Kwihlabathi lanamhlanje, kulula ukufumana iimeko zokuxinezeleka malunga. Kungakhathaliseki ukuba kubandakanya umsebenzi, iingxaki zemali, ukukhawuleza kwezempilo, iingxaki zolwalamano, ukukhuthazwa kweendaba kunye / okanye ezinye izinto, uxinzelelo lunokuqala ukujonga ubunzima kwimpilo yethu yonke kunye nokuphila kakuhle xa kungagcinwe kakuhle. Kananjalo, sivame ukuzenza uxinzelelo ngokwenza ukutya okunqongileyo kunye nokungabikho kokulala.

 

Ngapha koko, ngaphezulu kwesithathu kwisine sabantu eUnited States bafumana uxinzelelo rhoqo, apho isinye kwisithathu sabo bantu babonakalisa amanqanaba oxinzelelo njengo "gqithisileyo". Nangona uxinzelelo lwexesha elifutshane lunokuba luncedo, uxinzelelo lwexesha elide lunokukhokelela kwimicimbi eyahlukeneyo yezempilo. Uxinzelelo luthathelwe ingqalelo njengonobangela wezifo ezininzi, iingcali kwezempilo ziqikelela ukuba zinika isiqingatha seendleko ezinxulumene nokhathalelo lwempilo lwelizwe, ngokwe-US News & World Report.

 

Ukuxinezeleka Kuchaphazela njani iBhunga

 

Ukuxinezeleka kubonakalisa inkqubo yesantya evelisa ulwalamano, ukulungiselela ukuphendula okanye "ukulwa okanye ukuhamba," indlela yokukhusela eyilungisa umzimba ngenxa yengozi yokubangela intliziyo, umthamo wegazi kunye negazi. Oku kunciphisa igazi kude kwinkqubo yokutya kunye neengalo. Iimbumba ze-adrenal nazo zihambisa umxube okhethekileyo wamahomoni kunye neekhemikhali, kubandakanya i-adrenaline, i-epinephrine kunye ne-norepinephrin, enokuchaphazela impilo yabantu xa ihlala ifihliwe emzimbeni.

 

Kwakhona, uxinzelelo olungapheliyo lunokubangela ukuxhatshazwa kwemisipha. Ukuxhatshazwa kwemisipha okweqile entanyeni nasemva kungabangela ukugqithiswa komgudu, owaziwa njenge-subluxation, ekugqibeleni ukuphazamisa umsebenzi ofanelekileyo wesistim kunye nokwenza iimpawu umqolo obuhlungu kwaye sciatica. Ngethamsanqa, iindlela ezahlukeneyo zokulawula uxinzelelo, kubandakanya ukunakekelwa kwe-chiropractic nokucamngca kwengqondo, kunokukunceda ukunciphisa Ubuhlungu obungapheliyo, ngokuqhelekileyo idibene nokuxinezeleka okungapheliyo.

 

Ukunyamekela Ukunyamezela Ingqondo

 

Ukunyamekela kwe-Chiropractic yinto eyaziwayo, enye indlela yokwelapha esetyenziselwa ukunyanga iintlobo ezahlukeneyo zokulimala kunye neemeko ezinxulumene ne-musculoskeletal kunye ne-system ye-nervous.Ukulungisa ukungalunganga komgudu linyathelo lokuqala lokunciphisa uxinzelelo. Ukuba kukho i-subluxation emqolo, inkqubo ye-neva isenokungakwazi ukuthumela imiqondiso ngokufanelekileyo kuwo wonke umzimba. Ngokusebenzisa uhlengahlengiso lomqolo kunye nokusetyenziswa kwemanyuwali, ugqirha we-chiropractic unokulungelelanisa ngononophelo umqolo, ukhulule uxinzelelo lwezihlunu, uthomalalise iintlungu zomqolo kunye nokuphucula ukuhamba kwegazi, utshintsho olunokwazisa ingqondo ukuba icime impendulo "yokulwa okanye yokubaleka" umzimba ungabuyela kwimeko ekhululeke ngakumbi.

 

Ukongezelela, i-chiropractor inokuphinda icebise ukuguqulwa kwendlela yokuphila, kunye nokuguqulwa komgudu kunye nokusetyenziswa kweencwadi, ukukunceda ukunciphisa uxinzelelo. Ukuncedisa okunomsoco, ukulungiswa kokuvuselela, ukuxilongwa kwe-tissue massage, ubuchule bokuphucula kunye nokuguquka kwendawo yokucetyiswa yi-chiropractor ziinkqubo ezininzi zokulawula uxinzelelo ezinokukunceda ukuphucula iimpawu zentlungu engapheliyo ehambisana noxinzelelo. Inqaku elilandelayo lihlolisiso oluchanekileyo kunye nohlalutyo lweemeta olubonisa ukusetyenziswa kweempawu zengqondo zentlungu engapheliyo, kubandakanywa intlungu emva kunye ne-sciatica.

 

Ukucamngca Ukucamngca Ngeengxaki Ezingapheliyo: UkuHlola ngokuHlolo kunye nokuhlaziywa kweMeta

 

Abstract

 

• imvelaphi: Izigulane ezingapheliyo zihlala zifuna unyango ngokucamngca ngengqiqo.
• Injongo: Olu pho nonongo lujolise ekuveliseni ubungqina malunga nokusebenza ngokukhuselekileyo kunye nokukhusela kokungcungcutheka kwengqondo kwindlela yokunyangwa kwentlungu engapheliyo kubantu abadala.
• Indlela: Senze uhlolo oluhlelekile kwiilingo ezilawulwa ngokungenamthetho (RCTs) kunye nokuhlaziya i-meta-esebenzisa i-Hartung-Knapp-Sidik-Jonkman indlela yokwenza imizekelo engafanelekanga. Ubungqina bobuchule buhlolwe ngokusetyenziswa kwe-GRADE. Iziphumo zazibandakanya intlungu, ukuxinezeleka, umgangatho wobomi kunye nokusetyenziswa kwe-analgesic.
• iziphumo: IiRCT ezingamashumi amathathu nesibhozo zidibene neenqobo zokungena; ezisixhenxe zichazwe ngokukhuseleko. Sifumene ubungqina obuncinane bokucamngca kwengqondo kudibene nokuncipha okuncinci kwentlungu xa kuthelekiswa nazo zonke iintlobo zolawulo kwi-30 RCTs. Imiphumo ebalulekileyo yesistim yafunyanwa kwakhona kwiimpawu zokudandatheka kunye nomgangatho wobomi.
• Izigqibo: Nangona ukucamngca kwengqondo kukuphucula intlungu kunye neempawu zokudandatheka kunye nomgangatho wobomi, kufuneka i-RCT edibeneyo eyenziwe kakuhle, ekhuselekileyo kunye neyokhulu ukubonelela ngokukhawuleza ukuphumelela kokucamngca ngengqondo ngenxa yobuhlungu obungapheliyo.
• Izinto ezixhasayo zekhompyutha: Inguqulelo ye-intanethi yale nqaku (i-doi: 10.1007 / s12160-016-9844-2) iqulethe izinto ezongezelelweyo, ezifumaneka kubasebenzisi abagunyazisiweyo.
• Internet: Ubuhlungu obungapheliyo, Ukuqonda, Ukucamngca, Ukuphonononga ngokuchanekileyo

