Iintlungu ezisezantsi zibonisa esinye sezikhalazo eziqhelekileyo kwiindawo zempilo. Nangona ukulimala okwahlukeneyo kunye neemeko ezinxulumene ne-musculoskeletal kunye ne-nervous system zingabangela intlungu ephantsi, abaninzi abaqeqeshi bezempilo bakholelwa ukuba ukulimala komsebenzi kunokuba noqhagamshelwano oluxhaphakileyo kwiintlungu ezisezantsi. Ngokomzekelo, ukuma okungafanelekanga kunye nokunyakaza okuphindaphindiweyo kunokubangela ukulimala okunxulumene nomsebenzi. Kwezinye iimeko, iingozi zendalo emsebenzini zinokubangela ukwenzakala emsebenzini. Kwimeko nayiphi na into, ukuxilonga umthombo wentlungu ephantsi yesigulane ukumisela ngokuchanekileyo ukuba yeyiphi indlela yonyango yokubuyisela impilo yokuqala kunye nokuphila kakuhle ngokuqhelekileyo ngumngeni.

Okokuqala nokuphambili, ukufumana oogqirha abafanelekileyo kumthombo wakho othile weentlungu ezisezantsi kubalulekile ekufumaneni ukukhululeka kwiimpawu zakho. Uninzi lwabaqeqeshi bezempilo bafanelekile kwaye banamava ekuphatheni iintlungu ezisezantsi ezinxulumene nomsebenzi, kubandakanya oogqirha be-chiropractic okanye i-chiropractors. Ngenxa yoko, izikhokelo ezininzi zonyango zokulimala komsebenzi ziye zasekwa ukulawula iintlungu ezisezantsi kwimimiselo yezempilo. Ukunyamekela kwe-Chiropractic kugxile ekuxilongweni, ekuphatheni nasekukhuseleni ukulimala kunye neemeko ezahlukeneyo, ezifana ne-LBP, ehambelana ne-musculoskeletal and nervous system. Ngokulungisa ngokucophelela ukungahambi kakuhle komqolo, ukunakekelwa kwe-chiropractic kunokunceda ukuphucula iimpawu zentlungu ephantsi, phakathi kwezinye iimpawu. Injongo yale nqaku ilandelayo kukuxoxa ngezikhokelo zempilo yomsebenzi wokulawula iintlungu ezisezantsi.

Izikhokelo zezeMpilo zeZempilo zoLawulo lweNtlungu eNgaphantsi: Ukuthelekiswa kwamazwe ngamazwe

Abstract

• imvelaphi: Umthwalo omkhulu wentlalo noqoqosho lweentlungu ezisezantsi zigxininisa imfuno yokulawula le ngxaki, ngakumbi kwimeko yomsebenzi ngokufanelekileyo. Ukujongana noku, izikhokelo zemisebenzi ziye zakhutshwa kumazwe ahlukeneyo.
• Iinjongo: Ukuthelekisa izikhokelo ezikhoyo zamazwe ngamazwe zokulawula iintlungu ezisezantsi kwindawo yokunakekelwa kwempilo yomsebenzi.
• Iindlela: Izikhokelo zafaniswa ngokubhekiselele kwiikhrayitheriya zomgangatho owamkelwa ngokubanzi kusetyenziswa isixhobo se-AGREE kwaye kwakhona kushwankathelwa malunga nekomiti yesikhokelo, intetho, iqela ekujoliswe kulo, kunye novavanyo kunye neengcebiso zokulawula (oko kukuthi, iingcebiso, ukubuyela kwisicwangciso somsebenzi, kunye nonyango).
• Iziphumo kunye nezigqibo: Iziphumo zibonisa ukuba izikhokelo ngokwahlukeneyo zadibana nemilinganiselo yomgangatho. Iziphene eziqhelekileyo zijongene nokungabikho kokuphononongwa okufanelekileyo kwangaphandle kwinkqubo yophuhliso, ukungabikho kwengqalelo kwimiqobo yentlangano kunye neendleko ezithintekayo, kunye nokungabikho kolwazi malunga nokuba abahleli kunye nabaphuhlisi babezimele. Kwakukho isivumelwano ngokubanzi kwimiba emininzi ebalulekileyo ekulawuleni impilo yomsebenzi weentlungu zangasemva. Izindululo zovavanyo zibandakanya i-triage yokuxilonga, ukujonga iiflegi ezibomvu kunye neengxaki ze-neurological, kunye nokuchonga imiqobo enokubakho yengqondo kunye nendawo yokusebenza yokubuyisela. Izikhokelo ziphinde zavumelana ngeengcebiso zokuba intlungu ephantsi yimeko yokuzimela kwaye ukuhlala emsebenzini okanye ngokukhawuleza (kancinci) ukubuyela emsebenzini, ukuba kuyimfuneko ngemisebenzi eguqulwayo, kufuneka ikhuthazwe kwaye ixhaswe.

Insight of Dr. Alex Jimenez

Intlungu ebuyiswe emva kweyona nto yimiba echaphazelekayo yempilo ephathwe kwiiofisi ze-chiropractic. Nangona eli nqaku lilandelayo lichaza intlungu ephantsi ye-back as condition self limiting, imbangela ye-LBP yomntu inokubangela ukuba intlungu ephosakeleyo kwaye ibuhlungu kunye nokungahambi kakubi. Kubalulekile ukuba umntu oneempawu zeentlungu ezisezantsi zifuna unyango olufanelekileyo kunye ne-chiropractors ukuba ahlolisise kakuhle kwaye aphathe imicimbi yabo yempilo kunye nokubathintela ukuba babuyele kwixesha elizayo. Izigulane ezinamava aphantsi kwexesha elide kuneenyanga ze-3 zingaphantsi kweepesenti ze-3 zokuba zibuyele emsebenzini. Ukhathalelo lwe-Chiropractic yindlela ekhuselekileyo yokwenza unyango olungenakunceda ukubuyisela umsebenzi wokuqala wentsholongwane. Ukongezelela, ugqirha we-chiropractic, okanye i-chiropractor, unokubonelela ngeendlela zokuphila, njengokuncedisa okunomsoco kunye nempilo, ukukhawulezisa inkqubo yokubuyisela isiguli. Ukuphulukiswa ngokunyakaza kubalulekile ekubuyiseni kwe-LBP.

