Ukuxinezeleka kuyinyaniso yokuphila kwangoku. Kwiindawo apho iiyure zomsebenzi zanda kwaye amajelo asasaza ukuphazamisa iingqondo zethu kunye nenhlekelele enkulu ye-regent, akumangalisi ukuba kutheni abantu abaninzi banamazinga aphezulu okuxinezeleka rhoqo. Ngethamsanqa, abaqeqeshi abaninzi bezempilo bayaphumelela iindlela zokulawula uxinzelelo kunye nobuchule njengenxalenye yonyango lomgula. Nangona uxinzelelo luyimpendulo engokwemvelo eyenza ukulungelelanisa umzimba ngomngcipheko, uxinzelelo oluqhubekayo lunokuba nemiphumo emibi emzimbeni, obangela iimpawu zentlungu emva sciatica. Kodwa, kutheni ukuxinezeleka kakhulu kunokuchaphazela umzimba womntu?

 

Okokuqala, kubalulekile ukuqonda indlela umzimba obona ngayo uxinzelelo. Kukho ezintathu "iziteshi" ezisisiseko esizibona ngayo uxinzelelo: indawo, umzimba kunye neemvakalelo. Ukucinezelwa kwengqongqo kunokuba kuchaze; Ukuba uhamba endleleni ephumlileyo uze uvale ibhantshi elikhulu kufuphi, umzimba wakho uya kuqonda ukuba njengengozi esheshayo. Lo ngumxinzelelo wokusingqongileyo. Ukungcola kungomnye umzekelo wokuxinzezeleka kweemeko zendalo kuba uphazamisa ngaphandle komzimba xa umntu ebonakala kuyo.

 

Ukuxinezeleka ngomzimba kubandakanya izifo, ukungabikho kokulala kunye / okanye ukutya okungafanelekanga. Ukuxinezeleka ngokomzwelo kuyahluke, kuba kubandakanya indlela ubuchopho bethu buchaza izinto ezithile. Ngokomzekelo, ukuba umntu osebenza naye unomdla, unokugxininiswa. Imiba enjengokuthi, "uyandithukuthela ngesizathu esithile" okanye "kufuneka babe neentsasa ezinjengeentsasa", kunokubonakala ngathi uxinzelelo lwengqondo. Yintoni ekhethekileyo ngoxinzelelo lwengqondo, nangona kunjalo, kukuba sinokulawulwa kwindlela esinokufumana ngayo, ngakumbi kunokuba iimeko zendalo okanye izixinzelelo zomzimba.

 

Ngoku ukuba siqonda indlela umzimba onokuqonda ngayo ukuxinezeleka ngeendlela ezahlukeneyo, sinokuxoxa malunga nokuba ziphi iingxaki eziqhubekayo zinobuchule kwimpilo yethu yonke kunye nokuphila kakuhle. Xa umzimba ubeka phantsi koxinzelelo, ngokusebenzisa naziphi na iziteshi ezikhankanywe ngasentla, ukulwa komzimba okanye ukuphendula kwendiza kubangelwa. Inkqubo yomdla, okanye i-SNS, ivuselela, leyo eyenza intliziyo ibethe ngokukhawuleza kwaye yonke imizimba yomzimba iba namandla. Le yindlela yokukhusela eseleyo kwimihla yokuqala; Yiloo sizathu esiye saphila namhlanje, kunokuba sonke sifumane isidlo sasemini sabasweleyo abalambileyo kwintlango.

 

Ngelishwa, imbambano yangempela kukuba ebudeni bexesha langoku, abantu bahlala bexinezelekile kwaye umzimba womntu awukwazi ukwahlula phakathi kwesongelo esichengileyo kunye nombandela olula wentlalo. Kwiminyaka emininzi uphando lwezophando luqhutyelwe ukuqikelela umphumo wokuxinezeleka okungapheliyo emzimbeni womntu, kunye neziphumo ezinjengexinzelelo lwengqondo, ukwanda komngcipheko wesifo senhliziyo kunye nomonakalo kwimizimba yesisu kunye neempawu zentlungu yesifo kunye ne-sciatica.

 

Ngokwamanye amanyathelo okuphanda, ukuhlanganisa iindlela zokulawula uxinzelelo kunye neendlela ezahlukeneyo zonyango kunokunceda ukuphucula ngakumbi iimpawu kwaye kunokukhuthaza ukuphucula ngokukhawuleza. Ukunyamekela kwe-Chiropractic yindlela ekhethwa yonyango eyaziwayo yokusetyenziswa kwonyango kunye neemeko zesistim kunye neentsholongwane. Ngenxa yokuba unyango lwe-chiropractic lugxininise emthonjeni, ingcambu yesimiso se-nervous, i-chiropractic inokukunceda nokuxinezeleka. Phakathi kweempembelelo zokuxinezeleka kuluhlu, oluya kuthi lukhokelela ekugqithiseni okanye ukuchithwa kwempahla. Ukuguqulwa kwamagqabi kunye nokunyanzeliswa kwemigaqo kunokuncedisa ukuxhatshazwa kwemisipha, okuye kwanciphisa ubunzima kwimimandla ethile yomgudu kwaye kunceda ukunciphisa i-subluxation. Umgudu olinganiselayo uyinto ebalulekileyo yokusingatha uxinzelelo lomntu. Njengoko kuthethwe ngaphambili, ukutya okufanelekileyo kunye nokulala ngokwaneleyo kuyona nto ibaluleke kakhulu ekulawuleni uxinzelelo, okona unyango lwe-chiropractic unikezela ngcebiso yokuguqula indlela yokuphila yokuphucula amanqanaba okuxinwa kwesifo kunye nokunciphisa iimpawu zabo.

 

Injongo yendiqendu engezantsi kukubonisa inkqubo yophando yophuhliso eyenzelwe ukuthelekisa iyeza elongezelelweyo kunye neyezinye iinkqubo eziqhelekileyo zengqondo ubuhlungu obungapheliyo. Ulingo olulawulwa ngokungenamthetho luqhutywe ngenyameko kwaye iinkcukacha ezenziwe emva kovavanyo zophando zibhalwe ngezantsi. Njengoko kunye nezinye izifundo zophando, ulwazi olungaphezulu-ubungqina olusisiseko lungafuneka ukuba lunqume ngempumelelo umphumo wokulawulwa kwengcinezelo unyango lweentlungu zentlungu.

 

Ukuthelekiswa kweyeza elongezelelweyo nelinye kunye neNengqondo yesiqhelo Amachiza oNyango obuhlungu obungapheliyo: Iprotocol yengqondo Izindlela zoMzimba kwiNtlungu (i-MAP)

 

Abstract

 

imvelaphi

 

Ingxelo yempilo kunye neyosebenzayo yabantu abaneentlungu ezibuhlungu e-United States ziye zancipha kwiminyaka yamuva, nangona iindleko zonyango zanda kakhulu ngenxa yolu ngxaki. Nangona izigulana zengqondo zengqondo ezifana neenkolelo ezinxulumene nobuhlungu, iingcamango kunye nokuziphatha okuxhatshazwayo kubonakaliswe njani ukuba izigulane ziphendule njani unyango lweentlungu zentlungu, ezimbalwa izigulane zifumana unyango olujongene nale miba. I-ctnitive-behavioral therapy (CBT), ejongene neengqondo zengqondo, ifumaneke ukuba iyasebenza kwiintlungu zangemva, kodwa ukufikelela kumayeza aqeqeshekileyo. Olunye ukhetho lwonyango olunokukwazi ukujongana neengxaki zengqondo, ukunciphisa uxinzelelo lwengqondo (MBSR), luyafumaneka ngokubanzi. I-MBSR ifunyenwe ibe luncedo kwizimo ezahlukahlukeneyo zengqondo nangokwenyama, kodwa ayizange ifundwe kakuhle kwisicelo esinezigulana ezingapheliyo. Kulo vavanyo, siya kufuna ukujonga ukuba i-MBSR iyindlela yokwenza unyango olusebenzayo kunye nexabiso elinempilo kubantu abanobuhlungu obungapheliyo, ukuthelekisa ukusebenza kwayo kunye nokuphumelela kweendleko xa kuthelekiswa ne-CBT kunye nokuphonononga ukuguquguquka kweengqondo ezingabelana nemiphumo ye-MBSR kwaye CBT kwiziphumo zesigulane.

 

Izindlela / Ukuyila

 

Kulo vavanyo, siza kubangela ukuba abantu abadala be-397 babe neentlungu ezingapheliyo ezibuhlungu kwi-CBT, i-MBSR okanye kwiindawo zokunyamekela eziqhelekileyo (i-99 ngeqela ngalinye). Ezi zombini zongenelelo ziya kuba neesibhozo zeeveki ze-2-iiyure zeeyure ezixhaswa ngumsebenzi wasekhaya. Umgaqo-nkqubo we-MBSR uquka ikhefu le-6 yeeyure. Abaxineli abaxhamliweyo kwizabelo zonyango baya kuvavanya iziphumo ze-5, i-10, i-26 kunye nee-52 kwiiveki emva kokugqithiselwa. Iziphumo eziphambili ziya kuba nemida echaphazelekayo enxulumene nobuhlungu (ngokusekelwe kwi-Questionnaire ye-Roland Disability) kunye neempawu eziphazamisayo (ezibalwe kwi-0 ukuya kwi-10 yokulinganisa inani lamanani) kwiiveki ze-26.

 

ingxoxo

 

Ukuba i-MBSR ifumaneka ukuba yindlela yokwenza unyango olusebenzayo kunye nexabiso elinempilo kwizigulane ezinentlungu engapheliyo, iya kuba yongezwa ngokubaluleka kumanyathelo athatywayo anganyaniseki ezifumanekayo kwizigulane ezinegalelo ezibonakalayo zengqondo.

 

UkuBhaliswa koTyala

 

Clinicaltrials.gov I sazisi: NCT01467843.