 

intshayelelo

 

Ubuhlungu obungapheliyo, obuhlala buchazwa njengentlungu ehlala ixesha elide kuneenyanga ezi-3 okanye ezidlulileyo kwixesha eliqhelekileyo lokunyanga izicubu [1], kunokukhokelela kwiziphumo zonyango, ezentlalontle kunye nezoqoqosho, imiba yobudlelwane, imveliso elahlekileyo, kunye neendleko ezinkulu zokhathalelo lwempilo. IZiko lezeMpilo liyayamkela intlungu njengengxaki yempilo yoluntu ebiza ilizwe lethu ubuncinci i-560-635 yezigidigidi ngonyaka, kubandakanya iindleko zokhathalelo lwempilo kunye nemveliso elahlekileyo [2]. Ukuqhubela phambili, iintlungu ezingapheliyo zihlala zihamba kunye nokuphazamiseka kwengqondo njengokunyanga ngamayeza kunye nokudakumba okwenza unyango lube nzima [3]. Ukuxhaphaka okuphezulu kunye nohlobo lokuchasana kwintlungu engapheliyo, ngokudibeneyo kunye neziphumo ezibi zokuxhomekeka kwamayeza eentlungu, kukhokelele ekunyuseni umdla kwizicwangciso zonyango ezibandakanya unyango lokudibanisa okanye ezinye iindlela zonyango [4]. Enye yeendlela zokuziphatha ezisetyenziswa zizigulana kukucamngca ngengqondo. Ngokusekwe kwiindlela zakudala zokucamngca zaseMpuma, ingqondo iququzelela imeko yokuqwalaselwa. Iphawuleka ngokunika ingqalelo kumzuzu wangoku ngokuvuleka, ukwazi, kunye nokwamkelwa [5, 6]. Ukucamngca ngengqondo kucingelwa ukuba kusebenza ngokugxininisa engqondweni okwangoku kunye nokwandisa ulwazi lwendawo engaphandle kunye novakalelo lwangaphakathi, ukuvumela umntu ukuba abuyele umva kwaye enze amava kwakhona. Uphando lwangoku lusebenzisa i-neuroimaging yokucacisa iindlela ze-neurological ezisisiseko seziphumo zengqondo ezijolise kulwakhiwo lobuchopho njenge-posterior cingate cortex, ebonakala ngathi iyabandakanyeka ekusebenzeni ngokuzimela [7, 8]. Ukusetyenziswa kweklinikhi kwengqondo kubandakanya usetyenziso lweziyobisi gwenxa [9], ukuyeka icuba [10], ukunciphisa uxinzelelo [11], kunye nonyango lweentlungu ezingapheliyo [12-14].

 

Izifundo zokuqala kwengqondo kwizigulane ezibuhlungu zibonisa iziphumo ezithembisayo kwiimpawu zentlungu, ukuphazamiseka kwemizwelo, ukuxhalabisa, nokuxinezeleka, kunye nokusetyenziswa kweziyobisi ezinxulumene nobuhlungu [5]. Ukuphononongwa ngokubanzi kweziphumo kwiingcamango zengqondo zipapashwe kwiminyaka yamuva. Kulabo abavakalisa iziphumo zentlungu, ezininzi zijolise kwiintlobo ezithile zentlungu ezifana nentlungu ephantsi [13], i-fibromyalgia [15], okanye i-disordination disorder [16]. Ezinye zazingaphelelwanga kwi-RCTs [14, 17]. Kuye kubekho uphononongo olunzulu olunzulu olujoliswe kwizilingo ezilawulwayo zokungenelela kwengqondo yokubandezeleka okungapheliyo kuquka ukuhlaziywa [4] ebonisa ukuphuculwa kwimiqondiso ecinezelekileyo nokunyamezela, olunye uphononongo [18] ekukhunjuleni kwintlungu engapheliyo, i-fibromyalgia, kunye neentlungu ze-musculoskeletal ezibonisa iziphumo ezincinci zentlungu, kunye nokuphononongwa kwangoku [19] kwiimeko ezininzi zeentlungu ezithe zafumana ukuphucula intlungu, ukwamukelwa kwentlungu, umgangatho wobomi kunye nesimo sokusebenza. Ababhali balezi ngxelo bavakalisa ukukhathazeka ukuba kukho ubungqina obuncinane bokungenelela kokungenelela kwengqondo kwizigulane ezinentlungu engapheliyo ngenxa yeendlela zokwenza izinto. Baphetha ukuba uphando olongezelelweyo oluphezulu luyimfuneko ngaphambi kokuba kuphakanyiswe ukucamngca kwengqondo malunga neempawu zentlungu ezingapheliyo.

 

Injongo yale sifundo kwakukuqhuba ukuhlaziywa ngendlela echanekileyo kunye nokuhlaziywa kweemitha zengqondo kunye nokukhusela kokucamngca kwengqondo, njengesigqibo okanye i-monotherapy ukuphatha abantu abaneentlungu ezingapheliyo ngenxa ye-migraine, intloko yesifo, intlungu emva, i-osteoarthritis, okanye intlungu ye-neuralgic xa kuthelekiswa unyango njengesiqhelo, uluhlu lokulinda, akukho unyango, okanye ezinye iindlela zokhathalela. Ubuhlungu beyona miphumo ephambili, kwaye iziphumo ezizimbini ziquka ukudakumba, umgangatho wobomi kunye nokusetyenziswa kwe-analgesic. Umgaqo-nkqubo wokuhlaziywa ngokuchanekileyo ubhalisiwe kwi-registry yehlabathi jikelele ukuhlolwa kweenkqubo (PROSPERO 2015: CRD42015025052).

