Whiplash Ngenye yeentlobo ezixhaphakileyo zengozi ezibangelwa yengozi yemoto, ngokuqhelekileyo kwixesha lokugqibela. Nangona kunjalo, izifo ezinxulumene ne-whiplash zingahlakulela ngenxa yeemeko ezahlukeneyo, kuquka ukulimala kwezemidlalo, ipaki yokuzonwabisa okanye ukuphathwa kakubi ngokomzimba. I-Whiplash ivela xa izicubu ezithambileyo entanyeni, ezinjengeemisipha, iintambo kunye nemigqa, zandisa ngaphaya kohlobo lwazo lwendalo oluhambayo ngenxa yokunyuka kwe-head-and-out kwentloko. Ukongezelela, amandla amaninzi anempembelelo anokwelula kwaye aze aphule izakhiwo eziyinkimbinkimbi ezungeze umgudu wesibeleko.

 

Iimpawu zeengxaki ezinxulumene ne-whiplash zingathatha iintsuku, iiveki okanye iinyanga ukuba zibonise, yikho kutheni kubalulekile kubantu abaye babandakanyeka engozini yemoto ukuba bafune unyango lwangoku. Kukho iintlobo ezininzi zeendlela zokonyango ezinokunceda ngokufanelekileyo nangokuphatha i-whiplash. Injongo yale nqaku ilandelayo kukubonisa izikhokelo zonyango lweengxaki ezichaphazelekayo zentamo kunye izifo ezinxulumene ne-whiplash.

 

Ukunyangwa kweengxaki ze-Neck Pain-Associated Disorders kunye ne-Whiplash-Associated Disorders: Isikhokelo seZiklinikhi

 

Abstract

 

• Injongo: Injongo yayikukukhulisa isikhokelo sonyango solawulo kulawulo lweentlungu zentamo (ii-NADs) kunye nokuphazamiseka okunxulumene ne-whiplash (ii-WADs). Esi sikhokelo sithatha indawo yezikhokelo ze-2 zangaphambili ze-chiropractic kwii-NADs nakwii-WADs.
• Iindlela: Ukuphononongwa okuchanekileyo kwiinkalo zezihloko ze-6 (imfundo, ukunakekelwa kwamaninzi, ukukhubazeka, ukukhubazeka komsebenzi, unyango olusesikweni, iindlela zokuziphatha) zihlolwe kusetyenziswa Isixhobo Sokulinganisela Ukuvavanya Iimvavanyo Zokwenkqubo (AMSTAR) kunye nedatha efunyenwe kwiimvavanyo ezilawulwa ngononophelo. Sifake ingozi yokubala amanqaku kwi-Assessment of Recommendations, Assessment and Evaluation. Iingxelo zobungqina zisetyenziselwa ukushwankathela izigwebo zobungqina bobunjani, iinkcukacha ezihambelanayo kunye neziphumo ezipheleleyo, kunye nokudibanisa iziphakamiso kubungqina obuxhasayo. Iphaneli yesikhokelo yicandelo elibhekiselele kwimilinganiselo enqwenelekayo nemiphumo engathandekiyo. Ukuvumelana kwafezekiswa ngokusebenzisa iDelphi eguquliwe. Isikhokelo sasihloliswe ngabahlobo baxilongwa yi-10-ilungu lezemfundo elingaphandle (i-medical and chiropractic) kwikomiti yangaphandle.
• iziphumo: Ukuqala kwangoko (i-0-3 yeenyanga) iintlungu zentamo, sicebisa ukubonelela ngononophelo lwe-multimodal; ukuxhaphaza okanye ukuhlanganisa; Uluhlu lokuhamba-hamba ekhaya, okanye unyango lwe-multimodal yonyango (kumabanga I-II NAD); umsebenzi wokuqinisa owomeleleyo (ibakala III NAD); kunye nokhathalelo lweemodyuli ezininzi (ibanga lesi-III le-WAD). Ukuqhubeka (iinyanga ze-N3) iintlungu zentamo, sicebisa ukubonelela ngononophelo lwe-multimodal okanye uxinzelelo lokuzilawula; Ukunyanzeliswa ngonyango oluthambileyo; i-massage yedosi ephezulu; umsebenzi weqela elibekiweyo; ukubeka iliso kwiyoga; ukuvavanywa kokuqiniswa okanye ukuzivocavoca ekhaya (amabakala I-II NAD); ukhathalelo lwee-multimodal okanye iingcali (amabakala I-III NAD); kunye novavanyo olusebenzayo ngengcebiso okanye neengcebiso zodwa (amabakala I-II WAD). Kubasebenzi abaneentlungu eziqhubekayo zentamo kunye negxalaba, ubungqina buxhasa ukuxutywa okugadiweyo kunye nokungaqiniseki koqeqesho lwamandla amakhulu okanye iingcebiso zodwa (amabakala I-III NAD).
• Izigqibo: Indlela yokwenza i-multimodal, kuquka ukunyangwa kwonyango, iingcebiso zolawulo lokuzilawula, kunye nokuzilolonga kuyisicwangciso sonyango esiphumeleleyo sokwenyuka kwentlungu kunye nokuqhubekayo kwentlungu. (J Uluhlu lwePhysiol Ther 2016; 39: 523-44.e20) Eyona nto
• Imigomo: Isikhokelo sokuSebenza; Intlungu Yentambo; Ukulimala kweWiflash; Chiropractic; Uthintelo loNyango; Ulawulo lweZifo; Iingxaki zeMisculoskeletal

 

Insight of Dr. Alex Jimenez

I-Whiplash iyenzeka xa amandla amakhulu anefuthe ebangela ukuba intloko nentamo iqhube ngokukhawuleza ngasemva nasiphi na isalathisi, esolule izakhiwo eziyinkimbinkimbi ezijikeleze umlenze wesibeleko ngaphezu kohlobo oluqhelekileyo. Intlungu yomzimba, intloko kunye neentlungu ezibangelwa yi-whiplash zikhalazo eziqhelekileyo ezixelwa ngabantu ngabanye emva kokubandakanyeka kwengozi yemoto. Nangona kunjalo, i-whiplash inokubangelwa kwiimeko ezahlukeneyo. Izifo ezinxulumene neWiflash ziyimithombo ekhuselekileyo yokukhubazeka kunye nesizathu esivakalayo abaninzi abaxhoba ngeengozi zengozi bafuna unyango lwezilwanyana zonyango, oogqirha bezonyango kunye namagqirha enyango. Ngenhlanhla, izikhokelo ezininzi zonyango zikho ukuphucula ngokuphuculweyo kunye nokulawula iimpawu ze-whiplash. Ukunyamekela kwe-Chiropractic yindlela ekhethwa yonyango eyaziwayo yokukhathazeka kwe-whiplash. Ukuguqulwa kwamagqabi kunye nokusetyenziswa kwemigaqo kungasindisa ngokufanelekileyo kwaye ngokufanelekileyo ukulungelelaniswa kokuqala komgudu, ukunciphisa iimpawu nokunciphisa iingxaki ze-whiplash.

 

intshayelelo

 

Intlungu yentsimbi kunye nokuphazamiseka okunxulumene nayo (i-NAD), kubandakanya intloko kunye nokuqaqanjelwa kwentlungu engalweni nasemva ngasemva, ziqhelekile kwaye zikhokelela kumthwalo wentlalontle, wezengqondo kunye noqoqosho.1-4 Intlungu yentlungu, nokuba ibangelwa ngumsebenzi, ukwenzakala, okanye eminye imisebenzi, i-5 ngumthombo oxhaphakileyo wokukhubazeka kunye nesizathu esiqhelekileyo sokubonisana nabanikezeli beenkonzo zononophelo lwempilo, kubandakanya oochwephesha, abanyangi bomzimba, kunye noogqirha bokhathalelo lokuqala.6 Uqikelelo lwezehlo zonyaka zentlungu yentamo ezilinganiswe kwizifundo ze-4 ziphakathi kwe-10.4% kunye ne-21.3 %, ngeziganeko eziphezulu ezichongiweyo eofisini nakubasebenzi beekhompyuter.7 Nangona ezinye izifundo zixela ukuba phakathi kwe-33% kunye ne-65% yabantu baye bachacha kwintlungu yentlungu kunyaka we-1, iimeko ezininzi zilandela ikhosi ye-episodic ngaphezulu komntu ixesha lokuphila, kwaye ngenxa yoko, ukubuyela umva kuqhelekile.7 Intlungu yomqala ngoyena nobangela wokugula kunye nokukhubazeka okungapheliyo kwilizwe liphela.5,8 Kwi-2008 i-Bone kunye ne-Joint Decade Task Force kwi-Neck Pain kunye ne-Associated Disorders bathi 50 I-75% ukuya kwi-1% yabantu abaneentlungu zentamo baphinde babike iintlungu 5 ukuya kwiminyaka emi-4 kamva. 7 Izinto ezininzi ezinokutshintshwa nezingaguqukiyo kokusingqongileyo kunye nezinto zobuqu zichaphazela imeko yentlungu yentamo, kubandakanya ubudala, ukwenzakala kwentamo yangaphambili, ubunzima obukhulu beentlungu, ukuziqonda njengehlwempuzekileyo. impilo ngokubanzi, kunye noloyiko ukunqanda.XNUMX

 

Iintlungu zentamo ezinxulumene nokuphazamiseka okunxulumene ne-whiplash (ii-WADs) ikakhulu iziphumo zeengozi zemoto.9,10 Ukuphazamiseka okunxulumene neWhiplash kuphazamisa ubomi bemihla ngemihla yabantu abadala kwihlabathi liphela kwaye banxulunyaniswa neentlungu, ukubandezeleka, ukukhubazeka kunye neendleko. Ukuphazamiseka okunxulunyaniswa ne-Whiplash kuchazwa njengokulimala kwentamo okwenzeka ngokukhawuleza okukhawulezayo okanye ukuncipha kwentloko nentamo xa kuthelekiswa namanye amalungu omzimba, okwenzeka ngexesha lokungqubana kwezithuthi.3,11 Uninzi Abantu abadala abanokulimala kweemoto baxela iintlungu entanyeni kunye neentlungu ezingaphezulu. Ezinye iimpawu eziqhelekileyo ze-WADs zibandakanya intloko, ukuqina, igxalaba kunye nentlungu yangasemva, ukuba ndindisholo, isiyezi, ubunzima bokulala, ukudinwa, kunye nokusilela kwengqondo.10,12 Inqanaba lezehlo lonyaka lokutyelelwa liSebe likaxakeka ngenxa yokulimala kwe-whiplash emva kwendlela Ukuphazamiseka kuphakathi kwama-9,10 kunye nama-235 kwi-300 Ngo-100,000.3,13,14, bekukho i-2010 yezigidi zokulimala kwezithuthi ezingekho mthethweni e-United States.3.9 Iindleko zoqoqosho zokuphahlazeka kweemoto ngaloo nyaka ziye zafumana i-USD $ 11 yezigidigidi, kubandakanya i-242 yezigidigidi zeendleko zonyango kunye ne-23.4 yeedola. Izigidigidi kwimveliso elahlekileyo (kokubini kwintengiso nakumakhaya) .77.4 E-Ontario, ukungqubana kwezithuthi kungunobangela ophambili wokukhubazeka kunye nokusetyenziswa kokhathalelo lwempilo kunye nenkcitho, ekhokelela kwinkqubo yeinshurensi yemoto ehlawula phantse i-CND $ 11 yezigidigidi kwizibonelelo zengozi ngo-4.5

 

 

Ngaphezu kwe-85% yezigulane zineentlungu zentamo emva kwengozi yemoto, ngokuqhelekileyo zidibaniswa neentlobo kunye neengxaki kumqolo nangemida, intloko, isifo sengqondo kunye nokulimala kwengqondo ebuhlungu.Ukulimala kwe-10 kwimpembelelo kwimpilo jikelele, kwixesha elifutshane elibikwe ngu-29% ukuya kwi-40% yabantu abane-WAD kumazwe aseNtshona aphethe izicwangciso zokuhlawulela ukulimala kwe-whiplash. I-16,17 Ixesha loxeshanye lokuqala ukuhlaziywa kwengxelo liqikelelwa kwiintsuku ze-101 (95% yexesha lokuzithemba: 99-104) kwaye malunga ne-23% ayitholakali emva kwe-1 ngonyaka.13

 

 

 

 

I-2000-2010 I-Bone ne-Joint Decade Task Force kwiNeck Pain kunye neengxaki zayo eziManyeneyo zicebisa ukuba zonke iintlungu zentlungu, kuquka ii-WADs, i-18 zifakwe phantsi kohlelo lwe-NAD.19 NAD ingahlelwa kwiibakala ze-4, ezahluke ngobunzima iimpawu, iimpawu kunye nefuthe kwimisebenzi yobomi bemihla (Itheyibhile 1).

 

Ulawulo lweklinikhi yokuphazamiseka kwemisipha, kunye nentlungu yentamo ngokukodwa, kunokuba nzima kwaye kuhlala kubandakanya ukudibanisa ungenelelo oluninzi (ukhathalelo lweemodemodal) ukujongana neempawu kunye neziphumo zalo.19 Kulesi sikhokelo, ukhathalelo lweemodyuli ezininzi lubhekisa kunyango olubandakanya ubuncinci i-2 yonyango olwahlukileyo iindlela, ezibonelelwa nge-1 okanye uqeqesho oluninzi lwezempilo. 20 Unyango olwenziweyo (kubandakanya ukuphathwa komqolo), amayeza, kunye nokuzivocavoca ekhaya ngeengcebiso zihlala zisetyenziswa kunyango lweemodemodal ukuqala kwangoko kunye nentlungu eqhubekayo yentamo. 21,22 Ke, kukho isidingo ukumisela ukuba loluphi unyango okanye indibaniselwano yonyango olusebenzayo ekulawuleni i-NAD kunye ne-WAD.

 

Isizathu sokuphuhlisa esi siKhokelo

 

Iprotocol ye-Ontario yoLawulo lokuLawulwa kweTrafikhi (i-OPTIMa) yokuBambisana20 kutshanje ihlaziye uphononongo olucwangcisiweyo oluvela kwi-Bone and Joint Decade 2000-2010 Task Force kwi-Neck Pain kunye ne-Associated Disorders (i-Neck Pain Task Force) .23 Ngenxa yoko, yathathwa ngexesha lokuhlaziya izindululo zezikhokelo ze-2 chiropractic kwi-NAD (2014) 24 kunye ne-WAD (2010) 25 eveliswe yiCanada Chiropractic Association kunye neCanada Federation yeChiropractic Regulatory and Educational Accrediting Boards (i-edFederation ) kwisikhokelo esinye.

 

 

Ubume kunye nenjongo

 

Injongo yesi sikhokelo sonyango (CPG) yayikukuhlanganisa kunye nokusasaza obona bungqina bufumanekayo kulawulo lwabantu abadala kunye nezigulana ezindala ezinokuqala (0-3 iinyanga) kunye nokuqhubeka (iinyanga ze-N3) iintlungu zentamo kunye nokuphazamiseka okunxulumene nako, kunye Injongo yokuphucula ukwenziwa kwezigqibo zeklinikhi kunye nokunikezelwa kweenkonzo kwizigulana ezinamabanga e-NAD kunye ne-WAD I ukuya ku-III. Izikhokelo Iinkcazo ezibandakanya izindululo ezijolise ekwandiseni ukhathalelo lwezigulana oluye lwaziswa ngoqwalaselo olucwangcisiweyo lobungqina kunye novavanyo lwezibonelelo kunye nokwenzakala kwezinye iindlela zokhathalelo. 26

 

Abasebenzisi abakujoliswe kwesi sikhokelo ngabaphathi bezonyango kunye nabanye ababonelela ngononophelo lwempilo yononophelo abanikezela ngononophelo olulondolozo kwizigulane ezine-NAD kunye nee-WADs, kunye nabenzi bomgaqo-nkqubo. Sichaza ukunyamekela ngononophelo njengoko unyango lujoliswe ekukhuseleni amanyathelo okwelapha angenayo okanye inkqubo yokusebenza.

 

I-OPTIMa yapapasha isikhokelo esondeleleneyo kwiJenali ye-Spine yaseYurophu. 27 Nangona sifikelele kwiziphumo ezifanayo, i-OPTIMa yavelisa iingcebiso kusetyenziswa isakhelo seKomiti yeNgcebiso ngezeMpilo yeOntario (OHTAC) .28 Ngokwahlukileyo, isikhokelo sethu sisebenzisa ukuHlelwa koVavanyo lweeNgcebiso, uPhuhliso, Indlela yoVavanyo (GRADE). I-GRADE ibonelela ngendlela efanayo, enengqiqo, kunye necacileyo yokuhlela umgangatho (okanye ukuqiniseka) kobungqina kunye namandla engcebiso (www.gradeworkinggroup.org). I-GRADE yayisisona sixhobo esiphezulu sokufumana amanqaku phakathi kweenkqubo ezingama-60 zokubeka ubungqina29 kwaye sizimisele ukuphinda siveliswe phakathi kwamanqanaba aqeqeshiweyo. 30 IBAKALA ngoku ithathwa njengomgangatho kuphuhliso lwesikhokelo kwaye yamkelwe yimibutho emininzi yezikhokelo kunye namaphephancwadi.31 ICanada Chiropractic Guideline Initiative (CCGI) iphaneli yesikhokelo ejonge ukuvavanywa okusemgangathweni okumgangatho ophezulu, ihlaziye ukukhangela kweengxelo ezipapashiweyo zontanga ukuya kuDisemba 2015, emva koko yasebenzisa indlela yeGRADE yokwenza izindululo zolawulo lweentlungu zentamo kunye nokuphazamiseka okunxulumene noko.

 

Isikhokelo

 

Ukukwazisa umsebenzi walo, i-CCGI ibhekiselele ekuqhubekeni kwangoku kwindlela zokuqhuba ulwabelana ngolwazi, i-32 ifumana iziphakamiso ezisekelwe kwiziqinisekiso, i-31,33 ivumelanisa nezikhokelo ze-high quality, i-34 kunye ne-35 kunye nokwandisa ukufunyanwa kwe-CPGs.36,37 Ukujonga ngokubanzi isakhiwo kunye neendlela zeCCGI unikezelwa kwisiHlomelo 1.

 

tindlela

 

Zokuziphatha

 

Ngenxa yokuba akukho nxaxheba yongenelelo yoluntu olufunekayo kunye nokuhlalutya okwesibini, kwakuphandwe uphando olwenziwe kule khokelo.

 

Ukukhethwa kweZikhokelo zoPhuhliso lweePanethi

 

Iprojekthi yeCCGI iholele (AB) iqeshwe i-2 iihlalo (i-JO kunye ne-GS) kwiqela lokuphuhliswa kwikhokelo kwaye ikhethe ikomidi elilawulayo leprojekthi kunye nabahlawuli beplanethi. I-JO yaba ngumkhokeli wendlela yokukhokela kwiphaneli yesikhokelo. I-GS incede ukuqinisekiswa kwendawo yepaneli kwaye icebise ngemisebenzi ethile yamalungu eepaneli, ukuzinikela kwexesha, kunye nenkqubo yokwenza izigqibo zokufikelela ukuvumelana (ukuphuhliswa kwemibuzo ephambili kunye neengcebiso). Ukuqinisekisa ubungqina obanzi, iphaneli yesikhokelo kubandakanya oogqirha (PD, JW), abaphandi beekliniki (FA, MD, CH, SP, IP, JS) iindlela zeendlela (JO, AB, MS, JH), inkokheli / GS), kunye nommeli wegciwane le-1 (BH) ukuqinisekisa ukuba iimpawu zesigulane kunye nezikhethwayo ziqwalaselwa. Omnye umbonisi (JR) wabonisana nemihlangano ye-3 ebusweni besikhokelo se-Toronto (Juni noSeptemba 2015 no-Aprili 2016).

