Xa uye wabandakanyeka ungquzulwano lwemoto, ukulimala kwengozi ngenxa yeso siganeko akunakho ukuhlala kubangelwa ngumzimba. Uxinzelelo lwengqondo ngenxa yengozi okanye ukulimala kwimpembelelo yengozi yemoto inokuba yinto eninzi kakhulu, inokukhokelela kwiintlobo ezininzi zeempawu ezibuhlungu. Ukuba olo xinzelelo aluphathwa ngokukhawuleza, lunokubangela ukuphuhliswa kweemeko zengqondo. Ukuxinezeleka, ukuxhalaba, ukuxinezeleka kunye neemeko ezinzima, i-PTSD, okanye i-post stress traumatic disorder, ezinye zezinto eziqhelekileyo zengqondo ongaphetha ukuhlangabezana nazo emva kwengozi yemoto.

 

Ukuxhalabisa kunye noyiko olubi

 

Kwiimeko ezininzi, ixhoba lengozi yemoto inokuhlakulela uloyiko olungenangqondo ngenxa yeso siganeko. Njengokuba kunjalo, uninzi lwaba bantu baxela ukuba banamaxhala malunga nokubuyela emva kwevili kwakhona. Kubo, uloyiko lokuba kwenye ingozi lunokubangela ukuba baphephe ukuqhuba ngokupheleleyo. Abanye abantu abaninzi nangoku, uloyiko olungenangqondo lokuhlaselwa kukuphakuzela ngelixa usendleleni inokuba ngunobangela wokuba bathintele ukuqhuba ngokupheleleyo. Ukuba unxunguphalo kunye noloyiko olungenangqondo olubangelwa kukudakumba ngokweemvakalelo kwengozi yemoto luba mandundu, inokumenza umntu angaqhubeki eqhuba kwakhona.

 

ukudakumba

 

Kwakhona kunokwenzeka ukuba abantu abaye babandakanyeka engozini yemoto ukuphuhlisa uxinzelelo emva kwesi siganeko. Ekugqibeleni, uvuselela ukukhathazeka kwengqondo ngenxa yexinzelelo lomzimba. Kukho iimpawu ezininzi zokudakumba oza kuzibona ngokulula. Ezi ziquka iingxaki zokulala, ukulahlekelwa ngumdla kunye neentloko. Njengoko kuya kuba nzima, kunjalo, unokuphela ukuziva uhlungu okanye ungenathemba lonke ixesha, oku kunokubangela ukuba kubekho iimpawu ezimbi.

 

I-Post Traumatic Distress Disorder (PTSD)

 

Kunokwenzeka kakhulu kubantu abathintekayo kwingozi yemoto ukuba bahlupheke ngenxa yokugula kwengxaki yokuxinzelela, okanye i-PTSD. Ngokutsho kweZiko leSizwe le-PTSD, ubuninzi beepesenti ze-9 zabantu abafumana ukulimala kweengozi zengozi baqukumbela kwi-PTSD. Ukongezelela, ubuncinane i-14 ekhulwini labasindileyo bemoto abafuna ukunyamekela ngempilo yengqondo bafumana i-PTSD.

 

Uphando oluphando olutsha lubonise ukuba ukungenelela kwengqondo kunokuba kubalulekile kwimpilo yakho njengonyango lwenkcubeko, ingakumbi ukuba unesifo sengxaki yokukhathazeka, okanye iPTSD. Abaphandi baye babonisa ukuba ukunakekelwa kwe-chiropractic kunokukhokelela ekuqhubekeni okukhulu kwimeko yengqondo yomzimba yesigulane sempilo kunye nokuphila kakuhle.

 

 

Ukhathalelo lweChiropractic ngokuKhuseleko kweZingozi zeMoto

 

Ukujongana nokulimala kwengozi yemoto, njenge-whiplash, nto leyo eyenza ukuxhalaba nokukhathazeka, ukungakhathazeki kunye ne-PTSD ngokukhethekileyo, ifuna icebo elizininzi. I-Chiropractic yindlela yokwenza unyango olongezelelweyo ejolise kukulimala kunye / okanye iimeko ze-musculoskelet and systemous nervous system. I-chiropractor isebenzisa ngokubanzi ukulungiswa kwemigudu kunye neendlela zokuphatha ngokuchanekileyo ukulungisa ngokugqithiseleyo ukuphazamiseka kwemigulane, okanye ukuhluthwa, okungabangela intlungu kunye nokuphazamiseka. Ngokukhulula uxinzelelo kunye nokuxhatshazwa kwemisipha, ugqirha we-chiropractic, okanye i-chiropractor, unokuncedisa ukunciphisa uxinzelelo noxinzelelo lwengqondo olungabangela ukukhathazeka komntu, ukwesaba okungenangqondo, ukudandatheka kunye ne-PTSD. Ukuba kukho olunye uncedo olufunekayo, i-chiropractor ingancomela izigulane kwizonyango zononophelo olungcono kakhulu ukunceda ngeempawu zabo. Injongo yale nqaku ilandelayo kukubonisa ukuxhaphaka kwe-PTSD kubantu abachaphazelekayo ukugqitywa kwezithuthi kwakunye nokubonisa indlela ukungenelela kwengqondo ekugqibeleni kunokunceda ukuphucula kunye nokulawula iimpawu zokuxinwa kwabantu abanokuziva emva kokuphazamiseka kwemoto.

 

Ukubikezelwa kweNgxaki yokuPhathwa kwengxaki yokuPhathwa kweNgxaki ngokuPhenduka ngokukhawuleza kwi-Trauma.

 

Abstract

 

Izingozi zezithuthi zithuthi zihlala zibangele i-sequelae emzimbeni nangokwengqondo. Iingcali zeengcali ezahlukeneyo zonyango zibandakanyeka kunyango lwamaxhoba angozi. Akukho nto eyaziwayo malunga nezinto ezinokuthi ziqikelele ukuphazamiseka kwengqondo, umz. I-Posttraumatic Stress Disorder (PTSD) emva kweengozi kunye nendlela iingxaki zengqondo zithinta ngayo unyango. Kwi-179 ekufundwayo ekukhethiweyo, abaye bavunywa ngengozi yezithuthi zengxowankulu baye bavavanywa iintsuku ezimbalwa emva kwengozi yokuxilongwa ngengqondo, ubunzima bokulimala kunye ne-psychopathology. Bonke babezonyango kwaye kwafuneka baphathwe ngenxa yokuphulwa kwethambo. Kwi-6-iinyanga zokuvavanya ukuvavanya i-152 (85%) yezigulane zaphinda zaxoxwa kwakhona. Kwizigulane, i-18.4% yazalisekisa imigaqo ye-Posttraumatic Stress Disorder (DSM-III-R) kwiinyanga ze-6 emva kwengozi. Izigulane ezenza i-PTSD zalimala ngakumbi kwaye zibonisa iimpawu ezininzi zokuxhalaba, ukuxinezeleka kunye ne-PTSD iintsuku ezimbalwa emva kwengozi kunezigulane ezingenasifo sengqondo. Abagulane nePTSD bahlala ixesha elide esibhedlele kunezinye izigulane. Uhlalutyo oluninzi lokuguqulwa kwembonakaliso luye lwabonisa ukuba ubude bokubhedlelelwa esibhedlele kubangelwa ikakhulu kwizinto ezahlukahlukeneyo ezifana nokukhawuleza kokulimala, ubunzima beengozi, ubuntu obusesikweni kunye ne-psychopathology. I-posttraumatic stress disorder iqhelekile emva kweengozi zezithuthi. Izigulane ngePTSD ekulandelelweni zingabonwa yizinto ezifunyanwe ukuvavanywa kwangaphambili. Ukungathandabuzeki kwe-psychological sequelae efana ne-PTSD kubangela ukuhlala esibhedlele ixesha elide kwaye ngenxa yoko kuneendleko ezingaphezulu kunezigulane ezingekho kwi-PTSD.