 

Internet: Intlungu ebuhlungu, Ukunyangwa kwengqondo-yokuziphatha, Ukucamngca kwengqondo

 

imvelaphi

 

Ukuchonga unyango oluchanekileyo lweentlungu ezingapheliyo (i-CLBP) luhlala lucelomngeni kubakliniki, abaphandi, abahlawuli kunye nezigulane. Phantse i $ 26 ibhiliyoni isetyenziswe minyaka yonke e-United States ngeendleko ezichanekileyo zokunyamekela unyango lwentlungu [1]. Kwi-2002, iindleko eziqikelelweyo zokuveliswa kwabasebenzi abalahlekileyo ngenxa yeentlungu zangemva ziyi-19.8 billion [2]. Nangona kukho iinketho ezininzi zokuvavanya nokuphulukisa intlungu, kunye nokunyuka kweenkonzo zonyango ezixhomekeke kule ngxaki, isimo sempilo kunye nesimo sabantu abanobuhlungu emva e-United States siphumelele [3]. Ngaphezu koko, bobabini banikezeli kunye nezigulane abanelisekanga ngesimo se-quo [4-6] kwaye baqhubeke befuna iindlela ezingcono zokonyango.

 

Kukho ubungqina obuninzi bokuthi izigulane zengqondo zesigulane, ezinjengeenkolelo ezinxulumene nentlungu, iingcinga kunye nokuziphatha kokuziphatha, kunokuba nefuthe elibalulekileyo kumava entlungu kunye nemiphumo ekusebenzeni [7]. Obu bungqina buqaqambisa ixabiso elinokubakho lonyango lweentlungu zangasemva ezijongana nengqondo nomzimba. Ngapha koko, unyango kwezine ezisibhozo ezingezizo ezamayeza ezicetyiswe yiAmerican College of Physicians kunye nezikhokelo zeAmerican Pain Society zokuqaqanjelwa ziintlungu ezingapheliyo zibandakanya mind body components [8]. Olunye lonyango, unyango lwengqondo-yokuziphatha (i-CBT), lubandakanya izinto zomntu ezinje ngoqeqesho lokuphumla kwaye kufunyaniswe ukuba kuyasebenza kwiingxaki ezahlukeneyo zentlungu, kubandakanya iintlungu zangasemva [9-13]. I-CBT iye yaba lolona nyango lusetyenziswa ngokubanzi kwizigulana ezinentlungu engapheliyo. Olunye unyango lwengqondo, ukunciphisa uxinzelelo kwengqondo (MBSR) [14,15], ijolise kwiindlela zokufundisa ukwandisa ingqondo. I-MBSR kunye nongenelelo olunxulumene nengqondo olusekwe kufunyenwe luncedo kuluhlu olubanzi lweemeko zempilo yengqondo nangokwasemzimbeni, kubandakanya iintlungu ezingapheliyo [14-19], kodwa azifundisiswanga kakuhle iintlungu ezingapheliyo zangasemva [20-24] . Zimbalwa kuphela izilingo ezincinci ezivavanye ukusebenza kwe-MBSR yeentlungu zangasemva [25,26] kwaye konke kuxeliwe ukuphuculwa kwentlungu [27] okanye ukwamkelwa kwezigulana zentlungu [28,29].

 

Uphando olongezelelweyo malunga nokusebenza ngokuthelekisayo kunye nokusebenza kweendleko zonyango lomntu ngamnye kufuneka lube yinto ephambili kuphando lwentlungu emva kwezi zizathu zilandelayo: (1) ifuthe elikhulu lomntu kunye noluntu lwentlungu engapheliyo, (2) ukusebenza ngokuthobekileyo okwangoku Unyango, (3) iziphumo ezilungileyo zezilingo ezimbalwa apho abaphandi bavavanye unyango lwengqondo kubantu abaneentlungu zangasemva kunye (4) nokukhula kokuthandwa kunye nokhuseleko, kunye nexabiso eliphantsi kakhulu, lonyango lwengqondo. Ukunceda ukuzalisa olu lwazi, siqhuba uvavanyo olungenamkhethe ukuvavanya ukusebenza, ukuthelekisa ukusebenza kunye nokusebenza kweendleko ze-MBSR kunye neqela le-CBT, xa kuthelekiswa nokhathalelo lwezonyango oluqhelekileyo kuphela, kwizigulana ezinentlungu engapheliyo.

 

Iinjongo ezicacileyo

 

Iinjongo zethu ezithile kunye neengcamango ezihambelanayo zichazwe ngezantsi.

 

• 1. Ukuchonga ukuba i-MBSR iyinto engqinelanayo ngokufanelekileyo kunyango lwangonyango lwabantu abane-CLBP
• I-hypothesis 1: Abantu abathile abangenasiphelo kwikhosi ye-MBSR baya kubonisa i-short-term (i-8 kunye ne-26 iiveki) kunye nexesha elide (ii-52 kweeveki) ukuphuculwa kwezinto ezinxulumene nobuhlungu, ukukhathazeka okunye kunye nezinye iziphumo ezinxulumene nempilo kunezo zenzelwe ukunyamekela okuqhelekileyo kuphela .
• 2. Ukuthelekisa ukusebenza kwe-MBSR kunye neqela le-CBT ekunciphiseni umva umsebenzi ohambelana nomsebenzi kunye nentlungu ekhathazayo
• I-hypothesis 2: I-MBSR iya kusebenza ngakumbi kuneqela le-CBT ekunciphiseni ukusikelwa umda kwemisebenzi enxulumene nentlungu kunye neentlungu eziphazamisayo kwixesha elifutshane kunye nelide. Isizathu sale hypothesis isekwe (1) ekusebenzeni ngokuthobekileyo kwe-CBT yeentlungu ezingapheliyo ezifumanekayo kwizifundo ezidlulileyo, (2) iziphumo ezilungileyo zophando lokuqala olunomda oluvavanya i-MBSR yentlungu engapheliyo kunye (3) nobungqina obukhulayo bokuba Inxalenye ebalulekileyo yoqeqesho lwe-MBSR (kodwa hayi uqeqesho lwe-CBT) yoga iyasebenza kwiintlungu ezingapheliyo.
• 3. Ukuchonga abalamlamli naluphi na umphumo we-MBSR kunye neqela le-CBT kwiintlungu ezinxulumene nentlungu kunye nentlungu ephazamisayo
• I-hypothesis 3a: Imiphumo ye-MBSR kwimingcele yomsebenzi kunye neentlungu ezibuhlungu ziya kuxolelana ngokunyuka kwengqondo kunye nokwamkelwa intlungu.
• I-hypothesis 3b: Imiphumo ye-CBT kwimingcele yomsebenzi kunye neentlungu ezixhalabisayo iya kuxoxwa ngenguqu kwiinkcukacha ezinxulumene nobuhlungu (kunciphisa ukuphazamiseka, inkolelo yokuba umntu ukhubazekile ngentlungu kunye neenkolelo ukuba intlungu ibonisa ukulimala, kunye nokunyuka ekulawuleni okubonakalayo kwintlungu nokuzimela ubuchule bokulawula intlungu) kunye nokutshintshwa kweziphathamandla zokuziphatha (ukwandiswa kokusetyenziswa kokuphumla, ukunyamezela komsebenzi kunye nokujongana nezitatimende kunye nokunciphisa ukusetyenziswa kokuphumla).
• 4. Ukuthelekisa indleko-ukuphumelela kwe-MBSR kunye neqela le-CBT njengoko isetyenziselwa ukunakekelwa ngokuqhelekileyo kubantu abaneentlungu ezingapheliyo
• I-hypothesis 4: Bobabini i-MBSR kunye neqela le-CBT liya kuba neendleko ezifanelekileyo kwiinkathalo eziqhelekileyo.

 

Siza kuphinda sihlolisise ukuba ngaba izigulane ezithile zezigulane ziqikelela okanye ziyiphucula imiphumo yonyango. Ngokomzekelo, siza kuhlola ukuba izigulane ezinamaqondo aphezulu okudandatheka zingenakwenzeka ukuba ziphuculwe kunye ne-CBT kunye ne-MBSR okanye nokuba ngaba izigulane ziyakwazi ukufumana inzuzo kwi-CBT kunokusukela kwi-MBSR (oko kukuthi, ingaba inqanaba lokudakumba liyimodareyitha yemiphumo yonyango ).

 

Izindlela / Ukuyila

 

isishwankathelo

 

Senza uvavanyo lweklinikhi olungenamkhethe apho abantu abane-CLBP babelwe ngokungacwangciswanga kwiqela le-CBT, ikhosi yeqela le-MBSR okanye ukhathalelo oluqhelekileyo lodwa (Umzobo 1). Abathathi-nxaxheba baya kulandelwa iiveki ezingama-52 emva kokungeniswa. Abafowunelwa abafowunelwa abafihliweyo kwizabelo zonyango baya kuvavanya iziphumo ze-4, 8, 26 kunye ne-52 iiveki zasemva kwexesha. Iziphumo eziphambili esiza kuvavanya ukuba zinxulumene nokusilela kwimisebenzi kunye nentlungu ebuhlungu. Abathathi-nxaxheba baya kwaziswa ukuba abaphandi bophando bathelekisa iinkqubo ezimbini ezizisebenzisayo ezisetyenziselwa iintlungu ezizifumeneyo ziluncedo ekunciphiseni iintlungu nokwenza ukuba kube lula ukwenza imisebenzi yemihla ngemihla .

 

 

Iprotocol yolu vavanyo ivunyiwe yiKomidi yokuHlola iNkcazo yeNtloko yeCandelo lokuBambisana kwezeMpilo (i-250681-22). Bonke abathathi-nxaxheba baya kufunwa ukuba banike imvume yabo enolwazi phambi kokubhalisa kule sifundo.

 

Sample Sample and Setting

 

Umthombo oyintloko wabathathi-nxaxheba kulolu vavanyo uya kuba yiNtsebenziswano yezeMpilo yeQela (GHC), umzekelo wenkampani, inhlangano engekho ngenzuzo yokunakekelwa kwempilo ekhonza kwi-600,000 ababhalise kwiindawo zabo zokunakekela eziphambili e-Washington. Njengoko kudingeke ukuba kufumaneke iinjongo zokuqesha, i-mail address ngqo izothunyelwa kubantu 20 kwiminyaka eyi-70 ubudala abahlala kwiindawo eziqhutywa yi-GHC.

