Imigaqo yokuQela iMitholampilo ye-Back And Syndromes Pains

Imigaqo yokuLungisa iMitholampilo:

"Isigqibo sezonyango, imithetho yesifo somgudu kunye nokubikezelwa kwempembelelo yonyango: Ingxoxo yeengxelo zamuva kwiincwadi zokuvuselela"

Abstract

Imithetho yesigqibo seklinikhi yinto exhaphakileyo yobukho kuncwadi lwe-biomedical kwaye imele isicwangciso esinye sokuphucula ukuthathwa kwezigqibo zeklinikhi ukuphucula ukusebenza kunye nokusebenza kokunikezelwa kwezempilo. Kwimeko yophando lokubuyisela, imithetho yesigqibo seklinikhi ijolise kakhulu ekuhleleni izigulane ngokuxela kwangaphambili impendulo yabo yonyango kwiindlela zonyango ezithile. Ngokwesiko, iingcebiso zokuphuhlisa imigaqo yesigqibo seklinikhi ziphakamisa inkqubo ye-multistep (ukukhutshwa, ukuqinisekiswa, uhlalutyo lwempembelelo) usebenzisa indlela echaziweyo. Iinzame zophando ezijolise ekuphuhliseni umgaqo wesigqibo seklinikhi esekwe kwi-diagnostic ziye zahamba kule ngqungquthela. Upapasho lwakutsha nje kulo mgca wophando lusebenzise isigama esilungisiweyo esisekelwe kwisikhokelo sesigqibo sekliniki. Ukuguqulwa kwesigama kunye neendlela ezijikeleze imithetho yesigqibo seklinikhi kunokukwenza kube nzima ngakumbi kwiikliniki ukuba ziqaphele inqanaba lobungqina obuhambelana nomgaqo wesigqibo kunye nokuqonda ukuba obu bungqina bufanele buphunyezwe njani ukwazisa ukhathalelo lwesigulane. Sinikezela ngokufutshane ngophuhliso lomgaqo wesigqibo seklinikhi kumxholo woncwadi lokubuyisela kunye namaphepha amabini athile asanda kupapashwa kwiChiropractic kunye neManual Therapies.

Imigaqo yokuLungisa iMitholampilo

• Ukhathalelo lwempilo luye lwenziwa utshintsho olubalulekileyo lweparadigm ukuya kwindlela esekwe kubungqina. Indlela yokucinga yokuphucula ukuthathwa kwezigqibo zeklinikhi ngokudibanisa obona bungqina bukhoyo nobuchwephesha bezonyango kunye nezinto ezikhethwa zizigulana.
• Ekugqibeleni, injongo yobungqina obusekelwe kubungqina kukuphucula ukunikezelwa kwezempilo. Nangona kunjalo, ukuguqulelwa kobungqina besayensi ekusebenzeni kuye kwabonakalisa umzamo onzima.
• Imithetho yezigqibo zeklinikhi (CDRs), eyaziwa ngokuba yimithetho yokubikezela iklinikhi, iya ixhaphake kakhulu kuncwadi lokubuyisela.
• Ezi zixhobo ezenzelwe ukwazisa ukuthathwa kwezigqibo zeklinikhi ngokuchonga abanokuthi baqikelele iziphumo zovavanyo lokuxilonga, ukuxilongwa, okanye impendulo yonyango.
• Kuncwadi lokubuyisela kwisimo sangaphambili, ii-CDR zidla ngokusetyenziswa ukuqikelela impendulo yesigulane kunyango. Baye bacetywa ukuba bachonge amacandelwana afanelekileyo ekliniki kwizigulana ezibonisa ukuphazamiseka okungafaniyo okunje ngentamo engacacanga okanye ephantsi. umqolo obuhlungu, eyona mbono sijonge ukugxila kuyo.

