Ndetan Harrison, Evans Marion Willard, Felini Martha, Bae Sejong, Rupert Ronald, Singh Karan P
Parker College of Chiropractic, Research Institute, Dallas, TX 75229, USA.
J Manipulative Physiol Ther. 2010 Jul-Aug;33(6):419-24. doi: 10.1016/j.jmpt.2010.06.008.
The importance of integrating healthy behavior counseling into routine health care is universal but may depend on the type of medical care provider as well as the conditions presented by patients. The purpose of this study was to evaluate whether health promotion (HP) recommendations for known risk factors of arthritis differed between general medical doctors and doctors of chiropractic (DCs) in a nationally representative US population with arthritis.
Multiple logistic regression models were used for analyses of data from the Sample Adult Core component of the 2006 National Health Interview Survey (n = 6374 diagnosed with arthritis). Analyses were performed separately for recommendation of weight loss and increase in exercise by health profession subtype (chiropractor and medical doctor).
Comparing the reported HP efforts between DCs and medical doctors (MDs), while adjusting for the effect of physical therapist and body mass index, we observed no significant differences (weight loss: adjusted odds ratio [95% confidence interval] = 0.76 [0.50-1.18]; increased exercise: adjusted odds ratio [95% confidence interval] = 0.87 [0.59-1.29]).
Health promotion efforts to patients with arthritis do not differ significantly between MDs and DCs, as reported by National Health Interview Survey 2006. This investigation makes it difficult to suggest that DCs or MDs are doing all they can do to manage arthritis through suggested modification of lifestyle in their patients. More research specific to what is and can be recommended to those with arthritis should be conducted particularly because it relates to health-promoting behaviors. Given the recent implementation of required clinical competencies in HP into chiropractic college curriculums, future studies regarding translation of HP messages into public practice should be more informative.
将健康行为咨询纳入常规医疗保健的重要性是普遍存在的,但这可能取决于医疗服务提供者的类型以及患者所呈现的病情。本研究的目的是评估在美国具有全国代表性的患有关节炎的人群中,普通医生和脊椎按摩治疗师(DCs)针对关节炎已知风险因素提出的健康促进(HP)建议是否存在差异。
使用多个逻辑回归模型对2006年全国健康访谈调查的成人核心样本数据(n = 6374,诊断患有关节炎)进行分析。按健康职业亚型(脊椎按摩治疗师和医生)分别对体重减轻和增加运动量的建议进行分析。
在调整物理治疗师和体重指数的影响后,比较DCs和医生(MDs)报告的HP工作,我们未观察到显著差异(体重减轻:调整后的优势比[95%置信区间]=0.76[0.50 - 1.18];增加运动量:调整后的优势比[95%置信区间]=0.87[0.59 - 1.29])。
根据2006年全国健康访谈调查的报告,MDs和DCs对关节炎患者的健康促进工作没有显著差异。这项调查难以表明DCs或MDs通过建议患者改变生活方式来管理关节炎已竭尽全力。应该针对患有关节炎的人群具体能推荐什么以及可以推荐什么开展更多研究,特别是因为这与促进健康的行为相关。鉴于最近脊椎按摩治疗专业院校课程中已实施HP所需的临床能力要求,未来关于将HP信息转化为公共实践的研究应更具参考价值。