Kent Peter M, Keating Jennifer L, Taylor Nicholas F
Monash Department of Clinical Epidemiology at Cabrini Hospital, Victoria, Australia.
Man Ther. 2009 Feb;14(1):88-100. doi: 10.1016/j.math.2007.12.006. Epub 2008 Mar 7.
This study investigated the assessment of acute (<12 weeks duration) nonspecific low back pain (NSLBP) by primary care clinicians. The aims were to determine the methods used, whether methods differ across professional disciplines, and the extent to which clinicians assess across domains of health. Survey data were gathered from 651 primary care clinicians from six professional disciplines (Physiotherapy, Manipulative Physiotherapy, Chiropractic, Osteopathy, General Medicine, and Musculoskeletal Medicine). Descriptive statistics (proportions and frequency of use distributions) were used to describe assessment technique use, Mann-Whitney U tests were used to determine between-discipline differences in the use of each assessment technique, and Bonferroni-adjusted inferential confidence intervals were constructed to allow visual comparison of the use of assessment techniques from five health domains. The results indicate that the methods used by different professional disciplines to assess NSLBP vary considerably, as 44 out of 48 assessment techniques showed significantly different utilisation rates across professions. Furthermore, assessment across domains of health in this condition was variable, as clinicians commonly assess physical impairments and pain and less commonly assess activity limitation and psychosocial function (100% of clinicians very frequently or often assess physical impairment, 99% [95%CI 98-100%] assess pain, 21% [95%CI 15-27%] assess activity limitation, and 7% [95%CI 3-11%] assess psychosocial function). Adoption of greater standardisation of assessment by clinicians may require demonstration of the capacity of this standardisation to improve patient outcomes.
本研究调查了初级保健临床医生对急性（病程<12周）非特异性下腰痛（NSLBP）的评估情况。目的是确定所使用的方法、各专业学科的方法是否存在差异，以及临床医生在健康各领域进行评估的程度。从六个专业学科（物理治疗、手法物理治疗、整脊疗法、骨疗法、普通医学和肌肉骨骼医学）的651名初级保健临床医生收集了调查数据。使用描述性统计（使用分布的比例和频率）来描述评估技术的使用情况，使用曼-惠特尼U检验来确定各学科在每种评估技术使用上的差异，并构建经邦费罗尼校正的推断性置信区间，以便直观比较五个健康领域评估技术的使用情况。结果表明，不同专业学科用于评估NSLBP的方法差异很大，因为48种评估技术中有44种在各专业间的使用率存在显著差异。此外，在这种情况下，跨健康领域的评估情况各不相同，因为临床医生通常评估身体损伤和疼痛，而较少评估活动受限和心理社会功能（100%的临床医生非常频繁或经常评估身体损伤，99%[95%置信区间98 - 100%]评估疼痛，21%[95%置信区间15 - 27%]评估活动受限，7%[95%置信区间3 - 11%]评估心理社会功能）。临床医生采用更大程度的标准化评估可能需要证明这种标准化能够改善患者的治疗效果。
