Peterson Cynthia K, Mühlemann Daniel, Humphreys Barry Kim
Department of Chiropractic Medicine, Orthopaedic University Hospital Balgrist, University of Zürich, Forchstrasse 340, Zürich, Switzerland.
Chiropr Man Therap. 2014 Apr 1;22(1):15. doi: 10.1186/2045-709X-22-15.
Low back pain in pregnancy is common and research evidence on the response to chiropractic treatment is limited. The purposes of this study are 1) to report outcomes in pregnant patients receiving chiropractic treatment; 2) to compare outcomes from subgroups; 3) to assess predictors of outcome.
Pregnant patients with low back or pelvic pain, no contraindications to manipulative therapy and no manual therapy in the prior 3 months were recruited.Baseline numerical rating scale (NRS) and Oswestry questionnaire data were collected. Duration of complaint, number of previous LBP episodes, LBP during a previous pregnancy, and category of pain location were recorded.The patient's global impression of change (PGIC) (primary outcome), NRS, and Oswestry data (secondary outcomes) were collected at 1 week, 1 and 3 months after the first treatment. At 6 months and 1 year the PGIC and NRS scores were collected. PGIC responses of 'better' or 'much better' were categorized as 'improved'.The proportion of patients 'improved' at each time point was calculated. Chi-squared test compared subgroups with 'improvement'. Baseline and follow-up NRS and Oswestry scores were compared using the paired t-test. The unpaired t-test compared NRS and Oswestry scores in patients with and without a history of LBP and with and without LBP during a previous pregnancy. Anova compared baseline and follow-up NRS and Oswestry scores by pain location category and category of number of previous LBP episodes. Logistic regression analysis also was also performed.
52% of 115 recruited patients 'improved' at 1 week, 70% at 1 month, 85% at 3 months, 90% at 6 months and 88% at 1 year. There were significant reductions in NRS and Oswestry scores (p < 0.0005). Category of previous LBP episodes number at one year (p = 0.02) was related to ,improvement' when analyzed alone, but was not strongly predictive in logistic regression. Patients with more prior LBP episodes had higher 1 year NRS scores (p = 0.013).
Most pregnant patients undergoing chiropractic treatment reported clinically relevant improvement at all time points. No single variable was strongly predictive of, improvement' in the logistic regression model.
孕期下背痛很常见，而关于整脊治疗反应的研究证据有限。本研究的目的是：1）报告接受整脊治疗的孕妇的治疗结果；2）比较亚组的治疗结果；3）评估治疗结果的预测因素。
招募有下背或骨盆疼痛、无手法治疗禁忌证且在过去3个月内未接受过手法治疗的孕妇。收集基线数字评定量表（NRS）和奥斯维斯特问卷数据。记录疼痛持续时间、既往下背痛发作次数、既往妊娠期间的下背痛情况以及疼痛部位类别。在首次治疗后1周、1个月和3个月收集患者的整体变化印象（PGIC）（主要结局）、NRS和奥斯维斯特数据（次要结局）。在6个月和1年时收集PGIC和NRS评分。PGIC反应为“好转”或“明显好转”的被归类为“改善”。计算每个时间点“改善”的患者比例。卡方检验比较有“改善”的亚组。使用配对t检验比较基线和随访时的NRS和奥斯维斯特评分。非配对t检验比较有和无下背痛病史以及既往妊娠期间有无下背痛的患者的NRS和奥斯维斯特评分。方差分析按疼痛部位类别和既往下背痛发作次数类别比较基线和随访时的NRS和奥斯维斯特评分。还进行了逻辑回归分析。
115名招募患者中，52%在1周时“改善”，70%在1个月时“改善”，85%在3个月时“改善”，90%在6个月时“改善”，88%在1年时“改善”。NRS和奥斯维斯特评分有显著降低（p<0.0005）。单独分析时，1年时既往下背痛发作次数类别（p=0.02）与“改善”有关，但在逻辑回归中预测性不强。既往下背痛发作次数较多的患者1年时的NRS评分较高（p=0.013）。
大多数接受整脊治疗 的孕妇在所有时间点均报告有临床相关改善。在逻辑回归模型中，没有单一变量能强烈预测“改善”情况。