 

 

Ulwaphulo-olujoliswe kwiCandelo lokuThatha ukuChepha kweZenzo kunye nokuSebenza kwe-Whiplash engapheliyo: Iprotocol ye-Trimmed Controled Trial

 

Abstract

 

• Intshayelelo: Ngenxa yesigxina somgwaqo, intlungu eqhubekayo kunye nokukhubazeka emva kokulimala kwe-whiplash ziqhelekileyo kwaye zenze iindleko ezinkulu zomntu kunye nezoqoqosho. Ukufikelela kwi-50% yabantu abafumana inxeba ye-whiplash abayi kuphinda bafumane ngokuzeleyo baze bafike kwi-30% baya kuhlala bekhatywe ngokukhawuleza kwimeko. Isizathu sokuba kutheni iimpawu eziqhubekayo ezidlulileyo kwisigaba esicacileyo kwaye zihlala zingapheliyo, kodwa mhlawumbi ziphumo ezivela kumanyathelo ahlukeneyo phakathi kokulimala kwesakhiwo, ukukhubazeka ngokomzimba, kunye neengqondo zengqondo nezengqondo. Izimpendulo zengqondo zihambelana nesiganeko esibuhlungu ngokwazo ziba yinto ebonakalayo ebonakalayo kwimeko ye-whiplash. Nangona kukho ukuqonda, kunolwazi olunqongophele malunga nokusebenza kweengongenelelo zengqondo, ngokukhutshwa yodwa okanye ngokudibanisa ne-physiotherapy, ekunciphiseni izimo zengqondo zengqondo kunye nezobuhlungu ezichaphazelekayo. Iziphumo zophononongo zophando zibonise iziphumo ezintle zokusetyenziswa kweengxaki zengqondo zengqondo yokugulisa ingqondo, ukukhathazeka nokukhubazeka kubantu abane-whiplash engapheliyo. Iziphumo zibonise ukuba indlela edibeneyo ayikwazanga ukunciphisa kuphela iimpawu zengqondo, kodwa intlungu kunye nokukhubazeka.
• Iinjongo: Injongo ephambili yale nzingo elawulwayo ngokungapheliyo, kukuhlola uphando lwe-cognitive cognitive-tractatic disorder (PTSD), ekhutshwe yi-psychologist, kunye ne-physiotherapy ukuzivocavoca ukunciphisa intlungu kunye nokukhubazeka kwabantu abaneenkathazo ezingapheliyo kunye ne-post-traumatic disorder disorder (PTSD) . Ulingo lujolise ekuphandeni ukusebenza kwonyango oludibeneyo ekunciphiseni iimpawu zokuxinzelela emva kokukhathazeka, ukuxhalaba nokuxinezeleka.
• Abathathi-nxaxheba noCwangciso: Inani elipheleleyo labathathi-nxaxheba abangama-108 abanesifo esinganyangekiyo esihambelana ne-whiplash (WAD) kwibanga II le> 3 iinyanga kunye <iminyaka emi-5 kunye ne-PTSD (efunyaniswe ne-Clinic Administrated PTSD Scale (CAPS) ngokwe-DSM-5) ukufunda. Abathathi-nxaxheba baya kuvavanywa ngokuhlolwa kweefowuni nangobuqu kwilebhu yophando yaseyunivesithi. Ungenelelo luya kwenzeka kumazantsi mpuma eQueensland, eOstreliya nakumazantsi eDenmark.
• Ungenelelo: Iingcali zengqondo ziya kukhutshwa kanye ngeveki kwiiveki ze-10, kunye nabathathi-nxaxheba abaye banikezelwa ngokukhawuleza kwiprogram yokuziphatha kwengqondo okanye ukunyango oluxhasayo, bobabini bakhululwa yikliniki yeengqondo. Abathathi-nxaxheba baya kufumana iiseshoni ezilishumi zobugcisa-based based physiotherapy ukuqhutywa kwithuba leveki le-6.
• Imilinganiselo yesiPhumo: Isiphumo esiphambili siphumo ukukhubazeka kwentamo (Inkcazo yokukhubazeka kweNeck). Iziphumo eziPhezulu zijolise kuyo: ubukhulu bentlungu; Ubukho kunye nobunzima be-PTSD (i-CAPS V kunye ne-PTSD Uluhlu lwe-5); uxinzelelo lweengqondo (ukuxinezeleka, ukuxinezeleka koxinzelelo lwe-21); ukusebenza komonde (SF-12, Tampa Scale of Kinesiophobia, kunye ne-Patient-Specific Functional Scale); kunye neentlungu ezizenzekelayo kunye neentlekele (Inkqubo yokuPhepha kweNkqubo yokuPhucula ubuNtu kunye noPhulo lweNkathazo yokuPhepha). Emva kweengqondo ze-psychotherapy (iiveki ze-10 emva kwe-randomisation) kunye ne-physiotherapy (iiveki ze-16 emva kwe-randomisation), kunye ne-6-inyanga kunye ne-12-inyanga yokulandela, umhloli oyimfama uya kulinganisa iziphumo.
• Uhlalutyo: Konke ukuhlalutya kuya kwenziwa ngokusesikweni sokunyanga. Iziphumo eziphambili neziphambili ezilinganiswayo ziya kuhlaziywa zisebenzisa imizekelo yokuhlukumeza okuxubileyo kunye nemigangatho. Naliphi na umphumo wesayithi (i-Australia okanye iDenmark) iya kuhlolwa ngokuquka i-time-by-treatment-time-interaction term in the models of mixing. Ukuguqulwa kwesiphumo kuya kuhlolwa kuphela kwisiphumo esiphambili se-Index ye-Disability Disability Index.
• Ingxoxo: Olu pho nonongo luya kunika uvavanyo oluchanekileyo lwemiphumo yokufaka ulwaphulo olujoliswe kwingxaki yokuziphatha kwengqondo kwi-physiotherapy umzimba kubantu abane-WAD engapheliyo kunye ne-PTSD. Olu phofu lunokuchaphazela ukulawulwa kweklinikhi yenzakalo ye-whiplash kwaye iya kuba neklinikhi yokusebenza ngokukhawuleza e-Australia, eDenmark kunye noluntu olubanzi lwamazwe ngamazwe. Uphononongo luya kuba nefuthe kubo bobabini bezempilo kunye ne-inshorensi yomgaqo-nkqubo kwizigqibo zabo malunga nokukhetha unyango kunye nenkxaso-mali.

 

intshayelelo

 

Intlungu eqhubekayo kunye nokukhubazeka emva kokulimala kwe-whiplash ngenxa ye-traffic accident (RTC) eqhelekileyo kwaye ivelise iindleko ezinkulu zomntu kunye nezoqoqosho. Ukufikelela kwi-50% yabantu abafumana inzakalo ye-whiplash abayi kuphinda bafumane ngokuzeleyo baze bafike kwi-30% baya kuhlala bemodare ukukhubazeka kakhulu ngemeko [1-3]. Ingqalelo encinane yimiba yempilo yengqondo ehamba nale meko. Ubuninzi beengxaki zengqondo kuboniswe ukuba yi-25% ye-PTSD, i-31% yeNgqungquthela enkulu yoxinzelelo kunye ne-20% ye-General Distress Concerning Disorder [4-6]. I-akhawunti ye-Whiplash yokonzakala ngobuninzi babo nawaphi na amabango angenisweyo kunye neendleko ezinkulu ezithe zenziwa kwiQumrhu lika-Queensland lenkampani yesithathu eyanyanzelekileyo [7]. E-Australia, ukulimala kwe-Whiplash kubandakanya malunga ne-75% yazo yonke inokulimala ye-RTC [8] ngeendleko ezipheleleyo ezingaphezu kwe-$ 950 M ngonyaka (9], ezidlula iindleko zombini womgudu kunye nokulimala kwengqondo ebuhlungu [7]. EDenmark, i-whiplash ixabisa i-300 yezigidi ze-USD ngonyaka xa ukulahleka komsebenzi kufakwe [10].

