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Uvavanyo oluLungeleleneyo oluLungisiweyo

Iklinikhi yangasemva eLawulwayo ngokuLawulwa ngokuKhethekileyo kweChiropractic kunye neQela leMithi eliSebenzayo. Uphononongo apho abathathi-nxaxheba bahlulwe ngamathuba ngamaqela ahlukeneyo athelekisa unyango oluhlukeneyo okanye ezinye iindlela zokungenelela. Ukusebenzisa ithuba lokwahlula abantu ngokwamaqela kuthetha ukuba amaqela aya kufana kwaye iziphumo zonyango abalufumanayo zinokuthelekiswa ngokufanelekileyo.

Ngexesha lolingo, akwaziwa ukuba loluphi unyango olungcono. A Uvavanyo oluLungeleleneyo oluLungisiweyo okanye (RCT) ukuyila ngokuzenzekelayo ukwabela inxaxheba kwiqela lokulinga okanye iqela lokulawula. Njengoko kuqhutyelwa isifundo, ulwahlulo olulindelekileyo kuphela ukusuka kulawo maqela kunye nokuvavanya kwilingo elilawulwa ngokungenamthetho (RCT) isifundo sotshintsho sisenziwa.

eziluncedo

  • Ilula ukuphoqa imfama / i-mask kunokuba uphucule izifundo
  • I-randomization elungileyo ihlamba nayiphi na i-bias yabemi
  • Abantu abachaphazelekayo bayaboniswa ngokucacileyo
  • Iziphumo zingahlaziywa ngezixhobo ezichanekileyo izixhobo

nezingeloncedo

  • Ngaba ayibonakalisi ibangela
  • Ixabiso kakhulu ngexesha kunye nemali
  • Ukulahlekelwa ukulandelwa kubangelwa unyango
  • Amavolontiya angabonakaliyo: abantu abathatha inxaxheba bangabonakali bonke

Ngeempendulo kuyo nayiphi na imibuzo onokuba nayo nceda ufowunele uDkt Jimenez kwi-915-850-0900

Izikhokelo Zempilo Yokulimala KweeMpilo zoBuphuzi Bokubuyisela e-El Paso, TX

Izikhokelo Zempilo Yokulimala KweeMpilo zoBuphuzi Bokubuyisela e-El Paso, TX

by | Umqolo obuhlungu, Chiropractic, Ubuhlungu obungapheliyo, Uvavanyo oluLungeleleneyo oluLungisiweyo

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

 

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

 

Izikhokelo zezeMpilo zeZempilo zoLawulo lweNtlungu eNgaphantsi: Ukuthelekiswa kwamazwe ngamazwe

 

Abstract

 

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

 

Insight of Dr. Alex Jimenez

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

 

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

 

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

 

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

 

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

 

Imiyalezo Eyona

 

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

 

tindlela

 

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

 

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

 

Inkqubo yokukhutshwa kwaba:

 

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

 

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

 

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

 

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

 

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

 

Impembelelo yoMgaqo

 

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

 

iziphumo

 

Ukhetho lweZifundo

 

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

 

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

 

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

 

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

 

(4) eNew Zealand

 

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

 

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

 

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

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

 

(6) e-UK

 

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

 

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

 

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

 

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

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

 

Ukuvavanya koMgangatho weZikhokelo

 

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

 

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

 

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

 

Uluhlu lwee-1 Ukulinganisa kweZikhokelo zezeMpilo zeMisebenzi

 

Uphuhliso lweZikhokelo

 

Itheyibhile 2 inikeza ulwazi lomvelaphi kwinkqubo yophuhliso yezikhokelo.

 

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

 

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

 

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

 

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

 

Itheyibhile ye2 Inkcazelo yangemvelaphi yeZikhokelo

 

Iingcebiso ze-3 Occupational Guidelines

 

Iingcebiso ze-4 Occupational Guidelines

 

Iindululo zoLuntu kunye neNgcaciso zoLwazi

 

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

 

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

 

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

 

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

 

Isishwankathelo seNcomelo zoVavanyo lwe-LBP

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

ingxoxo

 

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

 

Iinkqubo zeMgangatho kunye noPhuhliso lweZikhokelo

 

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

 

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

 

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

 

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

 

Uvavanyo noLawulo lwe-LBP

 

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

 

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

 

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

 

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

 

Ukuphuhliswa kweziKhokelo zexesha elizayo kwiNgcaciso yezeMpilo

 

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

 

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

 

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

 

Imibulelo

 

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

 

Ukuququmbela, iimpawu zeentlungu ezisezantsi ziphakathi kwezinto eziqhelekileyo zempilo ezinxulumene nokulimala komsebenzi. Ngenxa yoko, izikhokelo zempilo emininzi zenzelwe ukulawulwa kwentlungu ephantsi. Ukunyamekelwa kwe-Chiropractic, phakathi kwezinye iindlela zonyango, kunokusetyenziswa ukuze kuncede isigulane sifumane ukukhululeka kwi-LBP yazo. Ngaphezu koko, le ngongoma engentla ibonise ukhuseleko kunye nokusebenza kweendlela ezahlukeneyo zonyango kunye nezinye iindlela zokunyangwa, unyango kunye nokukhusela iintlobo ezahlukeneyo zentlungu ezisezantsi. Nangona kunjalo, uphando olongezelelweyo uphando lufunekayo ukuze kuchaneke ngokufanelekileyo ukusebenza kwendlela nganye yonyango. Ulwazi oluchazwe kwiziko leSizwe loLwazi lweBiotechnology (NCBI). Ubungakanani beenkcukacha zethu zikhawulelwe kwi-chiropractic kunye nokulimala kwemigudu kunye nemeko. Ukuxoxa ngesihloko, nceda ukhululeke ukucela uDkt Jimenez okanye uqhagamshelane nathi 915-850-0900 .

 

Ikhutshwe nguDkt. Alex Jimenez

 

Green-Call-Now-Button-24H-150x150-2-3.png

 

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.

 

 

umfanekiso webhlogi weendaba eziphambili zephepha lephepha

 

ISIHLOKO ESIBALULEKILEYO: Ukwelashwa kweMigraine Pain

 

 

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

 