 

Inkcazo yokungeniswa kunye noKhuseleko

 

Sigaya abantu ukusuka kwi-20 ukuya kwi-70 yeminyaka yobudala iintlungu zangasemva eziye zaqhubeka ubuncinci iinyanga ezintathu. Inkqubo yokubandakanywa kunye nokukhutshelwa yaphuhliswa ukwandisa ukubhaliswa kwezigulana ezifanelekileyo ngelixa kuvavanywa abaguli abaneentlungu ezisezantsi zohlobo oluthile (umzekelo, i-spinal stenosis) okanye imeko enzima okanye abanokuba nobunzima ekugqibeni amanyathelo okufunda okanye ungenelelo ( umzekelo, isifo sengqondo). Izizathu zokukhutshelwa ngaphandle kwamalungu e-GHC zichongwe ngokusekwe (3) kwedatha ezenzekelayo erekhodwe (kusetyenziswa ukuHanjiswa kwaMazwe ngaMazwe kweZifo, inkqubo yoHlolo lweSithoba), ngalo lonke ixesha lotyelelo kulo nyaka uphelileyo kunye (1) nodliwanondlebe lokufaneleka olwenziwe umnxeba. Amalungu angengawo e-GHC, izizathu zokukhutshelwa ngaphandle zachongwa ngesiseko sodliwanondlebe ngomnxeba. Uluhlu lwe-2 kunye nolwe-1 luluhlu lweekhrayitheriya zokubandakanywa kunye nokukhutshelwa ngokwahlukeneyo, kunye nengqiqo yenqobo nganye kunye nemithombo yolwazi.

 

 

 

Ukongeza, sifuna ukuba abathathi-nxaxheba bazimisele kwaye bakwazi ukuya kwiiklasi ze-CBT okanye ze-MBSR ngexesha lokungenelela kweveki ye-8 xa kunikwe enye yalezo zonyango, kwaye baphendule imibuzo emine yokulandelelana ukuze sikwazi ukuvavanya iziphumo.

 

Iinkqubo zokuBasa

 

Ngenxa yokuba ungenelelo ngoncedo lubandakanya iiklasi, sithatha abathathi-nxaxheba kwii-cohorts ezilishumi ezinabantu abangamashumi amane anesihlanu umntu ngamnye. Sithatha abathathi-nxaxheba kwimithombo emithathu ephambili: (1) Amalungu e-GHC athe enza utyelelo kubanikezeli benkathalelo yabo yokuqala yeentlungu ezisezantsi kwaye iintlungu zabo ziye zaqhubeka ubuncinci iinyanga ezi-3, (2) amalungu e-GHC angakhange atyelele umboneleli wabo ophambili wokukhathalela iintlungu zomqolo kodwa abaphakathi kweminyaka engama-20 nengama-70 ubudala nabaphendula kumyalezo we-GHC ongathunyelwanga ekujoliswe kuwo okanye kwintengiso yethu kwi-GHC s kabini ngemagazini yonyaka kunye (3) nabahlali baphakathi kweminyaka engama-20 nama-70. iminyaka abaphendula ngqo iposikhadi yokugaya iposi.

 

Kubantu ekujoliswe kubo be-GHC, umdwelisi wenkqubo uza kusebenzisa ulawulo lwe-GHC kunye neeklinikhi zedatha yokuchonga amalungu afanelekileyo anokundwendwelwa kwiinyanga ezi-3 ukuya kwezi-15 ezidlulileyo kumboneleli obangele uxilongo oluhambelana nentlungu engapheliyo. La malungu e-GHC athunyelwa ngeposi ileta kunye noluhlu lokuhlola oluchaza isifundo kunye neemfuno zokufaneleka. Amalungu anomdla wokutyikitya inxaxheba kwaye abuyisa ingxelo ebonisa ukuba bazimisele ukuqhagamshelana nabo. Ingcali yophando ke ibiza umntu onokuthi athathe inxaxheba ukuba abuze imibuzo; misela ukufaneleka; Ukucacisa umngcipheko, izibonelelo kunye nokuzinikela okulindelekileyo kuphononongo; kwaye ucele imvume enolwazi. Emva kokuba imvume enolwazi ifunyenwe kumntu lowo, kuvavanywa umnxeba osisiseko.

 

Kubantu abangabonakaliyo be-GHC (okokuthi, amalungu e-GHC ngaphandle kokutyelelwa ngeentlungu ezifunyenwe ngasemva kwi-3 kwiinyanga ze-15 kodwa abanokuthi babe neentlungu ezisezantsi), umprogram usebenzisa i-data yolwazi yezolawulo kunye neklinikhi ukuchonga amalungu angamalungu afanelekileyo ayifaki kwisampuli ekujoliswe kuyo kumhlathi olandelelweyo. La manani aquka namalungu e-GHC aphendula kwisibhengezo kumagazini weGHC. Izindlela ezifanayo ezisetyenziselwa uluntu olujoliswe kuzo zisetyenziselwa ukudibanisa kunye nokucoca abathathi-nxaxheba, ukufumana imvume yabo enolwazi kwaye uqokelele ulwazi olusisiseko.

 

Ngokubhekiselele kubemi beendawo, sithenge iintlobo zamagama kunye neeadesi zesampula esikhethwe ngabantu abangahlali kwindawo yethu yokuqesha abaphakathi kwe-20 kunye ne-70 yeminyaka ubudala. Abantu abakoluhlu bathumela iposi zeposi ezithe ngqo ezichaza ucwaningo kuquka ulwazi malunga nendlela yokuqhagamshelana nabasebenzi bokufunda ukuba banomdla ukuthatha inxaxheba. Xa umntu onomdla edibanise iqela lophando inkqubo efanayo ichazwe ngasentla ilandelwa.

 

Ukuqinisekisa ukuba bonke abathathi-nxaxheba abahlolwayo baqala ukufaneleka ngexesha leeklasi ziqala, abo bavuma ngaphezulu kweentsuku ze-14 ngaphambi kokuqala kwamacandelo okungenelela baya kuphinda bahlaziywe malunga ne-0 kwiintsuku ze-14 ngaphambi kweklasi yokuqala ukuqinisekisile ukufaneleka kwabo. Inkxalabo ebalulekileyo kukukhupha abantu abangenawo ubuncinci bokulinganisa ukulinganisa kweentlungu ezibuhlungu kunye nokuphazamiseka okuchaphazelekayo nemisebenzi. Abo bantu abahlala befanelekile kwaye banike imvume yabo yokugqibela yokunika ulwazi baya kulawulwa kwimibuzo yolubuzo.

 

Randomization

 

Emva kokugqiba uvavanyo lokuqala, abathathi-nxaxheba baya kulandelwa ngokulinganayo kwi-MBSR, i-CBT okanye iqela eliqhelekileyo lokunyamekela. Abo bangahleliwe kwiqela le-MBSR okanye le-CBT abayi kwaziswa ngohlobo lwabo lonyango bade bafike kwiiklasi zokuqala, eziza kwenzeka ngaxeshanye kwisakhiwo esinye. Iqela longenelelo liya kunikwa ngokwendlela yokulandelelana kweekhompyuter zamanani akhethiweyo kusetyenziswa inkqubo eqinisekisa ukuba ulwabiwo alunakutshintshwa emva kokungeniswa. Ukuqinisekisa ulungelelwaniso kwinto ephambili yokuxela kwangaphambili, ukungeniswa ngokungacwangciswanga kuya kulungiswa ngokusekwe kwisixhobo sethu sokulinganisa iziphumo: inguqulelo eguqulweyo yemibuzo yemibuzo yokukhubazeka iRoland (RDQ) [30,31]. Siza kuhlulahlula abathathi-nxaxheba kumaqela amabini okusikelwa umda kwimisebenzi: ukumodareyitha (amanqaku e-RDQ? 12 kwisikali se-0 ukuya kwi-23) kunye nokuphakama (amanqaku e-RDQ? 13). Abathathi-nxaxheba baya kwenziwa ngokungacwangciswanga kwezi ziqwengana kwiibhloko ezinobungakanani obahlukeneyo (ezintathu, ezintandathu okanye ezisithoba) ukuqinisekisa ulwabiwo lwabathathi-nxaxheba olulungelelanisiweyo kodwa olungalindelekanga. Ngexesha lokugaya, isifundo se-biostatistician siyakufumana ukubalwa kwabathathi-nxaxheba kwiqela ngalinye ukuze kuqinisekiswe ukuba ialgorithm eyenziwe kwangaphambili ye-randomization isebenza kakuhle.

 

Uphulo lo kufunda

 

Iibini zeeklasi ze-CBT kunye ne-MBSR ziquka iiveki ezisibhozo zeveki ze-2 zeeyure ezongezelelweyo ngemisebenzi yasekhaya.

 

Ukunciphisa Ukunyanzeliswa Kwengqondo

 

Ukunciphisa uxinzelelo lwengqondo, inkqubo yonyango eneminyaka engama-30 eyenziwe nguJon Kabat-Zinn, ichazwe kakuhle kuncwadi [32-34]. Ababhali bohlalutyo lwe-meta lwakutsha nje bafumanise ukuba i-MBSR ineziphumo ezilinganiselweyo zokuphucula impilo yomzimba kunye nengqondo yezigulana ezineemeko ezahlukeneyo zempilo [16]. Inkqubo yethu ye-MBSR ilandelwa ngokusondeleyo kwi-original kwaye ibandakanya iiklasi ezisibhozo ze-2 ngeyure (eshwankathelwe kwiTheyibhile 3), ukubuyela iiyure ezingama-6 phakathi kweeveki ezi-6 ukuya kwezi-7 ukuya kuthi ga kwimizuzu engama-45 ngosuku lokuziqhelanisa nekhaya. Umgaqo-nkqubo we-MBSR wahlengahlengiswa ngumqeqeshi ophakamileyo we-MBSR ovela kwi-2009 MBSR's manual manual esetyenziswe kwiDyunivesithi yaseMassachusetts [35]. Le ncwadana ivumela ubungakanani bendlela abafundisi abazisa ngayo ingqondo kunye nokusebenza kwabo kubathathi-nxaxheba. Izibonelelo kunye nezinto zokuziqhelanisa nekhaya zibekiwe emgangathweni kolu phando.

