骨刺、脊椎側彎、椎間盤突出治療權威

治療腰部疼痛 脊椎矯正療法較一般治療有效

Anderson R, Meeker WC, Wirick BE, Mootz RD, Kirk DH, Adams A. A meta-analysis of clinical trials of spinal manipulation. J Manipulative Physiol Ther 1992;15(3):181-194.

此篇文獻在1992年對23 個不同的脊椎矯正治療臨床實驗做了整合統計分析。文獻指出,臨床實驗一致証實脊椎矯正療法對於治療腰部疼痛比其它治療方式更為有效。統計分析亦指出脊醫所使用的短槓桿、高速度骨關節矯正比一般治療所用的長槓桿、低速關節活動更為有效。

 

 

下背痛治療花費的比較

脊骨神經科(DC) vs.一般醫師(MD)

Bergemann, Brian W., PhD, Anthony J. Cichoke, D.C. “Cost Effectiveness of Medical Vs. Chiropractic Treatment of Low-Back Injuries.” Journal of Manipulative and Physiological Therapeutics, Vol3,No.3, Sept.,1980, Pages 143-147.

這是一篇由勞工健保協會統計資料所做的研究,以確認比較脊骨神經和一般非手術性治療對於下背痛的效果和保險花費。此篇研究報告有227病人,(113由脊骨神經醫師治療,114由一般醫師治療),年齡分佈從16~67歲。

資料分析顯示一個很明顯的結果,在醫療花費和生病請假時間方面,脊骨神經科的治療遠低於一般醫師治療。

這是由三種因素造成:1.看脊骨神經科的病人,都是持續給一位脊骨神經醫師看診;看一般醫師的病人,卻常常會看到兩位以上的不同醫師。2.從診斷完成到開始治療的時間,脊骨神經科遠短於一般醫師3.脊骨神經醫師不需要一些醫院的額外花費(例如:驗血)。全部醫院的診療費並沒有包含在此報告裡面。對不論是以前有受傷過或者是沒有受傷過的兩群實驗對象,脊骨神經科的花費與治療效果都是遠優於一般醫療。

 

職業傷害醫學雜誌:脊骨神經醫學在腰背痛的治療上較省錢

lJarvis KB, Phillips RB, Morris EK. “Cost per Case Comparison of Back Injury Claims of Chiropractic versus Medical Management for Conditions with Identical Diagnostic Codes.” Journal of Occupational Medicine, Volume 33, Number 8, August 1991, Pages 847-852.

l職業傷害醫學雜誌於1991年指出醫藥學的患者在腰痛治療的費用上為脊醫患者的10倍。

 

 

脊醫師、西醫師與和整骨醫師

對治療因工作引起的拉傷扭傷之比較

Johnson, Marjorie, D.C., Ph.D., et. al. “A Comparison of Chiropractic, Medical, and Osteopathic Care for Work-Related Sprains and Strains.” Journal of Manipulative and Physiological Therapeutics, Vol. 12, No. 5, October 1989, Pages 335-344.

因工作受傷而產生的醫療負擔及損失的工作日,經郵件詢問方式針對所有愛荷華州在1984年申請背,頸部拉扭傷所做的分析調查顯示,敘述的結果對不同治療方式如

脊醫師(DC)、西醫(MD)、整骨醫師(DO)的醫療成本及效益加以評估及分析:

這些分析以員工因傷損失4個以上工作天而需求勞保補償,並且完成了所有療程,及只接受專業醫療人員的治療,對接受脊醫師DC(n=266)治療的病人,他們平均補償損失的工作日比西醫MD之病人的(n=494,p<0.025)平均補償損失工作日少2.3天,並且比整骨醫師DO病人少3.8天(n=102,p<0.025),因此,脊醫師DC病患勞保賠償金額給付平均少其它病患。致於醫療成本的比較則因州政府資料不完整而無法做明確的比較。在可掌握的資料報告中顯示,38%病人有轉換醫師的行為,當病人轉換醫師時,大致上來說,當有脊醫師DC包括在內時,可以達到較少的工作天損失、較少的勞保補償支出及較低的醫療成本.。

 

 

脊骨神經醫學的療效具長期的效益

lMeade TW, Dyer S, et al. “Low Back Pain of Mechanical Origin: Randomized Comparison of Chiropractic and Hospital Outpatient Treatment.”British Medical Journal, Volume 300, Number 6737, June 2, 1990,Pages 1431-1437.

l在1990年,英國醫學雜誌指出脊骨神經醫學在治療腰痛上比物理治療更具有長期的效益。

 

 

脊骨神經醫學的治療效益在三年後仍繼續發酵

lMeade TW, Dyer S, et al. “Randomized Comparison of Chiropractic and Hospital Outpatient Management for Low-Back Pain: Results from Extended Follow Up,” British Medical Journal, Volume 311, Number 7001, August 5,1995, Pages 349-351.

l在1995年,英國醫學雜誌做了一項脊骨神經醫學療效三年後追蹤,肯定脊骨神經醫學的長期效益。

 

 

健保制度下脊骨神經科治療具較高的經濟效益

Mosley, Carrie, et.al “Cost-Effectiveness of Chiropractic Care in Managed Care Setting.” The American Journal of Managed Care, March 1996, Pages 280-282.

