Variation in diagnosis and treatment of chronic low back pain by traditional Chinese medicine acupuncturists
Variation in diagnosis and treatment of chronic low back pain by traditional Chinese medicine acupuncturists
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DOI：
10.1054/ctim.2001.0457
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发表时间：
2001-09-01
影响因子：
3.6
通讯作者：
Cherkin, DC
中科院分区：
文献类型：
--
作者：
Hogeboom, CJ;Sherman, KJ;Cherkin, DC
目的：评价慢性腰背痛中医诊断与治疗的评价者间信度。设计：采用拉丁方设计，6名中医针灸师在同一天对同样的6名患者进行评估。单位：西北针灸和东方医学研究所，西雅图，华盛顿。干预措施：仅评估。观察指标：中医诊断、穴位处方、辅助治疗建议。结果：20种诊断和65个穴位至少使用一次。大多数针灸师对每例患者的诊断均为“气滞血瘀肾虚证”，取穴均为UB 23。然而，针灸师之间关于诊断细节和其他穴位的一致性很差。没有诊断，只有一个穴位，优先用于一个亚组的患者。一些诊断和治疗建议更多地依赖于医生而不是病人。精细的诊断和大多数穴位与患者或医生无关。结论：中医诊断和治疗慢性腰痛的具体患者的建议有很大的不同医生。由于针灸师之间的一致性较低，使用个体化治疗组的针灸临床试验可能难以复制或评估。比较个体化治疗与精心制定的标准化方法，以确定哪一个，如果是，是上级。(C)2001年哈考特出版社有限公司
Objectives: To assess interrater reliability of Traditional Chinese Medicine (TCM) diagnosis and treatment of chronic low back pain. Design: Under a Latin square design, six TCM acupuncturists evaluated the same six patients on the same day. Setting: Northwest Institute of Acupuncture and Oriental Medicine, Seattle, Washington. Interventions: Assessment only. Outcome measures: TCM diagnosis, acupoint prescriptions, auxiliary treatment recommendations. Results: Twenty diagnoses and 65 acupoints were used at least once. The diagnosis of Qi/Blood Stagnation with Kidney Deficiency and the acupoint UB23 were used for every patient by most acupuncturists. However, consistency across acupuncturists regarding diagnostic details and other acupoints was poor. No diagnoses, and only one acupoint, were used preferentially for a subgroup of patients. Some diagnoses and treatment recommendations were dependent more on the practitioner than on the patient. Fine-grained diagnoses and most acupoints were unrelated to either patient or practitioner. Conclusions: TCM diagnoses and treatment recommendations for specific patients with chronic low back pain vary widely across practitioners. Acupuncture clinical trials using an individualized treatment arm may be difficult to replicate or evaluate because of low concordance among acupuncturists. Comparison of individualized treatment with a thoughtfully developed standardized approach is warranted to determine which, if either, is superior. (C) 2001 Harcourt Publishers Ltd.