Beliveau Peter J H, Wong Jessica J, Sutton Deborah A, Simon Nir Ben, Bussières André E, Mior Silvano A, French Simon D
Department of Public Health Sciences, Queen's University, Kingston, Canada.
UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Canada.
Chiropr Man Therap. 2017 Nov 22;25:35. doi: 10.1186/s12998-017-0165-8. eCollection 2017.
Previous research has investigated utilization rates, who sees chiropractors, for what reasons, and the type of care that chiropractors provide. However, these studies have not been comprehensively synthesized. We aimed to give a global overview by summarizing the current literature on the utilization of chiropractic services, reasons for seeking care, patient profiles, and assessment and treatment provided.
Systematic searches were conducted in MEDLINE, CINAHL, and Index to Chiropractic Literature using keywords and subject headings (MeSH or ChiroSH terms) from database inception to January 2016. Eligible studies: 1) were published in English or French; 2) were case series, descriptive, cross-sectional, or cohort studies; 3) described patients receiving chiropractic services; and 4) reported on the following theme(s): utilization rates of chiropractic services; reasons for attending chiropractic care; profiles of chiropractic patients; or, types of chiropractic services provided. Paired reviewers independently screened all citations and data were extracted from eligible studies. We provided descriptive numerical analysis, e.g. identifying the median rate and interquartile range (e.g., chiropractic utilization rate) stratified by study population or condition.
The literature search retrieved 14,149 articles; 328 studies (reported in 337 articles) were relevant and reported on chiropractic utilization (245 studies), reason for attending chiropractic care (85 studies), patient demographics (130 studies), and assessment and treatment provided (34 studies). Globally, the median 12-month utilization of chiropractic services was 9.1% (interquartile range (IQR): 6.7%-13.1%) and remained stable between 1980 and 2015. Most patients consulting chiropractors were female (57.0%, IQR: 53.2%-60.0%) with a median age of 43.4 years (IQR: 39.6-48.0), and were employed (median: 77.3%, IQR: 70.3%-85.0%). The most common reported reasons for people attending chiropractic care were (median) low back pain (49.7%, IQR: 43.0%-60.2%), neck pain (22.5%, IQR: 16.3%-24.5%), and extremity problems (10.0%, IQR: 4.3%-22.0%). The most common treatment provided by chiropractors included (median) spinal manipulation (79.3%, IQR: 55.4%-91.3%), soft-tissue therapy (35.1%, IQR: 16.5%-52.0%), and formal patient education (31.3%, IQR: 22.6%-65.0%).
This comprehensive overview on the world-wide state of the chiropractic profession documented trends in the literature over the last four decades. The findings support the diverse nature of chiropractic practice, although common trends emerged.
以往的研究调查了整脊疗法的利用率、接受整脊治疗的人群、原因以及整脊治疗师提供的护理类型。然而，这些研究尚未得到全面的综合分析。我们旨在通过总结当前关于整脊服务利用情况、就医原因、患者概况以及所提供的评估和治疗的文献，给出一个全面的概述。
从数据库建立到2016年1月，在MEDLINE、CINAHL和《整脊文献索引》中进行系统检索，使用关键词和主题词（医学主题词或整脊主题词）。符合条件的研究：1）以英文或法文发表；2）为病例系列、描述性、横断面或队列研究；3）描述接受整脊服务的患者；4）报告以下主题之一：整脊服务的利用率；接受整脊治疗的原因；整脊患者的概况；或所提供的整脊服务类型。两名审稿人独立筛选所有文献，并从符合条件的研究中提取数据。我们提供描述性数值分析，例如按研究人群或病情分层确定中位数率和四分位间距（例如，整脊利用率）。
文献检索共获得14149篇文章；328项研究（发表在337篇文章中）相关，并报告了整脊利用情况（245项研究）、接受整脊治疗的原因（85项研究）、患者人口统计学特征（130项研究）以及所提供的评估和治疗（34项研究）。在全球范围内，整脊服务的12个月中位数利用率为9.1%（四分位间距（IQR）：6.7%-13.1%），在1980年至2015年期间保持稳定。大多数咨询整脊治疗师的患者为女性（57.0%，IQR：53.2%-60.0%），中位年龄为43.4岁（IQR：39.6-48.0），且为在职人员（中位数：77.3%，IQR：70.3%-85.0%）。人们接受整脊治疗最常见的报告原因（中位数）是腰痛（49.7%，IQR：43.0%-60.2%）、颈部疼痛（22.5%，IQR：16.3%-24.5%）和肢体问题（10.0%，IQR：4.3%-22.0%）。整脊治疗师提供的最常见治疗方法包括（中位数）脊柱推拿（79.3%，IQR：55.4%-91.3%）、软组织疗法（35.1%，IQR：16.5%-52.0%）和正式的患者教育（31.3%，IQR：22.6%-65.0%）。
这一关于整脊行业全球状况的全面概述记录了过去四十年来文献中的趋势。研究结果支持了整脊疗法实践的多样性，尽管也出现了一些共同趋势。
