Band 106, Heft 8

Objective: To assess factors related to prescribing antibiotics for nonspecific upper respiratory tract infections (URTIs) by office-based osteopathic physicians. Methods: Retrospective analysis of physician office visits by patients with URTIs, using the National Ambulatory Medical Care Survey database for a 5-year period. Antibiotic prescribing was analyzed based on patient and physician characteristics. Multiple logistic regression modeling was then used to assess the independent contribution of these factors. Results: Between July 1, 1997, and June 30, 2001, there were 9.6 million patient visits to osteopathic physicians for URTIs in the United States. Antibiotics were prescribed in 56.4% (5.41 million) of these visits. Adults, nonwhites, females, patients with a concurrent condition such as acute bronchitis, acute otitis media, acute pharyngitis, acute sinusitis, or asthma, and patients requiring additional medications for their symptoms were more likely to be given antibiotics. In addition, family physicians, physicians who were not owners of their practices, and those practicing in nonmetropolitan areas were more likely to prescribe antibiotics. Conclusions: Antibiotics were prescribed in more than 4.8 million (50%) patient visits for URTIs. Greater efforts are needed to address some of the factors that influence prescribing practices.

Context : In testing an experimental new drug or therapy, the gold standard in biomedical research for determining treatment efficacy is the randomized controlled trial (RCT). In pharmaceutical trials, inert placebos are an easily administered control that facilitates blinded comparisons. In clinical trials that study the effects of manual interventions, researchers must carefully consider their use of treatment control models. Choosing credible controls that will minimize bias in osteopathic manipulative treatment (OMT) clinical trials poses unique challenges to researchers because of heterogeneous OMT methods and practice. Objective : To compare the treatment credibility of sham manipulative treatment and untreated controls to active OMT. Methods : Subjects recruited for an OMT clinical trial for chronic low back pain completed a treatment-credibility rating scale comparing two written descriptions of the study interventions offered. The scale was administered to subjects before trial entry and at 6-month follow-up. Scale scores were used to compute credibility ratios for both intervention protocols (ie, OMT vs sham manipulative treatment). Repeated measures analysis of variance was used to assess changes in the credibility ratio over time, including the measurement of study group and time main effects, as well as study group × time interaction effects. Results : Subjects (N=91) perceived OMT as a more credible therapeutic option than sham manipulative treatment both at trial entry and at 6-month follow-up ( P <.05). Among subjects completing the study protocol (n=66), there were no changes in perceived credibility of the study interventions over time. There were no significant differences in the credibility ratio among study groups ( P =.64) or over time ( P =.79). In addition, there were no significant study group × time interactions ( P =.59). Conclusions : In clinical trials, OMT may be perceived by subjects as a more credible treatment alternative than many control procedures. Treatment credibility can interact with subject expectations and study design in complex ways. When analyzing the treatment effects of OMT, investigators must consider the effects of these two subjective elements when competing interventions are offered and subjects are asked to self-report data. Study design should be optimized to equalize these effects among interventions.

Context: Sacroiliac joint dysfunction is diagnosed based on the combined results of several palpatory examinations. Previous studies have compared the interexaminer reliability of only one of these methods of diagnosis. Objective: To compare the interexaminer reliability of three methods of combining palpatory examinations to determine the side of sacroiliac joint dysfunction, sacral base position, and innominate bone position. Design: Blinded single-cohort reliability study. Methods: Patients with low back pain underwent two identical sets of palpatory examinations given by two physicians, separately, at a university spine center. The results of each set were compiled and interpreted by three methods: using the test result with the highest interexaminer reliability (method 1), requiring at least one test result to be abnormal for the variable to be abnormal (method 2), and requiring all test results to be abnormal for the variable to be abnormal (method 3). The κ was calculated for each method. Results: There were 24 subjects (mean age, 68.3 years), of which 15 (62%) were women. The κ was consistently higher with method 1, at 0.47, 0.08, and 0.32 for the sacral position, innominate bone position, and side of sacroiliac joint dysfunction, respectively. Corresponding values for method 2 were 0.09, 0.4, and 0.16, and for method 3 were 0.16, 0.1, and –0.33. Conclusion: Using the results of the most reliable examination consistently has the best interexaminer reliability.