Ukwamkela idatha yeenkcukacha, Iintlungu ezisezantsi ziba ngumphumo weentlobo zenzakalo kunye / okanye iimeko ezichaphazela i-lumbar umgudu kunye nezakhiwo zayo ezizungezile. Uninzi lweemeko zentlungu ephantsi, nangona kunjalo, ziya kuzixazulula ngokwabo kwimiba yeeveki. Kodwa xa iimpawu zeentlungu ezisezantsi zihlala zingapheliyo, kubalulekile ukuba umntu ochaphazelekayo afune unyango kwi-professional healthcare professional. Indlela kaMcKenzie isetyenziswe ngabaninzi beengcali zonyango ekwenzeni unyango oluphantsi kunye neziphumo zalo zibhaliswe ngokubanzi kwiinkalo ezahlukeneyo zophando. Amanqaku amabini alandelayo anikezelwa ukuhlola indlela kaMcKenzie kunyango lwe-LBP xa kuthelekiswa nezinye iintlobo zokhetho lwezokwelapha.

 

Ukusebenza kweMcKenzie Indlela yezilwanyana ezineNtsholongwane engaphantsi kweNonspecific: Iprotocol ye-Randomised-Placebo-Controlled Trial

 

Abstract

 

• imvelaphi: Indlela kaMcKenzie isetyenziswe ngokubanzi njengongenelelo olusebenzayo kunyango lwezigulane ezinentlungu engapheliyo. Nangona indlela kaMcKenzie ifaniswe namanye amanyathelo angenelelo, ayikaziwa nokuba le ndlela iphezulu kune-placebo kwizigulane ezineentlungu ezingapheliyo.
• Injongo: Injongo yolu vavanyo kukuvavanya indlela esebenzayo kuMcKenzie kwizigulane ezineentlungu ezingapheliyo.
• Design: Umtshini-mvavanyo-mpuphu, ingalo ye-2, ityala elilawulwa yindawo ye-placebo liza kwenziwa.
• Ukubeka: Olu phononongo luya kuqhutywa kwiiklinikhi zonyango lomzimba e-S�o Paulo, eBrazil.
• Aba nxaxheba: Abathathi-nxaxheba baya kuba zizigulane ze-148 zifuna ukunakekelwa kweentlungu ezingapheliyo ezinqumeni.
• Ukungenelela: Abathathi-nxaxheba baya kunikwa ikhefu kwi-1 yamaqela enyango ye-2: (1) Indlela ye-McKenzie okanye (2) i-placebo yonyango (i-ultrasound ekhutshwe ngayo kunye neyeza elincinci). Iqela ngalinye liya kufumana iiseshoni ze-10 zemizuzu ye-30 nganye (iiseshoni ze-2 ngeveki kwiiveki ze-5).
• Imilinganiselo: Iziphumo zeklinikhi ziya kufumaneka ekugqityweni kwonyango (iiveki ze-5) kunye ne-3, i-6, kunye ne-12 inyanga emva kokuhlaselwa. Iziphumo eziphambili ziya kuba nobuhlungu obukhulu (ukulinganiswa kunye neSibalo soBalo lweNqanaba lobuNqanaba) kunye nokukhubazeka (kulinganiswa ne-Questionnaire yokukhubazeka kwe-Roland-Morris) ekugqityweni kwonyango. Iziphumo zesibini ziya kuba nobuhlungu obukhulu; ukukhubazeka kunye nomsebenzi; i-kinesiophobia kunye nefuthe elibonakalayo kwihlabathi kwi-3, i-6, kunye ne-12 inyanga emva kokuhlaziywa; kunye nesimo sokuxhaswa kwezilwanyana kunye nefuthe elibonakalayo lehlabathi ekugqityweni kwonyango. Idatha iya kuqokelelwa ngumhloli ongenamfama.
• Imida: Iingcali ziza kuphazamiseka.
• Izigqibo: Le nto iya kuba yilingo lokuqala lokuqhathanisa indlela kaMcKenzie kunye ne-placebo yonyango kwizigulane ezineentlungu ezingapheliyo. Iziphumo zolu pho nonongo ziya kubangela ulawulo olungcono lwaba bantu.
• Isihloko: Ukuzivocavoca, Ukulimala kunye neMeko: I-Low Back, iiprotoksi
• Icandelo leSiqendu: Protocol

 

Intlungu ephantsi yomqolo yimeko enkulu yempilo ehambelana nezinga eliphezulu lokungabikho emsebenzini kunye nokusetyenziswa rhoqo kweenkonzo zempilo kunye namalungelo ekhefu lomsebenzi.[1] Iintlungu ezisezantsi zamva nje zilinganiswe yi-Global Burden of Disease Study njengenye yeemeko zempilo ze-7 ezichaphazela kakhulu abantu behlabathi, [2] kwaye ithathwa njengemeko yempilo ephazamisayo echaphazela abantu abaninzi kwiminyaka ubomi bonke.[2] Inqaku lokuxhaphaka kweentlungu ezisezantsi kuluntu jikelele kubikwa ukuba lufikelela kwi-18%, ukunyuka ukuya kwi-31% kwiintsuku ze-30 zokugqibela, i-38% kwiinyanga ezidlulileyo ze-12, kunye ne-39% nakweyiphi na indawo ebomini.[3] Iintlungu ezisezantsi zikwanxulunyaniswa neendleko zonyango eziphezulu.[4] Kuqikelelwa ukuba kumazwe aseYurophu iindleko ezithe ngqo nezingangqalanga ziyahluka ukusuka kwi-�2 ukuya �4 yeebhiliyoni ngonyaka.[4] Ukuxilongwa kweentlungu ezisezantsi kuhambelana ngokuthe ngqo nobude bexesha leempawu. yeendleko zolawulo lweentlungu zangasemva, ukuvelisa imfuno yophando olujolise ekufumaneni unyango olungcono kwezi zigulana.

 

Kukho iindlela ezininzi zokungenelela kunyango lwezigulane ezineentlungu ezingapheliyo ezisezantsi, kuquka indlela kaMcKenzie eyenziwe nguRobin McKenzie eNew Zealand kwi-1981. Indlela kaMcKenzie (eyaziwa nangokuthi i-Mechanical Diagnosis and Therapy [MDT]) yonyango olusebenzayo olubandakanya ukunyakaza okuphindaphindiweyo okanye izikhundla eziqhubekayo kwaye inecandelo lezemfundo ngenjongo yokunciphisa intlungu kunye nokukhubazeka kunye nokuphucula ukuhamba komgogodla.[8] Indlela kaMcKenzie ibandakanya ukuvavanywa kweempawu kunye neempendulo zemishini kwiintshukumo eziphindaphindiweyo kunye nezikhundla ezizinzileyo. Iimpendulo zezigulane kolu vavanyo zisetyenziselwa ukuzihlela zibe ngamacandelwana okanye ii-syndromes ezibizwa ngokuba yi-derangement, ukungasebenzi, kunye nokuma.[8�8] Ukuhlelwa ngokwelinye lala maqela likhokela imigaqo yonyango.

 

 

I-Derangement syndrome liqela elikhulu kwaye libonakaliswe zizigulane ezibonisa ukuphambili (ukuguquka kwentlungu esuka kude ukuya kwi-proximal) okanye ukusabalalisa intlungu [11] ngokuhlolwa kokunyakaza okuphindaphindiweyo kwelinye icala. Ezi zi gulane ziphathwa ngokunyuka ngokuphindaphindiweyo okanye izikhundla ezizinzileyo ezinokunciphisa intlungu. Izigulane ezichazwe njenge-syndrome ye-dysfunction zibonakalisa intlungu eyenzeka kuphela ekupheleni kwenkqubela yokuhamba enye inye. [8] Intlungu ayitshintshi okanye ixhomekeke ekuvavanyeni okuphindaphindiweyo. Umgaqo wonyango wezigulane ezingasebenziyo uhamba ngokuphindaphindiweyo kwisalathiso esabangela intlungu. Ekugqibeleni, izigulane ezichazwe njengezifo zengqondo zangemva kweso sifo zintlungu ephakathi nje kuphela ngexesha lokuhlala ngokuqhubekayo ekupheleni kwenkqubo yokunyuka (umzekelo, ukuhlala okulondoloziweyo okuqhubekayo). [8] Umgaqo wonyango wale syndrome uqulethe ukulungiswa kwesikhashana. [11]

 

Indlela kaMcKenzie ikwabandakanya icandelo lezemfundo elomeleleyo elisekwe kwiincwadi ezinesihloko esithi The Lumbar Spine: Mechanical Diagnosis & Therapy: Volume Two [11] and Treat Your Own Back. [12] Le ndlela, ngokungafaniyo nezinye iindlela zonyango, ijolise ekwenzeni izigulana ukuba zizimelele kunyango ngangokunokwenzeka kwaye ke zikwazi ukulawula iintlungu zabo ngononophelo lwasemva nasemva kokwenza imithambo ethile yengxaki yabo. [11] Ikhuthaza izigulana ukuba zihambise umqolo kwicala elingenabungozi kwingxaki yazo, oko ke kuthintele ukuthintelwa kokuhamba ngenxa ye-kinesiophobia okanye iintlungu. [11]

 

