Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, P.O. Box 1089, 0317, Blindern, Oslo, Norway.
Et Liv I Bevegelse (ELiB), The Norwegian Chiropractic Research Foundation, Oslo, Norway.
Chiropr Man Therap. 2023 Aug 31;31(1):33. doi: 10.1186/s12998-023-00507-y.
Chiropractors' clinical indicators for recommending preventive continued care to patients with low back pain include previous pain episodes, a history of long pain duration and improvement after initial treatment. Our objectives were, in a cohort of patients with neck pain, to examine whether these clinical indicators were associated with being recommended continued care beyond 4 weeks, and if so whether this recommendation was dependent of chiropractor characteristics, as well as if the number of clinical indicators influenced this recommendation.
In this multi-center observational study, 172 patients seeking care for a new episode of neck pain in chiropractic practice in Norway were included between September 2015 and May 2016. The chiropractors treated their patients as per usual, and for this study, baseline data and 4-week follow-up data were used. Patient data included the clinical indicators (1) previous episodes of neck pain, (2) a history of long duration neck pain and (3) improvement four weeks after initial treatment. The recruiting chiropractors were asked at 4-week follow-up if each patient was recommended continued care, defined as care planned beyond the first 4 weeks. Univariate and multivariable logistic regression models investigated the association between clinical indicators and the continued care recommendation, as well as the influence of chiropractor characteristics on this recommendation. Cross tabulations investigated the relationship between the number of indicators present and recommendation of continued care.
Long duration of neck pain was the strongest clinical indicator for being recommended continued care 4 weeks after the initial treatment. Chiropractor characteristics were not associated with this recommendation. In patients with all three clinical indicators present, 39% were recommended continued care. When two and one indicators were present, the percentages of those recommended continued care were 25% and 10%, respectively.
Chiropractors recommended continued care for patients experiencing neck pain based on their history of long pain duration, and this was not influenced by characteristics of the chiropractor. This differs from previous studies of indicators for maintenance care in patients with low back pain.
脊椎按摩师向背痛患者推荐预防性持续治疗的临床指标包括先前的疼痛发作、疼痛持续时间长的病史以及初始治疗后的改善。我们的目的是在一组患有颈痛的患者中，研究这些临床指标是否与推荐超过 4 周的持续治疗有关，如果是，这种推荐是否取决于脊椎按摩师的特征，以及是否有更多的临床指标影响这种推荐。
在这项多中心观察性研究中，2015 年 9 月至 2016 年 5 月期间，挪威脊椎按摩疗法诊所共招募了 172 名新出现颈痛的患者。脊椎按摩师按照常规治疗患者，本研究使用基线数据和 4 周随访数据。患者数据包括临床指标（1）先前的颈痛发作，（2）颈痛持续时间长的病史和（3）初始治疗后 4 周的改善。在 4 周随访时，招募的脊椎按摩师被问到每位患者是否被推荐继续接受治疗，定义为计划在最初 4 周后进行的治疗。单变量和多变量逻辑回归模型研究了临床指标与继续治疗推荐之间的关系，以及脊椎按摩师特征对这种推荐的影响。交叉表调查了存在的指标数量与继续治疗推荐之间的关系。
颈痛持续时间长是初始治疗后 4 周内被推荐继续治疗的最强临床指标。脊椎按摩师的特征与这种推荐无关。在所有三种临床指标都存在的患者中，有 39%被推荐继续治疗。当有两种和一种指标存在时，推荐继续治疗的比例分别为 25%和 10%。
脊椎按摩师根据患者疼痛持续时间长的病史，向颈痛患者推荐持续治疗，而这不受脊椎按摩师特征的影响。这与先前对腰痛患者维持性治疗指标的研究不同。
