Annen Michèle, Peterson Cynthia, Humphreys B Kim
Chiropractic Medicine Department, Faculty of Medicine, University of Zurich, Orthopaedic University Hospital Balgrist, Zürich, Switzerland.
Chiropractic Medicine Department, Faculty of Medicine, University of Zurich, Orthopaedic University Hospital Balgrist, Zürich, Switzerland.
J Manipulative Physiol Ther. 2018 Sep;41(7):561-570. doi: 10.1016/j.jmpt.2018.01.008.
The aim of this study was to determine if there was a difference in outcomes in patients with nonspecific low back pain, both with and without Modic changes (MCs), who received chiropractic care.
This prospective outcomes study included 112 patients with low back pain without disc herniation on magnetic resonance imaging. All patients were treated with spinal manipulative therapy. At baseline, the numerical rating scale (NRS) and Bournemouth Questionnaire (BQ) for disability were collected. The NRS, BQ, and Patient's Global Impression of Change (primary outcome) were collected at the follow-up time points of 1 week, 1 month, and 3 months to assess overall improvement. Magnetic resonance imaging scans were analyzed for the presence of MCs and, if present, classified as Modic I or II. The χ test was used to compare the proportion of patients reporting clinically relevant "improvement" between patients with and without MCs and between Modic I and Modic II patients. The unpaired Student t test was used to compare NRS and BQ at baseline and change scores at all follow-up time points.
For the primary outcome measure, the proportion of patients reporting relevant "improvement" (Patient's Global Impression of Change), and for the secondary outcome measures (NRS and BQ change scores), there were no significant differences between Modic positive and Modic negative patients or between Modic I and Modic II patients.
Neither the presence nor absence of MCs nor the Modic change category were related to treatment outcomes for patients with low back pain without disc herniation who received chiropractic care.
本研究旨在确定接受整脊治疗的非特异性下腰痛患者（无论有无Modic改变）的治疗结果是否存在差异。
这项前瞻性结果研究纳入了112例磁共振成像显示无椎间盘突出的下腰痛患者。所有患者均接受脊柱手法治疗。在基线时，收集数字评定量表（NRS）和用于评估残疾情况的伯恩茅斯问卷（BQ）。在1周、1个月和3个月的随访时间点收集NRS、BQ和患者总体变化印象（主要结局），以评估总体改善情况。分析磁共振成像扫描结果以确定是否存在Modic改变，若存在，则分类为Modic I型或II型。采用χ检验比较有和无Modic改变患者之间以及Modic I型和Modic II型患者之间报告临床相关“改善”的患者比例。采用非配对学生t检验比较基线时的NRS和BQ以及所有随访时间点的变化分数。
对于主要结局指标，报告相关“改善”（患者总体变化印象）的患者比例，以及对于次要结局指标（NRS和BQ变化分数），Modic阳性和Modic阴性患者之间或Modic I型和Modic II型患者之间均无显著差异。
对于接受整脊治疗的无椎间盘突出的下腰痛患者，Modic改变的有无以及Modic改变类型均与治疗结果无关。
