Hinton Paul M, McLeod Randall, Broker Blaine, Maclellan C Elizabeth
Private practice, Prince Albert, SK. Tel: 306 922-7028. Email:
J Can Chiropr Assoc. 2010 Jun;54(2):118-31.
To describe the extent to which chiropractors utilize standardized outcome and various clinical measures to systematically document patients' baseline health status and responses to treatment, with particular consideration being given towards quantifiable outcome instruments.
Cross-sectional mailed survey.
Registered chiropractors in the province of Saskatchewan.
A survey was mailed to all registrants of the Chiropractors' Association of Saskatchewan. Respondents graded their frequency of using various standardized pencil-and-paper instruments and functional chiropractic, orthopaedic and neurological tests in the contexts of both the initial intake assessment ('always,' 'commonly,' 'occasionally,' or 'never') and the course of subsequent treatment (after 'each visit,' after '9-12 visits,' 'annually,' when patient 'not responding,' on 'dismissal/discharge,' 'never' or for some 'other' reason). Data were tabulated for all item and response category combinations as frequencies and percentages using the total sample size as the denominator.
Of 164 registered chiropractors, 62 (38%) returned a completed questionnaire. A pain diagram was the most commonly used subjective outcome measure and was administered routinely (either "always" or "commonly") by 75% of respondents, at either the initial consultation or during a subsequent visit. Numerical rating and visual analogue scales were less popular (routinely used by 59% and 42% respectively). The majority of respondents (80%) seldom ("occasionally" or "never") used spine pain-specific disability indices such as the Low Back Revised Oswestry, Neck Disability Index or the Roland-Morris Questionnaire. As well, they did not use standardized psychosocial instruments such as the Beck Depression Index, or general health assessment measures such as the SF-36 or SF-12 questionnaire. Neurological testing was the most commonly used objective outcome measure. Most respondents (84% to 95%) indicated that they continually monitored neurological status through dermatomal, manual muscle strength and deep tendon reflex testing. Ranges of motion were routinely measured by 95% of respondents, usually visually (96%) rather than goniometrically or by some other specialized device (7%).
Our findings suggest that the majority of chiropractors do not use psychosocial questionnaires or condition-specific disability indices to document baseline or subsequent changes in health status. Chiropractors are more likely to rely on medical history taking and pain drawings during an initial intake assessment, as well as neurological and visually estimated range of motion testing during both initial intake and subsequent treatment visits.
描述脊椎按摩师在多大程度上利用标准化结局指标和各种临床测量方法来系统记录患者的基线健康状况及对治疗的反应，尤其关注可量化的结局工具。
横断面邮寄调查。
萨斯喀彻温省的注册脊椎按摩师。
向萨斯喀彻温省脊椎按摩师协会的所有注册人员邮寄了一份调查问卷。受访者对他们在初始接诊评估（“总是”“通常”“偶尔”或“从不”）以及后续治疗过程（“每次就诊后”“9 - 12次就诊后”“每年”“患者无反应时”“出院时”“从不”或因某些“其他”原因）中使用各种标准化纸笔工具以及功能性脊椎按摩、骨科和神经学检查的频率进行评分。以总样本量为分母，将所有项目和反应类别组合的数据制成频率和百分比表格。
在164名注册脊椎按摩师中，62名（38%）返回了完整的问卷。疼痛图是最常用的主观结局测量方法，75%的受访者在初次咨询或后续就诊时常规（“总是”或“通常”）使用。数字评分量表和视觉模拟量表的使用较少（分别为59%和42%）。大多数受访者（80%）很少（“偶尔”或“从不”）使用脊柱疼痛特异性残疾指数，如修订的下背痛Oswestry量表、颈部残疾指数或罗兰 - 莫里斯问卷。此外，他们不使用标准化的心理社会工具，如贝克抑郁量表，也不使用一般健康评估措施，如SF - 36或SF - 12问卷。神经学检查是最常用的客观结局测量方法。大多数受访者（84%至95%）表示，他们通过皮节、徒手肌力和深部腱反射检查持续监测神经状态。95%的受访者常规测量活动范围，通常是通过目测（96%）而非角度测量或其他专用设备（7%）。
我们的研究结果表明，大多数脊椎按摩师不使用心理社会问卷或特定疾病残疾指数来记录健康状况的基线或后续变化。脊椎按摩师在初始接诊评估时更倾向于依赖病史采集和疼痛绘图，在初始接诊和后续治疗就诊时都更倾向于依赖神经学检查和目测活动范围测试。