Iingxelo ezimbini zangaphambili ezicwangcisiweyo ziye zahlalutya imiphumo yendlela kaMcKenzie [9,10] kwizigulane ezineentlungu ezibuhlungu, eziphantsi, kunye nezingapheliyo. Uphononongo olwenziwa nguClare et al [9] lubonise ukuba indlela kaMcKenzie ibonise iziphumo ezingcono kwiintlungu zexesha elifutshane kunye nokuphucula ukukhubazeka xa kuthelekiswa nokungenelela okusebenzayo njengokuzivocavoca umzimba. Uphononongo olwenziwa nguMachado et al [10] lubonise ukuba indlela kaMcKenzie yanciphisa intlungu kunye nokukhubazeka kwixesha elifutshane xa kuthelekiswa nonyango olwenziwayo lweentlungu ezibuhlungu ezisezantsi. Kwiintlungu ezingapheliyo ezibuhlungu eziphantsi, ukuhlaziywa kwe-2 akukwazanga ukwenza izigqibo malunga nokusebenza kwendlela kaMcKenzie ngenxa yokungabikho kwezilingo ezifanelekileyo. Izilingo ezilawulwa ngokungahleliwe eziye zaphanda indlela kaMcKenzie kwizigulane ezineentlungu ezingapheliyo ezibuhlungu [13�17] zithelekisa indlela kunye nezinye iindlela zokungenelela ezifana nokuqeqeshwa kokumelana, [17] indlela kaWilliam, [14] ukuzivocavoca okungalawulwayo, [16] isiqu. ukuqinisa,[15] kunye nemithambo yokuzinzisa.[13] Iziphumo ezingcono ekunciphiseni ubunzima beentlungu zifunyenwe ngendlela kaMcKenzie xa kuthelekiswa nokuqeqeshwa kokumelana, [17] indlela kaWilliam, [14] kunye nokuzivocavoca okulawulwayo [16] Nangona kunjalo, umgangatho wemethodi yolu lingo[13�17] ungowona uphezulu.

 

Kuyaziwa kwiincwadi zokuthi indlela kaMcKenzie ivelisa iziphumo ezizuzisayo xa kuthelekiswa nongenelelo lwezonyango kwizigulane ezineentlungu ezingapheliyo; Nangona kunjalo, ukuza kubekho namhlanje, akukho zifundo ziye zafanisa indlela kaMcKenzie ngokubhekiselele kunyango lwe-placebo ukwenzela ukuchonga ukusebenza kwayo. UClare et al [9] wagqitha imfuneko yokuthelekisa indlela kaMcKenzie kunye ne-placebo unyango kwaye ufunde imiphumo yendlela ngexesha elide. Ngamanye amagama, awaziwa ukuba imiphumo emihle yeCheck McKenzie ingenxa yokusebenza kwayo kwangempela okanye nje kuphela kumphumo we-placebo.

 

Injongo yale sifundo iya kuba ukuvavanya indlela esebenzayo ye-McKenzie kwizigulane ezineentlungu ezingapheliyo zentlungu ezisezantsi ezinokusebenzisa isilingo esiphezulu esilungelelaniso se-placebo.

 

indlela yokwenza

 

IsiCwangciso soFundo

 

Oku kuya kuba ngumhloli ophononongo-mpu, ingalo ye-2, ityala elilawulwa yindawo elawulwa yindawo.

 

UkuFundela

 

Olu phononongo luya kuqhutywa kwiiklinikhi zonyango lomzimba e-S�o Paulo, eBrazil.

 

Ulungelelwaniso olufanelekileyo

 

Uphononongo luya kufaka izigulane ezifuna ukunakekelwa kweentlungu ezingapheliyo ezingaphantsi (ezichazwe njengeentlungu okanye ukuphazamiseka phakathi kweendleko ezibizileyo kunye neentlobo ezingaphantsi kwamagqabi, kunye okanye ngaphandle kweempawu ezibhekiselwe kumalungu angaphantsi, ubuncinane kwiinyanga ze-3 [18]), kunye ubukhulu bokuba ubunzima bokuba ubuncinane beengcambu ze-3 njengoko zilinganiselwe nge-0- kwi-10-Point Point ye-Numerical Rating Scale, ubudala phakathi kwe-18 kunye ne-80 iminyaka, kwaye bakwazi ukufunda isiPutukezi. Izigulane ziza kukhutshwa ngaphandle kokuba ziphikisana nokuzivocavoca umzimba (19] okanye i-ultrasound okanye i-shortwave therapy, ubungqina bentsholongwane yentsholongwane (oko kukuthi, enye imoto okanye ngaphezulu, i-reflex, okanye i-sensation deficits). , izifo ezivuthayo kunye nezifo ezithintekayo), izifo ezinzulu zesifo senhliziyo kunye nesifo se-metabolic, ukuhlinzwa kwangaphambili, okanye ukukhulelwa.

 

Procedure

 

Okokuqala, izigulane ziza kuxoxwa ngumbononongo ophononongoleyo, oya kugqiba ukufaneleka. Izigulane ezifanelekileyo ziya kwaziswa malunga neenjongo zesifundo kwaye zicele ukuba zisayine ifomu yokuvuma. Emva koko, idatha yesigulane yesigulane kunye nomlando wezokwelapha uya kubhalwa. Umvavanya uya kuqokelela iinkcukacha ezihambelana neziphumo zophando ekuhloleni okusisiseko, emva kokugqitywa kweeveki ze-5 zonyango, kunye ne-3, 6, kunye ne-12 inyanga emva kokuhlaziywa. Ngaphandle kwemilinganiselo yesiseko, zonke ezinye iimvavanyo ziya kuqokelelwa ngefowuni. Yonke into yokungena yedatha iya kubhala, ifakwe kwi-Excel (Microsoft Corporation, Redmond, Washington) ispredishithi, kwaye ihlolwe kabini phambi kohlalutyo.

 

 

Izisiphumo

 

Iziphumo zekliniki ziya kulinganiswa ekuhlolweni kokuqala, emva kokunyanga, kunye ne-3, i-6, kunye ne-12 inyanga emva kokunikezelwa okungahleliwe. Iziphumo eziphambili ziya kuba nobuhlungu obukhulu (ukulinganiswa kunye ne-Pain Numerical Rating Scale) [20] kunye nokukhubazeka (kulinganiswa ne-Questionnaire yokukhubazeka kwe-Roland-Morris) [21,22] emva kokugqitywa kweeveki ze-5 zonyango. Iziphumo zesibini ziya kuba nobuhlungu kunye nokukhubazeka i-3, i-6, kunye ne-12 inyanga emva kokusabalalisa nokukhubazeka kunye nomsebenzi (kulinganiswa yi-Patient-Specific Functional Scale), [20] isesiophobia (kulinganiswa neTampa Scale of Kinesiophobia), [23] kunye nempembelelo ebonakalayo yomhlaba wonke (kulinganiswa ne-Global Effected Scale Scale) [20] emva kwonyango kunye ne-3, i-6, kunye ne-12 inyanga emva kokuhlaziywa. Ngomhla wovavanyo lokuqala, umlwelwane ngamnye wokulinda uphuculo luya kuhlolwa kunye nokulindeleka koPhuculo loPhuculo lweNombolo, [24] olulandelwe uvavanyo usebenzisa indlela kaMcKenzie. [8] Izigulane zinokufumana ukugqithisa kweempawu emva kovavanyo lokuqala ngenxa yokuhlolwa komzimba we-MDT. Yonke imilinganiselo yayiphambene neenkcubeko ngokulandelelana kwisiPutukezi kwaye ihlolwa iiklinikhi kwaye ichazwe ngezantsi.

 

Ubunzima bobuNani boLungiso

 

I-Pain Numerical Rating Scale sisikali esivavanya amanqanaba obunzima beentlungu ezibonwa ngumguli usebenzisa isikali se-11-point (esihluka ukusuka kwi-0 ukuya kwi-10), apho i-0 imele � akukho ntlungu� kwaye i-10 imele �intlungu embi kakhulu. �[20] Abathathi-nxaxheba baya kuyalelwa ukuba bakhethe umndilili wokuqina kweentlungu ezisekelwe kwiintsuku ezi-7 zokugqibela.

 

I-Questionnaire yokukhubazeka kaRoland-Morris

 

Le mibuzo iqukethe izinto ze-24 ezichaza imisebenzi yemihla ngemihla izigulane zinzima ukuzenza ngenxa yentlungu ephantsi. [21,22] Iphakamileyo inani leempendulo eziqinisekileyo, eziphakamileyo izinga lokukhubazeka elihambelana nentlungu ephantsi. [21,22] Aba nxaxheba baya kufuneka ufundiswe ukuba uzalise i-questionnaire esekelwe kwiiyure zokugqibela ze-24.

