北欧维持护理计划——腰痛脊骨神经医学患者的病例管理：瑞典脊骨神经医学师的一项调查
The Nordic maintenance care program--case management of chiropractic patients with low back pain: a survey of Swedish chiropractors.
作者信息
Axén Iben, Rosenbaum Annika, Eklund Andreas, Halasz Laszlo, Jørgensen Kristian, Lövgren Peter W, Lange Fredrik, Leboeuf-Yde Charlotte
机构信息
Karolinska Institute, Stockholm, Sweden.
出版信息
Chiropr Osteopat. 2008 Jun 18;16:6. doi: 10.1186/1746-1340-16-6.
BACKGROUND
Chiropractic treatment for low back pain (LBP) can often be divided into two phases: Initial treatment of the problem to attempt to remove pain and bring it back into its pre-clinical or maximum improvement status, and "maintenance care", during which it is attempted to maintain this status. Although the use of chiropractic maintenance care has been described and discussed in the literature, there is no information as to its precise indications. The objective of this study is to investigate if there is agreement among Swedish chiropractors on the overall patient management for various types of LBP-scenarios, with a special emphasis on maintenance care.
METHOD
The design was a mailed questionnaire survey. Members of the Swedish Chiropractors' Association, who were participants in previous practice-based research, were sent a closed-end questionnaire consisting of nine case scenarios and six clinical management alternatives and the possibility to create one's own alternative, resulting in a "nine-by-seven" table. The research team defined its own pre hoc choice of "clinically logical" answers based on the team's clinical experience. The frequency of findings was compared to the suggestions of the research team.
RESULTS
Replies were received from 59 (60%) of the 99 persons who were invited to take part in the study. A pattern of self-reported clinical management strategies emerged, largely corresponding to the "clinically logical" answers suggested by the research team. In general, patients of concern would be referred out for a second opinion, cases with early recovery and without a history of previous low back pain would be quickly closed, and cases with quick recovery and a history of recurring events would be considered for maintenance care. However, also other management patterns were noted, in particular in the direction of maintenance care.
CONCLUSION
To a reasonable extent, Swedish chiropractors participating in this survey appear to agree on the clinical management for different cases of LBP.
背景
脊椎按摩疗法治疗腰痛通常可分为两个阶段：对问题进行初始治疗，试图消除疼痛并使其恢复到临床前状态或最大改善状态；以及“维持治疗”，在此阶段试图维持这一状态。尽管脊椎按摩疗法的维持治疗在文献中已有描述和讨论，但关于其确切适应症尚无相关信息。本研究的目的是调查瑞典脊椎按摩治疗师在各种类型腰痛情况的整体患者管理方面是否存在共识，尤其侧重于维持治疗。
方法
采用邮寄问卷调查的设计。向瑞典脊椎按摩治疗师协会的成员（他们曾参与基于实践的研究）发送一份封闭式问卷，问卷包含九个病例场景、六种临床管理方案以及自行创建方案的可能性，从而形成一个“九乘七”的表格。研究团队根据自身临床经验预先确定了“临床合理”答案的选择。将调查结果的频率与研究团队的建议进行比较。
结果
99名受邀参与研究的人员中有59人（60%）回复了问卷。出现了一种自我报告的临床管理策略模式，在很大程度上与研究团队建议的“临床合理”答案相符。一般来说，受关注的患者会被转诊以获取第二种意见，早期康复且无腰痛病史的病例会迅速结案，而康复迅速且有复发史的病例会考虑进行维持治疗。然而，也注意到了其他管理模式，特别是在维持治疗方向上。
结论
参与本次调查的瑞典脊椎按摩治疗师在不同腰痛病例的临床管理方面在合理程度上似乎存在共识。
Zotero 插件