 

Wonke amalungu e-CCGI, kubandakanywa izikhombisi-mbutho kunye nabahlaziyi baontanga, kufuneka baxelele nayiphi na ingxabano enokubaluleka kwesihloko phambi kokuthatha inxaxheba kunye nexesha lophuhliso lwenkqubela. Kwakungabikho ukuvakaliswa kweengxabano zomdla phakathi kwepaneli okanye ababuyekezi.

 

Uphuhliso Lwemibuzo Eyintloko

 

Iindawo ezi-6 zezihloko (ukusetyenziswa, ukunakekelwa kweemodemu, imfundo, ukukhubazeka komsebenzi, unyango olusesikweni, iindlela zokuziphatha) ngokulawulwa kokugcinwa kolawulo lwe-NAD kunye ne-WAD zamanqanaba I ukuya ku-III zifakwe kwi-5 ukuhlaziywa okucwangcisiweyo kwenkqubo ye-OPTIMa, i-38-42 phakathi Iingxelo ze-40 ekulawuleni iziphazamiso ze-musculoskelet.20 Iphaneli yadibanisa kwiintsuku ze-2 ngo-Juni 2015 ukucinga ngokuphathelele imibuzo engundoqo.

 

 

 

 

Uhlaziyo lokuSesha kunye noKhetho lokuFunda

 

Iphaneli ivavanye umgangatho wovavanyo olufanelekileyo ngokusetyenziswa kwesixhobo se-AMSTAR43 kunye neenqobo zayo ezili-11 (amstar.ca/Amstar_Checklist.php).

 

Kungenxa yokuba imihla yokugqibela yokukhangela ehlanganisiweyo yokuhlola i-2012,40,41 2013,38,39,42 kunye ne-2014,42 iphaneli ihlaziye uphando lweencwadi kwi-database ye-Medline neCochrane Central ngomhla kaDisemba 24, i-2015 ngokusebenzisa iindlela zokusesha ezipapashwe. Sasebenzisa inkqubo yokuhlola inkqubo yesigaba se-2 ukukhetha izifundo ezongezelelweyo ezifanelekileyo. Kwinqanaba le-1, ababuyekezi abazimeleyo be-2 bahlolisise izihloko kunye neengcamango zokuqaphela ukufaneleka nokufaneleka kwezifundo. Kwinqanaba le-2, iimbini ezifanayo zabahlalutyi abazimeleyo bahlolisise amanqaku apheleleyo okubhaliweyo ukuze benze isigqibo sokugqibela sokufaneleka. Ababuyekezi badibene ukulungisa iingxabano kunye nokufikelela kwisigqibo malunga nokufaneleka kwezifundo kuzo zombini izigaba, ngokubambisana nomhloli wesithathu ukuba kuyimfuneko. Izifundo zabandakanywa ukuba i-1 idibene ne-PICO (i-population, ukungenelela, i-comparator, imiphumo) kunye ne -2 zizilingo ezilawulwa ngokungahleliwe (RCTs) kunye neqela lokuqalisa okungenani abathathi-nxaxheba kwi-30 ngengalo yonyango kunye nemeko echaziweyo, kuba ubunzima beesampuli bubhekwa ubuncinci obufunekayo kwimimiselo engaqhelekanga yokumisela ukusabalalisa ngokuqhelekileyo.44

 

Idatha yokuPhepha nokuVavanywa koMgangatho

 

Iinkcukacha zacatshulwa kwizifundo ezidibeneyo ezichongiweyo kwisicatshulwa ngasinye senkqubo, kuquka ukucwangciswa kovavanyo, abathathi-nxaxheba, ukungenelela, ukulawula, iziphumo kunye nenkxaso-mali.

 

Ukusebenza kwangaphakathi kwezifundo ezifakiwe zahlolwe yiNtsebenziswano ye-OPTIMa ngokusebenzisa i-criteria ye-Scottish Intercollegiate Network Network (SIGN) .45

 

Amanqaku athathwe kwi-search ehlaziyiweyo, iimbini zababuyekezi abazizimeleyo ngokukhawuleza babonisa ukuqinisekiswa kwangaphakathi kwezifundo ezifanelekileyo ngokusetyenziswa kwe-SIGN criteria, i-46 efana ne-OPTIMa yokubambisana. Ababuyekezi bafikelela kwisivumelwano ngokuxoxa. Umhloli wesithathu wasetyenziselwa ukuxazulula ukungavumelani ukuba isivumelwano singenakufikelelwa. Amanqaku amaninzi okanye i-cutoff iphuzu lokuqinisekisa ukuba ukusetyenziswa kwangaphakathi kwezifundo akuzange kusetyenziswe. Esikhundleni salo, i-ISIGN criteria yayisetyenziselwa ukuncedisa ababuyekezi ekwenzeni isigwebo esipheleleyo esicacisiweyo kwengozi yeengcamango ezibandakanyiweyo. 47

 

I-synthesis of Results

 

I-OO ifunyenwe idatha esuka kwizifundo zesiganeko ezivunyelweneyo ngokubhekiselele kwiibhile zokubonisa. Umphononongo wesibili (AB) ngokukhawuleza uhlolisise idatha ekhishiwe. Senze ubungqina bokubaluleka kweziphumo kunye neziphumo eziqhotyoshelweyo ngokubhekiselele kuhlobo kunye nobude bentsholongwane (oko kukuthi, okwangoku [iimpawu ezihlala zihlala ngeenyanga zeB3] ngokuqhubekayo [iimpawu ezihlala kwiinyanga ezili-N3]).

 

Iphulo loPhuhliso

 

Sisebenzise iSixhobo soPhuhliso lweSikhokelo (http:// www.guidelinedevelopment.org), kwaye savavanya umgangatho wobungqina beziphumo zethu zomdla ngokusebenzisa indlela ye-GRADE.48 Sisebenzise iiprofayili zobungqina ukushwankathela ubungqina. I-49 Umgangatho wobungqina bokulinganisa (ophezulu, ophakathi, ophantsi, okanye ophantsi kakhulu) ubonisa ukuzithemba kwethu kuqikelelo lwesiphumo sokuxhasa isincomo kwaye siqwalasela amandla kunye nokulinganiselwa kobungqina obuvela kumngcipheko wokungakhethi, ukungachaneki, ukungahambelani. , ukungathanga ngqo kweziphumo, kunye nokupapashwa kwe-bias.50 Ukuhlolwa komgangatho wobungqina benziwa kwimeko yokubaluleka kwayo kwindawo yokunyamekela okuphambili.

 

 

Sebenzisa ubungqina kubuQeqesho (i-EtD)www.decide-collaboration.eu/etd-evidence- isakhelo sesigqibo), iphaneli yadibana ngokusesikweni ngoSeptemba 2015 no-Epreli 2016 ukuqwalasela ukulingana kweziphumo ezinqwenelekayo nezingafunekiyo ukumisela ukomelela kwesindululo ngasinye, kusetyenziswa isigwebo esinolwazi kumgangatho wobungqina kunye nobungakanani besiphumo, ukusetyenziswa kwezixhobo, ukulingana, ukwamkeleka , kunye nokwenzeka. Ukwenza isincomo, iphaneli yayifuna ukubonisa isigwebo esiphakathi esingathathi hlangothi ngokubhekisele kwibhalansi phakathi kweziphumo ezinqwenelekayo nezingalunganga zongenelelo, njengoko kuchaziwe kwi-EtD. Sichaze ukulinganiswa kwamandla kwengcebiso (eyomeleleyo okanye ebuthathaka) njengobungakanani beziphumo ezinqwenelekayo zongenelelo ezingaphaya kweziphumo ezingathandekiyo. Ingcebiso eyomeleleyo inokwenziwa xa iziphumo ezinqwenelekayo zigqithile kwiziphumo ezingathandekiyo. Ngokuchasene noko, kwenziwa isindululo esibuthathaka xa, kubhalansi lwamathuba, iziphumo ezinqwenelekayo zinokugqwesa kwiziphumo ezingathandekiyo. 49,51

 

 

Iphaneli yanikezela iingcebiso ezisekelwe kubungqina ukuba ukufunyaniswa kwamanani kunye neklinikhi kwafunyanwa ukungafani. Iphaneli ya landela inkqubo ye-2-nyathelo ekwenzeni isincomo. Saqale savuma ukuba kukho ubungqina beenguqu ezinokliniki ezithintekayo ngexesha eliqhubekayo kwintando yabantu kunye nokuba umlinganiselo omnye wokubaluleka kokusebenza kliniki kufuneka usebenziswe ngokufanayo. Sifinyelele kwisigqibo sokuvumelana sokuba i-20% ishintshe kwisiphumo somdla kuyo nayiphi na iqela lokufunda lalifuneka ukuba lenze isincomo. Isigqibo sokusebenzisa isigxina se-20% saziswa ngeengxelo ezipapashwe zikhoyo kunye nemibandela ekhoyo ebaluleke kakhulu ekhoyo yeeklinikhi (i-MCID) .52-55

 

Nangona kunjalo, ii-MCID ziyakwazi ukuhluka phakathi kwabantu, izicwangciso, kunye neemeko kwaye kuxhomekeke ekubeni ingaba iqela elingaphakathi okanye iqela eliphakathi kwamacandelo livavanywa. Ngoko ke, iphaneli iqwalasele ixabiso leMCID kwiziphumo ezifanelekileyo kakhulu (oko kukuthi, i-10% ye-analog scale [VAS] okanye i-Index ye-Disability Disability Index] [NDI; 5 / 50 kwi-UN], i-20% kwinqanaba lokulinganisa kwamanani [NRS] kunye ukhethe ukongezwa kwezi zixabiso njengomyinge xa ​​uvavanya phakathi kweemeko zeqela.52,54

 

Okwesibini, iziphumo ezivela kwizifundo ezifanelekileyo zisetyenziselwa ukwenza isindululo apho kufanelekileyo. Unyango olumiselwe ukuba lusebenze (umahluko ngokwamanani phakathi kwamanqaku esiseko kunye namanqaku alandelayo kunye nokubaluleka kwezonyango okusekwe kwi-MCID esetyenziswe kufundo) yacetyiswa yiphaneli yethu. Ukuba isifundo sifumene 2 okanye unyango olungaphezulu olusebenzayo ngokulinganayo kumda wethu, iphaneli yacebisa lonke unyango olufanayo.

 

 

Izikhokelo ze-EtD zagqitywa kwaye iziphakamiso zaqulunqwa malunga neenkomfa zeefowuni zeefomathi kunye namalungu eepaneli emva kokuthatha izigwebo malunga nezikhundla zesigqibo se-4: umgangatho wobungqina (ukuzithemba kokuqikelelwa kwempembelelo); ukulinganisela okunqwenelekayo (umzekelo, intlungu ephantsi kunye nokukhubazeka) kunye neziphumo ezingafunekiyo (umz., ukuphendula okungalunganga); ukuzithemba malunga neempawu kunye nezinto ezikhethwa ngabantu abajoliswe kuzo; kunye neempembelelo zengcebo (iindleko) .56,57 Isisombululo semigqaliselo yethu malunga nemimandla ichaza ulwalathiso (oko kukuthi okanye ukuchasene nendlela yokulawula) kunye namandla ezincomo (ubungakanani bokuba umntu unokuqiniseka ukuba izibembelelo zokungenelela zigqithise imiphumo engathandekiyo). Ifomathi ethile yalandelwa ukwenza iziphakamiso usebenzisa inkcazo yesigulane kunye nomlinganiselo wonyango.56 Iingxelo zongezelelwe ukucaciswa ukuba ziyadingeka. Ukuba iimpembelelo ezinqwenelekayo nezingathandekiyo zigwetywe ngokulinganayo kwaye ubungqina bezingenako ukunyanzelisa, iphaneli yagqiba ekubeni ingabhali nayiphi na isincomo.

 

Inkqubo yeDelphi eguqulweyo isetyenzisiwe kwintlanganiso yomntu ukufezekisa ukuvumelana kwisindululo ngasinye. 58 Besebenzisa isixhobo esikwi-intanethi (www.polleverywhere.com), iipaneli ziye zavota inqanaba lesivumelwano kunye nengcebiso nganye (kubandakanya umgangatho wobungqina kunye namandla ingcebiso) esekwe kwinqanaba le-3 (ewe, hayi, cala). Phambi kokuba kuvotwe, iipaneli zazikhuthazwa ukuba zixoxe kwaye zinike ingxelo ngengcebiso nganye ngokubhekisele kulungelelwaniso lwamagama acetyiswayo okanye izimvo ngokubanzi. Ukufezekisa ukuvumelana kunye nokubandakanywa kwincwadi ebhaliweyo yokugqibela, isindululo ngasinye kufuneka okungenani sibe nesivumelwano se-80% kunye nenqanaba lokuphendula okungenani le-75% yamalungu epaneli afanelekileyo. Zonke izindululo ziphumelele ngemvumelwano kumjikelo wokuqala.

 

 

Xa u

 

Ikomidi langaphandle elinamalungu ali-10 elinabantu ababandakanyekayo, abasebenzisi bokugqibela, kunye nabaphandi abavela eCanada, eUnited States, naseLebanon (Isihlomelo 2) ngokuzimeleyo baphonononge imibhalo ebhaliweyo, iingcebiso kunye nobungqina obuxhasayo. Isixhobo se-AGREE II sasetyenziselwa ukuvavanya umgangatho wendlela yesikhokelo.35 Impendulo efunyenweyo yaqokelelwa yaze yaqwalaselwa kuyilo oluhlaziyiweyo lomjikelo wesibini wokuphononongwa. Izitulo zepaneli yesikhokelo zinike impendulo eneenkcukacha kwizimvo zabavavanyi. Ukufumana uluhlu lwamagama, nceda ubone iSihlomelo 3.

 

 

iziphumo

 

Uphuhliso Lwemibuzo Eyintloko

 

Imibuzo engundoqo engamashumi amathathu nesibini yaveliswa ngokuhambelanayo ne-PICO (ulwabiwo-manani, ukungenelela, ukufanisa, isiphumo). Iphaneli yaqaphela ukugqithiswa kwimixholo kunye nokufaneleka phakathi kweminye imibuzo ebalulekileyo. Emva kokudibanisa imibuzo ye-3, ekugqibeleni siphendule imibuzo epheleleyo ye-29 (i-Table 2).

 

Ukhetho lokuFunda kunye noVavanyo lweMigangatho: Uhlolo lwe-OPTIMa

 

Ukukhangela kwe-OPTIMa kuvelisa izihloko ze-26 335 ezicatshulwayo.38-42 Emva kokususwa kwezinto eziphindiweyo kunye nokuhlolwa, amanqaku e-26 273 awazange ahlangabezane neendlela ezikhethiweyo zokukhetha, ukushiya ama-109 amanqaku afanelekileyo okuvavanya. Izifundo ezingamashumi amahlanu nesithoba (i-62 articles) ezipapashwe kwi-2007 ukuya kwi-2013 zithathwa njengezivumelekile ngokwesayensi kwaye zifakwe kwi-synthesis (iSithasiselo 4). Uhlolo ngalunye olusetyenziswayo lubalwa njengoluhlobo okanye oluphezulu (i-AMSTAR isi8-11) .59

 

Uhlaziyo lokuSesha kunye noKhetho lokuFunda

 

Ukukhangela kwethu okuhlaziyiweyo kuvelise amanqaku angama-7784. Sisuse iikopi eziphindwe kabini ezili-1411 kwaye sivavanye amanqaku angama-6373 ngokufaneleka (Amakhiwane 1-5). Emva kovavanyo, amanqaku angama-6321 awakhange ahlangane neenqobo zokukhetha (isigaba 1), eshiya amanqaku angama-52 ovavanyo olupheleleyo (isigaba 2) kunye novavanyo olubalulekileyo (izifundo ngesihloko sokhathalelo lwe-multimodal (n = 12), imfundo yesigulana eyakhelweyo (n = 3), ercukuzivocavoca umzimba (n = 8), ungenelelo ngoncedo lokukhubazeka (n = 13), unyango lwencwadi (n = 4), izicubu ezithambileyo (n = 2), kunye neendlela zokwenza izinto (n = 6) .52 RCTs , Izifundo ezi-4 ezamkelekileyo zesayensi zibandakanyiwe kwindibaniselwano yethu.Amanqaku ashiyekileyo asilele ukujongana nombuzo ophambili (n = 1); inani labantu abakhethiweyo (n = 2), iziphumo (n = 13), okanye ungenelelo (n = 11); akukho phakathi koqikelelo (n = 19); okanye bebeyimpinda (n = 1) okanye uhlalutyo lwesibini lwesifundo esifakiwe (n = 1) (Isihlomelo 5).

 

 

 

 

UVavanyo loMgangatho kunye neSthesis seZiphumo

 

Iprogram yobungqina be-GRADE kunye nomngcipheko weengcamango phakathi kwezifundo ezibandakanyiweyo zenziwa kwiiTables 3-15 kunye ne-Appendix 6, ngokulandelanayo.

 

izindululo

 

Sinika iingcebiso ngale ndlela:

• Ukuza kwexesha elizayo (iinyanga ze-0-3) kwii-grade I ukuya ku-III iNAD
• Ukuza kwexesha elizayo (iinyanga ze-0-3) kwii-grade I ukuya kwi-III WAD
• Ukuqhubeka (iinyanga ze-N3) kuma-grade I ukuya ku-III NAD
• Ukuqhubeka (iinyanga ze-N3) kwii-grade I ukuya kwi-III WAD

 

Iziphakamiso ze-Recent-Onset (i-0-3 inyanga) Iimabanga ze-I ukuya kwi-3 ze-NAD

 

Uncedo lweNcwadi

 

Umbuzo oyintloko 1: Ngaba ukunyanzelwa kwentamo vs ukunyakaza kwentamo kusetyenziswe ukuqala-kwangoko (iinyanga ze-0-3) kwii-I ukuya kwi-II NAD?

 

Isishwankathelo soBungqina. RCT enye nguLeaver et al. I-60 yavavanya ukuphumelela kokunyanzeliswa kwentamo okanye ukuhlanganiswa kwentamo ehanjiswa yi-physiotherapists, i-chiropractors, okanye i-osteopaths zamabanga okuqala okuqala ukuya kwi-II intlungu yentamo (? 2 NRS). Zonke izigulana zifumene iingcebiso, ukuqinisekiswa, okanye inkqubo yokuqhubeka nokuzilolonga njengoko kubonisiwe kunyango lwe-4 ngaphezulu kweeveki ezi-2 ngaphandle kokuba kufunyenwe ukubuyiswa okanye kwenzeka into embi kakhulu. Kwakungekho mahluko ubalulekileyo kubuyiso lwe-Kaplan-Meier curves phakathi kwamaqela okubuyiselwa kwintlungu yentamo kunye nokufumana kwakhona imisebenzi yesiqhelo, kwaye akukho mahluko ubalulekileyo phakathi kwamaqela entlungu, ukukhubazeka, okanye ezinye iziphumo (umsebenzi, isiphumo esibonwayo sehlabathi, okanye impilo- umgangatho wobomi ohambelana nawo) kuyo nayiphi na indawo yokulandelela (Itheyibhile 3).

