腰痛 の 予防 と 治療: 証拠,課題,有望 な 方向
Nadine E Foster1, Johannes R Anema2, Dan Cherkin3
1Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK.
Lancet (London, England)
|March 26, 2018
まとめ
腰痛の臨床ガイドラインでは 非薬物療法と慎重に薬を服用することを推奨しています. しかし,世界的な実践のギャップは依然として存在し,背中の障害の効果的な管理と予防のための新しい戦略が必要である.
科学分野:
- 医療サービス研究
- 運動器系障害
- 公衆衛生
背景:
- 腰痛 (LBP) の臨床ガイドラインは,同様の評価と管理戦略を提唱しています.
- これには生体心理社会的枠組み,非薬物療法 (教育,運動),持続的な症状に対する心理的プログラムが含まれます.
- ガイドライン に よる と,薬,画像 検査,手術 など を 慎重 に する こと も 勧め られ て い ます.
研究 の 目的:
- 腰痛に対する 根拠に基づいた勧告と 臨床実務の格差を解決する.
- 背中の障害を減らすための現在のアプローチを超えた潜在的な解決策を特定し,評価する.
- 実践と証拠を一致させ,活動を促進し,機能を改善するための戦略を探求する.
主な方法:
- 高所得国の既存の臨床実践ガイドラインと証拠のレビュー
- 腰痛に対する推奨される第一線治療の実施における世界的なギャップの分析
- LBPの管理と予防のための有望なまたは新興の解決策の特定と予備的な評価.
主要な成果:
- ガイドラインの勧告とLBPの世界的な臨床実践の間に重大な相違がある.
- 推奨される非薬学的治療の不足とイメージング,オピオイド,手術の過剰使用は一般的です.
- 現行のアプローチは 背中の障害を長期にわたって 減らすには不十分です
結論:
- 実践と証拠を一致させ 脊髄の異常に焦点を絞り 活動を促進することが重要です
- 潜在的な解決策には,実施戦略,再設計された臨床経路,統合された健康・職業介入,政策変更,公衆衛生のイニシアチブが含まれます.
- これらの戦略を大規模に実施するためにさらなる研究が必要である.
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