Iintlungu ezisezantsi (LBP) yenye yeengxaki zempilo eziqhelekileyo zamazwe amashishini. Nangona i-benign nature kunye nekhosi ephilileyo, i-LBP idla ngokuhambelana nokungakwazi, ukulahlekelwa kwemveliso ngenxa yekhefu lokugula, kunye neendleko eziphezulu zoluntu.[1]

Ngenxa yaloo mpembelelo, kukho imfuneko ecacileyo yezicwangciso eziliqili zolawulo olusebenzayo olusekwe kubungqina benzululwazi obuphuma kwizifundo zomgangatho ovakalayo wemethodi. Ngokuqhelekileyo, ezi zilingo ezilawulwa ngokungahleliwe (RCTs) ekusebenzeni kongenelelo lonyango, izifundo zokuxilonga, okanye izifundo ezilindelekileyo zokujonga kwizinto ezinobungozi okanye iziphumo ebezingalindelekanga. Ubungqina bobunzululwazi, obushwankathelweyo ngokuphononongwa okucwangcisiweyo kunye nohlalutyo lweemeta, lubonelela ngesiseko esiqinileyo sezikhokelo zokulawula i-LBP. Kwiphepha elidlulileyo, uKoes et al. kuthelekisa izikhokelo ezahlukeneyo ezikhoyo zeklinikhi zokulawula i-LBP ekujoliswe kuyo kwiingcali zempilo esisiseko, ebonisa ukufana okubonakalayo.[2]

Iingxaki kukhathalelo lwempilo emsebenzini zahlukile. Ulawulo lujolise ikakhulu ekucebiseni umsebenzi kunye ne-LBP kunye nokujongana nemiba yokubanceda ukuba baqhubeke nokusebenza okanye babuyele emsebenzini (RTW) emva koluhlu lokugula. Nangona kunjalo, i-LBP ikwangumba obalulekileyo kukhathalelo lwempilo yomsebenzi ngenxa yokungakwazi ukusebenza, ukulahleka kwemveliso, kunye nekhefu lokugula. Izikhokelo ezininzi, okanye amacandelo ezikhokelo, ngoku sele epapashiwe ejongene nemiba ethile yolawulo kwindawo yokhathalelo lwempilo yomsebenzi. Ekubeni ubungqina bumazwe ngamazwe, kuya kulindeleka ukuba iingcebiso zezikhokelo ezahlukeneyo zomsebenzi we-LBP ziya kuba zifana okanye zifana. Nangona kunjalo, akucaci ukuba izikhokelo ziyahlangabezana neenqobo zomgangatho owamkelweyo ngoku.

Eli phepha livavanya ngokunzulu izikhokelo zomsebenzi ezikhoyo ekulawuleni i-LBP kwaye lithelekisa uhlolo kunye nengcebiso zabo zolawulo.

Imiyalezo Eyona

• Kumazwe ahlukeneyo, izikhokelo zempilo yomsebenzi zikhutshwa ukuze kuphuculwe ulawulo lweentlungu ezisezantsi kwimeko yomsebenzi.
• Iziphene eziqhelekileyo zezi zikhokelo zibandakanya ukungabikho kokuphononongwa okufanelekileyo kwangaphandle kwinkqubo yophuhliso, ukungabikho kwengqalelo kwizithintelo zentlangano kunye neendleko, kunye nokungabikho kolwazi ngokuzimela kwabahleli kunye nabaphuhlisi.
• Ngokubanzi, iingcebiso zovavanyo kwizikhokelo zibandakanya ukuvavanywa kokuxilonga, ukujonga iiflegi ezibomvu kunye neengxaki ze-neurological, kunye nokuchonga izithintelo ezinokuthi zibekho ngokwasengqondweni nakwindawo yokusebenza ukuze kubuyiselwe.
• Kukho isivumelwano esiqhelekileyo malunga neengcebiso zokuthi intlungu ephantsi yimeko yokuzimela kwaye ukuhlala emsebenzini okanye ngokukhawuleza (kancinci) ukubuyela emsebenzini, ukuba kuyimfuneko ngemisebenzi eguqulwayo, kufuneka ikhuthazwe kwaye ixhaswe.

tindlela

Izikhokelo malunga nokulawulwa kwempilo yomsebenzi we-LBP zifunyenwe kwiifayile zomntu zababhali. Ukubuyiswa kuhlolwe ngophando lwe-Medline usebenzisa amagama angundoqo intlungu ephantsi, izikhokelo, kunye nomsebenzi ukuya ku-Oktobha 2001, kunye nokunxibelelana komntu kunye neengcali kwintsimi. Imigaqo-nkqubo kwafuneka ukuba ihlangabezane nezi ndlela zilandelayo zokubandakanywa:

• Izikhokelo ezijoliswe ekulawuleni abasebenzi abane-LBP (kwiimeko zokhathalelo lwempilo yomsebenzi okanye ukujongana nemiba yomsebenzi) okanye amacandelo ahlukeneyo emigaqo-nkqubo ejongene nezi zihloko.
• Izikhokelo zifumaneka ngesiNgesi okanye ngesiDatshi (okanye ziguqulelwe kwezi lwimi).

