Wirth Brigitte, Riner Fabienne, Peterson Cynthia, Humphreys Barry Kim, Farshad Mazda, Becker Susanne, Schweinhardt Petra
1Integrative Spinal Research Group, Department of Chiropractic Medicine, Balgrist University Hospital, Forchstr. 340, 8008 Zurich, Switzerland.
2Spine Division, Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland.
Chiropr Man Therap. 2019 Feb 5;27:6. doi: 10.1186/s12998-018-0225-8. eCollection 2019.
A close collaboration between surgeons and non-surgical spine experts is crucial for optimal care of low back pain (LBP) patients. The affiliation of a chiropractic teaching clinic to a university hospital with a large spine division in Zurich, Switzerland, enables such collaboration. The aim of this study was to describe the trajectories and outcomes of patients with chronic LBP referred from the spine surgery division to the chiropractic teaching clinic.
The patients filled in an 11-point numeric rating scale (NRS) for pain intensity and the Bournemouth Questionnaire (BQ) (bio-psycho-social measure) at baseline and after 1 week, 1, 3, 6 and 12 months. Additionally, the Patient's Global Impression of Change (PGIC) scale was recorded at all time points apart from baseline. The courses of NRS and BQ were analyzed using linear mixed model analysis and repeated measures ANOVA. The proportion of patients reporting clinically relevant overall improvement (PGIC) was calculated and the underlying factors were determined using logistic regression analyses.
Between June 2014 and October 2016, 67 participants (31 male, mean age = 46.8 ± 17.6 years) were recruited, of whom 46 had suffered from LBP for > 1 year, the rest for > 3 months, but < 1 year. At baseline, mean NRS was 5.43 (SD 2.37) and mean BQ was 39.80 (SD 15.16) points. NRS significantly decreased [F(5, 106.77) = 3.15, = 0.011] to 4.05 (SD 2.88) after 12 months. A significant reduction was not observed before 6 months after treatment start ( = 0.04). BQ significantly diminished [F(5, 106.47) = 6.55, < 0.001] to 29.00 (SD 17.96) after 12 months and showed a significant reduction within the first month ( < 0.01). The proportion of patients reporting overall improvement significantly increased from 23% after 1 week to 47% after 1 month ( = 0.004), when it stabilized [56% after 3 and 6 months, 44% after 12 months]. Reduction in bio-psycho-social impairment (BQ) was of higher importance for overall improvement than pain reduction.
Chiropractic treatment is a valuable conservative treatment modality associated with clinically relevant improvement in approximately half of patients with chronic LBP. These findings provide an example of the importance of interdisciplinary collaboration in the treatment of chronic back pain patients.
外科医生与非手术脊柱专家之间的密切合作对于腰痛（LBP）患者的最佳治疗至关重要。瑞士苏黎世一家拥有大型脊柱科的大学医院附属一家整脊教学诊所，这使得这种合作成为可能。本研究的目的是描述从脊柱外科转诊至整脊教学诊所的慢性LBP患者的治疗轨迹和结果。
患者在基线时以及1周、1、3、6和12个月后填写11点数字疼痛评分量表（NRS）以评估疼痛强度，并填写伯恩茅斯问卷（BQ）（生物 - 心理 - 社会测量）。此外，除基线外，在所有时间点记录患者的整体改善情况量表（PGIC）。使用线性混合模型分析和重复测量方差分析来分析NRS和BQ的变化过程。计算报告临床相关整体改善（PGIC）的患者比例，并使用逻辑回归分析确定相关因素。
在2014年6月至2016年10月期间，招募了67名参与者（31名男性，平均年龄 = 46.8 ± 17.6岁），其中46人患有LBP超过1年，其余患者患有LBP超过3个月但少于1年。基线时，平均NRS为5.43（标准差2.37），平均BQ为39.80（标准差15.16）分。12个月后，NRS显著降低[F(5, 106.77) = 3.15，P = 0.011]至4.05（标准差2.88）。在治疗开始后6个月之前未观察到显著降低（P = 0.04）。12个月后，BQ显著降低[F(5, 106.47) = 6.55，P < 0.001]至29.00（标准差17.96），并在第一个月内显示出显著降低（P < 0.01）。报告整体改善的患者比例从1周后的23%显著增加到1个月后的47%（P = 0.004），之后趋于稳定[3个月和6个月后为56%，12个月后为44%]。生物 - 心理 - 社会功能障碍（BQ）的减轻对整体改善的重要性高于疼痛减轻。
整脊治疗是一种有价值的保守治疗方式，约一半的慢性LBP患者经治疗后有临床相关改善。这些发现提供了一个范例，说明了跨学科合作在慢性背痛患者治疗中的重要性。