Imigaqo yokuLungisa iMitholampilo

• Ikhono lokuhlela okanye izigulane ezineengxaki ezingaqhelekanga ezifana neentlungu zomgogodla ziye zagxininiswa njengento ephambili yophando kwaye, ngenxa yoko, kugxilwe kwimigudu yophando oluninzi. Isibheno seendlela zokuhlela ezinje ngamandla abo okuphucula unyango oluphuculweyo kunye nokusebenza ngokudibanisa izigulane ezinonyango olululo. Kwixesha elidlulileyo, ukuhlelwa kwezigulane kuxhomekeke kwiindlela ezicacileyo ezisekelwe kwisithethe okanye uqwalaselo olungacwangciswanga. Ukusetyenziswa kwee-CDRs ukwazisa ulwahlulo yinzame enye kwindlela eqhutywa bubungqina, engaphantsi kokuxhomekeka kwithiyori engenasiseko.
• IiCDR ziphuhliswa kwinkqubo yamanyathelo amaninzi abandakanya izifundo zokuvela, ukuqinisekiswa, kunye nohlalutyo lwempembelelo, nganye nganye inenjongo echaziweyo kunye neendlela zendlela yokusebenza. Njengazo zonke iintlobo zobungqina obusetyenziselwa ukwenza izigqibo malunga nezigulane, ingqalelo kwindlela yokufunda efanelekileyo ibalulekile ekuhloleni iinzuzo ezinokuthi ziphunyezwe.

Iinzuzo Zemiqathango Yokuqulunqa Kwezonyango

• Inokwamkela izinto ezininzi kunokuba ingqondo yomntu inokuthi ithathele ingqalelo
• Imodeli yeCDR / CPR iya kuhlala isinika umphumo ofanayo (i-equation mathati)
• Inokuthi ichaneke ngakumbi kunesigwebo seklinikhi.

Ukusetyenziswa Kwezonyango zeMithethonqubo yokuBhekiswa kweMpilo

• Uxilongo Amathuba amahle kakhulu
• Ukuxela kwangaphambili Ukuqikelela umngcipheko weziphumo zezifo

 

 

johnsnyderdpt.com/for-clinicians/clinical-prediction-rules/cervical-manipulation-for-neck-pain/

johnsnyderdpt.com/for-clinicians/clinical-prediction-rules/thoracic-manipulation-for-neck-pain/

johnsnyderdpt.com/for-clinicians/clinical-prediction-rules/manipulation-for-low-back-pain

johnsnyderdpt.com/for-clinicians/clinical-prediction-rules/lumbar-spinal-stenosis/

Iwebhusayithi kaDkt. John Snyder

I-Flynn Clinical Prediction Rule Video

CDR Uhlalutyo lwempembelelo

Ekugqibeleni, ukuba luncedo kwe-CDR abukho ngokuchaneka kwayo kodwa kukukwazi kwayo ukuphucula iziphumo zekliniki kunye nokuphucula ukusebenza kakuhle kokhathalelo.[15] Nangona i-CDR ibonisa ukuqinisekiswa okubanzi, oku akuqinisekisi ukuba kuya kutshintsha ukwenza izigqibo zekliniki okanye ukuba utshintsho oluvelisayo luya kubangela ukhathalelo olungcono.

Utshintsho oluvelisayo luya kubangela ukhathalelo olungcono. McGinn et al. [2] ichonge iingcaciso ezintathu zokusilela kwe-CDR okwangoku. Okokuqala, ukuba isigwebo seklinikhi sichanekile njengesigqibo esinolwazi ngeCDR, akukho nzuzo ekusebenziseni kwayo. Okwesibini, ukusetyenziswa kwe-CDR kunokubandakanya izibalo ezinzima okanye iinkqubo ezityhafisa oogqirha ekusebenziseni i-CDR. Okwesithathu, ukusebenzisa iCDR kusenokungenzeki kuzo zonke iimeko ezingqongileyo okanye iimeko. Ukongezelela, siya kubandakanya inyaniso yokuba izifundo zovavanyo zingabandakanya izigulane ezingamelanga ngokupheleleyo abo babonwa kukhathalelo lwesiqhelo kwaye oku kunokunciphisa ixabiso langempela le-CDR. Ke ngoko, ukuqonda ngokupheleleyo ukusetyenziswa kwe-CDR kunye nokukwazi kwayo ukuphucula unikezelo lwezempilo, kuyafuneka ukuba kwenziwe uvavanyo lwepragmatic yokuba nokwenzeka kwayo kunye nefuthe xa isetyenziswa kwindawo ebonisa ukwenziwa kwehlabathi lokwenyani. Oku kunokwenziwa ngoyilo olwahlukileyo lophononongo olufana nolingo olungenamkhethe, ulingo olungenamkhethe, okanye ezinye iindlela ezinjengokuvavanya impembelelo yeCDR ngaphambi nasemva kokuphunyezwa kwayo.