作者回顧一些參與健保制度的背部及頸部疼痛之病患對其使用脊骨神經科

(簡稱脊醫)或其他治療方式的(ICD-9代碼720-724)醫療成本加以評估,並且應用影像檢視(電腦斷層和核磁共振)、病患滿意度及手術率的不同來做比較。這份分析研究是以1994/10/01至1995/10/01之間所申報的醫療費為準。

背頸病患之醫療費用顯著的低於其他非脊醫病患($539vs$774)。在非脊醫病患中,使用藥物及影像檢視明顯的比脊醫病患高。至於手術比例及病人滿意度則近乎相同。

最後的結論是,適當的使用脊醫可以達到成效。至於手術比例及病人滿意度

脊醫族群和非脊醫族群旗鼓相當,但脊醫族群平均成本明顯的低於非脊醫族群。

 

 

醫學界認同脊骨神經醫學的脊椎矯正療效

lShekelle Paul G, MD, MPH, Adams Alan, D.C., et al. “Spinal Manipulation for Low-Back Pain.” Annals of Internal Medicine, Vol. 117, No. 7, October 1992, Pages 590-598.

 由UCLA 和RAND Corporation 對腰痛的治療所做的一項研究報告中,醫學界推薦應用脊骨神經醫學的脊椎矯正技術來治療某些腰痛問題。

Stano, Miron, Ph.D., Smith, Monica, D.C. “Chiropractic and Medical Costs of Low Back Care.” Medical Care, Vol. 34, No. 3, 1996, Pages 191-204.

此項由《Medical Care雜誌》於1996年所做的報告應用了6183位患者的醫療保險支付資料來做分析。結果指出脊骨神經醫學在腰痛治療上較醫藥學的醫療具經濟效益。此報告並推薦醫療保險機構多加應用脊骨神經醫學來減少其經濟負擔。

 

 

整脊在慢性腰痛治療上較教育訓練有效

Triano, John,D.C., Brennan,Patricia,Ph.D.” Manipulative Therapy Versus Education programs in Chronic Low Back Pain.” SPINE, Vol. 20, No. 8, Pages 948-955.

此腰痛研究對象1,267病人均為腰痛超過七週以下或一年中發生五次以上腰痛經驗者。

此實驗呈現出美式整脊及腰痛教育訓練的成果。在1,267病患中隨機抽樣209位做為治療的樣本,患者在實驗開始前接受第一次檢查;二個星期的治療後再接受第二次檢查,並在二個星期的無治療情況後接受第三次檢查。

最後81.3%的患者完成此項實驗報告,實驗結果發現,接受美式整脊的患者腰痛有獲得明顯改善,在經過二個星期無治療的狀態下,患者仍持續保有原效果。而僅接受腰痛的教育訓練療法的另一組患者,疼痛指數依然偏高,一個月的實驗結束後,病患則未獲得顯著改善。

 

 

脊骨神經醫學對慢性腰痛有明顯的療效

Waagen, G.N., Haldeman,S., Cook,G., Lopez,D., DeBoer,F. “Short term trial of chiropractic adjustments for the relief of chronic low back pain.” Manual Medicine, Spring, 1986.

此實驗採用”Double-blind”的研究方式來證明美式整脊的療效。

19位下腰痛的病人接受二個星期的實驗,其中9位被選為實驗群,接受美式整脊治療;另10位患者則僅接受類似的按摩治療。

實驗結果發現,在第一組實驗患者的疼痛指數獲得明顯進步(*+1.3),相對第二組進步不顯著(*+0.7)。再經過兩個星期的治療後,第一組實驗患者的疼痛指數呈現出顯著的進步(+2.3),第二實驗組的疼痛指數則無明顯的差異。使用另一個疼痛指數值(Global Index),實驗結果也無不同。

在實驗的患者人數有限下,此實驗結果僅供初步參考。

*Visual Analogue Scale

 

 

Wolk, Steve,Ph.D. “An Analysis of Florida Workers’ Compensation Medical Claims for Back-Related Injuries.” ACA Journal of Chiropractic, Vol. 25, No. 7, July 1988

