Ukunyamekela kwe-Chiropractic yindlela ekhethwa yonyango eyaziwayo eqhelekileyo isetyenziselwa ukuhlukana kweemeko kunye / okanye iimeko, kubandakanywa iintlungu eziphantsi kunye ne-sciatica. Kakade ke, akuyiyo yonke intlungu ebonakalayo kwaye ayiyiyo yonke into ebangela umzimba. Ukuxinezeleka, uxinzelelo kunye nokuxinezeleka kuthinta izigidi zabantu ngonyaka. Nangona izigulane ezininzi zifuna unyango lweziyobisi zonyango ukuba ziphathwe ngempilo yabo yengqondo, abanye bangakwazi ukulawula nokunyanga iimpawu zabo ngendlela epheleleyo. Ukunyamekela kwe-Chiropractic yinkqubo yokulawula uxinzelelo oluyimpumelelo enokukunceda ukunciphisa iimpawu ezinxulumene noxinzelelo, njengentlungu ephantsi ye-back and sciatica.

 

Ukuxinezeleka Kukuthintela njani uMzimba?

 

Kukho iindidi ze-3 zokubandezeleka: umzimba, ukusingqongileyo kunye nemvakalelo.

 

• Ukuxinezeleka komzimba: Kubangelwa ukungabikho kokulala, izifo, ukuxhwaleka okanye ukulimala, kunye nokutya okungafanelekanga.
• Uxinzelelo lwendalo: Ebangelwa ngomsindo omkhulu (ngokukhawuleza okanye oqhubekayo), ukungcola kunye neziganeko zehlabathi, ezifana nemfazwe nezopolitiko.
• Ukuxinezeleka ngokomzwelo: Kubangelwe iintlobo ezahlukeneyo zezobomi, ezifana nezindlu ezihambayo, ukuqala umsebenzi omtsha kunye nokusebenzisana rhoqo. Ngokwahlukileyo kwezinye iindidi ezimbini zokuxinzezeleka, kunjalo, abantu banokulawula ukunyamezeleka kwabo. Oko kunokuxhomekeka kwisimo sengqondo somntu.

 

Ukuxinezeleka kunokuchaphazela umzimba womntu ngezindlela ezahlukeneyo, kokubili ngokuqinisekileyo nangokubi, ngokomzimba nangokomzwelo. Nangona uxinzelelo lwexesha elifutshane lunokuba luncedo, ukunyamezeleka kwexesha elide kunokubangela ezininzi iinkalo zempilo zengqondo kunye nomzimba. Ukunyamezela kusebenze impendulo "yokulwa okanye indiza", indlela ekhuselekileyo eyenziwa ngumonakalo onobubele ukulungiselela umzimba ukuba ubone ingozi ngokunyusa izinga lentliziyo kunye nokuphefumla kunye neengqondo, ngokomzekelo, ukukhanya kwamehlo kunokuba nzima. Emva kokuba uxinzelelo luyekile, inkqubo yesantya ephakathi ibuyisela umyalezo kumzimba kwaye iivitals zibuyela kwindawo evamile.

 

Kwimizekelo emininzi, inkqubo ye-nervous central ingakwazi ukubuyisela umqondiso kumzimba xa kufike ixesha lokubuyela kwindawo ekhululekile. Abantu abaninzi banamava okuqhubekayo, okuxinzelelekileyo, okubhekiswa njengengcinezelo engapheliyo. Isiganeko esithathayo sithatha umthwalo kumzimba womntu. Olu hlobo loxinzelelo lunokubakhokelela ekubandezelekeni, ukuxhalaba, ukunyaniseka nokudandatheka.

 

Ukulawula Ukunyamezela Kwakho

 

Ingcinezelo engapheliyo ingabangela iimpawu ezibuhlungu, ezinjengentlungu ephantsi ye-back and sciatica, enokubangela uxinzelelo olungakumbi. Ubuhlungu ngokubanzi bubangela iingxaki zengqondo, ezifana nokuxhalaba nokuxinezeleka, iinkqubo zokucinga, kunye nokungakwazi ukugxila. Abantu abaneengcinezelo ezingapheliyo abaneempawu ezibuhlungu banokuziva behluleka ukwenza kunye nokuzibandakanya kwimisebenzi eqhelekileyo.

 

Ulwaphulo lokuphathwa kwengcinezelo lunokunceda abantu baphuculwe kunye nokulawula uxinzelelo lwabo olungapheliyo kunye neempawu ezihambelana nazo. Ukunyamekela kwe-Chiropractic kunokukunceda ukunciphisa intlungu kunye nokuxhatshazwa kwemisipha, ukunciphisa ukunyamezela. Inkqubo yesiseko yomnatha nayo inokuzuza kwimiphumo yonyango lwe-chiropractic. Inkqubo ye-nervous central, okanye i-CNS, inceda ukulawula isimo sengqondo, kunye nempilo egcweleyo kunye nokuphila kakuhle, oko kuthetha ukuba inkqubo enokulinganisela ye-nervous inokukunceda ekuphuculeni intlalo jikelele.

 

Iinzuzo zoKhathalelo lweChiropractic

 

Ukunyamekela kwe-Chiropractic yindlela yokwelapha epheleleyo, eyenzelwe ukubuyisela umzimba kummandla wasezantsi kufuneka ugcine izihlunu kunye namaqela asebenza kakuhle. Ukuxinzezeleka kwengcinezelo kunokubangela ukuxhatshazwa kwemisipha ngasemva, ekugqibeleni kukukhokelela ekugqibeleni komzimba. Ukuchithwa kwe-spin, okanye ukuhluthwa, kunokufaka isandla kwiimpawu ezininzi, kubandakanya isicathulo kunye nokuhlanza, iintloko kunye ne-migraines, uxinzelelo kunye nemiba yokutya. I-chiropractor isetyenziselwa ukulungiswa kwemigudu kunye neendlela zokunyusa ukukhupha ukunyanzelisa nokunciphisa ukuvuvukala emlanjeni ukuphucula umsebenzo wamanzi kunye nokuvumela umzimba ukuba uziphilise ngokwasemvelo. Ukunciphisa intlungu kunokugqibeleni kuncedise ukunciphisa uxinzelelo kunye nokuphucula impilo nempilo. Ukunyamekela kwe-Chiropractic kungabandakanya ukuxilwa kunye nokucebisa ukunceda ukulawula uxinzelelo, ukuxhalabisa nokuxinezeleka.

 

Indlela yokuThatha iNkathazo

 

Uninzi lwezonyango ziza kusetyenziswa iindlela zonyango kunye nobuchule, njengokonyango lwangokwenyama, isenzo kunye nesondlo sokutya, ukuqhubela phambili ukwandisa ukuphathwa kwengcinezelo yokunyamekela kwe-chiropractic. Ezi zinguqu zendlela yokuphila zichaphazela yonke indawo yokuphila kwakho. Ukongezelela, injongo yendiqendu engezantsi kukubonakalisa impembelelo yokunciphisa uxinzelelo lwengqondo ngokubhekiselele kwindlela yokhathazeka kwengqondo nokuziphatha kunye nokunyamekela ngokuqhelekileyo ukuxinezeleka kunye neempawu ezinxulumene neentlungu ezingapheliyo kunye ne-sciatica.

