推拿治疗和一系列运动锻炼。记录治疗前后的Oswestry功能障碍评分。如果Oswestry评分改善≥50%，则认为干预成功。计算了这两个标准与治疗结果之间关联的敏感性、特异性和阳性似然比。
结果
141名患者（49%为女性，平均年龄 = 35.5（±11.1）岁）参与了研究。治疗前和治疗后的平均Oswestry评分分别为41.9（±10.9）和24.1（±14.2）。63名受试者（45%）治疗结果成功。这两个标准的敏感性为0.56（95%置信区间：0.43，0.67），特异性为0.92（95%置信区间：0.84，0.96），阳性似然比为7.2（95%置信区间：3.2，16.1）。
结论
本研究结果表明，两个因素，即症状持续时间少于16天以及膝部远端无症状，与脊柱推拿的良好预后相关。
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