在因下背痛寻求脊医治疗的患者中，诊断影像学对临床结局有何影响：一项匹配的观察性研究。
What are the effects of diagnostic imaging on clinical outcomes in patients with low back pain presenting for chiropractic care: a matched observational study.
机构信息
Faculty of Medicine, Health and Human Sciences, Macquarie University, Rm 347, 17 Wally's Walk, Sydney, 2109, Australia.
Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
出版信息
Chiropr Man Therap. 2021 Nov 23;29(1):46. doi: 10.1186/s12998-021-00403-3.
BACKGROUND
Evidence suggests that diagnostic imaging for low back pain does not improve care in the absence of suspicion of serious pathology. However, the effect of imaging use on clinical outcomes has not been investigated in patients presenting to chiropractors. The aim of this study was to determine if diagnostic imaging affects clinical outcomes in patients with low back pain presenting for chiropractic care.
METHODS
A matched observational study using prospective longitudinal observational data with one year follow up was performed in primary care chiropractic clinics in Denmark. Data was collected from November 2016 to December 2019. Participants included low back pain patients presenting for chiropractic care, who were either referred or not referred for diagnostic imaging during their initial visit. Patients were excluded if they were less than 18 years old, had a diagnosis of underlying pathology, or had previous imaging relevant to their current clinical presentation. Coarsened exact matching was used to match participants referred for diagnostic imaging with participants not referred for diagnostic imaging on baseline variables including participant demographics, pain characteristics, and clinical history. Mixed linear and logistic regression models were used to assess the effect of imaging on back pain intensity and disability at two-weeks, three-months, and one-year, and on global perceived effect and satisfaction with care at two-weeks.
RESULTS
2162 patients were included, with 24.1% referred for imaging. Near perfect balance between matched groups was achieved for baseline variables except age and leg pain. Participants referred for imaging had slightly higher back pain intensity at two-weeks (0.4, 95%CI: 0.1, 0.8) and one-year (0.4, 95%CI: 0.0, 0.7), and disability at two-weeks (5.7, 95%CI: 1.4, 10.0), but the changes are unlikely to be clinically meaningful. No difference between groups was found for the other outcome measures. Similar results were found when sensitivity analysis, adjusted for age and leg pain intensity, was performed.
CONCLUSIONS
Diagnostic imaging did not result in better clinical outcomes in patients with low back pain presenting for chiropractic care. These results support that current guideline recommendations against routine imaging apply equally to chiropractic practice.
背景
有证据表明，在没有严重病理嫌疑的情况下，对腰痛进行诊断性影像学检查并不能改善治疗效果。然而，在向脊椎按摩师就诊的患者中，影像学检查的使用对临床结果的影响尚未得到研究。本研究旨在确定对脊椎按摩治疗腰痛患者进行诊断性影像学检查是否会影响临床结果。
方法
在丹麦的初级保健脊椎按摩诊所进行了一项匹配的观察性研究，采用前瞻性纵向观察数据，并进行了为期一年的随访。数据收集时间为 2016 年 11 月至 2019 年 12 月。研究对象包括因腰痛就诊、在初次就诊时被转诊或未被转诊进行诊断性影像学检查的脊椎按摩治疗患者。如果患者年龄小于 18 岁、有潜在病理诊断或有与当前临床表现相关的先前影像学检查，则将其排除在外。使用粗化精确匹配法，根据基线变量（包括患者人口统计学特征、疼痛特征和临床病史），将转诊进行影像学检查的患者与未转诊进行影像学检查的患者进行匹配。使用混合线性和逻辑回归模型，评估影像学检查对两周、三个月和一年时的腰痛强度和残疾程度、两周时的总体感知效果和对护理的满意度的影响。
结果
共纳入 2162 例患者，24.1%的患者被转诊进行影像学检查。除年龄和腿部疼痛外，匹配组之间的基线变量几乎达到了完美平衡。转诊进行影像学检查的患者在两周时（0.4，95%CI：0.1，0.8）和一年时（0.4，95%CI：0.0，0.7）的腰痛强度更高，在两周时（5.7，95%CI：1.4，10.0）和一年时（5.7，95%CI：1.4，10.0）的残疾程度更高，但这些变化不太可能具有临床意义。两组在其他结局测量指标上没有差异。当对年龄和腿部疼痛强度进行调整的敏感性分析时，得到了相似的结果。
结论
在向脊椎按摩师就诊的腰痛患者中，诊断性影像学检查并未带来更好的临床结果。这些结果支持当前反对常规影像学检查的指南建议同样适用于脊椎按摩实践。
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