Shekelle P G, Hurwitz E L, Coulter I, Adams A H, Genovese B, Brook R H
West Los Angeles VA Medical Center, USA.
J Manipulative Physiol Ther. 1995 Jun;18(5):265-70.
Spinal manipulation is an efficacious therapy for some patients with low back pain (LBP). In this pilot study, we tested the feasibility of assessing the appropriateness of chiropractic spinal manipulation for patients with LBP.
Criteria for the appropriate and inappropriate use of spinal manipulation for low back pain were developed using the RAND/UCLA appropriateness method. Two separate expert panels, one multidisciplinary and one all chiropractic, each rated a comprehensive array of clinical scenarios for appropriateness. A random sample of practicing chiropractors was selected, and data were collected from ten randomly selected office records from each participating clinician. Assessment of the appropriateness for the use of spinal manipulation was made by comparing the care delivered with the appropriateness criteria determined by each expert panel.
Eight of thirteen (62%) eligible chiropractors agreed to participate. For the remainder, by the multidisciplinary panel's criteria, 38% of care was appropriate and 26% of care was inappropriate. By the all-chiropractic panel's criteria, the same cases were judged 74% appropriate and 7% inappropriate. The two panel's appropriateness ratings were in agreement on 48% of all cases.
In this geographic area, the rate of appropriate care is between 38% and 74% and the rate of inappropriate care is between 7% and 19%, depending on the criteria used to assess appropriateness. Data from other geographic areas of the U.S. will be needed before inferences to a larger population may be drawn, and we have demonstrated that such a study is feasible.
脊柱推拿对一些腰痛（LBP）患者是一种有效的治疗方法。在这项初步研究中，我们测试了评估脊椎按摩疗法对腰痛患者适用性的可行性。
使用兰德/加州大学洛杉矶分校适用性方法制定了脊柱推拿治疗腰痛的适用和不适用标准。两个独立的专家小组，一个是多学科小组，另一个全是脊椎按摩师小组，分别对一系列全面的临床情况进行适用性评级。选取了执业脊椎按摩师的随机样本，并从每位参与的临床医生的十份随机选择的办公室记录中收集数据。通过将提供的治疗与每个专家小组确定的适用性标准进行比较，来评估脊柱推拿使用的适用性。
13名符合条件的脊椎按摩师中有8名（62%）同意参与。对于其余的，根据多学科小组的标准，38%的治疗是合适的，26%的治疗是不合适的。根据全脊椎按摩师小组的标准，相同的病例被判定为74%合适，7%不合适。两个小组的适用性评级在所有病例的48%上达成一致。
在这个地理区域，合适治疗的比例在38%至74%之间，不合适治疗的比例在7%至19%之间，这取决于用于评估适用性的标准。在美国其他地理区域的数据可用之前，无法对更大的人群进行推断，并且我们已经证明这样的研究是可行的。