Ubuninzi beendlela zokwenza izigulane ezinobungozi obukhulu ngokusebenzisa iMicKenzie syndromes, iprogram yeentlungu, ukunyanzelisa, kunye nokuzinzisa imigaqo yekliniki yokuqikelela.

www.ncbi.nlm.nih.gov/pmc/articles/PMC3113271/

iinjongo

Iinjongo ziyi (1) ukucacisa inani lezigulane ezinokukhubazeka okungabonakaliswa ngokubanjwa yi-McKenzie syndromes (McK) kunye nokuhlelwa kohlobo lweentlungu (PPCs) ngokusebenzisa iindlela zokuhlola i-Mechanical and Therapy (MDT), ukunyanzelisa, nokuzinzisa izigulane imigaqo (i-CPRs) kunye (2) ngamnye kumntu weCPR okanye iStab CPR, ubeke amazinga okuhlaliswa kwezibalo usebenzisa iMcK ne-PPC.

I-CPRs yinkqubo eyimfuneko yokuxhomekeka kunye neprognostic apho iqela leempawu zesigulane ezichongiweyo kunye neempawu zeklinikhi kunye neempawu zihambelana nokubaliswa okubalulekileyo kweziphumo zesigulane.

Ii-CPR ezimbini ezihlukeneyo zaphuhliswa ngabaphandi ukuze bachonge izigulane eziza kusabela ngokufanelekileyo ekusebenziseni.33,34 Flynn et al. iphuhlise i-CPR yokuqala yokukhwabanisa isebenzisa iikhrayitheriya ezintlanu, oko kukuthi, akukho zimpawu ngaphantsi kwedolo, ukuvela kwamva nje kweempawu (<ientsuku ze-16), i-questionnaire ephantsi yokuphepha ukwesaba inkolelo36 umsebenzi (<19), i-hypomobility ye-lumbar spine, kunye ne-hip yangaphakathi. ukujikeleza i-ROM (> 35 ubuncinane i-hip enye) .33

ICPR kaFlynn yatshintshwa emva koko nguFritz et al. kwiikhrayitheriya ezimbini, ezingabandakanyi iimpawu ezingaphantsi kwedolo kunye nokuqala kweempawu zamva (<ientsuku ze-16), njengenye indlela yepragmatic yokunciphisa umthwalo wekliniki ukuchonga izigulane kukhathalelo oluphambili olunokuthi luphendule ukunyanzeliswa kwe-thrust.34 ngokuqinisekileyo

"I-Potentia.l Imigibe yeMithetho yokuQikelela kwezonyango"

Yiyiphi iMigaqo yokuQela kweeKliniki?

Umgaqo wokuxela kwangaphambili kweklinikhi (CPR) yindibaniselwano yeziphumo zeklinikhi eziye zabonisa ngokwezibalo ukuqikelelwa okunentsingiselo ekunqumeni imeko ekhethiweyo okanye i-prognosis yesigulane esinikwe unyango oluthile lwe-1,2. Ii-CPR zenziwe kusetyenziswa iindlela ezininzi zokwenza izibalo, zenzelwe ukuhlolisisa amandla okuqikelelwa kwamaqela akhethiweyo eenguqu zeklinikhi3,4, kwaye zijoliswe ekuncedeni oogqirha ukuba benze izigqibo ezikhawulezayo ezinokuthi ngokuqhelekileyo zixhomekeke kwi-biases5. Imithetho i-algorithmic kwindalo kwaye ibandakanya ulwazi olufutshane oluchonga elona nani lincinci lezalathi zokuxilonga ngokwezibalo kwimeko ekujoliswe kuyo6.

Imithetho yeklinikhi yokuxela kwangaphambili iphuhliswa ngokubanzi kusetyenziswa indlela ye-3-step14. Okokuqala, iiCPR zisifumene ngokubonakalayo-
ing iindlela zobalo ezininzi zokuvavanya amandla okuqikelela amaqela akhethiweyo eenguqu zeklinikhi3. Isinyathelo sesibini sibandakanya ukuqinisekiswa kwe-CPR kwisilingo esilawulwa ngokungahleliwe ukuze kuncitshiswe umngcipheko wokuba izinto eziqikelelwayo eziphuhliswe ngexesha lesigaba sokukhutshwa zikhethwe ngengozi14. Isinyathelo sesithathu sibandakanya ukwenza uhlalutyo lwempembelelo ekunqumeni indlela iCPR ephucula ngayo ukhathalelo, iyanciphisa iindleko, kwaye ichaze ngokuchanekileyo injongo ekujoliswe kuyo14.