 

Isigulane esisebenzayo seMonde

 

Isilinganiselo sokuSebenza ngokuPhezulu sisigxina sehlabathi; Ngenxa yoko, inokusetyenziswa kuyo nayiphi na inxalenye yomzimba. [25,26] Izigulane ziya kucelwa ukuba zichonge imisebenzi ye-3 abavakalelwa ukuba ayinakuyenza okanye ukuba kunzima ukuyenza ngenxa yentlungu yabo yangaphantsi. [25,26] Imilinganiselo ziya kuthathwa ngokusetyenziswa kohlobo lwe-Likert, i-11-point scales kumsebenzi ngamnye, kunye namanqaku aphakamileyo aphezulu (ukusuka kwi-0 ukuya kwi-10 points) emele amandla angcono yokwenza imisebenzi. [25,26] Siya kubala umyinge wale mi sebenzi esekelwe iiyure zokugqibela ze-24, ngamanqaku okugqibela ukusuka kwi-0 ukuya kwi-10.

 

Isiphumo soMhlaba oPhezulu

 

I-Scale Perceived Effect Scale luhlobo lwe-Likert, isikali esinamanqaku ali-11 (ukusuka ku-5 ukuya ku-5) othelekisa imeko yomguli kunye nemeko yakhe ekuqalekeni kweempawu. [20] Amanqaku afanelekileyo asebenza kwizigulana ezingcono kwaye amanqaku amabi asebenza kwizigulana ezibi kakhulu ngokunxulumene nokuqala kweempawu. [20]

 

Tampa Scale of Kinesiophobia

 

Esi sikali sivavanya inqanaba le-kinesiophobia (uloyiko lokuhamba) ngokusebenzisa imibuzo ye-17 ejongene nentlungu kunye nokuqina kweempawu.[23] Amanqaku kwinto nganye ahluka ukusuka kwi-1 ukuya kwi-4 amanqaku (umz., inqaku eli-1 �ngokungavumelani kakhulu,� amanqaku ama-2 �ngokungangqinelani ngokupheleleyo,� amanqaku ama-3 xa �ndivuma,� kunye neengongoma ezi-4 �ndivuma kakhulu�).[23] Kumanqaku ewonke, kuyimfuneko ukuguqulela amanqaku emibuzo 4, 8, 12, no-16.[23] Amanqaku okugqibela angahluka ukusuka kwi-17 ukuya kwi-68 amanqaku, kunye namanqaku aphezulu amele i-degree ephezulu ye-kinesiophobia. [23]

 

Ukulindeleka koPhuculo lweeNombolo zeNombolo

 

Esi sikali sivavanya ixesha elilindelekileyo lesigulane sokuphucula emva konyango kubudlelwane nonyango oluthile.[24] Iqulathe isikali samanqaku ali-11 ahluka ukusuka ku-0 ukuya kwi-10, apho u-0 umele �akukho xesha lilindelekileyo ukuphuculwa� kwaye i-10 limela �ukulindela uphuculo olukhulu olunokwenzeka.[24] Esi sikali siya kulawulwa kuphela ngosuku lokuqala lokuphucula Uvavanyo (isiseko) phambi kwe-randomization. Isizathu sokubandakanya esi sikali kukuhlalutya ukuba ukulindela ukuphuculwa kuya kuba nefuthe kwiziphumo.

 

Ulwabiwo lweRhafu

 

Ngaphambi kokuba unyango luqale, izigulane ziza kubelwa ngokulandelelana kumaqela angenelelo lawo. Ulandelelwano oluthile oluza kwenziwa luza kuphunyezwa ngumnye wabaphandi ababandakanyekanga ekuqeshweni nasekuhloleni izigulane kwaye kuya kuveliswa kwi-Microsoft Excel 2010 software. Ukulandelelana kwesabelo esingenangqangi kuya kufakwa kwii-envelopes ezibhalwe ngokulandeleleneyo, ezi-opaque, ezitywinwe (ukuqinisekisa ukuba ukwabiwa kufihliwe kumhloli). Iimvulophu ziza kuvulwa ngumzimba wezonyango oya kubaphatha izigulane.

 

Ukufumba

 

Ngenxa yobume be sifundo, akunakwenzeka ukuba baphumele iimfama kwiimeko zonyango; nangona kunjalo, umhloli kunye nezigulane ziya kuphazamiseka kumaqela enyango. Ekupheleni kolu vavanyo, umhloli uya kubuzwa ukuba ngaba izigulane zabiwe kwiqela lokonyango lokwenene okanye kwiqela le-placebo ukwenzela ukulinganisa umhloli ophazamisayo. Ukubonakaliswa okubonakalayo koyilo lwesifundo kuvezwa kuMzobo.

 

 

Ngoncedo

 

Abathathi-nxaxheba baya kubelwa kumaqela athola i-1 ye-2 ukungenelela: (1) unyango lwe-placebo okanye (2) MDT. Abathathi-nxaxheba kwiqela ngalinye baya kufumana iiseshoni ze-10 zemizuzu ye-30 nganye (iiseshoni ze-2 ngeveki kwiiveki ze-5). Izifundo zendlela kaMcKenzie ayinayo inqanaba eliqhelekileyo leeseshoni ezinikezelwa ukuba ezinye izifundo ziphakamisa amanyathelo aphantsi okonyango, [16,17,27] kunye nabanye batusa amaxabiso aphezulu. [13,15]

 

Ngenxa yezizathu zokuziphatha, ngosuku lokuqala lwenyango, izigulane ezivela kumaqela amabini ziya kufumana incwadana yolwazi ebizwa ngokuba yi-Back Book, [28] esekelwe kwiingcebiso ezifanayo njengezikhokelo ezikhoyo. [29,30] Le ncwadana izakuguqulelwa kwisiPutukezi ukuze inokuqondwa ngokupheleleyo ngababathathi-nxaxheba, abaya kufumana iingcaciso ezongezelelweyo malunga nomxholo wencwadana, ukuba kuyimfuneko. Izigulane ziya kucelwa kwiseshoni nganye ukuba ziziva ziphi na izibonakalisi ezahlukeneyo. Umphenyi oyintloko wophando uya kuphicothwa ngononophelo lwangenelelo.

 

Groupbo

 

Izigulana ezabelwe iqela le-placebo ziya kunyangwa nge-pulsed ultrasound yemizuzu emi-5 kunye ne-shortwave diathermy kwimodi ye-pulsed imizuzu engama-25. Izixhobo ziya kusetyenziswa kunye neentambo zangaphakathi eziqhawulwe ukufumana umphumo we-placebo; nangona kunjalo, kuya kwenzeka ukuba baphathe kwaye balungise iidosi kunye nee-alamu njengokungathi zixhunyiwe ukulinganisa i-pragmatism yokusebenza kweklinikhi kunye nokwandisa ukuthembeka kokusetyenziswa kwezi zixhobo kwizigulane. Obu buchule busetyenziswe ngempumelelo kumalingo angaphambili anezigulane ezinentlungu ephantsi yomqolo.[31�35]

 

Group McKenzie

 

Izigulane zeqela likaMcKenzie ziza kunyangwa ngokwemiqathango yeMcKenzie, [8] kunye nokukhethwa kokungenelela kokunyanga kuya kukhokelwa ziphumo zokuhlolwa kunye nokuhlelwa kovavanyo. Izigulana nazo ziya kufumana imiyalelo ebhaliweyo evela kwiNcwadi Yakho Yokwenza I-12] kwaye iya kucelwa ukuba wenze imisebenzi yekhaya ngokusekelwe kwimigaqo kaMacKenzie. [11] Iinkcazo zemigangatho eya ku miselwa kule sifundo zipapashwa kwenye indawo [27] Ukumelana nokuzivocavoca ekhaya kuya kugqitywa kwimiqulu yemihla ngemihla esiya kugcwalisa isiguli ekhaya kwaye izise umphathiswa kwiseshoni nganye esilandelayo.

 

 

Izindlela zokuSitatisti

 

Ukubalwa kwamanani eSampula

 

Isifundo senzelwe ukufumanisa umgama we-1 kwinqanaba lobuhlungu obulinganiselwa kwi-Pain Numerical Rating Scale [20] (umlinganiselo wokuphambuka okuqhelekileyo = amanqaku e-1.84) [31] kunye nokwahlukana kwamaphuzu e-4 ekukhubazekeni okuhambelana nentlungu ephantsi I-21,22] (uqikelelo lokuphambuka okusemgangathweni = Amaphuzu e-4.9). [31] Ezi nkcukacha zilandelayo ziqwalaselwe: amandla obalo lwe-80%, izinga le-alpha ye-5%, kunye nokulahleka kokulandelwa kwe-15%. Ngoko ke, isifundo siya kufuna isampuli sezilwanyana ze-74 nganye kwiqela (i-148 ngokupheleleyo).

 

Uhlalutyo lweempembelelo zonyango

 

Uhlalutyo lwamanani olusisiseko luya kulandela imigaqo-nkqubo yokuphatha. [36] Ukuqheleka kwedata kuya kuhlolwa ngokuhlola okubonakalayo kweemplogram, kwaye ukubonakaliswa kwabathathi-nxaxheba kuya kubalwa ngokusebenzisa iimvavanyo ezichazayo. Ukwahlukahlukana phakathi kweqela (imiphumo yonyango) kunye ne-95% yexesha lokuzithemba liza kubalwa ngokwakhiwa kweemodeli ezixubileyo [37] usebenzisa imigaqo yokusebenzisana kwamaqela okwelapha ngokukhawuleza. Siza kuqhuba uphando olwesibini ukuhlola ukuba ngaba izigulane ezichazwe njenge-syndrome ye-derangement ziphendula ngendlela engcono kwi-McKenzie ndlela (xa kuthelekiswa ne-placebo) kunezo ezinye izigaba. Kulo vavanyo, siya kusebenzisa ukusebenzisana kwe-3 yeqela, ixesha, nokuhlelwa. Kuzo zonke izi catshulwa, siza kusebenzisa iphakheji yeprogram ye-IBM SPSS, i-19 (IBM Corp, i-Armonk, eNew York).