 

 

Abathathi-nxaxheba baya kunikwa ipakethi yolwazi ngexesha leklasi yokuqala ebandakanya inkcazo yezifundo kunye nolwazi lokunxibelelana nabo; Ulwazi malunga nengqondo, ukucamngca, izakhono zonxibelelwano kunye nefuthe loxinzelelo emzimbeni, iimvakalelo kunye nokuziphatha; imisebenzi yasekhaya; imibongo; kunye noluhlu lwamagama. Zonke iiseshoni ziya kubandakanya ukuzivocavoca kwengqondo, kwaye konke kodwa okokuqala kuya kubandakanya i-yoga okanye ezinye iindlela zokuhamba okunengqondo. Abathathi-nxaxheba baya kunikwa ukurekhodwa kweaudio yendlela yokusebenza kwengqondo kunye neyoga, eya kuthi ibhalwe ngabahlohli babo. Abathathi-nxaxheba baya kucelwa ukuba basebenzise iindlela ezixoxwe kwiklasi nganye mihla le ukuya kuthi ga kwimizuzu engama-45 ngalo lonke ixesha lokungenelela nasemva kokuphela kweeklasi. Baya kunikwa nokufundwa ukuba bagqibe phambi kweklasi nganye. Ixesha liya kunikezelwa kwiklasi nganye kuphononongwe imiceli mngeni abathathi-nxaxheba abanayo ekwenzeni oko bakufundileyo kwiiklasi zangaphambili kunye nomsebenzi wesikolo. Umhla wokuzikhethela wokuziqhelanisa ngoMgqibelo phakathi kweklasi yesithandathu neyesixhenxe uya kunikwa. Le retreat yeeyure ezi-6 iya kubanjwa nabathathi-nxaxheba bethule kwaye kuphela ngumhlohli othethayo. Oku kuya kunika abathathi-nxaxheba ithuba lokwenza nzulu oko bakufundileyo eklasini.

 

Unyango lweCognitive-Behavioral

 

I-CBT yeentlungu ezingapheliyo zichazwe kakuhle kwiincwadi kwaye zithotywe ngokuzithoba ukuba zenzeke ngokufanelekileyo ekuphuculeni iingxaki zentlungu ezingapheliyo [9-13]. Akukho ncedo olulinganisiweyo lwe-CBT olwenzela intlungu engapheliyo, nangona zonke iindlela zokungenelela kwe-CBT zisekelwe ekuthatyeleni ukuba ukuqonda kunye nokuziphatha okuchaphazela ukuguqulwa kwintlungu engapheliyo kwaye ukuqonda ukuziphatha kunye nokuziphatha okungabonakaliyo kungaqatshelwa kwaye kuguqulwe ukuphucula ukusebenza kwegulane [36]. I-CBT igxininisa iindlela ezisebenzayo, ezicwangcisiweyo ukufundisa izigulane indlela yokuchonga, ukubeka esweni nokutshintsha iingcamango ezingathandabuzekiyo, iimvakalelo kunye nokuziphatha, ngokugxila ekuncedeni izigulane ukuba zithole izakhono ezingasetyenziswa kwiintlobo zeengxaki kunye nentsebenziswano phakathi kwesigulane kunye neengcali. Uhlobo lweendlela lufundiswa, kubandakanya ukuqeqeshwa kwizakhono zokuxubusha ubuhlungu (umzekelo, ukusetyenziswa kweziganeko zokuzibamba kakuhle, ukuphazamiseka, ukuphumula kunye nokuxazulula iingxaki). I-CBT iphinda ikhuthaze ukusekwa nokusebenza kwiinjongo zokuziphatha.

 

Iifom zomntu ngamnye kunye neqela ziye zasetyenziswa kwi-CBT. IQela le-CBT lidla ngokuba yinto ebalulekileyo yeenkqubo zonyango zonyango ezininzi. Siza kusebenzisa ifomathi ye-CBT ifomathi kuba ifumaneke ukuba iphumelele [i-37-40], inokusebenza kakuhle kunezo zonyango kwaye inika izigulane ezineenzuzo ezinokuthi zidibaniswe nazo, kunye nenkxaso kunye nokukhuthazwa kwabanye amava kunye neengxaki. Ukongezelela, ukusebenzisa iifom zeqela zombini i-MBSR kunye ne-CBT kuya kuphelisa ifom yokungenelelo njengenkcazo enokwenzeka ngayo nayiphi na ingqinano ekhoyo phakathi kweendlela ezimbini zokwelapha.

 

Kolu phando, siqulunqe incwadi eneenkcukacha zonyango kunye nomxholo othile kwiseshoni nganye, kunye nencwadi yomsebenzi yomthathi-nxaxheba enezinto ezinokusetyenziswa kwiseshoni nganye. Siye saqulunqa incwadi yomsebenzi kunye neencwadi zomthathi-nxaxheba ngokusekelwe kwimithombo esele ipapashiwe nakwizinto esizisebenzisileyo kwizifundo zangaphambili [39-47].

 

Ungenelelo lwe-CBT (Itheyibhile 3) iya kubandakanya iiseshoni zeeyure ezi-2 ngeveki eziya kuthi zibonelele (1) ngemfundo malunga nendima yeengcinga ezizenzekelayo (umzekelo, ukuphazamisa) kunye neenkolelo (umzekelo, ukukwazi ukulawula iintlungu, ukwenzakala kulingana nokulimala) okuqhelekileyo kubantu abanokudakumba, unxunguphalo kunye / okanye iintlungu ezingapheliyo kunye (2) nokuziqhelanisa nokuziqhelanisa nokuvavanya umngeni kwiingcinga ezingalunganga, ukusetyenziswa kweendlela zokumisa iingcinga, ukusetyenziswa kweendlela zokuziphatha ezizizo kunye nokubeka iinjongo , iindlela zokuphumla kunye nokujamelana neentlungu. Ungenelelo luya kubandakanya imfundo malunga nokuhamba komsebenzi kunye nokucwangciswa kunye nokuphinda uphinde uthintele kunye nokugcinwa kweenzuzo. Abathathi-nxaxheba baya kunikwa ushicilelo lweaudio lokuzonwabisa kunye nokuzilolonga imifanekiso kwaye bacelwe ukuba babeke iinjongo ngokubhekisele kwindlela yabo yokuphumla. Ngexesha leseshoni nganye, abathathi-nxaxheba baya kugqibezela isicwangciso somsebenzi oza kwenziwa ukuze kwenziwe imisebenzi phakathi kweseshoni. Ezi zicwangciso ziya kusetyenziswa njengeelogo zokumisela iinjongo ezithile zekhaya kunye nokujonga imisebenzi egqityiweyo phakathi evekini ukuze ijongwe kwiseshoni yeveki elandelayo.

 

Ukunyamekela

 

Iqela lokhathalelo eliqhelekileyo liya kufumana naluphi na ukhathalelo lonyango abanokuthi balufumane ngesiqhelo ngexesha lokufunda. Ukunciphisa ukuphoxeka okunokwenzeka ngokungabinakho ukunyanga unyango lwengqondo, abathathi-nxaxheba kweli qela baya kufumana imbuyekezo eyi- $ 50.

 

Sites Class

 

Iiklasi ze-CBT kunye ne-MBSR ziya kubanjwa kwiindawo ezikufutshane neendawo zokuhlala kwamalungu e-GHC eWashington (Bellevue, Bellingham, Olympia, Seattle, Spokane kunye neTacoma).

 

Ba fundisi

 

Bonke abaqeqeshi be-MBSR baya kufumana uqeqesho olusemthethweni ekufundiseni i-MBSR kwiziko le-Mindfulness kwiYunivesithi yaseMassachusetts okanye uqeqesho olufanayo. Baya kuba bobugcisa bobuchule kunye nokuqeqesha umzimba (umzekelo, i-yoga), baya kufundisa i-MBSR ngaphambili kwaye baya kwenza ukuba ingqalelo ibalulekileyo ebomini babo. Ukungenelela kwe-CBT kuya kuqhutywa ngabagqirha bezengqondo zecliniki kunye namava adlulileyo ekuboneleleni nge-CBT kwizigulane ezineentlungu ezingapheliyo.

 

UkuQeqesha nokuLawulwa kwabaTitshala

 

Bonke abafundisi be-CBT baya kuqeqeshwa kwiprotocol yokufunda ngongenelelo lwe-CBT ngabaphandi bezonyango zengqondo (BHB kunye neJAT), abanamava kakhulu kulawulo lwe-CBT kwizigulana ezineentlungu ezingapheliyo. I-BHB iya kubeka iliso kubaqeqeshi be-CBT. Omnye wabaphenyi (i-KJS) uya kuqeqesha abafundisi be-MBSR kwi-MBSR protocol elawulwayo kwaye abaphathe. Umqeqeshi ngamnye uya kuzimasa iiseshoni zokubeka esweni ngeveki, eziza kubandakanya ukuxoxa ngamava amnandi, imicimbi emibi, iinkxalabo eziphakanyiswe ngumqeqeshi okanye abathathi-nxaxheba kunye nokunyaniseka komgaqo. Uluhlu lokuthembeka kunyango olubonisa izinto ezibalulekileyo kwiseshoni nganye zenzelwe zombini iingalo ze-CBT kunye ne-MBSR. Ingcali yophando eqeqeshiweyo iya kusebenzisa uluhlu lokujonga ukuthembeka ngexesha lokujonga bukhoma iseshoni nganye. Ingcali yophando iya kubonelela ngengxelo kumphathi ukuze aququzelele ukubekwa esweni kwabaqeqeshi qho ngeveki. Ukongeza, zonke iiseshoni ziya kurekhodwa ngerekhodi. Iisuphavayiza ziya kumamela isampulu engahleliwe kwaye zicele iinxalenye zeeseshoni kwaye ziya kuzijonga zisebenzisa uluhlu lokutshekisha lokunyaniseka. Ingxelo iya kunikwa abaqeqeshi ngexesha leseshoni yabo yokujonga veki. Ukunyaniseka kunyango kuya kujongwa kuwo omabini amaqela ongenelelo yi-KJS kunye ne-BHB ngoncedo lweengcali zophando. Ukongeza, baya kujonga kwaye bavavanye kuluhlu lokuthembeka isampulu engahleliyo yeeseshoni ezirekhodiweyo.

