Skargren E I, Carlsson P G, Oberg B E
Department of Neuroscience and Locomotion: Physiotherapy, Faculty of Health Sciences, Linköping University, Sweden.
Spine (Phila Pa 1976). 1998 Sep 1;23(17):1875-83; discussion 1884. doi: 10.1097/00007632-199809010-00016.
A randomized trial was conducted in which patients with back and neck pain, visiting a general practitioner, were allocated to chiropractic or physiotherapy.
To compare outcome and costs of chiropractic and physiotherapy as primary treatment for patients with back and neck pain, with special reference to subgroups, recurrence rate, and additional health care use at follow-up evaluation 12 months after treatment.
Earlier studies on the effect of spinal manipulation have shown inconsistent results. Mostly they include only short-term follow-up periods, and few cost-effectiveness analyses have been made.
A group of 323 patients aged 18-60 years who had no contraindications to manipulation and who had not been treated within the previous month were included. Outcome measures were changes in Oswestry scores, pain intensity, and general health; recurrence rate; and direct and indirect costs.
No differences were detected in health improvement, costs, or recurrence rate between the two groups. According to Oswestry score, chiropractic was more favorable for patients with a current pain episode of less than 1 week (5%) and physiotherapy for patients with a current pain episode of greater than 1 month (6.8%). Nearly 60% of the patients reported two or more recurrences. More patients in the chiropractic group (59%) than in the physiotherapy group (41%) sought additional health care. Costs varied considerably among individuals and subgroups; the direct costs were lower for physiotherapy in a few subgroups.
Effectiveness and costs of chiropractic or physiotherapy as primary treatment were similar for the total population, but some differences were seen according to subgroups. Back problems often recurred, and additional health care was common. Implications of the result are that treatment policy and clinical decision models must consider subgroups and that the problem often is recurrent. Models must be implemented and tested.
开展了一项随机试验，将因颈肩痛就诊于全科医生的患者分配至接受整脊治疗或物理治疗组。
比较整脊治疗和物理治疗作为颈肩痛患者主要治疗方法的疗效及成本，特别关注亚组、复发率以及治疗后12个月随访评估时的额外医疗保健使用情况。
早期关于脊柱推拿效果的研究结果不一致。大多数研究仅纳入了短期随访期，且很少进行成本效益分析。
纳入323名年龄在18 - 60岁之间、无推拿禁忌且前一个月内未接受过治疗的患者。疗效指标包括Oswestry评分、疼痛强度和总体健康状况的变化；复发率；直接和间接成本。
两组在健康改善、成本或复发率方面未检测到差异。根据Oswestry评分，整脊治疗对当前疼痛发作少于1周的患者更有利（5%），而物理治疗对当前疼痛发作超过1个月的患者更有利（6.8%）。近60%的患者报告有两次或更多次复发。整脊治疗组寻求额外医疗保健的患者（59%）多于物理治疗组（41%）。个体和亚组之间的成本差异很大；在一些亚组中，物理治疗的直接成本较低。
整脊治疗或物理治疗作为主要治疗方法，对总体人群而言疗效和成本相似，但根据亚组情况存在一些差异。背部问题常复发，额外医疗保健很常见。结果表明，治疗政策和临床决策模型必须考虑亚组情况，且该问题往往是复发性的。必须实施并测试相关模型。
