RAND Corporation, Santa Monica, CA.
Office of Public Health Studies, University of Hawai'i, Mānoa, Honolulu, HI.
Spine (Phila Pa 1976). 2021 Oct 1;46(19):1344-1353. doi: 10.1097/BRS.0000000000004009.
RAND/UCLA Appropriateness Method (RUAM) applied to chiropractic manipulation for patients with chronic low-back pain (CLBP) and chronic neck pain (CNP).
Determine the rate of appropriate care provided by US chiropractors.
Spinal manipulation has been shown effective for CLBP and CNP but may not be appropriate for all patients with these conditions.
Ratings of the appropriateness of spinal and cervical manipulation previously developed by two RUAM expert panels were applied to data abstracted from random samples of patient charts from chiropractors in six US regions to determine the appropriateness of manipulation for each patient.
Of 125 chiropractors sampled, 89 provided charts that could be abstracted. Of the 2128 charts received, 1054 were abstracted. Charts received but not abstracted included 460 that were unusable (e.g., illegible), and 555 did not have CLBP or CNP. Across the abstracted charts 72% had CLBP, 57% had CNP, and 29% had both; 84% of patients with CLBP and 86% with CNP received manipulation. Patients with CLBP who had minor neurologic findings, sciatic nerve irritation, or no joint dysfunction were significantly less likely to receive manipulation. Patients with CNP who had substantial trauma etiology, no joint dysfunction, or no radiographs were significantly less likely to receive manipulation. Most manipulation for CLBP (64%) was appropriate and most manipulation for CNP (93%) was for patients where appropriateness was uncertain or equivocal. The proportions of patients receiving inappropriate manipulation for either condition were low (1%-3%) as were the numbers of patients presenting to these chiropractors for which manipulation was inappropriate.
Chiropractors in this US sample tend to provide manipulation to very few patients with CLBP or CNP for which it is inappropriate. However, more research is needed to determine which patients with CNP benefit from manipulation.Level of Evidence: 4.
拉筹伯大学适宜性方法（RUAM）应用于慢性下背痛（CLBP）和慢性颈痛（CNP）的脊骨按摩治疗。
确定美国脊医提供适宜护理的比率。
脊柱推拿已被证明对 CLBP 和 CNP 有效，但可能并不适合所有患有这些疾病的患者。
RUAM 两个专家小组先前制定的脊柱和颈椎推拿适宜性评分应用于从美国六个地区的脊医随机抽取的患者图表数据中，以确定每位患者推拿的适宜性。
在抽样的 125 名脊医中，有 89 名提供了可摘录的图表。在收到的 2128 份图表中，有 1054 份被摘录。未被摘录的图表包括 460 份无法使用（例如，字迹不清），555 份没有 CLBP 或 CNP。在摘录的图表中，72%的患者有 CLBP，57%的患者有 CNP，29%的患者同时有 CLBP 和 CNP；84%的 CLBP 患者和 86%的 CNP 患者接受了推拿。CLBP 患者有轻微的神经学发现、坐骨神经刺激或没有关节功能障碍，接受推拿的可能性显著降低。CNP 患者有严重的创伤病因、没有关节功能障碍或没有 X 光片，接受推拿的可能性显著降低。大多数 CLBP 的推拿（64%）是适宜的，大多数 CNP 的推拿（93%）是针对适宜性不确定或模棱两可的患者。两种情况下接受不适当推拿的患者比例都很低（1%-3%），这些脊医就诊的患者中，不适合进行推拿的患者数量也很少。
在这项美国样本研究中，脊医倾向于对极少数因不合适而接受 CLBP 或 CNP 推拿的患者进行治疗。然而，还需要更多的研究来确定哪些 CNP 患者受益于推拿。
4 级。