 

Ukugcinwa kwabathathi-nxaxheba kunye nokuxhomekeka kwiKhaya lokuSebenza

 

Abathathi-nxaxheba baya kufumana umnxeba wokukhumbuza phambi kweklasi yokuqala kunye nanini na balahlekelwa iklasi. Baya kucelwa ukuba barekhode umsebenzi wabo wemihla ngemihla kwiingodo zeveki. Imibuzo malunga nezenzo zabo zasekhaya ngeveki ezayo iya kufakwa kuzo zonke iintlanganiso zengxoxo-ndlebe. Ukugcina umdliwano-ndlebe unobungcali, iimbuzo zokunamathela ziya kubuzwa emva kokuba yonke idatha yesiphumo ibhalwe.

 

Amanyathelo

 

Siza kuvavanya ezahlukeneyo zeempawu ezisisiseko zabathathi-nxaxheba, kubandakanya neempawu zentlalontle, imbali ebuhlungu emva kunye nokulindelwa koncedo lonyango lwengqondo lomntu kwiintlungu zangasemva (Itheyibhile 4).

 

 

Siza kuvavanya isethi esiyintloko yeziphumo kwizigulane ezineengxaki zomgulane (umsebenzi ohambelana nomva, intlungu, imeko yezempilo jikelele, ukukhubazeka komsebenzi kunye nokwaneliseka kwesigulane) [48] ezihambelanayo neNkulumbiso ngeendlela, ukulinganisa, kunye nokuHlola koPhando kwiZiklinikhi Iimvavanyo zokuvavanywa kwizilingo zekliniki zonyango olungapheliyo kunye nokusebenza kakuhle [49]. Siza kulinganisa iziphumo zexeshana ezifutshane (i-8 kunye nee-26 iiveki) kunye neziphumo zexesha elide (iiveki ze-52). Siza kufaka i-short, i-4-iveki, ukuhlolwa kwangaphakathi kwemvume ukuvumela ukuhlalutya kwabalamli abaxhamliweyo kwimiphumo ye-MBSR kunye ne-CBT kwiziphumo eziphambili. Iipopu zokugqibela zezifundo ziiiveki ze-26. Abathathi-nxaxheba baya kuhlawulwa i-$ 20 nganye kwintlanganiso yophicotho-ndlebe elandelwayo ekugqibeleni ukunyusa izinga lokuphendula.

 

Imilinganiselo yesiPhumo esiPhambili

 

Amanyathelo esiphumo sokudibana aya kuba yimida enxulumene nokubuyela umva kunye neentlungu zangasemva ezixhalabisayo.

 

Ukuthintelwa kwemisebenzi enxulumene nomva kuya kulinganiswa ne-RDQ eguqulweyo, ebuza ukuba ingaba imisebenzi ethile ye-23 ithintelwe ngenxa yeentlungu zangasemva (ewe okanye hayi) [30]. Siphinde sayilungisa i-RDQ ukuze sibuze umbuzo malunga neveki ephelileyo kunokuba sithi "namhlanje". I-RDQ yoqobo ifunyenwe ithembekile, iyasebenza kwaye inovakalelo kutshintsho lweklinikhi [31,48,50-53], kwaye kufanelekile kulawulo lwefowuni kunye nokusetyenziswa kwezigulana ezinomda wokumodareyitha [50].

 

Ukukhathaza iintlungu zangasemva kuya kulinganiswa ngokubuza abathathi-nxaxheba ukuba babone ukuba zibuhlungu kangakanani iintlungu zabo zangasemva kwiveki ephelileyo kwisikali se-0 ukuya kwi-10 (0? =? ayisiyiyo kwaphela ingxaki ye-10 kunye ne-0? =? Botherngokukhathaza kakhulu). Kwisiseko sedatha ehlanganiswe kwiqela elifanayo lamalungu e-GHC aneentlungu zangasemva, sifumene le nyathelo lokuxhalaba ukuba lihambelane kakhulu nomlinganiso we-10 ukuya kwi-0.8 yentlungu (r? =? 0.9 ukuya ku-54; idatha engashicilelwanga (DCC kunye ne-KJS ) kunye namanyathelo okusebenza kunye neminye imilinganiselo yesiphumo [55] .Ukunyaniseka kwamanani okulinganisa amanani entlungu kuye kwabhalwa kakuhle, kwaye izikali ezinjalo zibonise ubuntununtunu ekufumaneni utshintsho kwintlungu emva konyango [XNUMX].

 

Siza kuhlalutya kwaye sinike ingxelo ngezi ziphumo ziphambili ngeendlela ezimbini. Okokuqala, ukulungiselela uhlalutyo lokugqibela lokugqibela, siya kuthelekisa iipesenti zabathathi-nxaxheba kumaqela amathathu onyango abafezekisa ukuphuculwa okunentsingiselo kwezonyango (? 30% yokuphuculwa kwesiseko) [56,57] ngexesha ngalinye (kunye nokulandelwa kweeveki ezingama-26 ukuba yindawo yokugqibela). Siza kuvavanya kamva, kuhlalutyo lwesiphumo sesibini, ulungelelwaniso lwentsingiselo ehlengahlengisiweyo phakathi kwamaqela kula manyathelo ngexesha lokulandela.

 

I ziphumo zoSondlo

 

Iziphumo zesibini esiza kuzilinganisa iimpawu ezixinezelekileyo, ukuxhalaba, ukuphazamiseka kwezinto ezinxulumene nentlungu, ukuphuculwa kwehlabathi jikelele kunye nokunyanga, ukusetyenziswa kwamachiza ngenxa yeentlungu zangemva, imeko yezempilo jikelele kunye neziphumo ezifanele.

 

Iimpawu ezixakekayo ziya kuhlolwa ngePhepha leMpilo yeMpilo-8 (PHQ-8) [58]. Ngaphandle kokupheliswa kombuzo malunga nokuzibulala, i-PHQ-8 iyafana ne-PHQ-9, efunyenwe inokuthenjwa, isebenzayo kwaye isabela ekutshintsheni [59,60].

 

Ukuxhalabisa kuya kulinganiswa kunye ne-2-Into e-Generalized Anxiety Disorder scale (GAD-2), ebonise ukuqonda okukhulu kunye nokuzikhethela ekufumaneni ingxaki yokukhathazeka jikelele kwiindawo zokunakekelwa kweprayimari [61,62].

 

Ukuphazanyiswa kwemisebenzi enxulumene nobuhlungu kunye nemisebenzi yemihla ngemihla kuya kuvavanywa kusetyenziswa izinto ezintathu kwi-Scated Chronic Pain Scale (GCPS). I-GCPS iqinisekisiwe kwaye yaboniswa ukuba ineepropathi zepsychometri elungileyo kuvavanyo lwabemi kunye nakwiisampulu ezinkulu zezigulana zononophelo lokuqala ezineentlungu [63,64]. Abathathi-nxaxheba baya kucelwa ukuba balinganise ezi zinto zintathu zilandelayo kwinqanaba le-0 ukuya kwi-10: iintlungu zabo zangasemva (iintlungu zangasemva zilungile ngoku), ezona ntlungu zabo zibuhlungu kwinyanga ephelileyo kunye nenqanaba labo leentlungu kwinyanga ephelileyo.

 

Ukuphuculwa kwehlabathi ngonyango kuya kulinganiswa ngePatient Global Impression of Change scale [65]. Lo mbuzo mnye ubuza abathathi-nxaxheba ukuba babeke umda kuphuculo lwabo kunyango kwinqanaba le-7-amanqaku asusela kuko konke kuphuculwe kakhulu ukuya kokubi kakhulu, kungekho lutshintsho lusetyenzisiweyo njengombindi. Ukulinganiswa kwehlabathi jikelele kokuphuculwa kwonyango kunika umlinganiselo wenzuzo yeklinikhi jikelele kunyango kwaye ithathwa njengenye yezona zinto ziphambili kwiziphumo zentlungu kwizilingo zekliniki [49].

 

Ukusetyenziswa kwamachiza kunye nokuzivocavoca ngentlungu emva kweveki edlulileyo kuya kuvavanywa nge-8-, 26- kunye ne-52-weekly questionnaires.

 

Iimeko eziqhelekileyo zempilo ziya kuhlolwa kunye ne-12-Into eFutshane yeSimo seMpilo yeFom (SF-12) [66], isixhobo esasetyenziswa ngokubanzi esinika amanqaku atshwankathelo kwimeko yempilo yengqondo nangokwengqondo. I-SF-12 iya kusetyenziselwa ukubala i-quality-adjusted years-life (QALYs) usebenzisa i-Survey Form Health Survey kwi-6 ubukhulu bokuhlalutya indleko [67].

 

Iziphumo ezifanelekileyo ziya kulinganiswa ngemibuzo evulelekileyo. Sifake imibuzo evulelekileyo kwizilingo zethu zangaphambili kwaye safumanisa ukuba zinika ukuqonda okuxabisekileyo kwiimvakalelo zabathathi-nxaxheba malunga nexabiso lezinto ezithile zongenelelo kunye nefuthe longenelelo kubomi babo. Siza kubandakanya imibuzo evulekileyo malunga nale micimbi ekupheleni kodliwanondlebe olulandelayo lwe-8-, 26- kunye ne-52 yeeveki.