 

Enye enye i-RCT ngu-Dunning et al. 61 yavavanya ukusebenza kwe-velocity eyodwa, i-low-amplitude (thrust) manipulation (n = 56) ejolise kumqolo ongaphezulu wesibeleko (C1-C2) kunye nomqolo ophezulu we-thoracic (T1-T2 ) xa kuthelekiswa (nokungathembeki) ukuhlanganiswa (n = 51) ejolise kwimimandla efanayo ye-anatomiki kwimizuzwana ye-30 kwizigulana ezineentlungu zentamo. Iziphumo zibonise ukunciphisa okukhulu intlungu (NPRS) kunye nokukhubazeka (i-NDI) kwiqela lokuxhaphaza xa kuthelekiswa nokuhlanganiswa kweeyure ezingama-48. Akukho ziganeko zibi ezixeliweyo. Iziganeko ezincinci ezibi azizange ziqokelelwe. Olu phononongo aluzange luchaze isincomo sethu kuba izikhalazo zezigulana ze1 zazingekabikho kwangoko (kuthetha ukuba iintsuku ezingama-N337 kumaqela omabini), kunye neziphumo ze-2 zalinganiswa ngeeyure ezingama-48 kuphela. IQela loPhuhliso lweZikhokelo (GDG) liqwalasele oku njengesithintelo esibalulekileyo sifundo kuba umntu akanakucinga ukuba ezi zibonelelo ziya kuba ziqhubeke ixesha elide. Iphaneli yavuma, nangona kunjalo, ukuba ezinye izigulana zinokuxabisa ukufumana iintlungu ezikhawulezayo nokuba zezokwexeshana.

 

Iphaneli inqume ukuba ukuqinisekiswa ngokubanzi kubungqina obuphantsi, kunye nesihlobo esikhulu esifanelekileyo kwimiphumo engathandekiyo. Ixabiso elincinci lokunikezela ngolu hlobo luza kwenza ukuba luvunywe ngakumbi kubachaphazelekayo kwaye lunokwenzeka ukuphumeza. Nangona iphaneli ithathe isigqibo sokuba imiphumo enqwenelekayo kwaye engathandekiyo yayingqinelana kakuhle, la mazwi alandelayo anikezelwa:

 

I ngcebiso: Kwizigulane ezineenyanga ze-0-3 zamanqaku (i-XNUMX-XNUMX iinyanga) I-II NAD II, sikhuthaza ukuphathwa okanye ukuxhaswa ngokusekelwe kwisigulane. (Ukunconywa okunyanzelekileyo, ububungqina obuncinane)

 

 

 

 

Lolonga

 

Umbuzo oyintloko 2: Ngaba kufuneka idibeneyo ye-neuromuscular technique ye-inhibition (i-0-3 iinyanga) i-I-II NAD?

 

Isishwankathelo soBungqina. U-Nagrale et al.62 uxele umahluko okhoyo kwezonyango kwiintlungu zentamo kunye neziphumo zokukhubazeka kwiiveki ezi-4. Olu phononongo lucebise ukuba ungenelelo lonyango oluthambileyo lwethishu kwi-trapezius ephezulu, ukudibanisa i-ischemic compression, i-strain-counterstrain, kunye ne-eneji yamandla emisipha, ibonelela ngezibonelelo ezifanayo zeklinikhi xa kuthelekiswa nobuchule bamandla emisipha bodwa. Abathathi-nxaxheba kwakufuneka babe nentlungu yentamo engaphantsi kweenyanga ezi-3.

 

Iphaneli yenze ubungqina obuchanekileyo kubungqina, kunye nemiphumo eminqweno enqwenelekayo kwaye engathandekiyo kwaye akukho ziganeko ezimbi. Iindleko eziphantsi zifunekayo ukungenelela kwaye akukho zixhobo ezithile ezifunekayo, ngaphandle koqeqesho lokubonelela ngobuchule. Ngenxa yokuba ukungenelela kuqhutywe kwaye kufundiswe, kuyamkeleka kwaye kuyakwazi ukuphumeza. Nangona kunjalo, iziphumo zalo kwimali yempilo ayinakuzimiselwa. Ngokubanzi, iphaneli inqume ukuba ibhalansi phakathi kwemiphumo enqwenelekayo neyinqwenelekayo yayingaqinisekanga, kwaye kukho ubungqina obufunekayo phambi kokuba kwenziwe isincomo.

 

Uncedo lweModododal

 

Umbuzo oyintloko 3: Ngaba ukunyamekelwa kweemodyuli ze-intramuscular ketorolac kufuneka kusetyenziswe kwiinyanga (0-3 zeenyanga) zamabanga amabakala I ukuya ku-III NAD?

 

Isishwankathelo soBungqina. McReynolds et al. I-63 inikeze iziphumo zexesha elifutshane zentlungu ebuhlungu kwaye iqukumbele ukuba iiseshoni zokunakekelwa kweemodemu (ukuphathwa kakubi, iindlela zobuqhophololo) zanikezela iziphumo ezilinganayo kwisitofu se-intramuscular ketorolac. Nangona kunjalo, ixesha lokulandelelana kweyure le-1 ngokuqhelekileyo li-atypical kwaye i-dosing yayinqunyelwe ukuba ingaphelelanga ukunakekelwa kwe-multimodal njengoko kuchazwe. Ukongezelela, isifundo sasijoliswe kwiimeko eziphuculweyo kuphela.

 

Iphaneli yaqinisekisa ukuqinisekiswa okuphantsi kobungqina beklinikhi, kunye nemiphumo emincinci enqwenelekayo kwaye engathandekiyo. Kukho umngcipheko omncinci wokunakekelwa kweemodemodal, ngokuqwalasela iziphumo ezichaziweyo. Ukusuka kumbono weklinikhi, izixhobo ezifunekayo zincinci zicinga ukuba akukho msebenzi ofunekayo. Nangona kunjalo, omnye ugqirha wanika ezininzi iindlela zokwelapha. Iindleko ziyahlukahluka kuxhomekeke kwingcaciso yokunakekelwa kweemodemodal. Olu khetho alufanele ludale ukungalingani kwempilo, ngaphandle kwabangenako ukufikelela kwiikliniki okanye ukhethe ukuhlawula ephaketheni, kwaye kuya kukwazi ukuphumeza. Iintlangano zobugcisa ziyakuthi zixhase ukhetho, kodwa ukwedluliswa kwemithi ye-multimodal kwanezindleko ezongezelelweyo, ezingenakulungeleka kubabini abahlawuli kunye nezigulane. Ngokubanzi, ibhalansi phakathi kweziphumo ezinqwenelekayo nezingathandekiyo aziqinisekanga kwaye uphando olongezelelweyo lufunekayo kule ndawo ngaphambi kokuba kwenziwe nasiphi na isincomo.

 

 

 

Lolonga

 

Umbuzo oyintloko 4: Ngaba ukunyamekela kweemodemu ngokubhekiselele ekusebenziseni i-home vs medication kusetyenziswe ukuqala-kwangoko (iinyanga ze-0-3) zamabanga a-II ukuya kwi-NAD?

 

Isishwankathelo soBungqina. Enye i-RCT nguBronfort okqhubekayo. 22 kuvavanye ukusebenza kononophelo lweemodemodal ngaphezulu kweeveki ezili-12 xa kuthelekiswa ne-12 yeeveki zokuzilolonga ekhaya kunye nenkqubo yengcebiso okanye amayeza kwintlungu yentamo (i-11-ibhokisi ye-NRS) kunye nokukhubazeka (NDI) kwizigulana zabantu abadala ze-181 kunye neentlungu zentamo yentamo (i-2-12 iiveki- ubude bexesha kunye nenqaku le-3 kwinqanaba le-10-point). Ukunyamekelwa kweemodemodal yi-chiropractor (kuthetha ukutyelelwa kwe-15.3, uluhlu lwe-2-23) kubandakanya ukuphathwa kunye nokuhlanganiswa, ukusilalisa izicubu ezithambileyo, ukuncedisa ukunweba, iipakethe ezishushu nezibandayo, kunye neengcebiso zokuhlala zisebenza okanye ukuguqula umsebenzi njengoko kufuneka. Ukuzivocavoca ekhaya imihla ngemihla kwakufuneka kwenziwe ukuya kuma-6 ukuya kuma-8 ngamaxesha ngosuku (inkqubo yokuzikhethela kuquka ukuzilolonga kwintamo kunye namagxa ehlombe) ngeengcebiso ngumgulisi womzimba (iiseshoni ezimbini zeyure-1, iiveki ezi-1-2 ngaphandle kwendlela kunye nomsebenzi wokuphila mihla le). Amayeza amiselweyo ngugqirha afaka iziyobisi ezingezizo ezokulwa nokudumba (i-NSAIDs), i-acetaminophen, i-opioid analgesic, okanye izihlunu zokuphumla (idosi ayichazwanga). Iziphumo eziboniswe kwiTheyibhile 4 zibonise ukuba ukhathalelo lwe-multimodal kunye nokuzivocavoca ekhaya kunye neengcebiso zazisebenza njengeyeza ekunciphiseni iintlungu kunye nokukhubazeka kwixesha elifutshane (iiveki ezingama-26). Nangona kunjalo, amayeza ayanyaniswa nomngcipheko ophezulu weziganeko ezigwenxa (uninzi lweempawu zesisu kunye nokozela kwi-60% yabathathi-nxaxheba) kunokwenza umthambo ekhaya. Ukhetho lwamayeza lwalusekwe kwimbali yomthathi-nxaxheba kunye nempendulo kunyango. Iiklinikhi kunye nezigulana kufuneka bazi ukuba ubungqina bangoku abonelanga ukumisela ukusebenza kweyeza elide le-opioid ekuphuculeni iintlungu ezingapheliyo kunye nomsebenzi. Ngokubalulekileyo, ubungqina buxhasa umngcipheko wokuxhomekeka kwidosi kwizenzakalisi ezinzulu, kubandakanya ukwanda komngcipheko wokudlula ngaphezulu, ukuxhomekeka kunye ne-myocardial infarction.64

 

I ngcebiso: Kwizigulane ezithandwayo (iinyanga ze-0-3) iinyawo zentlungu ye-intsimbi I-II, sincoma ukuba kusetyenziswe iindlela zokuhamba ekhaya, amayeza, okanye unyango olusetyenziswayo lokunciphisa intlungu nokukhubazeka. (Ukunconywa okunyanzelekileyo, ubungqina obunokulinganayo).

 

sokumakishwa: Izenzo zokuzibandakanya ekhaya zibandakanya iingcebiso zokuzinyamekela ngemfundo, ukuzilolonga kunye nokufundisa kwimisebenzi yokuphila kwansuku zonke. Amachiza afaka ii-NSAID, i-acetaminophen, i-muscle ephumayo, okanye ukudibanisa kwezi. Ulwaphulo olusesikweni olunezixhobo ezininzi luquka ukuphathwa kunye nokuhlanganiswa kunye nokusila okulula okulula, ukuhanjiswa okuncedisayo, iipakethi ezishisayo kunye ezibandayo kunye neengcebiso zokuhlala zisebenza okanye ziguqula umsebenzi njengoko kuyimfuneko.

 

Umbuzo oyintloko 5: Ngaba kufuneka ihlolwe ngokusetyenziswa kweengcebiso eziqiniweyo zokuncedisa i-advisory advice (ii-0-3 iinyanga) i-grade III yeNAD?

 

Isishwankathelo soBungqina. Enye i-RCT yi-Kuijper et al.65 yavandlakanya ukusebenza kweenkqubo zokuqiniswa eziphantsi kweliso kunye neengcebiso zokuhlala zikhuthele ukunyuka kwentlungu ye-grade III. Le RCT ibike ukuba imisebenzi yokuqinisa (n = 70) yayisebenza ngakumbi kuneengcebiso zokuhlala zisebenza (n = 66). Abaxhamli be-65 Trials balandelwa kwiiveki ze-3, iiveki ze-6 kunye neenyanga ze-6. Ngokusekelwe ekuvunyelwene kweplanethi, iziphumo ezizimisele ukubaluleka ekuhlolweni kokusebenza kule RCT zibandakanya intlungu nentsimbi (VAS) kunye nokukhubazeka (i-ND). Ezi ziphumo zibini kwaye zibaluleke kakhulu kwiikliniki (iThebhile 5).

 

Kule RCT, inkqubo yokuqinisa inkqubo yenziwa ngamaziko e-2 ngeeveki kwii-6 iiveki.65 Yayiquka imisebenzi yokuqiniswa ngokumalunga neefowuni kunye neentsuku zokuhlala ekhaya ukuze kuqinisekiswe imisipha yeentamo (ukuhamba, ukuzinza kunye nokuqiniswa kwemisipha ). Abathathi-nxaxheba kwiqela elifanisayo bacebiswe ukuba baqhubeke nemisebenzi yemihla ngemihla. La mabini maqela avunyelwe ukusebenzisa i-painkillers. Jonga Umbuzo Osemqoka 6 ngencomo kwikhola yomlomo wesibeleko.

 

I ngcebiso: Kwizigulana ezinenyanga (0-3 yeenyanga) ibanga lesithathu lentamo kunye nentlungu yengalo, sicebisa ukuba kwenziwe umthambo wokuqinisa okomeleleyo * endaweni yengcebiso zodwa. (Ingcebiso ebuthathaka, ubungqina obukumgangatho ophakathi)

 

sokumakishwa: * Imithambo eyomeleleyo yokugada ehleliweyo iqinisa ukomeleza nokuzilolonga kabini ngeveki kangangeeveki ezi-6 kusetyenziswa imithambo yemihla ngemihla yasekhaya (ebandakanya ukuhamba, ukuzinza nokomeleza izihlunu). Iingcebiso zodwa zibandakanya ukugcina imisebenzi yokuphila kwansuku zonke ngaphandle konyango oluthile.

 

 

 

 

 

 

Iimpawu zoMzimba

 

Umbuzo oyintloko 6: Ngaba iprogram yomlomo wesibeleko isomeleza ukusetyenziswa kwenkqubo yenkqubo yokusetyenziswa ngokutsha (iinyanga ze-0-3) ibanga lesi-3 le-NAD?

 

Isishwankathelo soBungqina. I-RCT enye ngu-Kuijper et al. 65 ngokungakhethiyo yabela abaguli abangama-205 abane-radiculopathy (NAD grade III) ye-1 yamaqela e-3 1: Ukuphumla kunye nekhola yomlomo wesibeleko ye-3 iiveki, emva koko walunyulwa phakathi kweeveki 3- 6 2; i-physiotherapy (ukuqinisa nokuzinzisa umqolo wesibeleko, imithambo eqinisiweyo yokuqinisa intamo kabini ngeveki iiveki ezi-6, kunye nemfundo yokwenza imithambo yasekhaya yemihla ngemihla); or3 iqela lolawulo (linda ubone ngcebiso ukuze uqhubeke nemisebenzi yemihla ngemihla). Zonke izigulana zifumene ukuqinisekiswa okubhaliweyo kunye nomlomo malunga nekhosi yesiqhelo yeempawu kwaye bavunyelwa ukuba banike iintlungu.

 

Ukugqithisa i-collar yesiqingatha esicinci se-collar okanye ukufumana iprogram yovavanyo olumgangatho oqhelekileyo kunye neenkqubo zasekhaya zeeveki ze-6 zanikezela ukuphucula okufanayo kwintlungu yesandla (VAS), intlungu yentamo (VAS), okanye ukukhubazeka (i-ND) ngokuthelekiswa nomgaqo-wokulinda nokubona kwiiveki ze6. Kwakungekho nantlukwano phakathi kweqela kwiinyanga ze-6.

 

Ngenxa yokungaqiniseki malunga nokukhubazeka kwe-iatrogenic okunxulunyaniswa nokusetyenziswa ixesha elide kwekhola yomlomo wesibeleko, i-27,42 isindululo esinye esenziwe kwisikhokelo sangoku sithanda ukomeleza iinkqubo zokuzilolonga ngaphezulu kwengcebiso, kunye nokusilela kwemvumelwano phakathi kwephaneli yesikhokelo, i-GDG igqibe ekubeni ingayenzi isindululo esichasene nokusetyenziswa kwekhola yomlomo wesibeleko (ivoti yokuqala kwisindululo esicetywayo neziphumo ezithe ngqo ezivela kolu phando [i-11% iyavuma, i-11% ayithathi cala, i-78% ayivumelani, i-1 ayivunywanga]. Ivoti yesibini iyathandwa kukususa intetho kwingcebiso (i-27% iyavuma, i-9% ayithathi cala, i-64% ayivumelani, i-1 ayizange ivote). Ukhetho kufuneka lusekwe kukhetho lwesigulana kunye nolawulo olutshintshiweyo ukuba ukubuyela kwimeko yesiqhelo kuhamba kancinci

 

Umbuzo oyintloko 7: Ngaba kufuneka unyango lwe-laser low-level (i-0-3 iinyanga) i-grade III yeNAD?

 

Isishwankathelo soBungqina. I-RCT enye ngu-Konstantinovic et al.67 yavavanya ukuphumelela kwe-laser treatment level (LLLT) ehambisa ii-5 ngamaxesha eveki ze-3 xa kuthelekiswa ne-placebo (unyango olusasebenzi olusasebenzi) olutshanje lwentlungu ye-grade III. I-LLLT ikhokelela kwi-statistically kodwa ingekho ukuphuculwa kweempawu zentlalo kwintlungu yentamo kunye nokukhubazeka kwiiveki ze-3 xa kuthelekiswa ne-placebo. Ukutshatyalaliswa kwenkqubela kwintlungu (20%) kunye nesisulu sengxaki (i-3.33%) yabonwa kwiqela leLLLT, ngelixa kungekho ziganeko ezimbi ezichazwe kwiqela le-placebo.

 

Iphaneli yaqinisekisa ukuba ubungqina bobuninzi bobubungqina bobuncinane, kunye nemiphumo emincinci enqwenelekayo kunye neziganeko ezincinci. I-LLLT inokubiza. Ukuba abaculi bakhetha ukungazithengi, kunokuchaphazela kakubi ukulingana kwempilo. Nangona kunjalo, ukhetho luyamkeleka kubachaphazelekayo kwaye kulula ukuba luphumeze. Iphaneli yayingaqinisekanga malunga nokulinganisela phakathi kweminqweno neminqweno engathandekiyo kwaye ivotelwe ngokumelene nokwenza isincomo ngenxa yokungabikho kobungqina obucacileyo (uLLLT yayingeyona ingcono kune-placebo kodwa zombini amaqela abonakalisiweyo kwiqela elitshintshileyo ngexesha elide).

 

UkuSebenza koKhuseleko lokuKhubazeka

 

Imibuzo ephambili 8 kunye ne9: Ngaba kufuneka isebenze ngongenelelo kuthintelo lokukhubazeka vs ukomelela kunye nokomeleza inkqubo yomthambo isetyenziselwe ukuqala kwangoko kokungangqamki komzimba okunxulumene nomsebenzi wokuphazamiseka kwamalungu?Ngaba kufuneka kusetyenziswe ukungenelela kokukhusela ukukhubazeka kwintamo evelayo yentsapho kunye nezikhalazo ezingasentla?

 

Ukuphonononga ubungqina bokungenelela kokuthintela ukukhubazeka emsebenzini, i-41 i-GDG igqibe kwelokuba intsalela phakathi kweziphumo ezinqwenelekayo nezingafunekiyo ibilungelelaniswe ngokuthe ngqo okanye ingaqinisekanga. Ngenxa yoko, iphaneli yesikhokelo khange ikwazi ukwenza izindululo zale mibuzo iphambili, kodwa kuphando oluzayo kunokwenzeka ukuba ixhase ngokuqinisekileyo okanye ngokungathandekiyo iintlobo ezahlukeneyo zongenelelo lothintelo lokukhubazeka emsebenzini.