 

tindlela

 

Isicwangciso soPhando

 

Sikhangele kwiziseko zedatha ze-elektroniki ze-PubMed, i-Cumulative Index to Nursing and Allied Health Literature (CINAHL), iPsycINFO, kunye neCochrane Central Register yeZilingo ezilawulwayo (CENTRAL) kwizilingo ezilawulwa ngolwimi lwesiNgesi ukusuka kuJuni ka-2016. Sidibanise iimeko zentlungu kunye amagama ayilwayo ngala magama alandelayo okuphendla kwengqondo: Ukucinga] [Mesh]) okanye Ukucamngca] [Mesh] okanye ingqondo ? Na okanye anapanasati okanye iZen okanye iPranayama okanye iSudarshan okanye iKriya okanye i-zazen okanye i-shambhala okanye i-buddhis * .Ukongeza kolu phando kunye nokumbiwa kwemigca ekubhekiswa kuyo kuzo zonke izifundo ezibandakanyiweyo, sibhekisa kuvavanyo lwangaphambili olucwangcisiweyo kwaye sabuyisa zonke izifundo ezibandakanyiweyo .

 

Ulungelelwaniso olufanelekileyo

 

Iqela elifanayo, i-RCT yabantu okanye iqoqo labantu abadala abavakalisa iintlungu ezingapheliyo zifakiwe. Izifundo apho umbhali echaze ubuhlungu obungapheliyo kunye nezifundo kwizigulana ezivakalisa intlungu ubuncinane beenyanga ezili-3 zifakiwe. Izifundo zafuneka ukuba zibandakanye ukucamngca ngengqondo, njengokuba isilungiselelo okanye i-monotherapy; uphando olwenziwe ngongoma olunzulu lwe-yoga, tai chi, qigong, kunye nobuchule bokucamngca ngaphandle kokubhekisela kwengqondo. Ukungenelela kwengqondo engazange ifune ukucamngca ngokusemthethweni, njengokwamkelwa kunye nokuzibophelela ngonyango (UMTHETHO) nawo akhankanywe. Izifundo kuphela ezichaze amanyathelo entlungu okanye utshintsho ekusetshenzisweni kwe-analgesic zifakiwe. Ukukhutshiswa kunye neenkomfa eziye zafakwa ngaphandle.

 

Iinkqubo

 

Abavavanyi babini abazimeleyo bahlolwe izihloko kunye nezicatshulwa zokufumana) ukulandela iseshoni yokulinga ukuqinisekisa ukutolikwa okufanayo kwenqubo yokubandakanywa kunye nokukhuphela. Izicatshulwa ezigwetywe njengokufanelekile ngomntu omnye okanye bobabini abavavanyi bafunyanwa njengombhalo opheleleyo. Ushicilelo olupheleleyo lwetekisi emva koko lwaphononongwa ngokuchasene neenqobo zokufaka ezichaziweyo. Ukuhamba kwezicatshulwa kuyo yonke le nkqubo kwabhalwa kwiziko ledatha le-elektroniki, kwaye izizathu zokukhutshelwa kupapasho olupheleleyo. Ukukhutshwa kwedatha kwaqhutywa kabini. Umngcipheko wokhetho wavavanywa kusetyenziswa iCchrane Risk yesixhobo seBias [20]. Olunye ucalucalulo olunxulumene ne-USPSTF yeekhrayitheriya zoThintelo lweeNkonzo zoThintelo (USPSTF) zokuqinisekiswa kwangaphakathi kwezifundo ezibandakanyiweyo kuvavanyiwe [21, 22]. Ezi nqobo zisetyenziselwe ukukala umgangatho wobungqina njengobulungileyo, obulungileyo, okanye obuhlwempuzekileyo kwisifundo ngasinye kubandakanya.

 

Iinkqubo zeMeta-Analytics

 

Xa idatha eyoneleyo yayifumaneka kwaye i-heterogeneity ye-statistical yayingaphantsi kwemingcele ekuvunyelwene ngayo [20], senze uhlalutyo lweemeta ukubonakalisa iziphumo zokusebenza kuzo zonke kubandakanya izifundo kwiziphumo zomdla kwaye sibonisa indawo yehlathi kuhlalutyo oluphambili lweemeta. Sisebenzise indlela yeHartung-Knapp-Sidik-Jonkman yeziphumo ezingahleliwe zohlalutyo lweemeta kusetyenziswa iindlela ezingalungelelaniswanga kunye nemilinganiselo yokusasazeka [23-25]. Ukufunda ukuphonononga iziphumo ezininzi zentlungu, sisebenzise imilinganiselo ethile yeentlungu, ezinje ngePhepha lemibuzo leMcGill Pain (MPQ) kuhlalutyo oluphambili lweemeta endaweni yesifo esibuhlungu se-SF-36, kunye nomndilili okanye amanyathelo obuhlungu ngokubanzi kunamanyathelo okuma njengentlungu ngexesha lovavanyo. Ngenxa yenani elincinci leziganeko ezimbi ezichaziweyo, uhlalutyo lobungakanani aluzange lwenziwe. Senze uhlalutyo lwamagqabantshintshi kunye ne-meta-regressions ukujongana nokuba ngaba kukho umahluko kubungakanani bezinto phakathi kweendlela zongenelelo ezahlukeneyo, abantu, okanye xa zisetyenziswa njenge-monotherapy ngokuchaseneyo nonyango olusebenzayo. Umgangatho womzimba wobungqina wavavanywa kusetyenziswa indlela ye-GRADE [22, 26] apho ukumiselwa okuphezulu, okuphakathi, okuphantsi, okanye okuphantsi kakhulu kwenziwa kwisiphumo ngasinye esikhulu [27].

 

iziphumo

 

Inkcazo yeZifundo ezifakiwe

 

Sichonge izikhalazo ezingama-744 ngophendlo lwedatha ye-elektroniki kunye neerekhodi ezili-11 ezongezelelweyo ezichongiweyo kweminye imithombo (jonga umfanekiso 1). Imibhalo epheleleyo yafunyanwa kwizicatshulwa ezingama-125 ezichongiweyo njengezinokuthi zifaneleke ngabavavanyi abazimeleyo; Ii-RCT ze-38 zidibene neekhrayitheriya zokufakwa. Iinkcukacha zeempawu zokufunda zibonisiwe kwiTheyibhile? 1 kunye nefuthe kwizifundo ezizodwa zibonisiwe kwiTheyibhile? 2.