 

Iimvavanyo ezisetyenziselwa ukuhlalutya umlamli

 

Ngengalo ye-MBSR, siza kuhlola iimpendulo zokubangela ukwanda kwengqiqo (ekulinganiselwe nge-Nonreactivity, Observing, Acting with Awareness, kunye ne-Noncudging subscals ye-Five Facet Mindfulness Questionnaire ifomu elifutshane [68-70] kunye nokwamkelwa kwentlungu ephakamileyo (kulinganiswa kunye I-Questionnaire Yokumkelwa Kwempendulo Engapheliyo [71,72]) kwiziphumo eziphambili. Kwiengalo ze-CBT, siya kuhlola iimpembelelo zokuphucula kwiinkonzo zentlungu kunye / okanye ii-appraisals (ezilinganiselwe kunye nePatient Self-Efficiency Questionnaire [73]; Uphando lweengxaki zobuhlungu 2-Into yokuLawula, ukukhubazeka, kunye nezicwangciso zokulimaza [74 -76]; kunye ne-Pain Catastrophizing Scale [77-80]) kunye nokutshintsha ekusebenziseni ubuchule bokubamba ubuhlungu (ukulinganiswa kobuhlungu obungapheliyo Ukujamelana ne-inventory 2-item item of relaxation kunye ne-Elemental Pacing scale [81,82] iziphumo. Nangona silindele ukuba iziphumo ze-MBSR kunye ne-CBT kwiziphumo ziza kuhanjiswa ngemibandela eyahlukeneyo, siya kuhlola iimiphumo zabo bonke abalamlamli abaza kubakho kwiziphumo kumabakala amayeza.

 

Iimvavanyo ezisetyenziselwa ukuhlaziywa kweendleko-ngempumelelo

 

Iindleko ezizodwa ziya kuqwalaselwa ngokusebenzisa iindleko zedatha ezikhishwe kwiirekhodi zonyango zekhompyutha zeenkonzo ezinxulumene nazo emva koko zinikezelwe okanye zihlawulwa yi-GHC kunye nemibiko yesigulane yenkathalo engagqithwanga yi-GHC. Iindleko ezichangekileyo ziqikelelwa kusetyenziswa i-questionnaire ye-Productivity and Trafficking Impression Questionnaire [83]. Ukusebenza kwongenelelo kuya kuvela kwi-SF-12 yesimo somgangatho wezempilo [84].

 

Uqoqo Lwedata, Ulawulo loMgangatho kunye noNgcaciso

 

Idatha iya kuqokelelwa kubathathi-nxaxheba ngabaqeqeshi beefowuni abaqeqeshiwe basebenzisa i-intanethi ye-intanethi yocwangco lwekhompyutha (i-CATI) yee-questionnaires ukwenzela ukunciphisa iimpazamo kunye nedata elahlekileyo. Imibuzo ngamava ngamacandelo athile angenelelo (umzekelo, i-yoga, ukucamngca, ukufundiswa kwezicwangciso zokuziphatha) eziya kuvula abaphandabuli kwiinkampani zonyango ziya kubuzwa ngexesha ngalinye emva kokuba zonke iziphumo zihlolwe. Siya kuzama ukufumana idatha yesiphumo kubo bonke abathathi-nxaxheba kwilingo, kubandakanywa nabangayi kubakho okanye bayeke kwiiklasi, abo bayeke ukubhaliswa kwisicwangciso sezempilo kunye nabasukayo. Abathathi-nxaxheba abangaphenduliyo kwiimvavanyo eziphindaphindiweyo zokufumana idatha yokulandelela ngefowuni baya kuthunyelwa i-questionnaire kubandakanya kuphela amanyathelo amabini aphambili kunye nokunika i-$ 10 yokuphendula.

 

Siza kuqokelela ulwazi kuwo onke amanqanaba okuqesha, ukurhoxiswa kwentsholongwane kunye nonyango ukuze sikwazi ukubika isigidimi sokuhamba ngokuhambelana neSIGQUBO (imiGangatho yokuHlanganiswa kweeNgxelo zokuPhendula) [85]. Ukugcina imfihlo yolwazi olunxulumene nesigulane kwisiseko seenkcukacha, iinombolo zokufunda ezizodwa ziya kusetyenziswa ukuchonga iziphumo zesigulane kunye nedatha yonyango. Inkqubo yokufunda isendaweni ukuqinisekisa ukuba bonke abasebenzi abafihliweyo baya kuhlala bexakeke kwiqela lonyango.

 

Ukukhuselwa kwabathathi-nxaxheba kunye noVavanyo loKhuseleko

 

Khuselo lwabathathi-nxaxheba

 

IBhodi yokuHlola iBakala yeGHC (i-IRB) ivume le sifundo.

 

Uhlolo loKhuseleko

 

Eli vavanyo liza kuhlolwa ngokukhuselwa yiBhodi yoLwazi lweNgcaciso kunye noKhuseleko (DSMB) oluqulunqwe ngunyango ojongene nokunyamekela okhunjulwayo kwi-mindfulness, i-biostatistician kunye neengcali zeengqondo ezinokliniki ezinamava ekuphatheni izigulane ezinentlungu engapheliyo.

 

Amava amaninzi

 

Siza kuqokelela idatha kumava amabi (AEs) kwimithombo eliqela: (1) iingxelo ezivela kubahlohli be-CBT kunye ne-MBSR zabo nabaphi na abathathi-nxaxheba abanomdla kubo; (2) udliwanondlebe olulandelayo lwe-CATI, 8- kunye nama-26 lweeveki apho abathathi-nxaxheba babuzwa malunga nawuphi na umonakalo abawuva ngexesha lonyango lwe-CBT okanye lwe-MBSR kunye naziphi na iingxaki ezinzulu zempilo ababenazo ngexesha elifanelekileyo; kunye (52) neengxelo ezizenzekelayo ezivela kubathathi-nxaxheba. Abaphenyi beeprojekthi kunye nomsebenzi we-GHC wokhathalelo oluphambili baya kuthi baphonononge iingxelo ze-AE kuyo yonke imithombo ngeveki. Naziphi na ii-AEs ezinzulu ziya kuxelwa ngokukhawuleza kwi-GHC IRB nakwiDSMB. Ii-AEs ezingekho nzulu ziya kurekhodwa kwaye zibandakanywe kwiingxelo eziqhelekileyo zeDSMB. Nakuphi na ukubhubha kwabathathi-nxaxheba abachongiweyo kuya kuxelwa kusihlalo weDSMB ngaphakathi kweentsuku ezisi-3 zokufunyanwa, nokuba kunjani na.

 

Imithetho yokumisa

 

Ulingo luya kugcinwa kuphela ukuba i-DSMB ikholelwa ukuba kukho ingozi engamkelekanga ye-AEs enkulu kwiyodwa okanye ngaphezulu kwezixhobo zonyango. Kule meko, i-DSMB inokugqiba isigqibo sokuphelisa enye yeengalo zetyala okanye lonke ulingo.

 

Imiba yeSatisati

 

Uluhlu lwesampula kunye nokungafani okubonakalayo

 

Ubungakanani besampulu yethu bakhethwa ukuqinisekisa amandla awaneleyo okufumana umahluko obalulekileyo ngokweenkcukacha manani phakathi kwala maqela mabini onyango lwengqondo kunye neqela lokhathalelo oluqhelekileyo, kunye namandla okufumana umahluko obalulekileyo ngokweenkcukacha-manani phakathi kwamaqela onyango amabini. Kuba siqwalasele umda kwimisebenzi yesigulana njengeyona nto ibaluleke kakhulu kwimilinganiselo yethu emibini yesiphumo, sisekele ukubalwa kobungakanani besampulu yethu kwi-RDQ eguqulweyo [30]. Sichaze ubungakanani besampulu yethu ngesiseko sepesenti yezigulana ezinokuphuculwa okunentsingiselo eklinikhi okulinganiswe ne-RDQ kuvavanyo lweeveki ezingama-26 (oko kukuthi, ubuncinci ama-30% ngokunxulumene nesiseko) [57].

 

Ngenxa yokuthelekiswa okuninzi, siya kusebenzisa uvavanyo olukhuselweyo olunqabileyo lwe-Fisher's [86], siqala sihlalutye ukuba ngaba kukho umahluko obonakalayo kuwo onke la maqela amathathu (kusetyenziswa i-omnibus? Ukuba sifumana umohluko, siya kuvavanya umahluko phakathi kwamaqela. Siza kudinga abathathi-nxaxheba abangama-2 (abangama-264 kwiqela ngalinye) ukufezekisa amandla angama-88% okufumana unyango lomntu wonke olwahlukileyo kunonophelo lwesiqhelo kwi-RDQ. Oku kucinga ukuba i-90% yeqela lokhathalelo eliqhelekileyo kunye ne-30% yeqela ngalinye lonyango lwengqondo liza kuba nokuphuculwa okunentsingiselo kwi-RDQ kwiiveki ezingama-55, amaqondo okuphucula afana nalawo siwabonayo kwinani elifanayo leentlungu kubantu Ukuvavanywa kolunye unyango kunye nolunye unyango kwiintlungu zangasemva [26]. Siza kuba namandla ubuncinci be-87% yokufumana umahluko obalulekileyo phakathi kwe-MBSR kunye ne-CBT kwi-RDQ ukuba i-MBSR ineepesenti ezingama-80 ezisebenza ngakumbi kune-CBT (Oko kukuthi, iipesenti ezingama-20 zeqela le-MBSR xa kuthelekiswa ne-75% yeqela le-CBT) .

 

Esinye isiphumo esisisiseko sokudibana nentlungu kukukhathaza amanqanaba. Ngobungakanani besampulu yabathathi-nxaxheba abangama-264, siya kuba namandla angama-80% okufumana umahluko phakathi kweqela lonyango lwengqondo kunye nokhathalelo oluqhelekileyo kwisikali sokukhathaza, sicinga ukuba i-47.5% yenkathalo yesiqhelo kunye ne-69.3% yengqondo nganye Iqela lonyango linama-30% okanye ukuphucuka okungaphezulu ukusuka kwisiseko kwinqanaba lokubandezeleka kobuhlungu. Siza kuba namandla ubuncinci be-80% yokufumana umahluko omkhulu phakathi kwe-MBSR kunye ne-CBT kwisikali sokukhathazeka ukuba i-MBSR ubuncinci yipesenti ye-16.7 yeepesenti isebenza ngakumbi kune-CBT (Oko kukuthi, i-87% yeqela le-MBSR ngokuchasene ne-69.3% ye-CBT iqela).

