Pollard Henry, de Luca Katie
School of Medicine, University of Notre Dame, Sydney, Australia.
Chiropr Osteopat. 2009 Nov 18;17:12. doi: 10.1186/1746-1340-17-12.
In New South Wales, Australia, an injured worker enters the workers compensation system with the case often managed by a pre-determined insurer. The goal of the treating practitioner is to facilitate the claimant to return to suitable duties and progress to their pre-injury status, job and quality of life. Currently, there is very little documentation on the management of injured workers by chiropractors in the Australian healthcare setting. This study aims to examine treatment protocols and recommendations given to chiropractic practitioners by one independent chiropractic reviewer in the state of New South Wales, and to discuss management strategies recommended for the injured worker.
A total of 146 consecutive Independent Chiropractic Consultant reports were collated into a database. Pain information and management recommendations made by the Independent Chiropractic Consultant were tabulated and analysed for trends. The data formulated from the reports is purely descriptive in nature.
The Independent Chiropractic Consultant determined the current treatment plan to be "reasonable" (80.1%) or "unreasonable" (23.6%). The consultant recommended to "phase out" treatment in 74.6% of cases, with an average of six remaining treatments. In eight cases treatment was unreasonable with no further treatment; in five cases treatment was reasonable with no further treatment. In 78.6% of cases, injured workers were to be discharged from treatment and 21.4% were to be reassessed for the need of a further treatment plan. Additional recommendations for treatment included an active care program (95.2%), general fitness program (77.4%), flexibility/range of movement exercises (54.1%), referral to a chronic pain specialist (50.7%) and work hardening program (22.6%).
It is essential chiropractic practitioners perform 'reasonably necessary treatment' to reduce dependency on passive treatment, increase compliance to active care programs and reduce the progression to chronic pain states. It is recommended that common findings be integrated in further research, to improve the management of treatment for patients with an occupational injury.
在澳大利亚新南威尔士州，受伤工人进入工伤赔偿系统，其案件通常由预先确定的保险公司管理。治疗医生的目标是帮助索赔人恢复到合适的工作岗位，并恢复到受伤前的状态、工作和生活质量。目前，在澳大利亚的医疗环境中，关于脊椎按摩治疗师对受伤工人的管理记录非常少。本研究旨在检查新南威尔士州一名独立脊椎按摩治疗师评审员给脊椎按摩治疗从业者的治疗方案和建议，并讨论为受伤工人推荐的管理策略。
总共146份连续的独立脊椎按摩治疗顾问报告被整理到一个数据库中。独立脊椎按摩治疗顾问给出的疼痛信息和管理建议被制成表格并分析其趋势。从报告中得出的数据本质上纯粹是描述性的。
独立脊椎按摩治疗顾问确定当前治疗计划为“合理”（80.1%）或“不合理”（23.6%）。顾问建议在74.6%的病例中“逐步停止”治疗，平均剩余六次治疗。在八个病例中，治疗不合理且不再进行进一步治疗；在五个病例中，治疗合理且不再进行进一步治疗。在78.6%的病例中，受伤工人将停止治疗，21.4%的病例将被重新评估是否需要进一步的治疗计划。额外的治疗建议包括积极护理计划（占95.2%）、一般健身计划（占77.4%）、灵活性/活动范围锻炼（占54.1%）、转诊至慢性疼痛专家（占50.7%）和工作强化计划（占22.6%）。
脊椎按摩治疗从业者必须进行“合理必要的治疗”以减少对被动治疗的依赖，提高对积极护理计划的依从性，并减少向慢性疼痛状态的发展。建议将常见发现纳入进一步研究，以改善职业损伤患者的治疗管理。