 

 

 

 

Ngokupheleleyo, izifundo ezibelwe abaxhamli be-3536; Isampula ubukhulu besuka kwi-19 ukuya kwi-342. Izifundo ezilishumi elinesibini zachaza ukubalwa kwamandla okuqala kunye nesayizi yeesampula ekujoliswe kuyo, izifundo ezilishumi azizange zichaze ulwazi malunga nokubala kwamandla, kwaye izifundo ezintathu zazingabonakali ekubaleni kwamandla okubala. Izifundo ezilishumi zichazwe kwakukho amandla aneleyo; Ababhali baqwalasela ezi zifundo. Uninzi lwezifundo lwaqhutywa eNyakatho yeMerika okanye eYurophu. Ixesha elidlulileyo labathathi-nxaxheba lusetyenziswa kwi-30 (SD, 9.08) ukuya kwi-78 iminyaka (i-SD, i-7.1.

 

Iziganeko zonyango zichazwe ziquka i-fibromyalgia kwizifundo ezisibhozo kunye nentlungu emva kwizifundo ezisibhozo. (Izigaba azihambelani ngokuthe ngqo; ezinye iifundo ziquka izigulane ezineemeko ezahlukeneyo.) I-Osteoarthritis yaxelwa kwizifundo ezimbini kunye ne-rheumatoid arthritis emithathu. Intloko ye-Migraine yaxelwa kwizifundo ezintathu kunye nolunye uhlobo lweentloko ezifundweni ezintlanu. Izifundo ezintathu zichazwe isifo sengqondo sesifo esilumkileyo (IBS). Izifundo ezisibhozo zivakalise ezinye izizathu zentlungu kunye nezifundo ezintathu azichazi imeko yonyango okanye umthombo wentlungu engapheliyo.

 

Ubungakanani bexesha lokungenelela luvela kwi-3 ukuya kwiiveki ze-12; Uninzi lwongenelelo (izifundo ze-29) zaziyiiveki ze-8 ubude. Izifundo ezingamashumi amabini nanye zaqhutyelwa ekunciphiseni uxinzelelo lokuxinwa kwengqondo (MBSR) kunye neyesithandathu kwi -rapy-based cognitive therapy (MBCT). Izifundo ezongezelelweyo ezilishumi elinanye zibikwe iziphumo kwezinye iindidi zokuqeqeshwa kwengqondo. I-RCT yeshumi elinesithathu ihlinzekele ukungenelela kwengqondo njenge-monotherapy, kwaye ishumi elinesibhozo sisebenzise ukungenelela kwengqondo njengoluphi unyango oluchanekileyo, olucacisa ukuba bonke abathathi-nxaxheba bafumene oku ngaphezu kweminye unyango njengamachiza. Izifundo ezisixhenxe zazingacacanga malunga nokuba ukungenelela kwengqondo kwakuyi-monotherapy okanye unyango oluthile. I-RCT ezilishumi elinesihlanu zasebenzisa unyango njengesiqhelo njengabaqhathanisayo, abathathu abasebenzisa iifomati ezingabonakaliyo, kunye namaqela asetyenziswe imfundo / inkxaso asetyenzisiweyo. Ngaphandle kwezi fomati eziqhelekileyo, olunye uphando lusetyenziswa ukulawulwa kwengcinezelo, ukusilalisa, ukungenelela kweentlungu ezininzi, ukuphumula / ukunweba, kunye nolwazi olunempilo / idayari zokutya njengoko zifana; Izifundo ezimbini zasebenzisa i-cognitive-behavioral therapy. Uphando oluninzi lwaba neengalo ezimbini.

 

Umgangatho woFundo kunye neengozi zeBhasi

 

Umgangatho wokufunda kwisifundo ngasinye ubandakanyiwe ubonakalisiwe kwiTheyibhile? 1. Izifundo ezilishumi elinanye zifumene inqanaba le- good esemgangathweni [28-38]. Izifundo ezilishumi elinesine zagwetywa ukuba zikumgangatho ofanelekileyo, ikakhulu ngenxa yokungacaci kweminye yeendlela [39-52]. Izifundo ezilishumi elinesithathu zagwetywa njengezintlupheko; ishumi ikakhulu ngenxa yemicimbi enokuphelela kwengxelo yesiphumo sokungafumaneki okanye esilahlekileyo sokunyanga (ITT) uhlalutyo kunye / okanye ngaphantsi kwama-80% okulandela [53-62] kwaye ezintathu ngenxa yeendlela ezingacacanga [63-65]. Iinkcukacha zokulinganiswa komgangatho kunye nomngcipheko wokukhetha kwisifundo ngasinye kubandakanyiwe kubonisiwe kwizixhobo ezongezelelweyo ze-1.

 

Amanyathelo

 

Izifundo zibike iinkqubo zesifo sengqondo ezifana ne-Visual Analog Scale, i-SF-36 intlungu ehlala phantsi, kunye ne-Questionnaire ye-McGill Pain Questionnaire. Amanyathelo omphumo wesibini afaka iimpawu zoxinzelelo (umzekelo, i-Beck Depression Inventory, i-Questionnaire yeMpilo yePilati yeMpilo), umgangatho wobomi obunempilo kunye nengqondo (umz., I-SF-36 engxenyeni yengqondo kunye nenyama), kunye nokukhubazeka / ukukhubazeka okusebenzayo (umzekelo, uRoland-Morris Imibuzo yokukhubazeka, iShean Disability Scale).

 

Impendulo Yonyango Yengxaki Ezingapheliyo

 

Ii-RCT ezingamashumi amathathu zichaze idatha yeziphumo eziqhubekayo kwizikali ezivavanya iintlungu ezingapheliyo [29, 31-33, 36, 39-49, 51-60, 62-64, 66].

