Osteopathic Research Center and the Department of Family Medicine, University of North Texas Health Science Center-Texas College of Osteopathic Medicine, Fort Worth, TX, USA.
J Osteopath Med. 2021 Sep 23;122(1):21-29. doi: 10.1515/jom-2021-0105.
It is generally acknowledged that osteopathic physicians take a holistic approach to patient care. This style may help prevent the progression of painful musculoskeletal conditions, particularly if combined with osteopathic manipulative treatment (OMT).
The study aimed to determine if osteopathic medical care lowers the risk of progression from localized chronic low back pain to widespread pain and lessens the impact of pain on health-related quality of life.
A historical cohort study was conducted within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION Pain Research Registry) using data acquired from April 2016 through March 2021. Registry participants aged 21-79 years with chronic low back pain at the baseline encounter were potentially eligible for inclusion if they had a treating physician, completed all four quarterly follow-up encounters, and did not report physician crossover at the final 12-month encounter. Eligible participants were classified according to the type of physician provider at baseline and thereby into osteopathic or allopathic medical care groups. Participants were also classified according to prior use of OMT at the final encounter. Widespread pain was measured at baseline and each quarterly encounter to determine the period prevalence rate of widespread pain and its severity over 12 months using the Minimum Dataset for Chronic Low Back Pain recommended by the National Institutes of Health. Participants who reported "not being bothered at all" by widespread pain during each encounter were classified as not having widespread pain, whereas those who were bothered "a little" or "a lot" at any quarterly encounter were classified as having widespread pain. The severity of widespread pain was measured by summing participant responses at each encounter. The Patient-Reported Outcomes Measurement Information System was used at each encounter to measure health-related quality-of-life (HRQOL) scores for physical function, anxiety, depression, fatigue, sleep disturbance, participation in social roles and activities, and pain interference with activities.
A total of 462 participants were studied, including 101 (21.9%) in the osteopathic medical care group and 73 (15.8%) who used OMT. The mean age of participants at baseline was 52.7 ± 13.2 years (range, 22-79 years) and 336 (72.7%) were female. A lower period prevalence rate of widespread pain was observed in the osteopathic medical care group (OR, 0.47; 95% CI, 0.27-0.81; p=0.006) and in the OMT group (OR, 0.40; 95% CI, 0.21-0.75; p=0.004), although the latter finding did not persist after adjustment for potential confounders. The osteopathic medical care and OMT groups both reported lower widespread pain severity. The osteopathic medical care group also reported better age- and sex-adjusted outcomes for each of the seven HRQOL dimensions throughout the study. The OMT group reported better outcomes in five of the HRQOL dimensions.
This study supports the view that osteopathic physicians practice a holistic approach to medical care that manifests itself through a lower risk of progression from chronic low back pain to widespread pain, lower widespread pain severity, and lesser deficits in HRQOL. Similar findings were generally associated with OMT use.
人们普遍认为整骨疗法医师采用整体方法治疗患者。这种方法可能有助于预防肌肉骨骼疼痛状况的恶化，尤其是与整骨手法治疗（OMT）联合使用时。
本研究旨在确定整骨医疗护理是否降低从局部慢性下背痛进展为广泛疼痛的风险，并减轻疼痛对健康相关生活质量的影响。
在疼痛登记处进行了一项历史队列研究，该登记处是流行病学、临床和干预研究与创新（PRECISION Pain Research Registry）的一部分，使用了 2016 年 4 月至 2021 年 3 月期间收集的数据。在基线就诊时患有慢性下背痛的 21-79 岁的登记参与者，如果他们有治疗医生、完成了所有四次季度随访就诊且在最后 12 个月就诊时没有报告医生转换，则有资格入组。符合条件的参与者根据基线时医生提供者的类型进行分类，从而分为整骨医学护理或全医学护理组。参与者还根据最后一次就诊时是否使用 OMT 进行分类。在基线和每次季度就诊时测量广泛疼痛，以使用美国国立卫生研究院推荐的慢性下背痛最小数据集确定广泛疼痛在 12 个月内的时期患病率及其严重程度。在每次就诊时报告“完全不困扰”广泛疼痛的参与者被归类为没有广泛疼痛，而在任何季度就诊时感到“有点”或“非常”困扰的参与者被归类为患有广泛疼痛。广泛疼痛的严重程度通过在每次就诊时汇总参与者的反应来衡量。每次就诊时都使用患者报告的结局测量信息系统来测量身体功能、焦虑、抑郁、疲劳、睡眠障碍、社会角色和活动参与度以及疼痛对活动的干扰等健康相关生活质量（HRQOL）评分。
共纳入 462 名参与者，其中 101 名（21.9%）接受整骨医学护理，73 名（15.8%）使用 OMT。参与者的平均年龄为 52.7±13.2 岁（范围 22-79 岁），其中 336 名（72.7%）为女性。在整骨医学护理组（OR，0.47；95%CI，0.27-0.81；p=0.006）和 OMT 组（OR，0.40；95%CI，0.21-0.75；p=0.004）中，广泛疼痛的时期患病率较低，尽管在调整了潜在混杂因素后，后者的结果并未持续存在。整骨医学护理和 OMT 组均报告广泛疼痛的严重程度较低。整骨医学护理组在整个研究期间还报告了七个 HRQOL 维度中每个维度的年龄和性别调整后更好的结局。OMT 组在五个 HRQOL 维度中报告了更好的结局。
本研究支持这样一种观点，即整骨医师采用整体方法治疗患者，这表现在从慢性下背痛进展为广泛疼痛的风险降低、广泛疼痛的严重程度降低以及健康相关生活质量的降低较小。一般来说，类似的发现与 OMT 的使用有关。