Ngenanto
Ucaphulo
1. IVan Tulder MW, iKoes BW, iBouter LM. Isifundo esineendleko zokugula seentlungu zangasemva eNetherlands. Intlungu ye1995; 62: 233-40.
2. Koes BW, van Tulder MW, Ostelo R, et al. Izikhokelo zezonyango zolawulo lweentlungu ezisezantsi ezikhuselekileyo: ngoncedo lwamazwe ngamazwe
uthelekiso. Isihlwele 2001; 26: 2504-14.
3. Intsebenziswano. Ukuvavanywa kweZikhokelo zoPhando kunye
I-Instrument Assessment, www.agreecollaboration.org.
4. Spitzer WO, Leblanc FE, iDupuis M. Indlela yesayensi kwi
uvavanyo kunye nolawulo lweengxaki ezinxulumene nomsebenzi. I-monograph yeeklinikhi. Ingxelo yeQela leQela laseQuebec lokuPhazamiseka kuMqolo. Umqolo 1987; 12 (suppl 7S): 1-59.
5. Igunya lokuSebenza likaVictoria. Izikhokelo zolawulo lwabaqeshwa abaneentlungu ezibuhlungu ezingaphantsi. UMelbourne: IGunya likaVictoria WorkCover Authority, i-1996.
6. Harris JS. Izikhokelo zonyango lomsebenzi. Beverly, MA: Press OEM, 1997.
7. ICandelo leNkcazo yeMbuyekezo kunye neKomiti yezeMpilo yeNational. Usebenza kwaye usebenza! Ukulawula iintlungu eziphantsi kweentlungu kwindawo yokusebenzela. I-Wellington, eNew Zealand, i-2000.
8. ICandelo leNkcazo yeMbuyekezo kunye neKomiti yezeMpilo yeNational, uMphathiswa wezeMpilo. Isikhokelo soMonde ukulawulwa kweentlungu eziphantsi. I-Wellington, eNew Zealand, i-1998.
9. UKendall, uLinton SJ, uCJ oyintloko. Isikhokelo sokuvavanya iiflegi zetyheli ezingokwasengqondweni kwintlungu esezantsi ebuhlungu. Imiba yomngcipheko wokukhubazeka kwexesha elide kunye nokuphulukana nomsebenzi. I-Wellington, New Zealand, UkuLungiswa kweNgozi kunye neNkampani ye-Inshurensi yeMbuyekezo yaseNew Zealand kunye neKomiti yezeMpilo yeSizwe, 1997.
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Isikhokelo sempilo emsebenzini solawulo lweentlungu ezisezantsi ezisezantsi emsebenzini iileta zamagqabi. ILondon: Icandelo lezeMpilo eMsebenzini, 12 (www.facoccmed.ac.uk).
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17. I-Yamamoto S. Izikhokelo malunga nokuthintela indawo yokusebenza yeentlungu ezisezantsi. Isaziso kumaziko emigangatho yezabasebenzi, uNombolo 57. IMpilo yezoShishino 1997; 35: 143-72.
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19. Lindstro? M Mna, u-Ohlund C, Eek C, et al. Iziphumo zomsebenzi ohleliweyo kwizigulana ezine-subacute low back pain: isifundo esingenamkhethe sesifundo sonyango kunye nendlela yokuziphatha yomgangatho wokuziphatha. Unyango lomzimba 1992; 72: 279-93.
20. IKarjalainen K, Malmivaara A, van Tulder M, et al. Unyango lwe-biopsychosocial ye-multidisciplinary yokunyanzelisa iintlungu ezisezantsi kubantu abadala abaneminyaka yokusebenza: uphononongo olucwangcisiweyo ngaphakathi kwesakhelo seCochrane Cooperative Back Review Group. Isihlwele 2001; 26: 262-9.
21. Staal JB, Hlobil H, van Tulder MW, et al. Amanyathelo okungenelela kokubuyela emsebenzini nasemsebenzini ngenxa yeentlungu ezisezantsi: uphononongo oluchazayo lweziqulatho kunye neengcinga zeendlela zokusebenza. Ezemidlalo ngeMidlalo 2002; 32: 251-67.
22. UHoogendoorn WE, van Poppel MN, uBongers PM, et al. Umthwalo ngokwasemzimbeni ngexesha lomsebenzi kunye nexesha lokuzonwabisa njengezinto ezinobungozi beentlungu zangasemva. I-Scand J Umsebenzi weNdawo yezeMpilo ngo-1999; 25: 387-403.
23. ULoisel P, uGosselin L, uDurand P, et al. Ulingo olusekwe kubemi, olungenamkhethe kuvavanyo lweentlungu. Isihlwele 1997; 22: 2911-18.
24. ULoisel P, uGosselin L, uDurand P, et al. Ukuphunyezwa kwenkqubo ye-ergonomics yokuthatha inxaxheba ekuvuseleleni abasebenzi abaphethwe ziintlungu zangasemva. Iappl Ergon 2001; 32: 53-60.
25. UFrank J, uSinclair S, uHogg-Johnson S, et al. Ukuthintela ukukhubazeka kwiintlungu ezisezantsi ezinxulumene nomsebenzi. Ubungqina obutsha bunika ithemba elitsha ukuba singafumana nje bonke abadlali balalela. I-CMAJ 1998; 158: 1625-31.
Vala i-Accordion
Ukuxhatshazwa komgudu ngokuxhatshazwa kweCervicogenic Headache e-El Paso, TX

Ukuxhatshazwa komgudu ngokuxhatshazwa kweCervicogenic Headache e-El Paso, TX

by | Chiropractic, entanyeni Pain, Uvavanyo oluLungeleleneyo oluLungisiweyo

Intloko yesiseko ibonakala njengeentlungu zentloko ezibangwa yintlungu yesifo ngokwaso. Ezi zintathu iintlobo zeengxaki eziphambili zentloko ziquka, neyamenza, iintlobo zentlungu kunye neentloko zentloko. Intlungu yentloko yimbozi ebuhlungu kunye neyoxinzelelo enokuthi ibe khona ngenxa yesinye isizathu esibangela. Intloko yesibini ibonakala njengeentlungu zentloko ezenzeka ngenxa yokulimala kunye / okanye imeko. Ukungahambisani nokugqithiswa kwemigulane, okanye ukuhluthwa kwemithi, kunye nomlenze womlomo wesibeleko, okanye intamo, ngokuqhelekileyo idibene neentlobo zempawu zentloko.

 

Intloko ye-Cervicogen iyintloko yesibini eyabangela ukulimala kunye / okanye imeko echaphazela izakhiwo ezijikelezileyo zentambo yomlomo, okanye intamo. Abaninzi abanonophelo lwezempilo baya kuncomela ukusebenzisa iziyobisi / amachiza ukunceda ukuphucula intloko, nangona kunjalo, unyulo oluninzi lwezonyango lungasetyenziswe ngokufanelekileyo kwaye luphumelele ukuphatha intloko yesibini. Injongo yale nqaku ilandelayo kukubonisa impembelelo yokunyanzeliswa komlomo wesibeleko kunye nokuphezulu kwe-thoracic ngokumalunga nokukhuthaza nokuzilolonga kwizigulane ezinentloko yomlomo.

 

Umgudu ophezulu weNtsholongwane kunye noPhakamiso oluPhakamileyo lweTrracic Versus and Exercise and Exercise in Patients with Cervicogenic headache: i-Multi-Center Randomized Clinical Trial

 

Abstract

 