Inkqubo yokukhutshwa kwaba:

• Izikhokelo malunga nokuthintela okuphambili (oko kukuthi, ukuthintela ngaphambi kokuqala kweempawu) ze-LBP ezinxulumene nomsebenzi (umzekelo, ukuphakamisa imiyalelo yabasebenzi).
• Izikhokelo zezonyango zokulawulwa kwe-LBP kwinkathalo ephambili. [2]

Umgangatho wezikhokelo ezibandakanyiweyo zavavanywa kusetyenziswa isixhobo se-AGREE, isixhobo esiqhelekileyo esenzelwe ngokukodwa ukunceda abaphuhlisi besikhokelo kunye nabasebenzisi bavavanya umgangatho wemethodological wemigaqo yezonyango [3].

Isixhobo se-AGREE sibonelela ngesakhelo sokuvavanya umgangatho kwizinto ezingama-24 (itheyibhile 1), nganye ilinganiswe kwisikali samanqaku amane. Ukusebenza ngokupheleleyo kuyafumaneka ku-www.agreecollaboration.org.

Abahlalutyi ababini (i-BS kunye ne-HH) balinganise ngokuzimeleyo umgangatho wezikhokelo baze badibane ukuze baxoxe ngokungaboni ngasonye kunye nokufikelela kwimvumelwano malunga nokulinganisa. Xa bengavumanga, umvandlakanyi wesithathu (MvT) wadibanisa umahluko oseleyo waza wagqiba malunga neereyithingi. Ukuququzelela uhlalutyo kolu hlaziyo, iireyithingi zatshintshwa zaba ziguquguqukayo ezidityanisiweyo zokuba ingaba umgangatho ngamnye ufunyenwe okanye awuhlangabezwanga.

Iingcebiso zovavanyo zishwankathelwe kwaye zifaniswa neengcebiso malunga neengcebiso, unyango, kunye nokubuyela kwizicwangciso zokusebenza. Izikhokelo ezikhethiweyo zibonakaliswe ngakumbi kwaye zafikelelwa malunga nekomiti yesikhokelo, unikezelo lwenkqubo, iqela ekujoliswe kulo, kunye nobungakanani apho iingcebiso zisekelwe kubungqina obukhoyo besayensi. Lonke olu lwazi lukhutshwe ngokuthe ngqo kwizikhokelo ezipapashiweyo.

Impembelelo yoMgaqo

• Ukulawulwa kweentlungu ezisezantsi kwinkathalo yezempilo yomsebenzi kufuneka kulandele izikhokelo ezisekelwe kubungqina.
• Izikhokelo zexesha elizayo zokulawula iintlungu ezisezantsi kunye nohlaziyo lwezo zikhokelo kufuneka ziqwalasele imilinganiselo yophuhliso olufanelekileyo, ukuphunyezwa, kunye novavanyo lweendlela njengoko kuphakanyiswe yintsebenziswano ye-AGREE.

iziphumo

Ukhetho lweZifundo

Uphando lwethu lufumene izikhokelo ezilishumi, kodwa ezine zazingabandakanywa ngenxa yokuba zijongene nokulawulwa kwe-LBP ekunyamekelweni kweprayimari, [15] yayijoliswe kwisikhokelo sabasebenzi abafakwe kuluhlu lokugula ngokubanzi (kungekhona ngokukodwa i-LBP), [16] yenzelwe uthintelo oluphambili lwe-LBP emsebenzini, [17] okanye aluzange lufumaneke ngesiNgesi okanye ngesiDatshi.[18] Ukhetho lokugqibela, ke ngoko, lubandakanya ezi zikhokelo zintandathu zilandelayo, ezidweliswe ngomhla wokukhutshwa:

(1) eKhanada (eQuebec). Indlela yesayensi yokuvavanya kunye nokulawulwa kweengxaki ezinxulumene nomsebenzi womgogodla. I-monograph yeekliniki. Ingxelo yeQuebec Task Force kwi-Spinal Disorders. Quebec Canada (1987) [4]

(2) eOstreliya (eVictoria). Izikhokelo zolawulo lwabasebenzi abaneentlungu ezisezantsi ezihlawulelwayo. IGunya le-Victorian WorkCover, e-Australia (1996).[5] (Olu luguqulelo oluhlaziyiweyo lwezikhokelo eziphuhliswe yi-South Australian WorkCover Corporation ngo-Okthobha ka-1993.)

(3) e-USA. IziKhokelo zokuSebenza ngamayeza eMsebenzini. IKholeji yaseMelika yoNyango lwezeMsebenzi kunye nokusiNgqongileyo. USA (1997) [6]

(4) eNew Zealand

(a)Iyasebenza kwaye iyasebenza! Ukulawula iintlungu ezibuhlungu ezisezantsi emsebenzini. IQumrhu leMbuyekezo yeNgozi kunye neKomiti yeSizwe yezeMpilo. ENew Zealand (2000).[7]

(b) Isikhokelo sesigulane sokulawula iintlungu ezisezantsi. IQumrhu leMbuyekezo yeNgozi kunye neKomiti yeSizwe yezeMpilo. ENew Zealand (1998) [8]

(c) Vavanya iiflegi ezityheli ngokwasengqondweni kwintlungu esezantsi yomqolo. IQumrhu leMbuyekezo yeNgozi kunye neKomiti yeSizwe yezeMpilo. ENew Zealand (1997) [9]

(5) eNetherlands. Isikhokelo saseDatshi sokulawula oogqirha bezemisebenzi yabasebenzi abaneentlungu ezisezantsi. Umbutho waseDatshi woNyango lwezeMisebenzi (NVAB). eNetherlands (1999) [10]

(6) e-UK

(a) Izikhokelo zempilo yomsebenzi wokulawula iintlungu ezisezantsi kwiinqununu zomsebenzi. IFaculty of Occupational Medicine. UK (2000) [11]

(b)Izikhokelo zempilo yomsebenzi zokulawula iintlungu ezisezantsi emsebenzini kubasebenzi. IFaculty of Occupational Medicine. UK (2000) [12]

(c) Izikhokelo zempilo yezemisebenzi yokulawula iintlungu ezisezantsi emsebenzini wokuphononongwa kobungqina. IFaculty of Occupational Medicine. UK (2000) [13]

(d)Incwadi engasemva, i-Ofisi yeZincwadi. UK (1996) [14]

Izikhokelo ezibini (i-4 kunye ne-6) ayikwazanga ukuvavanywa ngokuzimeleyo kumaxwebhu angaphezulu ababhekisela kuwo (4bc, 6bd), ngoko ke la maxwebhu afakwe kwakhona ekuhlaziyweni.

