Naidu Ishan, Ryvlin Jessica, Videlefsky Devin, Qin Jiyue, Mowrey Wenzhu B, Choi Jong H, Citron Chloe, Gary James, Benton Joshua A, Weiss Brandon T, Longo Michael, Matmati Nabil N, De la Garza Ramos Rafael, Krystal Jonathan, Echt Murray, Gelfand Yaroslav, Cezayirli Phillip, Yassari Neeky, Wang Benjamin, Castro-Rivas Erida, Headlam Mark, Udemba Adaobi, Williams Lavinia, Gitkind Andrew I, Yassari Reza, Yanamadala Vijay
Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA.
Department of Epidemiology and Public Health, Albert Einstein College of Medicine, New York, NY 10461, USA.
J Clin Med. 2022 May 5;11(9):2583. doi: 10.3390/jcm11092583.
Chronic back and leg pain are leading causes of disability worldwide. The purpose of this study was to compare the care in a unidisciplinary (USC) versus multidisciplinary (MSC) spine clinic, where patients are evaluated by different specialists during the same office visit. Adult patients presenting with a chief complaint of back and/or leg pain between June 2018 and July 2019 were assessed for eligibility. The main outcome measures included the first treatment recommendations, the time to treatment order, and the time to treatment occurrence. A 1:1 propensity score-matched analysis was performed on 874 patients (437 in each group). For all patients, the most common recommendation was physical therapy (41.4%), followed by injection (14.6%), and surgery (9.7%). Patients seen in the MSC were more likely to be recommended injection (p < 0.001) and less likely to be recommended surgery as first treatment (p = 0.001). They also had significantly shorter times to the injection order (log-rank test, p = 0.004) and the injection occurrence (log-rank test, p < 0.001). In this study, more efficient care for patients with back and/or leg pain was delivered in the MSC setting, which was evidenced by the shorter times to the injection order and occurrence. The impact of the MSC approach on patient satisfaction and health-related quality-of-life outcome measures warrants further investigation.
慢性背痛和腿痛是全球致残的主要原因。本研究的目的是比较单学科（USC）与多学科（MSC）脊柱诊所的治疗情况，在多学科诊所中，患者在同一次门诊就诊时由不同专家进行评估。对2018年6月至2019年7月期间以背痛和/或腿痛为主诉的成年患者进行资格评估。主要结局指标包括首次治疗建议、治疗医嘱下达时间和治疗实施时间。对874例患者（每组437例）进行了1:1倾向评分匹配分析。对于所有患者，最常见的建议是物理治疗（41.4%），其次是注射治疗（14.6%）和手术治疗（9.7%）。在多学科诊所就诊的患者更有可能被建议进行注射治疗（p<0.001），而作为首次治疗被建议进行手术的可能性较小（p = 0.001）。他们下达注射医嘱的时间（对数秩检验，p = 0.004）和进行注射治疗的时间（对数秩检验，p<0.001）也明显更短。在本研究中，多学科诊所为背痛和/或腿痛患者提供了更高效的治疗，这一点从下达注射医嘱和进行注射治疗的时间更短得到了证明。多学科治疗方法对患者满意度和健康相关生活质量结局指标的影响值得进一步研究。
