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Intloko ingaba yinkxalabo yokunyusa ngokwenene, ngakumbi ukuba ezi ziqala ukuvela rhoqo. Ngaphezu koko, iintloko zingabangela ingxaki enkulu xa uhlobo oluqhelekileyo lweentlungu zentloko luba yimigraine. Iintlungu zentloko zidla impawu ezibangelwa yingozi kunye / okanye imeko kunye nomlenze wesibeleko, okanye ngasemva nangentamo. Ngethamsanqa, iindlela ezahlukeneyo zonyango ziyafumaneka ukunceda unyango lwentloko. Ukhathalelo lwe-Chiropractic yindlela ekhethwa yonyango eyaziwa yinto eqhelekileyo ekucetyiswa intlungu, intloko kunye nemigraines. Injongo yolu lulwazi kuphando olulandelayo kukuqinisekisa ukusebenza kwe-chiropractic ye-spinal manialative treatment for migraine.

I-Chiropractic Spinal Treatment Therapy kwi-Migraine: iProgram yokuFunda ye-One-Blinded Placebo-Controled Randomized Trial Clinical Trial

 

Abstract

 

intshayelelo

 

I-Migraine ithintela i-15% yabemi, kwaye inempilo enkulu kunye nezoqoqosho zentlalo. Ulawulo lwe-Pharmacological yonyango lokuqala. Nangona kunjalo, iyeza elimangalisayo kunye / okanye iprophylactic alinakunyamezela ngenxa yemiphumo emibi okanye ukuchasene. Ngaloo ndlela, sijonge ukuvavanya ukuphumelela kwe-chiropractic ye-spinal manipulative therapy (CSMT) ye-migraineurs kwi-trial-clinic trial trial (rand).

 

Indlela kunye nohlalutyo

 

Ngokwezibalo zamandla, abathathi-nxaxheba abangama-90 bayadingeka kwi-RCT. Abathathi-nxaxheba baya kwenziwa ngokulandelelana kwelinye lamaqela amathathu: i-CSMT, indawo ye-placebo (ukunyanzelwa kwe-sham) kunye nolawulo (ulawulo oluqhelekileyo olungelulo olwezandla). I-RCT inezigaba ezithathu: inyanga enye e-1 yokungenela, ukungenelela kweenyanga ezi-3 kunye nohlalutyo olulandelayo emva kongenelelo kunye neenyanga ezi-3, 6 no-12? Indawo yokugqibela kukuphindaphindeka kwemigraine, ngelixa ubude be-migraine, amandla e-migraine, isalathiso sentloko (frequency x ubude be-x ngamandla) kunye nokusetyenziswa kwamayeza ngamanqaku esiphelo sesibini. Uhlalutyo oluphambili luya kuvavanya utshintsho kwimvamisa ye-migraine ukusuka kwisiseko ukuya esiphelweni songenelelo kunye nokulandela, apho amaqela e-CSMT kunye ne-placebo kunye ne-CSMT kunye nolawulo ziya kuthelekiswa. Ngenxa yokuthelekisa amaqela amabini, amaxabiso e-p angaphantsi kwe-0.025 aya kuthathelwa ingqalelo njengobalulekileyo ngokwezibalo. Kuwo onke amanqaku okuphela kunye nohlalutyo, ixabiso elisezantsi kwe-0.05 liya kusetyenziswa. Iziphumo ziya kuboniswa ngexabiso lexabiso le-p kunye ne-95% ye-CI.

 

Ukuziphatha nokuSasazwa

 

I-RCT iya kulandelwa izikhokelo zetyala leekliniki ezivela kwi-International Headache Society. IKomiti yesiFunda yaseNorway ye-Ethics Research Ethics kunye neNorway Social Science Data Services ziye zavuma le projekthi. Inkqubo iya kwenziwa ngokubhengezwa kweHelsinki. Iziphumo ziza kushicilelwa kwiintlanganiso zesayensi kunye nakwiimagazini ezihlaziywe ngontanga.

 

Inombolo yokuBhaliswa kweTyala

 

NCT01741714.

Internet: Iinkcukacha-manani kunye neendlela zophando

 

Amandla kunye nokulinganiselwa kwesi sifundo

 

  • Uphononongo luya kuba yonyango lokuqala lonyango olunezixhobo ezintathu (rCT) ukuhlola ukuphumelela kwe-chiropractic ye-spray manialative therapy ngokubhekiselele kwi-placebo (ukunyanzelwa kwe-sham) kunye nokulawula (qhubela phambili ulawulo lwamayeza olusisiseko ngaphandle kokufumana ukungenelela kwamanyathelo).
  • Ukusebenza kwangaphakathi okuqinileyo, kuba isicrotractor esisodwa iya kuqhuba zonke iindlela zokungenelela.
  • I-RCT inakho ukubonelela ngonyango olungenalo lwe-pharmacological for migraineurs.
  • Umngcipheko wokuphuma kwabafundi uyekisiwe ngenxa yeendlela zokuthintela ezingqongqo kunye nexesha leenyanga ezili-17 ze-RCT.
  • I-placebo eyamkelekileyo ngokuqhelekileyo ayizange isetyenziselwe unyango olusesikweni; Ngako oko, kukho umngcipheko wokungaboni kakuhle, ngelixa umphandi obonelela ngoncedo angakwazi ukukhunjulwa ngenxa yezizathu ezicacileyo.

 

imvelaphi

 

I-Migraine yinkinga yempilo eqhelekileyo kunye neendleko zempilo kunye nezoqoqosho zentlalo. Kwi-recent Burgment of Disease study, i-migraine yayisetyenziswe njengesimo sesithathu esiqhelekileyo. [1]

 

Umfanekiso wesetyhini ene-migraine iboniswe ngombane ephuma entloko.

 

Ngokumalunga ne-15% yabemi ngokubanzi abane-migraine. [2, 3] I-Migraine idla ngokuba yi-unilateral kunye ne-pulsating kunye nentloko ephakathi / ebuhlungu eyenziwa yinto eyenziwa ngumzimba wesiqhelo, kwaye ihamba kunye ne-photophobia kunye ne-phonophobia, isicaphucaphu kunye nokuhlanza ngamanye amaxesha.[4] I-Migraine ikhona kwiifom ezimbini ezinkulu, i-migraine ngaphandle kwe-aura kunye ne-migraine ene-aura (ngezantsi). I-Aura iguquguquka ukuphazamiseka kwe-neurological yembono, i-sensory kunye / okanye umsebenzi wokuthetha, okwenzeka ngaphambi kwentloko. Nangona kunjalo, ukuhluka kwe-intraindividual ukusuka ekuhlaselweni ukuya ekuhlaselweni kuqhelekileyo [5, 6] Imvelaphi ye-migraine ixutyushwa. Iimpembelelo ezibuhlungu zinokuvela kwi-nerve ye-trigeminal, i-central kunye / okanye i-peripheral mechanisms [7, 8] Izakhiwo ezibuhlungu zentlungu ye-Extracranial ziquka ulusu, imisipha, i-arteries, i-periosteum kunye namalungu. Ulusu lunobuntununtunu kuzo zonke iintlobo zesiqhelo zokuvuselela iintlungu, ngelixa izihlunu zexeshana nezentamo zinokuba ngumthombo wentlungu kunye nokuthamba kwi-migraine.[9�11] Ngokufanayo, i-frontal supraorbital, i-superficial temporal, i-posterior kunye ne-occipital arteries inovelwano kwiintlungu. [9, 12]

 

amaNqaku

 