 

Xa sihlalutya iziphumo zokuqala njengamanyathelo aqhubekayo, siya kuba namandla angama-90% okufumana umahluko we-2.4-point phakathi kokhathalelo oluqhelekileyo kunye nonyango lwengqondo yomntu kumanqaku esikali e-RDQ eguqulweyo kunye nomehluko wenqaku le-1.1 phakathi kononophelo lwesiqhelo kunye nengqondo Unyango lomzimba kwisikali sokuqaqanjelwa sisifo (sithatha ukulinganisa okuqhelekileyo ukuthelekisa iindlela ezimbini ezizimeleyo ngokwahluka okulinganayo kunye ne-P enamacala amabini? Ukuthatha ukuba ilahleko ye-0.05% ilandelwe (ngaphezulu kancinci kunaleyo ifunyenwe kuvavanyo lwentlungu yethu yangaphambili), siceba ukufumana isampulu yabathathi-nxaxheba abangama-5.2 (abangama-2.4 kwiqela ngalinye).

 

Zombini ezi ziphumo zokuqala ziya kuvavanywa e-P?

 

Uhlalutyo lweSatisati

 

Uhlalutyo oluphambili

 

Ekuthelekiseni kwethu unyango olusekelwe kwimilinganiselo yempembelelo, siya kuhlalutya iziphumo ezivandlakanywe kuzo zonke iindawo zokulandelelana kwixesha elilodwa, ukulungelelanisa ukulungelelaniswa okunokwenzeka phakathi kwabantu kunye neengxoxo zeqela zonyango usebenzisa i-equity estimation equations [89]. Ngenxa yokuba asikwazi ukuqiqa ngokuphathelele ukungafani kweqela okanye ixesha eliqhelekileyo, siya kubandakanya ixesha lokusebenzisana phakathi kwamacandelo amayeza kunye neengongoma zexesha. Siceba ukulungelelanisa iinqununu zesiphumo sokuqala, ubulili kunye nobudala, kunye nezinye iimpawu ezisisiseko ezifunyenwe ukuba zihluke kakhulu ngeqela lonyango okanye kwiziphumo zokulandelelana, ukuphucula ukuchaneka kunye namandla eemvavanyo zethu. Siza kuqhuba uhlalutyo olulandelayo lweziphumo zomgangatho oqhubekayo kunye nesiphumo sibini (ukuguqulwa kwezinto ezibalulekileyo ukusuka kwinqanaba lokuqala), kuquka onke amanqaku okulandelelana (4, 8, 26 kunye nee-52 iiveki). Inyango ye-MBSR iya kuthathwa yimpumelelo kuphela xa kuthelekiswa kwexesha le-26 ngeeveki kubalulekile. Amanye amaxesha amanqaku aya kuthatyathwa njengolu vavanyo lwesekondari.

 

Siza kusebenzisa indlela yokuphulukisa injongo ekuhlaleni konke ukuhlalutya; oko kukuthi, ukuhlolwa kwabantu ngabanye kuya kuhlaziywa ngamaqela angenalutho, kungakhathaliseki ukuthatha inxaxheba kuyo nayiphi na iklasi. Olu hlalutyo lunciphisa ukunyanzelisa okuqhelekileyo ukuba kwenzeka xa abathathi-nxaxheba abangafumani unyango olwenziwe ngaphandle kokuhlalutya. Imodeli yokulawula iya kuba kwifom elandelayo jikelele:

 

 

apho yt impendulo ngexesha lokulandelwa t, isiseko lixabiso lokujonga kwangaphambili kwesiphumo sesiphumo, unyango lubandakanya ukwahluka kwedummy kumaqela e-MBSR kunye ne-CBT, ixesha luthotho lwezinto eziguquguqukayo ezibonisa amaxesha okulandela kunye no-z vector yee-covariates ezimele ezinye izinto ezihlengahlengisiweyo. (Qaphela ukuba? 1,? 2,? 3 kunye no-4 zizithwali.) Iqela elichazayo kule modeli liqela lokhathalelo eliqhelekileyo. Iziphumo ezibambekayo neziqhubekayo, siya kusebenzisa imisebenzi efanelekileyo yekhonkco (umzekelo, ilog yebhanari). Ngexesha ngalinye lokulandelela apho i-omnibus? Uvavanyo lwe-2 lubalulekile ngokwezibalo, siya kuqhubeka ukuvavanya ukuba ngaba kukho umahluko phakathi kwe-MBSR kunye nokhathalelo oluqhelekileyo ukujongana nenjongo ye-1 kunye umahluko phakathi kwe-MBSR kunye ne-CBT ukujongana nenjongo ye-2. Siza kunika ingxelo ngokuthelekisa i-CBT kunyango oluqhelekileyo. Xa ugqiba ukuba i-MBSR yonyango olusebenzayo lweentlungu zangasemva, siya kufuna ukuba injongo ye-1, uthelekiso lwe-MBSR kukhathalelo oluqhelekileyo, kufuneka lubonwe.

 

Ngokusekelwe izilingo yethu edlulileyo iqolo, silindele ubuncinane 89% olulandelayo-phezulu kwaye, ukuba kunjalo ngokwenene, uhlalutyo lwethu ephambili eya kujongwa iya kuba uhlalutyo yetyala epheleleyo, kuquka zonke iziphumo wabona follow-up. Nangona kunjalo, siya kulungelelanisa kuzo zonke ii-covariates ezisisiseko eziphambili zempembelelo, amathuba abo okulahleka kunye nokwahlukana phakathi kwamaqela enyango. Ngokulungelelanisa la ma covariate asisiseko, sicinga ukuba imiphumo ekhoyo ekhompyutheni yethu ayiphumelekanga ngokungahleliyo (enikezelwe ukuba idatha yesiseko ilandelelanisa iipateni zedatha), endaweni yokulahlekelwa ngokupheleleyo. Siza kuqhuba uhlalutyo lobuninzi ngokusebenzisa indlela yokubangela ukungabi naluphi na ukungaqiniseki ukuba iziphumo zethu zizinzileyo ukuze zihlawulele iimpembelelo zeenkcukacha ezahlukeneyo [90].

 

UMlamli uhlalutyo Ukuba i-MBSR okanye i-CBT ifumaneka ukuba isebenze (ngokunxulumene nokunakekelwa ngokuqhelekileyo kunye / okanye komnye nomnye) ekuphuculeni umphumo oyintloko kwii-26 okanye ii-52 iiveki, siya kuhamba kwiinjongo ze-3 ukuchonga abalamlamli bemiphumo ye-MBSR kunye neqela le-CBT kwi-RDQ kunye neentlungu ezibuhlungu. Siza kwenza ulandelelwano lwee-mediation luhlalutya ngokwahlukileyo kwiziphumo ezibini eziphambili (i-RDQ kunye neentlungu ezibuhlungu ezinomlinganiselo wezinga) kunye nomlinganiselo wecandelo lohlukeneyo wonyango (ukunyamekela ngokuqhelekileyo ngokubhekiselele kwi-CBT, ukunakekelwa okuqhelekileyo ngokubhekiselele kwi-MBSR kunye ne-CBT ngokubhekiselele kwi-MBSR). Siza kuhlalutya ukuhlalutya umlamli ohlukeneyo kwiziphumo ze-26 kunye ne-52-zeveki (ukuba i-MBSR okanye i-CBT ifumaneke ukuba isebenze ngaloo maxesha).

 

Emva koko, sichaza ngokweenkcukacha uhlalutyo lomlamli wexesha leeveki ezingama-26. Uhlalutyo olufanayo luya kwenziwa kwinqanaba leeveki ezingama-52. Siza kusebenzisa isakhelo sendlela esetyenziswa ngokubanzi kaBaron noKenny [91]. Nje ukuba sibonise unxibelelwano phakathi konyango kunye nesiphumo esiguqukayo ('isiphumo sisonke' sonyango kwisiphumo), inyathelo lesibini iya kuba kukubonisa unxibelelwano phakathi konyango kunye nomlamli ngamnye wokubeka. Siza kwakha imodeli yokuhlengahlengisa kumlamli ngamnye ngenqaku le-4- okanye le-8-leveki yomlamli njengokwahluka okuxhomekekileyo kunye nenqaku lokuqala kumlamli kunye nesalathisi sonyango njengezinto eziguquguqukayo ezizimeleyo. Siza kuluqhuba olu hlalutyo kumlamli ngamnye onokubakho kwaye siya kubandakanya njengabanokuba ngabalamli kweli nyathelo lilandelayo kuphela abo banexabiso le-P? 0.10 kulwalamano nonyango. Inyathelo lesithathu iya kuba kukubonisa ukuncitshiswa kwesiphumo sonyango kwisiphumo emva kokususa isiphumo sabalamli. Siza kwakha imodeli ye-multimediator inverse probable weighted (IPW) yokuhlehlisa [92]. Le ndlela izakusivumela ukuba siqikelele iziphumo zonyango ngqo emva kokulinganisa kwakhona amaqela onyango ngokubhekisele kubalamli. Ngokukodwa, siza kuqala ukumodareyitha ukubakho kweziphumo zonyango, zinikwe abalamli (Oko kukuthi, bonke abalamli abafunyenwe benxulunyaniswa nonyango kwinyathelo 2), kusetyenziswa ukuhlengahlengiswa kwempahla kunye nokulungelelanisa izinto ezinokubaphazamisa. Sisebenzisa le modeli, siya kufumana amathuba aqikelelweyo okuba umntu ngamnye afumane unyango oluqwalaselweyo, ngokunikwa ixabiso lomlamli eliqwalaselweyo. Siza kuthi emva koko sisebenzise uhlalutyo lokuhlengahlengiswa kwe-IPW ukumodareyitha iziphumo eziphambili kwimeko yonyango ngelixa silungelelanisa amanqanaba asisiseko esiphumo kunye nomlamli. Ukuthelekisa imodeli enobunzima kunye nemodeli engaphelelanga kuya kusivumela ukuba siqikelele ukuba zingakanani na iimpembelelo zonyango ngqo kwiziphumo ezinxulumene noko ezinokuchazwa ngumlamli ngamnye onokubakho. Ukubandakanywa kwinqanaba le-3 kubo bonke abalamli abafunyenwe kubalulekile kwinqanaba 2 kuya kusenza sikwazi ukuvavanya ukuba ngaba izinto ezithile esizicingelayo ziya kuthi ngokwahlukileyo zichaphazele iziphumo ze-MBSR xa ithelekiswa ne-CBT ngokwenyani ilamla iziphumo zonyango ngalunye ngaphandle kweziphumo. ezinye 'iinkqubo eziguquguqukayo'.