 

Iimiphumo zoKucinwa koxinzelelo lwengqondo -Candelo lokuThuthukiswa kwengxaki kunye noKhathalelo lweZenzo kunye nokuNakekelwa koNcedo kwiNtshukumo yokuBala kunye nokuLawulwa kwemiSebenzi phakathi kwabantu abadala abaneNtsholongwane engaphantsi kweNtsholongwane.

 

Abstract

 

ukubaluleka

 

Ukunciphisa ukunyamezeleka kwengqondo (MBSR) ayizange ihlolwe ngokugqithiseleyo kubantu abadala nabasemgangathweni abaneentlungu ezingapheliyo.

 

injongo

 

Ukuvavanya ukuphumelela kweentlungu ezingapheliyo emva kwe-MBSR kunye nokunyamekela okuqhelekileyo (UC) kunye neyonyango yokuziphatha (CBT).

 

Ukuyila, Ukubeka, kunye nabathathi-nxaxheba

 

I-Randomised, i-interviewer-blind, trial elawulwayo kwinkqubo yokunakekelwa kwempilo e-Washington State yabantu abadala abangama-342 abaneminyaka engama-20-70 ubudala kunye ne-CLBP ababhalise phakathi kukaSeptemba 2012 no-Ephreli 2014 kwaye banikezelwa ngokulandelelana kwi-MBSR (n = 116), i-CBT (n = 113), okanye i-UC (n = 113).

 

Ngoncedo

 

I-CBT (uqeqesho ukutshintsha iingcamango ezinxulumene nentlungu kunye nokuziphatha) kunye ne-MBSR (ukuqeqeshwa ngokucamngca kwengqondo kunye ne yoga) zanikelwa kwii-8 zamahora e-2 ngeeyure. I-UC ibandakanye nayiphi na inxaxheba abathatha inxaxheba.

 

IziPhumo eziPhambili kunye neMilinganiselo

 

Iziphumo zaseprayimari yayiyipesenti yabathathi-nxaxheba enentsingiselo yeklinikhi (? 30%) yokuphuculwa kwesiseko kwimilinganiselo yokusebenza (iphepha lemibuzo elikhubazekileyo lokukhubazeka iRoland [RDQ]; uluhlu lwe-0 ukuya kwi-23) nakwiingxelo zokuqaqanjelwa ziintlungu zangasemva (0 ukuya kwisikali se-10 ) kwiiveki ezingama-26. Iziphumo zavavanywa kwakhona kwi-4, 8, kunye ne-52 iiveki.

 

iziphumo

 

Phakathi kwabathathi-nxaxheba abangama-342 (iminyaka yobudala, iminyaka engama-49 (uluhlu, 20-70); 225 (66%) abasetyhini; kuthetha ubude beentlungu zangasemva, iminyaka eyi-7.3 (uluhlu lweenyanga ezi-3 ukuya kwiminyaka engama-50), <60% waya kwi-6 okanye nangaphezulu Iiseshoni eziyi-8, i-294 (i-86.0%) igqibe isifundo kwiiveki ezingama-26 kwaye i-290 (84.8%) igqibe isifundo kwiiveki ezingama-52. Kuhlalutyo lokufuna ukunyanga, kwiiveki ezingama-26, ipesenteji yabathathi-nxaxheba enenkqubela phambili ebonakalayo kwi-RDQ yayiphezulu I-MBSR (61%) kunye ne-CBT (58%) kune-UC (44%) (iyonke P = 0.04; MBSR xa ithelekiswa ne-UC: RR [95% CI] = 1.37 [1.06 ukuya ku-1.77]; I-MBSR xa ithelekiswa ne-CBT: 0.95 [0.77 ukuya kwi-1.18]; I-CBT xa ithelekiswa ne-UC: 1.31 [1.01 ukuya ku-1.69]. Ipesenteji yabathathi-nxaxheba abanenkqubela phambili eklinikhi yokuphucula iintlungu yayingu-44% kwi-MBSR kunye ne-45% kwi-CBT, kuthelekiswa ne-27% kwi-UC (iyonke P = 0.01; MBSR kuthelekiswa UC: 1.64 [1.15 ukuya ku-2.34]; I-MBSR xa ithelekiswa ne-CBT: 1.03 [0.78 ukuya ku-1.36]; I-CBT xa ithelekiswa ne-UC: 1.69 [1.18 ukuya ku-2.41]). Iziphumo ze-MBSR zaqhubeka notshintsho oluncinci kwiiveki ezingama-52 kuzo zombini iziphumo zokuqala.

 

Izigqibo kunye nokuBheka

 

Phakathi kwabantu abadala abaneentlungu ezingapheliyo zangemva, unyango nge-MBSR kunye ne-CBT, xa kuthelekiswa ne-UC, kubangele ukuphucula ngakumbi kwiintlungu zangemva kunye nokusebenza kwemida kwiiveki ze-26, kungekho mvelaphi ephawulekayo kwiziphumo phakathi kwe-MBSR kunye ne-CBT. Ezi ziphumo zibonisa ukuba i-MBSR ingaba yindlela yokwenza unyango olufanelekileyo kwizigulane ezinentlungu engapheliyo.

 

intshayelelo

 

Iintlungu ezibuya emva kweyona nto ibangela imbembelelo yokukhubazeka e-US [1]. Nangona kukho iindlela ezininzi zokonyango kunye nokunyuka kweenkonzo zonyango ezixhomekeke kule ngxaki, isimo sokusebenza kwabantu abaneentlungu e-US siye sahlaselwa [2, 3]. Kukho imfuneko yonyango kunye nokusebenza okubonakalayo okusemngciphekweni ophantsi kwaye unokukwazi ukufumaneka ngokubanzi.

 

Iimpawu zengqondo zidlala indima ebalulekileyo kwiintlungu kunye nokukhubazeka komzimba kunye nengqondo [4]. Ngapha koko, i-4 ye-8 ye-non-pharmacologic yonyango ekhuthazwayo yeentlungu eziqhubekayo zangasemva zibandakanya i- mind-body components [4]. Enye yezi, unyango lokuqonda-ngokuziphatha (i-CBT), ibonakalise ukusebenza kweemeko ezahlukeneyo zentlungu engapheliyo [5 8] kwaye iyacetyiswa ngokubanzi kwizigulana ezineentlungu ezingapheliyo zentlungu (CLBP). Nangona kunjalo, ukufikelela kwesigulana kwi-CBT kulinganiselwe. Ukunciphisa uxinzelelo lwengqondo (MBSR) [9], enye indlela ye- mind-body , ijolise ekwandiseni ulwazi kunye nokwamkelwa kwamava omzuzwana, kubandakanya ukungonwabi komzimba kunye neemvakalelo ezinzima. I-MBSR iya isanda ngokuxhaphaka kwaye iyafumaneka e-US ke, ukuba ibonakalisiwe iyingenelo kwi-CLBP, i-MBSR inokubonelela ngolunye ukhetho kunyango lwengqondo kwinani elikhulu lamaMelika anale meko. I-MBSR kunye nolunye ungenelelo olusekwe engqondweni lufunyenwe luncedo kuluhlu lweemeko, kubandakanya iintlungu ezingapheliyo [10-12]. Nangona kunjalo, inye kuphela uvavanyo olukhulu lwezonyango (RCT) oluvavanye i-MBSR ye-CLBP [13], kwaye olo vavanyo lwalunqunyelwe kubantu abadala.

