Guenoun Olivier, Debarle Michel, Garnesson Coralie, Proisl Sylvie, Ray Delphine, Leboeuf-Yde Charlotte
Institute Franco-Européen de Chiropratique, 24 blv Paul Vaillant Couturier, F-94200 Ivry sur Seine, France.
Chiropr Man Therap. 2011 Sep 24;19:23. doi: 10.1186/2045-709X-19-23.
Not much is known about the French chiropractic profession on, for example, level of consensus on clinical issues.
The first objective was to investigate if French chiropractors' management choices appeared reasonable for various neck problem scenarios. The second objective was to investigate if there was agreement between chiropractors on the patient management. The third objective was to see to which degree and at what stages chiropractors would consider to interact with other health-care practitioners, such as physiotherapists, general practitioners and specialists.
A questionnaire was sent to a randomly selected sample of all French chiropractors known to the national chiropractic college. It consisted of an invitation to participate in the study, a brief case description, and drawings of five stages of how a case of neck pain gradually evolves into a brachialgia to end up with a compromised spinal cord. Each stage offered five management choices. Participants were asked at what stages patients would be treated solely by the chiropractor and when patients would be referred out for second opinion or other care without chiropractic treatment, plus an open ended option, resulting in a "five-by-six" table. The percentages of respondents choosing the different management strategies were identified for the different scenarios and the 95% confidence intervals were calculated. There was a pre hoc agreement on when chiropractic care would or would not be suitable. Consensus was arbitrarily defined as "moderate" when 50- 69% of respondents agreed on the same management choice and as "excellent" when 70% or more provided the same answer. It was expected that inter professional contacts would be rare.
The response rate was 53% out of 254 potential participants. The first two uncomplicated cases would generally have been treated by the chiropractors. As the patient worsened, the responses tended towards external assistance and for the most severe case, the majority of respondents would have referred the patient out. There was excellent consensus for the two extreme cases (the most benign and the most severe), moderate consensus for the cases next to these two and least agreement relating to the "middle" case. Inter-professional collaboration was contemplated mainly for the severe case.
The French chiropractors who participated in this study seem to have a similar approach to patients with neck pain that gradually develops into a brachialgia and worsens. However, it is not known if the large group of non-participants in the study would agree with this treatment strategy.
对于法国整脊行业，例如在临床问题上的共识程度，人们了解得并不多。
第一个目的是调查法国整脊师针对各种颈部问题情况所做出的管理选择是否合理。第二个目的是调查整脊师之间在患者管理方面是否存在共识。第三个目的是了解整脊师在何种程度以及在哪些阶段会考虑与其他医疗保健从业者互动，如物理治疗师、全科医生和专科医生。
向全国整脊学院已知的所有法国整脊师中随机抽取的样本发送一份问卷。问卷包括参与研究的邀请、简短病例描述以及颈部疼痛病例逐渐发展为臂丛神经痛并最终导致脊髓受损的五个阶段的示意图。每个阶段提供五种管理选择。参与者被问及在哪些阶段患者将仅由整脊师治疗，以及患者何时会被转介寻求第二种意见或接受非整脊治疗的其他护理，外加一个开放式选项，从而形成一个“5×6”表格。确定不同情况下选择不同管理策略的受访者百分比，并计算95%置信区间。对于整脊护理何时合适或不合适存在预先协议。当50%至69%的受访者对相同的管理选择达成一致时，共识被任意定义为“中等”；当70%或更多受访者给出相同答案时，共识被定义为“优秀”。预计跨专业联系会很少。
在254名潜在参与者中，回复率为53%。前两个不复杂的病例通常会由整脊师治疗。随着患者病情恶化，回复倾向于寻求外部帮助，对于最严重的病例，大多数受访者会将患者转介出去。对于两个极端病例（最轻微和最严重的）存在优秀的共识，对于这两个病例旁边的病例存在中等共识，而对于“中间”病例的一致性最低。主要针对严重病例考虑跨专业合作。
参与本研究的法国整脊师对于颈部疼痛逐渐发展为臂丛神经痛并恶化的患者似乎有类似的处理方法。然而，尚不清楚研究中大量未参与者是否会同意这种治疗策略。