 

Nangona ezinye iingeniso zaxelwa ukuba zithanda ukusetyenziswa kweekhompyutheni kunye nokufundiswa kokungenelela kokusebenza, i-68 ukuphuculwa komsebenzi okongeziweyo okungekho ngokwaneleyo ukuba kwenziwe isiluleko ngokubhekiselele kwi1 ixesha lokulandelelana kwee-8 iiveki kwizifundo ezihlaziyiweyo zifutshane ukuba ziqikelele inzuzo eqhubekayo yexesha elide; kunye ne -2 iindleko ezinokuthi zihambelane neprogram kunye nokufundiswa kwabasebenzi zingabalulekanga.

 

Ngokubanzi, kubonakala ukuba ukongeza ukuzithobela ikhompyutha (kunye nekhefu lokusebenzela emsebenzini), okanye iindawo zokusebenzela zodwa, kwinkqubo yokuguqulwa kwe-ergonomic kunye nemfundo kuphucula ukufumana okuzenzekelayo nokuzibonela ngezixhobo kubasebenzi bekhompyutheni abaneentamo kunye nezikhalazo zangasentla .41 Nangona kunjalo, akucaci ukuba ngaba ukongezwa kweendlela zokunyusa iikhompyutheni kwiindlela ezahlukeneyo zokungenelela kwendawo yokusebenza kutshintsha iziphumo ezibonakalayo zempilo. Uphando lwexesha elizayo lunokufumanisa iinkonzo ezongezelelweyo ukwenzela ukuba abathathi-nxaxheba baqwalasele iindleko ezongezelelweyo ezingenakunqandwa.

 

Iziphakamiso ze-Recent-Onset (i-0-3 inyanga) Iimabanga ze-I ukuya kwi-III ze-WAD

 

Uncedo lweModododal

 

Umbuzo oyintloko 10: Ngaba iimfuno zokunakekelwa kweemfuno zengxowankulu ziza kusetyenziswa kwiinyanga zangexeshana (i-0-3 iinyanga) i-I ukuya kwi-III WAD?

 

Isishwankathelo soBungqina. Inxalenye ye-2 ye-RCT ngeMvana okqhubekayo. 69 yavavanya ukusebenza kweengcebiso zomlomo xa kuthelekiswa nezinto ezibhaliweyo zokuphucula iintlungu (iintlungu zentamo ezilinganisiweyo) kunye nokukhubazeka (i-NDI) kwizigulana ezinamabanga okuqala okuqala ukuya kwi-III WAD. IMvana okqhubekayo. 69 ibandakanye inani labathathi-nxaxheba abangama-3851 abanembali yamanqanaba e-WAD I ukuya kwi-III engaphantsi kweeveki ezi-6 ubude bexesha abafuna unyango kwisebe likaxakeka. Inani elipheleleyo labathathi-nxaxheba abangama-2253 lafumana ingcebiso kulawulo olusebenzayo kwisebe likaxakeka elibandakanya iingcebiso zomlomo kunye neWhiplash Book, ebandakanya ukuqinisekiswa, ukuzilolonga, ukukhuthaza ukubuyela kwimisebenzi yesiqhelo, kunye neengcebiso ngokuchasene nokusebenzisa ikhola; Abathathi-nxaxheba abali-1598 bafumana ingcebiso yokhathalelo oluqhelekileyo, kubandakanya Ingcebiso yomlomo kunye ebhaliweyo kunye neyeza elichasayo, i-physiotherapy kunye ne-analgesics. Akukho mahluko phakathi kweqela waqwalaselwa kwiintlungu ezizimeleyo zentamo kunye nokukhubazeka ekulandeleleni kwinyanga ye-12 kwaye akukho mahluko kwiintsuku zomsebenzi ezilahlekileyo waqwalaselwa ekulandeleleni kwenyanga ye-4 (Itheyibhile 6).

 

I-Lamb kunye ne-69 babandakanye abathathi-nxaxheba be-599 ngee-WAD zamabanga ezi-I ukuya ku-III eziqhubekayo kwiiveki ze-3 emva kokuya kumaSebe angxamisekileyo. Abathathu abathathi-nxaxheba baphathwe ngumzimba we-physiotherapist (ii-6 kwiiseshoni ezingaphezu kweeveki ze-8) kubandakanya izicwangciso zengqondo (ukubeka iinjongo okanye ukuhamba, ukunyamezela, ukuqinisekiswa, ukuphumula, intlungu kunye nokufumana), iingcebiso zokuzilawula (ukuhamba kunye nokuma) ukuxhotyiswa kweengxube kunye nenqanaba lokunyakaza [ROM]; ukuzinza kwesibindi kunye nesigxina kunye nolwazi olufanelekileyo), kunye nomlomo wesibeleko kunye nentsholongwane ye-thoracic ummandla waseMiitland ukuxhotyiswa nokuphathwa; i-299 iyifumana iseshoni-esisodwa iseshoni sokomeleza kwi-physiotherapist ngexesha lokutyelela kwabo kwangaphambili kwisebe elingxamisekileyo. Akukho mmahluko ekukhubazekeni okuzimeleyo okhethiwe kwi-4-inyanga yokulandela; nangona kunjalo, ukunciphisa okukhulu kwimihla yomsebenzi elahlekile emva kokulandelwa kweenyanga ze-8 kwaqulunqwa ngeengcebiso zokuzilawula ngokwaso kwi-session-reincement. Iziphumo ezifanayo zifunyenwe kwisifundo sangaphambili.70

 

I ngcebiso: Kwizigulane zabantu abadala (iinyanga ze-0-3) Iimviwo ze-WAD I ukuya ku-III, sikhuthaza ukunakekelwa kwe-multimodal kwimfundo yodwa. (Ukunconywa okunyanzelekileyo, ubungqina obunokulinganisela)

 

sokumakishwa: Ukunakekelwa kwe-Multimodal kungabandakanya unyango olusesikweni (ukuhlanganiswa ngokubambisana, ezinye iindlela eziphathekayo eziphathekayo), imfundo kunye nokuzilolonga.

 

Imfundo ehlelwe

 

Umbuzo oyintloko 11: Ngaba ukulungiswa kwemfundo yesigulane kunye nokuqiniswa kwemfundo kusetyenziswe ukuqala-kwangoko (iinyanga ze-0-3) i-WAD?

 

Isishwankathelo soBungqina. I-Lamb kunye ne-69 zivakalise iziphumo kwiinyanga ze-4 ngenxa yokukhubazeka okuzimeleyo, ukuchonga ukungabikho koluhlu oluthile phakathi kweqela. Uphononongo lubonise ukuba iingcebiso zomlomo kunye ncwadana yemfundo inika izibonelelo ezifanayo.

 

Iphaneli yenze umgangatho olinganisekayo kubungqina beklinikhi, kodwa iziphumo ezinqwenelekayo ezingenakunqwenelekayo ngeziganeko ezincinci, ezincinci kunye nezidlulileyo. Ngokuninzi izinto ezifunekayo zokungenelela, kwaye ukusabalaliswa ngokubanzi kwezixhobo zemfundo ngokusebenzisa izixhobo zobugcisa kunokuncedisa ukunciphisa ukungalingani. Unyulo luyamkeleka kubachaphazelekayo kwaye lunokwenzeka ukuphumeza. Ngokubanzi, imiphumo enqwenelekayo mhlawumbi ingaphezu kwemiphumo engathandekiyo. Iphaneli yenze le sihloko kwaye ubungqina bayo buninzi buba nombuzo oyintloko kwi-10. Ngoko ke, esinye isincomo senziwe, ukujongana nezihloko zombini.

 

Iziphakamiso zokuqhubeka (iinyanga ezili-N3) amaBakala I ukuya ku-III iNAD

 

Lolonga

 

Umbuzo oyintloko 12: Ngaba kufuneka uhlolwe umsebenzi (oko kukuthi uqeqesho lwe-qigong) ngokungekho nonyango (uluhlu olulindileyo) lusetyenziswe ukuqhubeka (iinyanga ze-N3) kumabanga a-II ukuya kwi-NAD?

 

Isishwankathelo soBungqina. I-RCT ezimbini (iTheyibhile 7) livavanya ukuphumelela kwe-qigong egadiweyo xa kuqhathaniswa nokunyangwa kwamayeza angaphezulu kwaye akukho unyango entlungu yentlungu (i-101-point VAS), ukukhubazeka (NDI), kunye neNeck Pain kunye ne-Disability Scale kwizizonke zegciwane le-240 ubuhlungu bentliziyo engapheliyo (iinyanga ze-N6). 71,72 Rendant et al. I-72 ibike ukuba, kubantu abadala abaneentlungu ezingapheliyo zentamo, i-qigong ejongene neyona ndlela iphumelele ngakumbi kunokuba kungabikho unyango kwaye isebenzayo njengonyango lokunciphisa ubuhlungu bentamo nokukhubazeka kwiinyanga ze-3 kunye ne-6. Izigqibo malunga nokusebenza kwezi ncediso ze-2 xa kuthelekiswa nalukho unyango kwizigulana ezindala kuneminyaka eyi-55 ayikwazi ukukhangela kwizifundo ezifakiwe.

 

Ekuhloliseni kwabo ngongenelelo lweentlungu zentlungu kwizigulane ezisebekhulile, u-von Trott et al.71 ubone ukunciphisa intlungu nokukhubazeka kumaqela angenelelo kwi3 kunye ne-6 iinyanga (nangona zingabalulekanga). Ubungqina bokuba ubungqina bubekwe phantsi ukuya kusezantsi ngokusekelwe kwimiqathango ye-SIGN (indlela yokufihla engenakuchazwa). Kwi-von Trott et al. Ukufunda, ukungenelela kwakuqukethe iiseshoni ezimbini zee-45 ngeveki kwiinyanga ze-3 (iphelele zeeseshoni ze-24), i-71 kanti ngo-Rendant et al. izifundo, iindlela zokungenelela zenziwa nge-12 zonyango kwiinyanga ze-3 zokuqala kunye neyeza ze-6 kulezi zilandelayo zeenyanga ze-3 (iphelele zeeseshoni ze-18) .72 Ukunyanga kokunyanga kwezi zifundo zombini kwaquka ukujikelezwa komlomo wesibeleko ngokuphindaphindiweyo kunye nokuqiniswa nokuzivumelanisa nezimo ngendlela ye-Dantian qigong71 okanye I-Neiyanggong qigong.72 Iziphumo ezincinci ezincinci ezithintekayo zichazwe kumacandelo angenelelo kunye namaqhathaniso.

 

I ngcebiso: Kwizigulane zabantu abadala abaqhubekayo (iinyanga ze-N6) iintlungu zentlungu e-II ukuya kweyesibili, sikhuthaza ukuqeqeshwa kweqela eligadiweyo * ukunciphisa intlungu yentliziyo nokukhubazeka. (Ukunconywa okunyanzelekileyo, ubungqina obunokulinganisela)

 

sokumakishwa: Izigulane zifumene i-18 kwiiseshoni zeqela le-24 ngexesha le-4 kwiinyanga ze-6. Izigulane ziqwalaselwe zilinganisa i-40 / 100 kwisikali seentlungu (VAS). Iqela lokungenelela lafikelela kwi-MCID inqanaba le-10% umahluko kwiintlungu kunye neziphumo zokusebenza. * Ukuzivocavoca kwakuquka i-qigong okanye i-ROM, ukulungelelanisa, kunye nokuziqinisa. Akukho ubungqina bempembelelo enkulu kubantu abadala.

 

Umbuzo oyintloko 13: Ngaba kufuneka ihlolwe i-yoga vs imfundo isetyenziselwe ukuqhubeka (iinyanga ze-N3) kumabanga a-II ukuya kwi-NAD?

 

Isishwankathelo soBungqina. I-Yoga yindlela yamaNdiya yasendulo equka ukuzivocavoca, ukulawula ukuphefumla,
ukuluma. 20 Enye yeRCT nguMichalsen et al. I-73 yavavanya ukusebenza kwe-yoga ye-Iyengar xa kuthelekiswa nenkqubo yokuzikhathalela / yokuzivocavoca kwiintlungu zentamo (VAS) kunye nokukhubazeka (NDI) kwizigulana ezingama-76 ezineentlungu ezingapheliyo zentamo (iintlungu ubuncinci iinyanga ezi-3 kunye nenqaku elingaphezulu kwe-40 mm i-100-mm VAS). I-Yoga ibandakanya iseshoni yemizuzu engama-90 yeseshoni yeeveki ezili-9 kuluhlu olubanzi lwezithuba ezijolise ekuphuculeni ubhetyebhetye, ukulungelelana, ukuzinza kunye nokuhamba. Iqela lokuzikhathalela / lokuzilolonga kwafuneka liziqhelanise nemizuzu eli-10 ukuya kweli-15 ubuncinci amaxesha ama-3 ngeveki uthotho lweemithambo ezili-12 ezijolise ekoluleni izihlunu nasekuqiniseni nasekuhambeni ngokudibeneyo. Iziphumo zibonise ukuba i-yoga isebenza ngakumbi ekunciphiseni iintlungu zentamo kunye nokukhubazeka kwixesha elifutshane (i-4 kunye ne-10 iiveki) kunokuzinyamekela / ukuzilolonga (Itheyibhile 8). Akukho ziganeko zibi ezixeliweyo kwiqela ngalinye. Kolu phononongo, umgangatho wobungqina wehliselwe ezantsi kuba ukumfamekisa kwakunxityiswe kakubi. 45

 

Elinye i-RCT nguJeitler et al.74 yavandlakanya ukusebenza kweJyoti ukucamngca xa kuthelekiswa nokuzivocavoca ngentlungu yentamo (VAS). Iziphumo zibonise ukuba ukucamngca kweJyoti (ukuhlala ungenasiphako, ukuphinda ukuxubusha imantra, kunye nokuxilongwa kwamehlo ngelixa ugcine amehlo amehlo evaliwe) kusebenza ngakumbi kunokuba usebenzise umthambo (usetyenzisiweyo kunye nolwazi olusetyenzisiweyo ngaphambili) .74 Kuba Ukucamngca ngeJyoti kuquka kuphela i-1 yezinto ze-3 ze-yoga (okt, ukucamngca), i-Jeitler ne-al.74 ayinakucingwa ngokuphuhlisa iziphakamiso ezilandelayo.

 

I ngcebiso: Izigulane ezinokuqhubekayo (iinyanga ze-N3) zamabanga ezi-1 ukuya kwi-II intlungu yentlungu kunye nokukhubazeka, sikhuthaza i-yoga ejongene nemfundo kunye nokuqeqeshwa kwekhaya ukwenzela ukuphuculwa kwexesha elifutshane kwintlungu yentliziyo nokukhubazeka. (Ukunconywa okunyanzelekileyo, ububungqina obuncinane)

 

sokumakishwa: Ubunzulu bokuqala bubuhlungu bube ngaphezu kwe-40 / 100 kwaye ubude ubuncinane ubuncinane beenyanga ze-3. I-Yoga yayicacise uhlobo lwe-Iyengar, kunye neeseshoni ze-9 ezininzi kwiiveki ze-9.

 

Umbuzo oyintloko 14: Ngaba kufuneka ihlolwe imisebenzi yokuqinisa i-ROM yasekhaya okanye ukusetyenziswa okululayo kusetyenziswe ukuqhubeka (iinyanga ze-N3) zamabanga a-II ukuya kwi-NAD?

 

Isishwankathelo soBungqina. Ii-RCT ezintathu kuvavanye ukusebenza kweenkqubo zokuqinisa ezomeleleyo xa kuthelekiswa nokuzilolonga kwasekhaya kumabakala I kuye kwintlungu yesibini yentlungu kunye nokukhubazeka.38 Ii-RCTs ezimbini (Hakkinen et al. 75 kunye noSalo et al.76) azichazanga nto phakathi kokungafani kweqela kunyaka we-1 wokuqala okanye iziphumo eziziisekondari. Enye i-RCT (N = 170) ixele ukuba iindlela zokugada ezomeleleyo zazisebenza ngakumbi kunemithambo yeROM yasekhaya.77 Ii-RCT ezimbini ezincinci (N = 107) zifumanise ukuba zombini unyango lusebenza ngokulinganayo.75,76 Zonke izilingo ezi-3 zinokulandelwa kwe-1 unyaka. Ngokusekwe kwisivumelwano sepaneli, iziphumo ezimiselwe ukuba zibalulekile kuvavanyo lokusebenza kwezi RCTs kubandakanya iintlungu (NRS) kunye nokukhubazeka (NDI).

 

Kwi-RCT ngu-Evans okqhubekayo.77 inkqubo yokuqinisa inkqubo (ehanjiswa ngabanyangi bokuzilolonga) yagqitywa ukuba isebenze ngakumbi kunokusetyenziswa ekhaya. Inkqubo- ibandakanya iiseshoni ezingama-20 zokugada ngaphezulu kweeveki ezili-12 kwaye inentamo kunye nomzimba ongaphezulu wokomeleza inkqubo yokuqinisa ukunganyangeki kunye nangaphandle konyango lomqolo.77 Kwelinye icala, imithambo yasekhaya ibandakanya inkqubo eyodwa yokuqinisa intamo kunye negxalaba. ngengcebiso yokuqala malunga nokuma kunye nemisebenzi yemihla ngemihla (Itheyibhile 9). Kwii-2 RCTs ezibonisa ukulingana, inkqubo yokomeleza ibandakanya iiseshoni ezili-10 ezilawulwayo ngaphezulu kweeveki ezi-6 zokuzilolonga kwe-isometric kwintamo eguqukayo kunye nezixhobo ezandayo, igxalaba elinamandla kunye nokuzivocavoca okuphezulu, isisu kunye nokuzivocavoca ngasemva, kunye ne squats.43,44

 

I-RCT yesine nguMayers et al.78 yavandlakanya ukusebenza kweenkqubo zokuvuselela ukulungiswa kunye nokuqhathaniswa nokuzivocavoca ekhaya kuphela ngenxa yentlungu yomntu oneminyaka eyi-65 okanye ngaphezulu. Bonke abathathi-nxaxheba kwisifundo bafumana iiveki ze-12 zonyango. Elinye iqela lafumana i-20 egadiweyo kwiiseshoni zeeyure ze-1 zeeyure ngaphezu kokuzivocavoca ekhaya. Ukusetyenziswa kwasekhaya kubandakanya ezine i-45- kwii-minute ze-60 ukuphucula ukuguquguquka, ukulinganisela, nokulungelelanisa nokuphucula amandla kunye nokunyamezela kwethambo. Abathathi-nxaxheba bafumene imigaqo yokulawulwa kweentlungu, ukubonakaliswa ngokubonakalayo kweempawu zomzimba (ukuphakamisa, ukunyusa, ukudonsa, nokunyuka ukusuka kwindawo yokulala), nokuxubusha ukuze uhlale usebenza. Iziphumo zifunyenwe zivivinywa zokuzivuselela ngokuzibandakanya kunye nokuzivocavoca ekhaya malunga nokuzivocavoca ekhaya (NRS) kunye nokukhubazeka (i-I) kwiiveki ze-12. Nangona kunjalo, ukungafani kwamacandelo akuzange kufinyelele kubaluleka obalo.

 

I ngcebiso: Kwizigulane ezinokuqhubekayo (iinyanga ze-N3) zamabakala I-II ukuya kwintlungu yentamo, sikhuthaza ukuba kuqhutywe imisebenzi yokuqinisa okanye i-home exercises. (Ukunconywa okunyanzelekileyo, ububungqina obuncinane)

 

sokumakishwa: Ukunciphisa intlungu, ukuqeqeshwa kwamandla okongamela, okunikezelwa kunye nokuqeqeshwa kweROM kunye neengcebiso, zavavanywa kwiiveki ze-12 kwiiseshoni ze-20. Izenzo zokuzibandakanya ekhaya ziquka ukunweba okanye ukuzinzisa.