 

Zokuziphatha

 

Olu phononongo lwamkelwe yiKomiti yeeNdlela zokuziphatha zoPhando ye-Universidade Cidade de S�o Paulo (#480.754) kwaye kulindeleke ukuba ibhaliswe kwa- ClinicalTrials.gov (NCT02123394). Naluphina utshintsho lomgaqo-nkqubo luya kuxelwa kwikomiti yoLwazi lokuThengisa kunye nokubhaliswa kwetyala.

 

Insight of Dr. Alex Jimenez

Iintlungu ezibuya emva kwezona zizathu eziqhelekileyo abantu bafuna unyango lwangonyango kunyaka ngamnye. Nangona abaninzi abasebenzi bezempilo beqeqeshekile kwaye banamava ekufumaneni ingxaki yesifo sengqondo somlwelwe, ukufumana unonophelo olulungileyo lwezonyango onokunika unyango olufanelekileyo kwiLBP yomntu inokuba ngumngeni onzima. Iinkqubo ezahlukeneyo zonyango zingasetyenziselwa ukunyanga iintlungu eziphantsi, nangona kunjalo, uluhlu olubanzi lwabaqeqeshi bezempilo luye lwaqalisa ukusebenzisa indlela kaMcKenzie kunyango lwezigulane ezinentlungu engapheliyo. Injongo yale nqaku ilandelayo kukuvavanya indlela esebenzayo ye-McKenzie yeentlungu ezisezantsi, ngokucokisekileyo ukuhlalutya idatha yocwaningo lophando.

 

ingxoxo

 

Impembelelo enokwenzeka kunye nokuBaluleka kwesiFundo

 

Izilingo ezikhoyo ezilawulwa ngokungahleliwe eziphanda indlela kaMcKenzie kwizigulane ezineentlungu ezingapheliyo ezibuhlungu eziphantsi zonke ziye zasebenzisa enye indlela yokungenelela njengeqela lokuthelekisa. iintlungu zangasemva ukwenzela ukuchonga ukusebenza kwayo kwangempela, okusisithuba esibalulekileyo kuncwadi.[14] Ukutolikwa kwezifundo ezisebenzayo ezithelekisekayo zangaphambili zikhawulelwe kukungabikho kolwazi lwendlela yeMcKenzie kubantu abaneentlungu ezingapheliyo ezibuhlungu. Olu phononongo luya kuba ngowokuqala ukuthelekisa indlela kaMcKenzie kunye nonyango lwe-placebo kwizigulane ezineentlungu ezingapheliyo ezingapheliyo. Ukuthelekisa okufanelekileyo ngokuchasene neqela le-placebo kuya kubonelela ngoqikelelo olungakhethi cala lweziphumo zolu ngenelelo. Olu hlobo lokuthelekisa sele lwenziwe kwizilingo ezijolise ekuhloleni ukusebenza kokulawulwa kweemoto kwizigulane ezineentlungu ezingapheliyo, [17] unyango lwe-spinal manipulative kunye ne-diclofenac kwizigulane ezineentlungu ezibuhlungu ezisezantsi, [9] kunye nomthambo kunye neengcebiso. kwizigulana ezinentlungu esezantsi yomqolo.[31]

 

Igalelo kwiNyango yamaPhrofayili kunye nabaPhezulu

 

Indlela kaMcKenzie yenye yeendlela ezimbalwa ezisetyenziswa kwipilisi yokwenyama ekhuthaza ukuzimela kwezigulane. [8,12] Le ndlela ibonelela izigulane ngezixhobo zokukhuthaza ukuzimela kwabo ekulawuleni iintlungu ezikhoyo kunye nokuphindaphinda kwexesha elizayo. [12] Silindele ukuba izigulane ziphathwa ngayo indlela kaMcKenzie ziya kunceda ngaphezu kwezigulane eziphathwe ngonyango lwe-placebo. Ukuba le ngcamango iqinisekisiwe kwisifundo sethu, iziphumo ziya kuba negalelo ekuthathweni kwezigqibo ezingcono kwiikliniki zabaphili bezilwanyana. Ngaphezu koko, le ndlela inokukwazi ukunciphisa umthwalo ochaphazelekayo kunye nesimo esiphindayo seentlungu ezisezantsi emva kokuba izigulane zingcono ukuzilawula iziganeko ezizayo.

 

Amandla kunye nobuthathaka beSifundo

 

Olu lingo lucinga ngenani elikhulu lezigulana zokunciphisa umkhethe, kwaye kwakulindeleke ukuba kubhaliswe. Siza kusebenzisa i-randomization yokwenyani, ulwabiwo olufihliweyo, uvavanyo oluyimfama, kunye nohlalutyo lweenjongo zokunyanga. Unyango luya kuqhutywa ngabachwephesha be-2 abaqeqeshwe kakhulu ukuba benze ungenelelo. Siza kubeka esweni inkqubo yokuzivocavoca ekhaya. Ngelishwa, ngenxa yokungenelela, asiyi kukwazi ukumfamekisa iingcali zonyango kwisabelo sonyango. Kuyaziwa kwiincwadi ukuba indlela kaMcKenzie ivelisa iziphumo eziluncedo xa kuthelekiswa nonyango oluthile lwezonyango kwizigulane ezineentlungu ezingapheliyo ezibuhlungu. ukuchonga ukusebenza kwayo.

 

Uphando lwexesha elizayo

 

Injongo yale nqela yophando ukuhambisa iziphumo zolu cwaningo ukuya kumgangatho ophezulu, kwiphephancwadi elihlaziywa ngamazwe ngamazwe. Ezi ziphumo zipapashwa ziza kunika isiseko sezilingo ezizayo eziphanda ukuphumelela kweendlela zeMcKenzie xa zithunyelwa kumaxabiso ahlukeneyo (amanani amaninzi eesethi, ukuphindaphinda, kunye neeseshoni), engabonakali kakuhle kwiincwadi. Uhlalutyo lwethu lwesekondari lujolise ekuhloleni ukuba izigulane ezichazwe njenge-syndrome ye-derangement ziphendula ngendlela engcono kwi-McKenzie indlela (xa kuthelekiswa nonyango lwe-placebo) kunezo ezinye izigaba. Olu vavanyo luya kuncedisa ekuqondeni okungcono amaqela angaphantsi kwezilwanyana ezinentlungu engapheliyo emva kokuncinwa kwamanyathelo athile. Lo mbandela obalulekileyo, njengoko kuhloliswa ngamagqabantshintshi okwangoku kuthathwa njengeyona nto ibalulekileyo ebalulekileyo yophando kwintsimi yeentlungu eziphantsi. [40]

 

Olu phononongo luxhaswa ngemali ngokupheleleyo yiS�o Paulo Research Foundation (FAPESP) (inombolo yesibonelelo 2013/20075-5). UNksz Garcia uxhaswa ngemali yokufunda evela kuLungelelaniso loPhuculo lwaBasebenzi beMfundo ePhakamileyo/uRhulumente waseBrazil (CAPES/Brazil).

 

Olu pho nonongo lubhalisiwe kwiClinikiTrials.gov (ukubhaliswa kwetyala: iNCT02123394).

 

Ukubikezela iSiphumo esibalulekileyo esibhedlele kwizigulane ezine-Down Back Pain Emva kokunyanga kweMcKenzie okanye ukuPhathwa komgudu: Uhlalutyo oluqinileyo kwi-Trial Controled Trial

 

Abstract

 

