Rubinstein Sidney M, Leboeuf-Yde Charlotte, Knol Dirk L, de Koekkoek Tammy E, Pfeifle Charles E, van Tulder Maurits W
Institute for Research in Extramural Medicine (EMGO Institute), VU University Medical Center, Amsterdam, The Netherlands.
J Manipulative Physiol Ther. 2008 Feb;31(2):94-103. doi: 10.1016/j.jmpt.2007.12.006.
This study examines which variables may predict adverse events in subjects undergoing chiropractic treatment for neck pain.
This was a prospective, multi-center, cohort study. All new patients, 18 to 65 years of age with neck pain of any duration, who had not undergone chiropractic care or manual therapy in the prior 3 months, were eligible. Sources of data were questionnaires administered during the first 3 treatments. In all, 60 putative prognostic variables were examined, including descriptors of the patient, chiropractor, and type of treatment delivered. Adverse events were defined as either a new complaint, or the worsening of an existing complaint by more than 30% on an 11-point numerical rating scale. Multivariate random coefficients logistic regression analyses were conducted to determine predictors for the following outcome variables: (1) any adverse event after any of the first 3 visits, (2) any type of adverse event after the first visit only, and (3) specific types of adverse events after the first visit only (ie, headache, increased neck pain, pain and/or stiffness at the treated area).
In total, 579 patients were recruited, of whom 529 fulfilled the inclusion criteria. The reported use of a manipulative technique involving cervical rotation, and working status of the patient (sick leave or workers' compensation) were moderately associated with an adverse event after any of the first 3 visits. Patients who had visited their general practitioner in the 6 months before treatment, however, were less likely to have an adverse event. A longer duration with neck pain in the preceding year was moderately associated with specific types of events after the first visit, namely, headache or worsening of the presenting neck pain. Increased neck pain after the first visit was the easiest outcome variable to predict (area under the curve, 0.88; 95% confidence interval, 0.84-0.91).
Of the 60 independent variables examined, only 4 were found to be predictive of adverse events after chiropractic treatment for neck pain, one of which was found to be protective. The chiropractic practitioner can identify 3 of these variables before initiating treatment.
本研究探讨哪些变量可预测接受脊椎按摩治疗颈痛患者的不良事件。
这是一项前瞻性、多中心队列研究。所有18至65岁、有任何时长颈痛且在过去3个月内未接受过脊椎按摩治疗或手法治疗的新患者均符合条件。数据来源为前3次治疗期间发放的问卷。总共检查了60个假定的预后变量，包括患者、脊椎按摩师的描述以及所提供治疗的类型。不良事件定义为新出现的症状，或在11点数字评分量表上现有症状恶化超过30%。进行多变量随机系数逻辑回归分析以确定以下结局变量的预测因素：（1）前3次就诊中任何一次后的任何不良事件；（2）仅首次就诊后的任何类型不良事件；（3）仅首次就诊后的特定类型不良事件（即头痛、颈痛加重、治疗部位疼痛和/或僵硬）。
总共招募了579名患者，其中529名符合纳入标准。报告使用涉及颈椎旋转的手法技术以及患者的工作状态（病假或工伤赔偿）与前3次就诊中任何一次后的不良事件中度相关。然而，在治疗前6个月看过全科医生的患者发生不良事件的可能性较小。前一年颈痛持续时间较长与首次就诊后的特定类型事件（即头痛或当前颈痛加重）中度相关。首次就诊后颈痛加重是最容易预测的结局变量（曲线下面积为0.88；95%置信区间为0.84 - 0.91）。
在所检查的60个独立变量中，仅发现4个可预测脊椎按摩治疗颈痛后的不良事件，其中1个具有保护作用。脊椎按摩治疗师在开始治疗前可识别出其中3个变量。
