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脊椎按摩师与神经外科医生对腰痛患者的诊断及管理一致性。

Diagnostic and management concordance between chiropractors and neurosurgeons for patients with low back pain.

作者信息

Mathieu Janny, Beauséjour Marie, Châtillon Claude-Édouard, O'Shaughnessy Julie, Tétreau Charles, Hincapié Cesar A, Schweinhardt Petra, Descarreaux Martin, Marchand Andrée-Anne

机构信息

Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.

Department of Community Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada.

出版信息

Sci Rep. 2025 Jul 2;15(1):23248. doi: 10.1038/s41598-025-04529-9.

Abstract

Low back pain is the leading contributor to disability worldwide and a major cause of primary care visits. Alternative models of care delivery drawing on musculoskeletal experts' skills and knowledge have received increasing attention for their potential ability to improve timely access to appropriate healthcare for patients with musculoskeletal disorders. The aim of this study was to evaluate diagnostic and management concordance between chiropractors, known as musculoskeletal experts, and neurosurgeons for patients with low back pain. Before being seen by a neurosurgeon, 101 eligible participants (mean age: 60.32 years) were evaluated by a chiropractor. Overall diagnostic agreement between chiropractors and neurosurgeons was 74.7%, with a moderate inter-rater diagnosis agreement (κ = 0.51; 95%CI [0.35-0.68]). Chiropractors were significantly less likely to attribute a diagnosis of non-specific LBP to participants (31.6%) compared to neurosurgeons (43.2%) (p = 0.02), with an agreement proportion of 80.0%. Overall management agreement was 82.0%, indicating that chiropractors possess good skills in triaging patients with low back pain, which can optimize patient trajectories by accelerating management of non-surgical cases and reducing waiting lists for spine surgery consultations. Prospective studies are needed to evaluate the impact of a chiropractor-informed triage on clinical outcomes and healthcare utilization for patients with low back pain.

摘要

腰痛是全球导致残疾的主要原因,也是基层医疗就诊的主要原因。利用肌肉骨骼专家的技能和知识的替代护理模式,因其有可能改善肌肉骨骼疾病患者及时获得适当医疗保健的能力而受到越来越多的关注。本研究的目的是评估整脊师(作为肌肉骨骼专家)与神经外科医生对腰痛患者的诊断和管理一致性。在由神经外科医生诊治之前,101名符合条件的参与者(平均年龄:60.32岁)由一名整脊师进行了评估。整脊师和神经外科医生之间的总体诊断一致性为74.7%,评分者间诊断一致性为中等(κ = 0.51;95%CI [0.35 - 0.68])。与神经外科医生(43.2%)相比,整脊师将参与者诊断为非特异性腰痛的可能性显著降低(31.6%)(p = 0.02),一致性比例为80.0%。总体管理一致性为82.0%,这表明整脊师在对腰痛患者进行分诊方面具备良好技能,这可以通过加快非手术病例的管理和减少脊柱手术咨询的等候名单来优化患者的就医流程。需要进行前瞻性研究来评估整脊师指导的分诊对腰痛患者临床结局和医疗保健利用的影响。

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