美國佛羅里達州脊骨神經醫學教育研究基金會與佛州勞工局,勞工與職業傷害醫療賠償部門,就超過一萬名在職場上遭受背部相關傷害的勞工﹐針對賠償的醫療花費、住院率、以及工作失能率,患者接受內科醫學與脊骨神經醫學治療的差別做出研究分析。

結果發現,高達51.3% 接受脊骨神經醫學治療者,縮短了職場完全失能的時間。在相同的診斷案件中,接受內科醫學治療者,平均需花費美金1100元,而接受脊骨神經醫學治療者,卻只需花費美金558元,降低了58.8% 的費用。脊骨神經醫學的治療將住院率降至20.3%,然而,接受內科醫學治療的病患,住院率卻仍高達52.2%。

這份分析證明了,脊骨神經醫學的治療是一個有效、快速又節省的治療選擇。

 

 

澳洲大學的研究報告

脊醫的脊椎矯正在治療脊椎疼痛上,比針灸及西醫的藥物治療較有效。

Spine. 2003 Jul 15;28(14):1490-502; discussion 1502-3.

Chronic spinal pain: a randomized clinical trial comparing medication, acupuncture, and spinal manipulation.

Giles LG, Muller R.

National Unit for Multidisciplinary Studies of Spinal Pain, The University of Queensland, The Townsville Hospital, Australia. lgiles@austarnet.com.au

STUDY DESIGN: A randomized controlled clinical trial was conducted. OBJECTIVE: To compare medication, needle acupuncture, and spinal manipulation for managing chronic (>13 weeks duration) spinal pain because the value of medicinal and popular forms of alternative care for chronic spinal pain syndromes is uncertain. SUMMARY OF BACKGROUND DATA: Between February 1999 and October 2001, 115 patients without contraindication for the three treatment regimens were enrolled at the public hospital's multidisciplinary spinal pain unit. METHODS: One of three separate intervention protocols was used: medication, needle acupuncture, or chiropractic spinal manipulation. Patients were assessed before treatment by a sports medical physician for exclusion criteria and by a research assistant using the Oswestry Back Pain Disability Index (Oswestry), the Neck Disability Index (NDI), the Short-Form-36 Health Survey questionnaire (SF-36), visual analog scales (VAS) of pain intensity and ranges of movement. These instruments were administered again at 2, 5, and 9 weeks after the beginning of treatment. RESULTS: Randomization proved to be successful. The highest proportion of early (asymptomatic status) recovery was found for manipulation (27.3%), followed by acupuncture (9.4%) and medication (5%). Manipulation achieved the best overall results, with improvements of 50% (P = 0.01) on the Oswestry scale, 38% (P = 0.08) on the NDI, 47% (P < 0.001) on the SF-36, and 50% (P < 0.01) on the VAS for back pain, 38% (P < 0.001) for lumbar standing flexion, 20% (P < 0.001) for lumbar sitting flexion, 25% (P = 0.1) for cervical sitting flexion, and 18% (P = 0.02) for cervical sitting extension. However, on the VAS for neck pain, acupuncture showed a better result than manipulation (50% vs 42%). CONCLUSIONS: The consistency of the results provides, despite some discussed shortcomings of this study, evidence that in patients with chronic spinal pain, manipulation, if not contraindicated, results in greater short-term improvement than acupuncture or medication. However, the data do not strongly support the use of only manipulation, only acupuncture, or only nonsteroidal antiinflammatory drugs for the treatment of chronic spinal pain. The results from this exploratory study need confirmation from future larger studies.

 

 

脊椎矯正配合復健運動能有效改善頸椎疼痛

Spine. 2002 Nov 1;27(21):2383-9.

Two-year follow-up of a randomized clinical trial of spinal manipulation and two types of exercise for patients with chronic neck pain.

Evans R, Bronfort G, Nelson B, Goldsmith CH.

Northwestern Health Sciences University, Bloomington, Minnesota 55431, USA. revans@nwhealth.edu