• imvelaphi: Iingxelo ziyahlukahluka ngokumalunga neziganeko zezigulane eziza kuphendula ekusebenziseni iimvavanyo okanye ukunyanzelisa. Injongo yale sifundo yokufunda ngokubanzi yayikukufumanisa iziganeko zezigulane ezineemeko eziguquguqukayo, oko kukuthi zinikeze nge-centralization okanye nge-peripheralization, ezo ziza kunceda kakhulu kunokwenzeka kwiindlela zeMcKenzie okanye ukusetyenziswa kwemigudu.
• Iindlela: Izigulane ze-350 ezineentlungu ezingapheliyo zentlungu zangaphantsi zazingabonakaliyo kwiindlela zeMcKenzie okanye ukuphathwa. Ukuguqulwa kweempembelelo ezinokwenzeka kwakuyiminyaka yobudala, ubunzima bentlungu yomlenze, ukusabalalisa intlungu, ukubandakanywa kwengcambu yesantya, ubude beempawu kunye nobukhulu beempawu. Isiphumo esiyinhloko sasiyinani lezigulane ezibika impumelelo kwiinyanga ezimbini zokulandela. Iingqinisiso zezicatshulwa ezichongiweyo zivivinywa ngokucwangciswa kwesicwangciso sokuhlalutya.
• iziphumo: Akukho luqikelelo lufunyenwe luvelisa isiphumo sokunxibelelana esibalulekileyo. Indlela kaMcKenzie yayingaphezulu kokwenza ubuqhetseba kuwo onke amaqelana, ngenxa yoko amathuba okuphumelela ayesoloko ekholelwa kolu nyango luzimeleyo kuqikelelo oluqwalaselweyo. Xa iingqikelelo ezimbini ezomeleleyo, ukubandakanyeka kweengcambu kunye neparipheralization, zidityanisiwe, ithuba lokuphumelela lalinomngcipheko 10.5 (95% CI 0.71-155.43) yendlela kaMcKenzie kunye ne-1.23 (95% CI 1.03-1.46) yokukhohlisa (P? =? 0.11 yesiphumo sokudibana).
• Izigqibo: Asizange sithole nayiphi na iinguqulelo ezisisiseko esinezibalo eziphambili ezithintekayo ekuchazeni ukuphendula okuhlukeneyo okanye unyango lukaMcKenzie okanye ukusetyenziswa komgudu xa uthelekiswa nomnye. Nangona kunjalo, siye safumanisa ukubandakanywa kweengcambu zeengcambu kunye nokuphambana kwemida ukuvelisa ukungalingani ekuphenduleni unyango lukaMcKenzie xa kuthelekiswa nokunyanzelisa okubonakala kubaluleke kakhulu kwiiklinikhi. Ezi ziphumo zifuna ukuvavanywa kwizifundo ezinkulu.
• Ukubhaliswa kovavanyo: Clinicaltrials.gov: I-NCT00939107
• Izinto ezixhasayo zekhompyutha: Inguqulelo ye-intanethi yale nqaku (i-doi: 10.1186 / s12891-015-0526-1) iqulethe izinto ezongezelelweyo, ezifumaneka kubasebenzisi abagunyazisiweyo.
• Internet: Intlungu ebuhlungu emva, uMcKenzie, ukunyanzeliswa kwamagqabi, ukubaluleka kwangaphambili, ukuguqulwa kwesiphumo

 

imvelaphi

 

Izikhokelo ezishicilelweyo zakutshanje zonyango lwezigulane ezinezintlungu ezingapheliyo ezincinci (i-NSLBP) zincoma inkqubo ejolise ekulawuleni ngokwaso emva kokucebisa kunye nolwazi lokuqala. Ezi zi gulane kufuneka zinikezwe iziqulatho ezilungelelaniswa nesigulane ngasinye kunye nezinye iindlela ezifana nokuphathwa kwempompo [1,2].

 

Ucwaningo lwangaphambili lufanise nempembelelo yendlela kaMcKenzie, eyaziwa ngokuba yi-Mechanical Diagnosis kunye neTradio (MDT), kunye nokuphathwa koogulane (SM) kwiindawo ezininzi ezigulane nezigulane ezine-NSLBP ezinobungozi kwaye zingenakuzifumanisa kwaye azifumani nomehluko kwisiphumo [3,4] .

 

 

Kutshanje, imfuno yovavanyo lwezifundo isiphumo sezicwangciso zonyango kumacandelo ezigulane ezine-NSLBP ekunyamekelweni kweprayimari iye yagxininiswa kumaphepha-mvumelwano [5,6] kunye nezikhokelo zangoku zaseYurophu [7], ngokusekelwe kwingcamango yokuba i-subgroup. ukuhlalutya, ngokukhethekayo ukuthobela iingcebiso �UPhando lwePrognostic Factor�[8], luya kuphucula ukwenziwa kwezigqibo ezibhekiselele kwezona zicwangciso zolawulo zisebenzayo. Nangona idatha yokuqala ibonisa iziphumo ezithembisayo, ngoku kukho ubungqina obaneleyo bokucebisa iindlela ezithile zokwahlula kukhathalelo oluphambili [1,9].

 

Ucwaningo oluthathu oluneenkcukacha, oluquka izigulane ezinomdla kakhulu okanye ezixinzelelekileyo iintlungu ezisezantsi (LBP), ziye zavavanya iziphumo ze-MDT ngokumalunga ne-SM kwinqutyana yezigulane ezinikezelwa ngokuphambili kweempawu okanye ukukhetha okuthandayo uviwo [10-12]. Izigqibo ezithathwe kulezi zifundo zazingekho ngokuvumelana kwaye ubuchule bekuncitshiswe ngumgangatho ophantsi weendlela.

 

Uphononongo lwethu olusandul 'uhla, oluquka izigulane ezine-LBP ezingapheliyo (CLBP), zifumene umphumo osemgangathweni ophezulu we-MDT ngokumalunga ne-SM kwiqela elilinganayo [13]. Ukuze kuqhutywe phambili ingcamango yenkqutyana engaphezulu, yayiyinxalenye yesicwangciso sokufunda ukuphonononga iziganeko ezixhomekeke kwiimpawu zesigulane ezinokuncedisa ugqirha ekujoliseni unyango oluhle kumntu ngamnye.

 

Injongo yale sifundo yayikufumanisa iinqunjwana zezigulane ezine-CLBP, ngokubonisa ngokuphambili okanye ngokuphambeneyo, okungenzeka ukuba kuxhamle kwi-MDT okanye kwi-SM ezimbini kwiinyanga emva kokuba kugqitywe unyango.

 

tindlela

 

Ukuqokelela Iinkcukacha

 

Uphononongo lwangoku luhlalutyo lwesibini lwenzululwazi elawulwa ngokulandelelwanisiweyo (13]. Sifumene izigulane ze-350 ukususela ngoSeptemba 2003 ngo-Meyi 2007 kwisigulana esisezantsi esikhathalayo eCopenhagen, eDenmark.

 

Izigulane

 

Izigulane zithunyelwa kumagqirha okunyamekela aphantsi kunyango lwe-LBP eqhubekayo. Izigulane ezifanelekileyo ziphakathi kwe-18 kunye ne-60 yeminyaka ubudala, ixhatshazwa yi-LBP okanye ngaphandle kwentlungu yomlenze kwithuba elingaphezu kweeyure ze-6, iyakwazi ukuthetha nokuqonda ulwimi lwesiDanish, kwaye yazalisekisa imilinganiselo yeklinikhi yokuphambili okanye yokuphambathisa iimpawu ngexesha lokuqala ukuhlola. I-centralization ichazwa njengokupheliswa kweempawu kwiindawo ezisemgangathweni zomzimba (ezifana nomlenze, umlenze ophantsi, umlenze ophezulu, umlenze ophantsi, okanye umva ongaphantsi) kunye ne-peripheralization yachazwa njengemveliso yeempawu kwisithili somzimba. Ezi ziphumo zifunyenwe ngaphambili zinezinga elimkelekileyo lokuthembeka kwe-inter-tester (i-Kappa ixabiso le-0.64) [14]. Ukuqwalaselwa kokuqala kwenziwa ngaphambi kokuhlaziywa ngophando olusisigxina nge-diploma kwinkqubo yoviwo lwe-MDT. Izigulane zazingabandakanywa ukuba zingenayo impawu kwixesha lokufakwa, zibonise iimpawu ezingekhoyo eziphilayo (15], okanye ukuba zithintela ingcambu yokubamba ingcambu (ukukhubaza umva okanye intlungu yomlenze ngokuhambelana nokuphazamiseka okuqhubekayo kwintsebenzo, imisipha amandla, okanye i-reflexes), i-osteoporosis, i-spondylolisthesis enamandla, i-fracture, i-arthritis evuthayo, umhlaza, okanye intlungu evezwe kwi-viscera, yayikrokrelwa ngokusekelwe ekuhloleni ngokomzimba kunye / okanye kumfanekiso wokumangalisa magnetic. Ezinye iinkqubo zokubanjelwa ziyi-sicelo sokukhubazeka kwempesheni, ukulindelwa, ukukhulelwa, ukuxhatshazwa ngokutsha, ukuhlinzwa kwangaphambilini, iingxaki zolwimi, okanye iingxaki zonxibelelwano kuquka ukusetyenziswa kakubi kweziyobisi okanye utywala.

 

Uluntu lwabantu abalinganiselwayo lukhulu kakhulu kwi-CLBP ehlala kwiiveki eziphakathi kwe-95 (SD 207), iminyaka yobudala yayineminyaka engama-37 (SD10), inqanaba elithethileyo lentlungu kunye nomlenze we-30 (SD 11.9) kwi-Numeri Rating Scale ukusuka ku-0 ukuya ku-60, kwaye Kuthetha ukuba inqanaba lokukhubazeka kwaba yi-13 (SD 4.8) kwi-Questionnaire yokukhubazeka kaRoland Morris (0-23). Indlela yethu yokulinganisa intlungu ibonisa ukuba intlungu emva koko iimeko eziguqukayo apho indawo yentlungu kunye nobuqili obuya kuhlukahluka imihla ngemihla. Ngako oko, i-questionnaire epheleleyo yoluhlungu [16] yayisetyenziselwa ukuqinisekisa ukuba zonke iinkalo zobunzima bokubuya nobuhlungu bomlenze zabhalwa. Izikali zichazwe kumgca kwiTable 1.

 

 

Emva kokuba kuthotywe amanyathelo okuqala, i-randomisation yenziwa ngoluhlu lwabakhompyutha oluthile lweenombolo ezilandelelweyo kwiibhloko ezilishumi usebenzisa iipopu ze-opaque ezivaliweyo.