  • imvelaphi: Nangona kungenelelo oluqhelekileyo olusetyenziswayo, akukho zifundo eziye zafanisa ngokuthe ngempumelelo ukusebenza kobubele besibeleko kunye neentlobo zentsimbi ekubambiseni nasekusebenziseni umsebenzi kubantu abaneentloko zentliziyo (CH). Injongo yale sifundo yayikuthelekisa imiphumo yokuxhaphaza kunye nokuzilolonga kubantu abane-CH.
  • Iindlela: Abathathi-nxaxheba abalikhulu elineshumi (n? =? 110) kunye ne-CH babengenangqondo yokufumana ukunyanzeliswa komlomo wesibeleko kunye ne-thoracic (n? =? 58) okanye ukuhlanganisa kunye nokuzivocavoca (n? =? 52). Isiphumo esiphambili sasinamandla entloko njengoko kulinganiswa neNqanaba leNqanaba lePain yeNumeric (NPRS). Iziphumo zesekondari zibandakanya ukuphindaphindeka kwentloko, ubude beentloko, ukukhubazeka njengoko kulinganiswa yi-Neck Disability Index (NDI), ukuthatha amayeza, kunye noVavanyo lweHlabathi loTshintsho (GRC). Ixesha lonyango yayiziiveki ze-4 kunye novavanyo lokulandelela kwiveki ye-1, iiveki ze-4, kunye neenyanga ze-3 emva kweseshoni yokuqala yonyango. Injongo ephambili yavavanywa ngeendlela ezi-2 zokuxubusha imodeli yohlalutyo (ANOVA), kunye neqela lonyango (ubuqhetseba xa kuthelekiswa nokuhlanganisa kunye nokuzilolonga) njengezinto eziguqukayo kunye nexesha (isiseko, iveki e-1, iiveki ezi-4 kunye neenyanga ezi-3) njenge ngaphakathi kwizifundo eziguqukayo.
  • iziphumo: I-2X4 ANOVA ibonakalise ukuba abantu abane-CH abafumene ukuphathwa komlomo wesibeleko kunye ne-thoracic bafumana amava okuphungula okukhulu kwintloko yamandla (p?
  • Izigqibo: Iiseshoni ezisibhozo ezisibhozo ze-colervical upper and thoracic manipulation zaboniswa ukuba zisebenze ngakumbi kunokwenziwa kunye nokuzilolonga kwizigulane ezine-CH, kwaye iziphumo zagcinwa kwiinyanga ze-3.
  • Ukubhaliswa kovavanyo: NCT01580280 Epreli 16, 2012.
  • Internet: Intloko ye-Cervicogenic, Ukunyanzelisa umlenze, Ukuxhaswa, ukuphakama okukhulu kwe-amplitude

 

UDkt Jimenez White Coat

Insight of Dr. Alex Jimenez

Xa kuthelekiswa nentloko eyintloko, njengaye neyamenza, intloko yesifo kunye nentloko yeentlobo zentlungu, intloko yesibini ibonakala njengentlungu yentloko ebangelwa esinye isifo okanye ingxaki yomzimba. Kwimeko intloko cervicogenic, unobangela intlungu entloko ngenxa yokwenzakala kunye / okanye imeko ecaleni emqolo wesibeleko kunye nezakhiwo eziyingqongileyo, kubandakanywa amalungu omqolo, IiCD intervertebral kunye kwizihlunu ezithambileyo. Ukongezelela, abaninzi abanonophelo bezempilo bayakholelwa ukuba intloko yesifo esintloko sinokudityaniswa nemicimbi yempilo kwintsipho yomlomo, okanye intanyeni. Ulwaphulo lwentloko lwe-Cervicogenic lufanele lujolise kumthombo weempawu kwaye luyahlukahluka kuxhomekeke kwisigulane. Ukunyamekela kwe-Chiropractic isebenzisa ukulungiswa kwemisipha kunye nokusetyenziswa kwezinto eziphambili ukubuyisela ngokusisiseko isakhiwo kunye nomsebenzi wesiqulatho, kunceda ukunciphisa uxinzelelo kunye noxinzelelo ukuze kuphuculwe iimpawu zentloko, phakathi kolunye uhlobo lweentloko. Ukhathalelo lwe-Chiropractic lungasetyenziselwa ukunceda unyango lwentloko, njengemigraines.

 

imvelaphi

 

Ukwahlula-hlula kwamazwe onke ukuphazamiseka kwentloko kuchaza i-cervicogenic headache (CH) njenge, ache intloko ebangelwa kukungalungelelani komqolo womlomo wesibeleko kunye ne-bony, disc, kunye / okanye izihlunu ezithambileyo, zihlala kodwa zingahambi rhoqo neentlungu zentamo. [1 ] (iphe. 760) Ukuxhaphaka kwe-CH kuye kwaxelwa ukuba kuphakathi kwe-0.4 kunye ne-20% yenani lentloko [2, 3], kwaye liphezulu njenge-53% kwizigulana ezinentloko emva kokulimala kwe-whiplash [4]. Iimpawu eziphambili ze-CH zihlala zibandakanya: ukungahambelani kwentlungu yentloko ngaphandle kokutshintsha-cala, ukunyusa iintlungu ngoxinzelelo lwangaphandle entanyeni ye-ipsilateral, uluhlu olulinganiselweyo lwesibeleko sokuhamba, kunye nokuxhokonxwa kohlaselo ngeentshukumo ezahlukeneyo ezomeleleyo okanye eziqhubekayo zentamo [4, 5].

 

Abantu ngabanye abane-CH bahlala bephathwa ngonyango olusisigxina lomlenze kubandakanya ukuhlanganiswa kunye nokuphathwa [6]. Ukuhlanganiswa komgudu kubandakanya iindlela ezincitshisiweyo, eziyingqiqo, ezizenzekelayo. [7] Kuhlalutyo olusandul 'ukuhlaziywa kwangoko, iBronfort kunye noogxa baxelele ukuba unyango olusisigxina lomlenze (kokubili ukugqugquzela nokuphathwa) lwalusebenza kakuhle ekulawuleni abantu abadala abane-CH [8]. Nangona kunjalo, abazange babike ukuba ukunyanzeliswa kwabangela ukuba iziphumo eziphezulu ziqhathaniswa nokuququzelela ulawulo lwaba bantu.

 

Izifundo ezininzi ziye zaphanda umphumo wokunyanzeliswa komgogodla kulawulo lwe-CH [9-13]. Haas okqhubekayo. [10] iphande ukusebenza ngokunyanzelwa komlomo wesibeleko kwizifundo ze-CH. Jull okqhubekayo. [11] ubonakalise ukusebenza ngokukuko kunyango olusebenzayo kunye / okanye umthambo kulawulo lwe-CH. Nangona kunjalo iqela lonyango elikhohlisayo libandakanya ubuqhetseba kunye nokuhlanganisa ngenxa yoko ayinakugqitywa ukuba isiphumo esiyinzuzo sisisiphumo sokuxhaphaza, ukuhlanganisa okanye ukudibanisa.

 

Izifundo ezimbalwa ziye zavavanya izibonelelo zokuxhaphaza ngokuchasene nokuququzelela ulawulo lwentlungu yentliziyo kunye okanye ngaphandle kokuzivocavoca [14-16]. Nangona kunjalo, akukho zifundo ziye zathelekisa ngokuthe ngqo iimpembelelo zokuxhaphaza xa kuthelekiswa nokuhlanganisa kunye nokuzilolonga kwizigulana ezine-CH. Ukuqwalaselwa kwemingcipheko yokunyanzeliswa [17], kubalulekile ukufumanisa ukuba ngaba ukunyanzelwa kukhokelela kwiziphumo eziphuculweyo xa kuthelekiswa nokuququzelela ulawulo lwezigulana ezine-CH. Ke ngoko, injongo yolu vavanyo lweklinikhi olungenamsebenzi yayikukuthelekisa iimpembelelo zokuchasana nokugaya kunye nokuzilolonga kwizigulana ezine-CH. Siye sagxininisa ukuba izigulana ezifumana ukwenzakaliswa kwisithuba seeveki ezi-4 zonyango ziya kuba nokuncipha okukhulu kwintloko ebuhlungu, ukuphindaphindeka kwentloko, ubude bentloko, ukukhubazeka, kunye nokuthatha amayeza kunyango olulandelayo lweenyanga ezi-3 kunezigulana ezifumana ukuhlanganiswa komlomo wesibeleko kunye ne-thoracic kudityaniswa nokuzilolonga .

