Whedon James M, Davis Matthew A, Phillips Reed B
Instructor, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH.
J Chiropr Humanit. 2010 Dec;17(1):40-6. doi: 10.1016/j.echu.2010.10.001. Epub 2010 Oct 30.
The appropriate role for chiropractic in US health care has not been established, but third-party payors and public policy makers must make decisions about the appropriate role for chiropractors in health care systems and for the services that chiropractors provide. Appropriateness studies for chiropractic may inform those decisions. The purpose of this article is to discuss the implications and limitations of appropriateness studies for chiropractic.
We reviewed the general context for assessment of the appropriateness and the application of appropriateness studies to chiropractic in particular. We evaluated the implications and limitations for chiropractic of methods of small area analysis and the RAND-UCLA Appropriateness Method. The RAND-UCLA Appropriateness Method has been applied to the evaluation of spinal manipulation. Regional variations in chiropractic utilization have yet to be described through small area analysis, but these methods appear to hold some potential for assessing the appropriateness of chiropractic care. Both small area analysis and the RAND-UCLA method offer limited possibilities for the assessment of chiropractic appropriateness.
Future assessment of the appropriate role for chiropractic in US health care will raise issues beyond the scope of previous appropriateness studies. Studying the appropriate role for chiropractic will require consideration of the clinical discipline in its entirety, rather than individual consideration of specific interventions. A fair assessment of chiropractic appropriateness will require new evidence and perhaps new research methodologies.
整脊疗法在美国医疗保健中的适当作用尚未确定，但第三方支付方和公共政策制定者必须就整脊师在医疗保健系统中的适当作用以及整脊师提供的服务做出决策。整脊疗法的适宜性研究可能会为这些决策提供参考。本文旨在探讨整脊疗法适宜性研究的意义和局限性。
我们回顾了评估适宜性的总体背景，特别是适宜性研究在整脊疗法中的应用。我们评估了小区域分析方法和兰德-加州大学洛杉矶分校适宜性方法对整脊疗法的影响和局限性。兰德-加州大学洛杉矶分校适宜性方法已应用于脊柱推拿的评估。整脊疗法利用情况的区域差异尚未通过小区域分析来描述，但这些方法似乎在评估整脊疗法护理的适宜性方面具有一定潜力。小区域分析和兰德-加州大学洛杉矶分校方法在评估整脊疗法适宜性方面的可能性都有限。
未来对整脊疗法在美国医疗保健中适当作用的评估将提出超出以往适宜性研究范围的问题。研究整脊疗法的适当作用需要从整体上考虑这一临床学科，而不是单独考虑特定干预措施。对整脊疗法适宜性进行公平评估需要新的证据，或许还需要新的研究方法。
