CHIROPRACTIC VERSUS MEDICAL CARE FOR LOW-BACK PAIN

腰痛的脊椎按摩治疗与医疗护理

• 批准号: 2910700
• 负责人: HAL M MORGENSTERN
• 金额: $ 37.77万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 1995
• 资助国家: 美国
• 起止时间: 1995-05-01 至 2001-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2910700
• 关键词: alternative medicine; backache; chiropractic; functional ability; health care cost /financing; human subject; human therapy evaluation; medical rehabilitation related tag; occupations; outcomes research; patient care management; physical therapy; self care; therapy

Low-back pain is one of the most prevalent and costly problems facing the U.S. health-care system. Although it is the second most frequent primary complaint reported by patients seeking medical care, there is a dearth of research and a lack of consensus on how to treat low-back pain. Consequently, patients receive a multitude of treatments, many of which may be ineffective and/or inefficient. The purpose of this study is to assess the effectiveness and cost effectiveness of 4 popular management strategies used in the treatment of low-back pain. The study has 6 specific aims: 1) determine which management strategy, chiropractic care or medical care, is more effective in terms of pain reduction, functional status improvement, and patient satisfaction for musculoskeletal low-back pain in a multi-specialty group practice; 2) assess the effectiveness of physical therapy among low-back- pain patients receiving chiropractic or medical care; 3) determine which strategy is the most cost-effective for treating low-back pain; 4) assess the relationship between patient satisfaction with care and other outcome measures, i.c., pain and functional status improvement; S) estimate the effects of occupational factors on low-back-pain outcomes; and 6) estimate the effects of self care on low-back-pain outcomes. The study will be conducted in a 100,000-member multi-specialty group practice over a 5-year period. About 250 ambulatory patients will be randomized to each of 4 treatment groups in a balanced factorial design: chiropractic care with and without physical therapy, and medical care with and without physical therapy. Subjects will be followed for 18 months after the start of treatment with outcome assessments at 2 and 6 wks, and 6, 12, and 18 mos. Sources of data include a physical examination and personal interview at baseline, follow-up questionnaires, exit telephone interviews and provider assessments, medical charts, and computer records. Baseline exams and interviews will obtain a broad array of information on sociodemographic, clinical, psychosocial, and occupational factors. Follow-up questionnaires mailed to participants will address general health status, functional status, low-back-pain severity, recurrence and duration, self care for low-back pain, days of restricted activity and disability. Medical charts and records will be used to obtain data on health-care use and the costs of services for the 18-month follow-up period. Cost-effectiveness analyses will be conducted in two ways: from the perspective of the institution (based on costs of services), and from the perspective of the payer (based on charges). Major strengths of this study are: randomization of eligible patients from a single group practice into 4 treatment groups; inclusion of patients with a broad array of low-back-pain etiologies; comprehensive collection of data on many (nonrandomized) factors that might affect low-back pain; and use of several outcome measures. The results of this project will help elucidate the roles of medical doctors, chiropractors, and physical therapists in the treatment of low-back pain, and they will have important implications to national health-care policy.

下背痛是最普遍和昂贵的问题之一， 美国保健系统。虽然这是第二个最频繁的初选 病人投诉寻求医疗护理，有缺乏 研究和缺乏共识，如何治疗腰痛。 因此，患者接受多种治疗，其中许多 可能是无效和/或低效的。 本研究的目的是评估有效性和成本 4种常用治疗策略的有效性 腰痛该研究有6个具体目标：1）确定 管理策略，脊椎护理或医疗护理，是更有效的 在疼痛减轻、功能状态改善和患者 多专业组中肌肉骨骼腰痛的满意度 实践; 2）评估物理治疗的有效性之间的低回- 接受脊椎按摩或医疗护理的疼痛患者; 3）确定 策略是最具成本效益的治疗腰痛; 4）评估 患者对护理满意度与其他结果之间关系 措施，即，疼痛和功能状态改善; S）估计 职业因素对腰痛结果的影响; 6）估计 自我护理对腰痛结果的影响。 这项研究将在一个10万人的多专业小组中进行 实践了5年。约250名门诊病人将在 在平衡析因设计中随机分配至4个治疗组： 脊椎按摩护理，有和没有物理治疗，以及医疗护理， 而且没有物理治疗受试者将接受18个月的随访 治疗开始后，在第2周和第6周进行结局评估，以及 6、12和18个月。 数据来源包括身体检查和个人访谈， 基线、后续问卷、离职电话访谈和提供者 评估、医疗图表和计算机记录。基线检查和 访谈将获得广泛的社会人口信息， 临床、心理和职业因素。随访问卷 邮寄给受试者将解决一般健康状况，功能 状态、腰痛严重程度、复发和持续时间、自我护理 腰痛、活动受限和残疾的天数。医疗图表 记录将用于获取有关医疗保健使用和费用的数据 18个月随访期的服务。成本-效果分析 将通过两种方式进行：从机构的角度 （基于服务成本），并从付款人的角度（基于 收费）。 本研究的主要优势是：从以下患者中随机选择合格患者： 将一组实践分为4个治疗组;纳入患者 下背痛病因广泛;全面收集 关于可能影响腰痛的许多（非随机）因素的数据; 以及使用多个结果测量。这个项目的成果将有助于 阐明医生、脊医和理疗师的角色， 治疗师在治疗腰痛，他们将有重要的 对国家卫生政策的影响。

项目成果

Use of a Markov transition model to analyse longitudinal low-back pain data.

使用马尔可夫转变模型来分析纵向腰痛数据。

• DOI: 10.1191/0962280203sm321ra
• 发表时间: 2003
• 期刊: Statistical methods in medical research
• 影响因子: 2.3
• 作者: Yu,Fei;Morgenstern,Hal;Hurwitz,Eric;Berlin,ThomasR
• 通讯作者: Berlin,ThomasR

The impact of treatment confidence on pain and related disability among patients with low-back pain: results from the University of California, Los Angeles, low-back pain study.

• DOI: 10.1016/s1529-9430(02)00414-x
• 发表时间: 2002-11-01
• 期刊: The spine journal : official journal of the North American Spine Society
• 作者: Goldstein, Michael S;Morgenstern, Hal;Yu, Fei
• 通讯作者: Yu, Fei

Comparing the satisfaction of low back pain patients randomized to receive medical or chiropractic care: results from the UCLA low-back pain study.

比较随机接受医疗或脊椎按摩治疗的腰痛患者的满意度：加州大学洛杉矶分校腰痛研究的结果。

• DOI: 10.2105/ajph.92.10.1628
• 发表时间: 2002
• 期刊: American journal of public health
• 影响因子: 12.7
• 作者: Hertzman-Miller,RuthP;Morgenstern,Hal;Hurwitz,EricL;Yu,Fei;Adams,AlanH;Harber,Philip;Kominski,GeraldF
• 通讯作者: Kominski,GeraldF