Chronic low back pain in older adults: What physicians know, what they think they know, and what they should be taught
Chronic low back pain in older adults: What physicians know, what they think they know, and what they should be taught
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DOI：
10.1111/j.1532-5415.2006.00883.x
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发表时间：
2006-11-01
影响因子：
6.3
通讯作者：
Weiner, Debra K.
中科院分区：
文献类型：
--
作者：
Cayea, Danelle;Perera, Subashan;Weiner, Debra K.
慢性下腰痛(CLBP)是老年人常见的、令人衰弱的问题。关于初级保健医生(PCP)对处理这一问题的知识和信心的文献很少。向宾夕法尼亚州西部的初级保健医生邮寄了一份自我管理的调查问卷，以衡量对老年人CLBP常见贡献者的评估和治疗的知识，对通过体检诊断这些贡献者的信心，以及信心水平和知识之间的关联。这项调查结合了项目和序数表，PCP使用体检和患者小插曲对他们检测CLBP(例如纤维肌痛)的各种因素的信心进行排名，然后是旨在评估知识的多项选择题。在634份调查问卷中，有153份收回(24.1%)。总体而言，大多数初级保健医生对他们诊断任何列出的CLBP贡献者的能力不是很有信心(大多数项目<；40%)。PCP对发现脊柱侧弯最有信心，对梨状肌的肌筋膜痛最不自信。在回答与特定主题有关的所有问题方面，受访者的数量范围很广(3.9%的受访者回答了与特定主题有关的问题，70.4%的受访者回答了髋关节骨性关节炎)。知识得分和信心评级之间没有关系(P>；在所有比较中均为0.05)。这一结果表明，需要在老年人中开展更多关于CLBP的PCP教育。它还表明，准确的需求评估不应该仅仅依赖于医生的信心评级。
Chronic low back pain (CLBP) is a common and debilitating problem in older adults. Little exists in the literature about primary care physicians' (PCPs') knowledge of and confidence in managing this problem. A self-administered survey was mailed to PCPs in western Pennsylvania to measure knowledge of the evaluation and treatment of common contributors to CLBP in older adults, confidence in diagnosing these contributors through physical examination, and the association between confidence levels and knowledge. The survey combined items with an ordinal scale on which PCPs ranked their confidence in detecting various contributors to CLBP (e.g., fibromyalgia) using physical examination and patient vignettes followed by multiple choice questions designed to assess knowledge. One hundred fifty-three of 634 surveys were returned (24.1%). Overall, the majority of PCPs did not feel "very confident" in their ability to diagnose any of the contributors of CLBP listed (most items < 40%). PCPs felt most confident in detecting scoliosis and least confident detecting myofascial pain of the piriformis muscle. There was a wide range in the number of respondents answering all questions related to a particular topic correctly (3.9% for sacroiliac joint syndrome to 70.4% for hip osteoarthritis). There was no relationship between knowledge scores and confidence ratings (P >.05 for all comparisons). The results point to a need for more PCP education about CLBP in older adults. It also suggests that accurate needs assessment should not rely on physician confidence ratings alone.