Ukuvavanya koMgangatho weZikhokelo

Ekuqaleni, bekukho isivumelwano phakathi kwabavavanyi babini malunga ne-106 (77%) ye-138 amanqaku amanqaku. Emva kweentlanganiso ezimbini, isivumelwano safikelelwa kuzo zonke izinto ngaphandle kwezine, ezifuna umgwebo ngumhloli wesithathu. Itheyibhile yoku-1 ibonisa iireyithingi zokugqibela.

Zonke izikhokelo ezibandakanyiweyo zibonise iindlela ezahlukeneyo zokulawula i-LBP kwimpilo yomsebenzi. Kwimigaqo-nkqubo emihlanu yesithandathu, iinjongo ezipheleleyo zenkqubo zichazwe ngokucacileyo, [46, 1014] abasebenzisi ekujoliswe kubo benkqubo bachazwe ngokucacileyo, i-514] iziphakamiso eziphambili ezicacileyo zifakwe, [4, 614] okanye ukuhlaziywa okubalulekileyo. Iikhrayitheriya zathiwa thaca ngeenjongo zokuhlola nophicotho-zincwadi.[49, 1114]

Iziphumo zovavanyo lwe-AGREE zibonise ukuba akukho nasinye sezikhokelo esinike ingqwalasela eyaneleyo kwimiqobo yentlangano enokubakho kunye neempembelelo zeendleko ekuphumezeni iingcebiso. Kwakhona kwakungacacanga kuzo zonke izikhokelo ezibandakanyiweyo ukuba ngaba bezizimele ngokuzimeleyo kumbutho wenkxaso-mali nokuba ngaba kukho ukungqubana komdla kumalungu eekomiti zophuhliso lwesikhokelo. Ngaphaya koko, bekungacacanga kuzo zonke izikhokelo ukuba ngaba iingcali ziye zayiphonononga ngaphandle imigaqo-nkqubo ngaphambi kokupapashwa. Kuphela isikhokelo sase-UK sichaza ngokucacileyo indlela esetyenziselwa ukuqulunqa iingcebiso kunye nokubonelela ngokuhlaziywa kwendlela. [11]

Uphuhliso lweZikhokelo

Itheyibhile 2 inikeza ulwazi lomvelaphi kwinkqubo yophuhliso yezikhokelo.

Abasebenzisi ekujoliswe kubo kwizikhokelo babengamagqirha kunye nabanye ababoneleli bezempilo kwinkalo yokhathalelo lwempilo yomsebenzi. Imigaqo-nkqubo eliqela nayo yayijoliswe ekwaziseni abaqeshi, abasebenzi [68, 11, 14], okanye amalungu emibutho enomdla kwimpilo yasemsebenzini.[4] Isikhokelo saseDatshi sasijoliswe kuphela kugqirha wezempilo wasemsebenzini.[10]

Iikomiti zesikhokelo ezinoxanduva lokuphuhlisa izikhokelo ngokubanzi bezineenkalo ezininzi, kubandakanywa amacandelo afana ne-epidemiology, i-ergonomics, i-physiotherapy, i-general practice, amayeza omsebenzi, unyango lomsebenzi, i-orthopedics, kunye nabameli bemibutho yabaqeshi kunye nemibutho yabasebenzi. Abameli beChiropractic kunye ne-osteopathic babekho kwikomiti yesikhokelo yezikhokelo zaseNew Zealand.[79] Iqela labasebenzi baseQuebec (eCanada) likwabandakanya abameli beyeza lokubuyisela kwisimo sangaphambili, i-rheumatology, uqoqosho lwezempilo, umthetho, i-neurosurgery, ubunjineli be-biomechanical, kunye nesayensi yelayibrari. Ngokwahlukileyo koko, ikomiti yesikhokelo yesikhokelo saseDatshi yayiquka oogqirha basemsebenzini kuphela.[10]

Izikhokelo zikhutshwe njengoxwebhu olwahlukileyo, [4, 5, 10] njengesahluko kwincwadi yesifundo, [6] okanye njengamaxwebhu amaninzi anxulumeneyo. [79, 1114]

I-UK, [13] i-USA, [6] kunye ne-Canadian [4] izikhokelo zinike ulwazi malunga neqhinga lokukhangela elisetyenziselwa ukuchongwa koncwadi olufanelekileyo kunye nokulinganiswa kobungqina. Kwelinye icala, amaDatshi [10] kunye neAustralia[5] izikhokelo zixhasa iingcebiso zabo kuphela ngeereferensi. Izikhokelo zaseNew Zealand azizange zibonise unxibelelwano oluthe ngqo phakathi kweengcebiso kunye neenkxalabo [79]. Umfundi uthunyelwe kolunye uncwadi ukuze afumane ulwazi olungemvelaphi.