Ulwahlulo lwaMazwe ngamazwe lweengxaki zeNtloko-II Iingqinisiso zokuxilongwa kwe-Migraine

 

Migraine ngaphandle kweAura

  • A. Ubuncinci uhlaselo oluhlanu luzalisekisa imilinganiselo B�D
  • B. Uhlaselo olubuhlungu lwentloko oluthatha iiyure ezi-4�72?h (lunganyangwanga okanye lunganyangwanga ngempumelelo)
  • C. Intloko ine ubuncinane ezimbini kwezi zinto zilandelayo:
  • 1. Indawo engasetyenziswayo
  • 2. Umgangatho wokupasa
  • 3. Ubuhlungu obukhulu okanye obunzima obubuhlungu
  • 4. Ukuhlaziywa okanye kubangela ukuphepha ukuqhutyelwa komzimba
  • D. Ngethuba lokubamba intloko ubuncinane enye yezi zinto zilandelayo:
  • 1. Isihlunu kunye / okanye ukuhlanza
  • 2. Photophobia kunye nefonophobia
  • E. Akunakubangelwa kwenye ingxaki
  • Migraine nge aura
  • A. Ubuncinane uhlaselo olubini luzalisekisa imilinganiselo B�D
  • B. Aura equkwa ubuncinane kwezi zinto zilandelayo, kodwa akukho mandla obuthathaka:
  • 1. Izimpawu ezibonakalayo ezibuyiselwayo ziquka iimpawu ezintle (oko kukuthi, izibane ezikhanyayo, amabala okanye imigca) kunye / okanye iimpawu ezimbi (oko kukuthi, ukulahleka kombono). Ubuhlungu obukhulu okanye obunzima obubuhlungu
  • 2. Izimpawu ezinokubuyiselwa ngokupheleleyo eziquka iimpawu ezintle (oko kukuthi, izikhonkwane kunye neenaliti) kunye / okanye iimpawu ezingalunganga (oko kukuthi,
  • 3. Ukuphazanyiswa kwentetho ye-dysphasic
  • C. ubuncinane ezimbini kwezi zinto zilandelayo:
  • 1. Izimpawu ezingabonakaliyo ezibonakalayo kunye / okanye iimpawu ezingabonakaliyo
  • 2. Ubuncinci uphawu lwe-aura olukhula kancinci kancinci ngaphezulu kwe-5? Min kunye / okanye iimpawu ezahlukileyo ze-aura zenzeka ngokulandelelana ngaphezulu kwe-5? Min
  • 3. Uphawu ngalunye luhlala 5 kunye no 60?
  • D. Ukufezekisa iikhrayitheriya zentloko ye-BD ye-1.1 Migraine ngaphandle kwe-aura kuqala ngexesha le-aura okanye kulandela i-aura ngaphakathi kwe-60? Min
  • E. Akunakubangelwa kwenye ingxaki

 

Ulawulo lwe-Pharmacological lukhetho lokuqala lonyango lwe-migraineurs. Nangona kunjalo, ezinye izigulane azinyamezeli amayeza abukhali kunye / okanye i-prophylactic ngenxa yemiphumo emibi okanye ukuchasana ngenxa ye-comorbidity yezinye izifo okanye ngenxa yomnqweno wokuphepha amayeza ngenxa yezinye izizathu. Umngcipheko wokusetyenziswa kakubi kwamayeza ngenxa yokuhlaselwa rhoqo kwe-migraine kubonisa ingozi enkulu yempilo kunye neenkxalabo zeendleko ezithe ngqo kunye nezingathanga ngqo. Ukuxhaphaka kwamayeza asetyenziswa kakhulu yintloko ebuhlungu (MOH) yi-1�2% kuluntu ngokubanzi, [13�15] oko kukuthi, malunga nesiqingatha sabemi abaphethwe yintloko ebuhlungu engapheliyo (iintsuku zentloko ezili-15 okanye ngaphezulu ngenyanga) bane-MOH.[16] I-Migraine ibangela ilahleko yeentsuku zokusebenza ezingama-270 ngonyaka ngabantu abayi-1000 ukusuka kubemi ngokubanzi.[17] Oku kuhambelana malunga neminyaka eyi-3700 yomsebenzi elahlekileyo ngonyaka eNorway ngenxa ye-migraine. Iindleko zezoqoqosho nge-migraineur nganye ziqikelelwa ukuba yi-$ 655 e-USA kunye �579 eYurophu ngonyaka. bhiliyoni kumazwe e-EU, i-Iceland, iNorway neSwitzerland ngelo xesha. I-Migraine ixabisa ngaphezu kokuphazamiseka kwemithambo-luvo okufana nesifo sengqondo esiyingozi, i-multiple sclerosis, isifo sika-Parkinson kunye ne-stroke.[18] Ngaloo ndlela, iindlela zonyango ezingezona ze-pharmacological zifanelekile.

 

Inkqubo yeDiversified kunye nendlela yeGonstead yizona ndlela ziqhelekileyo zonyango zokusebenzisa unyango lwe-chiropractic ekusebenzeni, ezisetyenziswe ngu91% kunye ne-59%, ngokulandelanayo, [21, 22] kunye nezinye iindlela zokungenelela ezingekho mbhalo iindlela zokuhamba, ukulungiswa kwemisipha kunye nokuqhutyelwa kwamanzi, ukuvuselelwa, ukulungiswa kwangaphambili kunye nokuzivocavoca kunye nesondlo ngokubanzi kunye neengcebiso zezokwelapha.

 

Izilingo ezimbalwa ze-spinal manipulative (SMT) ezilawulwa ngokungenamkhethe (RCTs) zisebenzisa i-Diversified technique iye yaqhutyelwa kwi-migraine, iphakamisa umphumo kwi-migraine frequency, ubude be-migraine, ubukhulu be-migraine kunye nokusetyenziswa kweyeza. Ii-RCT ziziphene zemethodological ezifana nokuxilongwa kwentloko engachanekanga, oko kukuthi, ukuxilongwa kwemibuzo esetyenzisiweyo akuchanekanga, [23] ukungonelanga okanye akukho nkqubo ye-randomisation, ukungabikho kweqela le-placebo, kunye neendawo eziphambili kunye nesekondari ezingachazwanga.[26�27] Ukongezelela , Ii-RCT zangaphambili azizange zihambelane nemigaqo yeklinikhi ekhuthazwayo evela kwi-International Headache Society (IHS) [28, 31] Okwangoku, akukho RCTs isebenzise indlela ye-Gonstead chiropractic SMT (CSMT). Ngaloo ndlela, ukuqwalasela ukusilela kwendlela kwii-RCT zangaphambili, i-RCT yekliniki elawulwa yi-placebo kunye nomgangatho ophuculweyo we-methodological uhlala uqhutyelwa kwi-migraine.

 

Indlela ye-SMT yesenzo kwi-migraine ayaziwa. Kuxoxwa ukuba i-migraine inokuthi ivele kwi-complexity of nociceptive afferent responses ezibandakanya umqolo wesibeleko esiphezulu (C1, C2 kunye neC3), ekhokelela kwimeko ye-hypersensitivity yendlela ye-trigeminal ehambisa ulwazi lwengqondo yobuso kunye nobuninzi bentloko. , 34] Uphando lucebise ukuba i-SMT inokuvuselela iinkqubo ze-neural inhibitory kumanqanaba ahlukeneyo e-spinal cord, kwaye inokuthi isebenze iindlela ezahlukeneyo ezisezantsi ezithintelayo. iindlela ezongezelelweyo ezingahlolisiswanga ezinokuchaza umphumo we-SMT enayo kwi-mechanical pain sensitisation.

