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Management of people with acute low-back pain: a survey of Australian chiropractors

机译：急性下腰痛患者的管理：澳大利亚脊医的调查

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Introduction Chiropractors commonly provide care to people with acute low-back pain (LBP). The aim of this survey was to determine how chiropractors intend to support and manage people with acute LBP and if this management is in accordance with two recommendations from an Australian evidence-based acute LBP guideline. The two recommendations were directed at minimising the use of plain x-ray and encouraging the patient to stay active. Methods This is a cross sectional survey of chiropractors in Australia. This paper is part of the ALIGN study in which a targeted implementation strategy was developed to improve the management of acute LBP in a chiropractic setting. This implementation strategy was subsequently tested in a cluster randomised controlled trial. In this survey phase of the ALIGN study we approached a random sample of 880 chiropractors in three States of Australia. The mailed questionnaire consisted of five patient vignettes designed to represent people who would typically present to chiropractors with acute LBP. Four vignettes represented people who, according to the guideline, would not require a plain lumbar x-ray, and one vignette represented a person with a suspected vertebral fracture. Respondents were asked, for each vignette, to indicate which investigation(s) they would order, and which intervention(s) they would recommend or undertake. Results Of the 880 chiropractors approached, 137 were deemed ineligible to participate, mostly because they were not currently practising, or mail was returned to sender. We received completed questionnaires from 274 chiropractors (response rate of 37%). Male chiropractors made up 66% of respondents, 75% practised in an urban location and their mean number of years in practice was 15. Across the four vignettes where an x-ray was not indicated 68% (95% Confidence Intervals (CI): 64%, 71%) of chiropractors responded that they would order or take an x-ray. In addition 51% (95%CI: 47%, 56%) indicated they would give advice to stay active when it was indicated. For the vignette where a fracture was suspected, 95% (95% CI: 91%, 97%) of chiropractors would order an x-ray. Conclusion The intention of chiropractors surveyed in this study shows low adherence to two recommendations from an evidence-based guideline for acute LBP. Quality of care for these patients could be improved through effective implementation of evidence-based guidelines. Further research to find cost-effective methods to increase implementation is warranted.
机译：简介脊医通常为患有急性下腰痛（LBP）的人提供护理。这项调查的目的是确定脊椎治疗师打算如何支持和管理急性LBP患者，以及这种管理是否符合澳大利亚基于证据的急性LBP指南的两项建议。这两项建议的目的是尽量减少使用普通X射线，并鼓励患者保持活跃。方法这是澳大利亚脊医的横断面调查。本文是ALIGN研究的一部分，在该研究中，制定了有针对性的实施策略，以改善脊椎治疗中急性LBP的管理。随后在一项随机对照试验中对该实施策略进行了测试。在ALIGN研究的调查阶段，我们随机抽取了澳大利亚三个州的880名脊医。邮寄的问卷包括五个患者短片，旨在代表那些通常会出现急性LBP的脊医。根据指南，有四个小插图代表不需要腰部X线平片的人，而一个小插图代表一个疑似椎骨骨折的人。对于每个小插图，都要求受访者指出他们将下令进行哪些调查，以及他们将建议或进行哪些干预。结果在所接洽的880名脊医中，有137名被认为没有资格参加脊医，主要是因为他们目前没有在实践，或者将邮件退回了发件人。我们收到了274名脊医的完整问卷（答复率为37％）。男性按摩师占受访者的66％，在城市实践的占75％，在实践中的平均年数为15。在没有显示X射线的四个小插图中，有68％（95％的置信区间（CI）： 64％，71％的脊椎治疗师回答说，他们将订购或拍摄X光片。此外，有51％（95％CI：47％，56％）表示他们会建议在保持活动状态时保持活跃。对于怀疑有骨折的小插图，将有95％（95％CI：91％，97％）的脊椎治疗师订购X光片。结论在本研究中调查的脊椎治疗师的意图表明，他们对急性LBP循证指南的两项建议依从性较低。通过有效实施循证指南，可以改善这些患者的护理质量。有必要进行进一步的研究以找到具有成本效益的方法来增加实施。

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