Iindululo zoLuntu kunye neNgcaciso zoLwazi

Nangona zonke izikhokelo zijolise kubasebenzi abane-LBP, kwakusoloko kungacaci ukuba ngaba bajongana ne-LBP ebukhali okanye engapheliyo okanye zombini. I-LBP ebukhali kwaye engapheliyo yayisoloko ingachazwanga, kwaye amanqaku anqunyulwe anikezelwa (umzekelo, <iinyanga ze-3). Bekukade kungacaci nokuba ezi zibhekiselele ekuqalekeni kweempawu okanye ukungabikho emsebenzini. Nangona kunjalo, isikhokelo saseKhanada sazisa inkqubo yokuhlelwa (i-acute / subacute / engapheliyo) esekelwe ekusasazweni kwamabango okuphazamiseka komgogodla ngexesha lokungabikho emsebenzini.

Zonke izikhokelo zahlula i-LBP ethile kunye nengekho ngqo. I-LBP ethile ixhalabele iimeko ezinobuzaza zeflegi ebomvu njengokwaphuka, amathumba, okanye usulelo, kunye nezikhokelo zeDatshi kunye ne-UK zikwahlula i-radicular syndrome okanye intlungu yengcambu yomthambo.[1013] Zonke iinkqubo zazihambelana kwiingcebiso zabo zokuthatha imbali yeklinikhi kunye nokwenza uvavanyo lomzimba, kubandakanywa nokuhlolwa kwe-neurological. Kwiimeko ekurhaneleka ukuba zizifo ezithile (iiflegi ezibomvu), iimviwo ze-x-reyi zacetyiswa ngobuninzi bezikhokelo. Ukongeza, iNew Zealand kunye ne-US guideline nayo yacebisa uviwo lwe-x-reyi xa iimpawu zingaphucukanga emva kweeveki ezine. isigulane esine-LBP (eyahlukileyo kuzo naziphi na iimpawu zekliniki).[6]

Uninzi lwezikhokelo zithathela ingqalelo iimeko zengqondo njengeeflegi ezityheli njengemiqobo ekubuyiseleni ukuchacha ekufuneka ababoneleli bezempilo bajongane nayo. Izikhokelo zaseNew Zealand [9] kunye ne-UK [11, 12] zidwelise ngokucacileyo izinto kunye nemibuzo ecetyisiweyo ukuchonga ezo flegi ezityheli ngokwengqondo.

Zonke izikhokelo zijongene nokubaluleka kwembali yeklinikhi echonga izinto eziphathekayo kunye nengqondo yendawo yokusebenza echaphazelekayo kwi-LBP, kubandakanywa iimfuno zomzimba zomsebenzi (ukuphatha ngesandla, ukuphakamisa, ukugoba, ukujija, kunye nokuvezwa kwe-vibration yomzimba wonke), iingozi okanye ukulimala, kunye nobunzima obubonakalayo. ekubuyeleni emsebenzini okanye kubudlelwane emsebenzini. Izikhokelo zamaDatshi kunye neKhanada ziqulethe iingcebiso zokwenza uphando kwindawo yokusebenza[10] okanye uvavanyo lwezakhono zomsebenzi xa kuyimfuneko.[4]

Isishwankathelo seNcomelo zoVavanyo lwe-LBP

• Inkqubo yokuxilonga (engekho i-LBP, i-radicular syndrome, i-LBP ethile).
• Ungafaki iiflegi ezibomvu kunye nokuhlolwa kwe-neurological.
• Ukuchonga iingxaki zengqondo kunye nezithintelo ezinokuthi zibuyele.
• Ukuchonga izizathu zomsebenzi (umzimba kunye nengqondo) ezinokuthi zihlobene neengxaki ze-LBP kwaye zibuyele emsebenzini.
• Iimviwo ze-X-Rayi kuphela kwiimeko ezikrokrelekayo ze-pathology ethile.

Iingcebiso malunga neNkcukacha kunye neengcebiso, unyango, kunye nokubuyela kwiinkqubo zokusebenza

Uninzi lwezikhokelo lucetyisiwe ukuqinisekisa umqeshwa kunye nokubonelela ngolwazi malunga ne-LBP yokuzikhawulela kunye ne-prognosis enhle. Ukukhuthazwa kokubuyela kumsebenzi oqhelekileyo ngokubanzi kangangoko kwakucetyiswa rhoqo.

Ngokuhambelana nesiphakamiso sokubuyela kumsebenzi oqhelekileyo, zonke izikhokelo zikwagxininise ukubaluleka kokubuyela emsebenzini ngokukhawuleza, nangona kusekho i-LBP ethile kwaye, ukuba kuyimfuneko, ukuqala ngemisebenzi eguqulwayo kwiimeko ezinzima kakhulu. Imisebenzi ke ngoko inokwandiswa ngokuthe ngcembe (iiyure nemisebenzi) de kufikelelwe ekubuyeleni emsebenzini ngokupheleleyo. Izikhokelo zase-US kunye neDatshi zibonelela ngeeshedyuli ezicacileyo zexesha lokubuyela emsebenzini. Indlela yamaDatshi iphakamise ukubuyela emsebenzini kwisithuba seeveki ezimbini kunye nohlengahlengiso lwemisebenzi xa kuyimfuneko.[10] Inkqubo yesiDatshi nayo yagxininisa ukubaluleka kokulawula ixesha elide malunga nokubuyela emsebenzini.[10] Isikhokelo sase-US sicebise zonke iinzame zokugcina isigulane kumanqanaba aphezulu omsebenzi, kubandakanywa nemisebenzi yomsebenzi; iithagethi zexesha lokukhubazeka ngokwemiqathango yokubuyela emsebenzini zanikwa njengeentsuku ze-02 ezinemisebenzi ehlengahlengisiweyo kunye neentsuku ezingama-714 ukuba imisebenzi ehlengahlengisiweyo ayisetyenziswanga / ayifumaneki.[6] Ngokwahlukileyo kwabanye, umgaqo waseKhanada wacebisa ukubuyela emsebenzini kuphela xa iimpawu kunye nezithintelo zokusebenza ziphuculwe.[4]