 

Intlungu yesikhumba iyimpawu ezikhawulayo zabanye abalandela ukulimala kwe-whiplash. Ngoku kwamkelwa ngokuqhelekileyo ukuba kukho ukulimala kokuqala komnxeba omnye entanyeni entanyeni [11] nangona isakhiwo esithile esilimazile kwizigulane ngabanye kunzima ukuchonga kwiinkqubo zamagcisa zamanje. Isizathu sokuba kutheni iimpawu eziqhubekayo ezidlulileyo kwisigxina esisigxina kwaye zihlala zingapheliyo zicaca kodwa ziphumo zivela kwiintsebenziswano eziyinkimbinkimbi phakathi kokulimala kwesakhiwo, ukukhubazeka ngokomzimba, izinto zengqondo kunye neengqondo [12]. Nangona kunjalo kuyacaca ukuba i-WAD engapheliyo yimeko engapheliyo kunye neyinkimbinkimbi ebandakanya ukukhubazeka okungokwenyama, njengokulahleka kwentshukumo, ukuphazamiseka kwindlela yokuhamba kunye nokuphazamiseka kwengqondo [13] kwakunye neentlungu ezinxulumene nengqondo ezinjengezokuphazamiseka [14, 15], isixhosa [16] , ukukhusela umsebenzi kunye nokuzinyameka kolawulo lweentlungu [17]. Ukongezelela uphando olutshanje luye lwabonisa ukuba iimpawu zoxinzelelo zengcinezelo okanye uxinzelelo oluneemeko ziqhelekileyo [18-20]. Ngaloo ndlela kuya kubonakala kunengqiqo ukuba ukungenelela okujoliswe kokubonakalayo ngokomzimba nangokwengqondo kwimeko ye-whiplash kuya kuba yinzuzo.

 

Ngokuchasene neemeko ezininzi eziqhelekileyo zeentlungu ze-musculoskeletal (umz. Iimpendulo zengqondo ezinxulumene nesiganeko esibuhlungu ngokwaso, iimpawu zoxinzelelo lwasemva koxinzelelo, ziyavela njengezinto ezibalulekileyo ezongeziweyo zengqondo kwimeko ye-whiplash. Idatha yamva nje ibonisa ukuba iimpawu zoxinzelelo lwasemva koxinzelelo zixhaphakile kubantu abaye bafumana ukulimala kwe-whiplash emva kweengozi zemoto [18, 20, 21]. Ubukho bokuqala beempawu zoxinzelelo lwasemva koxinzelelo kubonisiwe ukuba bunxulunyaniswa nokubuyiswa kokusebenza okungalunganga kokulimala [13, 18]. Idatha yamva nje esuka kwilabhoratri yethu ibonakalisile ukuba kulandela ukulimala kwe-whiplash i-17% yabantu iya kulandela umkhondo weempawu zokuqala zoxinzelelo / ezinzima zesttraumatic eziqhubeka ubuncinci iinyanga ze-12 kunye ne-43% ziya kulandela umkhondo weempawu zokuqala eziphakathi ezinciphileyo kodwa zihlala ubuncinci ukuya kumodareyitha (amanqanaba enklinikhi) amanqanaba ubuncinci iinyanga ezili-12 (ubude besifundo) [4]. Jonga uMzobo 1. La manani abalulekile njengoko ayafana nokuxhaphaka kwe-PTSD kubantu abangeniswe esibhedlele kulandela ukonzakala Okubi kakhulu kwemoto [22].

 

 

Nangona i-WAD engapheliyo yinkinga yempilo ebonakalayo inani lezilingo ezishicilelwe ngokungahleliwe (RCTs) lilinganiselwe [23]. Ukuphononongwa ngokuchanekileyo kwenkqubo kugqityiwe ukuba kukho ubungqina bokuba iinkqubo zokuzilolonga zisebenza ngokuthobekileyo ekunciphiseni iintlungu ezinxulumene ne-whiplash, ubuncinci kwixesha elifutshane [23]. Umzekelo, uStewart et al [24] ubonise inqaku le-2 kuphela (kwisikali se-10) kuncipha kumanqanaba entlungu kwangoko emva kweeveki ezi-6 zongenelelo ngononophelo olusebenzayo olunamathele kwiinqununu ze-CBT ezinxulumene nentlungu kodwa kungabikho ziphumo zibalulekileyo Ukulandelwa kwexesha elide kweenyanga ezi-6 ne-12. Kwi-RCT yokuqala eqhutyelwe kwilabhoratri yethu (epapashwe kwi-2007), indlela ethe kratya yokuzivocavoca intamo nayo yahambisa kuphela iimpembelelo, kuba iintlungu kunye namanqaku okukhubazeka ancipha ngamanani afanelekileyo ekliniki (8 14% kwi-Neck Index Index) xa xa kuthelekiswa neseshoni enye yengcebiso [25].

 

Ukuphononongwa ngokuchanekileyo kwanokugqitywa ukuba kukho ubungqina obuphikisanayo malunga nokusebenza kweengongenelelo zengqondo ezithunyelwa yedwa okanye ngokudibanisa ne-physiotherapy [23]. Izifundo ezibandakanyiweyo ekuhlaziyweni zazingumgangatho ogqithisileyo kwaye zisetyenziswa kakhulu kwi-CBT kwindlela ethile ukujongana neengxabano ezinxulumene nobuhlungu kunye noxinzelelo [26, 27]. Akukho zifundo ezijoliswe ngqo kwiimpawu ze-PTSD.

 

Yiyo loo nto isindululo esibonakala sisengqiqweni songenelelo ekujoliseni imeko yengqondo kunye neentlungu ezinxulumene ne-WAD engapheliyo ayisebenzi njengoko bekulindelekile. Olu lindelo lusekwe kwiziphumo ezilungileyo ngakumbi ngeendlela ezinjalo kwezinye iimeko zentlungu yesisculoskeletal ezifana ne-back back [28].

 

Kwimizamo yokuqonda ukuba kutheni iindlela zokuzivocavoca zingasebenzi kakuhle kwi-WAD engapheliyo, sithathe i-NHMRC (570884) yezilingo ezilawulwa ngokungekho mthethweni ezibandakanya ukuguqulwa kweempawu ze-PTSD kunye nokuphazamiseka kwemizwa. Kolu lukhulu (n = 186) luvavanyo oluninzi, uhlalutyo lokuqala lubonisa ukuba kuphela iipesenti ezingama-30 zezigulana ezine-WAD ezingapheliyo kunye nokuchongwa kwe-PTSD ezinotshintsho olufanelekileyo lwezonyango kwiNeck Disability Index amanqaku (> 10% yotshintsho) xa kuthelekiswa ne-70% yezigulana ze-WAD ngaphandle kwe-PTSD kulandela inkqubo yokubuyisela kwimeko yesiqhelo. Bonke kubandakanya abathathi-nxaxheba baxela amanqanaba aphakathi okanye aphezulu entlungu kunye nokukhubazeka okubonisa ukuba ubukho bokubambisana kwe-PTSD kuthintela impendulo elungileyo kulungiso lomzimba. Asinakufumana siphumo sokuguqula naluphi na utshintsho lweemvakalelo. Iziphumo zolu phononongo zisikhokelela ekubeni siphakamise ukuba ukunyanga i-PTSD kuqala kwaye emva koko kumiselwe ukubuyisela kwimeko yesiqhelo umzimba kuya kuba ngongenelelo olusebenzayo ukuphucula iziphumo zempilo ye-WAD engapheliyo.