 

Izifundo ezisibhozo zahlangabezana neekhrayitheriya zokubandakanywa kovavanyo kodwa azange zibe negalelo kuhlalutyo lwe-meta kuba khange banike ingxelo yedatha enokubakho [28, 30, 34, 35, 38, 50, 61, 65]. Iimpawu zabo zokufunda zibonisiwe kwiTheyibhile? 1, kunye neziphumo zenqanaba lokufunda kunye nezizathu zokuba zazingekho kuhlalutyo oluhlanganisiweyo zibonisiwe kwiTheyibhile? 2.

 

Isikali seentlungu kunye nabathelekisi bahluka ukusuka kufundo ukuya kufundo. Ixesha lokulandela eliphakathi yayili-12 iiveki, zinoluhlu lwe-4 ukuya kwi-60 iiveki. Umzobo? 2 bonisa iziphumo zohlalutyo lweemeta kusetyenziswa idatha kolona landiso lude kwisifundo ngasinye. Uhlalutyo oluhlanganisiweyo lubonisa impembelelo ebalulekileyo yokucamngca kwengqondo xa kuthelekiswa nonyango njengesiqhelo, ulawulo lokuhamba, kunye namaqela emfundo / enkxaso (SMD, 0.32; 95% CI, 0.09, 0.54; 30 RCTs). Ubunzulu be-heterogeneity bufunyenwe (I 2 = 77.6%). Kwakungekho bungqina bokupapashwa (Begg sp = 0.26; Uvavanyo lwe-Egger p = 0.09). Ukuphanda ukuba ngaba uqikelelo lonyango lomelele na xa kungabandakanywa izifundo ezikumgangatho ophantsi kunye nokuphonononga imvelaphi enokubakho ye-heterogeneity enkulu, siqhube uhlalutyo lobuntununtunu kubandakanya kuphela izifundo ezifanelekileyo okanye ezilungileyo. Ukuphuculwa kuhlala kubalulekile, ubungakanani besiphumo babuncinci (SMD, 0.19; 95% CI, 0.03, 0.34; 19 RCTs), kwaye kwakungekho heterogeneity encinci (I 2 = 50.5%). I-Meta-regressions ibonise ukuba utshintsho kwiziphumo zentlungu elungileyo- (p = 0.42) kunye nomgangatho olungileyo (p = 0.13) izifundo bezingahlukanga kangako kutshintsho kwizifundo ezikumgangatho ophantsi.

 

 

Kuhlalutyo lweqela, isiphumo besingabalulekanga ngokweenkcukacha kwiiveki ezili-12 okanye ngaphantsi (SMD, 0.25; 95% CI,? 0.13, 0.63; 15 RCTs; I 2 = 82.6%) kodwa ibalulekile kwixesha lokulandela emva kweeveki ezili-12 ( I-SMD, 0.31; 95% CI, 0.04, 0.59; 14 RCTs, I 2 = 69.0%). Uvavanyo lweBegg lwalungabalulekanga ngokweenkcukacha-manani (p = 0.16) kodwa uvavanyo luka-Egger lwabonisa ubungqina benkcazo yokupapashwa (p = 0.04). Umgangatho wobungqina bokuba ukucamngca ngengqondo kunxulunyaniswa nokwehla kweentlungu ezingapheliyo xa kuthelekiswa nolawulo kuphantsi ngokubanzi kunye nokulandelwa kwexesha elifutshane kunye nexesha elide ngenxa yokungahambelani, ukungafani, kunye nokukhetha ukupapashwa. Itheyibhile eneenkcukacha ibonisa umgangatho wobungqina bokufumana iziphumo kwisiphumo ngasinye esikhulu kwiZinto eziNgezelelweyo ze-Elektroniki 2.

 

Ukuze sikwazi ukubonisa iziphumo ezinokliniki, sibala utshintsho lweepesenti kwiimpawu zentlungu ukusuka kwisiseko ukuya ekulandeleni ukucamngca kwengqondo kunye namaqela okuthelekisa kwisifundo ngasinye kwaye ubonise iziphumo kwiTable 2. Emva koko sabala inani elipheleleyo lokutshintsha kweepesenti zokucamngca ngokwamaqondo xa kuthelekiswa namaqela okuthelekisa kwiziphumo zokucamngca kwintlungu ekulandeleleni okude. Iipesenti zotshintsho olutshintsho kwiintlungu zokucamngca ngamaqela? Ubuninzi, 0.19). Ixabiso le-p lomahluko phakathi kwamaqela lalibalulekile (p = 0.91).

 

ukudakumba

 

Iziphumo zoxinzelelo zichazwe kwii-12 RCTs [29, 31, 33, 34, 45, 46, 48, 49, 51-53, 56]. Ngokubanzi, ukucamngca kunciphise amanqaku oxinzelelo xa kuthelekiswa nonyango njengesiqhelo, inkxaso, imfundo, ulawulo loxinzelelo, kunye namaqela okulawula uluhlu lokulinda (SMD, 0.15; 95% CI, 0.03, 0.26; 12 RCTs; I 2 = 0%). Akukho heterogeneity ifunyenweyo. Umgangatho wobungqina ukalwe njengophakamileyo ngenxa yokunqongophala kwe-heterogeneity, iziphumo zokufunda ezingaguquguqukiyo, kunye nokuchaneka kwesiphumo (amaxesha amancinci okuzithemba).

 

Umgangatho woBomi

 

Izifundo ezilishumi elinesithandathu zichaze umgangatho wobomi obunxulumene nempilo yengqondo; Iziphumo zokucamngca ngengqondo zazibalulekile kuhlalutyo oluhlanganisiweyo xa kuthelekiswa nonyango njengesiqhelo, amaqela enkxaso, imfundo, ulawulo loxinzelelo, kunye nolawulo lokulinda (SMD, 0.49; 95% CI, 0.22, 0.76; I 2, 74.9%). [32-34, 45-49, 52, 54, 56, 59, 60, 62-64]. Izifundo ezilishumi elinesithandathu zilinganise umgangatho wobomi obunxulumene nempilo [32 [34, 36, 45-49, 52, 54, 56, 60, 62-64]. Uhlalutyo oluhlanganisiweyo lubonise umphumo obalulekileyo wokucamngca kwengqondo xa kuthelekiswa nonyango njengesiqhelo, amaqela enkxaso, imfundo, ulawulo loxinzelelo, kunye nolawulo lokulinda (SMD, 0.34; 95% CI, 0.03, 0.65; I 2, 79.2%). Zombini uhlalutyo lomgangatho wobomi lubone ukungalingani okukhulu, kwaye umgangatho wobungqina ulinganiswe njengemodareyitha yempilo yengqondo (amathuba amancinci okuzithemba, iziphumo ezingqinelanayo) kunye nezantsi kumgangatho wobomi obunxulumene nempilo.