 

Lo RCT uthelekisa i-MBSR kunye ne-CBT kunye nenkathalo evamile (UC). Sifumanisa ukuba abantu abadala abane-CLBP ngokungaqhelekanga kwi-MBSR baza kubonisa ukuphuculwa kancinci kunye nexesha elide kwimilinganiselo yokusebenza enxulumene nentlungu, emva kweentlungu ezibuhlungu, kunye nezinye iziphumo, xa kuthelekiswa nezo zikhethiweyo kwi-UC. Sifumanisa ukuba i-MBSR yayiza kuba ngaphezu kwe-CBT kuba iquka i-yoga, efunyenwe iphumelele kwi-CLBP [14].

 

tindlela

 

IsiCwangciso soFundo, ukuCwangcisa, kunye nabaNxaxheba

 

Sasipapashe ngaphambili i-Mind-Body Approach to Pain (MAP) protocol protocol [15]. Owona mthombo wabathathi-nxaxheba yayiliQela lezeMpilo (i-GH), inkqubo enkulu yokudityaniswa kwezempilo e-Washington State. Iileta ezichaza ukulingwa kunye nokumema ukuthatha inxaxheba zithunyelwe ngeposi kumalungu e-GH afezekise irekhodi yezobuchwephesha (i-EMR) yokubandakanywa / yokukhutshelwa, kunye neesampulu zabemi kuluntu olunikezelwa yi-GH. Abantu abaphendule kwizimemo bahlolwe kwaye babhaliswa ngomnxeba (Umzobo 1). Abathathi-nxaxheba abanokubakho baxelelwa ukuba baya kwenziwa ngokungacwangciswanga kwenye yeenkqubo ezimbini ezizezabo zisetyenziselwa iintlungu ezizisebenzisileyo eziye zafunyanwa ziluncedo ekunciphiseni iintlungu nokwenza ukuba kube lula ukwenza imisebenzi yemihla ngemihla okanye ukuqhubeka kononophelo oluqhelekileyo kunye ne- $ 50. Abo babelwe i-MBSR okanye i-CBT zange baziswe ngolwabiwo lwabo lonyango bade baye kwiseshoni yokuqala. Sithathe abathathi-nxaxheba kwizixeko ezi-6 kumaza ali-10 ahlukeneyo.

 

 

Sithathe abantu abangama-20 ukuya kwiminyaka engama-70 ubudala kunye neentlungu ezingachazwanga ezisezantsi eziqhubeka ubuncinci iinyanga ezintathu. Abantu abaneentlungu zangasemva ezinxulunyaniswa noxilongo oluthile (umzekelo, i-spinal stenosis), kunye nembuyekezo okanye imicimbi yokumangalelana, abanokuba nobunzima ekuthatheni inxaxheba (umzekelo, abangakwaziyo ukuthetha isiNgesi, abangakwaziyo ukuya kwiiklasi ngexesha elimiselweyo nendawo), okanye ngubani olinganisileyo inkathazo yokubandezeleka <3 kunye / okanye ukuphazamiseka kwentlungu kunye nemisebenzi <4 kwizikali ezi-3-0 azifakwanga. Iikhrayitheriya zokubandakanywa kunye nokukhutshelwa kwavavanywa kusetyenziswa idatha ye-EMR kunyaka ophelileyo (kubabhalisi be-GH) kunye nodliwanondlebe lokuhlola. Abathathi-nxaxheba babhaliswa phakathi kukaSeptemba 10 no-Epreli 2012. Ngenxa yokubhalisa kancinci, emva kokuba ababhalisi abangama-2014 babhalisile, sayeka ukungabandakanyi abantu abaneminyaka engama-99-64 ubudala, amalungu e-GH ngaphandle kotyelelo lwamva nje lwentlungu yomqolo, kunye nezigulana ezine-sciatica. Umgaqo olandelwayo uvunyiwe yiKomiti yoPhononongo lweziFundo zoLuntu yeGH. Bonke abathathi-nxaxheba banike imvume enolwazi.

 

Randomization

 

Ngokukhawuleza emva kokubonelela ngemvume kunye nokugqiba uvavanyo lokuqala, abathathi-nxaxheba babekwa ngokungalinganiyo ngokulinganayo kwi-MBSR, i-CBT, okanye i-UC. I-Randomization yahlulwa ngamanqaku esiseko (? 12 kuthelekiswa? 13, 0 23 isikali) yenye yamanyathelo esiphumo esiphambili, i-Roland Disability Questionnaire (RDQ) eguqulweyo [16]. Abathathi-nxaxheba babekwa ngokungacwangciswanga ngaphakathi kwezi strata kwiibhloko ze-3, 6, okanye ze-9. randomization.

 

Ngoncedo

 

Bonke abathathi-nxaxheba bafumana naluphi na unyango olwaluqhelekileyo olwamkelayo. Abo bangabonakaliyo kwi-UC bafumana i-$ 50 kodwa akukho qeqesho lwe-MBSR okanye i-CBT njengenxalenye yesifundo kwaye bekhululekile ukufuna nayiphi na unyango, ukuba ngaba, bafuna.

 

Ungenelelo lwaluthelekiswa nefomathi (iqela), ubude bexesha (iiyure ezingama-2 / iiveki zeeveki ezisi-8, nangona inkqubo ye-MBSR ikwabandakanya ukubuyela umva kweeyure eziyi-6), ukuphindaphinda (ngeveki), kunye nenani labathathi-nxaxheba kwiqela ngalinye. Iinkcukacha zongenelelo]. Ungenelelo ngalunye lwenziwa ngokomgaqo olandelwayo apho bonke abaqeqeshi baqeqeshwa khona. Abathathi-nxaxheba kuwo omabini ungenelelo banikwa iincwadi zomsebenzi, ii-CD ezimanyelwayo, kunye nemiyalelo yokuziqhelanisa nekhaya (umzekelo, ukucamngca, ukuskena umzimba, kunye neyoga kwi-MBSR; ukuphumla kunye nemifanekiso kwi-CBT). I-MBSR ihanjiswe ngabaqeqeshi be-15 nge-8 kwiminyaka eyi-5 yamava e-MBSR. Abathandathu babafundisi-ntsapho babefumene uqeqesho kwiziko lokuCamngca kwiYunivesithi yaseMassachusetts Medical School. I-CBT yahanjiswa yi-29 enelayisensi ye-Ph.D. Inqanaba leengqondo ezinamava kwiqela kunye ne-CBT nganye yeentlungu ezingapheliyo. Uluhlu lokutshekishwa kwamacandelo eprotocol yonyango agqityiwe ngumncedisi wophando kwiseshoni nganye kwaye aqwalaselwa qho ngeveki ngumphandi wophando ukuqinisekisa ukuba zonke izinto zonyango zisiwe. Ukongeza, iiseshoni zirekhodwe ngeaudiyo kwaye umphandi ofundayo wajonga ukubambelela komgaqo kumntu okanye ngokurekhodwa komsindo ubuncinci iseshoni yeqela ngalinye.