 

Umfanekiso wesibini womfazi onomgraine kunye nomzobo obonakalisa ingqondo yomntu ngexesha le-migraine.

 

Injongo yale sifundo kukuvavanya ukuphumelela kwe-CSMT ngokubhekiselele kwi-placebo (ukuphathwa kakubi) kunye nokulawula (qhubela phambili ukulawulwa kwemithi ye-pharmacy ngaphandle kokufumana ukungenelela kwamanyathelo) kubaxhamli be-RCT.

 

Indlela kunye noyilo

 

Le yi-RCT elawulwa yi-placebo elawulwa yi-placebo ngamaqela amathathu afanayo (i-CSMT, i-placebo kunye nolawulo). I-hypothesis yethu ephambili kukuba i-CSMT inika ubuncinci i-25% yokunciphisa inani leentsuku ze-migraine ngenyanga (30? Iintsuku / inyanga) xa kuthelekiswa ne-placebo kunye nolawulo ukusuka kwisiseko ukuya esiphelweni songenelelo, kwaye silindele ukuba ukuncitshiswa okufanayo kube zigcinwa kwiinyanga ezi-3, 6 ne-12? Ukuba unyango lwe-CSMT lusebenza kakuhle, luya kunikwa abathathi-nxaxheba abafumene i-placebo okanye ulawulo emva kokugqitywa kwesifundo, oko kukuthi, emva kokulandelwa kweenyanga ezili-12? Olu phononongo luza kuhambelana nezikhokelo zezilingo ezinconywayo ezivela kwi-IHS, 32 33 kunye nezikhokelo ze-CONSORT kunye ne-SPIRIT. [41, 42]

 

Abemi abagulayo

 

Abathathi-nxaxheba baya kugaywa kwixesha likaJanuwari ukuya kuSeptemba 2013 ngeSibhedlele seYunivesithi yase-Akershus, ngokusebenzisa oogqirha ngokubanzi kunye nentengiso yeendaba, oko kukuthi, iipowusta ezinolwazi oluqhelekileyo ziya kufakwa kwiiofisi zabasebenzi ngokubanzi kunye nolwazi lomlomo kwi-Akershus kunye ne-Oslo. , Norowe. Abathathi-nxaxheba baya kufumana ulwazi oluthunyelweyo malunga neprojekthi elandelwa ludliwano-ndlebe olufutshane lwefowuni. Abo baqeshwe kwiiofisi zoogqirha jikelele kuya kufuneka baqhagamshelane nomphandi weklinikhi oneenkcukacha zakhe zoqhagamshelwano zinikezelwe kwiipowusta ukuze bafumane ulwazi olubanzi malunga nophononongo.

 

Abathathi-nxaxheba abafanelekileyo baphakathi kwe-18 kunye ne-70? Iminyaka yobudala kwaye ubuncinci kuhlaselo lwe-migraine ngenyanga. Abathathi-nxaxheba bafunyaniswe ngokwemigaqo yokuqonda isifo yoHlelo lwaMazwe ngaMazwe lweZifo zeNtloko (ICHD-II) ngugqirha wezifo zengqondo kwisibhedlele iAkershus University. [43] Bavunyelwe kuphela ukuba babekho ngokudibeneyo kwentloko-yentloko kwaye hayi ezinye iintloko eziphambili.

 

Iikhrayitheriya zokukhutshwa zichasene ne-SMT, i-spinal radiculopathy, ukukhulelwa, uxinzelelo kunye ne-CSMT kwiinyanga ezili-12 ezidlulileyo. Abathathi-nxaxheba abathi ngexesha le-RCT bafumane naluphi na ungenelelo olwenziweyo ngabanyangi bomzimba, oochwephesha bezonyango, i-osteopaths okanye abanye oochwephesha ekunyangeni iintlungu ze-musculoskeletal kunye nokukhubazeka, kubandakanya unyango lwe-massage, ukudityaniswa ngokudibeneyo kunye nokuphathwa, [44] batshintshe amayeza abo entloko okanye ukukhulelwa baya kukhutshwa ukufunda ngelo xesha kwaye uthathwe njengayeka phakathi esikolweni. Bavunyelwe ukuqhubeka nokutshintsha amayeza abo aqhelekileyo e-migraine lonke uvavanyo.

 

Ekuphenduleni koqhagamshelwano lokuqala, abathathi-nxaxheba abazalisekisa imigaqo-nkqubo yokungeniswa bayamenywa ukuba baqhutywe vavanyo ngumphandi we-chiropractic. Uvavanyo luquka udliwano-ndlebe kunye novavanyo lwangaphakathi ngokugxininiswa ngokukodwa kwikholamu yomgcini. Ulwazi olubhaliweyo nolwabhaliweyo malunga neprojekthi luya kunikwa kwangaphambili kwaye umlomo kunye nemvume ebhaliweyo iya kufumaneka kuwo onke amacandelo athatywayo ngexesha lodliwano-ndlebe nangomphandi weklinikhi. Ngokuhambelana nokusebenza kakuhle kweekliniki, zonke izigulane ziya kwaziswa malunga nezibi kunye neenzuzo kwakunye nokungabikho kokungalunganga kokungenelela kubandakanywa ukunyamekela kwendawo kunye nokukhathala kwimihla yokunyanga. Akukho ziganeko ezibi kakhulu eziye zaxelwa kwi-chiropractic Gonstead indlela. [45, 46] Abathathi-nxaxheba abaye bangenelela kumanyathelo okungenelela okanye asebenzayo baya kufumana uviwo olupheleleyo lwe-spinal radiography kwaye zicwangciselwe kwiiseshoni zokungena kwi-12. Iqela lolawulo aliyi kubonakaliswa kulolu vavanyo.

 

RCT

 

I-RCT yeklinikhi ineenyanga ezi-1 zokuqhutywa kunye nokungenelela kweenyanga ezi-3? Iprofayile yexesha iya kuvavanywa ukusuka kwisiseko kude kube sekupheleni kokulandelwa kwazo zonke iindawo zokuphela (Umzobo 1).

 

Umzobo we-1 Isatifiketi soMgca wokuFunda

Umzobo 1: Uluhlu lokufunda. I-CSMT, unyango lwe-chiropractic unyango olusisigxina; Indawo ye-Placebo, ukunyanzelwa kwe-sham; Ukulawula, qhubela phambili ulawulo oluqhelekileyo lwe-pharmacological ngaphandle kokufumana ukungenelela kwangaphakathi.

 

Ukuqalisa

 

Abathathi-nxaxheba baya kugcwalisa iphepha ledayari eliqinisekisiweyo le-1 inyanga enye ngaphambi kokungenelela okuya kusetyenziswa njengedatha esisiseko kubo bonke abathathi-nxaxheba. [47, 48] Idayari eqinisekisiweyo ibandakanya imibuzo ehambelana ngqo nendawo zokugqibela nezesekondari. I-ray-ray iya kuthathwa kwindawo yokuma kwi-anterioposterior kunye ne-lateral planes yomgudu wonke. I-X-ray iya kuvavanywa ngumphandi we-chiropractic.

 

Ukurhoxiswa

 

Amaqashiso alungisiweyo atywiniweyo ngongenelelo oluthathu, oko kukuthi, unyango olusebenzayo, i-placebo kunye neqela lolawulo, ziya kwahlulwa ngokwamacandelwana amane ngobudala kunye nesini, oko kukuthi, i-18�39 kunye ne-40�70?iminyaka yobudala kunye namadoda nabasetyhini, ngokulandelelanayo. Abathathi-nxaxheba baya kwabelwa ngokulinganayo amaqela amathathu ngokuvumela umthathi-nxaxheba ukuba azobe iqashiso elinye kuphela. I-block randomisation iya kulawulwa liqela eliqeqeshwe ngaphandle ngaphandle kokubandakanyeka kumphandi wekliniki.

