| ObjectiveChronic Low Back Pain (CLBP) is a common and frequently encountered illness in community medical service. Due to CLBP’s complicated etiological factors and long course of disease, CLBP is hard to be treated. The purposes of this research are to discuss the value and meaning of traditional Chinese medicine (TCM) in accordance with its advantages towards CLBP treatment; to offer a sound TCM health care service proposal that will be appropriate for community CLBP treatment based on clinical research; to explore a new model for reliable and effective TCM treatment and services to chronic illnesses in the community; to strengthen and implement the policies and reform of the primary medical care services and to further explore the innovated clinical approach and model of the TCM treatment in community medical services.Methods1. Propose a TCM health care service plan for community CLBP based on the analysis and conclusions of modern and ancient literatures on CLBP treatment and care.2. Organize experts to review the proposal on the basis of practical working procedures and medical staff s technical level in the community medical service centre and to articulate details of the TCM treatment for CLBP in terms of guidance, diet therapy, life style and intervention model.3. Choose 120 patients of CLBP for observation in three communities in central Guangzhou city and adopt multi-focus, perspective and randomized control-case study.4. Treatments:(1) Test group:After TCM syndrome basic therapy, when VAS score is lower or equivalent to 3, TCM health care service plan is adopted to intervene (TCM continuous intervening service and health education including the health care idea of "Wu Qin Xi", diet therapy, life style, etc.)(2) Control group:adopt equivalent TCM syndrome basic therapy to the test group, when VAS score is lower or equivalent to 3, terminate the treatment or any other intervention.5. To observe the pain rating scale during the study (VAS score), VAS curative effect index comparison, treatment result rating scale (JOA score), CLBP Quality of Life improvement (WHOQOL-BREF rating), recurrence rate, compliance, etc. Evaluate the feasibility, effectiveness and health economics index of the proposal.Results1. General data:118 cases were studied in the research including 59 cases in the test group and 59 cases in the control group. The difference of the gender, age and timing of the pain is not statistically significant (P>0.05). Furthermore, the difference is not statistically significant in two groups’ VAS score and JOA rating (P>0.05). Thus, two groups are comparable to each other.2. Treatment results:both groups’ adopting rate of the TCM syndrome basic therapy are 94.9%; After adopting the TCM health care service plan in the test group,32 cases are reported clinical recovery,11 cases of significant effective,6 cases of effective,10 cases of ineffective, and the effective rate is 83.1%. In the control group, which did not adopt any TCM health care service plan,10 cases are reported clinical recovery,1 case of significant effective,9 cases of effective,39 cases of ineffective, and the effective rate is 33.9%. The difference is statistically significant (P<0.05). As a result, the effectiveness of the treatment in the test group excels the control group.3. Pain Rating Scale Comparison:The difference of VAS and JOA between two groups before the TCM health care service plan was adopted (when the primary treatment was finished) is not statistically significant (P>0.05), the pain rating scale of the two groups are comparable to each other before any treatments. The VAS score after the adoption of the TCM health care service plan in the 1st,3rd and 6th month, and through repeated measures design analysis of variance, the differences between two groups are significantly different (P<0.05). As a result, the effectiveness of the treatment in the test group excels the control group.4. VAS Curative Effect Index Comparison:The difference of VAS Curative Effect Index between two groups is not statistically significant (P>0.05) after adopting TCM syndrome basic therapy. So the VAS Curative Effect Indexes of the two groups are comparable to each other before adoption of the TCM health care service plan. After VAS Curative Effect Index being tested by generalized estimating equations, in the 1st,3rd and 6th months after adoption of the TCM health care service plan, there is no center effect among the three communities((P>0.05) and the difference between two groups in terms of VAS Curative Effect Index and testing time is statistically significant (P<0.05). As a result, the effectiveness of the treatment in the test group excels the control group. The difference of VAS Curative Effect Index in the 6th and 1st months after the adoption of the TCM health care service plan is significant (P<0.05) and the effectiveness of the treatment in the 6th month excels that in the 1st month. So the longer the TCM health care service plan is adopted, the better the effect is.5. WHOQOL BREF-All Areas Scores Comparison:The difference of WHOQOL BREF-All Areas Scores between two groups is not statistically significant (P>0.05) when they were in the first visit, and after adopting TCM syndrome basic therapy. So the WHOQOL BREF-All Areas Scores of the two groups are comparable to each other before adoption of the TCM health care service plan. Through repeated measures design analysis of variance, the difference of WHOQOL BREF-All Areas Scores in the 1st,3rd and 6th months after adoption of the TCM health care service plan is as the following:the difference of WHOQOL BREF-All Areas Scores in the 1st and 3rd months between the two groups is not statistically significant (P>0.05); in the 6th month, the difference of WHOQOL BREF scores in the areas of physiology, psychology and social relation is significant (P<0.05); however, in the field of environment, the difference is not statistically significant (P>0.05). From the above, it can be concluded that in the 6th month, the effectiveness of the treatment in the test group excels the control group.6. Cost-effectiveness Analysis:According to the primary effectiveness identification criteria (VAS Curative Effect Index), the cost-effectiveness of the results of the pre-treatment and pro-treatment within the group and the results of the pre-treatment and pro-treatment between the groups were analyzed. One patient in the test group was found effective cost of 41 rmb after the treatment while the control group is 683.6 rmb. The test group enjoyed higher economic benefit after adopting the TCM health care service plan.ConelusionThe result of the study has found out that the TCM health care service plan towards community CLBP treatment is more effective and sustained. It can effectively reduce the recurrence rate of CLBP, enhance the patients’quality of life and be of better economic value. Therefore, the TCM health care service plan studied in the research is a valid attempt to cure CLBP. The result is worth to be improved and promoted and is of practical value. |
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