MANUAL THERAPY IN PRIMARY CARE OF ACUTE LOW BACK PAIN

下背痛带来痛苦的负担（症状和残疾）， 与医疗保健有关的社会沉重代价，失业， 赔偿 两种职业，对抗疗法医生和脊椎按摩师， 为急性腰痛患者提供最多的护理。 的作用 诸如脊柱推拿疗法（SMT）的手动疗法已经被 争议 随机试验已经证明了一些好处， 治疗，但这些疗法在对抗疗法系统中的作用还没有 被评估。 我们提出了一个新的培训和评估研究，以确定是否 对抗疗法医生可以有效地整合手动治疗，包括 简单的脊柱操作，应用到初级保健实践中。 所在地 研究将是北卡罗来纳州，那里的成功实践- 在许多领域进行了基于基础的研究，包括背痛 research. 我们提出两个研究问题： RQI：医生能否可靠地学习手动治疗方法， 包括脊椎按摩吗 RQ 2：使用简单的脊柱手法治疗能否改善临床 急性背痛患者的预后如何？ 将招募25名初级保健医生参加一项 教授手法治疗的培训项目 培训将涉及手- 脊柱推拿治疗的经验 培训结束后，医生将招募320名患者， 进行脊柱推拿治疗的随机试验。 急性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; 对照患者将接受与常规治疗相同的就诊次数。 将在基线和第2、4和8周时对受试者进行访谈。 的 主要结局指标是由罗兰- 下腰痛专用Morris功能状态量表。 其他成果 将有时间改善，恢复工作和病人满意度。 基层护理对脊柱推拿治疗效果的评价 医生将允许在广泛使用之前对治疗进行评估， 对抗疗法医学界。

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.