<br>腰痛的主动、被动和手法治疗干预措施对阿片类药物处方和医疗保健利用的影响,Physical Therapy

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腰痛的主动、被动和手法治疗干预措施对阿片类药物处方和医疗保健利用的影响
Physical Therapy ( IF 3.5 ) Pub Date : 2023-12-19 , DOI: 10.1093/ptj/pzad173
Shawn Farrokhi _{1,

2,

3} , Laura Bechard _{1,

2,

4} , Sara Gorczynski _{1,

2,

4} , Charity Patterson ₅ , Joseph Kakyomya ₅ , Brad D Hendershot _{1,

3,

6} , Rachel Condon ₇ , L T C Matthew Perkins ₆ , Daniel I Rhon ₃ , Anthony Delitto ₅ , Michael Schneider ₅ , Christopher L Dearth _{1,

3,

6}

Affiliation

目的本研究的目的是探讨使用主动、被动和手法治疗干预措施治疗腰痛与一年的护理升级事件（包括阿片类药物处方、脊柱注射、专科护理就诊和住院治疗）之间的关联。方法这是一项回顾性队列研究，纳入了通过军事卫生系统数据库确定的 4827 名患者，这些患者于 2015 年 1 月 1 日至 2018 年 1 月 1 日期间在 4 个门诊接受了腰痛物理治疗师的护理。一年的护理升级使用调整后的比值比根据物理治疗师干预的类型（即主动、被动或手法治疗）对事件进行评估。结果大多数患者（89.9%）接受了积极干预。包含至少 1 次被动干预的就诊比例高出 10% 的患者，发生一年护理升级事件的可能性高出 3% 至 6%。同样，如果护理过程中使用的被动干预措施比主动干预措施的比例高出 10%，则一年内护理升级事件的可能性就会增加 5% 至 11%。与仅接受主动干预的患者相比，接受机械牵引和 2 种或更多不同被动干预的患者发生一年护理升级事件的可能性高出 50% 至 220%，但接受机械牵引和 2 种或多种不同被动干预的患者发生一年护理升级事件的可能性高出 50%接受手法治疗的人。结论更多地使用被动干预措施治疗腰痛与一年护理升级事件的几率升高相关。此外，使用特定的被动干预措施（例如机械牵引）与主动干预措施相结合会导致护理升级事件不理想，而手法治疗的使用则与更有利的下游医疗保健结果相关。影响物理治疗师应明智地使用被动干预措施来治疗腰痛，因为它们与接受阿片类药物处方、脊柱注射和专科护理就诊的可能性更大有关。

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The Influence of Active, Passive, and Manual Therapy Interventions for Low Back Pain on Opioid Prescription and Health Care Utilization

Objective The aim of this study was to explore associations between the utilization of active, passive, and manual therapy interventions for low back pain with one-year escalation-of-care events including opioid prescriptions, spinal injections, specialty care visits, and hospitalizations. Methods This was a retrospective cohort study of 4827 patients identified via the Military Health System Data Repository who received physical therapist care for low back pain in 4 outpatient clinics between January 1, 2015 and January 1, 2018. One-year escalation-of-care events were evaluated based on type of physical therapist interventions (ie, active, passive, or manual therapy) received using adjusted odds ratios. Results Most patients (89.9%) received active interventions. Patients with 10% higher proportion of visits that included at least 1 passive intervention had a 3% to 6% higher likelihood of one-year escalation-of-care events. Similarly, with 10% higher proportion of passive to active interventions used during the course of care, there was a 5% to 11% higher likelihood of one-year escalation-of-care events. When compared to patients who received active interventions only, the likelihood of incurring one-year escalation-of-care events were 50 to 220% higher for those who received mechanical traction and 2 or more different passive interventions, but lower by 50% for patients who received manual therapy. Conclusion Greater use of passive interventions for low back pain was associated with elevated odds of one-year escalation-of-care events. In addition, the use of specific passive interventions such as mechanical traction in conjunction with active interventions resulted in suboptimal escalation-of-care events, while the use of manual therapy was associated with more favorable downstream health care outcomes. Impact Physical therapists should be judicious in use of passive interventions for management of low back pain as they are associated with greater likelihood of receiving opioid prescriptions, spinal injections, and specialty care visits.

更新日期：2023-12-19

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