 

I-CBT egxininiswe ngolu hlobo yonyango olusebenza kakuhle kwiimpawu ze-PTSD [i-29] kunye nezikhokelo ze-Australia zonyango lwe-Stress Disorder Disorder kunye ne-PTSD icebisa ukuba i-CBT enokuxhatshazwa ngabanye kufuneka ibonelelwe ngabantu abanezimo [30]. Kukho idatha efumanekayo ukubonisa ukuba i-CBT egxininiswe ngengozi inokuthi ibe nefuthe kungekhona kwiimpawu ze-PTSD kodwa nakwiintlungu nokukhubazeka. Iziphumo zoviwo olusandul 'uvavanyo lwangoku zihlolisise ubudlelwane obunxulumene phakathi kwe-PTSD kunye nentlungu engapheliyo kwi-323 abasinde kwizingozi [31]. Iziphumo zibonise ukugcinwa ngokubandezeleka kweentlungu ezinzima kunye neempawu zoxinzelelo ezingemva kwe-5 emva kokulimala kwithuba emva kweenyanga eziyi-6 ukulimala kwithuba (ingxaki engapheliyo), iimpawu ze-PTSD zichaphazeleke kakhulu kwiintlungu kodwa kungekudala. Nangona esi sifundo asizange sigxininise ngokukodwa kwi-whiplash ukwenzakala, sibonelela ukuba ukujongana neempawu ze-PTSD kwisigaba esingapheliyo se-WAD kunokuvumela ukuba kunciphise amanqanaba entlungu ngaleyo ndlela kuququzelele iimpembelelo ezinokuba zibuhlungu / ukukhubazeka ezijoliswe kubaphathi ezifana nokuzilolonga kunye ne-CBT ejoliswe entlungu.

 

Ngokusekelwe kwiziphumo zethu zokubambisana kwe-PTSD kunye ne-WAD, senze isifundo esincinci sokuqhubela phambili ngenjongo yokuvavanya imiphumo ye-CBT ejoliswe ngengozi kwiimeko zengqondo, intlungu kunye nokukhubazeka kubantu abane-WAD engapheliyo [32]. Abafundi abangamashumi amabini anesithandathu abane-WAD abangapheliyo kunye nokuxilongwa kwe-PTSD babethelwe ngoncedo unyango (n = 13) okanye akukho-Intervention (n = 13). Iqela lonyango lenze iiseshini ze-10 zeveki zengxowankulu ye-CBT ye-PTSD. Ukuvavanywa kwe-PTSD ukuxilongwa, iimpawu zeengqondo, ukukhubazeka, kunye neempawu zentlungu zenziwe kwinqanaba lokuqala kunye nokuvavanywa (emva kweeveki ze-10-12). Ukulandela ukungenelela kwonyango, kwakungekho nje ukunciphisa okuphawulekayo kwiimpawu zengqondo (ubunzima be-PTSD); iinombolo zidibana nenkqubo yokuxilonga i-PTSD; ukuxinezeleka, ukuxhalaba kunye neengxaki zokuxinwa) kodwa kunye nokunciphisa okukhulu kwintlungu nokukhubazeka kunye nokuphuculwa komsebenzi ngokomzimba, intlungu yomzimba kunye nendima yenyama ye-SF36 (Itheyibhile 1).

 

1 Table. Iziphumo zovavanyo lomqhubi wolu vavanyo

	I-CBT egxininisekile	Akukho Ulawulo lokungenelela
Index Index (0-100) *
Isiseko	43.7 (15)	42.8 (14.3)
Ukungenelela kweposi	38.7 (12.6)	43.9 (12.9)
Umsebenzi we-SF-36 ngokwasemzimbeni
Isiseko	55.8 (25.9)	55.4 (28.2)
Ukungenelela kweposi	61.5 (20.1)	51.1 (26.3)
I-SF -36 Intlungu yomzimba
Isiseko	31.2 (17.2)	22.6 (15.5)
Ukungenelela kweposi	41.8 (18)	28.2 (15.8)
I-Posttraumatic Stress Disorder Diagnosis (SCID-IV)
Isiseko	I = 13 (100%)	I = 13 (100%)
Ukungenelela kweposi	I = 5 (39.5%)	I = 12 (92.3%)

* amanqaku aphezulu = amabi; Amanqaku aphezulu = ngcono

 

Iziphumo zolu pho nonongo lubonisa ukuba i-CBT egxininiswe ngogonyamelo kwabanikezelayo abane-WAD engapheliyo ineempembelelo, kungekhona nje kwiimeko zengqondo kodwa nakwiintlungu nokukhubazeka iimpawu ezikhawulayo zalo mqathango. Nangona utshintsho oluthethayo lwe-5% lwalunxwemeni ngokwemfuno yekliniki [33], ubungakanani befuthe lokuguqulwa kwe-UN lwalulinganisela (d = 0.4) kwaye lubonisa isithembiso somphumo omkhulu kwisayizi enkulu yesampula [34]. Nangona kunjalo iziphumo zolu vavanyo lwezamehlo zibonisa ukuba i-CBT yodwa ingabikho ngokwaneleyo ukulawulwa ngempumelelo kwe-WAD engapheliyo kwaye ngenxa yesi sizathu silingo lwethu olucetywayo luya kudibanisa le ndlela ngokusebenza. Ezi ziphumo zikwaphulwa komhlaba kwindawo yokulawulwa kwe-whiplash kwaye kubalulekile ukuba bavavanywa ngokutsha kwi-design epheleleyo.

 

Isishwankathelo, sele sibonise ukuba abantu abane-WAD abangapheliyo kunye neempawu ze-PTSD ezilinganayo aziphenduli ngokusesikweni sokuncedisa ukulungiswa ngokomzimba njengabantu abangenazo iimpawu ze-PTSD [25]. Uphononongo olusandul 'uvavanyo lwangoku nje lubonisa ukuba i-CBT egxininiswe ngengozi inomphumo onobuncedo kwisimo sengqondo kunye nentlungu nokukhubazeka. Siphakamisa ukuba ngokuphambi kwe-PTSD, iimpawu ze-PTSD kunye nokukhubazeka okuhambisanayo kuya kunciphisa ukuvumela ukungenelela ukuba kusebenze ngakumbi kunokuba kubonwe kuze kube yimini [24, 25]. Ngako-ke uphando lwethu olucetywayo luya kujongana nalolu gaba oluchongiweyo ngolwazi ngokuba ngowokuqala ukuvavanya ukuphumelela kokungenelela kwe-CBT ejoliswe ngengozi elandelelweyo elandelwe ngumsebenzi we-WAD ongapheliyo.

 

Injongo ephambili yale projekthi kukuphanda ukuphumelela kwe-CBT ejoliswe ngogonyamelo kunye nokuzivocavoca ukunciphisa intlungu nokukhubazeka kwabantu abane-whiplash engapheliyo ne-PTSD. Iinjongo zesekondari kukuphanda ukuphumelela kwe-CBT ejoliswe ngogonyamelo kunye nokuzivocavoca ukunciphisa iimpawu zokuxinwa kwe-posttraumatic, uxinzelelo kunye nokuxinezeleka, nokuphanda ukuphumelela kwe-CBT ejolise ngengozi yodwa kwiimpawu zengcinezelo yokuhamba kwengqondo kunye nentlungu / ukukhubazeka.

 

Olu lingo kulindeleke ukuba luqale ngoJuni 2015 kwaye lugqitywe ngoDisemba 2018.