 

Ukukhubazeka okusebenzayo (iMilinganiselo yokukhubazeka)

 

Izifundo ezine zichaze amanqaku okukhubazeka anokukhuselwa kwiPhepha lemibuzo likaRoland-Morris lokuKhubazeka kunye neSheehan yokuKhubazeka [33, 36, 47, 55]. Ukwahlula phakathi kokuqonda kunye namaqela othelekiso ekulandeleleni bekungabalulekanga ngokweenkcukacha (SMD, 0.30; 95% CI,? 0.02, 0.62; I 2 = 1.7%), nangona iziphumo zisondela kubaluleka. Akukho heterogeneity ifunyenweyo. Umgangatho wobungqina walinganiswa uphantsi ngenxa yokungaqwalaselwa kunye nesayizi encinci yesampulu.

 

Usetyenziso lobuchule

 

Zine kuphela izifundo ezixeliweyo zokusebenzisa ii-analgesics njengesiphumo. Kuphononongo lwe-MBSR kunyango lwentlungu engapheliyo ngenxa yesifo sokungaphumeleli sasemva kwesifo [55], kwi-12 yeeveki ezilandelelanayo, iilogs zamayeza e-analgesic zeqela elingenelelayo libonisa ukwehla kokusetyenziswa kwe-analgesic xa kuthelekiswa nezo zikwiqela lolawulo ( 1.5 (SD = 1.8) vs. 0.4 (SD = 1.1), p = <0.001). Uphononongo lokucamngca ngengqondo kunye nonyango lokuziphatha ngokuziphatha kunye nokunyamekela okuqhelekileyo kweentlungu ezisezantsi [35] uxele ukuba i-morphine elinganayo yedosi (mg / ngosuku) yeeopioid yayingahlukanga kakhulu phakathi kwamaqela kuzo zombini iiveki ze-8 kunye ne-26. Ngokufanayo, ukulingwa kwe-MBSR yeentlungu zangasemva [38] akufumananga mahluko ubalulekileyo phakathi kwamaqela ekusebenziseni ngokwakho amayeza eentlungu. Ekugqibeleni, ukuvavanywa kwengqondo ekuphuculeni ukubuyisela ingqondo (OKUNYE) kwintlungu engapheliyo ye-etiologies eyahlukeneyo [44] ifumene abathathi-nxaxheba abangenelelo ngokungenakwenzeka ukuba bangasayi kufikelela kwiinkqubo zokusetyenziswa kwe-opioid kwangoko emva kwonyango (p = 0.05); Nangona kunjalo, ezi ziphumo azange zigcinwe ekulandeleni inyanga-3.

 

Iziganeko ezimbi

 

I-7 kuphela ye-38 iquka ii-RCT ezichazwe kwiziganeko ezimbi. Zine zithi akukho ziganeko ezimbi ezenzekayo [36, 47, 50, 57]; Omnye wachaza ukuba abathathi-nxaxheba ababini bafumana iimvakalelo ezinqwenelekayo zomsindo ngentlungu yabo kwaye ababini abathathi-nxaxheba bafumana uxhalaba olukhulu [46]; Izifundo ezimbini zizaliswe iziphumo ezinobungozi obucothayo kwi-yoga kunye nokuphumla kwe-muscle [35, 38].

 

Iimpawu zoFundo zoModareli

 

Iimeta-regressions zaqhutywa ukuze zichonge ukuba ngaba utshintsho kwiziphumo zentlungu zichanekile ngendlela eyahlukileyo ngamacandelo amaninzi. Akukho nto eyahlukileyo kwimpumelelo phakathi kwe-MBSR (izifundo ze-16) kunye ne-MBCT (izifundo ze-4; p = 0.68) okanye ezinye iintlobo zokungenelela kwengqondo (izifundo ze-10; p = 0.68). Xa kuthelekiswa ne-MBSR (izifundo ze-16) kuzo zonke ezinye iindlela zokungenelela (izifundo ze-14), kwakungekho nomehluko kwimpumelelo (p = 0.45). Njengoko kuchaziwe ngcaciso engentla, iimeko zonyango zichazwe ziquka i-fibromyalgia, intlungu emva, i-arthritis, intloko yesifo, kunye nesifo sengqondo se-brit (syndrome). Iimeta-regressions ezingaphakamisanga ukungafani phakathi kwentloko (izifundo ezithandathu) kunye nezinye iimeko (p = 0.93), intlungu emva (izifundo ezisibhozo) nezinye iimeko (p = 0.15), kunye ne-fibromyalgia (izifundo ezisibhozo) nezinye iimeko (p = 0.29 ). Ukubunjwa kwezesini (% yindoda) kwakungekho nxulumano kunye nentlungu (p = 0.26). Ubude obude beprogram yongenelelo buvela kwi-3 ukuya kwiiveki ze-12 (ithetha iiveki ze-8). I-Meta-regression ayizange iphakamise ukungalingani phakathi kokungenelela kwamanqanaba aphezulu kunye ne-medium- (p = 0.16) okanye ukungenelela okuphantsi (p = 0.44). Akukho mahluko ochanekileyo kwintlungu phakathi kokunyangwa kweyeza kunye ne-monotherapy (p = 0.62) okanye phakathi kwonyango kunye nokungenelela apho oku kungacacanga (p = 0.10) yafunyanwa. Ekugqibeleni, kwakungenohluko oluchanekileyo kwimpumelelo enoba ngaba i-comparator yonyango njengesiqhelo, uluhlu lokulinda, okanye olunye uncedo (p = 0.21).