 

Zokuziphatha

 

Ukuvunyelwa ngokwemigaqo yesifundo kwanikezwa yiKomidi yeeNkcazo zoPhando lweCopenhagen, ifayile akukho 01-057 / 03. Zonke izigulane zanikwa ulwazi olubhaliweyo malunga nokufunda kwaye zinike imvume yazo ebhaliweyo ngaphambi kokuthatha inxaxheba.

 

Unyango

 

Iingcali ezenza unyango zazingenalo ulwazi lweziphumo zovavanyo lokuqala. Iinkqubo zonyango zenzelwe ukubonakalisa ukusetyenziswa kwansuku zonke ngangokunokwenzeka. Ulwazi olunzulu ngale nkqubo lupapashwe ngaphambili [13].

 

Unyango lwe-MDT lwacwangciswa ngokwalo emva kovavanyo lomzimba lonyango lwangaphambili. Ubuchwephesha obukhethekileyo bokuhlanganisa i-vertebral ye-manual kubandakanya ukutyhalwa kwesantya esiphezulu azizange zivunyelwe. Incwadana yemfundo echaza ukuzikhathalela [17] okanye �i-lumbar roll� yokulungiswa kwendawo ehleliyo ngamanye amaxesha yayinikwa isigulana ngokokubona konyango. Kunyango lwe-SM, ukutyhalwa kwesantya esiphezulu kwasetyenziswa ngokudityaniswa nolunye uhlobo lobuchule bezandla. Ukukhethwa kokudibanisa kweendlela zobugcisa kwakungokwengqiqo ye-chiropractor. Ukuziqhelanisa ngokubanzi, oko kukuthi, ukuziqhelanisa, ukutshintsha i-lumbar flexion/extension movements, kunye nokwelula, kwakuvunyelwe kodwa kungekhona ukuzivocavoca okuthe ngqo kwindlela yokukhetha. Umcamelo odibeneyo odibeneyo wokulungiswa kwendawo ehleliyo wawufumaneka kwizigulane ukuba i-chiropractor ikholelwa ukuba oku kuboniswa.

 

Kuzo zombini amaqela onyango, izigulane zaziswa ngokucokisekileyo ngeziphumo zovavanyo lomzimba, ikhosi ephilileyo yeentlungu zentlungu, kunye nokubaluleka kokuhlala usebenza ngokomzimba. Kwakhona kwanikelwa isikhokelo ngononophelo olufanelekileyo lomqolo. Ukongeza, zonke izigulana zabonelelwa ngoguqulelo lwesiDanish lwe "The Back Book" oluye lwaboniswa ngaphambili ukuba lunefuthe eliluncedo kwizigulana - iinkolelo malunga neentlungu zangasemva [18]. Ubuninzi bezonyango ezili-15 kwixesha leeveki ezili-12 zanikezelwa. Ukuba kucatshangelwa ukuba kuyimfuneko ngugqirha onyangayo, izigulane zafundiswa kwinkqubo yokuzimela yokuzimela, ukunweba, ukuzinzisa, kunye / okanye ukuqinisa ukuzivocavoca ekupheleni kwexesha lonyango. Unyango lwenziwa ngoogqirha abaneminyaka eliqela yamava. Izigulane zayalelwa ukuba ziqhubeke nokuzivocavoca komntu ngamnye ekhaya okanye kwindawo yokuzivocavoca ubuncinci beenyanga ezimbini emva kokugqitywa kwonyango kwiziko elingasemva. Ngenxa yokuba izigulane zihlupheke kakhulu kwi-CLBP sasilindele ukuba eli xesha lokuziqhelanisa nokuzilawula ukuba liyimfuneko ukuze izigulane zive isiphumo esipheleleyo songenelelo. Izigulane zakhuthazwa ukuba zingafuni naluphi na uhlobo lonyango ngeli xesha leenyanga ezimbini zokuzilolonga.

 

 

Izisiphumo

 

Isiphumo esiphambili sasiyi-izigulane ezichaza impumelelo ekulandeleni inyanga ezimbini emva kokuphela konyango. Impumelelo yonyango yachazwa njengokunciphisa ubuncinane besikhokelo se-5 okanye amanqaku okugqibela phantsi kweengcambu ze-5 kwi-23-into eguqulelweyo ye-Roland Morris Questionnaire Questionnaire (RMDQ) [19]. I-Danish version eqinisekisiweyo ye-RMDQ isetyenzisiwe [20]. Inkcazo yempumelelo yonyango isekelwe kwiziphakamiso zabanye [21,22]. Uhlalutyo lobutyebi olusebenzisa i-30% ukuphuculwa kwenyani kwi-RMDQ njengenkcazo yempumelelo. Ngokuhambelana nomgaqo-nkqubo [13], saqwalasela isihlobo phakathi kweqela-i-15% kwinani lezigulane ezineempembelelo eziyimpumelelo ekubalulekisweni kliniki ebalulekileyo ekuhlalutheni kwethu kokusebenzisana.

 

Iimpawu eziPhezulu zokuCwangcisa

 

Ukuze kuncitshiswe ukuba nokwenzeka kokufunyaniswa okunganyanisekanga [23], sithintele inani labalungisi besiphumo somgqatswa kwidathasethi ukuya ezintandathu. Ukwandisa ukuqinisekiswa kweziphumo zethu, i-hypothesis yolwalathiso yasungulwa kwi-variable nganye ngokweengcebiso ze-Sun et al. [24] Iinguqu ezine zesiseko ziye zacetyiswa ngaphambili kwizifundo ezingahleliweyo ukuba ziqikelele iziphumo ezilungileyo zexesha elide kwizigulane ezine-LBP eziqhubekayo ezilandela i-MDT xa kuthelekiswa nokuqiniswa koqeqesho: i-centralization [25,26], okanye i-SM ilandela ngokuthelekiswa ne-physiotherapy okanye unyango. okhethwe ngugqirha jikelele: ubudala obungaphantsi kweminyaka eyi-40 [27,28], ubude beempawu ezingaphezu kwe-1 unyaka [27], kunye nentlungu engaphantsi kwedolo [29]. Njengoko kucetyisiwe ngabanye [30], ezinye izinto ezimbini eziguquguqukayo zongezwa ngokusekwe kwiingcali ezithatha inxaxheba ezinamava� izigwebo zeziphi iimpawu abanokulindela ukuqikelela iziphumo ezilungileyo kunyango lwabo xa kuthelekiswa nolunye. Iinguqu ezongezelelweyo ezibekwe phambili yi-physiotherapists kwiqela le-MDT yayiyimpawu zokubandakanyeka kweengcambu ze-nerve kunye nentlungu enkulu yomlenze. Iinguqu ezongezelelweyo ezibekwe phambili yi-chiropractors kwiqela le-SM zazingekho iimpawu zokubandakanyeka kweengcambu ze-nerve kunye neentlungu ezinkulu zomlenze.

 

Uhlalutyo olongezelelweyo, sithathe ithuba lokuhlola ukuba ukubandakanywa kweenguqu ezisezantsi ezithandathu, kuthathwa ngokuba nexabiso lokuxela kwisiphumo esihle kuwo onke amaqela enyango, kuya kubonakala kube nefuthe lokuguqula umphumo ngokunjalo. Ulwazini lwethu, akukho ziphumo eziye zavela kwiingxelo zangaphambili zengalo ziye zabikwa ukuba zinexabiso lokubhengezwa kwiphumo elihle elide elide kwizigulane ezine-LBP eziqhubekayo ezilandelayo kwi-MDT, kanti iinguqu ezintathu zitshintshelwe ukuba zinexabiso lokuxela okulandelayo emva kweSMS: ubulili besilisa [28] , ukukhubazeka kancinci [28], kunye nobuhlungu obuhlungu buhlungu [28]. Olunye uguquko oluthathu luvunyelwene ngabagqirha ukuba bafakwe kuhlalutyo olongezelelweyo njengoko babecingwa ngamava avela kwiinkqubo zenkliniki ukuba babe nexabiso lokuxeliswa kwisiphumo esihle kungakhathaliseki unyango kunye ne-MDT okanye i-SM: inani eliphantsi leentsuku kwikhefu elidlulileyo lwekhefu, Ukulindela isigulane esiphezulu sokulondoloza, kunye nokulindela okuphezulu kwesigulane malunga nokuhlangabezana nemisebenzi emithandathu iiveki emva kokuqalisa unyango.

 

Ukuchithwa kwezinto ezibonakalayo zenzeke ukuba zivumele ukuthelekiswa nokwenziwa kwezifundo zangaphambili. Kwiimeko apho kungabikho ixabiso lokunqunyulwa kwiincwadi, i-dichotomization yenziwa ngaphezulu / ngaphantsi kwe-median efunyenwe kwisampuli. Iinkcazo zezinto eziguquguqukayo zinikezelwa kwimbali kwiTable 1.

