Murphy Donald R, Hurwitz Eric L
Rhode Island Spine Center, 600 Pawtucket Avenue, Pawtucket, RI 02860 USA.
Chiropr Man Therap. 2011 Oct 21;19:26. doi: 10.1186/2045-709X-19-26.
Low back pain (LBP) is common and costly. Development of accurate and efficacious methods of diagnosis and treatment has been identified as a research priority. A diagnosis-based clinical decision guide (DBCDG; previously referred to as a diagnosis-based clinical decision rule) has been proposed which attempts to provide the clinician with a systematic, evidence-based means to apply the biopsychosocial model of care. The approach is based on three questions of diagnosis. The purpose of this study is to present the prevalence of findings using the DBCDG in consecutive patients with LBP.
Demographic, diagnostic and baseline outcome measure data were gathered on a cohort of LBP patients examined by one of three examiners trained in the application of the DBCDG.
Data were gathered on 264 patients. Signs of visceral disease or potentially serious illness were found in 2.7%. Centralization signs were found in 41%, lumbar and sacroiliac segmental signs in 23% and 27%, respectively and radicular signs were found in 24%. Clinically relevant myofascial signs were diagnosed in 10%. Dynamic instability was diagnosed in 63%, fear beliefs in 40%, central pain hypersensitivity in 5%, passive coping in 3% and depression in 3%.
The DBCDG can be applied in a busy private practice environment. Further studies are needed to investigate clinically relevant means to identify central pain hypersensitivity, poor coping and depression, correlations and patterns among the diagnostic components of the DBCDG as well as inter-examiner reliability and efficacy of treatment based on the DBCDG.
腰痛（LBP）很常见且代价高昂。开发准确有效的诊断和治疗方法已被确定为研究重点。已提出一种基于诊断的临床决策指南（DBCDG；以前称为基于诊断的临床决策规则），该指南试图为临床医生提供一种系统的、基于证据的方法来应用生物心理社会护理模式。该方法基于三个诊断问题。本研究的目的是呈现连续腰痛患者使用DBCDG的检查结果患病率。
收集了一组腰痛患者的人口统计学、诊断和基线结局测量数据，这些患者由三名接受过DBCDG应用培训的检查人员之一进行检查。
收集了264例患者的数据。发现内脏疾病或潜在严重疾病体征的患者占2.7%。发现中枢化体征的患者占41%，腰椎和骶髂节段体征的患者分别占23%和27%，神经根体征的患者占24%。诊断出具有临床意义的肌筋膜体征的患者占10%。诊断为动态不稳定的患者占63%，恐惧信念的患者占40%，中枢性疼痛超敏反应的患者占5%，消极应对的患者占3%，抑郁的患者占3%。
DBCDG可应用于繁忙的私人执业环境。需要进一步研究以调查识别中枢性疼痛超敏反应、应对不良和抑郁的临床相关方法，DBCDG诊断成分之间的相关性和模式，以及检查人员之间的可靠性和基于DBCDG的治疗效果。
