Safety, efficacy, and cost effectiveness of evidence-based guidelines for the management of acute low back pain in primary care
Safety, efficacy, and cost effectiveness of evidence-based guidelines for the management of acute low back pain in primary care
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DOI：
10.1097/00007632-200112010-00017
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发表时间：
2001-12-01
期刊：
影响因子：
3
通讯作者：
Bogduk, N
中科院分区：
文献类型：
--
作者：
McGuirk, B;King, W;Bogduk, N
研究设计。进行了一项涉及平行基准审计的病例对照研究。比较急性腰痛的循证医疗护理和常规护理的安全性、有效性和成本效益。背景资料摘要。虽然有几套治疗急性腰痛的指南被推广，但没有证据表明遵循这些指南会产生更好的结果。设立了专门诊所，训练有素的医务人员根据循证指南对急性腰痛患者进行治疗。其结果由独立研究护士审核。与此同时，由自己的全科医生管理的患者的结果分别由研究护士使用相同的评估工具进行审计。在这两种情况下，患者表现出显著的程度和恢复率，复发率低。然而，循证医疗使治疗费用显著降低；疼痛明显减轻，持续6个月和12个月；3个月、6个月和12个月时需要继续护理的患者显著减少；患者在12个月时完全康复的比例明显更高；而且更大比例的患者认为他们的治疗非常有帮助，并对他们的治疗提供积极的，主动的评论。循证护理的即时效果略好于良好的常规护理，但从长期来看，循证护理在临床和统计上取得了显著的收益，需要继续护理并保持疼痛的患者较少。消费者赞成循证医疗。
Study Design. A case-control study involving parallel benchmarking audits was conducted.Objective. To compare the safety, efficacy, and cost effectiveness of evidence-based medical care and usual care for acute low back pain.Summary of Background Data. Although several sets of guidelines have been promoted for the management of acute low back pain, there is no evidence that following guidelines results in better outcomes.Methods. Special clinics were established, at which trained medical practitioners managed patients with acute low back pain according to evidence-based guidelines. Their outcomes were audited by independent research nurses. Meanwhile, and separately, the outcomes of patients managed by their own general practitioners were audited by research nurses using the same instruments of assessment.Results. In both settings, patients showed remarkable degrees and rates of recovery, with low rates of recurrence. However, evidence-based medical care resulted in a significantly lower cost of treatment; a significantly greater reduction in pain, sustained at both 6 and 12 months; significantly fewer patients requiring continuing care at 3, 6, and 12 months; a significantly greater proportion of patients fully recovered at 12 months; and significantly greater proportions of patients rating their treatment as extremely helpful and offering positive, unsolicited comments about their treatment.Conclusions. The immediate results from evidence-based care are marginally better than those from good usual care, but in the long term, evidence-based care achieves clinically and statistically significant gains, with fewer patients requiring continuing care and remaining in pain. Consumers approve of evidence-based care.