 

uyilo

 

Olu pho nonongo luya kuba luvavanyo olulawulwa ngokungahleliwe oluvavanya iiveki ezili-10 ze-CBT ezijolise kwintlungu xa kuthelekiswa neeveki ezili-10 zonyango oluxhaswayo, ngasinye silandelwa yiprogram ye-6 yeveki. Iziphumo ziya kulinganiswa ngeeveki ezili-10, iiveki ezili-16, iinyanga ezi-6 kunye ne-12 emva kwenkqubo. Abantu abangama-108 abanesifo esinganyangekiyo se-whiplash (> iinyanga ezi-3, iminyaka emi-5 ubude bexesha) kunye ne-PTSD (DSM-5 efunyaniswe ine-CAPS) iya kubhaliswa kuphononongo. Iziphumo zokulinganisa abavavanyi ziya kuba yimfama kulwabiwo lwamaqela onyango abelweyo. Umgaqo-nkqubo uhambelana nezikhokelo ze-CONSORT.

 

 

tindlela

 

nxaxheba

 

Inani elipheleleyo labathathi-nxaxheba abangama-108 abane-whiplash engahambelaniyo nengxaki (WAD) yebanga II (ubude beempawu> iinyanga ezi-3 kunye <iminyaka emi-5) kunye ne-PTSD iya kuqeshwa eSoutheast Queensland nase-Zealand, eDenmark. Abathathi-nxaxheba baya kugaywa ngokusebenzisa:

 

1. Izibhengezo (irejista yezempilo yesizwe yaseDenmark, iphephandaba, i-newsletter kunye ne-intanethi): abathathi-nxaxheba abanokubamenywa ukuba baqhagamshelane nabasebenzi beprojekthi.
2. I-Physiotherapy kunye neZigqirha zonyango ngokubanzi: uphando luya kuphakanyiswa kwi-physiotherapy kunye neeklinikhi zonyango apho abasebenzi beprojekthi sele benalo ubudlelwane. Izigulane ezithathwa ukuba zifanelekile ukufakwa ziza kunikwa iphepha leenkcukacha malunga neprojekthi kwaye bamenywa ukuba badibane nabasebenzi beprojekthi ngokuthe ngqo.

 

Kukho inkqubo emibini yokumisela ukufakwa kwesi sifundo: intetho yangaphambili ye-intanethi / ye-intanethi yalandelwa ukuhlolwa kweemvavanyo zonyango. Udliwano-ndlebe lokuqala luya kubona ixesha lokulimala kwe-whiplash (i-criteria yokungeniswa) kunye neentlungu ezilinganayo ngokusekelwe kwizikolo ze-NA, kunye neendlela zokungabikho zokukhutshwa. Ubunzima be-PTSD buza kusekelwe kwizikolo ze-PCL-5 ezinokuzithengisa, ezifuna ubuncinane amanqaku athile ngokumachiza kunye namanqaku amancinci ka-30 ngokubanzi. Inkcazo yeprojekthi iya kunikwa onke amavavolontiya kwinqanaba lokuqala loqhagamshelwano. Amavolontiya abonwa njengokuba afanelekileyo aya kumenywa ukuba aye kwi-clinical examination screen. Ukuba ngaphezulu kweeveki ezine kudlulela phakathi kwintlanganiso yodliwano-dliwano lwesefoni kunye nokuhlolwa kwekliniki kunokuba amanyathelo we-NA kunye ne-PCL-5 aya kulawulwa kwakhona.

 

Ngaphambi kokuba kwenziwe uvavanyo lokuhlola iikliniki, izavolontiya ziya kunikwa ulwazi ngolwazi-nxaxheba kwaye zacelwa ukuba zizalise amaxwebhu emvume enolwazi. Ngexesha loviwo lokuphonononga, abathathi-nxaxheba abanobudlelwane obunzima bokubambisana nokufana nokukhula kwe-spinal pathology baya kuqwalaselwa kwaye bangafakwa ngaphandle kokuthatha inxaxheba. Ukukhusela i-pathology enzulu, uvavanyo lokuxilongwa luya kwenziwa emva kwe-Motor Accident Authority ye-NSW Whiplash Guidelines [35]. Uhlolo lokuhlola luya kubandakanya udliwano-ndlebe lwengcali kunye nomncedisi wophando oya kulawulo lwe-PTSD ye-PNDX ye-5 (CAPS 5) ukucacisa ubungqina kunye nobukhulu be-PTSD [36]. Umncedisi wophando uya kuqinisekisa ukungabikho kwemigqaliselo yokungabikho njengembali edlulileyo okanye ukunikezwa kwangoku kwengqondo yengqondo, ukuphazamiseka kwengqondo, ukuphazamiseka kwengqondo kunye nokusetyenziswa kakubi kweziyobisi ngokweziyobisi. Ukuba abathathi-nxaxheba baxela ukuxilongwa kweenkqubo zokungabandakanywa kwicandelo elichaphazelekayo le-SCID-ndiya kusebenzisa ukucacisa ukuxilongwa.

 

Ngexesha lesikrini sokuqala okanye ngexesha lonyango, ukuba umntu othabatha inxaxheba ubonwa njengoyena mntu usemngciphekweni wokuzenzakalisa okanye wokuzibulala, uya kuthunyelwa kukhathalelo olufanelekileyo ngokwemigangatho yobungcali yoochwephesha bengqondo. Abathathi-nxaxheba abahlangabezana neekhrayitheriya zokubandakanywa (i-NDI> 30% kunye nokuchongwa kwe-PTSD) baya kuvavanywa kuwo onke amanyathelo esiphumo seziphumo ezisisiseko. Kungenzeka ukuba amavolontiya amenyiwe ukuba aye kuvavanyo lweklinikhi lokuvavanywa ngekhe ahlangabezane neekhrayitheriya zokubandakanywa (i-NDI> 30% kunye nokuchongwa kwe-PTSD) kwaye ke ayizukubandakanywa ekuthatheni inxaxheba. Amavolontiya aya kwaziswa ngeli thuba ngexesha lodliwanondlebe ngomnxeba nangexesha lenkqubo yemvume enolwazi. Udliwanondlebe luya kurekhodwa kwaye ukhetho olungenahleliwe luya kuvavanywa ngokungqinelana

 

Iingqinisiso zokufakwa

 

• I-WAD yeBakala lesi-II (i-37] engapheliyo kwimizuzu engama-3 ubuncinane kodwa ingaphantsi kwe-5 iminyaka
• Ubuncinci iintlungu eziphakathi kunye nokukhubazeka (> 30% kwi-NDI)
• Ukuxilongwa kwe-PTSD (DSM-5, APA, 2013) usebenzisa i-CAPS 5
• Umdala phakathi kwe-18 kunye ne-70 yeminyaka ubudala
• Unolwazi lwesiNgesi okanye isiDanish (ngokuxhomekeke kwilizwe lokuthatha inxaxheba)

 

Iimpawu zokungabikho

 

• Eyaziwayo okanye okhankanywayo obunzulu bokugulisa umthambo (isib. Izidumbu ze-metastatic, ezivuthayo okanye ezikhuselekileyo zomgudu)
• Ukuchithwa okanye ukuchithwa ngexesha lokulimala (WAD Grade IV)
• Iingcambu zeengcambu zilahla (ubuncinci i-2 yezibonakaliso ezilandelayo: ukutshatyalaliswa / ukutshintsha kwe-reflex / ukulahlekelwa kwintlupheko ehambelana nomnye wamagulane)
• Ugqirha lomlingo kwiinyanga ezidlulileyo ze-12
• Imbali okanye intetho yangoku ye-psychosis, i-bipolar disorder, i-brain disorder disorder okanye ukuxinezeleka okukhulu.

 

Usayizi wesampula

 

Sinesithakazelo ekufumaneni ulwahlulo olubalulekileyo lwezempilo phakathi kokungenelela okubini, kuba iinkalo zokuqala zecandelo ngalinye lilingana ngokulingana nesiphumo se-randomisation. Ukusukela kwisibini-test test-test isampuli ye-86 (43 ngeqela) liya kunika amandla e-80% ukufumana umahluko omkhulu kwi-alpha 0.05 phakathi kweqela lithetha iindlela ze-10 kwinqanaba le-100 NA (ngokuthatha i-SD ye-16, ngokusekelwe kwidata lethu lomqhubi kunye nedatha kwizilingo zamva nje). Iimpembelelo ezincinci kunokuba zingenakwenzeka ukuba ziqwalaselwe njengekliniki. Ukuvumela ukulahleka kwe-20% ukulandelwa ngeenyanga ze-12, siya kubafuna abathathi-nxaxheba be-54 ngeliqela lonyango.

