J Orthop Sports Phys Ther. 2017 May;47(5):347-358. doi: 10.2519/jospt.2017.6561. Epub 2017 Mar 3.
Study Design Electronic cross-sectional survey. Background The American Physical Therapy Association (APTA) evidence-based practice guideline for low back pain (LBP) elaborated on strategies to manage nonspecific LBP in routine physical therapy practice. This guideline described LBP associated with mobility deficit, leg pain and a directional preference, coordination impairment (lumbar instability), and fear-avoidance behavior. Objectives To assess American physical therapists' adherence to the clinical practice guidelines (CPGs) for LBP of the Orthopaedic Section of the APTA, and to compare adherence among physical therapists with different qualifications. Methods The investigators contacted 1861 members of the Orthopaedic Section of the APTA and 1000 members of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT). Participants made treatment choices for 4 clinical vignettes: LBP with mobility deficit, coordination impairment, leg pain (directional preference), or fear-avoidance behavior. The investigator used logistic regression analyses to compare guideline adherence among physical therapists with the following qualifications: orthopaedic clinical specialists (PTOs), Fellows of the AAOMPT (PTFs), PTOs and PTFs (PTFOs), and physical therapists without clinical specialization but with a musculoskeletal interest (PTMSs). Results A total of 410 physical therapists completed all sections of the survey (142 PTOs, 110 PTFOs, 74 PTFs, and 84 PTMSs). Adherence to the APTA's CPG was highest for LBP associated with leg pain and a directional preference (72.2%), followed by LBP with mobility deficit (57.1%), LBP with coordination impairment (46.1%), and fear-avoidance behavior (29.5%). Physical therapists who were PTFOs adhered better to the CPG for LBP than did PTMSs for all 4 patient vignettes. Orthopaedic clinical specialists adhered better to the CPG for LBP for the vignettes of mobility deficit and of LBP with fear-avoidance behavior than did PTMSs. Conclusion Physical therapists who were PTFOs and PTOs adhered better to the CPG than did PTMSs. Based on our preliminary results, further education on the CPG for LBP management is needed, particularly for managing LBP with coordination impairment and with fear-avoidance behavior. J Orthop Sports Phys Ther 2017;47(5):347-358. Epub 3 Mar 2017. doi:10.2519/jospt.2017.6561.
电子横断面调查。
美国物理治疗协会（APTA）针对非特异性下腰痛（LBP）的循证实践指南详细阐述了在常规物理治疗实践中管理 LBP 的策略。该指南描述了与运动功能障碍、腿痛和方向偏倚、协调性障碍（腰椎不稳定）以及恐动行为相关的 LBP。
评估美国物理治疗师对 APTA 骨科部分的 LBP 临床实践指南（CPG）的依从性，并比较不同资质的物理治疗师之间的依从性。
研究人员联系了 1861 名 APTA 骨科分会成员和 1000 名美国骨科手动物理治疗师协会（AAOMPT）成员。参与者为 4 个临床病例做出治疗选择：运动功能障碍、协调性障碍、腿痛（方向偏倚）或恐动行为相关的 LBP。研究人员使用逻辑回归分析比较了以下具有不同资质的物理治疗师的指南依从性：骨科临床专家（PTOs）、AAOMPT 院士（PTFs）、PTOs 和 PTFs（PTFOs）以及没有临床专业但有肌肉骨骼兴趣的物理治疗师（PTMSs）。
共有 410 名物理治疗师完成了调查的所有部分（142 名 PTOs、110 名 PTFOs、74 名 PTFs 和 84 名 PTMSs）。对 APTA 的 CPG 的依从性最高的是与腿痛和方向偏倚相关的 LBP（72.2%），其次是运动功能障碍相关的 LBP（57.1%）、协调性障碍相关的 LBP（46.1%）和恐动行为相关的 LBP（29.5%）。PTFOs 比 PTMSs 更遵守所有 4 个患者病例的 CPG，PTFOs 比 PTMSs 更遵守 CPG 来治疗 LBP。骨科临床专家对 CPG 的依从性优于 PTMSs，治疗运动功能障碍和 LBP 伴恐动行为的病例。
PTFOs 和 PTOs 比 PTMSs 更遵守 CPG。根据我们的初步结果，需要对 LBP 管理的 CPG 进行进一步教育，特别是对协调性障碍和恐动行为相关的 LBP 管理。
循证实践指南；物理治疗；下腰痛；骨科