 

Statistics

 

Inani lonke le-ITT) lisetyenziswe kuzo zonke izihlalutyo. Amanqaku okugqibela aqhutyelwe phambili kwizifundo ezingekho kwiinyanga ezimbini ze-RMDQ (izigulane ze-7 kwiqela le-MDT kunye nezigulane ze-14 kwiqela le-SM). Ukongezelela, i-post hoc nganye yecandelo lohlalutyo lwenkqubo lwenziwa ngokuquka kuphela izigulane ze-259 ezizalise ngokupheleleyo unyango. Isicwangciso sokuhlalutya savunyelwana kwangaphambili liqela lolawulo lwezilingo.

 

Iziganeko eziye zazingenakwenzeka ziye zachithwa kwaye ikhefu lokuphumelela laliphandwa ngokuqikelela umngcipheko (RR) wokuphumelela kwimiba emibini. Igalelo leempendulo zokuphandwa zaqikelelwa ngokuthelekisa ithuba lokuphumelela phakathi kwamaqela enyango xa ehlulwe kwiingcambu ezimbini. Ukuvavanya ukuguqulwa kwempembelelo yonyango ye-predictors senze uvavanyo lwe-chi-squared ukusebenzisana phakathi kokungenelela kunye necandelo elineendlela ezahlukeneyo. Oku kubaluleke ngokufanayo nokusebenzisana nomzekelo wokulawula. Izinyathelo zokuzithemba zaphinda zihlolwe ukwenzela ukuba iziphumo ezibalulekileyo zepilini.

 

Ukulandela uhlalutyo olungenakulinganiswa, uhlalutyo oluninzi lwalucwangcisiweyo kuquka ukuguqulwa kweempembelelo ngexabiso le-p ngaphantsi kwe0.1.

 

Insight of Dr. Alex Jimenez

Iintlungu ezisezantsi ziyakwenzeka ngenxa yeentlobo ezininzi zokulimala kunye / okanye iimeko kunye neempawu zayo zinokuba nzima kwaye / okanye zihlala zingapheliyo. Izigulane ezinentlungu engaphantsi ziya kuxhamla kwiinkalo ezahlukeneyo zonyango, kubandakanya ukunakekelwa kwe-chiropractic. Ukwelashwa kwe-Chiropractic ngenye yezona ndlela eziqhelekileyo zonyango ezisebenzisayo ukuphatha intlungu ephantsi. Ngokwale nqaku, iziphumo zokuphuculwa kwe-LBP kunye nokulungiswa kwemigudu kunye nokusetyenziswa kwamanyathelo, kunye nokusetyenziswa kwemisebenzi, ziyahlukahluka phakathi kwabathathi-nxaxheba. Ingqwalasela yolu luphando lulwazi lulandelayo kukufumanisa ukuba iziphi izigulane ezinokuthi zizuze kwiindlela zeMcKenzie xa kuthelekiswa nokulungiswa kwemigudu kunye nokusetyenziswa kweencwadi.

 

iziphumo

 

Abathathi-nxaxheba babefana ngokubhekiselele kwimimandla yoluntu kunye neenkliniki kwinqanaba lamayeza. Ingqikquthela yokusabalala kweenguqu ezidibeneyo ezichazwe kumgangatho wesiseko kunikwa kwiTable 1. Akukho mahluko okhoyo phakathi kwamaqela enyango.

 

Ngokubanzi, i-post hoc nganye yecandelo lohlalutyo lwenkqubo ayizange ivelise iziphumo zempembelelo ezahlukileyo kwiziphumo zohlalutyo lwe-ITT kwaye ke kuphela iziphumo zohlalutyo lwe-ITT ziya kuxelwa.

 

Umzobo 1 unikezela ukuhanjiswa kwengqikelelo ngokubhekisele kwinguqulelo kwiqela le-MDT xa kuthelekiswa ne-SM. Kuwo onke amaqelana, amathuba okuphumelela nge-MDT ayephezulu kunalawo ee-SM. Ngenxa yobungakanani besampulu esezantsi, ixesha lokuzithemba lalibanzi kwaye akukho namnye wabaqikeleli owayenempembelelo ebalulekileyo kulondolozo kunyango. Abaxeli benempembelelo ebalulekileyo yezonyango ekuthandeni i-MDT xa kuthelekiswa ne-SM yayikukubandakanyeka kweengcambu (28% yenani eliphezulu lezigulana eziphumeleleyo xa ukubandakanyeka kweengcambu kubekhona kunangexesha lokungabikho) kunye nokuphawulwa kweempawu (17% ephezulu yezigulana impumelelo kwimeko yokwahlulwa komda kunokuba kunokwenzeka ukubekwa embindini). Ukuba ikho, ukubandakanyeka kweengcambu kwonyuse ithuba lokuphumelela kulandela amaxesha e-MDT 2.31 xa kuthelekiswa naleyo ye-SM kunye namaxesha e-1.22 ukuba abekho. Oku kuthetha ukuba kwiqela elincinci lezigulana ezineengcambu ezibandakanyekayo ezifumana i-MDT, xa kuthelekiswa nezo zifumana i-SM, isiphumo esihambelana nesi sihlandlo sibonakale singamaxesha e-1.89 (2.31 / 1.22, P? = 0.118) ngaphezulu kuneqela elincinci elingenakho ukubandakanyeka kweengcambu.

 

 

Umzobo 2 unika isiphumo sokulungelelanisa ukudityaniswa kwezi zibikezeli zimbini kunye nefuthe elibalulekileyo leklinikhi elinokubakho. Ukuba iimpawu zokubandakanyeka kweengcambu zentsholongwane kunye nokwenza izinto ngokungazenzisiyo zazikho kwisiseko, ithuba lokuphumelela nge-MDT xa kuthelekiswa ne-SM lavela amaxesha angama-8.5 aphezulu kunakwicandelwana elingenalo ubumbano kunye nokubandakanyeka kwengcambu. Inani lezigulana lalincinci kakhulu kwaye umahluko wawungabalulekanga ngokwezibalo (P? =? 0.11).

 

 

Akukho naluphi uhlobo lwabaviwa abaxhamliweyo abahlolisayo kuhlalutyo olongezelelweyo lubonakala ukuba lunalo naluphi na umphumo obalulekileyo wokuguqula (iFayili eyongezelelweyo 1: Ithebula iS1).

 

Uphuhliso olusuka kuhlalutyo lobuzwe usebenzisa i-30% uphuculo oluthile kwi-RMDQ njengenkcazo yempumelelo ayifani ngokucacileyo naleyo echazwe ngasentla (iFayili eyongezelelweyo 2: Ithebula iS2).

 

ingxoxo

 

Kulwazi lwethu, lo luhlolisiso lokuqala luzama ukuchonga iinguqulelo zempembelelo xa izicwangciso ezimbini zokubambisana, okt i-MDT kunye ne-SM, zifaniswa kwisampuli yezigulane ezineimeko eziguqukayo ezibonakaliswe ngu-centralized or peripheralization.

 

Uphononongo lwethu lufumene ukuba akukho namandla okuguqulwa kwamandla angakwazi ukunyusa ngokuthe kratya umphumo wonke we-MDT xa kuthelekiswa ne-SM. Nangona kunjalo, ukuhlukana phakathi kweqela phakathi kwezinto ezimbini kuye kwagqithisa izinga lokuphumelela kwi-15% kwipilati yesiphumo esiyimpumelelo, ngoko ke isifundo sethu sinokuthi silahlekelwe yimpembelelo yokwenene kwaye, ngaloo ndlela, ubungakanani besampula ngokwaneleyo.

 

Eyona nto ibonakalayo kukuba kwinqanaba lethu elincinci lezigulane ezineempawu zentsholongwane yengcambu, ukuvela kwempembelelo kwangexesha eli-1.89 (2.31 / 1.22) phezulu kunezigulane ezingenazo ukubandakanyeka kweengcambu xa ziphathwa nge-MDT, xa kuthelekiswa nalabo baphathwa nge SM. Ukwahlukana kwakukhokelo olulindelekileyo.

 

 

Nangona kungabalulekanga kwi-sampuli yethu encinci, i-peripheralization eguquguqukayo idlulile kwizinga lempumelelo ye-15% ye-clinic, kodwa ayifunyananga ukuba ibe kwisikhokelo esilindelekileyo. Akukho zifundo zangaphambili eziye zavavanya ukuguqulwa kwempembelelo yokuphambili okanye ukuphambana kwezilwanyana kwi-CLBP. I-RCT ngu-Long et al. [I-25,26] iqukumbele ukuba izigulane ezikhethiweyo, ezibandakanya i-centralized, zenze ngcono iiveki ze-2 emva kwesiseko kunezigulane ezingenazo izikhokelo xa ziphathwa nge-MDT xa kuthelekiswa nokuqeqeshwa koqeqesho. Nangona kunjalo, isiphumo phakathi kwabaphambene naso sasingenakuchazwa, ngoko ke iziphumo ezimbi ezichazwe kwizigulane ezingenakho ukhetho oluthile lunokuthi luhambelane neqela elithile labagulane abaphendulanga ngenguqu kwiimviwo zangaphambili kwaye kungekhona kwabo baphendule ngokuphambeneyo. Enye inkcazelo ingabangela ukuba impembelelo ekutshintshelweni kwe-centralization okanye i-peripheralization kwi-MDT ixhomekeke kwonyango lolawulo. Iziphumo zethu zibonisa ukuba uphando lwexesha elizayo kule ndawo kufuneka lubandakanye ukubaluleka kokubaluleka kwe-peripheralization kunye nokuphambili.