 

Ukungenelela

 

Ukurhoxiswa

 

Abathathi-nxaxheba baya kunikwa igalelo kwinqanaba leyeza. Ishedyuli yokurhoxiswa iya kuveliswa yi-biostatistician. I-Randomisation iya kuba ngamabhulokhi avumelekileyo angaphambukiyo kwi-4 kwi-8. Iimvulophu ezifakwe ngokulandeleleneyo, ezibhaliweyo, ezivulekileyo ziza kusetyenziswa ukufihla i-randomisation. Ulwabiwo lweqela luya kwenziwa ngokukhawuleza emva kokugqitywa kwamanyathelo okusekwa ngumboneleli ozimeleyo (ongaboniyo uphando). Lo mncedisi uphando oya kulungiselela onke amaxesha okuqeshwa kunye nabaphengululi abayimfama kuzo zonke iziphumo zempatho. Abathathi-nxaxheba baya kufundiswa ukuba bangabonakali iinkcukacha malunga nenkatho yabo kumviwo ukuze bancedise ukuphazamisa. Izigulane ziya kulungiswa ukufumana unyango lwabo lokuqala kwiveki enye yokurhweba.

 

Iqela lokungenelela - I-Traum-focal-cognitive-therapy (CBT)

 

Ungenelelo lwengqondo olujolise kwiimpawu ze-PTSD luya kubandakanya iiseshoni ezili-10 zeeveki ezingama-60-90 zeeseshoni ezijolise ngokukodwa kwi-CBT esekwe kwizikhokelo ze-Australia zonyango lwabantu abadala abane-Acute Stress Disorder kunye ne-PTSD [38] (jonga 2 Table). Iseshoni yokuqala iya kugxila ekuboneleleni ngemfundo yengqondo ngokubhekisele kwiimpawu eziqhelekileyo ze-PTSD, ukugcina izinto kunye nokubonelela ngesiseko sezinto ezahlukeneyo zonyango. Iiseshoni ezimbini nezithathu ziya kuqhubeka nokukhulisa ulwazi lwesigulana seempawu ze-PTSD kwaye zifundise iindlela zokulawula uxinzelelo kubandakanya ukuphefumla okunzulu kunye nokuphumla kwezihlunu okuqhubekayo. Uhlengahlengiso lwengqondo olubandakanya ukucel'umngeni kwiingcinga ezingancediyo kunye ezingenangqondo kunye neenkolelo ziya kuqala kwiseshoni yesithathu kwaye ziqhubeke kulo lonke unyango. Abathathi-nxaxheba baya kuqala ukubonakaliswa ixesha elide kwiseshoni yesine eya kuthi ibhangqwe ngokuphumla kunye nomceli mngeni wokuqonda. Iseshoni yesithandathu iya kwazisa ukubonakaliswa okuhleliweyo kwi-vivo. Ukuphinda uthintelo kuya kubandakanywa kwiiseshoni ezimbini zokugqibela [12]. Abathathi-nxaxheba baya kucelwa ukuba bagqibezele umkhuba wasekhaya ngexesha leseshoni yabo eya kurekhodwa kwaye iziswe kwiseshoni elandelayo. Unyango luya kuhanjiswa ngoochwephesha ababhalisiweyo ngoqeqesho lwasemva kwesidanga sokuqala kunye namava ahambisa ungenelelo olujolise kwingxaki yomothuko.

 

Ithebula 2. Inkcazo yeprogram ye-CBT

iKhusi	isishwankathelo
1	Isingeniso kunye nesizathu
2	Uqeqesho lokuphumula
3	Uqeqesho lokuphumula kunye nobunzima beengcamango
4 and 5	Inkcazo engumngcipheko kunye nexesha elide
6	Ukubonakaliswa kwexesha elide kunye nokuchaswa kwe-vivo
7 and 8	Ukubonakaliswa kwexesha elide kunye nokuvezwa kwe-vivo
9	Ukuphinda uthintele
10	Ukuphindaphinda ukukhusela nokuphela kokonyango

 

 

Iqela lolawulo - Uncedo lweNyango

 

Iseshoni yokuqala iya kubandakanya imfundo malunga noxinzelelo kunye nenkcazelo yonyango loxhasayo. Iiseshoni ezilandelayo ziya kubandakanya iingxoxo zeengxaki zangoku kunye nezakhono zokusombulula iingxaki. Ukusetyenziswa kwekhaya kuya kubandakanya ukugcinwa kwedayari kweengxaki zangoku kunye nemizwelo. Ulwaphulo oluncedisayo luya kuphesela ngokukhawuleza ukukhutshwa, ukulungiswa kwengqondo okanye ukuphathwa koxinzelelo. Ukuba iziphumo zolu vavanyo ziyakuthandeka kwaye abathathi-nxaxheba abangenakwenziwa ngolu hlobo lokungenelela banokuxilongwa kwe-PTSD kwi-12 inyanga yokulandelelana, baya kunikwa ukuthunyelwa kwi-psychologist klinikhi.

 

Iprogram yo kuHlola

 

Ukulandela iseshoni ye-10 yeeseshoni zonyango (inxaxheba okanye ukulawula), Bonke abathathi-nxaxheba baya kuthatha inxaxheba kwinkqubo efanayo yokuzilolonga. Iprogram yovavanyo lweveki ye-6 iya kwenziwa phantsi kwesigqeba kwi-physiotherapist (iiseshoni ze-2 nganye kwiiveki ezine zokuqala; kunye neseshoni ye-1 ngeveki 5 kunye neveki ye6) kwaye iya kubandakanya iindlela ezithile zokuphucula ukuhamba nokulawula kwentamo kunye namabhinqa emigxala kunye nokusebenza okufanelekileyo kunye nokulungelelanisa (jonga i-Table 3). Ukuzivocavoca kuya kulungiswa ngumzimba we-physiotherapist ngamnye ngamnye.

 

Inkqubo iqala ngovavanyo lweklinikhi yeentloko zomlomo wesibeleko kunye nemisipha ye-axio-scapular-girding kwaye iquka iimvavanyo ezivavanya amandla okufumana izihlunu ngendlela edibeneyo, iimvavanyo zokulinganisela, i-parentesthesia ye-colervical kunye nokulawula ukunyakaza kwamehlo kunye neemvavanyo zokunyamezela komzimba Amanqanaba aphantsi okuqhekeza ngokuzithandela. Iimpazamo ezithile ezichongiweyo zibhekiswe kwiprogram yokuqhuba umsebenzi ejongene nokuqhutyelwa phambili yi-physiotherapist. Le nkqubo yonyango yenkcazo ichazwe ngokubanzi [15] kwaye igxininise ekusebenzeni nasekuphuculeni ukulungelelaniswa nokunyamezela amandla entanyeni ye-flexor, i-extensor kunye ne-scapular muscle kwimisebenzi ethile kunye nemisebenzi esebenzayo, kunye neprogram eneenkcukacha ezijoliswe kwi-postural control inkqubo, kubandakanywa nezenzo zokulinganisela, ukuqhutyelwa kwintloko yokufudukela kwintloko kunye nokuzivocavoca ukulawula ukuhamba kwamehlo.

 

Abathathi-nxaxheba baya kwenza imithambo ekhaya, kanye ngemini. Incwadi yelog iya kugqitywa ngabathathi-nxaxheba ukurekhoda ukuthotyelwa kwemithambo. Kwangelo xesha, i-physiotherapist iya kukhokelela kwizifundo ukuba zibuyele kwimisebenzi yesiqhelo.