 

tindlela

 

nxaxheba

 

Kolu vavanyo lweklinikhi olunamaziko amaninzi, izigulana ezilandelelanayo ezine-CH ezibonisa i-1 kwezi-8 zeeklinikhi zonyango zonyango ezivela kwiindawo ezahlukeneyo (Arizona, Georgia, New York, Ohio, Pennsylvania, South Carolina) zaqeshwa ngaphezulu kwenyanga engama-29. ixesha (ukusukela ngo-Epreli 2012 ukuya ku-Agasti 2014). Ukuze izigulane zifaneleke, kwafuneka zibonise ukuxilongwa kwe-CH ngokwemiqathango ehlaziyiweyo yokuxilonga [5] eyenziwe yiCervicogenic Headache International Study Group (CHISG) [5, 18, 19]. I-CH yahlelwa ngokwe- major criteria (ingabandakanyi ubungqina obuqinisekisayo ngovavanyo lwe-anesthetic blockades) kunye neempawu zentloko yentloko ye-CHISG. Ke ngoko, ukuze zibandakanywe kufundo, abaguli kuye kwafuneka babonakalise zonke ezi ndlela zilandelayo: (1) ukungathandani kwentlungu entloko ngaphandle kwecala, ukuqala entanyeni engasemva engaphezulu okanye kwingingqi ye-occipital, ekugqibeleni ukusasazeka kwindawo ye-oculofrontotemporal Icala elibonakalisayo, (2) intlungu ebangelwa ukunyakaza kwentamo kunye / okanye izikhundla ezixhasayo, (3) ukunciphisa inani lokunyakaza kwintlambo yomlomo wesibeleko [20] (oko kukuthi, ngaphantsi okanye ulingana no-32 wokujikeleza kwesokudla okanye kwesobunxele kwi-rotation Uvavanyo lwe-Flexion-Rotation Test [21-23], (4) iintlungu ezibangelwa luxinzelelo lwangaphandle okungenani elinye lamalungu aphezulu omlomo wesibeleko (C0-3), kunye (5) nokumodareyitha ukuya kubuhlungu, ukungabethi kunye nentlungu engathandekiyo. Ukongeza, abathathi-nxaxheba kuye kwafuneka ukuba babe nesifo sokuqaqanjelwa yintloko ubuncinci nge-1 ngeveki ubuncinci beenyanga ezi-3, ubuncinci benqaku lokuqaqanjelwa yintloko yamanqaku amabini (0 10 kwisikali se-NPRS), inqaku lokukhubazeka elincinci lama-20% okanye enkulu (okt, amanqaku ali-10 okanye ngaphezulu kwinqanaba le-0 NDI50 NDI), kwaye ube phakathi kwe-18 kunye ne-65 ewe rs yobudala.

 

Izigulane zazingabandakanywa ukuba zibonise ezinye iintloko eziphambili (oko kukuthi, i-migraine, i-TTH), iqhutywe kwiintsholongwane zombini, okanye ibonisa iiplagigi ezibomvu (oko kukuthi, isifo, isifo, isifo, isifo se-rheumatoid, i-osteoporosis, ukuphucula uxinzelelo lwegazi ngaphezu kwe-140 / 90 mmHg, imbali eqhubekayo yokusetyenziswa kwe-steroid, njl.), eboniswe ngeempawu ezibini okanye ngaphezulu ezinomdla ezihambisana nexinzelelo yengcambu yesisu (ubunzima be-muscle obubandakanya iqela elikhulu le-muscle lomgca ophezulu, linciphisa umgca ophezulu ongathandabuzekiyo we-tendon reflex, okanye ukuncipha okanye ukungabikho ukupakisha kunoma yiphina impendulo ephezulu), eboniswe ukuxilongwa kwentsholongwane yomlomo wesibeleko, yabonisa iimpawu eziphezulu ezisemgangathweni, yayinobungqina bendlela yokubandakanyeka kwenkqubo ye-nervous (hyperreflexia, ukuphazamiseka kwengqondo esandleni, ukungahlali kakuhle kwezandla, ukungahlali ngexesha lokuhamba , i-nystagmus, ukulahleka kwezinto ezibonakalayo, ukukhathazeka okungabonakaliyo ubuso, ukuguqulwa kwintliziyo, ubukho bentlalo es), waba imbali yokwenzakala whiplash phakathi kweeveki 6 edlulileyo, kwafuneka utyando phambi entloko okanye emqaleni, wafumana unyango ngenxa entloko okanye emqaleni buhlungu nawuphi na umlondolozi ngaphakathi kwinyanga edlulileyo, wafumana unyango ngokwasemzimbeni okanye unyango kwamathambo yintloko okanye intlungu yentamo kwiinyanga ze-3 zangaphambili, okanye isenzo somthetho esilindile malunga nentlungu okanye intamo yentlungu.

 

Uncwadi olutshanje lubonisa ukuba ukuvavanywa kwangaphambili kweengxaki zomlomo wesibeleko akukwazi ukufumanisa abo bantu basengozini yokuxhatshazwa kweengculaza ukusuka kwimizimba yomlomo wesibeleko [24, 25], kunye naziphi na iimpawu ezifunyenweyo ngexesha lokuvavanywa kwangaphambili kunokusenokungahambelani neenguqu zokuhamba kwegazi umthambo we-vertebral [26, 27]. Ngenxa yoko, ukuhlolwa kobunzima bokubeletha komlomo kwangaphambili akuzange kwenziwe kulolu cwaningo; Nangona kunjalo, imibuzo yokujonga i-artery disease artery kufuneka ibe yinto engalunganga [24, 28, 29]. Olu pho nonongo luvunyiwe yiBhodi yokuHlola yeziNtu e-Long Island University, eBrooklyn, NY. Uhlolisiso lubhaliswe kwi-www.clinicaltrials.gov kunye ne-trial identifier NCT01580280. Zonke izigulane zaziswa ukuba ziya kufumana ukuphathwa okanye ukuxhotyiswa kunye nokuzivocavoca kwaye zinikeze imvume enolwazi phambi kobhaliso lwabo kwisifundo.

 

Ukunyanga ama-Therapists

 

Iingcali zonyango ezilishumi elinambini (iminyaka yobudala engama-36.6, i-SD 5.62) ithathe inxaxheba kunikezelo lonyango kwizigulana kolu phononongo. Babenomndilili we-10.3 (i-SD 5.66, iminyaka engama-3 20) yamava onyango, kwaye bonke babegqibe inkqubo ye-60 h yokuthweswa isidanga emva koqeqesho ebandakanya uqeqesho olusebenzayo kubuchwephesha bobuchwephesha kubandakanya ukusetyenziswa komlomo wesibeleko kunye ne-thoracic manipulation. Ukuqinisekisa ukuba zonke iimviwo, ukuvavanywa kweziphumo, kunye neenkqubo zonyango zazimiselwe emgangathweni, bonke abanyangi abathatha inxaxheba emzimbeni kwakufuneka ukuba bafunde incwadi yemigaqo yokusebenza kwaye bathathe inxaxheba kwiseshoni yoqeqesho eyi-4 kunye nomphenyi oyintloko.