Iinketho zonyango ezicetyiswa rhoqo kuzo zonke izikhokelo ezibandakanyiweyo zezi: iyeza lokunciphisa iintlungu, [5, 7, 8] iinkqubo zokuzilolonga ngokuthe ngcembe, [6, 10] kunye nokuvuselelwa kwezinto ezininzi [1013] Isikhokelo sase-US sicebise ukuba kuthunyelwe kwisithuba seeveki ezimbini kwinkqubo yomthambo ebandakanya imithambo ye-aerobic, imithambo yokulungisa izihlunu zomboko, kunye nenani lokuzilolonga.[6] Isikhokelo saseDatshi sicebise ukuba ukuba akukho nkqubela phambili kwiiveki ezimbini zokungabikho komsebenzi, abasebenzi kufuneka bathunyelwe kwiprogram yomsebenzi ohleliweyo (ukwandisa ukuzivocavoca ngokuthe ngcembe) kwaye, ukuba akukho phuculo kwiiveki ezine, kwinkqubo yokubuyisela kwi-multidisciplinary. ] Isikhokelo sase-UK sicebise ukuba abasebenzi abanobunzima bokubuyela kwimisebenzi yesiqhelo kwiiveki ze-10 kufuneka bathunyelwe kwinkqubo yokubuyisela esebenzayo. Le nkqubo yokubuyisela kufuneka ibandakanye imfundo, ukuqinisekiswa kunye neengcebiso, inkqubo eqhubekayo yokuzivocavoca ngamandla kunye nokuqina komzimba, kunye nokulawulwa kweentlungu ngokwemigaqo yokuziphatha; kufuneka ifakwe kwindawo yomsebenzi kwaye iqondiswe ngokuqinileyo ekubuyeleni emsebenzini. kubungqina benzululwazi.

Isishwankathelo seNcomelo malunga neNkcukacha, isiluleko, Ukubuyela kwiiNkqubo zoMsebenzi, kunye noTywala kwabasebenzi abane-LBP

• Qinisekisa umsebenzi kwaye unike ulwazi olwaneleyo malunga nemvelo yokunciphisa i-LBP kunye ne-prognosis enhle.
• Cebisa umsebenzi ukuba aqhubeke nemisebenzi yesiqhelo okanye abuyele kwimithambo yesiqhelo kwaye asebenze ngokukhawuleza, nokuba kusekho iintlungu.
• Uninzi lwabasebenzi abane-LBP babuyela kwimisebenzi eqhelekileyo okanye engaphantsi ngokukhawuleza. Qwalasela uhlengahlengiso lwexeshana lwemisebenzi yomsebenzi (iiyure/imisebenzi) kuphela xa kukho imfuneko.
• Xa umqeshwa ehluleka ukubuyela emsebenzini kwiiveki ze-212 (kukho ukuhluka okukhulu kwinqanaba lexesha kwizikhokelo ezahlukeneyo), bathumele kwinkqubo yokwandisa ngokuthe ngcembe, okanye ukuvuselelwa kwezinto ezininzi (ukuzivocavoca, imfundo, ukuqinisekiswa, kunye nokulawula intlungu emva kwemigaqo yokuziphatha. ). Ezi nkqubo zokubuyisela kwisimo sangaphambili
  kufuneka zifakwe kwisimo somsebenzi.

ingxoxo

Ulawulo lwe-LBP kwimeko yezempilo yomsebenzi kufuneka lujongane nobudlelwane phakathi kwezikhalazo eziphantsi kunye nomsebenzi kunye nokuphuhlisa izicwangciso ezijolise ekubuyiseleni ngokukhuselekileyo emsebenzini. Olu phononongo luthelekise izikhokelo zempilo yasemsebenzini ezivela kumazwe ahlukeneyo. Imigaqo-nkqubo ayifane ifakwe kwiMedline, ke xa sikhangela izikhokelo, kwafuneka sithembele ikakhulu kwiifayile zobuqu kunye nonxibelelwano lomntu.

Iinkqubo zeMgangatho kunye noPhuhliso lweZikhokelo

Uvavanyo ngeso sixhobo se-AGREE [3] lubonise ukungafani komgangatho wezikhokelo ezihlaziyiweyo, ezinokuthi zibonise ukuhlukahluka kwimihla yokuphuhliswa nokupapashwa kwezikhokelo. Umzekelo waseCanada, umzekelo, wanyatheliswa kwi-1987 kunye ne-Australian guide ku-1996. [4, 5] Ezinye izikhokelo zatshanje kwaye zibandakanya ubungqina obuninzi obungqina kunye nokunye okwangoku.

Iintsilelo ezininzi eziqhelekileyo ezihambelana nenkqubo yokuphuhliswa kwezikhokelo ziboniswe ngovavanyo ngeso sixhobo. Okokuqala, kubalulekile ukucacisa ukuba ngaba isikhokelo sizimeleyo ngokuzimeleyo kwiziko lenkxaso-mali, kwaye ingaba kukho iingxabano zomdla kumalungu ekomidi lesikhokelo. Akukho nanye yezikhokelo ezidibeneyo ezichaze ngokucacileyo le micimbi. Ukongezelela, ukuhlaziywa kwangaphandle kwesikhokelo ngeengcali zeklinikhi kunye neendlela zezobuchwepheshe ngaphambi kokushicilelwa kwakungenakho kuzo zonke izikhokelo ezibandakanyiweyo kule ngxelo.

Izikhokelo ezininzi zanikeza ulwazi olunzulu ngendlela yokwenza uxwebhu olufanelekileyo olufunyenwe kwaye luguqulelwe kwiziphakamiso. [4, 6, 11, 13] Ezinye izikhokelo zisekela iingcebiso zabo ngokubhekisele, [5, 7, 9, 10] kodwa oku akuvumeli ukuvavanywa ukuzinza kwezikhokelo okanye iingcebiso zabo.