 

I-MBSR yamodareyithwa ngokusondeleyo emva kwenkqubo yoqobo ye-MBSR [9], ngokulungelelaniswa kwencwadana yemiyalelo ka-2009 ye-MBSR [18] ngumhlohli omkhulu we-MBSR. Inkqubo ye-MBSR ayijolisanga ngokukodwa kwimeko ethile enjengeentlungu. Zonke iiklasi zazibandakanya umxholo we-didactic kunye nokusebenza kwengqondo (ukuskena umzimba, i-yoga, ukucamngca [ukujonga iingcinga, iimvakalelo, kunye neemvakalelo kulo mzuzu wangoku ngaphandle kokuzama ukuzitshintsha, ukuhlala ngokucamngca ngokwazisa ngokuphefumla, ukuhamba ukucamngca]). Umgaqo-nkqubo we-CBT ubandakanya iindlela ze-CBT eziqhelekileyo ezisetyenziswa kwaye zifundelwa i-CLBP [8, 19-22]. Ungenelelo lubandakanya (1) imfundo malunga nentlungu engapheliyo, ubudlelwane phakathi kweengcinga kunye nokuphendula ngokweemvakalelo nangokwasemzimbeni, ucoceko lokulala, ukuthintela ukubuyela umva, kunye nokugcinwa kweenzuzo; kunye (2) nokuziqhelanisa nokuziqhelanisa notshintsho lweengcinga ezingasebenziyo, ukuseta kunye nokusebenzela ukufikelela kwiinjongo zokuziphatha, izakhono zokuphumla (ukuphefumla esiswini, ukuphumla kwezihlunu okuqhubekayo, imifanekiso ekhokelwayo), ukuhambahamba komsebenzi, kunye neendlela zokulwa nentlungu. Phakathi kweseshoni imisebenzi yayiquka ukufunda izahluko zeSikhokelo sokuSinda kwiNtlungu [21]. Ingqondo, ukucamngca, kunye neendlela zeyoga zabhalwa kwi-CBT; iindlela zokucela umngeni kwiingcinga ezingasebenziyo zabhalwa kwi-MBSR.

 

Ukulandelisa

 

I-interview interviewers efihliweyo kwiqela lonyango liqokelele idatha ngefowuni kwinqanaba lokuqala (phambi kwe-randomization) kunye ne-4 (unyango lwangaphakathi), i-8 (emva kokunyanga), i-26 (iphambili yokupasa), kunye nee-52 iiveki emva kwexesha. Abathathi-nxaxheba bahlawuliswa i-$ 20 kwintetho nganye.

 

Amanyathelo

 

Ulwazi lwentlupheko nolwasemva lwafunyanwa kwisiseko (Itheyibhile 1). Zonke iziphumo zephumela eziphambili zalawulwa ngexesha ngalinye; Iziphumo zesekondari zahlolisiswa ngamaxesha onke ngaphandle kweeveki ze-4.

 

 

IziPhumo eziziiPrayimari

 

Ukubuyela umva okunxulumene nobunzima bokusebenza kuye kwavavanywa yi-RDQ [16], yaguqulwa yaya kwi-23 (xa kuthelekiswa nezinto zokuqala ezingama-24) kunye nokubuza malunga neveki ephelileyo kunanamhlanje kuphela. Amanqaku aphezulu (uluhlu 0 23) abonisa umda omkhulu wokusebenza. I-RDQ yoqobo ibonakalise ukuthembeka, ubunyani, kunye novakalelo kutshintsho lweklinikhi [23]. Ukukhathazeka okubuhlungu kwiveki ephelileyo kulinganiswe ngomlinganiso we-0 10 (0 = ayikhathazi kwaphela, 10 = botherngokukhathaza kakhulu ). Uhlalutyo lwethu oluphambili luvavanye iipesenti zabathathi-nxaxheba ngokuphuculwa okunentsingiselo kwezonyango (? 30% yokuphuculwa kwesiseko) [24] kumlinganiso ngamnye. Uhlalutyo lwesekondari luthelekisa utshintsho olulungelelanisiweyo lwentsingiselo ukusuka kwisiseko phakathi kwamaqela.

 

Iziphumo eziPhezulu

 

Iimpawu zoxinzelelo zavavanywa yiPhepha leMibuzo lezeMpilo loMonde-8 (PHQ-8; uluhlu, 0 24; amanqaku aphezulu abonisa ubukhali obukhulu [25]. Ixhala lilinganisiwe kusetyenziswa inqaku le-2 yento ejikeleze uxinzelelo lokuPhazamiseka (i-GAD-2; uluhlu, 0 ;6; amanqaku aphezulu abonisa ubukhali obukhulu) [26]. Ubunzima beentlungu buhlolwe njengentsingiselo yokulinganiswa kwe-0-10 (ukuqaqanjelwa komqolo okwangoku kunye nokuqaqanjelwa ngumva kwinyanga ephelileyo; uluhlu, 0-10; amanqaku aphezulu abonisa ubungqongqo) kwi-Scated Chronic Pain Scale [27] . Isigulana esiBonisa ukuTshintshwa kweSikali soTshintsho [28] bacele abathathi-nxaxheba ukuba babeke umlinganiso wokuphuculwa kwabo kwintlungu kwinqanaba le-7-amanqaku (ehambe ngokupheleleyo, engcono, engcono, ethe kratya, ngokulinganayo, embi ngakumbi, kwaye embi kakhulu ). Imeko yempilo yomzimba kunye nengqondo yavavanywa kunye ne-12-yeFom yeFom yeFom yezeMpilo (SF-12) (0 isikali; amanqaku asezantsi abonisa imeko yezempilo ehlwempuzekileyo) [100]. Abathathi-nxaxheba baphinde babuzwa malunga nokusetyenziswa kwabo kwamayeza kunye nokuzilolongela iintlungu zangasemva kwiveki ephelileyo.

 

Amava amaninzi

 

Amava amaninzi atyunjwe ngexesha lexesha lokungenelela kunye nemibuzo yodliwano-ndlebe ngokulandelelana malunga nokuphazamiseka okukhulu, intlungu, okanye ukulimala okubangelwa ukungenelela.