Nangona kukho ingxabano encinci eyakha ngokucophelela i-CPRs inokuphucula ukwenziwa kweklinikhi, kokwazi kwam, akukho zikhokelo ezichazayo iimfuno zendlela yokwenza i-CPRs ukunyuswa kuzo zonke iimeko zengqondo. Izikhokelo zenziwe ukuze kuphuculwe ubunzulu bokuyila kunye nokunika ingxelo. Uluhlu olulandelayo luchaza iindlela ezinokuthi zenze i-CPRs emigodini enokuthi ithintele kakhulu ukutshintshwa kwe-algorithm. Kwinkalo yokuvuselelwa, ezininzi zeCPR ziye zichazwe; Ngako oko, izimvo zam apha zibonakalisa iCPRs echazwe.

Iimpawu zokuSebenza

Ii-CPR zenzelwe ukucacisa isethi yeempawu ezivela kubantu abaninzi abaza kukhethwa ngokulandelelana ngokulandelelana kwezigulane5,15. Ngokuqhelekileyo, isiphumo sabemi esisebenzayo sisincinci esincinci sesampulu enkulu kwaye sinokumela kuphela ipesenti encinci yomthwalo wemihla ngemihla wonyango. Ukumiselwa kunye nendawo yesampula enkulu kufuneka i-generalizable15,16, kwaye izifundo ezilandelayo zokuqinisekisa zifuna ukuhlolwa kwe-CPR kumaqela ahlukeneyo ezigulane, kwiindawo ezahlukeneyo, kunye neqela eliqhelekileyo lesigulane elibonwa ngoogqirha abaninzi16. Ngenxa yokuba ii-CPR ezininzi ziphuhliswa ngokusekelwe kwiqela elihluke kakhulu elinokuthi okanye lingabonisi inani labantu abaqhelekileyo bezigulane, i-spectrum transportability17 yee-algorithms ezininzi ze-CPR zangoku zinokulinganiselwa.

Imithetho yokubikezela kweklinikhi isebenzisa imilinganiselo yesiphumo ukumisela ukusebenza kokungenelela. Amanyathelo esiphumo kufuneka abe nenkcazo yokusebenza enye5 kwaye afune ukuphendula ngokwaneleyo ukuze kuthathwe utshintsho olufanelekileyo kwimeko14 ngokwenene; ukongeza, le milinganiselo kufuneka ibe ne-cut-cut off score eyakhiwe kakuhle16,18 kwaye iqokelelwe ngumlawuli oyimfama15. Ukukhethwa kwenqaku le-ankile elifanelekileyo lomlinganiselo wenguqu yokwenyani kusaxoxwa19-20. Uninzi lweziphumo zeziphumo zisebenzisa i-questionnaire esekelwe kwi-recall-based questionnaire efana ne-global rating of change score (GRoC), efanelekileyo xa isetyenziswe kwixesha elifutshane kodwa ihlupheka ngenxa yokukhumbula ukukhumbula xa isetyenziswe kuhlalutyo lwexesha elide19-21.

I-drawback enokuthi yenzeke kwi-CPRs kukungaphumeleli kokugcina umgangatho weemvavanyo kunye nemilinganiselo esetyenziswa njenge-predictors kwi-algorithm. Ngoko ke, uvavanyo lwembono kunye nemilinganiselo kufuneka izimele enye kwenye ngexesha le-model16; ngalinye kufuneka lenziwe ngendlela enentsingiselo, eyamkelekileyo4; oogqirha okanye abalawuli bedatha kufuneka bamfameke kwimilinganiselo yeziphumo zesigulane kunye nemeko22.

imithombo

Imingxunya enokubakho yemithetho yokuxelwa kwangaphambili kwezonyango; Ijenali yencwadi yokuNyanga kunye noNyango oluNyanzelekileyo uMqulu we-16 Inani leSibini [69]

UJeffrey J Hebert noJulie M Fritz; Isigqibo sezonyango, imithetho yesifo somgudu kunye nokubikezelwa kwesiphumo sonyango: Ingxoxo yeengxelo zangoku kwincwadi yokuvuselela