 

Ukungenelela

 

Unyango olusebenzayo luquka i-CSMT ngokusebenzisa indlela ye-Gonstead, [21] oko kukuthi, udibaniso oluthile, u-velocity, low-amplitude, umgcini osisigxina somgca ongekho ukulungiswa kwesimo esilungelelweyo esilungelelaniswe kumsebenzi wokungasebenzi kwemigulane (ugcini lwe-spine). iimvavanyo ze-chiropractic.

 

Ungenelelo lwe-placebo luqukethe ukuphathwa kwe-sham, oko kukuthi, uqhakamshelwano olubanzi olungacacanga, isantya esisezantsi, islow-amplitude sham push maneual in a non-purpose and non-therapeutic directional line. Lonke unxibelelwano olungelolonyango luya kwenziwa ngaphandle kwekholamu yomqolo kunye nokudibanisa okwaneleyo kwaye ngaphandle kokuzilungisa kwithishu ethambileyo ukuze kungabikho mingxunya idibeneyo. Kwezinye iiseshoni, umthathi-nxaxheba wayelala ebhentshini leZenith 2010 HYLO kunye nomphenyi emi kwicala lasekunene lomthathi-nxaxheba ngesandla sakhe sasekhohlo sibekwe kwicala lasekunene lomthathi-nxaxheba ngesinye isandla esomeleza. Kwezinye iiseshoni, umphandi uyokuma kwicala lasekhohlo lomthathi-nxaxheba kwaye abeke intende yakhe yasekunene ngaphezulu komda wasekhohlo we-scapular edge ngesandla esisekhohlo sokuqinisa, ehambisa iphulo lokutyhala elingenanjongo. Ngenye indlela, umthathi-nxaxheba ulele kwindawo efanayo yokuma njengeqela lonyango elisebenzayo kunye nomlenze ongezantsi ngokuthe tye kwaye umlenze ongaphezulu uguqulwe kunye neqatha lomlenze wangaphezulu uphumle kumlenze osemazantsi wedolo, ukulungiselela intshukumo yokuma kwentshukumo esecaleni, eya kuthi zisiwe njengokutyhala okungenanjongo kwindawo enobukhazikhazi. Iindlela ezizezinye zokukhohlisa ziya kutshintshaniswa ngokulinganayo phakathi kwabathathi-nxaxheba be-placebo ngokomgaqo olandelwayo ngexesha lonyango lweeveki ezili-12 ukomeleza ubunyani besifundo. Amaqela asebenzayo kunye ne-placebo aya kufumana uvavanyo olufanayo lwesakhiwo kunye nokuhamba ngaphambi nasemva kongenelelo ngalunye. Akukho lungelelwaniso okanye iingcebiso ziya kunikwa abathathi-nxaxheba ngexesha lokulingwa. Ithuba lonyango lizakubandakanya uthethathethwano oluli-12, okt, kabini ngeveki kwiiveki ezi-3 zokuqala ezilandelwa kube kanye ngeveki kwiiveki ezi-2 ezizayo kwaye kube kanye kwiveki yesibini kude kufike iiveki ezili-12. Imizuzu elishumi elinesihlanu iya kwabelwa ngokuthetha-thethana ngomthathi-nxaxheba ngamnye. Zonke iindlela zongenelelo ziya kuqhutywa kwisibhedlele iAkershus University kwaye zilawulwe ngugqirha wezonyango onamava (AC).

 

Umfanekiso wesinye indoda endala efumana i-chiropractic ukunakekelwa kwemigraine.

 

UDkt Jimenez usebenza kwi-neckrest_preview ye-wrestler

 

Iqela lolawulo liya kuqhubeka nokunyamekela ngokuqhelekileyo, oko kukuthi, ulawulo lwezonyango ngaphandle kokufumana ukungenelela kwamanyathelo ngumphenyi weklinikhi. Iindlela ezifanayo zokukhutshwa zisetyenziswa kwiqela lolawulo ngexesha lonke lokufunda.

 

Ukufumba

 

Emva kweseshoni yonyango nganye, abathathi-nxaxheba abafumana ukungenelela okusebenzayo okanye i-placebo baya kugcwalisa i-questionnaire ye-de-blinding elawulwa liqela elizimeleyo eliqeqeshwe ngaphandle ngaphandle kokubandakanyeka kumphandi weklinikhi, oko kukuthi, ukubonelela nge-dichotomous "ewe" okanye "hayi" impendulo njenge ukuba ngaba unyango olusebenzayo lufunyenwe. Le mpendulo yalandelwa ngumbuzo wesibini malunga nokuba baqiniseke kangakanani na ukuba unyango olusebenzayo lwafunyanwa kwi-0�10 isikali sokulinganisa amanani (NRS), apho i-0 imele ukungaqiniseki ngokupheleleyo kwaye i-10 imele ukuqiniseka ngokupheleleyo. Iqela lolawulo kunye nomphandi weklinikhi abanako ngenxa yezizathu ezicacileyo ukuba bangaboni. [49, 50]

 

Ukulandelisa

 

Uhlalutyo lokulandelela luya kwenziwa kwiindawo zokugqibela ezilinganiswe emva kokuphela kongenelelo kwaye kwi-3, 6 ne-12 yeenyanga? Ngeli xesha, bonke abathathi-nxaxheba baya kuqhubeka nokuzalisa iphepha lokujonga iintlungu kwidayari kwaye bayibuyise rhoqo ngenyanga. Kwimeko yedayari engaguquguqukiyo okanye amaxabiso ashiyekileyo kwidayari, abathathi-nxaxheba baya kuqhakamshelwa kwangoko ekufumaneni ukunciphisa ukukhumbula ukukhumbula. Abathathi-nxaxheba baya kuqhagamshelwa ngefowuni ukukhusela ukuthotyelwa.

 

Amaphuzu okuPhambili kunye neeSondari

 

Amanqaku aphambili kunye nesekondari adweliswe ngezantsi. Amanqaku okugqibela ahambelana nezikhokelo zovavanyo lweklinikhi ezicetyiswayo ze-IHS. [32, 33] Sichaza inani leentsuku ze-migraine njengeyona ndawo yokugqibela kwaye silindele ubuncinane i-25% yokunciphisa inani leentsuku ukusuka kwisiseko ukuya ekupheleni kokungenelela, kunye umgangatho ofanayo wokunciphisa ugcinwa ekulandeleni. Ngokwesiseko sophononongo lwangaphambili kwi-migraine, ukunciphisa i-25% kuthathwa njengoqikelelo olulondolozayo. [30] Ukunciphisa i-25% kulindeleke kwakhona kumanqaku okugqibela esibini ukusuka kwisiseko ukuya ekupheleni kokungenelela, ukugcina ekulandeleni ixesha le-migraine, i-migraine intensity kunye ne-headache index, apho isalathisi sibalwa njengenani leentsuku ze-migraine (ientsuku ze-30)) ubude be-migraine ubude (iiyure ngosuku) �ubunzima obuphakathi (0�10 NRS). Ukunciphisa i-50% yokusetyenziswa kweyeza ukusuka kwisiseko ukuya ekupheleni kokungenelela kunye nokulandelwa kulindeleke.