Izikhokelo zixhomekeke kububungqina bobunzululwazi, obuya kutshintshwa ngexesha, kwaye kubetha ukuba esinye isikhokelo esinikezela ukuhlaziywa kwangomso. [11, 12] Mhlawumbi kukho izilungiso ezicwangciselwe ezinye izikhokelo kodwa azichazwa ngokucacileyo (kunye ngokucacileyo kukho kuya kuhlaziywa kwangaphambili akuthethi kuya kwenzeka ngokwenene). Oku kunqongophala kwengxelo kungabambelela nakweminye imigaqo-nkqubo ye-AGREE esayilinganisa kakubi. Ukusetyenziswa kwesakhelo se-AGREE njengesikhokelo sokuphuhlisa kunye nokunika ingxelo ngezikhokelo kufuneka kuncede ukuphucula umgangatho wezikhokelo zexesha elizayo.

Uvavanyo noLawulo lwe-LBP

Iinkqubo zokuxilonga ezicetyiswayo kwizikhokelo zempilo yomsebenzi zifana kakhulu neengcebiso zezikhokelo zeklinikhi, [2] kwaye, ngokunengqiqo, umahluko ophambili wawugxininise ekujonganeni nemiba yomsebenzi. Iindlela ezichaziweyo zokujongana nemiba yendawo yokusebenza ekuvavanyeni kwe-LBP yomsebenzi ngamnye ochaphazelekayo ekuchongeni imisebenzi enzima, imingcipheko, kunye nemiqobo yokubuyela emsebenzini ngeembali zomsebenzi. Ngokucacileyo, le miqobo yokubuyela emsebenzini ayichaphazeli nje kuphela ubunzima bomthwalo wenyama, kodwa ikwachaphazela iingxaki zomsebenzi zengqondo ngokwasengqondweni malunga noxanduva, intsebenziswano nabasebenzi osebenza nabo, kunye nentlalontle emsebenzini.[10] Ukuhlolwa kweeflegi ezityheli ezihambelana nomsebenzi zengqondo kunokunceda ukuchonga abo basebenzi basengozini yeentlungu ezingapheliyo kunye nokukhubazeka.[1113]

Into ebonakalayo ebalulekileyo yesikhokelo kukuba zihambelana neziphakamiso zabo ukuqinisekisa umqeshwa nge-LBP, nokukhuthaza nokuxhasa ukubuyela emsebenzini naseminye impawu eziqhubekayo. Kukho ukuvumelana ngokubanzi ukuba abasebenzi abaninzi abafanele balinde baze bangabi nabuhlungu ngokupheleleyo ngaphambi kokuba babuyele emsebenzini. Uluhlu lwezonyango zonyango olunikezwa yiCanada nase-Australia zikhombiselele ukungabikho kobufakazi ngelo xesha, [4, 5] eshiya abasebenzisi izikhokelo abazikhethele zona. Nangona kunjalo, kunokungabaza ukuba ngaba izintlu ezinjalo zenza igalelo ekunakekeleni ukunyamekela, kwaye kwindlela esiyijonga ngayo izikhokelo kufuneka zisekelwe kubungqina bobunzulu besayensi.

I-US, Dutch, kunye ne-UK izikhokelo zokusebenza [6, 1013] zincoma ukuba unyango olusebenzayo lwe-multidisciplinary lungenelelo oluthembisayo lokubuyela emsebenzini, kwaye oku kuxhaswa bubungqina obuqinileyo obuvela kwi-RCTs [19, 20] Nangona kunjalo, uphando oluninzi lusekho. efunekayo ukuchonga umxholo ongowona kunye nokuqina kwezo phakheji zonyango.[13, 21]

Nangona kukho ubungqina begalelo lezinto zendawo yokusebenza kwi-aetiology ye-LBP, [22] iindlela ezicwangcisiweyo zokulungiswa kwendawo yokusebenza azikho, kwaye azibonelelwa njengeziphakamiso kwizikhokelo. Mhlawumbi oku kubonisa ukunqongophala kokuzithemba kubungqina kwimpembelelo epheleleyo yemibandela yendawo yokusebenza, ubunzima bokuguqulela kwisikhokelo esisebenzayo, okanye ngenxa yokuba le miba ibhidaniswa nomthetho wendawo (eyayichatshazelwa kwisikhokelo sase-UK [11]). Kungenzeka ukuba ukungenelela kwe-ergonomics ethatha inxaxheba, ephakamisa ukubonisana nomsebenzi, umqeshi, kunye ne-ergonomist, kuya kuba yinzuzo yokubuyisela kumsebenzi wokungenelela.[23, 24] Ixabiso elinokubakho lokufumana bonke abadlali kwicala[25, 1113]. I-XNUMX] yagxininiswa kwi-Dutch kunye ne-UK izikhokelo, [XNUMX] kodwa ukuvavanya ngakumbi le ndlela kunye nokuphunyezwa kwayo kuyadingeka.

Ukuphuhliswa kweziKhokelo zexesha elizayo kwiNgcaciso yezeMpilo

Injongo yale ngqwalaselo yayikunikezela ngokubaluleka kokubanzi kunye nokuphononongwa ngokubalulekileyo kwezikhokelo zomsebenzi wokulawula i-LBP. Uvavanyo olubalulekileyo lwezikhokelo lujoliswe ekuncediseni ukuphuhliswa kwexesha elizayo kunye nokuhlaziywa okucwangcisiweyo kwezikhokelo. Kwimihlaba ekhulayo yokukhokela indlela esicwangcisiweyo sibheka onke amanyathelo adlulileyo njengento ehloniphekileyo; siyaqonda imfuneko yesikhokelo sekliniki, kwaye siyaqonda ukuba abaphuhlisi abakhuthazayo abakwazi ukulinda uphando ukuze banikeze yonke indlela kunye nobungqina obufunekayo. Nangona kunjalo, kukho indawo yokuphucula kunye nezikhokelo zexesha elizayo kunye nokuhlaziywa kufuneka kuqwalasele imigaqo yokuphuhliswa kakuhle, ukuphunyezwa, nokuvavanywa kwezikhokelo njengoko kuphakanyiswe ngumbambano ohlangeneyo.

