Fowler Raymond P
Private practice of chiropractic.
J Chiropr Med. 2004 Autumn;3(4):129-37. doi: 10.1016/S0899-3467(07)60100-1.
To present recommendations for conservative strategies to improve the management of uncomplicated back pain and to evaluate the financial crisis currently facing the workers' compensation system due in part to rapidly rising medical costs.
Medical costs in the workers' compensation system have risen at an alarming rate placing a tremendous burden on the cost of doing business in the United States. Historically, treatment for back pain in the United States has been a pathology-based approach; the literature supports a functional restorative approach for clinical efficacy and cost effectiveness.
Narrative overview of the literature.
Computerized databases were searched for relevant literature in the English language from the years 1994-2004, including: Alternative Health Watch; Cochrane Database of Systematic Reviews; Pre-CINAHL; CINAHL; MEDLINE; AgeLine; SPORT Discus. A narrative synthesis of the literature was written from retrieved articles.
A history and overview of the workers' compensation system is presented. Concerns regarding rising medical costs and recommendations for strategies to improve cost and quality of care with an emphasis on ergonomic and functional restoration recommendations are made.
A percentage of costs in the workers' compensation system go towards treating uncomplicated back pain; recurrences and chronicity of back pain are key contributors to these costs, which are currently increasing. Ergonomic advice plays a key role in helping the patient with musculoskeletal injuries heal faster and prevent costly flare-ups. Conservative care, which includes chiropractic manipulation, ergonomic recommendations, and exercise rehabilitation with an emphasis on coordination and endurance training, is supported by the literature as a possible method of cost containment.
提出关于改善单纯性背痛管理的保守策略建议，并评估工人赔偿系统目前面临的金融危机，部分原因是医疗成本迅速上升。
工人赔偿系统中的医疗成本以惊人的速度增长，给美国的商业成本带来了巨大负担。从历史上看，美国对背痛的治疗一直是基于病理学的方法；文献支持采用功能恢复性方法以提高临床疗效和成本效益。
文献叙述性综述。
检索1994年至2004年期间的英文相关文献的计算机数据库，包括：《替代健康观察》；《考科蓝系统评价数据库》；《预护理学及健康领域数据库》；《护理学及健康领域数据库》；《医学索引》；《老年学数据库》；《体育科学数据库》。根据检索到的文章撰写文献的叙述性综述。
介绍了工人赔偿系统的历史和概况。对医疗成本上升的担忧以及关于改善护理成本和质量的策略建议，重点是人体工程学和功能恢复建议。
工人赔偿系统中的一部分成本用于治疗单纯性背痛；背痛的复发和慢性化是这些成本的关键因素，目前这些成本正在增加。人体工程学建议在帮助肌肉骨骼损伤患者更快康复并防止代价高昂的病情复发方面起着关键作用。文献支持保守治疗，包括脊椎按摩治疗、人体工程学建议以及强调协调和耐力训练的运动康复，作为一种可能的成本控制方法。