 

amaNqaku

 

Amaphuzu okuPhambili kunye neeSondari

 

IziPhelo zePrayimari

  • 1. Inani leentsuku ze-migraine kunyango olusebenzayo ngokumelene neqela le-placebo.
  • 2. Inani leentsuku ze-migraine kunyango olusebenzayo kunye neqela lokulawula.

Amaphuzu okugqibela eSiphelo

  • 3. Ubude be-Migraine kwiiyure kwindlela yokwelapha esebenzayo ngokumelene neqela le-placebo.
  • 4. Ubude be-Migraine kwiiyure kwindlela yokwenza unyango olusebenzayo kunye neqela lokulawula.
  • 5. I-VAS eyaziwayo ngokweenyango ezisebenzayo kunye neqela le-placebo.
  • 6. I-VAS ngokuzimelayo kwindlela yokwelapha esebenzayo kunye neqela lokulawula.
  • 7. Isalathisi seentloko (ubuninzi x ubude x intensity) kwindlela yokwenza unyango oluhambelana neqela le-placebo.
  • 8. Isalathisi seentloko kwonyango olusebenzayo ngokumelene neqela lokulawula.
  • 9. Isifo semithi yamakhanda entloko kwindlela yokwelapha esebenzayo ngokumelene neqela le-placebo.
  • 10. Imithi yonyango yeentloko kwindlela yokwelapha esebenzayo kunye neqela lokulawula.

 

*Uhlalutyo lwedatha lusekwe kwixesha lokuqhuba ngokuchasene nokuphela kongenelelo. Inqaku 11�40 liya kuphinda-phindwa inqaku 1�10 ngasentla kulandelelwano lweenyanga ezi-3, 6 nezi-12, ngokulandelelanayo.

 

UkuCwangciswa kwedatha

 

Isatriki sokuhamba kwamathathi siboniswa kwiSifayile 2. Impawu ezisemgangathweni kunye neempawu zeklinikhi ziya kubalwa njengeendlela kunye nee-SD zokuguquka okuqhubekayo kunye namanani kunye neepesenti eziguqukayo. Ngamanye amaqela amathathu aya kuchazwa ngokwahlukileyo. Amaphuzu okuphambili kunye nesekondari aya kuboniswa ngamanqaku afanelekileyo achaza kwiqela ngalinye kunye nexesha ngalinye. Ukuqheleka kwamaphuzu okugqibela kuya kuvavanywa ngokucacileyo kwaye utshintsho luya kuqwalaselwa ukuba luyimfuneko.

 

Umzobo we-2 Umtsalane woMgca oLindelekileyo

Umzobo 2: Ukulindela umzobo wokuhamba. I-CSMT, unyango lwe-chiropractic unyango olusisigxina; Indawo ye-Placebo, ukunyanzelwa kwe-sham; Ukulawula, qhubela phambili ulawulo oluqhelekileyo lwe-pharmological ngaphandle kokufumana ukungenelela kwangaphakathi.

 

Utshintsho kumaphuzu okuphambili nolwasekondari ukusuka kwisiseko kuze kube sekupheleni kokungenelela kwaye ukulandelelwaniswa kuya kufaniswa phakathi kwamaqela asebenzayo kunye ne-placebo kunye namaqela asebenzayo kunye nokulawula. I-hypothesis engabonakaliyo ithi akukho mvelaphi ephawulekayo phakathi kwamaqela ekutshintsheni okuqhelekileyo, ngelixa enye i-hypothesis ithi ukungafani kwe-25% kukhoyo.

 

Ngenxa yexesha lokulandelela, ukurekhodwa okuphindaphindiweyo kweziphambili eziphambili nezesekondari kuya kufumaneka, kwaye ukuhlalutya kwendlela yokugqibela kunye neyesibini kuya kuba ngumdla omkhulu. Amakhonkco e-intra-individual (i-cluster effect) kungenzeka ukuba abekhona kwiedatha ngokulinganisa okuphindaphindiweyo. Umphumo weCluster uya kuhlolwa ngokubala i-intraclass coefficient equantifying inani leyantlukwano eyahlukileyo ebonakalayo ngenxa yokuhlukahluka kwamanye amazwe. Umgangatho kumaphuku okugqibela uza kuvavanywa ngumzekelo wokulungiswa komgca wenkcazelo yexesha elide. Umzekelo odibeneyo odibeneyo ulawula idatha engalinganiyo, inika yonke into efumanekayo evela kwizigulane ezingenangqondo ukuba zifakiwe, kwakunye nokuphuma kwezinto ezihambayo. Imizekelo yokunyanzeliswa kunye neempembelelo ezingapheliyo kwicandelo lexesha kunye nokwabiwa kweqela kunye nokusebenzisana phakathi kwababini kuya kuqikelelwa. Ukusebenzisana kuya kuthintela ukungafani phakathi kwamacandelo malunga nokuhamba kwexesha kumaphuzu okugqibela kwaye usebenza njengolu vavanyo lwe-omnibus. Iziphumo ezingalindelekanga kwizigulane ziya kufakwa ukulungelelanisa uqikelelo lwama-intraindividual correlations. Iintlambo eziqhelekileyo ziya kuqwalaselwa. Iimodeli ezidibeneyo ezixubileyo ziya kuqinganiswa nenkqubo ye-SAS PROC MIXED. Ukuqhathaniswa kokubini kokubili kuya kwenziwa ngokufumana ixesha elilodwa ixesha elihlukileyo phakathi kweqela ngalinye kunye neenombolo eziphambili ze-p kunye ne-95% CI.

 

Bobabini i-protocol kunye neenjongo zokuphatha izihlalutya ziya kwenziwa xa zifanelekileyo. Konke uhlalutyo luya kwenziwa ngumgcini-manani, uphuphuthelwe ukunikezelwa kweqela kunye nabathathi-nxaxheba. Zonke iziphumo ezimbi ziya kubhaliswa kwaye zinikezelwe. Abathathi-nxaxheba abafumana nayiphi na imiphumo emibi ngexesha lovavanyo baya kuba nelungelo lokufowuna umphandi wekliniki kwipowuni yefowuni yeprojekthi. Idata iya kuhlaziywa nge-SPSS V.22 kunye ne-SAS V.9.3. Ngenxa yokuqhathaniswa kweqela ezimbini kwisiphelo sokugqibela, amaxabiso ephantsi kwe-0.025 aya kuqwalaselwa njengento ebalulekileyo. Kuzo zonke iziphumo zokugqibela kunye nokuhlalutya, inqanaba lokubaluleka kwe0.05 liya kusetyenziswa. Amanani angabikhoyo angabonakala kwiimviwo zengxoxo ezingaphelelanga, ii-diary ezingaphelelanga zentloko, iiseshoni zokungena kwiingxoxo kunye / okanye ngenxa yokulahla. Umzekelo wokulahleka uza kuhlolwa kunye nokulahlekelwa kwamanani athathwa ngokufanelekileyo.