 

Umbuzo oyintloko 15: Ngaba ukusetyenziswa ngokuqiniswayo ngokubhekiselele ekusebenziseni ngokubanzi ukusetyenziswa kusetshenziselwa ukuqhubeka (iinyanga ze-N3) kumabanga a-II ukuya kwi-NAD?

 

Isishwankathelo soBungqina. UGriffiths okqhubekayo.79 thaca iziphumo ezingabalulekanga zeklinikhi zentlungu kunye nokukhubazeka phakathi kwezigulana ezineentlungu eziqhubekayo zentamo kwaye zagqitywa ukuba akukho sibonelelo songeziweyo sokubandakanya umthambo othile we-isometric kwinkqubo yokuziqhelanisa ngokubanzi. Imilinganiselo yayifikelele kwiiseshoni ze-4 ngexesha leeveki ezi-6, ngengcebiso yamaxesha ama-5 ukuya kwali-10 ekhaya. Inkqubo yokuziqhelanisa ngokubanzi ibandakanya ukuzivocavoca emva, iROM esebenzayo, ama-5 ukuya kuma-10 amaxesha imihla ngemihla ngokuqiniswa.

 

Iphaneli emiselweyo kukho ukuqiniseka okuphantsi kubungqina beklinikhi kunye nokungaqiniseki kwiziphumo ezinqwenelekayo zongenelelo. Ukuzivocavoca kwe-Isometric kunemiphumela emibi ekulindelweyo, kufuna izibonelelo ezincinci, kwaye zamkelekile ngokubanzi kubachaphazelekayo kwaye kunokwenzeka ukuba kuzalisekiswe. Nangona kunjalo ukungaqiniseki kuhlala kuhambelana nefuthe labo kubulungisa kwezempilo kunye nokulingana phakathi kweziphumo ezinqwenelekayo nezingalunganga. Uphando oluthe kratya luyafuneka kule ndawo ngaphambi kokuba kwenziwe ingcebiso.

 

Umbuzo oyintloko 16: Ngaba kufuneka idibaniswe ukuqiniswa kokulawulwa, iROM, kunye nokuzivumelanisa ukuguquguquka ngokuchasene nonyango (uluhlu olulinde) lusetyenziswe ukuqhubeka (iinyanga ze-N3) zamabanga a-II ukuya kwi-NAD?

 

Isishwankathelo soBungqina. von Trott et al. 71 kunye noRendant et al. I-72 inikezele iziphumo ezibalulekileyo zokunciphisa intlungu yentamo kunye nokukhubazeka okwenzela ukuqiniswa kokuhlanganisana, iROM, kunye nokuzivumelanisa nezimo. Ezi zifundo zombini zidibanisa abantu abahlukahlukeneyo kwaye zikhokelela kwiziphumo ezifanayo (von Trott et al.71 ezibhekiswe kubantu abadala).

 

Iphaneli ebekwe ukuba kukho ubungqina obunokulinganisela kwisibonakaliso sekliniki, kunye nemiphumo enkulu enqwenelekayo neyincinci engalindelekanga. Nangona kunjalo kukho ukungafani nakwiziganeko ezingathandekiyo zokuqiniswa kwe-ROM kunye nokuzivumelanisa nezimo, kunye neengxaki zezo ziganeko ezimbi ezizimeleyo. Ngokomzekelo, ukuzilolonga okunokwenzeka kunokuhambelana nentlungu emfutshane emva kokungenelela. Ukongezelela, indawo echanekileyo ingadingeka ukuba iqhutywe, engayenza iindleko ezinkulu ezifuneka ziqwalaselwe ngaphambili. Ngenxa yoko, akukho ukuqinisekiswa malunga nokukwazi ukuphumeza kwaye ingaba oku kunokuchaphazela kakhulu ukungalingani kwempilo. Nangona kunjalo, ukhetho luya kwamkeleka kubachaphazelekayo. Ngokubanzi, imiphumo enqwenelekayo mhlawumbi ingaphezulu kwemiphumo engathandekiyo. Iphaneli yabeka le sihloko kwaye ubungqina bayo buninzi obubandakanyekayo nombuzo oyintloko Umbuzo we-12 (qigong uthathwa njengomsebenzi). Ngoko ke, ukuphakanyiswa kwe-1 kwenziwa, ukujongana nezihloko zombini.

 

Uncedo lweNcwadi

 

Umbuzo oyintloko 17: Ngaba ukunyamekela kwe-multimodal vs self-management kusetyenziswe ukuqhubeka (iinyanga ze-N3) zamabanga-I-II NAD?

 

Isishwankathelo soBungqina. Enye i-RCT nguGustavsson et al. 80 yavavanya ukusebenza kakuhle kokuzilawula kwe-Persist- musculoskeletal tension type tension pain for grade I to II neck pain. Bathelekise iziphumo zonyango lweentlungu kunye neqela lokungenelela kweqela elilawulayo (n = 77) kunyango lwonyango olwenziwa ngokuzimeleyo (n = 79). Amanyathelo entlungu (i-NRS) kunye nokukhubazeka (i-NDI) aqokelelwa kwisiseko nakwi-10 nakwiiveki ze-20. La mabini maqela ayenamahluko phakathi kweqela ukunciphisa iintlungu kunye nokukhubazeka. Kwi-20 yeeveki ezilandelelweyo emva komndilili weeseshoni ze-7, ngokusekwe kumanyathelo asetyenzisiweyo, iintlungu ezininzi kunye noxinzelelo lokungenelela kweqela elinegalelo kwimpembelelo yokunyanga iintlungu kunye nezigulana ezilawula iintlungu kunye nokukhubazeka kuneqela lokhathalelo lweemodyuli ezininzi. Iziphumo zokuqala zonyango zaye zagcinwa ngaphezulu kweminyaka emi-2 yokulandela (Itheyibhile 10) .81

 

I ngcebiso: Kwizigulana ezingapheliyo (iinyanga ze-N3) iintlungu zentamo kunye nokuphazamiseka okunxulumene namabakala I ukuya kwi-II, sicebisa ukhathalelo lwe-multimodal * okanye uxinzelelo lokuzilawula ngokusekwe kukhetho lwesigulana, impendulo yangaphambi kokhathalelo, kunye nezixhobo ezikhoyo. (Ingcebiso ebuthathaka, ubungqina obukumgangatho osezantsi)

 

sokumakishwa: * Ukhathalelo lomntu ngamnye lubandakanya unyango olwenziwayo (ubuqhetseba, ukugaya, ukuthambisa, ukulandelela), ukwenza iyeza, ukufudumeza, ukukhuthaza amandla ombane, umthambo, kunye / okanye i-ultrasound. Ukuzilawula koxinzelelo kunokubandakanya ukuphumla, ukuzilolonga kunye nokuzilolonga ngomzimba, iintlungu noxinzelelo lwezifundo zokuzilawula, kunye nengxoxo. Iqela lokhathalelo lwe-multimodal lafumana i-avareji yeeseshini ze-7 (uluhlu lwe-4-8), xa kuthelekiswa ne-11 (uluhlu 1-52) leseshoni yeqela lokuzilawula loxinzelelo kwiiveki ezingama-20.

 

Education

 

Umbuzo oyintloko 18: Ngaba kufuneka ulungise imfundo yesigulane ngokuthethelela ngonyango ukusetyenziswa ngokuqhubekayo (inyanga ze-N3) i-NAD?

 

Isishwankathelo soBungqina. USherman okqhubekayo.82 uxele iziphumo ezingabalulekanga kwezonyango kwiiveki ezi-4 zokukhubazeka. Olu phononongo lucebisa incwadi yokuzinakekela ngeposi kunye nesifundo sonyango lokuthambisa lubonelela ngezibonelelo ezifanayo zeklinikhi
izigulane ezinentlungu yentlungu.

 

Iphaneli yamisela ukuqinisekiswa ngokubanzi kobubungqina obuphantsi, kunye nemiphumo embi kakhulu engalindelekanga kwaye akukho ziganeko ezimbi ezibangelwa ukungenelela (ezinye iintloko ezinokwenzeka). Kukho ukungaqiniseki kwiindleko ezifunekayo, kubandakanywa abasebenzi abafunekayo, izixhobo kunye neentlobo. Kanti olu khetho luyakwazi ukuphumeza kwiimeko ezininzi kwaye lunempembelelo enamandla yokunciphisa ukungalingani kwempilo. Njengeqhinga lokukhusela, ukungenelela kuyamkeleka kubachaphazelekayo, kubandakanywa nabasebenzi be-chiropractic, izigulane kunye nabenzi bomgaqo-nkqubo. Iphaneli yayingaqinisekanga malunga nokulinganisela phakathi kwemiphumo enqwenelekayo neminqweno. Izifundo ezongezelelweyo eziphezulu zifunekayo kule ndawo phambi kokuba kwenziwe nasiphi na isincomo.

 

Uncedo lweNcwadi

 

Umbuzo oyintloko 19: Ngaba kufuneka ukusetyenziswa ngokusetyenziselwa amabakala aqhubekekayo ukuya kwi-II NAD?

 

Isishwankathelo soBungqina. U-Evans et al.77 uthelekisa ukuxhaphaka komgogodla ukongeza kwiiveki ezingama-20 zonyango lokugada (iiseshoni ezingama-20) ukuya kunyango lokulolonga umntu yedwa kubantu abadala abanamanqanaba aqhubekayo ukuya kwintlungu yesibini yentamo, ngelixa uMaiers okqhubekayo. 78 uthelekisa ukunyanzeliswa komgogodla ukongeza ekhaya ukuzilolonga (iiseshoni ezingama-20 ubuninzi) ukwenza umthambo ekhaya kuphela kubantu abadala abanamanqanaba aqhubekayo ukuya kwintlungu yesibini yentamo. Iziphumo zentlungu kunye nokukhubazeka kwii-12 kunye nee-52 iiveki azizange zifinyelele kubaluleko phakathi kweqela, ngaphandle kwinqanaba leentlungu kwiiveki ezili-12 kwisifundo se-Maiers.78 I-RCT yesithathu nguLin et al.83 yabelwe izigulane ezingama-63 eziqhubekayo zentamo (NAD I-II) kwiqela lokulinga (n = 33) liphathwe nge -cervical spine manipulation kunye ne-Chinese yemveli yokuthanjiswa (TCM) xa kuthelekiswa ne-TCM yodwa (n = 30) ngaphezulu kweeveki ezi-3. Iziphumo zithanda ukunyanzeliswa komlomo wesibeleko kunye ne-TCM ngaphezulu kwe-TCM yodwa yentlungu (i-NPS) kunye nokukhubazeka (iphepha lemibuzo elinokukhubazeka eNorthwick Park Neck) kwiinyanga ezi-3 (Itheyibhile 11).

 

Iphaneli yagqiba ukuqinisekiswa okuphantsi kobubungqina, kunye nemiphumo emincinci enqwenelekayo kwaye engathandekiyo yokungenelela. Zimbalwa izibonelelo ezifunekayo ukungenelela, kwaye mhlawumbi ziyamkeleka kubachaphazelekayo kwaye zinokwenzeka ukuphumeza. Nangona iphaneli ithathe isigqibo sokuba imiphumo enqwenelekayo kwaye engathandekiyo yayingqinelana kakuhle, le nkcazo elandelayo inikwe.

 

I ngcebiso: Kwizigulane ezineemigangatho eqhubekayo ndiya kwi-NAD yesi-2, sincoma ukunyanga ngokubambisana ne-tissue yonyango. (Ukunconywa okunyanzelekileyo, ububungqina obuncinane)

 

sokumakishwa: Ukuvavanywa emva kweeseshoni ezisibhozo zeeseshoni ze-20 (malunga nexesha le-3-iveki). Akunakubandakanya ukuphathwa njengonyango olulodwa.

 

Uncedo lweNcwadi

 

Umbuzo oyintloko 20: Ngaba ukuhlambalaza ngokungafuneki unyango (uluhlu olulinde) luya kusetyenziswa ukuqhubeka (iinyanga ze-N3) kumabanga a-II ukuya kwi-NAD?

 

Isishwankathelo soBungqina. USherman et al.82 kunye noLauche okqhubekayo.84 uxele umahluko okhoyo ngaphandle kwezonyango kwiziphumo zokukhubazeka kwii-4 nakwiiveki ze-12 ngokwahlukeneyo. USherman okqhubekayo.82 yacebisa ukuba iSweden kunye / okanye i-massage yeklinikhi eneengcebiso zokuzikhathalela ngomlomo ibonelela ngezibonelelo ezifanayo zeklinikhi kwincwadi yokuzikhathalela yeziphumo zokukhubazeka. U-Lauche et al.84 ucebise ukuba uthambe umsipha kunye nokuphumla kwezihlunu okuqhubekayo kukhokelela kutshintsho olufanayo kukhubazeko. USherman et al.85 uxele iziphumo zentlungu yentamo kunye nokukhubazeka kwiiveki ze-4 kwaye wacebisa ukuba iidosi eziphezulu zokuthambisa zinika uncedo lweklinikhi oluphezulu (Itheyibhile 12).

 

Iphaneli yamisela ubungqina obuphantsi kobubungqina, kunye nemiphumo emincinci enqwenelekayo kwaye engathandekiyo. Izindleko ezongezelelweyo zingadinga ukufumana inzuzo yeklinikhi. U-Sherman et al.85 wacebisa ubuncinci beeyure ze-14 zabasebenzi bexesha elifunekayo. Ngenxa yeendleko ezinxulumene ne-massage ye-high-dose, kungenzeka ukuba ayamkelekanga ngokupheleleyo kwizigulana okanye abahlawuli. Nangona kunjalo, olu khetho luyenzeka kwaye lunzima ukuphunyezwa kwiindawo ezifundisweyo kunye neentlupheko ezifana nezifundo ezifundwe ngokubanzi.85 Ngokubanzi, iphaneli yanquma imiphumo efunayo mhlawumbi ingaphezu kwemiphumo engathandekiyo kwaye icebise ukunikela le ndlela.

 

I ngcebiso: Izigulane ezinezinyanga eziqhubekayo (iinyanga ze-N3) zamabanga ama-I ukuya kwe-II NAD, sikhuthaza ukuba i-massage dose ephakamileyo ingabikho nonyango (uludwe olulindelekileyo) olusekelwe kwizikhetho ezikhethiweyo kunye nezixhobo ezikhoyo. (Ukunconywa okunyanzelekileyo, ububungqina obuncinane)

 

sokumakishwa: Amanyathelo anikezelwa ngamaxesha e-3 kwii-60 imizuzu ngeveki kwiiveki ze-4. Amanqanaba amancinci kunye nobude abuzange abe neenzuzo zonyango, kwaye asikwazi ukuphakamisa ukunikela njengendlela yokukhetha.

 

Iimpawu zoMzimba

 

Umbuzo oyintloko 21: Ngaba i-LLLT ingasetyenziselwa ukuqhubeka (iinyanga ze-N3) zamabanga a-II ukuya kwi-NAD?

 

Isishwankathelo soBungqina. Emva kokuhlolwa kwesekisi epheleleyo kunye nokuphononongwa, akukho zifundo ezijongene nokungafani phakathi kweqela phakathi kweziphumo zentlungu okanye ukukhubazeka zifakiwe ukuzisa lo mbuzo obalulekileyo. Ukungabikho kobungqina kunye nokungaqiniseki kwi-balance balance phakathi kwezinto ezinqwenelekayo kunye neziphumo ezingafunekiyo kwaholela iplanethi ukuba inqumle ukuba ingabhali isincophiso kwesi sihloko ngeli xesha. Izifundo ezingaphezulu kweyona mfuno zifunekayo kule ndawo ngaphambi kokuqinisekiswa kwimiqathango okanye iingcebiso.

 

Umbuzo oyintloko 22: Ngaba i-transcutaneous electrical nerve stimulation nge-multimodal program ye-tissue yonyango isetyenziselwa ukuqhubeka (iinyanga ze-N3) zamabanga a-II ukuya kwi-NAD?

 

Isishwankathelo soBungqina. Emva kokuhlolwa kwesekisi epheleleyo kunye nokuphononongwa, akukho zifundo ezijongene nokungafani phakathi kweqela phakathi kweziphumo zentlungu okanye ukukhubazeka zifakiwe ukuzisa lo mbuzo obalulekileyo. Ukungabikho kobungqina kunye nokungaqiniseki kwinqanaba elifanelekileyo phakathi kweziphumo ezinqwenelekayo kunye neziphumo ezingathandekiyo kukhokelela ukuba iphaneli ithathe isigqibo sokuba ungabhali ngcebiso malunga nesi sihloko ngeli xesha. Izifundo ezingaphezulu kweemfuno eziphezulu zifuneka kule ndawo phambi kokuqinisekiswa kwimiqathango okanye iingcebiso.

 

Umbuzo oyintloko 23: Ngaba ukulandelwa komlomo kusetyenziswe kwiBakala III i-NAD (ixesha eliguqukayo)?

 

Isishwankathelo soBungqina. Emva kokuhlolwa kwesekisi epheleleyo kunye nokuphononongwa, akukho zifundo ezijongene nokungafani phakathi kweqela phakathi kweziphumo zentlungu okanye ukukhubazeka zifakiwe ukuzisa lo mbuzo obalulekileyo. Ukungabikho kobungqina kunye nokungaqiniseki kwi-balance balance phakathi kwezinto ezinqwenelekayo kunye neziphumo ezingafunekiyo kwaholela iplanethi ukuba inqumle ukuba ingabhali isincophiso kwesi sihloko ngeli xesha. Izifundo ezingaphezulu kweyona mfuno zifunekayo kule ndawo ngaphambi kokuqinisekiswa kwimiqathango okanye iingcebiso.

 

Uncedo lweModododal

 

Umbuzo oyintloko 24: Ngaba ukunakekelwa kweemali eziphezulu kunye nokunyamekela ngonyango kuya kusetshenziselwa amabakala aqhubekekayo ukuya ku-III NAD?

 

Isishwankathelo soBungqina. Enye i-RCT ngu-Walker et al.86 ivavanye ukusebenza kononophelo lweemodemodal kwiintlungu zentamo kunye okanye ngaphandle kwempawu zangaphezulu (i-I-III). Bathelekisa iziphumo zonyango oludityanisiweyo lokhathalelo lweemodyuli kunye nokuzivocavoca ekhaya (n = 47) kongenelelo oluncinci lwe-multimodal (n = 47). Omabini la maqela ongenelelo afunyenwe ngokomndilili weeseshoni ezi-2 ngeveki ngeeveki ezi-3. Akukho ngenelelo lwenziweyo emva kweeveki ezi-6. Isiseko semibuzo ebiziweyo ibandakanya iintlungu zentamo kunye nengalo (VAS) kunye nokukhubazeka (NDI). Onke amanyathelo ayaphindaphindwa kwi-3, 6, kunye ne-52 iiveki. Izigulana kwinkathalo ye-multimodal kunye neqela lokuzilolongela ekhaya lalinokuncipha okukhulu kwiintlungu zexesha elifutshane kunye nakwithuba elifutshane kunye nexesha elide lokukhubazeka xa kuthelekiswa neqela lokungenelela elincinci (iTheyibhile 13). Uhlalutyo lwesibini lwe-Walker et al. I-Study87 igqibe ekubeni izigulana ezifumana zombini i -cervical thrust kunye ne-nonthrust manipulation azange zibengcono kuneqela elifumana ukunganyaniseki komlomo kuphela. Olu hlalutyo lwesibini olunikwe amandla aluvumeli nasiphi na isitatimende esichazayo ngokubakho okanye ukungabikho kwonyango ngendlela enye kwenye. Ukuncitshiswa kwentlungu echazwe kukhathalelo lweemodyuli ezininzi kunye neqela lokuzilolonga xa kuthelekiswa kakuhle notshintsho lwamanqaku oluchazwe lolunye uphononongo, kubandakanya uHoving et al.88,89

 

Kwi-RCT, i-Monticone ne-al.90 yavandlakanya ukunyamekela kolondolozo lwe-multimodal ukwenzela intlungu yentliziyo. Baqhathanisa umphumo wonyango wokunakekelwa kwamaninzi kuphela (n = 40) ekunakekelweni kwamaninzi ngokubambisana nenkqubo yokuziphatha kwengqondo (n = 40). La mabini maqela ancitshiswe intlungu (NRS) kunye nokukhubazeka (i-NPDS), kodwa kwakungabikho nkcenkcesho yekliniki phakathi kwamaqela kwiiveki ze-52. Ukongezwa kwendlela yokuziphatha kwengqondo engakhange ibonelele iziphumo ezingaphezulu kunokhathalelo lwe-multimodal kuphela.