 

Insight of Dr. Alex Jimenez

Ukuxinzezeleka kwengcinezelo ngumcimbi omkhulu eMelika kwaye uye waba nempembelelo enobungozi kwimpilo yonke kunye nokuphila kwabantu baseMerika. Ukuxinezeleka kunokuchaphazela indawo ezahlukeneyo zomzimba. Ukuxinezeleka kunokunyusa izinga lentliziyo kwaye kubangela ukuphefumula ngokukhawuleza, okanye ukuxhatshazwa kwe-hyperventilation, kunye nokuxhatshazwa kwemisipha. Ukongezelela, uxinzelelo lubangela "ukulwa okanye ukusabaleka" impendulo, nto leyo eyenza inkqubo yentsholongwane yomsindo ukukhulula umxube wamahomoni kunye neekhemikhali emzimbeni. Ngenhlanhla, ukunakekelwa kwe-chiropractic kunokukunceda ekulawuleni uxinzelelo. Ukwelashwa kwe-Chiropractic kusebenze isistim se-parasympathetic eyancipha "ukulwa okanye ukuphendula". Ukongezelela, ukunakekelwa kwe-chiropractic kunokunceda ukunciphisa uxinzelelo lomzimba, ukuphucula iimpawu zentlungu engapheliyo.

 

ingxoxo

 

Ngokomlinganiselo, ukucamngca kwengqondo kwahlanganiswa nempembelelo encinci yeempawu zentlungu ephuculweyo xa kuthelekiswa nonyango njengesiqhelo, ukulawula okungahambiyo, kunye nezemfundo / amaqela enkxaso kwi-meta-analysis of 30. Nangona kunjalo, bekukho ubungqina benkcenkceshe enkulu phakathi kwezifundo kunye nokukhishwa kwenkcazo enokubangela ukuba kubekho ubungqina obuphantsi. Ukusebenza kokucamngca kwengqondo kwintlungu ayizange ihluke ngohlobo lwongenelelo, imeko yonyango, okanye ubude okanye ubukhulu bongenelelo. Ukucamngca ngengqiqo kwahlanganiswa nophuculo olulinganisekileyo ekudakaleni, umgangatho wempilo obunxulumene nempilo kunye nomgangatho wobomi obunxulumene nempilo. Ubuninzi bobubungqina obuphakamileyo bokudakumba, ukulinganisela umgangatho wobomi bengqondo, kunye nokuphantsi komgangatho wobomi obunxulumene nempilo. Izifundo ezine kuphela ezichazwe ngenguqu ekusetshenzisweni kwe-analgesic; iziphumo zaxutyushwa. Iziganeko ezimbi kwii-RCT ezibandakanyiweyo zazingabonakali kwaye azibizi, kodwa uninzi lwezifundo aluzange ziqokelele iinkcukacha ezichaphazelekayo.

 

Olu hlalutyo luneendlela eziningana zokwenza izinto: ukucwangciswa kophando lwephambili, ukukhethwa kuphando lokuphinda kunye nolwazi oluchanekileyo lwenkcazelo yolwazi, uphando olunzulu lweenkcukacha ze-elektroniki, umngcipheko wokuvavanya i-bias, kunye novavanyo olunzulu lobungqina obusetyenziswe ukwenza uhlolo lwezigqibo. Omnye umda wukuthi asizange sidibanise nabalobi bokufunda; Iziphumo ezichazwe ekuhlaziyweni zisekelwe kwidatha epapashwe. Sifake iifomati ezingenayo i-data eyaneleyo yokuphonononga umgangatho wokufunda. Ukongeza, sifaka kuphela izifundo ezipapashwe ngesiNgesi.

 

Izifundo ezibandakanyiweyo zinemiqathango emininzi. Izifundo ezingamashumi amathathu nesibhozo ziphakanyiswe njengezinga elibi, ngokuyininzi ngenxa yokungabi nalutho lwe-ITT, ukulandelelana kakubi, okanye ukunika ingxelo engafanelekanga yezindlela zokwenza okungahambiyo kunye nokufihla ukwabiwa. Ababhali bezifundo ezilishumi babika amandla angenamanani okubala ukuba bafumane ukungafani kwiziphumo zentlungu phakathi kokucamngca kwengqondo kunye nomfanisi; Ababhali baqwalasela ezi zifundo. Ezinye izifundo ezilishumi azizange zibike ukubala kwamandla. Ubungakanani besampula babuncinane; Izifundo ze-15 zihleli ngaphantsi kwabathathi-nxaxheba be-50.

 

Iimfuno ze-RCT ezicwangcisiweyo, ezilungeleleneyo kunye ezinkulu zifunekayo ukuze kuphuhliswe ubungqina bobuchule obungakwazi ukunikela ngokukhawuleza ukuqikelela kokusebenza kwayo. Izifundo kufuneka zibhalise iisampula ezinkulu ngokwaneleyo ukufumanisa ukungqinelana kwamanani kwiziphumo kwaye kufuneka zilandelelanise nabathathi-nxaxheba kwi-6 kwiinyanga ze-12 ukwenzela ukuvavanya imiphumo yexesha elide lokucamngca. Ukuhambelana nokusebenza kwengqondo kunye nokusetyenziswa kwamanye amayeza kufuneka kuhlolwe rhoqo. Impawu zokungenelela, kubandakanywa iqondo elithe gqithwayo, alisayi kusekwa ngokuthe ngqo. Ukuze kuhlolwe iziphumo ezithile zongenelelo, uphando lufanele lube nolwaphulo-oluhambelana nokulawula. Iimvavanyo ezincinci zingaqhutyelwa ukuphendula le mibuzo. Ezinye iziphumo ezingaphandle kwendawo yokuphononongwa kungabalulekile ukuhlola. Njengoko iimpembelelo zengqondo zinxulumene nokuhlolwa kweentlungu, kunokunceda kwiilingo ezizayo ukugxila kwiziphumo eziphambili kwiimpawu ezinxulumene nentlungu enjengomgangatho wobomi, ukuphazamiseka okubangelwa intlungu, ukunyamezela intlungu, imiba kunye neengxaki ezinxulumene nazo. ezinjenge-opioid. Iimpapasho zexesha elizayo kwii-RCT zokucamngca ngengqiqo kufuneka zihambelane neMigangatho yokuHlanganiswa kweeMvavanyo (IMISEBENZI).

 

Iingxelo ezintathu ze-RCT ezibhekiselele kwiziganeko ezincinci ezinokungcamngca ngengqiqo. Nangona kunjalo, i-7 kuphela ye-38 iquka ii-RCT ezichazwe ukuba iziganeko ezimbi zihlolwe kwaye ziqokelelwe. Ngaloo ndlela umgangatho wobungqina kwiziganeko ezimbi ezichazwe kwii-RCT aziwanelanga ukuhlolwa okubanzi. Ukunikezelwa kwengxelo yeziganeko ezimbi ngexesha lokucamngca, kubandakanya i-psychosis [67], iilingo ezizayo kufuneka ziqokelele ngokutsha iirekhodi ezichaphazelekayo. Ukongezelela, ukuphononongwa ngokuchanekileyo kwezifundo zokuqwalasela kunye neengxelo zengxelo ziza kubangela ukukhanya okongeziweyo kwiziganeko ezimbi ngexesha lokucamngca ngengqiqo.

