Bishop Mark D, Bialosky Joel E, Cleland Josh A
Department of Physical Therapy, University of Florida, USA.
J Man Manip Ther. 2011 Feb;19(1):20-5. doi: 10.1179/106698110X12804993426929.
The purpose of this secondary analysis was 1) to examine patient expectations related to a variety of common interventions for low back pain (LBP) and 2) to determine the influence that specific expectations about spinal manipulation might have had on self-report of disability.
We collected patients' expectations about the benefit of specific interventions for low back pain. We also collected patients' general expectations about treatment and tested the relationships among the expectation of benefit from an intervention, receiving that intervention and disability-related outcomes.
Patients expected exercise and manual therapy interventions to provide more benefit than surgery and medication. There was a statistical association between expecting relief from thrust techniques and receiving thrust techniques, related to meeting the general expectation for treatment (chi-square: 15.5, P = 0.008). This was not the case for patients who expected relief from thrust techniques but did not receive it (chi-square: 6.9, P = 0.4). Logistic regression modeling was used to predict change in disability at treatment visit 5. When controlling for whether the general expectations for treatment were met, intervention assignment and the interaction between intervention assignment and expectations regarding thrust techniques, the parsimonious model only included intervention as the significant contributor to the model (P < 0.001). The adjusted odds ratio of success comparing thrust techniques to non-thrust in this study was 41.2 (11.0, 201.7).
The findings of this secondary analysis indicate that patients seeking intervention for LBP expect active interventions and manual therapy to significantly help improve their pain more than interventions like traction, rest, surgery, or medication. Additionally, in patients who meet the clinical prediction rule for good prognosis when managed with thrust techniques, treating with thrust techniques is more important than matching treatment to patient expectation.
本次二次分析的目的是：1）研究患者对各种常见腰痛（LBP）干预措施的期望；2）确定对脊柱推拿的特定期望可能对残疾自评产生的影响。
我们收集了患者对腰痛特定干预措施益处的期望。我们还收集了患者对治疗的总体期望，并测试了干预措施益处期望、接受该干预措施与残疾相关结果之间的关系。
患者期望运动和手法治疗干预措施比手术和药物能带来更多益处。期望通过推力技术缓解疼痛与接受推力技术之间存在统计学关联，这与满足总体治疗期望有关（卡方检验：15.5，P = 0.008）。而期望通过推力技术缓解疼痛但未接受该技术的患者则不然（卡方检验：6.9，P = 0.4）。使用逻辑回归模型预测第5次治疗访视时残疾情况的变化。在控制总体治疗期望是否得到满足、干预分配以及干预分配与对推力技术期望之间的相互作用后，简约模型仅将干预作为模型的显著贡献因素（P < 0.001）。在本研究中，将推力技术与非推力技术相比，成功的调整比值比为41.2（11.0，201.7）。
本次二次分析的结果表明，寻求腰痛干预措施的患者期望主动干预和手法治疗比牵引、休息、手术或药物等干预措施能更显著地帮助改善疼痛。此外，对于采用推力技术治疗时符合良好预后临床预测规则的患者，采用推力技术治疗比使治疗与患者期望相匹配更为重要。