 

Iiphysiotherapists ziya kuhambelana nemigaqo-nkqubo yokuziphatha ngexesha lokuqeqesha kunye nokulawulwa kwazo zonke izixhobo [26]. Imigaqo-mpawu yokuziphatha kwengqondo iquka ukukhuthazwa kokuthengwa kwekhono ngokufakela imodeli, ukubeka iinjongo eziqhubekayo, ukubeka iliso kwinkqubela phambili, kunye nokuqiniswa okubonakalayo kwenkqubela phambili. Ukuzithemba kuya kukhuthazwa ngokukhuthaza izifundo ukuba zenze ingxaki yokusombulula iingxaki kunokuba zifune ukuqinisekiswa kunye neengcebiso, ngokukhuthaza iziphumo ezifanelekileyo ezifanelekileyo kunye nokukhuthaza ukuziqinisa. Umsebenzi wemihla ngemihla ekhaya uya kukhuthazwa kwaye uhlolwe usebenzisa idayari. Imiyalelo yokusebenzisa imiyalelo iya kubonelelwa.

 

3 Table. Ubume benkqubo yesenzo

Iveki	Iiseshoni ngeveki	amacandelo
1	2	Isiseko kunye novavanyo lokulandelela ukukhokela ukumiselwa kokuqala kunye nenkqubela phambili yenkqubo Zilolonge ukuphucula imisipha yomlomo wesibeleko kunye ne-scapular, kinaesthesia kunye nebhalansi Imfundo neengcebiso Inkqubo yasekhaya yemihla ngemihla kubandakanya ukuzilolonga kunye nokwanda okuhleliweyo kwemisebenzi yomzimba Imigaqo ye-CBT enjengokumiselwa kweenjongo, ukomeleza okusetyenziswa zii-physiotherapists Session Ukukhupha iseshoni ukomeleza inkqubela phambili kunye nesicwangciso somsebenzi oqhubekayo
2	2
3	2
4	2
5	1
6	1

 

 

Izisiphumo

 

Kuvavanyo lokuqala, iimpawu zobuqu ezifana nobudala, ubulili, izinga lemfundo, isimo sembuyekezo, usuku lwengozi kunye nolwazi malunga neempawu ze-whiplash ziya kuqokelelwa. Amanyathelo okulandela ezi zilandelayo aya kuhlolwa ngumbono ongenamfama kwinqanaba, iiveki ze-10, iiveki ze-16, iinyanga ze-6 kunye neenyanga ze-12 zithuba emva kokuhlaziywa.

 

Inkcazo yokukhubazeka kweNeck (i-NDI) iya kuba yiprayimari yesiphumo esiphambili [21]. I-IN ingumlinganiselo ochanekileyo kunye nenyathelo elithembekileyo yentlungu yokukhubazeka ephakamileyo yentsimbi [21] kwaye icetyiswa ukuba isebenziswe nguMbutho wePlastiki kunye neCandelo lamaKhosi eMinyaka yeeNtshontsho (7) kunye neNgqungquthela ye-Whiplash yamazwe ngamazwe [11, 16].

 

Amanyathelo omphumo wesibini afaka:

 

1. Umlinganiselo wentlungu ephezulu kwiveki ephelileyo (i-0-10 isikali) [39]
2. Umlinganiselo wesantya uxinzelelo kwiiyure zokugqibela ze-24 (isikali se-0-10) [39]
3. Umbono wezigulana ngokubuyela kwimeko yesiqhelo (-5 ukuya kuthi ga kwisikali se-5) [39]
4. Ugqirha ulawulo lwe-PTSD kwisi5 (CAPS 5) [40].
5. Uluhlu lokuhlola lwe-PTSD (i-PCL-5) [41]
6. Ukuxinezeleka Uxinzelelo lwe-stress-21 (DASS-21) [42]
7. Umlinganiselo wesizukulwana wezinga lempilo (SF-12) [43]
8. Umlinganiselo owenziwe ngumonde wokukhubazeka (Isigulane-esisodwa seSikhathi esisebenzayo) [44]
9. Amanyathelo okwenyama (intlupheko yomlomo wesibeleko, umlenze wexinzelelo, uxinzelelo lwentlungu ebandayo)
10. Ubunzima bokuPhathwa kweNhlungu (PCS) [45]
11. I-Questionnaire ye-Self-Efficiency Questionnaire (PSEQ) [46]
12. I-Tampa Scale yeKinesiophobia (TSK) [47]

 

Ukulindela kwempembelelo yonyango oluxhamlayo kuya kulinganiswa kunye ne-Credibility Expectancy Questionnaire (CEQ) [48] kwiveki yokuqala kunye neyokugqibela yonyango ngalinye. Ukusebenzisana okusebenzayo njengoko kuchazwe ngumxhasi kunye nodokotela (psych okanye physio) kuya kulandelwa kwiveki yokuqala neyokugqibela kwonyango ngalinye usebenzisa i-Working Alliance Inventory (WAI) [49].

 

Ukubeka iliso kwiSayithi zeZonyango

 

Iindawo zonyango ziya kufumaneka kwiindawo ezinokufumaneka lula kwizithuthi zikawonkewonke. Iimvavanyo ziya kwenziwa ukuba zinezo zengqondo kunye neeseshoni zoqeqesho ezigcinwe kwisayithi enye. Ngaphambi kokuqala kwetyala, izazi zeengqondo kunye ne-physiotherapists kwisayithi nganye yonyango ziya kunikwa umgaqo-nkqubo ochaphazelekayo. Iingcali zengqondo ziza kuqeqeshwa ukuphumeza inkqubo ye-CBT kunye neyeza ezixhaswa ngabaphandi abakhulu kwiindibano zocweyo zomhla. Iiphysiotherapists ziya kuqeqeshwa ngabaphandi abakhulu ukuphumeza inkqubo yoqeqesho kwinkqubo yokusebenzela enye.

 

Ngaphambi kokuba uqalise uvavanyo, amaziko anikezela ngeenkonzo ezahlukeneyo kunye nabagqirha baya kunikelwa ikopi yenkqubo yesilingo kunye nonyango. Zomibini zonyango zonyango ziya kuqhutywa ngokulandelelana kwenkqubo. Iingcali ziyakufuneka ukuba zirekhode iseshoni nganye kwaye zizalise uluhlu lokutshekisha kwi-protocol. Isampuli esingahleliyo kwezi rekhodi kunye nohlalutyo luza kuvavanywa kwaye kubekwe esweni oluqhubekayo olunikezwa yingcali yeengqondo kwiqela lophando. Imizimba ye-Physiotherapy iya kusekelwe kwisilingo sokuqala sokuvavanya kwi-WAD engapheliyo [25]. Ukuphicothwa kweeseshini ze-physiotherapy kuya kwenziwa kabini ngexesha lokungenelela ngongcali ophando oluphezulu kule ndawo. Ukunikezelwa kuza kwenzeka phakathi kwengqondo kunye ne-physiotherapist ukuqhubeka nokunyamekela.

 

Iziganeko ezimbi

 

Ngaphandle kwekomiti yokuziphatha eqhelekileyo enikezelwe ngamalungiselelo okunika ingxelo ngemiphumo emibi, izacatshulwa ziya kucelwa ukuba zibike naziphi na iziganeko ezimbi kwiiNtloko zoPhando. Kwakhona kwi-16 iveki yokulandelelana, ulwazi malunga nemiphumo emibi yonyango iya kufunwa kuzo zonke izifundo usebenzisa imibuzo evulekile. Kwi-6 kunye ne-12 ilandelelwano lweenyanga, idatha ephathelele kwinani lokubuhlungu kwentlungu, kunye nenani lonxibelelwano lwezempilo luya kuqokelelwa.