 

Uphando olongezelelweyo oluhlolisayo umphumo wokucamngca ngengqondo kwiintlungu ezingapheliyo kufuneka kugxininise ekuqondeni okungcono nokuba kukho ubuncinane ubuncinane okanye ixesha lokucamngca ukuze liphumelele. Nangona uphando lwangoku luye lwavelisa iziphumo ezintle zokukhumbula ingqondo, ezi ziphumo ziba ziincinci ukuya kumyinge kwaye zisekelwe kumzimba wobungqina obungcono, owona mgangatho. Indlela ekhoyo yokuqhubela phambili uphando malunga nentlungu engapheliyo kukuba kukuphucula iinkcazo zengenelelo kunye neyokulawula, ukuchonga iziphumo ezahlukileyo zezicwangciso ezahlukeneyo zokungenelela okunzima, kwaye usebenze kumgangatho oqhelekileyo wokuvavanya inzuzo yokwelapha [68]. Izilingo eziphezulu zeentloko eziqhathanisa ukungenelela kwengqondo yolu hlobo olufanayo kodwa ngokuhlukahluka kwamacandelo okanye umthamo kunokuba luncedo ukukhupha amanqaku afanelekileyo kula macandelo [69].

 

Ngokufana neengxelo ezidlulileyo kule ndawo, sigqiba ekubeni nangona ukunyanzeliswa kwengqondo kunengqondo kubonisa ukuphuculwa okubalulekileyo kwintlungu engapheliyo, ukuxinezeleka, kunye nomgangatho wobomi, ubuthathaka emzimbeni wobungqina bubathintela izigqibo eziqinileyo. Ububungqina obukhoyo abuzange banikeze imiphumo eqhubekayo kwiziphumo zentlungu, kwaye zifundo ezimbalwa zifumaneke kwiindlela zokucamngca ngengqondo ngaphandle kwe-MBSR. Ubungqina bobuchule bokungenelela kwengqondo ekunciphiseni ubuhlungu obungapheliyo buphantsi. Kwakukho ubungqina obuphezulu obuphezulu bokucamngca ngengqiqo ekudandathekeni kunye nemiphumo yempilo yengqondo ehambelana nomgangatho. Olu hlaziyo luhambelana neengxelo zangaphambilini ezigqityiweyo ukuba kukho i-RCT enokwakheka kakuhle, echanekileyo, kunye ne-RCT emikhulu efunekayo ukuze kuphuhliswe ubungqina bobuchule obuya kunika ngokuthe ngqiqweni ukuqikelela kokusebenza kwengcamango engqondweni. Okwangoku, ubuhlungu obungapheliyo buqhubeka bubangela umthwalo omkhulu kuluntu kunye nabantu ngabanye. Indlela yokwelapha intsha yokulawula ubuhlungu obungapheliyo njengokucamngca kwengqondo kuya kuba yamkelwa zizigulane ezibuhlungu.

 

I-Electronic Supplementary Material

 

Ncbi.nlm.nih.gov/pmc/articles/PMC5368208/

 

Ukuthotyelwa kweMigangatho yokuHlola

 

Inkxaso kunye neNkcazo

 

Ukuhlaziywa okucwangcisiweyo kuye kwaxhaswa ngeSebe lezoKhuselo zeZiko loBugcisa kwiMpilo yeNgqondo kunye neNgxaki yeBrain Injury (inkontileka yenombolo 14-539.2). Iziphumo kunye nezigqibo ezikule ngqangi zizo zabalobi kwaye akumele zimelele iimvo zeSebe lezoKhuselo zeZiko loBugcisa kwiZempilo ze-Psychological and Traumatic Brain Injury.

 

Ababhali beNkcazo yoLwaphulo lweNtshisekelo kunye nokuHlonipha kwiMigangatho yamaGunya abaPhezulu

Ababhali i-Hilton, i-Hempel, i-Ewing, i-Apaydin, i-Xenakis, i-Newberry, uClalaiaco, i-Maher, i-Shanman, i-Sorbero, noMaglione bayakuxela ukuba abanakho ukulwa. Zonke iinkqubo, kubandakanywa nenkqubo yemvume enolwazi, zenziwa ngokuhambelana nemigangatho yokuziphatha yekomiti ejongene nokuzama kweziluntu (iziko kunye nelizwe) kunye ne-Helsinki Declaration ye-1975, njengoko ihlaziywe kwi-2000.

 

Ukuqukumbela, uxinzelelo luya kuthintela ekugqibeleni impilo yethu yonke kunye nokuphila kakuhle ukuba ingalawulwa kakuhle. Ngethamsanqa, iindlela ezininzi zokulawula uxinzelelo, kubandakanya ukunakekelwa kwe-chiropractic kunye nokucamngca kwengqondo, kunokukunceda ukunciphisa uxinzelelo kunye nokuphucula intlungu engapheliyo enokuxinzezeleka. Ukwelashwa kwe-Chiropractic yindlela ebalulekileyo yokulawulwa kwengcinezelo kuba iyakwazi ukuzolalisa "ukulwa okanye ukusabaleka" impendulo ehambelana nokucinezeleka okungapheliyo. Le nqaku apha ngasentla ibonise nendlela ukucamngca kwengqondo kungabakho ubuchule obuphambili bokulawulwa kwengcinezelo yokuphucula impilo kunye nokuphila kakuhle. Ulwazi oluchazwe kwiziko leSizwe loLwazi lweBiotechnology (NCBI). Ubungakanani beenkcukacha zethu zikhawulelwe kwi-chiropractic kwakunye nokulimala kwemigudu kunye nemeko. Ukuxoxa ngesihloko, nceda ukhululeke ukucela uDkt Jimenez okanye uqhagamshelane nathi 915-850-0900 .

 

Ikhutshwe nguDkt. Alex Jimenez

 

 

Imixholo eyongezelelweyo: Ubunzima bokubuyisela

 

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

 

 

ISIHLOKO ESIBALULEKILEYO: Ukulawula uxinzelelo lomsebenzi

 

 

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