 

Iinkqubo zokuHlola

 

Zonke izigulana zibonelele ngolwazi lwedemokhrasi, zalinda iphepha lemibuzo leNeck Pain Medical Screening Questionnaire, zaza zagqitywa iindlela zokuzixela, ezilandelwa yimbali emiselweyo kunye novavanyo lomzimba kwisiseko. Amanyathelo okuzixela abandakanya ukuqina kwentloko njengoko kulinganiswa yi-NPRS (0-10), i-NDI (0-50), ukuphindaphindeka kwentloko (inani leentsuku ezineentloko kwiveki ephelileyo), ubude beentloko (iiyure ezipheleleyo zentloko kwilixa lokugqibela iveki), kunye nokutya amayeza (inani lamaxesha isiguli sithathe iyeza lokuthomalalisa iintlungu okanye i-counter-the-counter kwiyeza elidlulileyo kwiveki ephelileyo).

 

Uviwo standardised emzimbeni wawungapheleliselwanga, kodwa zaqukwa imilinganiselo C1-2 (atlanto-yezihlunu joint) ilungelo eyimpumelelo ekhohlo ukujikeleza ROM usebenzisa Flexion-Ukujikeleza Uvavanyo (FRT). Ukuthembeka kwe-FRT kuye kwafunyaniswa kukuhle kakhulu (ICC: 0.93; 95% CI: 0.87, 0.96) [30].

 

Izisiphumo

 

Esona siphumo siphambili sokusetyenziswa kolu phononongo yayikukuqina kwentloko yesigulana njengoko kulinganiswa yi-NPRS. Izigulana zacelwa ukuba zibonise ubungakanani beentlungu zentloko kwiveki ephelileyo zisebenzisa inqanaba le-11 ukusuka kwi-0 ('akukho ntlungu') ukuya kwi-10 ('iintlungu ezimbi ezinokucingelwa') kwisiseko, i-1-iveki, i-1-inyanga, kunye neenyanga ezi-3 emva kweseshoni yokuqala yonyango [31]. I-NPRS sisixhobo esithembekileyo nesisebenzayo sokuvavanya ubunzima beentlungu [32-34]. Nangona kungekho datha ikhoyo kwizigulana ezine-CH, i-MCID ye-NPRS ibonakalisiwe ukuba yi-1.3 kwizigulana ezineentlungu zentamo [32] kunye ne-1.74 kwizigulana ezineemeko ezahlukeneyo zentlungu engapheliyo [34]. Ke ngoko, sikhethe ukubandakanya kuphela izigulana ezinamanqaku e-NPRS enamanqaku ama-2 (20%) okanye ngaphezulu.

 

Amanyathelo esiphumo sesibini afaka i-NDI, uVavanyo lweHlabathi loTshintsho (i-GRC), ukuphindaphindeka kwentloko, ubude beentloko, kunye nokutya amayeza. I-NDI sesona sixhobo sisetyenziselwa ukuvavanya ukukhubazeka okuzimeleyo kwizigulana ezinentlungu yentamo [35-37]. I-NDI yincwadi yemibuzo yokuzixela ene-10-izinto ezilinganiswe ukusuka kwi-0 (akukho kukhubazeka) ukuya ezintlanu (ukukhubazeka ngokupheleleyo) [38]. Iimpendulo zamanani zento nganye zishwankathelwe amanqaku apheleleyo aphakathi kwe-0 kunye ne-50; Nangona kunjalo, abanye abavavanyi bakhethe ukuphindaphinda amanqaku aluhlaza ngamabini, emva koko banike ingxelo nge-NDI kwisikali se-0 100% [36, 39]. Amanqaku aphezulu abonisa ukwanda kwenqanaba lokukhubazeka. I-NDI ifunyenwe ineziphumo eziqinisekileyo zokuvavanywa kokuvavanywa kwakhona, ukuthembeka kokwakha okuqinisekileyo, ukungaguquguquki kwangaphakathi kunye nokuphendula okuhle kuvavanyo lokukhubazeka kwizigulana ezineentlungu zentamo [36], i-radiculopathy yomlomo wesibeleko [33, 40], isifo esihambelana ne-whiplash [38, I-41, i-42], kunye neentlungu zentamo ezingacaciswanga [43, 44]. Nangona kungekho zifundo ziye zavavanya iipropathi ze-psychometric ye-NDI kwizigulana ezine-CH, sikhethe ukubandakanya kuphela izigulana ezinamanqaku e-NDI ngamanqaku alishumi (20%) okanye ngaphezulu, kuba la manqaku asikiweyo athatha i-MCID ye-NDI, ethi kuye kwaxelwa ukuba kuthelekiswe amanqaku amane, asibhozo, kunye alithoba (0 50) kwizigulana ezinentlungu engafaniyo yentamo [44], iintlungu zentamo yomatshini [45], kunye ne-radiculopathy yomlomo wesibeleko [33], ngokwahlukeneyo. Ukuhamba rhoqo kwentloko kwakulinganiswa njengenani leentsuku ezinentloko kwiveki ephelileyo, ukusukela kwi-0 ukuya kwiintsuku ezisi-7. Ubude beentloko bulinganiswa njengeeyure ezipheleleyo zentloko kwiveki ephelileyo, ngamanqanaba amathandathu anokwenzeka: (1) 0 5 h, (2) 6 10 h, (3) 11 15 h, (4) 16-20 h, (5) 21 25 h, okanye (6) 26 okanye ngaphezulu iiyure. Ukutya amayeza kwakulinganiswa njengenani lamaxesha apho isigulana sithathe amayeza okanye amayeza e-anti-inflammatory kwiveki ephelileyo yeentloko zabo, ngeendlela ezintlanu: (1) hayi kwaphela, (2) kanye nge iveki, (3) kanye ngeentsuku ezimbalwa, (4) kanye okanye kabini ngemini, okanye (5) kathathu okanye nangaphezulu ngemini.

 

Izigulana zibuyiselwe kwi-1-iveki, iiveki ze-4, kunye ne-3-iinyanga zokulandelelana apho iziphumo zengxelo ezikhankanywe ngasentla zaqokelela kwakhona. Ukongeza, kwi-1-iveki, ii-4-iiveki kunye ne-3-iinyanga ezilandelelanayo, izigulane zigqibe umbuzo we-GRC we-15-point based on the scale described by Jaeschke et al. [46] ukulinganisa umbono wabo wokuphucula umsebenzi. Amanqanaba okulinganisa ukusuka kwi-7 (into eninzi kakhulu kakhulu) ukuya kwi-zero (ngokufanayo) ukuya kwi-7 (into eninzi kakhulu). Izichasiselo ezingapheliyo zokuhlaselwa okanye ukuphucula zinikwe ixabiso ukusuka -1 ukuya kwi-6 kunye ne-1 ukuya kwi-6, ngokulandelanayo. I-MCID ye-GRC ayikwabikwa ngokukodwa kodwa amanqaku e-4 kunye ne-5 sele ebonisa ukuba utshintsho olulinganisiweyo kwisimo sengqondo (46]. Nangona kunjalo, kufuneka kuqatshelwe ukuba kungekudala uSchmitt no-Abbott babike ukuba i-GRC inokuthi ingayinxulumani neenguqu kwimisebenzi kubantu abanokulimala kwe-hip kunye ne-ankle [47]. Zonke izicwangciso zempatho ziqokelelwa ngumhloli ongenabonelelo kwisabelo seqela.