 

Ukubalwa kwamandla

 

Ubungakanani besampulu yokubala kusekwe kwiziphumo kuphando olusandula ukupapashwa lokuthelekiswa kweqela kwi-topiramate. [51] Sicinga ukuba umahluko ophakathi wokunciphisa inani leentsuku kunye ne-migraine ngenyanga phakathi kwamaqela asebenzayo kunye namaqela e-placebo ziintsuku ze-2.5? Umahluko ofanayo uthathwa phakathi kwamaqela asebenzayo kunye nolawulo. I-SD yokunciphisa iqela ngalinye kuthathwa ukuba ilingana no-2.5. Ngaphantsi kokucingelwa, kwi-avareji, iintsuku ze-10 migraine ngenyanga kwisiseko kwiqela ngalinye kwaye akukho lutshintsho kwi-placebo okanye kwiqela lolawulo ngexesha lokufunda, ukunciphisa kweentsuku ze-2.5 kuhambelana nokuncitshiswa yi-25%. Kuba uhlalutyo oluphambili lubandakanya ukuthelekiswa kwamaqela amabini, sibeka inqanaba lokubaluleka kwi-0.025. Ubungakanani besampulu yezigulana ezingama-20 ziyafuneka kwiqela ngalinye ukuze kufunyanwe umahluko obalulekileyo ngokweenkcukacha-manani ekunciphiseni i-25% ngamandla angama-80%. Ukuvumela abafundi abaphumayo esikolweni, baceba ukuqesha abathathi-nxaxheba abali-120.

 

UDkt Jimenez White Coat

Insight of Dr. Alex Jimenez

“Ndiye ndacetyiswa ukuba ndifune ukhathalelo lwe-chiropractic ngenxa yentloko yam ebuhlungu. Ngaba unyango lwe-chiropractic spinal manipulative luyasebenza kwi-migraine? ”�Iindidi ezininzi ezahlukeneyo zonyango zingasetyenziselwa ukuphatha ngokufanelekileyo i-migraine, nangona kunjalo, ukunakekelwa kwe-chiropractic yenye yeendlela zonyango ezidumileyo zokuphatha i-migraine ngokwemvelo. Unyango lwe-Chiropractic spinal manipulative thrust yemveli ye-high-velocity low-amplitude (HVLA). Eyaziwa nangokuthi i-spinal manipulation, i-chiropractor yenza le ndlela ye-chiropractic ngokusebenzisa amandla alawulwa ngokukhawuleza kwi-joint ngelixa umzimba ubekwe ngendlela ethile. Ngokutsho kwenqaku elilandelayo, unyango lwe-chiropractic spinal manipulative lunokunceda ngokufanelekileyo ukunyanga i-migraine.

 

ingxoxo

 

Ukuqwalasela ngeendlela

 

I-RT ye-SMT zangoku kwi-migraine ibonisa indlela yokwenza uphando ngokuphathelele imvama ye-migraine, ixesha kunye nobukhulu. Nangona kunjalo, isigqibo esiqinileyo sifuna i-RCs elawulwa yi-placebo elawulwa yi-placebo eneendlela ezimbalwa zokungaphumeleli kweendlela. [30] Ezi zifundo zifanele zihambelane nezikhokelo zecilisi ze-IHS ezicetyiswayo nge-freraine frequency njengendlela yokuphela ephezulu kunye ne-migraine ubude, i-migraine ngamandla, i-headache index kunye nokusetyenziswa kwamachiza njengendawo yokugqibela yesiphelo. [32, 33] Inkcazo yeentloko, kunye nokudibanisa ubude, ubude kunye nobukhulu, unikezela ubungqina bezinga lokuhlupheka. Ngaphandle kokungabikho kwemvumelwano, isalathisi seentloko sinconywe njengesiphelo semigangatho yesibini esiphelekileyo esamkelweyo. [33, 52, 53] Amaphuzu okugqibela kunye nesekondari aya kuqokelelwa ngempumelelo kwi-diary head validity diagnosis head to all participants ukuze banciphise khumbula i-bias. [47, 48] Okusemandleni ethu kolwazi, le yonyango lokuqala lokufumana unyango kwi-RCT ene-three-armed armored-blinded-controlled RCT. Uyilo lokufunda luhambelana neziphakamiso ze-RCTs ze-pharmological ngokubanzi. Ii-RCT eziquka iqela le-placebo kunye neqela lokulawula lixhamla kwii-RCT ezidityanisiweyo eziqhathanisa ezimbini zonyango zonyango. I-RCT inika kwakhona indlela efanelekileyo yokuvelisa ukhuseleko kunye nedatha yokusebenza.

 

Umfanekiso wesetyhini ene-migraine ephethe intloko yakhe.

 

Ukungaphumeleli okuyimpumelelo kungumngcipheko weRCT. Ukubambeka kudla kunzima njengoko kungekho ncedo olumiselweyo lwe-chiropractic lwamanyathelo olusetyenziswayo olungasetyenziswa njengeqela lolawulo kulo mhla. Nangona kunjalo, kuyimfuneko ukuquka iqela le-placebo ukwenzela ukuvelisa umphumo wenene we-intervention entle. Ukuvumelana malunga neendawo ezifanelekileyo ze-placebo esifanelekileyo kwilingo leklinikhi ye-SMT phakathi kweengcali ezimela oogqirha kunye nabafundi, nakuba kunjalo, akuzange kufumaneke. [54] Akukho zifundo ezidlulileyo, ekuhambeni kolwazi lwethu, ziqinisekisile ukuphuhliswa ngempumelelo kwecandelo lovavanyo lweklinikhi ye-CSMT iiseshoni zonyango. Sizimisele ukunciphisa umngcipheko ngokulandela umgaqo-nkqubo ocetywayo weqela le-placebo.

 

Impendulo ye-placebo iphezulu kakhulu kwi-pharmacological kwaye ithathwa njengento ephakamileyo efanayo kwizifundo ezingekho ze-pharmacological clinical; nangona kunjalo, kusenokuba kuphakamileyo kwiprogram ye-RCT yocalulo kunye nokuthintana nomzimba kubandakanyeka. [55] Ngokufanayo, inkxalabo yemvelo malunga nokuqwalasela ingqalelo iya kubandakanywa kwiqela lokulawula njengoko lingabonwa ngabani okanye lingabonwa okuninzi ngumphandi weklinikhi njengamanye amaqela amabini.

 

Kuhlala kukho umngcipheko wokuyeka isikolo ngenxa yezizathu ezahlukeneyo. Ukusukela ukuba ixesha lokulingwa liinyanga ezili-17 ezineenyanga ezili-12 zokulandela, umngcipheko wokulahleka kokulandela uyonyuswa. Ukuvela kolunye ungenelelo olwenziwayo ngexesha lesilingo yenye ingozi, njengoko abo bafumana unyango okanye olunye unyango lwezomzimba kwenye indawo ngexesha lesilingo baya kurhoxiswa kufundo kwaye bathathwe njengabaphumileyo ngexesha lolwaphulo-mthetho.

 

Imvume yangaphandle ye-RCT ingaba ubuthathaka njengoko kukho omnye uphando. Nangona kunjalo, sifumene ukuba luncedo kubaphenyi abaninzi, ukwenzela ukuba banikele ngolwazi olufanayo kubathathi-nxaxheba kuwo onke amaqela amathathu kunye nokungenelela kwangaphakathi kwi-CSMT nakwiqela le-placebo. Ngaloo ndlela, sinenjongo yokuphelisa ukuhlukahluka kophenonongo onokuba khona ukuba kukho abaphandi ababini okanye ngaphezulu. Nangona indlela yeGonstead yindlela yesibini eqhelekileyo esetyenziswayo phakathi kwezilwanyana zonyango, asiyiboni inkxalabo yokuxhalabisa xa kufikelele ekuveleni nasekuqinisekiseni kwangaphandle. Ukongezelela, inkqubo ye-block randomisation iya kunika isampuli ehambelanayo phakathi kwamaqela amathathu.