Ukuphunyezwa kwezikhokelo kungaphaya kwelo phengululo, kodwa kwaphawulwa ukuba akukho ncwadana yezikhokelo ezichazwe ngokucacileyo izicwangciso zokusetyenziswa, ngoko ke akuqinisekanga ukuba yeyiphi iqela ekujoliswe kuzo ekufikelelwe kuyo, kwaye yiyiphi imiphumo enokuba nayo . Oku kungaba yindawo eneziqhamo ukuphanda phambili.

Ubukho bezi zikhokelo zempilo yomsebenzi bubonisa ukuba izikhokelo zeklinikhi zokhathalelo oluphambili ezikhoyo kwi-LBP2 zithathwa njengezingafanelekanga okanye azanelanga kukhathalelo lwempilo yomsebenzi. Kukho imbono ecacileyo kumazwe ngamazwe ukuba iimfuno zabasebenzi abafumana iintlungu zokungasemva zinxulunyaniswa ngokusisiseko kwimiba eyahlukahlukeneyo yomsebenzi engabandakanywanga yisikhokelo sokhathalelo olusisiseko oluqhelekileyo kwaye, ngenxa yoko, ukuziqhelanisa. Okuvelayo kukuba, nangona kukho iziphene zemethodological, isivumelwano esibonakalayo siyabonakala kuluhlu lwezicwangciso zempilo ezisisiseko zokulawula umsebenzi onentlungu yomqolo, ezinye zazo ezivelisa izinto ezintsha kunye nomngeni kwiimbono ebezibanjwe ngaphambili. Kukho ukuvumelana ngomyalezo osisiseko wokuba ukulahlekelwa ngumsebenzi ixesha elide kuyingozi, kwaye ukubuya komsebenzi kwangethuba kufanele kukhuthazwe kwaye kube lula; akukho mfuneko yokulinda ukusonjululwa kweempawu ngokupheleleyo. Nangona izicwangciso ezicetyiswayo zinokwahluka ngandlel’ ithile, kukho ukuvumelana okukhulu ngexabiso lesiqinisekiso esilungileyo neengcebiso, ubukho bomsebenzi (owexeshana) olungisiweyo, ukulungisa iimeko zasemsebenzini (ukufumana bonke abadlali becala), kunye nokubuyisela kwisimo sangaphambili sabasebenzi abanobunzima bokubuyela emsebenzini.

Imibulelo

Olu pho nonongo luxhaswe yiBhunga leNkxaso yeNtsholongwane yeMpilo yaseDutch (CVZ), isibonelelo se-DPZ. 169 / 0, Amstelveen, eNetherlands. I-JB Staal ngoku isebenza kwiSebe le-epidemiology, iYunivesithi yaseMaastricht, i-PO Box 616 6200 MD Maastricht, eNetherlands. UV van Mechelen uphinde ube yinxalenye yeCandelo loPhando malunga noMsebenzi weMvelo, Umsebenzi kunye neMpilo, umzimba @ umsebenzi TNO-VUmc.

Ukuququmbela, iimpawu zeentlungu ezisezantsi ziphakathi kwezinto eziqhelekileyo zempilo ezinxulumene nokulimala komsebenzi. Ngenxa yoko, izikhokelo zempilo emininzi zenzelwe ukulawulwa kwentlungu ephantsi. Ukunyamekelwa kwe-Chiropractic, phakathi kwezinye iindlela zonyango, kunokusetyenziswa ukuze kuncede isigulane sifumane ukukhululeka kwi-LBP yazo. Ngaphezu koko, le ngongoma engentla ibonise ukhuseleko kunye nokusebenza kweendlela ezahlukeneyo zonyango kunye nezinye iindlela zokunyangwa, unyango kunye nokukhusela iintlobo ezahlukeneyo zentlungu ezisezantsi. Nangona kunjalo, uphando olongezelelweyo uphando lufunekayo ukuze kuchaneke ngokufanelekileyo ukusebenza kwendlela nganye yonyango. Ulwazi oluchazwe kwiziko leSizwe loLwazi lweBiotechnology (NCBI). Ubungakanani beenkcukacha zethu zikhawulelwe kwi-chiropractic kunye 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. Umqolo obuhlungu isikhalazo esiqhelekileyo esinokubangelwa ngenxa yeemeko ezahlukeneyo kunye / okanye iimeko. Ngokuphindaphindiweyo amaxesha, ukuguqulwa kwemvelo komgudu kunye nomdala kunokubangela intlungu emva. Iidiski zeHerniated kwenzeka xa i-disc, i-gel-like centre ye-disc intervertebral iqhubezela ngeengqungquthela kwijikelezo zayo zangaphandle, ukuxilisa nokucaphukisa izimpande zentliziyo. Iingxoxo ze-Disc zivame ukuqhutyelwa kwi-back back, okanye i-lumbar spine, kodwa nazo zingenzeka kunye nomlenze womlomo wesibeleko okanye intamo. Ukufakelwa kwamathambo afunyenwe kwinqanaba eliphantsi ngenxa yokulimala kunye / okanye imeko ehlaseleyo ingakhokelela kwimpawu ze-sciatica.

ISIHLOKO ESIBALULEKILEYO: Ukwelashwa kweMigraine Pain

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