 

I ngcebiso: Kwizigulana ezibonisa ukunyuka kwentlungu ye-neck I ukuya ku-III, sikhuthaza ukuba oogqirha banikela ngononophelo lwengqondo kunye / okanye ingcali ngokubhekiselele kwintetho yesigulane. (Ukunconywa okunyanzelekileyo, ububungqina obuncinane)

 

sokumakishwa: Ukunyamekelwa kweemodemodal kunye nokuzivocavoca kunokubandakanya ukunyanzeliswa / ukungahambisani nokunyanzeliswa kwamalungu, amandla omzimba, ukuzolula, kunye nokuzivocavoca ekhaya (ukurhoxiswa komlomo wesibeleko, ukuqiniswa kwentamo eqinile, ukujikeleza komlomo wesibeleko). Ungenelelo oluncinci lweendlela ezininzi lunokubandakanya iingcebiso zangasemva, ukhuthazo lokugcina intshukumo yentamo kunye nemisebenzi yemihla ngemihla, ukujikeleza umthambo wesibeleko, imiyalelo yokuqhubeka nokunyanga amayeza, kunye nonyango olushushu (10%) lwe-ultrasound kwi-0.1 W / cm2 yemizuzu eyi-10 isetyenziswe entanyeni. kunye nokuzivocavoca iROM yomlomo wesibeleko.

 

Lolonga

 

Umbuzo oyintloko 25: Ngaba iqela limele lisebenzise imfundo okanye isiluleko ukuba isetyenziselwe abasebenzi abaneentlungu kunye nentlungu yentlungu?

 

Isishwankathelo soBungqina. Sidibanise imibuzo ephambili Ngaba inkqubo yemfundo yesigulana ehambelana nemithambo isetyenziselwa iintlungu eziqhubekayo zentamo kunye nokuphazamiseka okunxulumene nabasebenzi? Kunye exercisesNgaba imithambo esekwe kwindawo yokusebenzela vs iingcebiso kufuneka isetyenziselwe iintlungu zentamo kubasebenzi? (n = 537) nguZebis et al.91 kuvavanye ukusebenza koqeqesho lwamandla kwindawo yokusebenza xa kuthelekiswa nokufumana iingcebiso zokuhlala ukhuthele emzimbeni ngokunganyanzelekanga kwentamo kunye neentlungu zamagxa. Iziphumo zibonise ukunciphisa okufanayo kwintamo kunye neentlungu zentlungu kwiiveki ezingama-20 kwinkqubo yovavanyo xa kuthelekiswa neengcebiso (Itheyibhile 14). Ungenelelo lwaluneeseshoni ezi-3 ngeveki, imizuzu engama-20 nganye, ukuya kuthi ga kwiiveki ezingama-20 (iiseshoni ezingama-60 zizonke).

 

Inkqubo yokuzivocavoca kwindawo yokusebenza ibandakanya amandla oqeqesho olomeleleyo lokuxhomekeka kwimigaqo yokuqhubela phambili kokuhamba ngamandla kwaye ibandakanye intamo kunye nemisipha yamagxa eyomeleza ngokwenza imithambo eyahlukeneyo ye-4 ye-dumbbell kunye ne-1 yokuzivocavoca kwimisipha eyolulayo. Ngaphezulu kwe-15% yabasebenzi ababelwe kwiqela lomsebenzi elinika ingxelo ngezikhalazo ezincinci nezethutyana. Iqela lokuthelekisa alichazanga izehlo ezimbi.

 

Uhlalutyo lwengqungquthela92 ye-Zebis et al. I-LEARN91 iquka abafazi be-131 abanesiseko sokunyuka kwentlungu ye-30 mm VAS ukusuka kwi-537 yabesilisa nabathathi-nxaxheba. Iziphumo zithandeka ukuqeqeshwa okuchasene nxamnye neengcebiso zokuhlala zisebenzela intlungu (VAS) kwiiveki ze-4. Olu phofu aluzange lufakiwe kuba ukufunyaniswa bekuye kwaqwalaselwa kakade kwisifundo sokuqala.

 

I ngcebiso: Kubasebenzi abanobuhlungu bentamo kunye nentlungu, sincoma ukuxilongwa okuxutywayo kunye nokungaqiniseki kwamandla okuphakamisa amandla okanye iingcebiso zodwa. (Ukunconywa okunyanzelekileyo, ubungqina obunokulinganisela)

 

sokumakishwa: Ukunciphisa ubunzima beentlungu, iiseshoni ze-3 ngeveki, nganye imizuzu ye-20 ehlala njalo, ngaphezu kwexesha le-20. Ukuzivocavoca kuquka ukuqiniswa. Ezinye izixhobo eziyimfuneko zifunekayo ukwenzela ukuphunyezwa kokungenelela kokusebenza.

 

Imfundo eLungisiweyo yeMonde

 

Umbuzo oyintloko 26: Ngaba kufuneka kwenziwe iiprogram zemfundo yesigulane ngokubhekiselele kwiiprogram zokuzivocavoca eziqhubekayo (inyanga ze-N3) i-NAD kwabasebenzi?

 

Isishwankathelo soBungqina. UAndersen et al.93 uxele iziphumo ezingabalulekanga kwezonyango kwiiveki ezili-10 zentlungu kunye nentlungu, ebonisa ukuba kuthunyelwa ulwazi nge-imeyile ngeveki malunga nokuziphatha ngokubanzi kunye neenkqubo zokuthinjwa kwamagxa zibonelela ngezibonelelo ezifanayo zeklinikhi. Ukanti ukuphunyezwa koqeqesho lokuqina ngamandla kwiindawo zempangelo zokwenza umsebenzi (ukwenziwa kokuzilolonga kubomi bemihla ngemihla kunye nokwandisa ixesha lokuzonwabisa) kuxhaswa ngokubanzi.94,95 Kwenye i-RCT, ukunciphisa iintlungu kwakukukhulu kakhulu kun iqela lifumana iingcebiso zodwa. 91 Iziphumo ezivela kwiZebis et al. I-91 ibandakanyiwe kwicandelo longenelelo lomsebenzi kwesi sikhokelo.

 

Iphaneli iqiniseke ngokuqinisekileyo ngokuqinisekileyo kwinkcazo yobukliniki, kunye nemiphumo eminqweno encinci kwaye engathandekiyo yokungenelela. Iimithombo ezifunekayo zincinci, zicinga ukuba ugqirha unika imfuyo imfundo. Ukungalingani kwezeMpilo kuya kuthinteka ngokufanelekileyo, kwaye ukungenelela kuya kwamkeleka kubachaphazelekayo kwaye kufezekiswe ukuphumeza. Iphaneli yenze isigqibo sokungaphinda kwezi ziphumo kwili candelo langoku. Iphaneli yabonwa ukuba inzuzo yokwandisa ubukhulu kunye nobukhulu bemigqaliselo yokusebenza yayingagcini kuphela kulabo basebenzayo kwimimandla yoshishino okanye kunoma yiphina iqela elithile labantu ngaphandle kwabantu abadala.

 

UkuSebenza koKhuseleko lokuKhubazeka

 

Imibuzo ephambili 27-29: Ngaba ukuqina okusekwe ekusebenzeni ngokubhekisele ekomelezeni okusekwe eklinikhi kusetyenziselwa ukuqhubeka (iinyanga ze-N3) ezinxulumene nomsebenzi we-rotator cuff tendinitis? Ngaba kufuneka kungenelelwe ngoncedo lokuthintela ukukhubazeka kusetyenziselwe iintlungu eziqhubekayo zentamo kunye negxalaba? Ngaba kufuneka kungenelelwe ngoncedo lokuthintela ukukhubazeka kusetyenziselwe iinyanga eziqhubekayo (zeenyanga ze-N3) iimpawu eziphezulu?

 

 

Isishwankathelo soBungqina. Ukuphonononga ubungqina bokungenelela kokuthintela ukukhubazeka emsebenzini, i-41 i-GDG igqibe kwelokuba intsalela phakathi kweziphumo ezinqwenelekayo nezingafunekiyo ibilungelelene okanye ayiqinisekanga unc kwimibuzo ephambili 27-29. Ngenxa yoko, iphaneli yesikhokelo khange ikwazi ukwenza izindululo zale mibuzo iphambili, kodwa uphando lwexesha elizayo kunokwenzeka ukuba luxhase ngokuqinisekileyo okanye ngokungalunganga iintlobo ezahlukeneyo zongenelelo lothintelo lokukhubazeka.

 

Iziphakamiso zokuqhubeka (iinyanga ezili-N3) amaBakala I ukuya ku-III WAD Exercise

 

Umbuzo oyintloko 30: Ngaba kufuneka ihlolwe ukusetyenziswa jikelele kunye neengcebiso ngeengcebiso kuphela ezisetyenziselwa ukuqhubeka (iinyanga ze-N3) kwii-I ukuya kwi-IIWAD?

 

Isishwankathelo soBungqina. Kwi-RCT, uStewart et al. (2007) I-96 ivavanye ukusebenza kweeseshoni zeengcebiso ze-3 iyodwa xa kuthelekiswa neeseshoni zeengcebiso ze-3 zidityaniswe neeseshoni zokuzilolonga ezili-12 ngaphezulu kweeveki ezi-6 kwintlungu yentamo (NRS) kunye nokukhubazeka (NDI) phakathi kwezigulana ezili-134 ezinamabanga aqhubekekayo ukuya kwi-II WAD. Iziphumo, eziboniswe kwiTheyibhile 15, zibonise ukuba imithambo egadiweyo eneengcebiso iyasebenza njengeengcebiso zodwa kwixesha elide (iinyanga ezili-12). Iingcebiso zibandakanya imfundo esemgangathweni, ukuqinisekiswa, kunye nenkuthazo yokuqalisa kwakhona imisebenzi elula kwaye ibandakanya ukubonisana kwe-1 kunye neefowuni zokulandelela ezi-2. Nangona kunjalo, umgangatho wobungqina wehliselwe kumgangatho osezantsi ngokusekwe kwiimpawu zoMqondiso (i-randomization kunye nemilinganiselo yesiphumo kuye kwaqwalaselwa ngayo) kunye nenani eliphantsi labathathi-nxaxheba kunye neminyhadala.45

 

Isilingo se-pragmatic esinikwe izigulane ze-172 ezinezigaba ze-WAD eziqhubekayo ukuya ku-II ukufumana inkqubo epheleleyo ye-12 yeveki-nkqubo (ii-20 iiseshoni kuquka iinkqubo zokwenza unyango olusesikweni kwiveki yokuqala [akukho ukuphathwa] kunye neyeza zokuziphatha ezikhutshwa ngaba physiotherapists) okanye iingcebiso (iseshoni ye-1 kunye inkxaso yefowuni) .97 Inkqubo yokusebenza ngokubanzi ayizange isebenze ngaphezu kweengcebiso zodwa ekunciphiseni ubuhlungu okanye ukukhubazeka, nangona iziphumo zifunyenwe uqeqesho olunzulu lwe-physiotherapy yoqeqesho kwiingcebiso.

 

Iphaneli yamisela ubungqina obuphantsi kobubungqina, kunye nemiphumo eminqweno engathandekiyo kwaye engathandekiyo kwaye akukho ziganeko ezingathandekiyo (izigulane ze-5 ezifumene inkqubo epheleleyo yokuzilolonga kunye ne-4 eyafumana iingcebiso zineziganeko ezincinci eziphambene nexesha elide). Ngokubanzi, iphaneli yagqiba ibhalansi phakathi kweziphumo ezinqwenelekayo nezingathandekiyo ezinjengeendleko ezingaqinisekanga, kwaye kukho ubungqina obufunekayo phambi kokuba kwenziwe isincomo.

 

Kwi-20 yeveki ye-RCT, i-Gram et al. (2014) I-98 ihamba ngeenombolo ze-351 kwabasebenzi kwii-2 amaqela okuqeqesha afumana inani elifanayo leenkqubo ezicwangcisiweyo ze-3 ngamaxesha ngeveki, kunye neqela le-1 lijongene nalo lonke ixesha lokungenelela kwaye elinye lifumana iliso elincinci kuphela, kunye neqela lokubhekisa (ngaphandle kokuzivocavoca ). Nangona iziphumo zibonise ukuba uqeqesho oluphantsi kwendawo yokusebenza lwanciphisa intlungu yentamo, iziphumo zazingekho ezibalulekileyo kwiikliniki kwaye zombini amaqela okuqeqesha aphuculwe ngokuzimeleyo kwimeko yolawulo. Iphaneli yagqiba ekubeni ingacingi ngolu hlobo lwesifundo ekuqulunqeni isincomo kuba umsebenzi awuzange uhambelane ngqo kunye neengcebiso kunye nokulahleka okufunekayo ukulandelelana kwenzeka kumaqela. Nangona uhlolo olujongene noluntu olubonakalayo luncedo, iindleko ziphezulu. Oku kunokwenzeka ukuba kuncitshiswe, nangona kunjalo, ngokunikezela unyango lweqela, olunokunyusa ukuthotyelwa kunye nokuphendula ngeqela elongeziweyo.

 

I ngcebiso: Izigulane ezinokuqhubekayo (iinyanga ze-N3) kwii-I-II ze-WAD, sichaza ukuzithobela ngokucetyiswayo kunye neengcebiso okanye iingcebiso zodwa ezisekelwe kwintetho yesigulane kunye nezibonelelo ezikhoyo. (Ukunconywa okunyanzelekileyo, ububungqina obuncinane)

 

sokumakishwa: Izibonelelo ezingakumbi zifunekayo ukuze ziqhutywe.

 

Uncedo lweModododal

 

Umbuzo oyintloko 31: Ngaba ukunyamekela kwe-multimodal vs program yolawulo lokuzilawula kusetshenziselwa ukuqhubeka (iinyanga ze-N3) ibakala lesi-II le-WAD?

 

Isishwankathelo soBungqina. I-Jull et al.99 yabika akukho ziphumo zeclini okanye izibalo ezibalulekileyo zentlungu nokukhubazeka kwiiveki ze-10. Bacetyisa ukuba ukunakekelwa kwe-multimodal (ukuqeqeshwa, ukukhuthaza, imfundo kunye neengcebiso ze-ergonomic) kwanikezela iziphumo ezifanayo kwinkqubo yokulawula ngokwazo ngokusekelwe kwincwadana yemfundo (indlela ye-whiplash, ukuqinisekiswa kokubuyisela, ukuhlala esebenzayo, icebo le-ergonomic, ukusetyenziswa). Ukunyamekela akuzange kubandakanye ukunyanzeliswa kwe-high speed. Nangona esi sifundo sizodwa kwii-physiotherapists, kulungile phakathi kwendawo ye-chiropractors (i-therapists).

 

Enye enye i-RCT nguJull okqhubekayo. 100 yavavanya ukusebenza kakuhle kweendlela ezahlukeneyo zonyango kwizigulana ezine-whiplash ebukhali (iiveki ze-b4 emva kwengozi). Izigulana ezinikezelwe ngongenelelo ngoncedo lwe-pragmatic (n = 49) banokufumana amayeza kubandakanya i-opioid analgesia, i-multimodal physiotherapy, kunye ne-psy- chology yoxinzelelo lwasemva kwengozi kwiiveki ezili-10. Akukho mahluko ubalulekileyo kubuninzi bokubuyiselwa kwimeko yesiqhelo (i-NDI? 8%) phakathi kwamaqela okhathalelo lwepragmatic kunye nesiqhelo afunyenwe kwiinyanga ze-6 okanye ze-12. Kwakungekho phuculo kumanqanaba angoku okungafumaneki kwiinyanga ezi-6 (i-63.6%, ukhathalelo lwepragmatic; i-48.8%, inkathalo yesiqhelo), engabonakalisi luncedo longenelelo lokuqala lweenkqubo ezininzi.

 

Iphaneli yaqinisekisa ukuqinisekiswa okuphantsi kobungqina bekliniki, kunye nemiphumo eminqweno enqwenelekayo neyengathandeki ebhengeziweyo. Kodwa kukho iindleko ezincinci kunye nezibonelelo ezifunekayo ukuphumeza ukungenelela. Inkcazo ye-elektroniki yecandelo lezemfundo lononophelo lwama-multimodal linganciphisa ukungalingani kwempilo. Inketho ingamkeleka kwiikliniki (ukucinga iindlela zokunakekelwa kokubambisana), abenzi bomgaqo-nkqubo kunye nezigulane kwaye kuya kwenzeka ukuba ziphumelele kwizicwangciso zokunyamekela. Ngokubanzi, ibhalansi phakathi kwemiphumo enqwenelekayo neyinqwenelekayo ayiqinisekanga, kwaye akukho ncomo enikezelwa ngeli xesha. Izifundo ezongezelelweyo kufuneka ziqhutyelwe kule ndawo kwaye kufuneka zibandakanye ukunakekelwa kwezinto ezininzi ezibandakanya ukuqhutyelwa kwezinto eziphezulu okanye ukunyanzelisa.

 

Education

 

Umbuzo oyintloko 32: Ngaba isilungiso semfundo yesigulane esilungelelaniswayo singasetyenziselwa ukuqhubeka (iinyanga ze-N3) iWAD?

 

Isishwankathelo soBungqina. UStewart et al. (2007) I-96 ibike ngokungabalulekanga kwezonyango phakathi kokungafani kweentlungu kunye neziphumo zokukhubazeka kwiiveki ezi-6. Olu phononongo lucebise ukongeza inkqubo yokuzivocavoca esekwe kumzimba kuqeqesho olungenelelo ngoncedo olunikezela ngezibonelelo ezifanayo zeklinikhi njengemfundo eyakhiwe yodwa.

 

Iphaneli yaqinisekisa ukuqinisekiswa okuphantsi kobungqina, ngeempembelelo ezinqwenelekayo ezingathandekiyo ezingathandekiyo. Izikhalazo eziphambili zibuhlungu beentlungu, ubuhlungu beentolo, kunye nobuhlungu bomsantya ngeentloko ezincinci.96 Iimithombo ezincinci ezifunekayo ukungenelela zinganciphisa ukungalingani kwempilo, kwaye ukhetho luyamkeleka kubachaphazelekayo kwaye lunokwenzeka ukuphumeza kwiimeko ezininzi.

 

Iphaneli inqume ukuba lo mbuzo obalulekileyo wawunomdla omkhulu kunye nombuzo oyintloko kwi-5 kwaye wagqiba ekubeni enze iziphakamiso ze-1 ezijongene nezihloko zombini.

