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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.
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/
I-Flynn Clinical Prediction Rule Video
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.
www.ncbi.nlm.nih.gov/pmc/articles/PMC3113271/
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.
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.
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.
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
Umgangatho wobuchule wokuSebenza *
Ulwazi olulapha ku "Imigaqo yokuQela iMitholampilo ye-Back And Syndromes Pains"Akujoliswanga ukuthatha indawo yobudlelwane obubodwa kunye nomntu oqeqeshiweyo wezempilo okanye ugqirha onelayisensi kwaye akusiyo isiluleko sonyango. Sikhuthaza ukuba wenze izigqibo zezempilo ngokusekelwe kuphando lwakho kunye nentsebenziswano kunye nochwepheshe bezempilo abaqeqeshiweyo.
Ulwazi lweBlog kunye neengxoxo zoMda
Umda wethu wolwazi ilinganiselwe kwiChiropractic, i-musculoskeletal, amayeza omzimba, impilo, igalelo le-etiological ukuphazamiseka kwe-viscerosomatic ngaphakathi kweentetho zeklinikhi, ezinxulumene ne-somatovisceral reflex clinical dynamics, i-subluxation complexes, imiba yezempilo ebuthathaka, kunye / okanye amanqaku amayeza asebenzayo, izihloko kunye neengxoxo.
Sibonelela kwaye sibonise intsebenziswano yeklinikhi neengcaphephe kumacandelo ahlukeneyo. Ingcali nganye ilawulwa ngumsebenzi wabo wobugcisa kunye negunya labo lokufumana iphepha-mvume. Sisebenzisa iiprothokholi ezisebenzayo zempilo kunye nempilo entle ukunyanga nokuxhasa ukhathalelo lokwenzakala okanye ukuphazamiseka kwenkqubo ye-musculoskeletal.
Iividiyo zethu, izithuba, izihloko, imixholo, kunye nokuqonda zibandakanya imiba yezonyango, imiba, kunye nezihloko eziyelelene kwaye zixhase ngokuthe ngqo okanye ngokungathanga ngqo umda wokuziqhelanisa wethu.
I-ofisi yethu izamile ngokufanelekileyo ukubonelela ngeengcaphulo ezixhasayo kwaye ichonge uphando olufanelekileyo lophando okanye izifundo ezixhasa izithuba zethu. Sinikezela ngeekopi zophando ezixhasayo ezifumanekayo kwiibhodi ezilawulayo nakuluntu ngesicelo.
Siyaqonda ukuba sigubungela imicimbi efuna inkcazo eyongezelelweyo yokuba inganceda njani kwisicwangciso esithile sokhathalelo okanye inkqubo yonyango; ke, ukuqhubeka nokuxoxa ngombandela ongentla, nceda ukhululeke ukubuza UDkt Alex Jimenez, DC, okanye qha ga mshelana nathi 915-850-0900.
Silapha ukunceda wena kunye nosapho lwakho.
Iintsikelelo
UDkt Alex Jimenez D.C., I-MSACP, RN*, I-CCST, IFMCP*, I-CIFM*, I-ATN*
email: qeqeshi@elpasofunctionalmedicine.com
Ilayisenisi njengoGqirha weChiropractic (DC) kwi Texas & New Mexico*
Texas DC Ilayisensi # TX5807, New Mexico DC Ilayisensi # I-NM-DC2182
Unikwe Ilayisensi njengoMongikazi oBhalisiweyo (RN*) in Florida
Florida License RN Ilayisensi # I-RN9617241 (Nombolo yolawulo. 3558029)
Ubume obubambeneyo: ILayisensi yeeNkcazo ezininzi: Ugunyaziswe Ukuziqhelanisa I-40 States*
UGqr. Alex Jimenez DC, MSACP, RN* CIFM*, IFMCP*, ATN*, CCST
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