CHIROPRACTIC VERSUS MEDICAL CARE FOR LOW BACK PAIN

下腰痛是最普遍和代价最高的问题之一 美国的医疗保健系统。尽管这是第二频繁的初选 就医患者投诉少之又少 关于如何治疗腰背痛的研究和缺乏共识。 因此，患者接受了多种治疗，其中许多 可能是无效和/或低效的。 这项研究的目的是评估效果和成本。 四种流行管理策略在慢性阻塞性肺疾病治疗中的效果 腰背痛。这项研究有6个具体目标：1)确定 管理策略，脊椎护理或医疗护理，更有效 在减轻疼痛、改善功能状态和患者方面 多专科人群对肌肉骨骼下腰痛的满意度 实践；2)评估物理治疗对腰背痛患者的疗效。 接受脊椎按摩或医疗护理的疼痛患者；3)确定 治疗下腰痛的策略是最具成本效益的；4)评估 患者对护理的满意度与其他结局的关系 措施、I.C.、疼痛和功能状态改善；S)评估 职业因素对下腰痛结果的影响；6)估计 自我护理对腰背痛结局的影响。 这项研究将在一个10万人的多专业小组中进行 为期5年的练习。大约250名门诊患者将被 按平衡析因设计随机分为4个处理组： 接受和不接受物理治疗的脊椎疗法，以及 而且没有接受物理治疗。受试者将被跟踪观察18个月。 在治疗开始后2周和6周进行结果评估，以及 6、12和18个月。 数据来源包括体检和个人面试，地址为 基线、跟踪调查问卷、退出电话采访和提供者 评估、病历和计算机记录。基线检查和 采访将获得关于社会人口统计的广泛信息， 临床、心理社会和职业因素。跟踪调查问卷 邮寄给参与者的内容将涉及一般健康状况、功能 状态、腰背痛严重程度、复发和持续时间、自我护理 腰痛，活动受限和残疾的日子。医疗表 并将使用记录来获得有关医疗保健使用和费用的数据 在18个月的随访期内提供服务。成本效益分析 将以两种方式进行：从机构的角度 (根据服务成本)，从付款人的角度(基于 被指控)。 这项研究的主要优点是：将符合条件的患者从 将单一小组实践分成4个治疗组；纳入患者 有广泛的腰背痛病因；全面的收集 关于可能影响下腰痛的许多(非随机)因素的数据； 以及几个结果衡量标准的使用。这个项目的结果将对我们有所帮助 阐明医生、脊椎按摩师和理疗师的角色 治疗腰背痛的治疗师，他们将有重要的 对国家卫生保健政策的影响。

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.