 

Usayizi wesampula

 

Ubungakanani besampulu yabathathi-nxaxheba be-264 (i-88 kwiqela ngalinye) bakhethwa ukubonelela ngamandla afanelekileyo okufumana umahluko phakathi kwe-MBSR kunye ne-CBT kunye ne-UC kwiiveki ezingama-26. Ukubalwa kobungakanani besampulu bekusekwe kwiziphumo zophuculo olunentsingiselo lweklinikhi (? 30% ukusuka kwisiseko) kwi-RDQ [24]. Uqikelelo lokuphuculwa okubonakalayo kweklinikhi ngongenelelo kunye namaqela e-UC ayesekwe kuhlalutyo olungashicilelwanga lwedatha ukusuka kuvavanyo lwethu lwangaphambili lokuthanjiswa kwe-CLBP kuluntu olufanayo [30]. Ubungakanani besampulu banike amandla awaneleyo kuzo zombini iziphumo ezisisiseko. Ubungakanani besampulu obucwangcisiweyo bunike i-90% yamandla okufumana umahluko we-25% phakathi kwe-MBSR kunye ne-UC kwinxalenye yokuphuculwa okunentsingiselo kwi-RDQ, kunye ne-80% yamandla okufumana umahluko wama-20% phakathi kwe-MBSR kunye ne-CBT, ithatha i-30% yabathathi-nxaxheba be-UC. kunye ne-55% yabathathi-nxaxheba be-CBT babonisa ukuphucuka okunentsingiselo. Ukuphuculwa okubonakalayo kwintlungu yokubandezeleka, ubungakanani besampulu obucwangcisiweyo bunikwe? 80% yamandla okufumana umahluko we-21.8% phakathi kwe-MBSR kunye ne-UC, kunye ne-16.7% umahluko phakathi kwe-MBSR kunye ne-CBT, ithatha ukuba i-47.5% kwi-UC kunye ne-69.3% kwi-CBT ibonise ukuphucuka okunentsingiselo. .

 

Ukuvumela ukulahleka kwe-11% ukulandelelana, saceba ukufumana abathathi-nxaxheba be-297 (i-99 ngeqela). Ngenxa yokuba amaxabiso okulandelelana ayephantsi kunokuba kulindelwe, kwagqitywa umbane osongeziweyo. Ingqungquthela yabathathi-nxaxheba be-342 babengenangqiqo ukufezekisa ubungakanani beesampula ekujoliswe kuzo kwe-264 kunye nedatha epheleleyo yeziphumo kwiiveki ze-26.

 

Uhlalutyo lweSatisati

 

Ukulandela isicwangciso sohlalutyo esichazwe kwangaphambili [15], iyantlukwano phakathi kwamaqela amathathu kwisiphumo ngasinye esiphambili savavanywa ngokufaka imodeli yokuhlengahlengisa ebandakanya amanyathelo eziphumo kuwo onke amanqaku amane emva kwesiseko (4, 8, 26, kunye neeveki ezingama-52) . Imodeli eyahlukileyo yayilungelelene nesiphumo ngasinye seprayimari (i-RDQ kunye nokukhathazeka). Izalathi zexesha-lendawo, iqela elingenamkhethe, kunye nonxibelelwano phakathi kwezi zinto zixabisekileyo zibandakanyiwe kwimodeli nganye yokuqikelela iimpembelelo zongenelelo ngexesha ngalinye. Iimodeli zazilungile kusetyenziswa uqikelelo ngokubanzi lwee-equation (GEE) [31], ezenza ukuba ulungelelwaniso lube phakathi kwabantu. Iziphumo eziphambili zebhanari, sisebenzise imodeli yokuguqulwa kwePoisson eguqulweyo kunye nekhonkco yelog kunye nomlinganiso oqingqiweyo wokwahluka kwesandwich [32] ukuqikelela umngcipheko. Kumanyathelo aqhubekayo, sisebenzise iimodeli zokuhlengahlengisa ngokulandelelana ukuqikelela utshintsho lwentsingiselo ukusuka kwisiseko. Iimodeli ezihlengahlengisiweyo kubudala, isini, imfundo, ubude beentlungu (<1 unyaka ngokuchaseneyo? 1 unyaka ukusukela oko wafumana iveki ngaphandle kwentlungu yangasemva), kunye nenqaku lesiseko kumlinganiso wesiphumo. Ukuvavanywa kweziphumo eziziisekondari kulandele indlela yohlalutyo efanayo, nangona iimodeli zingabandakanyi amanqaku eeveki ezi-4 ngenxa yokuba iziphumo zesibini azikhange zivavanywe kwiiveki ezi-4.

 

Sasivavanya ukubaluleka kwenani lamanyathelo okungenelela kwinqanaba ngalinye ngexesha. Sagqiba isigqibo sokubheka i-MBSR ngempumelelo kuphela ukuba ukungafani kweqela kubalulekile kwi-26 yeveki yokuphela. Ukukhusela ekuchaseni ezininzi, sasebenzisa uFisher ukukhusela okungafaniyo okuphawulekayo okukuyo [33], okufuna ukuba ukuthelekiswa kokunyanga kwamanye amabini kwenziwa kuphela xa uvavanyo olupheleleyo lwe-omnibus luba luphawu oluthile.

 

Ngenxa yokuba amaxabiso ethu okulandelela ahlukile kumaqela ongenelelo kwaye ebephantsi kunoko bekulindelwe (Umzobo 1), sisebenzise indlela yokuchonga ukungaphenduli njengovavanyo lwethu oluphambili lokunika ingxelo ngokunokwenzeka ekuphenduleni. Indlela yokufaka imputation isebenzisa isakhelo semodeli yokuxutywa kwemodeli kusetyenziswa inyathelo le-2 ye-GEE ndlela [34]. Inyathelo lokuqala liqikelele imodeli ye-GEE echazwe ngaphambili ngesiphumo sokulungiswa kwedatha yecovariates, kodwa uhlengahlengiso ngakumbi kwiipateni zokungaphenduli. Sifake ezi zilandelayo zilahleko zesikhombisi esilahlekileyo: ukulahleka kwesinye isiphumo, ukungabikho kwesinye isiphumo kunye ne-CBT eyabelwe, ukulahleka kwesinye isiphumo kunye ne-MBSR eyabelwe, kunye nokulahleka? Amanqaku exesha) Isinyathelo sesibini siqikelele imodeli ye-GEE echazwe ngaphambili, kodwa yayiquka iziphumo ezichaziweyo ukusuka kwinqanaba 2 kulabo abanamaxesha okulandelela okulandelwayo. Sihlengahlengise uqikelelo lokwahluka kwiakhawunti ngokusebenzisa imilinganiselo yesiphumo esichaziweyo kwiziphumo ezingakhange zibonwe.