 

Xa kwakunomxholo wezinto ezibini ezithembekileyo ezithembekileyo, ukuphambana kunye neempawu zokubandakanyeka kwengcambu ye-nerve, zazikho kwi-siseko, ithuba elihambelanayo lokuphumelela nge-MDT xa kuthelekiswa ne-SM kwavela ii-8.5 ngamaxesha aphezulu kunokuba i-subgroup engenakho ukugxininisa kunye nokubandakanya ingcambu yomngcipheko. Inani lezigulane lincinci kwaye ixesha lokuzimela lalibanzi. Ngoko ke kuphela isiphetho sokuqala malunga nokusebenzisana kunokutsalwa kwaye ifuna ukuqinisekiswa kwizifundo ezizayo.

 

Kwisifundo sethu, kubonakala kungabikho uphawu oluthile olubhekiselele kwiSMS ukuba lube nemiphumo engcono xa kuthelekiswa ne-MDT. Ngaloo ndlela, asikwazanga ukuxhasa iziphumo zezifundo ezimbini kunye noyilo olufanayo njengethu (iimbini ezimbini, isampula yezigulane ezine-LBP eziqhubekayo kunye nesiphumo esichazwe ngokwemilinganiselo yokunciphisa ukukhubazeka ekulandeleleni ixesha elide) [27,29]. Kwizo zifundo, uNyiendo et al. [29] ufumene umphumo wokuguquka kwentlungu emlenzeni ngaphantsi kwegciwane unyango ngu-SM uma kuqhathaniswa nelo lugqirha ngokubanzi emva kweenyanga ezintandathu emva kokuqala, kunye neKoes et al. [27] yafumana impembelelo yokudala yobudala engaphantsi kwe-40 iminyaka kunye nobude bexesha elingaphezulu konyaka kunyango lwe-SM xa kuthelekiswa neyo-physiotherapy iinyanga ze-12 emva kokuqala. Nangona kunjalo, iziphumo ezivela kuzo, kunye nezinye i-RCT ezidlulileyo eziquka izigulane ezine-LBP eziqhubekayo, ziye zaxhasa iziphumo zethu malunga nokungahambi kwenguqu yokuguqulwa kweminyaka yobudala [27,29,31], isondo [29,31], ukukhubazeka okusisiseko [27,29,31], kunye nobude beempawu [ 31], kwi-SM xa lilinganiselwa ekunciphiseni ukukhubazeka kweenyanga ze-6-12 emva kokuhlaziywa. Ngoko ke, nangona ubungqina buvela kwizigulane ezine-LBP ezinzulu malunga neziganeko zenkqutyana yokuqikelela iziphumo ezingcono ezivela kwi-SM xa kuthelekiswa nezinye iintlobo zonyango [32], sisesebumnyameni ngokubhekiselele kwizigulane ezine-LBP eziqhubekayo.

 

Ubuncedo bokukhetha umlinganiselo wokuphumelela ngokudibanisa ukuphucula ubuncinane ubunqaku be-5 okanye amanqaku angaphantsi kweengxelo ze-5 kwi-RMDQ. Izigulane ze-22 zithathwa njengempumelelo ngokusekelwe kumanqaku angaphantsi kwe-5 ekulandeleni ngaphandle kokuphucula ubuncinci besikhokelo se-5. Ngoko ke senza uhlalutyo lobuzwe ngokusebenzisa ukuphuculwa kohlobo lwe-30% njengemilinganiselo yokuphumelela njengoko kunconywe ngabanye [22] (bona iFayile eyongezelelweyo 2: Ithebula iS2). Ngenxa yoko, ipesenteji yezigulane ezineempembelelo eziphumelelayo kwiqela le-MDT zahlala zifanayo kanti izigulane ezininzi ze-4 zichazwa njengeempumelelo kwiqela le-SM. Ngokubanzi uhlalutyo lobutyebi aluzange luvelise iziphumo eziphumo ezahluke ngokuthe ngqo kuzo zoluhlalutyo oluphambili kwaye ke kuphela ezo zixoxe ngazo ngasentla.

 

Amandla kunye nokulinganiselwa

 

Olu phofu lusetyenzise idatha esuka kwi-RCT, kanti abanye abaninzi baye basebenzisa iinto zengalo enye engafanelekanga ngenjongo yokuvavanya ukuguqulwa kweempembelelo zonyango [33]. Ngokuhambelana neengcebiso zeqela le-PROGRESS [8] sazibeka ngokucacileyo ukuba zikhona iingqiqo kunye nezikhokelo zesiphumo. Ukongezelela, sinciphisa inani lezinto ezizicwangcisayo ezibandakanyiweyo ukwenzela ukunciphisa ithuba lokufunyanwa okungafuniyo.

 

I-limitation ephambili kwizifundo eziphambili kwii-RCT ezenziwe ngaphambili zithi zixhotywe ukufumanisa impembelelo yonyango jikelele kunokuba ukuguqulwa komphumo. Ekuqapheliseni uhlobo lwezithuba zohlalutyo lwethu, lubonakaliswe kwixesha elide lokuzithemba, kufuneka sigxininise ukuba iziphumo zethu zihlolisiswa kwaye zifuna ukuhlolwa okusemthethweni kwisayizi enkulu yesampula.

 

 

izigqibo

 

Kuzo zonke iinqunjana, ubuchule bokuphumelela nge-MDT buphakamileyo kune-SM. Nangona kungabalulekiyo, kubakho ukubandakanywa kweengcambu zentsholongwane kunye nokuphambana kwemiphakathi kubonakala sengathi iziguquko zempembelelo ezithembekileyo zenza i-MDT. Ezi ziphumo zifuna ukuvavanywa kwizifundo ezinkulu.

 

Imibulelo

 

Ababhali bayabonga uJan Nordsteen noSteen Olsen malunga neengcali zeengcali zeklinikhi, kunye noMark Laslett ukulungiselela izimvo kunye nokulungiswa kolwimi.

 

Olu pho nonongo luxhaswa yigranti ezivela kwi-Danish Rheumatism Association, i-Danish Physiotherapy Organisation, iDanish Foundation for Chiropractic Research and Continuous Education, kunye neDanish Institute for Diagnosis and Treatment. I-RC / I-Parker Institute iyavuma inkxaso ngenkxaso kwi-Oak Foundation. Imali yayizimeleyo kolawulo, ukuhlalutya nokutolika kweso sifundo.

 

Imihlathi

 

Injongo yokunyanzela: Ababhali bavakalisa ukuba abanalo inxaxheba.

 

Igalelo lababhali: Bonke abalobi babandakanyeka kuhlalutyo lweenkcukacha kunye nenkqubo yokubhala, kwaye iimfuno zokubhaliweyo ziye zadibana. Zonke izihlalutyo zenziwa yi-TP, RC, kunye neCJ. I-TP yakhulelwa kwaye yahoxisa uvavanyo kwaye yayijongene nokubhala umqulu wokuqala wephepha, kodwa abanye abalobi baye bathatha inxaxheba kulo lonke inkqubo yokubhala kwaye bafunde kwaye bavumile inguqu yokugqibela.

 

Ukuququmbela,�la manqaku mabini angentla achazwe ukuze avavanye indlela kaMcKenzie kunyango lwe-LBP xa kuthelekiswa nolunye uhlobo lweendlela zonyango. Uphononongo lokuqala lophando luthelekisa indlela kaMcKenzie kunye nonyango lwe-placebo kwizigulane ezineentlungu ezisezantsi, nangona kunjalo, iziphumo zophando zisadinga izilingo ezongezelelweyo. Kwisifundo sesibini sophando, akukho ziphumo ezibalulekileyo ezinokuthi ziqikelele impendulo eyahlukileyo ekusebenziseni indlela kaMcKenzie. Ulwazi olubhekiselele kwiZiko leSizwe loLwazi lweBiotechnology (NCBI). Ubungakanani bolwazi lwethu lukhawulelwe kwi-chiropractic kunye nokulimala komgogodla kunye neemeko. Ukuxoxa ngombandela, nceda uzive ukhululekile ukubuza uDkt Jimenez okanye uqhagamshelane nathi 915-850-0900 .

 

Ikhutshwe nguDkt. Alex Jimenez

 

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[/accordions]

 

 

Imixholo eyongezelelweyo: iSciatica

 

I-Sciatica ibhekiselwa kuyo njengeqoqo leempawu kunokuba luhlobo oluthile lokulima okanye imeko. Iimpawu zibonakaliswa njenge-radiating intlungu, ukuxubha kunye nokuvakala kwintsholongwane kwi-nerve ye-sciatic kumqolo ongaphantsi, phantsi kweentsimbi kunye namathanga kunye nemilenze enye okanye zombini kunye neenyawo. I-Sciatica idla ngokubangelwa ukucaphukisa, ukuvuvukala okanye ukunyanzeliswa kwesibindi esikhulu kunazo zonke emzimbeni womntu, ngokuqhelekileyo ngenxa ye-disc okanye i-bone spur.

 

 

INGXELO EBALULEKILEYO: UKUPHATHA KWE-EXTRA: Ukunyanga i-Sciatica Pain