MANUAL THERAPY IN PRIMARY CARE OF ACUTE LOW BACK PAIN

腰痛带来痛苦的负担(症状和残疾)和 与医疗保健、失业和 补偿。两个职业，对抗疗法医生和脊椎按摩师， 为急性腰背痛患者提供最好的护理。的作用 手法疗法，如脊柱手法疗法(SMT)，已经被 有争议的。随机试验已经证明了人工操作的一些好处。 疗法，但这些疗法在对抗疗法系统中的作用还没有 已经评估过了。 我们提出了一项新的培训和评估研究，以确定 对抗疗法医生可以有效地整合手动治疗，包括 简单的脊椎手法，进入初级保健实践。世界末日的地点 研究将在北卡罗来纳州进行，在那里成功的实践- 已经在许多领域进行了基础研究，包括背部疼痛 研究。我们提出了两个研究问题： RQI：医生能否可靠地学习手动治疗的方法， 包括脊椎手法？ RQ2：使用简单的脊椎手法疗法能否改善临床 急性背痛患者的预后？ 将招募25名初级保健医生参加一项 培训计划，教授徒手治疗。培训将涉及双手- 关于脊椎手法治疗的经验。 培训结束后，医生将招募320名患者参加他们的 脊椎手法疗法的随机试验。 急性下腰痛的序贯患者将随机接受 主治医生在三周内进行最多5次SMT治疗； 对照组患者将获得与通常治疗相同的就诊次数。 受试者将在基线、2周、4周和8周接受采访。这个 主要的结果衡量标准将是患者的功能，由罗兰- 莫里斯功能状态量表专用于下腰痛。其他结果 会有时间去改进，回到工作岗位，让患者满意。 初级保健对脊柱手法治疗效果的评价 医生将允许在广泛使用之前对治疗进行评估 对抗疗法医疗界。

Low back pain carries a burden of suffering (symptoms and disability) and heavy costs to society related to medical care, lost work, and compensation. Two professions, allopathic physicians and chiropractors, provide most care for patients with acute low back pain. The role of manual therapies, such as spinal manipulative therapy (SMT), has been controversial. Randomized trials have demonstrated some benefit to manual therapy, but the role of these therapies in the allopathic system has not been evaluated. We propose a novel training and evaluative study to determine whether allopathic physicians can effectively integrate manual therapy, including simple spinal manipulation, into primary care practice. The site of the research will be the state of North Carolina, where successful practice- based research has been conducted in many areas, including back pain research. We propose two research questions: RQI: Can physicians reliably learn the approach to manual therapy, including spinal manipulation? RQ2: Can use of simple spinal manipulation therapy improve the clinical outcomes of patients with acute back pain? Twenty-five primary care physicians will be recruited to participate in a training program to teach manual therapy. The training will involve hands- on experience in spinal manipulative therapy. Following training, the physicians will enroll 320 patients in their practices into a randomized trial of spinal manipulative therapy. Sequential patients with acute low back pain will be randomized to receive up to 5 SMT treatments from the primary physician over a three week period; control patients will receive an equal number of visits as usual therapy. Subjects will be interviewed at baseline and at 2,4, and 8 weeks. The primary outcome measure will be patient function as measured by the Roland- Morris functional status scale specific for low back pain. Other outcomes will be time to improvement, return to work and patients satisfaction. Evaluation of the effectiveness of spinal manipulation by primary care physicians will allow the assessment of a therapy prior to wide use by the allopathic medical community.