STUDY DESIGN: Randomized clinical trial. OBJECTIVES: To compare the effects of spinal manipulation combined with low-tech rehabilitative exercise, MedX rehabilitative exercise, or spinal manipulation alone in patient self-reported outcomes over a two-year follow-up period. SUMMARY OF BACKGROUND DATA: There have been few randomized clinical trials of spinal manipulation and rehabilitative exercise for patients with neck pain, and most have only reported short-term outcomes. METHODS: One hundred ninety-one patients with chronic neck pain were randomized to 11 weeks of one of the three treatments. Patient self-report questionnaires measuring pain, disability, general health status, improvement, satisfaction, and OTC medication use were collected after 5 and 11 weeks of treatment and 3, 6, 12, and 24 months after treatment. Data were analyzed taking into account all time points using repeated measures analyses. RESULTS: Ninety-three percent (178) of randomized patients completed the 11-week intervention phase, and 76% (145) provided data at all evaluation time points over the two-year follow-up period. A difference in patient-rated pain with no group-time interaction was observed in favor of the two exercise groups [F(2141) = 3.2; P= 0.04]. There was also a group difference in satisfaction with care [F(2143) = 7.7; P= 0.001], with spinal manipulation combined with low-tech rehabilitative exercise superior to MedX rehabilitative exercise (P = 0.02) and spinal manipulation alone (P < 0.001). No significant group differences were found for neck disability, general health status, improvement, and OTC medication use, although the trend over time was in favor of the two exercise groups. CONCLUSION: The results of this study demonstrate an advantage of spinal manipulation combined with low-tech rehabilitative exercise and MedX rehabilitative exercise versus spinal manipulation alone over two years and are similar in magnitude to those observed after one-year follow-up. These results suggest that treatments including supervised rehabilitative exercise should be considered for chronic neck pain sufferers. Further studies are needed to examine the cost effectiveness of these therapies and how spinal manipulation compares to no treatment or minimal intervention.

 

 

UCLA 研究指出,脊骨神經醫學與內科醫學在治療下背部疼痛有相近的療效。

Spine. 2002 Oct 15;27(20):2193-204.

Comment in:

a.. Spine. 2003 Jul 15;28(14):1625-6.

b.. Spine. 2003 Nov 1;28(21):2486-7; author reply 2486.

A randomized trial of medical care with and without physical therapy and chiropractic care with and without physical modalities for patients with low back pain: 6-month follow-up outcomes from the UCLA low back pain study.

Hurwitz EL, Morgenstern H, Harber P, Kominski GF, Belin TR, Yu F, Adams AH; University of California-Los Angeles.

Department of Epidemiology, University of California-Los Angeles School of Public Health, Los Angeles, California 90095-1772, USA. ehurwitz@ucla.edu

STUDY DESIGN: A randomized clinical trial. OBJECTIVES: To compare the effectiveness of medical and chiropractic care for low back pain patients in managed care; to assess the effectiveness of physical therapy among medical patients; and to assess the effectiveness of physical modalities among chiropractic patients. SUMMARY OF BACKGROUND DATA: Despite the burden that low back pain places on patients, providers, and society, the relative effectiveness of common treatment strategies offered in managed care is unknown. METHODS: Low back pain patients presenting to a large managed care facility from October 30, 1995, through November 9, 1998, were randomly assigned in a balanced design to medical care with and without physical therapy and to chiropractic care with and without physical modalities. The primary outcome variables are average and most severe low back pain intensity in the past week, assessed with 0 to 10 numerical rating scales, and low back-related disability, assessed with the 24-item Roland-Morris Disability Questionnaire. RESULTS: Of 1,469 eligible patients, 681 were enrolled; 95.7% were followed through 6 months. The mean changes in low back pain intensity and disability of participants in the medical and chiropractic care-only groups were similar at each follow-up assessment (adjusted mean differences at 6 months for most severe pain, 0.27, 95% confidence interval, -0.32-0.86; average pain, 0.22, -0.25-0.69; and disability, 0.75, -0.29-1.79). Physical therapy yielded somewhat better 6-month disability outcomes than did medical care alone (1.26, 0.20-2.32). CONCLUSIONS: After 6 months of follow-up, chiropractic care and medical care for low back pain were comparable in their effectiveness. Physical therapy may be marginally more effective than medical care alone for reducing disability in some patients, but the possible benefit is small.

 

 

美國UCLA大學公共衛生部臨床研究報告指出脊醫效果比西醫的成效上;病患對脊醫的滿意度較高

Am J Public Health. 2002 Oct;92(10):1628-33.

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

Hertzman-Miller RP, Morgenstern H, Hurwitz EL, Yu F, Adams AH, Harber P, Kominski GF.

Department of Epidemiology, UCLA School of Public Health, University of California-Los Angeles, Los Angeles, CA, USA. hertzman_miller@post.harvard.edu

OBJECTIVES: This study examined the difference in satisfaction between patients assigned to chiropractic vs medical care for treatment of low back pain in a managed care organization. METHODS: Satisfaction scores (on a 10-50 scale) after 4 weeks of follow-up were compared among 672 patients randomized to receive medical or chiropractic care. RESULTS: The mean satisfaction score for chiropractic patients was greater than the score for medical patients (crude difference = 5.5; 95% confidence interval = 4.5, 6.5). Self-care advice and explanation of treatment predicted satisfaction and reduced the estimated difference between chiropractic and medical patients' satisfaction. CONCLUSIONS: Communication of advice and information to patients with low back pain increases their satisfaction with providers and accounts for much of the difference between chiropractic and medical patients' satisfaction.