 

Uhlalutyo lweSatisati

 

Isifundo se-biostatistician siya kuhlalutya idatha ngendlela ephosakeleyo. Konke ukuhlalutya kuya kwenziwa ngenjongo yokuphatha isiseko. Iziphumo eziphambili nezesekondari ezilinganiselwe kwiiveki ze-10, iiveki ze-16, iinyanga ze-6, kunye neenyanga ze-12 ziya kuhlaziywa ngokusebenzisa imodeli yokuhlukumeza edibeneyo kunye neendlela eziza kubandakanywa amanqaku asemgangathweni abo njengesivumelwano, izifundo njengemiphumo engahleliyo kunye nemeko yonyango njengoko izinto. I-Diagnostics izakusetyenziswa ukuhlolisisa iingcinga, kubandakanywa ukuhambelana kwamanani. Ubungakanani bemibala buya kubalwa kuwo onke amanyathelo kunye nobukhulu be0.2 njengento encinci, i-0.5 kunye ne-0.8 enkulu. I-Alpha iya kusekwa kwi-0.05. Nawuphi na umphumo wesayithi (i-Qld okanye iDenmark) iya kuvavanywa ngokubandakanya indawo yexesha lokusebenzisana kweqela-nge-time kwiimodeli ezixutywayo. Ukuguqulwa kwesiphumo kuya kuhlolwa kuphela kwisiphumo esiphambili se-NA.

 

Inkxaso

 

• Ulingo luxhaswa ngemali nge-NHMRC Project grant 1059310.
• IBhunga leProjekthi ye-Danish Victims Fund i-14-910-00013

 

Okubalulekileyo

 

Le projekthi ijongene nengxaki ebaluleke kakhulu kwimpilo yabantu. I-Whiplash ngumthwalo omkhulu wempilo kwi-Australia kunye nakwamanye amazwe apho kukho izithuthi. Iindlela ezisetyenziswayo ezikhoyo zokulawulwa kwe-WAD ezingapheliyo ziboniswe ukuba zisebenza ngokukhawuleza. Esinye isizathu sokuba oku kungenziwa ngenxa yokungabikho kokuqwalaselwa kwindlela esetyenziswayo ngokusesikweni kwengqondo yezigulane ezilinzakeleyo. Olu pho nonongo luya kunika uvavanyo oluchanekileyo lwemiphumo yokufaka i-CBT egxininisekile ekusebenziseni abantu abane-WAD engapheliyo ne-PTSD.

 

Olu phofu lunokuchaphazela ukulawulwa kweklinikhi yengozi ye-whiplash kwaye iya kuba nekliniki yokusebenza ngokukhawuleza. Nakuphi na ukungenelela okuya kuphucula iziphumo zempilo kubantu abane-whiplash esingapheliyo kuya kuba nefuthe elide kwiAstreliya nakwamanye amazwe. Uphononongo lwethu luya kuba nefuthe kubo bobabini bezempilo kunye nabasebenzi bomshuwalense kwizigqibo zabo malunga nokukhetha unyango kunye nenkxaso-mali. Uphando lwe-WHO International Clinical Trials Registry Platform Research Portal kwi-2 / 3 / 13 ayibonakali nolu vavanyo olucwangcisiweyo okanye olugqityiweyo oluya kuphinda luphindwe umsebenzi wethu.

 

Ukungquzulana kweNtshisekelo

 

Ababhali bavakalisa ukuba akukho mpikiswano.

 

Indima yeengxaki zengqondo kwi-Recover from Common Whiplash

 

Abstract

 

Kuyakwamkelwa ngokubanzi ukuba izinto zengqondo zihlobene nokuziphatha kokugula kwaye kukho ubungqina bokuba banokuchaphazela izinga lokubuyiswa kwezifo ezibangelwa yintlungu. Amandla okuxinwa kwengqondo, iimpawu ze-somatic, kwaye ngokuzenzekelayo ahlolwe ukukhubazeka kwengqondo ukuqikelela ukuba ukuphulukana okukhawulezileyo kwi-whiplash efanayo kuqhutyelwe uphando olulandelayo. Izigulane ze-78 ezilandelelanayo ezibhekiselele kwi-7.2 (SD 4.5) iintsuku emva kokuba zenze i-whiplash efanayo kwiingozi zeemoto zahlolwa ukunyamezela kwengqondo, ukukhathazeka okungathandekiyo, iimpawu zobuntu, izikhalazo ze-somatic, kunye nokuphazamiseka kwengqondo kunye novavanyo oluninzi oluqhelekileyo. Kwiinyanga ze-6 kamva izigulane ze-57 zafunyanwa ngokupheleleyo kwaye i-21 yayineempawu eziqhubekayo. Amanqaku amaqela eenguqu ezizimeleyo ezivandlakanywe kumviwo-siseko aqikelelwe. Uhlalutyo olwenziwe ngokukhawuleza lubonisa ukuba izinto zengqondo, ukungathinteki kakubi, kunye neempawu zobuntu zazingabalulekanga ekuqaliseni isiphumo. Nangona kunjalo, ubuhlungu bokuqala buhlungu entanyeni, ukukhubazeka okunxulumene nokulimala, kunye nobudala bezinto ezibalulekileyo zokuqikelela ukuziphatha kwezifo. Esi sifundo, esasisekelwe kwisampula esingalindelekanga kwaye esaqwalasela ezinye izinto ezinokuthi ziqikelele kunye neemeko zengqondo, azixhasayo iziphumo ezidlulileyo ukuba iziganeko zengqondo ziqikelela ukuziphatha kwezigulane kwizigulane zentsholongwane.

 

Insight of Dr. Alex Jimenez

Ukubandakanyeka engozini yemoto kunokuba yinto ephazamisayo kunoma ubani. Ukuxhatshazwa ngokwenyama kunye neengxaki zemali, ukukhathazeka ngokomzwelo, ingozi yemoto ingafaka umthwalo onzima kulabo bantu abaye bafumana, ngakumbi ukuba ukulimala kwengozi yemoto kuqale ukuthatha inkokhelo engqondweni. Izigulane ezininzi zivakashela iofisi ye-chiropractic ngokuxhalabisa, ukwesaba okungenangqondo, ukudandatheka kunye ne-PTSD emva kokubandakanyeka kwingozi yemoto. Ukufunda ukuthembela kwakhona ukufumana ukunakekelwa kwe-chiropractic kunokuba ngumngeni, kodwa ngokulungelelanisa nokusebenza kakuhle kwemilenze kunye nokunyanzeliswa kwemisebenzi, abasebenzi bethu banokunika izigulane ngengqondo yokhuseleko abayidingayo ukuqhubeka unyango kunye nokufezekisa impilo kunye nokuphila kakuhle.

 

Ukuququmbela,Iingozi zeemoto zinokubangela ukonzakala komzimba kunye neemeko, ezinje nge-whiplash, iintlungu zomqolo kunye nentloko, kunye nemicimbi yezemali, nangona kunjalo, ukonzakala kwengozi yemoto kunye neengxaki zinokukhokelela kuxinzelelo lweemvakalelo. Ngokwezifundo zophando ezisekwe kubungqina, njengale ingentla, uxinzelelo lweemvakalelo luye lwadityaniswa neempawu ezingapheliyo zentlungu. Ngethamsanqa, abaphandi baye baqhuba uphando oluninzi ukubonisa indlela ukungenelela kwengqondo, njengokunakekelwa kwe-chiropractic, kunokunceda ukunciphisa uxinzelelo lweemvakalelo kunye nokuphucula iimpawu ezibuhlungu. 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. Umqolo obuhlungu isikhalazo esiqhelekileyo esinokubangelwa 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

 

 

IINGCUKACHA EZIBALULEKILEYO: UKUPHATHA KWE-EXTRA: I-Car Accident Injury Treatment El Paso, TX I-Chiropractor