 

ingxoxo

 

Esi sikhokelo esisekelwe kubungqina senza umgangatho ogqwesileyo wokulawula i-NAD kunye ne-WAD ebangelwa okanye iqhutywe yintlupheko yemoto kunye nokuhlaziywa kwe-2 izikhokelo zangaphambili kwizihloko ezifanayo.24,25 Esi sikhokelo sikhombisa ukuqala kwexesha (iinyanga ze-0-3) kwaye ziqhubeka ( Iinyanga ze-N3) ii-NAD kunye ne-WADs kwibakala I ukuya ku-III. Awufihla ulawulo lweentlungu ze-musculoskeletal thoracic okanye ubuhlungu bendonga yesifuba.

 

Iziphumo eziphambili ezichazwe kwizifundo ezikhethiweyo zibuhlungu bentamo nokukhubazeka. Nangona zonke iziphakamiso ezibandakanyiweyo kule khokelo zisekelwe kwingcipheko ephantsi ye-RCTs, i-quality yebakala ngokubanzi ibonisa ukungabikho ngqalelo kwezinye izinto eziqwalaselwa yiBakala njengemigqaliselo, kwaye ngoko amandla okuncoma athathaka okwangoku. Ukuphuculwa kwamandla okuncinci kuthetha ukuba oogqirha kufuneka bazinike ixesha elithile kwinkqubo yokwenza izigqibo ezibiweyo kunye nokuqinisekisa ukuba ukhetho oluchanekileyo lubonisa iimpawu zesigulane kunye nezinto ezikhethwayo.Izimpembelelo ze-56 ezingachazwanga kwesi sikhombiso akunakukhuthazwa ukuphathwa kwezigulane ezineNAD okanye iWAD ngenxa yokungabikho kobu bungqina malunga nokusebenza kwazo kunye nokhuseleko (Itheyibhile 16).

 

Uhlolo olusandul 'ukuhlaziywa kwenkqubo kunye nokuhlaziywa kwemeta nge-Wiangkham (2015) i-101 ekusebenzeni kolawulo oluxhasayo kwinqanaba le-WAD eliqhelekileyo II liquka ii-RCT ze-15, zonke zivavanywa njengengozi ephezulu ye-bias (n = abathathi-nxaxheba be-1676), kumazwe akwa-9. Ababhali baphetha ukuba iingenelo ezixhasayo (unyango olungenanto), kubandakanywa nezenzo zokubambisana, iindlela zobuqili, izixhobo zenyama, iindlela zokuziphatha, kunye nezemfundo, zisebenza ngokukhawuleza kwi-WAD yesiGaba sesi-II ukunciphisa intlungu phakathi kunye nexesha elide kunye nokuphucula iROM yesibeleko ngexesha elifutshane lifaniswa ne-standard or control intervention.101 Nangona ukufunyaniswa kwiphepha le-Wiangkham ngokuqhelekileyo kuhambelana nalabo bavela kwiinkcazo ezichanekileyo esizifakelwe kwesi sikhokelo, i-24,25 ukuxhamla ingozi enkulu kunye nezilingo ezinobunzima bezilwanyana ezisemgangathweni zijongene nobunzima bokubungqina kwesi sigqibo esandula kutshanje.

 

Ukufana kunye nokungafani kunye neengcebiso nge-OPTIMa Cooperation

 

Okokuqala, izindululo zokulawulwa kokonzakala okuncinci entanyeni zisanda kukhutshwa liSebe lezeMali lase-Ontario ngokusebenzisana ne-OPTIMa Ukusebenzisana 20 kwaye lapapashwa njengesikhokelo esahlukileyo. Baqwalasele umngcipheko wokhetho lokubandakanya ii-RCTs zisebenzisa i-SIGN criteria27 kunye nezikhokelo zezikhokelo eziphuhlisiweyo kusetyenziswa isakhelo se-OHTAC esiguquliweyo, i-45 esekwe kwizigqibo ze-28 izigqibo3: Inzuzo yeklinikhi iyonke (ubungqina bokusebenza kunye nokhuseleko) 1; ixabiso lemali (ubungqina bokusebenza ngempumelelo apho bukhoyo); kunye2 nohambelwano kunye neenqobo ezilindelekileyo zentlalo kunye neenqobo ezisemgangathweni. Kwisikhokelo sangoku, sisebenzise indlela ye-GRADE, ethi, ukongeza ekuqwalaseleni umngcipheko wokhetho lwe-RCTs ezibandakanyiweyo, ithathela ingqalelo ezinye izinto ze-3 (ukungachaneki, ukungangqinelani, ukungangqalanga, ukupapashwa kokukhetha) ukukala ukuzithemba kuqikelelo lwempembelelo (umgangatho ubungqina) kwisiphumo ngasinye.4 Ngenxa yokungaqwalaselwa koqikelelo kwii-RCTs ezininzi, umgangatho opheleleyo wezifundo ezamkelekileyo uthathwa njengephantsi. GRADE ithathela ingqalelo izigqibo ezifanayo njenge-OHTAC eguqulweyo yokuphuhlisa iingcebiso xa emva koko isenza ukureyitha kokuzithemba kwiziphumo zoqikelelo kuzo zonke iziphumo ngokusekwe kwiziphumo ezithathwa njengezibalulekileyo kwisindululo esithile.102 Ngokufanelekileyo, iphaneli yesikhokelo yacelwa ukuba thatha ingqalelo obu mgangatho uphantsi wobungqina xa ugweba iziphumo 'ezinqwenelekayo'. Xa izibonelelo zeziphumo ezibalulekileyo zigqithisile kuneziphumo ezingathandekiyo zongenelelo, kwenziwa isindululo esibuthathaka (okt, iingcebiso zokhathalelo). Oku kunokwenzeka ukuba kubandakanya ukuqinisekisa ukuba abaguli bayaziqonda iimpembelelo zokhetho abalwenzayo, mhlawumbi besebenzisa uncedo olusemthethweni lokuthatha izigqibo.56 Nangona kunjalo, ukuba isigwebo sasilungelelene okanye sasingaqinisekanga, akukho siphakamiso sinokwenziwa.

 

Okwesibini, i-OPTIMa i-20 icetyise ukuba ukungenelela kufuneka kuhanjiswe kuphela ngokungqinelana nobungqina obupapashiweyo bokusebenza, kubandakanywa iipameter of dosage, ubude, kunye nexesha elifanelekileyo. Ukugxininiswa kwinqanaba lokuqala (iinyanga ze-0-3) kufuneka kube semfundo, iingcebiso, ukuqinisekiswa, umsebenzi kunye nokukhuthaza. Abaqeqeshi bezempilo kufuneka bakhuthazwe ukuba baqwalasele ukulinda okulindileyo kunye nokubeka iliso njengekliniki njengokhetho olusekelwe kwindlela yokwelapha. Kubantu abalimele abafuna unyango, ukungenelela ixesha kunye nokungenelela kwamanyathelo kufuneka kusetyenziswe isisombululo esifanelekileyo, indlela esebenza ngokufanayo kwizigulane kwisigaba esiqhubekayo (iinyanga ze-4-6). Nangona usebenzisa iindlela ezahlukileyo ukufumana iingcebiso, iikhompyutha ze-2 zikhokelela ngokukhokelo olufanayo.

 

Okwesithathu, i-OPTIMa20 ixele ukuba ungenelelo olulandelayo alukhuthazwanga ukuqala kwangoko kwe-NAD: imfundo yesigulana eyenziweyo iyodwa (nokuba kungomlomo okanye kubhaliwe); i-strain-counterstrain okanye i-massage yokuphumla; ikhola yomlomo wesibeleko; i-electroacupuncture (ukukhuthaza umbane ngamanqaku okucoca kunye neenaliti zokutshiza okanye i-electrotherapy esetyenziswe kwesikhumba), isihloko esingagqitywanga kwisikhokelo sethu; ukukhuthaza izihlunu zombane; ubushushu (basekliniki). Kwangokunjalo i-NAD ephikisayo, iinkqubo ezizodwa zeklinikhi ezijongwa kwimithambo yokuqinisa idosi ephezulu, uxinizelelo-strain okanye uthambiso lokuphumla, unyango lokuphucula iintlungu okanye iziphumo zokukhubazeka, ukukhuthazeka kwemithambo yombane yokuhambisa umbane (TENS), ukukhuthaza izihlunu zombane, ukuhambisa umthambo omfutshane, ukufudumeza (useklinikhi), ukusebenza kwe-electroacupuncture kunye ne-botulinum tox. Ngokwahlukileyo, ngokusekwe kwi-RCT nguZebis et al.91 isikhokelo sangoku sicebisa ukunikezela ngononophelo lwe-multimodal kunye / okanye imfundo yesigulana kubasebenzi beshishini ababonisa ngentlungu yamanqanaba entamo I kuye ku-III. Nangona imfundo yesigulana esetyenzisiweyo isetyenziswe yodwa ayinakulindeleka ukuba ivelise izibonelelo ezinkulu kwizigulana ezinentlungu yentamo, esi sicwangciso sinokuba luncedo ngexesha lokufumana kwakhona abaguli abane-WAD eqhubekayo xa isetyenziswa njengonyango olongezelelekileyo. ). Kufuneka kuqatshelwe, nangona kunjalo, ukuba uphononongo oludlulileyo alukwazanga ukwenza naziphi na izigqibo ezichanekileyo malunga nokusebenza kwe-TENS njengonyango olwahlukileyo lwentlungu ebuhlungu ye-40 okanye yentlungu engapheliyo ye-80 kubantu abadala, nangokuphumelela kwonyango lobushushu.103

 

Ukuthelekiswa kweziphakamiso nge-2 izikhokelo ze-chiropractic zangaphambilini i-24,25 ibonisa ukuba indlela yokwenza i-multimodal equka unyango olusesikweni, isiluleko kunye nokuzilolonga kusekho isicwangciso esicetywayo sokukhetha unyango lwentamo. Nangona kunjalo, iindlela zonyango ezibandakanyiweyo kwiinkathalelo zentlupheko ephakanyisiweyo zihluke ngokubhekiselele kumgangatho wobungqina obukhoyo ngexesha. Isikhokelo se-2010 ngokulawulwa kweengcebiso zonyango eziphunyeziweyo ze-WAD ezisekelwe kubungqina obuncinci obuvela kwi-8 efumanekayo kwi-RCT kunye no-3 ophando lwezifundo. I-25 Ngokubanzi, iingcebiso ze-WAD zangoku kwaye ziqhubekayo zinjalo (ukunakekelwa kwamaninzi, kunye nokunyamekela nokusetyenziswa ngononophelo, ngokulandelana) . Isikhokelo se-2014 kwintlungu ye-neck24 yenze iingcebiso zonyango ze-11 ezivela kwi-41 RCTs. Isikhokelo samanje siphuhlisa iziphakamiso ze-13 ezivela kwi-26 engciphekweni ephantsi ye-RCTs. Ngokuhambelana ne-2014 isikhokelo24 malunga nentlungu yesantya esandula, ukuhlaziywa kwangoku kukhombisa ukubonelela ngononophelo lwentlalo ebandakanya ukunxibelelana, iingcebiso kunye nokuzivocavoca. Iingcebiso ezikhoyo ngoku zibonisa ukuba kunikezelwa ukuqiniswa kokuqulunqwa kwamacandelo kunye nokuzinzileyo. Ngokufanayo nesikhokelo se-2014 ngokubandezeleka kwentlungu (i-I-II), ii-24 ezi ngcebiso zikhoyo zibonisa ukuba kunika inkxaso eninzi ebonisa ulwaphulo olusesikweni (unyango olusisigxina okanye unyango) kunye nokuzilolonga. Iinkcukacha malunga nemimiselo ethile yokuqhutywa kwemisebenzi zinikezelwe ngoku, kuquka neengcebiso zokuhlolwa okungalawulwayo kunye nokungabonakali, ukuqeqeshwa ngamandla, kunye nokuqeqeshwa kwamagqabantshi aphantsi, njengenkqubo yokusetyenziswa kwendawo kunye ne yoga ejongene nayo.

 

Iziganeko ezimbi

 

Esi sikhokelo asikhange siqwalasele ngokuthe ngqo ubungqina kwiziganeko ezibi kunyango. Nangona kunjalo, ekuhlaziyweni nguWong et al. 42 kunyango olusetyenziswayo kunye neendlela zokuziphatha, i-22 yengozi ephantsi ye-RCTs ye-bias ijongene nomngcipheko wokulimala ngononophelo. Uninzi lweziganeko ezibi bezimnene ukuya kumodareyitha kwaye zihamba okwexeshana (ubukhulu becala ukwanda kokuqina kunye neentlungu kwindawo yonyango, ngenqanaba elimalunga ne-30%). Akukho ziganeko zichaphazelekayo ze-neurovascular ezichaphazelekayo. Olunye uphononongo lwee-RCTs ezipapashiweyo kunye nezifundo eziza kubakho zeqela liqinisekisile ukuba malunga nesiqingatha sabantu abaphathwe ngonyango olusebenzayo banokulindela ukuba zincinci ukumodareyitha izehlo ezimbi emva konyango, kodwa umngcipheko weziganeko ezimbi ezincinane zincinci.107 Ukuhlanganiswa kwedatha kwii-RCTs zonyango kwimeko yezehlo ezichaseneyo ibonakalise ukuba umngcipheko osondeleyo wezinto ezincinci okanye eziphakathi ezigwenxa ziyafana kunyango olusebenzayo kunye nokunyanga unyango, kunye nongenelelo lwe-sham / passive / control.

 

Umbono opheleleyo wokugulana nesigulane kunye nokubambisana kweemfuno zesigulane ngentlungu kunye nokukhubazeka kukhuthazwa. I-108,109 Nangona abaphathi bezonyango abangekho uxanduva lolawulo lwe-pharmacologic, kufuneka babe nolwazi olwaneleyo malunga nama-pharmacologic agents kunye neziganeko ezimbi. Omnye u-RCT22 ovumelekileyo ufumene ukuqeqeshwa kwekhaya kunye neengcebiso zokuba ziphumelele njengamachiza (acetaminophen, i-NSAID, i-muscle relaxant, kunye ne-opioid analgesic) ekunciphiseni ubuhlungu nokukhubazeka ngexesha elifutshane kwizigulane ezinezigulane ezibuhlungu okanye zentlungu. Nangona kunjalo, amayeza ahlanganiswe nomngcipheko ophezulu kwiziganeko ezimbi. Inomdla, ubungqina bwakutshanje bubonisa ukuba i-acetaminophen ayinakulungele ukulawula intlungu ephantsi, i-110,111 kunye nokuphumelela kwexesha elide lokwelashwa kwe-opioid ekuphuculeni ubuhlungu obungapheliyo nomsebenzi akuqinisekanga.64 Nangona kunjalo, umngcipheko oxhomekeke kumthamo wezonyango ezinzima uhambelana Ukusetyenziswa kwexesha elide le-opioid (ingozi eyongeziweyo yokugqithisa ngokwexesha, ukusetyenziswa kakubi kwe-opioid kunye nokuxhomekeka, ukuphulwa komzimba, ukuchithwa kwe-myocardial, kunye nokusetyenziswa kwamachiza ukuphathwa kakubi ngokwesondo) .64 Ingozi yokulimala ngokwe-opioid ngokungalindelekanga ibonakala ibaluleke kakhulu kwiiveki zokuqala ze-2 emva ukuqaliswa kwee-agent agents.112,113

 

izindululo

 

I. Abachaphazelekayo

 

Ukukhetha uMboneleli weMpilo. Uluhlu lweenkonzo zononophelo zonyango (ii-chiropractors, oogqirha bezonyango jikelele, ii-physiotherapies, i-massage therapists kunye ne-osteopaths) ukubonelela ngononophelo lwe-NAD kunye ne-WADs.108,114 Ukuqwalasela izinga lezakhono ezifunekayo ukuhambisa unyango olusesikweni, lwezonyango (umz., umyalelo wendlela yokuzilolonga ethile) kunye nesekelwe kwintetho yesigulane ngasinye, ukunyanzeliswa komgudu wesibeleko njengengxenye yokunakekelwa kwemimandla kufuneka ihanjiswe ngabaqeqeshi abaneemvume eziqeqeshwe ngokufanelekileyo. 115

 

II. Abasebenzi

 

Iindlela eziPhambili zokuSebenza ngeeNkxaso-Uvavanyo lokuQala nokuQapha.

 

Esi sikhokelo sijongana ngqo nonyango lwe-NAD kunye ne-WAD kumabanga 5 ukuya ku-III. Ngokubalulekileyo, iphaneli yethu ixhasa ezi zilandelayo 27 zinconywayo zokunyanga kwizigulana ezichazwe kwisikhokelo se-OPTIMa1: Iiklinikhi kufuneka2 zilawule imeko enkulu yolwakhiwo okanye ezinye iimeko zesifo njengeyona nto ibangela iintlungu zentamo- ezinxulumene nokuphazamiseka ngaphambi kokuhlelwa njengebakala I, II, okanye III3 ; ukuvavanya iimeko zokuxela ukulibaziseka ukubuyisela4; ukufundisa kunye nokuqinisekisa abaguli malunga nokuziphatha okuhle nokuzimelela kwenkqubo yesiqhelo yamabanga e-NAD I ukuya ku-III kunye nokubaluleka kokugcina ukusebenza kunye nokunyakaza5; thumela izigulana ezineempawu eziya zisiba mbi kunye nabo bakhulisa iimpawu zomzimba nezengqondo zokuphonononga ngakumbi nangaliphi na ixesha xa bekhathalelwe; kwaye116 siphinde sivavanye isigulana kutyelelo ngalunye ukufumanisa ukuba ngaba ukhathalelo olongezelelweyo luyimfuneko na, imeko iya isiba mandundu, okanye isigulana siphilile. Izigulana ezinika ingxelo yokufumana kwakhona okubalulekileyo kufuneka zikhutshwe. Iingcebiso ezifanayo zaye zayilwa yiNeck Pain Task Force24,25 nakwizikhokelo zeengcali zangaphambili kulawulo lweWAD kunye neNAD ngoochwephesha.XNUMX

 

Iinzuzo zoMsebenzi wePhysical and Self-management. Ukufundisa izigulane malunga neenzuzo zokwenza umzimba kunye nokuthatha inxaxheba ekunyamekeleni kuye kwaba ngumgangatho wokunyamekela kumazwe ngamazwe. Naphezu kwezibonelelo zokwenza umthambo wokunyamezela intlungu engapheliyo kunye nobubungqina obuqinileyo obuthandayo ukwenza umsebenzi oqhelekileyo wokunciphisa ukuxhatshazwa okunxulumene noko, ababoneleli abanonophelo abahluleli ukubeka njalo kwizigulane.117-120 Xa imiselweyo, inani lolawulo kunye neentlobo zokuzilolonga landela izikhokelo zenkqubo kwaye azixhunyiwe kwizinga lokukhubazeka kwesigulane. 118,121

 

Ukukhuthazwa kwemisebenzi yomzimba, kubandakanywa nokuzilolonga, yinkqubo yokuqala yonyango ebonwa ibalulekileyo ekukhuselweni nasekunyangeni intlungu ye-musculoskelet kunye neengxaki ezihambelana nayo (umzekelo, isifo senhliziyo yesifo se-coronary, uhlobo lwe-2 yesifo sikashukela, nokudakumba) .123-126 Kwabancinci zezigulane ezineentlungu ezingapheliyo, ulungiso lwezonyango kunye neyeza zonyango zifanelekileyo; kwaye kwiimeko ezimbalwa, ulawulo lweentlungu ezininzi okanye utyando lungabonakaliswa. 118

 

Abantu abaneentlungu zesisu baya kuhlala bengasebenzi. Ngelishwa, ukungasebenzi komzimba kunxulunyaniswa nemiphumo emibi yezempilo, kubandakanya ukwanda kwengozi yesifo sentliziyo, uhlobo lweswekile sesibini, kunye nomhlaza webele kunye nekholon, kunye nexesha lokuphila elifutshane ngokubanzi.2 Umbutho wezeMpilo weHlabathi127 ubonelele ngesikhokelo esicacileyo kwimisebenzi yempilo yezempilo. abantwana, abantu abadala, kunye nabadala. Ukongeza, uphando lwakutsha nje lubonisa ukuba abaguli be-WAD abanamanqanaba aphezulu okunyanzelwa kokuziphatha izicwangciso zineentlungu ezihamba kancinci kunye nokubuyiselwa kokukhubazeka.128 Izicwangciso zokuxhasa ukuzilawula (i-SMS) ezijolise ekwandiseni imisebenzi yomzimba kunye neendlela zokulwa ezisebenzayo zibalulekile ekulawuleni ngokufanelekileyo iintlungu zomqolo kunye comorbidities ezinxulumene. 129-124,125,130 I-CCGI iphuhlise inguqulelo yolwazi esekwe kwithiyori (KT) yokungenelela ekujoliseni izithintelo ekutshintsheni indlela yokuziphatha yobungcali ukunyusa ukufunyanwa kwezicwangciso zeSMS phakathi kwezonyango zaseCanada.134 Udliwanondlebe lweeklinikhi ezichonge imimandla ye-135 yeengcingane njengoko kufanelekile (okt, izinto eziqwalaselweyo Ukuchaphazela ukusetyenziswa kononophelo lweemodemodal ukulawula iintlungu ezingathethekiyo zentamo) .9 Ungenelelo, olubandakanya i-webinar kunye nemodyuli yokufunda kwi-Brief Action Planning, sisicwangciso esiliqili esime kakuhle seSMS esivumela iinjongo ezijolise kwizigulana135 kwaye kuvavanywa ukulingwa phakathi kweCanada Iingcali zonyango (uvavanyo oluqhubekayo lomqhubi) .136 Ababoneleli ngononophelo bayakhuthazwa ukuba benze uphononongo lweklinikhi ngamaxesha athile kunye nokujonga ukuqhubela phambili kwesigulana kwezicwangciso zokuzilawula ngelixa betyhafisa ukuxhomekeka kunyango olungenamsebenzi.