 

Kutyelelo lokuqala izigulana zigqibe onke amanyathelo eziphumo zaza zafumana iseshoni yokuqala yonyango. Izigulana zigqibe iiseshoni zonyango ze-6 8 zokunyanzelwa okanye ukuhlanganiswa kudityaniswa nokuzilolonga ngaphezulu kweeveki ezi-4. Ukongeza, izifundo zacelwa ukuba zikhe zehlelwa naziphi na iziganeko ezimbi ze- major [48, 49] (ukubetha okanye ukusilela ngokusisigxina kwemithambo-luvo) kwixesha ngalinye lokulandela.

 

Randomization

 

Ukulandela uvavanyo olusisiseko, abaguli babelwa ngokungacwangciswanga ukuba bafumane ukuphathwa okanye ukuhlanganiswa kunye nokuzilolonga. Ulwabiwo olufihliweyo lwenziwa kusetyenziswa itafile eyenziweyo eyenziwe ngamakhompyutha eyenziwe ngumntu ongabandakanyekanga ekugayeni abaguli ngaphambi kokuqala kwesifundo. Ngamnye, amakhadi esalathiso alandelwe ngokulandelelana kunye nokunikezelwa okungacwangciswanga kwalungiselelwa indawo nganye kwezisi-8 zokuqokelela idatha. Amakhadi esalathiso asongwa abekwa kwiimvulophu ze-opaque ezitywiniweyo. Imfama kuviwo olusisiseko, ugqirha onyangayo wavula imvulophu kwaye waqhubeka nonyango ngokwendlela elabelwe ngayo iqela. Izigulana ziyalelwe ukuba zingathethi ngenkqubo ethile yonyango efunyenwe nonyango oluvavanyayo. Ugqirha ovavanyayo uhlala eyimfama kwisabelo seqela lonyango ngalo lonke ixesha; Nangona kunjalo, ngokusekwe kubume bongenelelo kwakungenakwenzeka kwizigulana ezingaboniyo okanye ukunyanga abanyangi.

 

Iqela lokuPhatha

 

Ukunyanzeliswa kokujolisa ekunene nasekhohlo kwi-C1-2 articulations and bilateral T1-2 articulations were done on a least one of 6 8 treatment sessions (Amakhiwane. 1 no? No2) .2). Kwezinye iiseshoni zonyango, abanyangi baphindaphinde i-C1-2 kunye / okanye i-T1-2 yokukhohlisa okanye bajolise kwezinye iindlela zomqolo (okt, C0-1, C2-3, C3-7, T2-9, ribs 1 9) besebenzisa ubuqhetseba. . Ukukhethwa kwamacandelo omgogodla ekujoliswe kuwo kwashiywa kwingqondo yonyango kwaye yayisekwe kwindibaniselwano yeengxelo zesigulana kunye novavanyo lwencwadi. Kuzo zombini izibeleko eziphezulu zomlomo wesibeleko kunye neziphezulu, ukuba akukho kuphuma okanye kuvakala isandi kwisilingo sokuqala, ugqirha wabeka isigulana endaweni yesibini kwaye wenza unyanzeliso lwesibini. Ubuninzi beenzame ze-2 zenziwa kwisigulana ngasinye esifana nezinye izifundo [14, 50-53]. Oogqirha bayalelwa ukuba ubuqhetseba kunokwenzeka ukuba buhambisane nezandi ezininzi ezivakalayo ezivakalayo [54-58]. Izigulana zakhuthazwa ukuba zigcine imisebenzi yesiqhelo ngaphakathi kwemida yentlungu; Nangona kunjalo, ukuhlanganiswa kunye nokuchongwa kwemithambo, okanye nakuphi na ukusetyenziswa kwezinye iindlela, khange kunikezwe kweli qela.

 

Umzobo we-1 HVLA Thrust Ukunyanzelisa Ukuqondisa ngakwesokudla kwi-C1-2 Ukuqhagamshelana | El Paso, TX I-Chiropractor

 

Umzobo we-2 HVLA Thrust Manipulation Uqondiswe ngokuthe ngqo kwi-Upper Thoracic Spine | El Paso, TX I-Chiropractor

 

Ukujolisa okujolise kwi-C1-2 kwenziwa kunye nesigulana kwi-supine. Kule ndlela, isigulana sashiya i-atlas yangasemva ye-atlas yaqhakamshelaniswa nenxalenye yecala eliphambili le-phaphalx yonyango lwesobunxele ngomnwe wesibini usebenzisa i-adcradle hold . Ukwenza indawo ibekwe kumlo wasekhohlo we-C1-2, isigulana sasibekiwe sisebenzisa ulwandiso, ukutshintsha okungasemva (i-PA), ukugoba kwicala elingaphandle kunye nokutshintsha-tshintsha kwecala. Ngelixa sigcina esi sikhundla, i-Therapist yenze i-velocity eyodwa, i-low-amplitude thrust manipulation kwi-atlanto-axial ngokudibeneyo isebenzisa ujikelezo lwasekunene kwi-arc ejongene neliso elingaphantsi kunye nokuguqulela kwitafile (Ikhiwane. 1). Oku kuye kwaphindaphindwa kusetyenziswa inkqubo efanayo kodwa yajongwa kumgaqo olungileyo we-C1-2.

 

Ukujolisa okujolise kwi-T1-2 kwenziwa kunye nesigulana kwi-supine. Kule ndlela, isiguli sasimbambe / iingalo kunye neengalo zakhe esifubeni kunye neengqini ezihambelanayo nesikhokelo esiphezulu. Ingcali yonyango yaqhakamshelana neenkqubo ezinqamlezileyo zomqolo ongezantsi wecandelo lokunyakaza ekujoliswe kulo kunye nokuphakama kwangoko kunye ne-phalanx ephakathi yedigri yesithathu. I-lever ephezulu yafakwa kwindawo yentshukumo yokujolisa ngokudibanisa ukujikeleza kude kunye nokugoba kwicala kwicala lonyango ngelixa isandla esingaphantsi sisebenzisa ukubizwa kunye nokuphambuka kwe-radial ukufezekisa ukujikeleza ukuya kwicala lokugoba, ngokulandelelana. Isithuba esingaphantsi kwenkqubo ye-xiphoid kunye nomda we-costochondral womgqirha wasetyenziswa njengendawo yokunxibelelana ngokuchasene nezigulana zesigulana sokuhambisa ubuqhetseba ngaphambili ukuya kwicala elingasemva elijolise kwi-T1-2 kumazwe amabini (Ikhiwane. 2).

