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首页> 外文期刊>European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society >Chiropractic spinal manipulation and the risk for acute lumbar disc herniation: a belief elicitation study
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Chiropractic spinal manipulation and the risk for acute lumbar disc herniation: a belief elicitation study

机译：脊椎按摩疗法脊柱操纵与急性腰椎间盘突出危险的风险：信仰阐释研究

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Purpose Chiropractic spinal manipulation treatment (SMT) is common for back pain and has been reported to increase the risk for lumbar disc herniation (LDH), but there is no high quality evidence about this. In the absence of good evidence, clinicians can have knowledge and beliefs about the risk. Our purpose was to determine clinicians’ beliefs regarding the risk for acute LDH associated with chiropractic SMT. Methods Using a belief elicitation design, 47 clinicians (16 chiropractors, 15 family physicians and 16 spine surgeons) that treat patients with back pain from primary and tertiary care practices were interviewed. Participants’ elicited incidence estimates of acute LDH among a hypothetical group of patients with acute low back pain treated with and without chiropractic SMT, were used to derive the probability distribution for the relative risk (RR) for acute LDH associated with chiropractic SMT. Results Chiropractors expressed the most optimistic belief (median RR 0.56; IQR 0.39–1.03); family physicians expressed a neutral belief (median RR 0.97; IQR 0.64–1.21); and spine surgeons expressed a slightly more pessimistic belief (median RR 1.07; IQR 0.95–1.29). Clinicians with the most optimistic views believed that chiropractic SMT reduces the incidence of acute LDH by about 60% (median RR 0.42; IQR 0.29–0.53). Those with the most pessimistic views believed that chiropractic SMT increases the incidence of acute LDH by about 30% (median RR 1.29; IQR 1.11–1.59). Conclusions Clinicians’ beliefs about the risk for acute LDH associated with chiropractic SMT varied systematically across professions, in spite of a lack of scientific evidence to inform these beliefs. These probability distributions can serve as prior probabilities in future Bayesian analyses of this relationship.
机译：目的脊椎按摩术脊柱操纵治疗（SMT）对于背部疼痛是常见的，并且据报道，增加腰椎间盘突出（LDH）的风险，但没有高质量的证据。在没有良好证据的情况下，临床医生可以有关于风险的知识和信仰。我们的目的是确定临床医生对与脊椎按摩术SMT相关的急性LDH风险的信念。使用信念闪光设计，47名临床医生（16名脊椎治疗师，15名家庭主义者和16家脊椎外科医生）进行了采访了从初级和高等教育实践中治疗患有腰痛的患者。参与者在没有脊椎按摩术SMT治疗的急性低腰疼的急性低腰疼痛患者中急性LDH的引发率估计，用于导出与脊前SMT相关的急性LDH相对风险（RR）的概率分布。结果脊椎按摩师表示最乐观的信念（中位数RR 0.56; IQR 0.39-1.03）;家庭医生表达了一个中立的信念（中位数RR 0.97; IQR 0.64-1.21）;和脊柱外科医生表达了一个悲观的信念（中位数RR 1.07; IQR 0.95-1.29）。临床医生最乐观的观点认为，脊椎按摩术SMT将急性LDH的发病率降低约60％（中位数RR 0.42; IQR 0.29-0.53）。那些具有最悲观的观点的人认为，脊椎按摩术SMT将急性LDH的发病率提高约30％（中位数1.29; IQR 1.11-1.59）。结论临床医生对与脊椎按摩术SMT相关的急性LDH风险的信念，尽管缺乏科学证据来告知这些信念。这些概率分布可以作为这种关系的未来贝叶斯分析的现有概率。

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