 

Ukuqinisekiswa kwangaphakathi, nangona kunjalo, kunamandla ngokuba nekliniki eyodwa. Iyanciphisa umngcipheko wokukhethwa kwintetho, ulwazi kunye neziphumo zokulinga. Ukongezelela, ukuxilongwa kwabo bonke abathathi-nxaxheba kwenziwa ngabafundi bamayeza abanegazi kwaye kungekhona ngamaphepha emibuzo. Udliwano-ndlebe oluchanekileyo unobunzulu obuphezulu kunye nobunzima xa kuthelekiswa nombuzo wemibuzo. [27] Izinto ezinokubakhuthaza ngabanye, ezinokuthi zithintele ingqiqo yezinto ezithatha inxaxheba kunye nezinto ezikhethwa ngabanye xa unyango luyancitshiswa ngokuba nomphenyi omnye. Ukongezelela, ukuqinisekiswa kwangaphakathi kuqiniswa ngakumbi yenkqubo efihliweyo yokurhoxiswa kwenkqubo. Ukusukela ekubeni iminyaka yobudala kunye nabangqingili banokudlala indima kwimigraine, i-block randomisation yafunyaniswa kuyimfuneko ukulinganisela iingalo ngamanqanaba kunye nobulili ukwenzela ukunciphisa i-bias enxulumene neminyaka yobudala.

 

Umfanekiso we-X-ray ebonisa ukulahlekelwa kwe-bososis ye-colervus njengokuba kunokubangela ukuba u-migraine.

I-ray-ray ebonisa ukulahlekelwa kwintsholongwane yesibeleko njengesizathu esibangelwa ukufuduka kwemigraine.

 

Ukuqhuba i-X-rays ngaphambi kokungenelela okusebenzayo kunye ne-placebo kwafunyaniswa ukuba kuyasebenza ukuze kubonwe i-posture, i-joint kunye ne-disc integrity. ukuvezwa kwakucatshangelwa ukuba kuphantsi. [56, 57] uvavanyo lwe-X-ray lufunyenwe luyimfuneko ukuze kuqinisekiswe ukuba i-X-rays yomqolo epheleleyo iluncedo kwizifundo ezizayo okanye cha.

 

Ekubeni singazi kakuhle iindlela zokusebenza kakuhle, kwaye zombini intambo yomgudu kunye nomgangatho ophakathi wehla okhutshiwe, asibonanga sizathu sokuba singabandakanyi indlela epheleleyo yonyango lwangaphakathi. Kuye kwandiswe kwakhona ukuba intlungu kwiindawo ezinomqolo ezahlukileyo akufanele ithathwe njengengxaki ehlukeneyo kodwa kunokuba ibe lilungu elinye. [60] Ngokufanayo, kubandakanywa nendlela epheleleyo yomgudu kunqanda ukwahlula phakathi kwe-CSMT kunye namaqela e-placebo. Ngaloo ndlela, inokuqinisa ubungako bokuphupha impumputhe kwiqela le-placebo elifezekileyo. Ukongeza, bonke oonobumba be-placebo baya kwenziwa ngaphandle kwekholomu yomgcini, ngoko ukunciphisa intambo yomgudu ongabonakaliyo.

 

Ixabiso loNcedo kunye neSayensi

 

Le RCT iya kugxininisa kwaye iqinisekise i-Gonstead CSMT ye-migraineurs, engazange ifundwe ngaphambili. Ukuba i-CSMT ibonisa ukuba iyasebenza, iya kubonelela ngonyango olungenalo lweyeza. Oku kubaluleke ngakumbi kuba abanye abathintekayo abanakho ukuphumelela kweempawu zecawa kunye / okanye i-prophylactic medication, ngelixa ezinye zinemiphumo engavumelekiyo okanye i-comorbidity yezinye izifo eziphikisana namayeza ngelixa abanye banqwenela ukuphepha amachiza ngezizathu ezahlukahlukeneyo. Ngaloo ndlela, ukuba i-CSMT isebenza, iyakwazi ukuba nefuthe ekwenzeni unyango lwe-migraine. Uphononongo luphinde luxoxisane ngokubambisana phakathi kwezilwanyana zonyango kunye namagqirha, okubalulekileyo ukwenzela ukuba ukhathalelo lwezempilo luphumelele. Ekugqibeleni, indlela yethu ingasetyenziswa kwi-chiropractic yexesha elizayo kunye nezinye ii-RCT zonyango kwi-headache.

 

Ukuziphatha nokuSasazwa

 

Zokuziphatha

 

Uphononongo luvunyiwe yiKomiti yeNgingqi yaseNorway yeeNqobo zoPhando lwezoNyango (REK) (2010/1639/REK) kunye neeNkonzo zeDatha yeNzululwazi yeNtlalo yaseNorway (11�77). Ukubhengezwa kweHelsinki kulandelwa ngenye indlela. Yonke idatha ayiyi kuchazwa ngelixa abathathi-nxaxheba kufuneka banike imvume yomlomo nebhaliweyo. I-inshurensi ibonelelwa �INkqubo yaseNorway yeMbuyekezo kwiZigulana� (NPE), eliqumrhu lesizwe elizimeleyo elasekwa ukuba liqhube amabango embuyekezo kwizigulana eziye zafumana ukwenzakala ngenxa yonyango phantsi kwenkonzo yezempilo yaseNorway. Umgaqo wokumisa wachazwa ukurhoxisa abathathi-nxaxheba kolu phononongo ngokuhambelana neengcebiso kulwandiso lwe-CONSORT lweNgxelo eNgcono yokuNxwema [61]. Ukuba umthathi-nxaxheba unika ingxelo kwi-chiropractor yakhe okanye kubasebenzi bophando ngesiganeko esibi kakhulu, uya kuhoxiswa kwisifundo kwaye athunyelwe kugqirha wabo jikelele okanye isebe elingxamisekileyo esibhedlele kuxhomekeke kwimeko yesiganeko. Isethi yokugqibela yedatha iya kufumaneka kumphandi wekliniki (AC), i-statistician ezimeleyo kunye nemfama (JSB) kunye noMlawuli weSifundo (MBR). Idatha iya kugcinwa kwikhabhathi etshixiweyo kwiZiko loPhando, kwiSibhedlele seYunivesithi yaseAkershus, eNorway, iminyaka emi-5.

 

Ukusasazwa

 

Le projekthi ilindeleke ukuba igqitywe iminyaka emi-3? Emva kokuqala kwayo. Iziphumo ziya kupapashwa kwiijenali zamazwe aphesheya ezivavanywe ngoontanga ngokuhambelana neNgxelo ye-CONSORT 2010. Iziphumo ezilungileyo, ezimbi, kunye neziphumo ezingathandabuzekiyo ziya kupapashwa. Ukongeza, isishwankathelo esibhaliweyo seziphumo ziya kufumaneka ukuba zithathe inxaxheba xa kuceliwe. Bonke ababhali kufuneka bakulungele ukuloba ngokwe-International Committee of Medical Journal Editors, 1997. Umbhali ngamnye kufanele ukuba athathe inxaxheba ngokwaneleyo emsebenzini ukuthatha uxanduva loluntu kumxholo. Isigqibo sokugqibela malunga nomyalelo wokubhala siya kugqitywa xa iprojekthi igqityiwe. Iziphumo ezivela kufundo zinokuthi, ngokungaphezulu, ziboniswe njengeeposta okanye iintetho zomlomo kwinkomfa yesizwe kunye / okanye yamazwe aphesheya.

 

Imibulelo

 

Isibhedlele sase-Akershus University sinobubele sinikezela ngezixhobo zophando. I-Clinic1, i-Oslo, eNorway, yenza uvavanyo lwe-X-ray.