 

UkuQinisa kunye neQela lokuSebenza

 

Ukuhanjiswa okujolise ekunene nasekhohlo kwi-C1-2 articulations kunye ne-T1-2 articulations zenziwa ubuncinci kwiseshoni enye ye-6 8 yonyango. Kwezinye iiseshoni zonyango, abanyangi baphindaphinde i-C1-2 kunye / okanye i-T1-2 yokuhambisa okanye ukujolisa kwezinye iindlela zomqolo (okt, C0-1, C2 / 3, C3-7, T2-9, ribs 1 9) besebenzisa ukugaya. . Ukukhethwa kwamacandelo omgogodla ekujoliswe kuwo kwashiywa kwingqondo yonyango kwaye yayisekwe kwindibaniselwano yeengxelo zesigulana kunye novavanyo lwencwadi. Nangona kunjalo, ukuthintela 'ukunxibelelana' okanye 'isiphumo sokuqwalaselwa' xa kuthelekiswa neqela elikhohlisayo, abanyangi bayalelwa ukuba badibanise icandelo elinye lomlomo wesibeleko (okt ekunene nasekhohlo) kunye necandelo elinye le-thoracic okanye ubambo oluchazayo kwiseshoni nganye yonyango.

 

Ukubambisana okujoliswe kwi-C1-2 ukuchazwa kwenzelwe. Kule ndlela, umgqirha wenza enye ye-30 yokuphelela kwe-grade ye-grade engasemva kwesigxina se-PA kwi-C1-2 yesigaba sokunyuswa njengoko ichazwe nguMaitland [7]. Le nkqubo inye yaphindwa kwakhona kwi-bout ye-30 enye ukuya kwi-joint-axial joint joint. Ukongezelela, kwaye ubuncinane kwiseshoni enye, ukuhlanganiswa okubhekiselele kwisigxina esiphezulu se-thoracic (T1-2) kunye nesigulane esilungileyo esenziwa. Ngenxa yale nqubo, uphando lwenza enye ye-30 ye-grade cent ye-grade IV ye-PA mobilizations kwi-T1-2 inxalenye yesiphakamiso njengoko kuchazwe nguMaitland [7]. Ngoko ke, sasebenzisa i-180 (oko kukuthi, i-30 s bouts) malunga ne-2 Hz). Ngokucacileyo, akukho bungqina obuphezulu bokubakho ukuza kuthi ukuba ixesha elidlulileyo lokubambisa luchukumisa ukunciphisa ubuhlungu ngaphezu kwexesha elifutshane okanye ama-dosage of mobilisation [59, 60].

 

Ukuziqhelanisa ne-cranio-cervical flexion exercises [11, 61-63] zenziwa kunye nesigulana kwi-supine, amadolo egobile kunye nokuma kwentloko emiselweyo ngokubeka i-craniocervical kunye ne-spines spines kwindawo esembindini, enje ngokuba umgca phakathi Ngaphambili ibunzi nesilevu zazithe tyaba, kwaye umgca othe tyaba usuka kwitrgus yendlebe wahlula intamo ixesha elide. I-unit ye-biofeedback yoxinzelelo lomoya (i-Chattanooga Group, Inc., i-Hixson, i-TN) ibekwe ecaleni kwesigulana emva kwentamo yesigulana kwaye yaxhonywa ngaphambili kwisiseko se-20 mmHg [63]. Ukuzivocavoca okuhleliweyo, izigulana zacelwa ukuba zenze inyathelo le-craniocervical flexion action (noda nod of the head, similar to showing yes ) [63] kunye nokuzama ukujolisa ekujongeni uxinzelelo lwe-22, 24, 26, 28, kunye ne-30 mmHg ukusuka isiseko sokuphumla se-20 mmHg kwaye sibambe isikhundla sizinzile nge-10 s [61, 62]. Intshukumo yokunqwala intloko yenziwa ngendlela ethambileyo kwaye ecothayo. Ukuphumla kwe-10 kwavunyelwa phakathi kwezilingo. Ukuba uxinzelelo luye lwaphambuka ngaphantsi koxinzelelo ekujoliswe kulo, uxinzelelo lwalungagcinwanga luzinzile, endaweni yezithambisi ezingaphezulu (i-sternocleidomastoid okanye i-anterior scalene) yenzekile, okanye ukurhoxiswa kwentamo kwaqatshelwa ngaphambi kokugqitywa kwe-10 s isometric hold, yathathwa njengokungaphumeleli [63]. Uxinzelelo ekujoliswe kulo lokugqibela olusebenzayo lwalusetyenziselwa ukumisela inqanaba lokuzivocavoca kwesigulana ngasinye apho iiseti ze-3 zokuphindaphinda kwe-10 nge-10 s isometric hold zenziwa. Ukongeza ekuvuseleleni nasekusebenziseni umthambo we-cranio-wesibeleko, izigulana zacelwa ukuba zenze i-10 min yemithambo eqhubekayo yokuxhathisa (okt, ukusebenzisa iTherabands okanye iintsimbi zasimahla) kwimisipha yebhanti yegxalaba ngexesha leseshoni yonyango nganye, kunyamezelwano lwabo, kunye egxile ngokukodwa kwi-trapezius esezantsi kunye ne-serratus yangaphambili [11].

 

Usayizi wesampula

 

Ubungakanani besampula kunye nokubala kwamandla kwenzelwa ukusebenzisa iprojekthi ye-intanethi kwi-MGH Biostatistics Centre (eBoston, MA). Izibalo zisekelwe ekufumaneni u-2-point (okanye i-20%) umahluko kwi-NPRS (ubukhulu beentloko) kwiinyanga ze-3 ukulandelelana, kuthatha ukuphambukiswa okuqhelekileyo kwamanqaku amathathu, uvavanyo lwe-2-tailed, kunye ne-alpha level 0.05. Oku kwavelisa ubungakanani beesampula zezigulane ze-49 ngeliqela. Ukuvumela ukuba izinga lokulahla elilondolozo lwe-10%, siceba ukufumana izigulane ze-108 ubuncinane kwisifundo. Ubungakanani besampula bukhulule ngaphezu kwe-90% amandla okufumanisa utshintsho oluphawulekayo kwiimpawu ze-NPRS.

 

Uhlalutyo lweenkcukacha

 

Iinkalo ezichazayo, kubandakanywa amanqaku eenkcukacha zohlulo lwezigaba kunye namanyathelo okutyekela kunye nokusabalalisa ukuguquguquka okuqhubekayo kubalwa ukufingqa idatha. Iimpembelelo zonyango kwi-headache intensity kunye nokukhubazeka zihlolwe nganye nge-2-by-4 uhlalutyo lwemodeli yokuxhatshazwa (ANOVA), kunye neqela lonyango (ukuxhaphaza ngokubhekiselele ekukhuthazeni nasekusebenziseni umsebenzi) njengento ephakathi kwezifundo kunye nexesha (isiseko, Iveki ye-1, iiveki ze-4, kunye ne-3 inyanga ukulandelelana) njengezifundo ezikhoyo ngaphakathi. I-ANOVA ezahlukileyo zenziwa nge-NPRS (intloko yesisindo) kunye ne-(ukukhubazeka) njengento exhomekeke kuyo. Kwi-ANOVA nganye, ingcamango yenzalo yindlela yokusebenzisana kwe-2 (iqela ngexesha).

