Fritz Julie M, Brennan Gerard P, Leaman Howard
Division of Physical Therapy, University of Utah, 520 Wakara Way, Salt Lake City, Utah, 84119, USA.
Spine J. 2006 May-Jun;6(3):289-95. doi: 10.1016/j.spinee.2005.11.002.
Previous research has identified clinical characteristics of patients who are likely to respond favorably to thrust manipulation. The application of this evidence and its effect on clinical outcomes among patients with occupational low back pain has not been examined.
Examine patients treated in physical therapy with occupational low back pain who fit a subgroup likely to respond to thrust manipulation.
STUDY DESIGN/SETTING: Retrospective review of clinical database.
Patients with low back pain of less than 16 days duration with no symptoms distal to the knee or signs of nerve root compression receiving workers' compensation and referred to physical therapy were included.
Self-report measures: numeric pain rating and Oswestry disability questionnaire. FUNCTIONAL MEASURES: Number of visits, duration, and costs of physical therapy.
Physical therapy notes for the first two sessions were examined. Patients were categorized as having received thrust manipulation, nonthrust manipulation, or no manipulation. Pain intensity and disability were recorded at initial and final sessions. The number of sessions, length of stay, and costs of physical therapy were recorded. Comparisons were made between patients receiving manipulation versus no manipulation, and between those receiving thrust versus nonthrust manipulation.
Two hundred fifteen patients were included (mean age 35.9 [+/-10.1] years, 67.9% male). Thrust manipulation was received by 107 (49.8%) patients; 36 (16.7%) received nonthrust manipulation and 72 (33.5%) received no manipulation. Patients receiving manipulation (thrust or nonthrust) experienced greater reductions in pain and disability with treatment. Patients receiving thrust manipulation had fewer sessions, a shorter length of stay, and lower costs in physical therapy than patients receiving nonthrust manipulation.
The evidence supporting superior clinical outcomes with the use of manipulation for a subgroup of patients was corroborated by this retrospective review of patients with occupational low back pain. The use of thrust manipulation appeared to be more efficient than the use of nonthrust manipulation for these patients.
先前的研究已经确定了可能对推力手法治疗反应良好的患者的临床特征。但尚未研究该证据的应用及其对职业性腰痛患者临床结局的影响。
研究在物理治疗中接受治疗的职业性腰痛患者中，适合对推力手法治疗有反应的亚组患者。
研究设计/场所：对临床数据库进行回顾性研究。
纳入了持续时间少于16天、膝关节以下无症状或无神经根受压体征、接受工伤赔偿并转诊至物理治疗的腰痛患者。
自我报告指标：数字疼痛评分和奥斯威斯功能障碍问卷。功能指标：物理治疗的就诊次数、持续时间和费用。
检查前两节课的物理治疗记录。患者被分类为接受了推力手法治疗、非推力手法治疗或未接受手法治疗。在初始和最后一次治疗时记录疼痛强度和功能障碍情况。记录物理治疗的就诊次数、住院时间和费用。对接受手法治疗与未接受手法治疗的患者，以及接受推力手法治疗与非推力手法治疗的患者进行比较。
纳入215例患者（平均年龄35.9 [±10.1]岁，男性占67.9%）。107例（49.8%）患者接受了推力手法治疗；36例（16.7%）接受了非推力手法治疗，72例（33.5%）未接受手法治疗。接受手法治疗（推力或非推力）的患者在治疗后疼痛和功能障碍的减轻程度更大。与接受非推力手法治疗的患者相比，接受推力手法治疗的患者物理治疗的就诊次数更少、住院时间更短且费用更低。
这项对职业性腰痛患者的回顾性研究证实了支持对部分患者使用手法治疗能取得更好临床结局的证据。对于这些患者，使用推力手法治疗似乎比使用非推力手法治疗更有效。
