Murphy Donald R, Hurwitz Eric L, Nelson Craig F
Rhode Island Spine Center, Pawtucket, RI 02860, USA.
Chiropr Osteopat. 2008 Aug 11;16:7. doi: 10.1186/1746-1340-16-7.
Spinal pain is a common and often disabling problem. The research on various treatments for spinal pain has, for the most part, suggested that while several interventions have demonstrated mild to moderate short-term benefit, no single treatment has a major impact on either pain or disability. There is great need for more accurate diagnosis in patients with spinal pain. In a previous paper, the theoretical model of a diagnosis-based clinical decision rule was presented. The approach is designed to provide the clinician with a strategy for arriving at a specific working diagnosis from which treatment decisions can be made. It is based on three questions of diagnosis. In the current paper, the literature on the reliability and validity of the assessment procedures that are included in the diagnosis-based clinical decision rule is presented.
The databases of Medline, Cinahl, Embase and MANTIS were searched for studies that evaluated the reliability and validity of clinic-based diagnostic procedures for patients with spinal pain that have relevance for questions 2 (which investigates characteristics of the pain source) and 3 (which investigates perpetuating factors of the pain experience). In addition, the reference list of identified papers and authors' libraries were searched.
A total of 1769 articles were retrieved, of which 138 were deemed relevant. Fifty-one studies related to reliability and 76 related to validity. One study evaluated both reliability and validity.
Regarding some aspects of the DBCDR, there are a number of studies that allow the clinician to have a reasonable degree of confidence in his or her findings. This is particularly true for centralization signs, neurodynamic signs and psychological perpetuating factors. There are other aspects of the DBCDR in which a lesser degree of confidence is warranted, and in which further research is needed.
脊柱疼痛是一个常见且往往会导致功能障碍的问题。对于脊柱疼痛的各种治疗方法的研究大多表明，虽然几种干预措施已显示出轻度至中度的短期益处，但没有一种单一治疗方法对疼痛或功能障碍有重大影响。脊柱疼痛患者非常需要更准确的诊断。在之前的一篇论文中，提出了基于诊断的临床决策规则的理论模型。该方法旨在为临床医生提供一种策略，以得出可据此做出治疗决策的具体工作诊断。它基于三个诊断问题。在本文中，介绍了基于诊断的临床决策规则中所包含的评估程序的可靠性和有效性的相关文献。
检索了Medline、Cinahl、Embase和MANTIS数据库，以查找评估与问题2（调查疼痛源特征）和问题3（调查疼痛持续因素）相关的脊柱疼痛患者基于诊所的诊断程序的可靠性和有效性的研究。此外，还检索了已识别论文的参考文献列表和作者的文库。
共检索到1769篇文章，其中138篇被认为相关。51项研究与可靠性相关，76项研究与有效性相关。一项研究同时评估了可靠性和有效性。
关于基于诊断的临床决策规则的某些方面，有多项研究使临床医生能够对其发现有合理程度的信心。对于症状集中化、神经动力学体征和心理持续因素尤其如此。基于诊断的临床决策规则的其他方面则需要较低程度的信心，并且需要进一步研究。
