诊断和治疗急性非特异性腰痛:医生是否遵循指南?
Maria Trachsel1, Maurizio A Trippolini2,3,4, Ilaria Jermini-Gianinazzi5
1Department of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland.
Swiss medical weekly
|February 14, 2025
概括
瑞士的全科医生经常偏离急性非特异性腰部疼痛的临床指南. 尽管意识到这一点,但许多人还是建议成像和可能有害的治疗方法,这与基于证据的护理相矛盾.
科学领域:
- 主要护理医学 医疗保健
- 基于证据的实践.
- 疼痛管理 疼痛管理
背景情况:
- 对急性非特异性腰部疼痛的临床指南主张保守的管理,包括保持活跃,避免不必要的成像或强烈的阿片类药物.
- 目前基于证据的建议与常见的临床实践形成鲜明对比,导致患者的护理不够理想.
研究的目的:
- 评估瑞士的全科医生 (GPs) 如何遵守治疗急性非特异性腰部疼痛的临床指南.
- 确定一般医生使用的推和实际管理策略之间的差异.
主要方法:
- 通过对患有急性非特异性腰部疼痛的患者进行了两种不同的临床病例调查.
- 一般医生 (GPs) 得到了假设的患者场景,并询问了他们的诊断和治疗方法.
- 标签变化包括患者人口统计学,疼痛持续时间和病史,以评估管理差异.
主要成果:
- 虽然大多数全科医生 (61%) 知道指南,76% 知道"明智选择"的建议,但他们的做法有很大的差异.
- 显著的百分比的全科医生使用诊断成像,如X射线 (18-32%) 和MRI (31-62%).
- 经常推潜在有害的治疗方法,包括肌肉松剂 (77-78%),口服类固醇 (26-33%),脊髓注射 (28-42%) 和活动限制 (71-82%).
结论:
- 瑞士全科医生对急性非特异性腰部疼痛的治疗经常与当前基于证据的指导方针相矛盾,尽管有报道.
- 该研究强调了指导方针建议和临床实践之间的巨大差距,很大一部分全科医生选择成像和可能有害的干预措施.
- 需要在初级保健中更好地实施基于证据的低腰痛策略,以减轻风险并优化患者的治疗结果.
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