 

 

 

 

III. Uphando

 

Ngokubanzi, umgangatho wophando ngokulawulwa ngokuzimeleyo kwama-NAD kunye nee-WAD zihlala ziphantsi, ngokucacileyo zichaza ukuba iingcebiso ezibuthakathaka kuphela eziza kwenziwa kwiinkqubo zonyango. Ukongezelela, ukubika kweeRCT kuqhubeka. Iziphakamiso ze-138 zangaphambili zokuphucula umgangatho wophando zisasebenza. Uphando lwe24,25 oluzayo lufanele lujolise ekucaciseni indima yokunyanga kwemilenze yonyango yedwa okanye njengenxalenye yokunakekelwa kwemimandla yokulawulwa kwentlungu yentsimi yakutsha kwaye ibe nexesha elaneleyo lokulandelelana . Ngokomzekelo, inani elikhulu lokuvakatyezela isigulane kwiinkonzo eziphuthumayo unyaka ngamnye ngenxa yentlungu kunye nentlungu yesandla esiphumela kwi-WADs.14,139 I-RCT encinci ibonelele ukuba ukunyanzeliswa kwemisipha yentsholongwane yinto engafanelekanga kwi-NSAID ye-intramuscular for relief relief in these patients. I-63 Nangona kunjalo, isayizi encinane yesampula, ukuthelekisa iseshoni enye yokunyanzeliswa komgogodla kwi-injection ye-NSAID, kwaye ukulandelelwa kwe-1-suku kwakungekho ummeli wezonyango.

 

Zizinto ezimbalwa ezenziwa ngokutsha ngokutsha ngokucetyiswa uphando lwekhwalithi ye-chiropractic ye-NADs. Ukongezelela, uphononongo olubandakanyiweyo kwiingxelo aluqikelelanga iinjongo eziphezulu zonyango (oko kukuthi, i-dosage efanelekileyo kunyango phantsi kovavanyo). Izilingo zeekliniki ezilungiselelwe kakuhle kunye nenani elaneleyo labathathi-nxaxheba, unyango lwexesha elide, kunye nexesha lokulandelelana lifunekayo ukwandisa ukuzithemba kwiingcebiso kunye nokuqhubela phambili ukuqonda kwethu ngokunyamekela nokunyanzelisa ukunyamekela, Ukulawulwa kwezigulane ezine-NAD kunye nee-WAD.

 

Ukusasazwa kunye neSicwangciso sokuSebenza. Iingqinisiso ezisekelwe kwiingqinisiso zijolise ekuphuculeni ukwenziwa kwezigqibo zeklinikhi kunye nokunakekelwa kwezigulane.140,141 Xa ilandelwa, i-CPG ziyakwazi ukuphucula iziphumo zempilo kunye nokusebenza kwenkqubo yokunakekelwa kwempilo.142-144 Nangona kunjalo, ukunyanzeliswa okuphantsi kwe-CPG kuye kwaqatshelwa kwiinkonzo zempilo amacandelo145 kunye nokulawulwa kweemeko ze-musculoskeal, kubandakanywa i-NAD kunye ne-WADs.77,101,102 Ezi zikhethi zifaka isandla kwiintlobo ezahlukeneyo zendawo ekusebenziseni kunye nomgangatho weenkonzo zonyango. 146

 

Imizamo yokuvala i- search-practice gap ikhokelele kumdla okhulayo kwi-KT.145,147 Inguqulelo yolwazi ichazwa njengotshintshiselwano, ukuhlanganiswa, kunye nokusetyenziswa ngokufanelekileyo kolwazi ukuphucula impilo kunye nokubonelela ngeenkonzo ezifanelekileyo zempilo. Uguqulelo lolwazi lwe-148 lujolise ekuvaleni umsantsa wokuziqhelanisa nophando kunye nokuphucula iziphumo zesigulana ngokukhuthaza ukudityaniswa kunye notshintshiselwano lophando kunye nolwazi olusekwe kubungqina kunyango.

 

Ukulungiselela ukumiliselwa kwesikhokelo, siqwalasele uLuhlu lokuKhangela lokuPhunyezwa koCwangciso lokuKhangela 149 kunye nezicwangciso ezifumanekayo kunye nobungqina obuxhasayo141,150 ukonyusa ukuthathwa kwesikhokelo. Nangona iziphumo zongenelelo lwe-KT zihlala zithambile, zinokubaluleka kwinqanaba lempilo yabemi.37

 

Ukuphakamisa ulwazi, imibutho yobuchwephesha be-chiropractic iyakhuthazwa ukuba yazise amalungu ayo ngezikhokelo ezintsha zeCCGI kunye nezixhobo ezifikeleleka ngokulula kwiwebhusayithi yethu (www. chiroguidelines.org). Isikhokelo sokuphunyezwa kwezixhobo zokusebenza sisetyenziselwe ukucacisa iinjongo zezixhobo; chonga abasebenzisi bokugqibela kunye nomxholo kunye nokuseta apho izixhobo ziya kusetyenziswa; ukunika imiyalelo yokusetyenziswa; kunye nokuchaza iindlela zokuphuhlisa izixhobo kunye nobungqina obunxulumeneyo kunye nokuvavanya izixhobo.151 Izixhobo zokuphumeza ezenzelwe ukunyusa ukuthathwa kwesikhokelo zibandakanya iingcali kunye nezigulane� izinikezelo (umzobo 8, iSihlomelo 7); i-algorithms (iFig. 6 kunye ne-7), ii-webinars, iividiyo, kunye neemodyuli zokufunda (www.cmcc. ca / CE); izintlu zokukhangela; kunye nezikhumbuzo zobume bempilo.152-154 I-CCGI iseke uthungelwano lweenkokheli zoluvo kulo lonke elaseCanada (www.chiroguidelines.org). Ngokusekwe kwimizamo eyimpumelelo yokuphumeza isikhokelo se-WAD e-Australia kusetyenziswa iinkokheli zoluvo phakathi kwe-physiotherapists ezilawulwayo, i-chiropractors, kunye ne-osteopaths, i-155 i-CCGI icwangcisa uthotho lwezifundo zokuphumeza phakathi kwe-chiropractors zaseCanada.137 Siza kuphinda sivavanye ngaphakathi kwinethiwekhi yophando olusekwe kubuchwephesha. 156 Isikhokelo sokubeka esweni ukusetyenziswa kwe-chiropractic kulucelomngeni kuba ukusetyenziswa kweerekhodi zezempilo ze-elektroniki ukuqokelela rhoqo ulwazi lweklinikhi akuqhelekanga eCanada kwaye abo basebenzisa iirekhodi zempilo ze-elektroniki bahlala beqokelela izikhombisi ezahlukeneyo. 157 Nangona kunjalo, ukuphindaphindwa kokukhutshelwa (ukuthumela isikhokelo sokufikelela esivulekileyo kwiwebhusayithi yeCCGI) kunye nenani labathathi-nxaxheba ababhalisiweyo kunye nokugqitywa kwemathiriyeli yokufunda e-intanethi (iwebhsayithi, ividiyo, kunye nemodyuli yokufunda) ziya kubekwa esweni inyanga nenyanga njengenyathelo lommeli lokuthathwa kwesikhokelo.

 

Isikhokelo sokuHlaziya

 

Iindlela zokuhlaziya izikhokelo ziya kuba ngolu hlobo: 1) Ukutshintshwa kwenguqu kubungqina, ukungenelela okukhoyo, ukubaluleka kunye nokuxabisa kweziphumo, izibonelelo ezikhoyo okanye ukufaneleka kweengcebiso kwiiklinikhi (uphendlo olunonxibelelwano lwencwadi unyaka ngamnye kwi-3-5 iminyaka kunye novavanyo kwiingcali kwintsimi ngonyaka): 2) ukuvavanya imfuneko yokuhlaziya (ukufaneleka kobungqina obutsha okanye ezinye iinguqu, uhlobo kunye nobubanzi bokuhlaziywa); kunye ne-3) ukuxubusha inkqubo, izixhobo kunye nexesha eliya kwiKomidi eliPhakamisayo leCandelo leCCGI, oza kufaka isiluleko kwiKomidi eliLawulayo i-Guideline ukwenza isigqibo sokuhlaziya nokucwangcisa inkqubo.158-163

 

Amandla kunye nokulinganiselwa

 

Ukungaphumeleli kwesi sikhokelo kubandakanya ubungakanani obuphantsi kunye nomgangatho wobungqina obuxhasayo obufunyenweyo ngexesha lophando. Uninzi lwentlupheko yobungqina obuxhasa iziphumo ngenxa yokungahambi kakuhle. Ukongezelela, uphando olutsha olutshanje lweengxelo ezipapashwe ziquka i-2 yolwazi (i-Medline neCockrane Central Register yezilingo ezilawulwayo) kodwa yayinganyelwe kwiiNgxelo ezipapashwe ngeNgesi, ezinokuthi zingabandakanyi izifundo ezithile. Oku kunjalo, umthombo ongenakwenzeka wokuxhamla.Izifundo ze-164,165 ezihlolisayo amava awayephila kuzo azibandakanyi. Ngaloo ndlela, oku kuhlaziywa akunakukwazi ukuvakalisa indlela abagulane abaxabisekileyo ngayo kunye nokuvavanywa kwabo kwiinkqubo zonyango okanye iindlela eziphathekayo. Nangona ukwakhiwa kweplanethi yezikhokelo kwakuhluke, kunye neendlela zezobuchwepheshe, iikliniki zeengcali, kunye nabachaphazelekayo kunye nabamele isigulane, ilungu le-1 kuphela livela kwelinye i-health-disciplinary discipline (physiotherapist). Ububanzi beli khokelo lugxile kwiziphumo ezikhethiweyo ezifana nentlungu kunye nokukhubazeka, nangona uphando lubandakanyiweyo uphonononge iziphumo ezininzi ezongezelelweyo.

 

isiphelo

 

Le CPG iphakamisa isiqalo sokuqala (2005) kunye nokuhlaziywa kwentlungu yesikhokelo seentamo kunye ne-2014 ehambelana nezikhokelo ze-whiplash eziveliswa yiCanada Chiropractic Association (CCA); I-Canadian Federation ye-Chiropractic Regulatory and Education Accrediting Boards (CFCREAB).

 

Abantu bafanele bathathe unonophelo ngokusekelwe kwiinketho zokwelapha ezisisiseko. Ngokusekelwe kwizikhetho ezikhethwe zizigulane kunye nezibonelelo ezikhoyo, indlela edibeneyo ye-multimodal yokubandakanya ulwaphulo olusetyenziswayo kunye neengcebiso malunga nokulawulwa kwezinto zokuzilawula kunye nokuzilolonga (ukuphathwa ngeso / ukungahlawulwanga okanye ekhaya) ingaba isicwangciso sonyango esiphumelelayo sokuqala nokuqhubekayo kweNAD kunye namanqanaba e-WAD ku III. Inkqubela kufuneka ihlolwe rhoqo ngenxa yobungqina benkxaso, ngokukodwa kwisiseko sokunciphisa intlungu kunye nokunciphisa ukukhubazeka.

 

Imithombo Yenkxaso kunye Neengxabano Zomdla

 

Iimali ezibonelelwe yiCanada yaseCanada. Iimbono zeziko lezezimali azizange zithinte umxholo wesikhokelo. Akukho zintlukwano zomdla ezichazwe kulolu cwaningo.

 

Isikhokelo sokuKhutshwa kweNkcazo

 

Izikhokelo ezisekwe kubungqina ezipapashwe yiCCGI zibandakanya izindululo ezijolise ekwandiseni ukhathalelo lwezigulana oluye lwaziswa ngoqwalaselo olucwangcisiweyo lobungqina kunye novavanyo lwezibonelelo kunye nokwenzakala kwezinye iindlela zokhathalelo. 21 Izikhokelo zenzelwe ukwazisa izigqibo zeklinikhi. ayimiselwanga kwindalo, kwaye musa ukuthatha indawo kukhathalelo lobuchwephesha okanye iingcebiso, ezihlala zifunwa kuyo nayiphi na imeko. Ngapha koko, izikhokelo azinakugqitywa okanye zichaneke kuba izifundo ezitsha ezipapashwe kade kwinkqubo yokuphuhliswa kwesikhokelo okanye emva kokupapashwa azifakwanga nakwesiphi isikhokelo ngaphambi kokuba sisasazwe. I-CCGI kunye namalungu eqela elisebenzayo, ikomiti elawulayo, kunye nabachaphazelekayo (i- CCGI Parties ) bayaluchaza lonke uxanduva ngokuchaneka okanye ukugqibelela kwesikhokelo, kwaye babhengeza onke amawaranti, abonakalisiweyo okanye acacisiweyo. Abasebenzisi besikhokelo bayacelwa ukuba bafune ulwazi olutsha olunokuthi lube nefuthe kwizifo kunye / okanye kwizindululo zonyango eziqulathwe sisikhokelo. Amaqela eCCGI ayaqhubeka nokulahla lonke uxanduva lwayo nayiphi na into eyenzakalisayo (kubandakanya, ngaphandle komda, ngqo, ngokungathanga ngqo, ngesohlwayo, okanye isohlwayo esenzekileyo) ezivela ekusetyenzisweni, ukungakwazi ukusebenzisa, okanye iziphumo zokusetyenziswa kwesikhokelo, nasiphi na isikhombisi isetyenziswe kwisikhokelo, okanye kwimathiriyeli, kulwazi, okanye kwiinkqubo eziqulathwe sisikhokelo, ngokusekwe kuyo nayiphi na ithiyori yezomthetho nokuba yeyiphi na okanye akukho ngcebiso malunga nokuba kungenzeka loo monakalo.

 

Ngokuphononongwa ngoluhlu olunzulu nolusisigxina, ii-CPGI ezisekelwe kubufakazi be-CPG zifaka idatha kwiincwadi ezihlaziywe ziontanga. Olu lwazi luhlangabezana neempendulo ezibandakanyiweyo zokubandakanya umbuzo wophando lweklinikhi, i-CCGI ekuqwalaseleni, ngexesha lokupapashwa, ukuba kubekho ubungqina obungcono obufumanekayo ngenjongo yolwazi jikelele. Olu bungqina lubugqithisi obuhlukileyo ukusuka kwizifundo zokuqala zendlela eyahlukileyo. I-CCGI incomela ukuba amanyathelo omsebenzi wokuphucula umgangatho, ukubuyisela okusekelwe ekusebenzeni, kunye neenjongo zokunika ingxelo yoluntu kufuneka kusekelwe kwiziphakamiso eziqulunqwe ngokukhawuleza.

 

Ulwazi loNcedo

 

Ncbi.nlm.nih.gov/pubmed/27836071

 

Izicelo eziSebenzayo

 

• Indlela yokwenza i-multimodal kuquka uphando olusesikweni, iingcebiso zolawulo lokuzilawula, kunye nokuzilolonga kungenza isicwangciso sonyango esiphumelelayo sokubandezeleka kwentsholongwane kunye nokuqhubekayo kwintlungu kunye neengxaki ze-whiplash.

 

Imibulelo

 

Siyabulela aba bantu balandelayo ngegalelo labo kweli phepha: UGqr John Riva, DC, umboniseli; UHeather Owens, uMququzeleli woPhando, ukujonga iimpazamo; UCameron McAlpine (UMlawuli wezoNxibelelwano noThengiso, uMbutho wase-Ontario Chiro), ngoncedo lokuvelisa uxwebhu lwamaqabane olujolise kwizigulana ezine-NAD; amalungu ephaneli yesikhokelo abasebenza kwiphaneli yemvumelwano yaseDelphi, abenze ukuba le projekthi inokwenzeka ngokunikela ngobuchule babo kunye nesigwebo seklinikhi.

 

IziHlomelo kunye nezinye iiNkcukacha

 

Ncbi.nlm.nih.gov/pubmed/27836071

 

Ukuqukumbela, ukuphazamiseka okunxulumene ne-whiplash kunokubangela ukonakala kwizakhiwo ezintsonkothileyo zomqolo womlomo wesibeleko, okanye intamo, kuba amandla amakhulu eempembelelo anokwandisa izicubu ezithambileyo ngaphaya kohambo lwendalo. Uninzi lwabaqeqeshi bezempilo banokuphatha ngokukhuselekileyo nangempumelelo i-whiplash kunye nokunye ukulimala kwengozi yemoto. Iziphumo zenqaku elingentla zibonisa ukuba indlela ye-multimodal, kubandakanya unyango olululo, iingcebiso zokuzilawula kunye nokuzilolonga inokuba sisicwangciso esifanelekileyo sonyango kuzo zombini ukuqala kwangoko kunye nentlungu eqhubekayo yentamo ebangelwa kukuphazamiseka okunxulumene ne-whiplash. Iziko loLwazi lweBiotechnology (NCBI). Ubungakanani bolwazi lwethu lukhawulelwe kwi-chiropractic kunye nokulimala komqolo kunye neemeko. Ukuxoxa ngesihloko, nceda ukhululeke ukubuza uGqirha Jimenez okanye unxibelelane nathi ku 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.

 

ISIQENDU ESIBALULEKILEYO ESIBALULEKILEYO: Unyango lweNhlungu zobuhlungu kwi-El Paso, TX

 

 

IINKCUKACHA EZINYE: I-EXTRA EXTRA: El Paso, Tx | Abadlali