 

Lonke uhlalutyo lulandele indlela yokwenza unyango. Abathathi-nxaxheba babandakanywa kuhlalutyo ngokwabiwa kwe-randomization, ngaphandle kwenqanaba lokuthatha inxaxheba. Lonke uvavanyo kunye nexesha lokuzithemba lalinamacala amabini kwaye ukubaluleka kweenkcukacha-manani kwachazwa njengexabiso le-P? 2. Lonke uhlalutyo lwenziwa kusetyenziswa ubalo lwephakheji ye-R version 0.05 [3.0.2].

 

iziphumo

 

Umzobo 1 ubonakalisa ukuhamba kwabafundi abathatha inxaxheba kuphononongo. Phakathi kwabantu abayi-1,767 ababonisa umdla ekuthatheni inxaxheba kufundo kwaye bavavanyelwa ukufaneleka, i-342 yabhaliswa kwaye yenziwa ngokulandelelana. Izizathu eziphambili zokukhutshelwa ngaphandle kukungakwazi ukuya kwiiseshoni zonyango, iintlungu ezihlala ixesha elide <iinyanga ezi-3, kunye neentlungu ezincinci okanye ukuphazamiseka kwimisebenzi. Bonke kodwa abathathi-nxaxheba be-7 baqeshwa kwi-GH. Phantse i-90% yabathathi-nxaxheba i-MBSR kunye ne-CBT baya kwiseshoni ye-1 ubuncinci, kodwa yi-51% kuphela kwi-MBSR kunye ne-57% kwi-CBT eya okungenani iiseshoni ezi-6. Kuphela ngama-26% abo bangenangqondo kwi-MBSR abaye kwi-6-hour retreat. Amanqanaba okuphendula ngokulandelelana asukela kuma-89.2% kwiiveki ezi-4 ukuya kuma-84.8% kwiiveki ezingama-52, kwaye ebephezulu kwiqela le-UC.

 

Kwisiseko, amaqela onyango ayefana nakwimpawu zentlalo kunye neempawu zentlungu ngaphandle kwabafazi abaninzi kwi-UC kunye nabambalwa abaphumelele kwiikholeji kwi-MBSR (1 Table). Ngaphezulu kwe-75% uxele ubuncinci unyaka ukusukela ngeveki ngaphandle kwentlungu yangasemva kwaye uninzi lwentlungu luxeliweyo okungenani kwi-160 yeentsuku ezili-180 ezidlulileyo. Amanqaku e-RDQ (11.4) kunye neempawu zokukhathaza iintlungu (6.0) zibonise amanqanaba aphakathi obukhali. Iipesenti ezilishumi elinanye zichaze ukusebenzisa i-opioids kwintlungu yabo kwiveki ephelileyo. Iipesenti ezilishumi elinesixhenxe ubuncinci ubuncinci benqanaba lokudakumba (amanqaku e-PHQ-8? 10) kunye ne-18% ubuncinci banamanqanaba aphakathi oxinzelelo (amanqaku e-GAD-2? 3).

 

Iziphumo eziPrayimari

 

Kwiphepha lokugqibela eliphambili le-26-veki, amaqela ahluka kakhulu (P = 0.04) ngepesenti kunye nophuculo olunentsingiselo kwi-RDQ (MBSR 61%, UC 44%, CBT 58%; 2 Table). Abathathi-nxaxheba abangahleliyo kwi-MBSR babenamathuba amaninzi kunalawo angahleliwe ukuya kwi-UC ukubonisa uphuculo olunentsingiselo kwi-RDQ (RR = 1.37; 95% CI, 1.06 1.77), kodwa ayizange yahluke kakhulu kuleyo ye-CBT. Ukwahluka ngokubanzi phakathi kwamaqela ekuphuculweni okubonakalayo kweklinikhi kwintlungu yokukhathazeka kwiiveki ezingama-26 kwakubaluleke kakhulu (MBSR 44%, UC 27%, CBT 45%; P = 0.01). Abathathi-nxaxheba abangahleliyo kwi-MBSR babenokubonisa ukuphucuka okunentsingiselo xa kuthelekiswa ne-UC (RR = 1.64; 95% CI, 1.15 2.34), kodwa hayi xa kuthelekiswa ne-CBT (RR = 1.03; 95% CI, 0.78-1.36). Ukwahluka okuphawulekayo phakathi kwe-MBSR kunye ne-UC, kunye nokungafani okungafaniyo phakathi kwe-MBSR kunye ne-CBT, kwipesenti kunye nomsebenzi onentsingiselo kunye nokuphuculwa kweentlungu kuqhubeka kwiiveki ezingama-52, ezinobungozi obufanayo obufana nezo kwiiveki ezingama-26 (Itheyibhile 2a). I-CBT yayingaphezulu kwe-UC kwiziphumo ezibini eziphambili kwi-26, kodwa hayi i-52, iiveki. Iziphumo zonyango zazingabonakali ngaphambi kokuphela konyango (iiveki ezisibhozo). Ngokubanzi iziphumo ezifanayo zafunyanwa xa iziphumo zokuqala zahlalutywa njengezinto eziqhubekayo, nangona umahluko wawubalulekile ngokweeveki ze-8 kwaye iqela le-CBT liphucule ngaphezulu kweqela le-UC kwiiveki ezingama-8 (52 Table).

 

 

 

Iziphumo eziPhezulu

 

Iziphumo zempilo yengqondo (ukuxinezeleka, ukuxhalabisa, i-SF-12 Ingxube Yengqondo) yahluke kakhulu kumaqela kwi-8 kunye ne-26, kodwa ingekho i-52, iiveki (Itheyibhile 3). Phakathi kwala manqanaba kunye namaxesha, abathathi-nxaxheba abangenakulinganiswa kwi-MBSR banokuphucula ngaphezu koo-RC kuphela kwi-UC kuphela kwixinzelelo kunye ne-SF-12 yeCental Component amanyathelo kwiiveki ze-8. Abathathi-nxaxheba abangenakulinganiswa kwi-CBT baphuculwe ngaphezu kwezo zintsholongwane kwi-MBSR ekudakaleni kwiiveki ze-8 kunye nexhala kwiiveki ze-26, kwaye ngaphezu kweqela le-UC kwi-8 kunye ne-26 kwiiveki kuzo zonke iindlela ezintathu.

 

 

Amaqela ahluke kakhulu ekuphuculeni kwintlungu ebonakalayo kuyo onke amaxesha amathathu, ngokuphucula okukhulu kwi-MBSR kunye ne-CBT kunokuba ku-UC kwaye akukho mmahluko omkhulu phakathi kwe-MBSR kunye ne-CBT. Akukho nantlukwano epheleleyo kwimiphumo yonyango yabonwa kwi-SF-12 yePhysical score okanye amanqaku ayenziwa ngokuzenzekelayo ngamachiza ngenxa yentlungu. Amaqela ahluke kwii-26 kunye nee-52 iiveki ekuphuculweni kwehlabathi jikelele, kunye neqela le-MBSR kunye ne-CBT libika ukuphucula okukhulu kuneqela le-UC, kodwa lingafani nakakhulu.