 

Uhlalutyo lweZindleko

 

Uluvo lokujonga iindleko zentlalontle (CUA) luyakwenziwa ukuthelekisa ukunyuka kweendleko zentlalo ezivezwe kwingalo nganye yonyango (iindleko zonyango ngqo ezihlawulwe yi-GHC kunye nomthathi-nxaxheba kunye neendleko zemveliso) kukusebenza okuneziphumo zokutshintsha kwabathathi-nxaxheba QALYs [ 93]. Olu hlalutyo luya kubakho kuphela kubathathi-nxaxheba abafundwayo abavela kwi-GHC. Le CUA inokusetyenziswa ngabenzi bomgaqo-nkqubo abachaphazelekayo kulwabiwo olubanzi lwezixhobo ezinxulumene nempilo [94,95]. Ngombono womhlawuli, iindleko zonyango ngqo (kubandakanya neendleko zongenelelo) ziya kuthelekiswa notshintsho kwii-QALY. Le CUA iyakusinceda ukuba siqonde ukuba iyavakala na into yokuba uqoqosho lwe-MBSR lube yinkonzo ebuyiselweyo phakathi kwabahlali. Inkqubo ye-bootstrap iya kusetyenziselwa ukuqikelela amaxesha okuzithemba [96]. Kuhlalutyo lwesibini olwenziwe ukuvavanya ubuntununtunu beziphumo kwiingcaciso ezahlukeneyo zeendleko zesiphumo, ezinje ngeengcinga ezahlukileyo zamaxabiso emivuzo asetyenziselwa ukuxabisa imveliso kunye nokubandakanywa kokusetyenziswa kwezixhobo zononophelo lwempilo olungahambelani nomva [97] kwixabiso elipheleleyo leendleko , iya kuqwalaselwa. Kuhlalutyo lwendleko-yokusebenza, siya kusebenzisa injongo yokunyanga nokulungisa iindleko zokusebenzisa ukhathalelo lwempilo kunyaka omnye wekhalenda ngaphambi kokubhaliswa kunye nezinto ezisisiseko ezinokuthi zinxulunyaniswe neqela lonyango okanye isiphumo, njengokusebenzisa amayeza, ukulawula abanokudideka. Silindele ukuba kuya kubakho idatha encinci yokulahleka, kodwa uhlalutyo lobuntununtunu (njengoko kuchaziwe apha ngasentla kwiziphumo eziphambili) luya kwenziwa ukuvavanya amanyathelo endleko.

 

Insight of Dr. Alex Jimenez

Ukugxininiswa yimpendulo yomzimba kwixinzelelo lomzimba okanye yengqondo. Imiba emininzi inokubangela uxinzelelo, okwenza ukuba kusebenze impendulo "yokulwa okanye indiza", indlela yokukhusela eyilungisa umzimba ngenxa yengozi ebonakalayo. Xa ugxininisekile, inkqubo ye-nervous sympathetic ivuselela kwaye ifihla intlangano edibeneyo yamahomoni kunye neekhemikhali. Ukuxinezeleka kwexesha elifutshane kunokuba luncedo, nangona uxinzelelo lwexesha elide ludibaniswe kwiintlobo zemicimbi yezempilo, kubandakanywa intlungu emva iimpawu ze-sciatica. Ngokweziphumo zophando, ukulawulwa koxinzelelo kuye kwaba yongeziweyo ebalulekileyo kwiindlela ezininzi zokonyango ngenxa yokunciphisa uxinzelelo kunokunceda ukuphucula imiphumo yesiphumo. Ukunyamekela kwe-Chiropractic isebenzisa utshintsho lomgudu kunye neendlela zokuhamba ngokubambisana kunye nokuguqulwa kwendlela yokuphila ukuze uphathe umlanjwane, ingcambu yesimiso se-nervous, kunye nokukhuthaza ukunciphisa amanqanaba oxinzelelo ngokutya okunempilo, ukuqina kunye nokulala.

 

ingxoxo

 

Kolu vavanyo, siya kufuna ukufumanisa ukuba indlela eyandayo yokujongana noxinzelelo ukuncitshiswa koxinzelelo-kukukhetha unyango olusebenzayo nolunendleko kubantu abaneentlungu ezingapheliyo. Ngenxa yokugxila kwayo engqondweni nasemzimbeni, i-MBSR inamandla okujongana nezinye zezinto zengqondo ezibaluleke kakhulu kwiziphumo ezibi. Kolu vavanyo, siya kuthelekisa ukusebenza kunye nokusebenza kweendleko ze-MBSR kunye ne-CBT, efunyenwe ukuba iyasebenza kwiintlungu zangasemva kodwa ayifumaneki ngokubanzi. Olu phononongo luza kuphinda luphonononge izinto eziguquguqukayo ezinokuthintela iziphumo ze-MBSR kunye ne-CBT kwiziphumo zesigulana. Ukuba i-MBSR ifunyenwe iyindlela efanelekileyo yokunyanga kunye nexabiso elifanelekileyo kubantu abaneentlungu ezingapheliyo, iya kuba lulongezo olubalulekileyo kunyango olufumanekayo kwizigulana ezinegalelo elibonakalayo lengqondo kule ngxaki.

 

Isimo sovavanyo

 

Ukuqashwa kwaqala ngo-Agasti 2012 kwaye yagqitywa ngo-Ephreli 2014.

 

izifinyezo

 

I-AE: Isiganeko esibi; I-CAM: Iyeza elongezelelweyo nelinye; I-CATI: Udliwanondlebe oluncediswa yikhompyuter; I-CBT: Unyango lwengqondo kunye nokuziphatha; I-CLBP: Iintlungu ezingapheliyo zangasemva; I-CUA: Uhlalutyo lweNdleko yokuSebenza; DSMB: Idatha kunye neBhodi yoKhuseleko; I-GHC: Intsebenziswano yeQela lezeMpilo; I-ICD-9: Ukwahlulahlulwa kwamazwe onke kwezifo uHlaziyo lwesiThoba; I-IPW: Ubunzima obunokwenzeka obunobunzima; I-IRB: IBhodi yokuHlola yamaZiko; I-MBSR: Ukunciphisa uxinzelelo kwengqondo; I-NCCAM: Iziko leLizwe leNyango eliNcedisayo kunye nelinye; QALY: Umgangatho wobomi wolungelelwaniso lomgangatho.

 

Ukugqithisa inzala

 

Ababhali bavakalisa ukuba abanalo inxaxheba.

 

Igalelo lababhali

 

DC kunye ne-KS evezwe yolu vavanyo. DC, i-KS, i-BB, i-JT, i-AC, i-BS, i-PH, i-RD kunye ne-RH inxaxheba ekucoceni ukucwangciswa kokufunda kunye nokusetyenziswa kweenkqubo kunye nokukhethwa kwamanyathelo okuphumelela. I-AC icwangcise izicwangciso zokuhlalutya izibalo. I-JT kunye ne-AC zicwangcise izicwangciso zokuhlalutya umlamli. BS, BB kunye ne-JT bavelise izinto zokungenelela kwe-CBT. I-PH icwangciswe izicwangciso zokuhlalutya indleko-ngempumelelo. DC iqulunqe le mibhalo. Bonke abalobi bathathe inxaxheba ekubhaliseni umbhalo wesandla baze bafunde kwaye bavumile isicatshulwa sokugqibela.

 

Imibulelo

 

IZiko leLizwe leNyango eliNcedisayo kunye neNye iyeza (i-NCCAM) libonelele ngenkxaso-mali kolu vavanyo (isibonelelo se-R01 AT006226). Uyilo lolu vavanyo lwaye lwaqwalaselwa kwaye lwamkelwa yiOfisi yeNCCAM yeMicimbi yezeKlinikhi kunye neMicimbi yoLawulo.

 

Ukuququmbela, okusingqongileyo, uxinzelelo lomzimba kunye neemvakalelo kunokubangela "ukulwa okanye ukuphendula ngenqwelomoya" ophetheyo ukulungiselela umzimba womntu ngengozi. Nangona uxinzelelo lubalulekile ekwandiseni ukusebenza kwethu, uxinzelelo olungapheliyo lunokuba nefuthe elibi ekuhambeni kwexesha, kubonakalisa iimpawu ezinxulumene nentlungu yasemva kunye ne-sciatica. Ukhathalelo lweChiropractic isebenzisa iindlela ezahlukeneyo zonyango, kunye neendlela zolawulo loxinzelelo kunye neendlela, ukunceda ukunciphisa uxinzelelo kunye nokuphucula kunye nokulawula iimpawu ezinxulumene nokulimala kunye / okanye iimeko zenkqubo ye-musculoskeletal kunye neenkqubo zovalo. Ulwazi lweBiotechnology (NCBI). Ubungakanani bolwazi lwethu lukhawulelwe kwi-chiropractic kunye nokulimala komqolo kunye neemeko. Ukuxoxa ngomxholo, nceda ukhululeke ukubuza uGqirha Jimenez okanye unxibelelane nathi apha 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: I-EXTRA EXTRA: Ungcono!

 

 

EZINYE IINGCUKACHA EZIBALULEKILEYO: UKWENZISA: Ukulimala kwezemidlalo? | Vincent Garcia | Umonde | El Paso, TX I-Chiropractor