 

Imihlathi

 

Abaxhasi: I-AC kunye ne-PJT babenombono wokuqala kwisifundo. I-AC ne-MBR ifumane inkxaso-mali. I-MBR icwangcise ukuyila ngokubanzi. I-AC ilungiselele uxwebhu loqulunqo lokuqala kunye ne-PJT ibeke ingxelo ngenguqu yokugqibela yenkqubo yophando. I-JSB yenza yonke i-statistical analysis. I-AC, i-JSB, i-PJT kunye ne-MBR babandakanyeka ekuchazeni nasekuncedisweni ekuhlaziyweni nasekulungiseleleni kwincwadi yesandla. Bonke abalobi baye bafunda kwaye bavumile isicatshulwa sokugqibela.

 

Inkxaso: Isifundo sifumane inkxaso-mali evela kwi-Extrastiftelsen (inombolo yesibonelelo: 2829002), iNorth Chiropractic Association (inombolo yesibonelelo: 2829001), iSibhedlele se-Akershus University (inombolo yesibonelelo: N / A) kunye neYunivesithi yase-Oslo eNorway (inombolo yesibonelelo: N / A) .

 

Injongo yokunyanzela: Akukho nto ipapashwe.

 

Imvume yomonde: Ku funyenwe.

 

Ukuvunywa kwemiqathango: IKomiti yesiFunda yaseNorway ye-Ethics Research Ethics ivume le projekthi (i-ID yemvume: 2010 / 1639 / REK).

 

Iprovenance kunye nokuhlolwa koontanga: A nga thunyelwa; uhlolo lwangaphandle.

 

Uvavanyo oluLungeleleneyo oluLawulayo lwe-Chiropractic Spinal Treatment Therapy kwi-Migraine

 

Abstract

 

Injongo: Ukuvavanya ukuphumelela kwe-chiropractic ye-spinal manipulative therapy (SMT) kunyango lwe-migraine.

 

Design: Iilingo elilawulwa ngokungalindelekanga lwexesha leenyanga ze-6. Icandelo lalingamacandelo e-3: Iinyanga ze-2 zokuqokelela idatha (phambi kokonyango), iinyanga ze-2 zonyango, kunye nezinye iinyanga ze-2 zokuqokelela idatha (emva kokonyango). Ukuthelekiswa kweziphumo kwizinto zokuqala ezisezantsi zenziwa kwiphepha leenyanga ze-6 zombini kwiqela le-SMT kunye neqela lolawulo.

 

Ukubeka: Isiko loPhando lweChiropractic saseYunivesithi yaseMacquarie.

 

Aba nxaxheba: Amavolontiya angamakhulu amabini anamabini anesixhenxe phakathi kwexesha le-10 kunye ne-70 iminyaka babesetyenziselwa ukuthengiswa kweendaba. Ukuxilongwa kwe-migraine kwenziwe ngesiseko somgangatho we-International Headache Society, ubuncinane ubuncinane bodwa kwimigraine ngenyanga.

 

Amanyathelo: Iinyanga ezimbini ze-SMT (iindlela ezihlukahlukeneyo) zokulungiswa kwe-vertebral ezimiselwe ngunyango (ubuninzi bezonyango ze-16).

 

Izisiphumo eziphambili zeziphumo: Abathathi-nxaxheba bagqiba i-diaries ephezulu yamaphepha entloko ngexesha lonke uvavanyo luchaza ukuphindaphindiweyo, ubunzima (amanqaku afanayo anjengokufaniswa), ixesha, ukukhubazeka, iimpawu ezihambelanayo kunye nokusetyenziswa kwamachiza nganye kwisiqhelo.

 

iziphumo: Impendulo yomndilili yeqela lonyango (n = 83) ibonakalise ukuphuculwa kweenkcukacha manani kwimigraine (P <.005), ubude bexesha (P <.01), ukukhubazeka (P <.05), kunye nokusetyenziswa kwamayeza (P <.001 xa kuthelekiswa neqela lolawulo (n = 40). Abantu abane basilele ukugqibezela ukulingwa ngenxa yezizathu ezahlukeneyo, kubandakanya notshintsho kwindawo yokuhlala, ingozi yemoto, kunye nokunyuka rhoqo kwemigraine. Icacisiwe ngamanye amagama, i-22% yabathathi-nxaxheba baxele ngaphezulu kwe-90% yokuncipha kwemigraines njengesiphumo seenyanga ezi-2 ze-SMT. Phantse iipesenti ezingama-50 zabathathi-nxaxheba baxele ukuphucuka okubonakalayo ekuziphatheni kwesiqendu ngasinye.

 

Isiphelo: Iziphumo zolu phando zixhasa iziphumo zangaphambili zibonisa ukuba abanye abantu baxela ukuphucuka okubonakalayo kwimigraines emva kwe-chiropractic SMT. Ipesenti ephezulu (> 80%) yabathathi-nxaxheba baxele uxinzelelo njengeyona nto iphambili kwimigraines yabo. Kubonakala kunokwenzeka ukuba ukhathalelo lwe-chiropractic lunefuthe kwimeko yomzimba enxulumene noxinzelelo kwaye kwaba bantu iziphumo ze-migraine ziyancitshiswa.

 

Ekugqibeleni, unyango lwe-chiropractic unyango olusisigxina lungasetyenziselwa ngempumelelo ukunceda ukuphathwa kwemigraine, ngokutsho kophando lophando. Ukongezelela, ukunakekelwa kwe-chiropractic kukuphucula impilo nempilo yabantu. Inkolelo yomzimba womntu wonke iyakholelwa ukuba yinto ebalulekileyo yeyona nto eyenza ukunakekelwa kwe-chiropractic kusebenza kakuhle. Ulwazi oluchazwe kwiziko leSizwe loLwazi lweBiotechnology (NCBI). Ubungakanani beenkcukacha zethu zikhawulelwe kwi-chiropractic kunye nokulimala kwemigudu kunye nemeko. Ukuxoxa ngesihloko, nceda ukhululeke ukucela uDkt Jimenez okanye uqhagamshelane nathi 915-850-0900 .

 

Ikhutshwe nguDkt. Alex Jimenez

 

Green-Call-Now-Button-24H-150x150-2-3.png

 

Imixholo eyongezelelweyo: Intlungu Yentambo

 

Intlungu yesikhumba isishalazo esiqhelekileyo esinokubangelwa ngenxa yeemeko ezahlukeneyo kunye / okanye iimeko. Ngokwezibalo, ukulimala kwengozi yemoto kunye nokulimala kwe-whiplash zizinye zezona zinto zixhaphake iintlungu phakathi kwabantu bonke. Ngethuba lengozi yengozi, igalelo elizenzekelayo elivela kweso siganeko kunokubangela ukuba intloko nentamo iqhume ngokukhawuleza emva kwanoma iyiphi na indlela, eyonakalise izakhiwo eziyinkimbinkimbi ezungeze umgudu wesibeleko. Ixinzelelo kumathambo kunye nemigqa, kunye neyezinye izicubu entanyeni, kunokubangela iintlungu zentamo kunye nokubonakalisa imiqondiso emzimbeni womntu.

 

umfanekiso webhlogi weendaba eziphambili zephepha lephepha

 

ISIHLOKO ESIBALULEKILEYO: I-EXTRA EXTRA: Ungcono!

 

Ngenanto
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Ubume obubambeneyo: ILayisensi yeeNkcazo ezininzi: Ugunyaziswe Ukuziqhelanisa I-40 States*

UGqr. Alex Jimenez DC, MSACP, RN* CIFM*, IFMCP*, ATN*, CCST
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