 

Amava amaninzi

 

Abangamashumi amathathu be-103 (29%) abathathi-nxaxheba abaya kwixeshana ze-1 MBSR babike amava amaninzi (okwethutyana kwandisa intlungu nge yoga). Abathathi-nxaxheba be-100 (10%) abaye baye kwiseshoni enye ye-CBT kwiseshoni babika amava amaninzi (okwenzakala okwenzisayo okwethutyana kunye nokuphumula kwemizimba). Akukho ziganeko ezibi kakhulu ezichazwe.

 

Insight of Dr. Alex Jimenez

Ulwaphulo lolawulo lwengcinezelo lubandakanya ukudibanisa iindlela zokulawula uxinzelelo kunye nobuchule kunye nokuguquka kwendlela yokuphila ukunceda ukuphucula nokulawula uxinzelelo kunye neempawu ezihambelana nazo. Ngenxa yokuba wonke umntu uyasabela kwingcinezelo kwiindlela ezahlukeneyo, unyango loxinzelelo luya kuhluka ngokuxhomekeke kwimpawu ezithile umntu ahlangabezana nazo kwaye ngokubhekiselele kumgangatho wabo wobunzima. Ukunyamekela kwe-Chiropractic yinkqubo efanelekileyo yokuphathwa kwengcinezelo eyanceda ukunciphisa uxinzelelo olungapheliyo kunye neempawu ezichaphazelekayo ngokunciphisa intlungu kunye nokuxhatshazwa kwemisipha kwizakhiwo ezijikeleze umgudu. Ukungalungiswanga kwamagulane, okanye ukuxilongwa, kunokudala uxinzelelo kunye nezinye iimpawu, ezinjengentlungu ephantsi ye-back and sciatica. Ukongezelela, iziphumo zengqaku engentla zibonise ukuba ukunciphisa uxinzelelo lokukhathazeka kwengqondo, okanye i-MBSR, yinkqubo yokulawula uxinzelelo oluphezulu kubantu abadala abaneentlungu ezingapheliyo.

 

ingxoxo

 

Phakathi kwabantu abadala abane-CLBP, zombini i-MBSR kunye ne-CBT zikhokelela ekuphuculweni okukhulu kwintlungu yangemva kunye nokunciphisa ukusebenza kwi-26 kunye ne-52 iiveki, xa kuthelekiswa ne-UC. Kwakungekho nantlukwano ebonakalayo kwiziphumo phakathi kwe-MBSR kunye ne-CBT. Iziphumo zazingumodareyitha ngobukhulu, obuqhele ukwenziwa kunyango olusekwe kubungqina olucetyiswayo lwe-CLBP [4]. Ezi zibonelelo ziyamangalisa zinikwe ukuba kuphela yi-51% yezo zingenangqondo kwi-MBSR kunye ne-57% yabo balandelwe i-CBT? 6 yeeseshoni ezi-8.

 

Iziphumo zethu zihambelana nezigqibo zokuhlaziywa kwe-2011 [35] ukuba ukungenelela kwe-ceptcceptance-based such as MBSR ineempembelelo ezincedo kwimpilo yengqondo nangokwengqondo yezigulane ezineentlungu ezingapheliyo, ezifana nezo ze-CBT. Zihambelana kuphela nenye enye i-RCT enkulu ye-MBSR ye-CLBP [13], eyafumanisa ukuba i-MBSR, xa kuthelekiswa nexesha- kunye neqela lokulawula imfundo yezempilo ehambelana nexesha, kwaye inikezela ngezibonelelo zomsebenzi emva konyango (kodwa hayi Ukulandelwa kweenyanga ezi-6) kunye nentlungu eqhelekileyo ekulandeleni inyanga ezi-6 (kodwa hayi emva konyango). Umahluko ohlukeneyo phakathi kwetyala lethu kunye nelabo (ebelilinganiselwe kubantu abadala? Iminyaka engama-65 kwaye inemeko eyahlukileyo yokuthelekisa) inokuba noxanduva lokwahluka kweziphumo.

 

Nangona uvavanyo lwethu lungekho mqathango olawulayo ngenxa yokungabikho kwempembelelo yomqeqeshi kunye nokuthatha inxaxheba kweqela, i-CBT kunye ne-MBSR ziye zaboniswa ukuba zisebenza ngakumbi kunokuba zilawulwe kwaye zisebenze ngokungenelela kwiimeko zentlungu. Ukongezelela kwilingo labantu abadala asebekhulile nge-CLBP [14] efumene i-MBSR ukuba isebenze ngakumbi kunemeko yokulawulwa kwemfundo yezempilo, ukuhlaziywa kwe-CBT kwindlela esandul ekuphuculeni intlungu kunye nokukhubazeka ngokulandelelana kwexesha elide kunye nexesha elide [7]. Uphando olongezelelweyo lufunekayo ukuchonga amodareyitha kunye nabalamlamli beempembelelo ze-MBSR malunga nomsebenzi kunye nentlungu, ukuvavanya iingenelo ze-MBSR ngaphaya komnyaka omnye, kwaye zichonge ixabiso lentsebenzo. Uphando luyafuneka kwakhona ukuchonga izizathu zeseshoni ezingekho ukuhamba kunye nezindlela zokwandisa ukuhamba, kunye nokuchonga inani elincinane leeseshoni ezifunekayo.

 

Ukufumana kwethu ukunyuka kokusebenza kwe-MBSR kwiiveki ezingama-26-52 ezinxulumene nonyango lwasemva kokubini kwiziphumo zokuqala ezichaseneyo nokufunyenwe kwizifundo zethu zangaphambili zokucoca umzimba, ukubhucunga umzimba kunye neyoga eqhutywa kuluntu olunye nolingo lwanamhlanje [30, 36, 37 ]. Kwezi zifundo, iziphumo zonyango ziye zehla phakathi kokuphela konyango (i-8 ukuya kwi-12 iiveki) kunye nokulandelwa kwexesha elide (i-26 ukuya kwi-52 iiveki). Iziphumo ezihlala ixesha elide ze-CBT ze-CLBP zixeliwe [7, 38, 39]. Oku kuphakamisa ukuba unyango lomzimba olunjenge-MBSR kunye ne-CBT lunokubonelela abaguli ngezakhono ezihlala ixesha elide ezisebenzayo zokulawula iintlungu.

 

Kwakukho ukungafani phakathi kwe-CBT kunye ne-UC ngaphezu kwe-MBSR kunye ne-UC kumanyathelo okukhathazeka kwengqondo. I-CBT yayiphezulu kwi-MBSR kwinqanaba lexinzelelo kwiiveki ze-8, kodwa ukumahluko phakathi kwamaqela kwakuncinane. Ngenxa yokuba isampuli ayinakuxinezeleka kakhulu kwisiseko, uphando olongezelelweyo lufunekayo ukuthelekisa i-MBSR kwi-CBT kwimeko yesigulane esicinezelekileyo.

