Comparative Effectiveness of Usual Care With or Without Chiropractic Care in Patients with Recurrent Musculoskeletal Back and Neck Pain.
Comparative Effectiveness of Usual Care With or Without Chiropractic Care in Patients with Recurrent Musculoskeletal Back and Neck Pain.
复制标题
有或没有脊椎按摩治疗的常规护理对复发性肌肉骨骼背部和颈部疼痛患者的效果比较。
DOI：
10.1007/s11606-018-4539-y
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发表时间：
2018
影响因子：
5.7
通讯作者：
Haas,Mitchell
中科院分区：
文献类型：
--
作者：
Elder,Charles;DeBar,Lynn;Ritenbaugh,Cheryl;Dickerson,John;Vollmer,WilliamM;Deyo,RichardA;Johnson,EricS;Haas,Mitchell
背景脊椎按摩疗法是治疗背部和颈部疼痛的一种流行的替代疗法，在随机试验中其疗效与常规疗法相当。然而，通过传统护理环境提供的脊椎按摩治疗的有效性在很大程度上仍然是未知的。目的比较常规护理加或不加整脊治疗对慢性复发性肌肉骨骼背痛和颈痛患者的疗效。研究设计采用倾向评分匹配对照的前瞻性队列研究。参与者使用回顾性电子健康记录数据，我们开发了一个倾向评分模型，预测脊椎按摩治疗转诊的可能性。符合条件的背部或颈部疼痛的患者，然后联系转诊脊椎治疗，并参加了一项前瞻性研究。对于每例转诊患者，联系并入组了2例倾向评分匹配的非转诊患者。我们对参与者进行了为期6个月的前瞻性随访。主要指标主要结果包括疼痛严重程度、干扰和症状困扰。次要结果包括疼痛相关的医疗保健支出。两组（N= 70转诊，139非转诊）的疼痛评分在前3个月显著改善，3个月和6个月之间的变化较小。未观察到显著的组间差异。（严重程度-0.10（95% CI-0.30，0.10），干扰-0.07（-0.31，0.16），困扰-0.1（-0.39，0.19））。在控制了基线费用的差异后，在6个月的登记后随访期间，非转诊组的平均总费用显著高于转诊组（1996 SD = 3874 vs 1086 SD= 1212，p=. 034）。调整年龄、性别和Charlson合并症指数的差异后，这一发现减弱，不再具有统计学意义（p=. 001）。072）。结论：我们发现两组之间在患者报告或经济结果方面没有统计学显著差异。由于临床结果相似，提供脊椎按摩疗法护理不会增加成本，因此提供脊椎按摩疗法服务为喜欢这种护理的患者提供了一个额外的可行选择，而无需额外费用。
Background Chiropractic care is a popular alternative for back and neck pain, with efficacy comparable to usual care in randomized trials. However, the effectiveness of chiropractic care as delivered through conventional care settings remains largely unexplored. Objective To evaluate the comparative effectiveness of usual care with or without chiropractic care for patients with chronic recurrent musculoskeletal back and neck pain. Study design Prospective cohort study using propensity score-matched controls. Participants Using retrospective electronic health record data, we developed a propensity score model predicting likelihood of chiropractic referral. Eligible patients with back or neck pain were then contacted upon referral for chiropractic care and enrolled in a prospective study. For each referred patient, two propensity score-matched non-referred patients were contacted and enrolled. We followed the participants prospectively for 6 months. Main measures Main outcomes included pain severity, interference, and symptom bothersomeness. Secondary outcomes included expenditures for pain-related health care. Key results Both groups’(N= 70 referred, 139 non-referred) pain scores improved significantly over the first 3 months, with less change between months 3 and 6. No significant between-group difference was observed.(severity− 0.10 (95% CI− 0.30, 0.10), interference− 0.07 (− 0.31, 0.16), bothersomeness− 0.1 (− 0.39, 0.19)). After controlling for variances in baseline costs, total costs during the 6-month post-enrollment follow-up were significantly higher on average in the non-referred versus referred group (1996SD=3874vs 1086 SD= 1212, p=. 034). Adjusting for differences in age, gender, and Charlson comorbidity index attenuated this finding, which was no longer statistically significant (p=. 072). Conclusions We found no statistically significant difference between the two groups in either patient-reported or economic outcomes. As clinical outcomes were similar, and the provision of chiropractic care did not increase costs, making chiropractic services available provided an additional viable option for patients who prefer this type of care, at no additional expense.