Hincapié Cesar A, Cassidy J David, Côté Pierre, Rampersaud Y Raja, Jadad Alejandro R, Tomlinson George A
Injury Prevention Research Office, Division of Neurosurgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
Eur Spine J. 2018 Jul;27(7):1517-1525. doi: 10.1007/s00586-017-5295-0. Epub 2017 Sep 18.
Chiropractic spinal manipulation treatment (SMT) is common for back pain and has been reported to increase the risk for lumbar disc herniation (LDH), but there is no high quality evidence about this. In the absence of good evidence, clinicians can have knowledge and beliefs about the risk. Our purpose was to determine clinicians' beliefs regarding the risk for acute LDH associated with chiropractic SMT.
Using a belief elicitation design, 47 clinicians (16 chiropractors, 15 family physicians and 16 spine surgeons) that treat patients with back pain from primary and tertiary care practices were interviewed. Participants' elicited incidence estimates of acute LDH among a hypothetical group of patients with acute low back pain treated with and without chiropractic SMT, were used to derive the probability distribution for the relative risk (RR) for acute LDH associated with chiropractic SMT.
Chiropractors expressed the most optimistic belief (median RR 0.56; IQR 0.39-1.03); family physicians expressed a neutral belief (median RR 0.97; IQR 0.64-1.21); and spine surgeons expressed a slightly more pessimistic belief (median RR 1.07; IQR 0.95-1.29). Clinicians with the most optimistic views believed that chiropractic SMT reduces the incidence of acute LDH by about 60% (median RR 0.42; IQR 0.29-0.53). Those with the most pessimistic views believed that chiropractic SMT increases the incidence of acute LDH by about 30% (median RR 1.29; IQR 1.11-1.59).
Clinicians' beliefs about the risk for acute LDH associated with chiropractic SMT varied systematically across professions, in spite of a lack of scientific evidence to inform these beliefs. These probability distributions can serve as prior probabilities in future Bayesian analyses of this relationship.
脊椎按摩疗法（SMT）常用于治疗背痛，据报道会增加腰椎间盘突出症（LDH）的风险，但尚无关于此的高质量证据。在缺乏充分证据的情况下，临床医生可能对该风险有一定的认识和看法。我们的目的是确定临床医生对于脊椎按摩疗法SMT与急性LDH风险之间关系的看法。
采用信念诱导设计，对47名治疗原发性和三级护理机构中背痛患者的临床医生（16名脊椎按摩师、15名家庭医生和16名脊柱外科医生）进行了访谈。参与者对一组假设的接受和未接受脊椎按摩疗法SMT治疗的急性下背痛患者中急性LDH的发病率估计，被用于推导脊椎按摩疗法SMT与急性LDH相关的相对风险（RR）的概率分布。
脊椎按摩师表达了最乐观的看法（RR中位数为0.56；四分位间距为0.39 - 1.03）；家庭医生表达了中立的看法（RR中位数为0.97；四分位间距为0.64 - 1.21）；脊柱外科医生表达了稍悲观的看法（RR中位数为1.07；四分位间距为0.95 - 1.29）。看法最乐观的临床医生认为脊椎按摩疗法SMT可使急性LDH的发病率降低约60%（RR中位数为0.42；四分位间距为0.29 - 0.53）。看法最悲观的临床医生认为脊椎按摩疗法SMT会使急性LDH的发病率增加约30%（RR中位数为1.29；四分位间距为1.11 - 1.59）。
尽管缺乏科学证据来支持这些看法，但临床医生对于脊椎按摩疗法SMT与急性LDH风险之间关系的看法在不同专业间存在系统性差异。这些概率分布可作为未来对该关系进行贝叶斯分析的先验概率。