 

Imilinganiselo yale sifundo mayiyivunyelwe. Abafundi abathathi-nxaxheba babhalise kwinkqubo eyodwa yokunakekelwa kwezempilo kwaye bafunde ngokubanzi. Ubuninzi bokufumana iziphumo kwezinye izicwangciso kunye nabantu abaziwayo. Ngokumalunga ne-20% yabathathi-nxaxheba abangazange bafumaneke kwi-MBSR kunye ne-CBT balahlekelwa ukulandelelana. Sizama ukulungisa i-bias kwi-data engekhoyo ekuhlalutheni kwethu ngokusebenzisa iindlela zokubhaliweyo. Ekugqibeleni, ukufunyanwa kwezinto ezifunyenweyo kwi-CBT ezithunyelwe kumntu kunokuba ifomathi yeqela ayiziwa; I-CBT inokuphumelela xa ikhutshwa ngabanye [40]. Amandla okufundela afaka isampula enkulu kunye namandla afanelekileyo okufumana izibalo ukufumana iziphumo ezinokliniki, ukuhambelana okufutshane kwe-MBSR kunye ne-CBT ukungenelela kwifomathi, kunye nokulandelwa kwexesha elide.

 

izigqibo

 

Phakathi kwabantu abadala abaneentlungu ezingapheliyo zangemva, unyango nge-MBSR kunye ne-CBT, xa kuthelekiswa ne-UC, kubangele ukuphucula ngakumbi kwiintlungu zangemva kunye nokusebenza kwemida kwiiveki ze-26, kungekho mvelaphi ephawulekayo kwiziphumo phakathi kwe-MBSR kunye ne-CBT. Ezi ziphumo zibonisa ukuba i-MBSR ingaba yindlela yokwenza unyango olufanelekileyo kwizigulane ezinentlungu engapheliyo.

 

Imibulelo

 

Inkxaso-mali / Inkxaso: Uphando oluchaziweyo kolu papasho luxhaswe liZiko leSizwe leMpilo eQinisekayo kunye neHlanganisiweyo yamaZiko ezeMpilo kaZwelonke phantsi kweNombolo yeBhaso R01AT006226. Umxholo luxanduva lwababhali kuphela kwaye ayimelanga izimvo ezisemthethweni zamaZiko ezeMpilo kaZwelonke.

 

Inxaxheba yomxhasi: Uphononongo oluthile aluzange lube nenxaxheba ekwakheni nasekuqhubeni isifundo; ukuqokelela, ulawulo, uhlalutyo, nokutolika kwedatha; ukulungiselela, ukuhlaziywa, okanye ukuvunywa kwincwadi yesandla; okanye isigqibo sokungenisa eso sikripthi sokushicilela.

 

Imihlathi

 

Ncbi.nlm.nih.gov/pmc/articles/PMC4914381/

 

I ngcaciso

 

• UDaniel C. Cherkin, IQumrhu loPhando lwezeMpilo; Amasebe eNkonzo zezeMpilo kunye nonyango lwezeMpilo, kwiYunivesithi yaseWashington.
• UKaren J. Sherman, iQumrhu loPhando lwezeMpilo; ISebe le-Epidemiology, iYunivesithi yaseWashington.
• UBenjamin H. Balderson, i-Group Health Research Institute, iYunivesithi yaseWashington.
• Andrea J. Cook, iQela loPhando lwezeMpilo; Isebe le-Biostatistics, iYunivesithi yaseWashington.
• UMelissa L. Anderson, IQumrhu lePhando lwezeMpilo, iYunivesithi yaseWashington.
• URene J. Hawkes, i-Group Health Research Institute, iYunivesithi yaseWashington.
• UKelly E. Hansen, IQumrhu lePhando lwezeMpilo, iYunivesithi yaseWashington.
• UJudith A. Turner, iSebe leZengqondo kunye neNzululwazi yeNtsebenzo kunye neMpilo yoLungiso, kwiYunivesithi yaseWashington.

 

Ukuququmbela,Ukhathalelo lwe-irchiropractic lubonwa njengonyango olusebenzayo lokunyanga uxinzelelo lweentlungu ezisezantsi kunye ne-sciatica. Kuba uxinzelelo olungapheliyo lunokubangela imicimbi eyahlukeneyo yezempilo ekuhambeni kwexesha, ukuphucula kunye nokulawula uxinzelelo ngokufanelekileyo kubalulekile ekufezekiseni impilo kunye nokuba sempilweni. Ukongeza, njengoko kubonisiwe kwinqaku elingentla ukuthelekisa iimpembelelo zokunciphisa uxinzelelo lwengqondo kunye nonyango lokuziphatha kunye nokunyamekela kwesiqhelo uxinzelelo olunxulumene nentlungu engapheliyo, ukunciphisa uxinzelelo kwengqondo, okanye i-MBSR, iyasebenza njengonyango lolawulo loxinzelelo . Ulwazi olukhankanyiweyo kwiZiko leLizwe leNgcaciso yeBiotechnology (NCBI). Ubungakanani bolwazi lwethu lukhawulelwe kwi-chiropractic kunye nokulimala komqolo kunye neemeko. Ukuxoxa ngesihloko, nceda ukhululeke ukubuza uGqirha Jimenez okanye unxibelelane nathi ku 915-850-0900 .

 

Ikhutshwe nguDkt. Alex Jimenez

 

 

Imixholo eyongezelelweyo: Ubunzima bokubuyisela

 

Ngokwezibalo, malunga ne-80% yabantu baya kuba neempawu zentlungu emva koko kanye ngexesha lokuphila kwabo. Intlungu ebuyayo yinkxalabo eqhelekileyo enokubangelwa ngenxa yeemeko ezahlukeneyo kunye / okanye iimeko. Ngokuphindaphindiweyo amaxesha, ukuguqulwa kwemvelo komgudu kunye nomdala kunokubangela intlungu emva. Iidiski zeHerniated kwenzeka xa i-disc, i-gel-like centre ye-disc intervertebral iqhubezela ngeengqungquthela kwijikelezo zayo zangaphandle, ukuxilisa nokucaphukisa izimpande zentliziyo. Iingxoxo ze-Disc zivame ukuqhutyelwa kwi-back back, okanye i-lumbar spine, kodwa nazo zingenzeka kunye nomlenze womlomo wesibeleko okanye intamo. Ukufakelwa kwamathambo afunyenwe kwinqanaba eliphantsi ngenxa yokulimala kunye / okanye imeko ehlaseleyo ingakhokelela kwimpawu ze-sciatica.

 

ISIHLOKO ESIBALULEKILEYO: Ukulawula uxinzelelo lomsebenzi

 

 

IINGXELO EZIBALULEKILEYO: UKUPHATHA KWE-EXTRA: Ukukhetha i-Chiropractic? | Familia Dominguez | Izigulane | El Paso, TX I-Chiropractor