 

Uvavanyo oluzimeleyo t lwalusetyenziselwa ukumisela umahluko phakathi kweqela ngotshintsho lwepesenti ukusuka kwisiseko ukuya kwi-3-inyanga yokulandelelana kokubini kwentloko kunye nokukhubazeka. Ulwahlulo olwahlukileyo lweMannhitWhitney U lwenziwa rhoqo ngeentloko, i-GRC, ubude beentloko kunye nokutya amayeza njengokuhluka okuxhomekekileyo. Senze i-Little'ss Missing ngokupheleleyo kuVavanyo lwe-Random (MCAR) [64] ukumisela ukuba amanqaku eedatha alahlekileyo ahambelana nokuyeka kwabafundi abalahlekile ngokungahleliwe okanye alahlekileyo ngenxa yezizathu zenkqubo. Uhlalutyo olunomdla kunyango lwenziwa kusetyenziswa uLindelo-loMgangatho apho idatha engekhoyo ibalwa kusetyenziswa ukubuyiswa kwemilinganiselo. Ukuthelekiswa okucwangcisiweyo kokubini kwenziwa kwenzelwa ukuvavanya umohluko phakathi kwesiseko kunye nexesha lokulandelela phakathi kwamaqela kusetyenziswa ukulungiswa kweBonferroni kwinqanaba le-alpha le -05.

 

Senza izigulane zidibeneyo njengabaphenduli kwi-3-inyanga yokulandela emva kokusebenzisa amanqaku aphuculwayo okuphucula amaphuzu e-2 kwintloko yesifo njengentengo ye-NPRS. Amanani ayedinga ukuphatha (NNT) kunye ne-95% yexesha lokuzithemba (CI) nabo babalwa kwixesha le-3 lokulandelela kweenyanga basebenzisa ngasinye sale nkcazo ngemiphumo ephumelelayo. Uhlalutyo lwedatha lwenziwe nge-SPSS 21.0.

 

iziphumo

 

Izigulana ezingamakhulu amabini anamashumi mahlanu ananye ezinezikhalazo eziphambili zentloko ziye zavavanywa ukufaneleka. Izizathu zokungafaneleki zinokufumaneka kwi Ikhiwane. 3, umzobo wokuhamba wokugaywa kwesigulana kunye nokugcinwa. Kwizigulana ezingama-251 ezihloliweyo, izigulana ezili-110, ezineminyaka yobudala engama-35.16 (SD 11.48) kunye nobude beempawu zeminyaka emi-4.56 (SD 6.27), yanelisile iikhrayitheriya zokufaneleka, yavuma ukuthatha inxaxheba, kwaye yahlelwa ngendlela engekho mthethweni (n ? =? 58) kunye nokuhlanganisa kunye nokuzilolonga (n? =? 52) amaqela. Izinto eziguquguqukayo ezisisiseko kwiqela ngalinye zinokufumaneka kwiTheyibhile 1. Abalishumi elinambini bezonyango ezivela kwiiklinikhi zonyango zonyango ezingalaliswayo ezisisi-8, 25, 23, 20, 14, 13, 7 okanye ezi-6 ngokulandelelana; Ngapha koko, ngamnye wabanyangi abali-2 wanyanga malunga nomyinge olinganayo wezigulana kwiqela ngalinye. Kwakungekho mahluko ubalulekileyo (p? =? 12) phakathi kwenani leentsingiselo zeeseshoni zonyango ezigqityiweyo zeqela lokukhohlisa (0.227, SD 7.17) kunye nokuhlanganisa kunye neqela lokuzilolonga (0.96, SD 6.90). Ukongeza, inani elichaziweyo leeseshoni zonyango ezijolise kwi-C1.35-1 articulation yayiyi-2 (SD 6.41) yeqela lokukhohlisa kunye ne-1.63 (SD 6.52) yokuhlanganisa kunye neqela lokuzilolonga, kwaye oku bekungafani ngokwahlukileyo (p? =? 2.01). Amakhulu asixhenxe abaguli abangama-0.762 abagqibe onke amanyathelo eziphumo kwiinyanga ezi-110 (ukulandelelwa kwe-3%). Ukulahleka okuncinci ngokuPheleleyo kuvavanyo lweRandom (MCAR) kwakungabalulekanga ngokwezibalo (p? =? 97); Ke ngoko, sisebenzise ubuchwephesha bokulindela-bokwandisa ukubekwa endaweni yamaxabiso ashiyekileyo kunye namaxabiso aqikelelweyo kwiziphumo zeenyanga ezi-0.281 ezilahlekileyo.

 

Umzobo we-3 Flow Figure of Recitment Recruitment and Storage ... El Paso, TX I-Chiropractor

 

Itheyibhile ye-1 Isiseko seNguqulelo, iMimographic and Outcome Measures | El Paso, TX I-Chiropractor

 

Iqela lilonke ngokudibana kwexesha lesiphumo sokuqala sobunzima beentloko kwakubalulekile ngokwe-NPRS (F (3,106)? =? 11.196; p?

 

Itheyibhile 2 Iinguqu kwiintloko zeNtloko kunye nokukhubazeka | El Paso, TX I-Chiropractor

 

Itheyibhile 3 Ipesenteji yeziGaba Ukufumana i-50, i-75, kunye ne-100 Ipesenti yokunciphisa | El Paso, TX I-Chiropractor

 

Kwiziphumo ezisekondari iqela elibalulekileyo ngokudibana kwexesha belikho kwi-NDI (F (3,106)? =? 8.57; p?

 

Uvavanyo lukaMann Whitney U lubonakalise ukuba abaguli abakwicandelo eliphezulu lomlomo wesibeleko kunye neqela eliphezulu lokuxhaphaza abanamava aqaqanjelwa yintloko rhoqo kwiveki e-1 (p?

 

Khange siqokelele nayiphi na idatha malunga neziganeko ezimbi ze- minor [48, 49] (iimpawu zexeshana zemithambo-luvo, ukwanda kokuqina, ukukhupha iintlungu, ukudinwa okanye enye into); Nangona kunjalo, akukho ziganeko ze- major ezimbi [48, 49] (ukubetha okanye ukusilela ngokusisigxina kwe-neurological) kwaxelwa elinye iqela.

 

ingxoxo

 

Ingxelo yeSigqeba esiPhezulu

 

Kulwazi lwethu, olu phononongo luvavanyo lokuqala lweklinikhi olungenakuthelekiswa nanto ngokuthelekisa ngokuthe ngqo ukusebenza kokubini komlomo wesibeleko kunye ne-thoracic ekuhlanganiseni nasekuzilolongeni kwizigulana ezine-CH. Iziphumo zicebisa iiseshoni ezi-6 ukuya kwezi-8 zokuxhaphaza ngaphezulu kweeveki ezi-4, ezijolise ikakhulu kumlomo wesibeleko (C1-2) kunye ne-thoracic ephezulu (T1-2) spines, kukhokelele kuphuculo olukhulu kwintloko, ukukhubazeka, ukuphindaphindeka kwentloko, ubude beentloko. , kunye nokutya amayeza kunokugaya ukudibanisa nokuzilolonga. Uqikelelo lwenqaku lokutshintsha kweqela phakathi kwentloko yamandla (amanqaku e-2.1) kunye nokukhubazeka (amanqaku e-6.0 okanye i-12.0%) idlulile kwii-MCID ezichaziweyo kuwo omabini la manyathelo. Nangona i-MCID ye-NDI kwizigulana ezine-CH ingekaphandwa, kufanele ukuba kuqatshelwe ukuba uqikelelo olusezantsi lwe-95% CI yokukhubazeka (amanqaku e-3.5) yayingezantsi kancinci (okanye yayiqikelelwa kumatyala amabini) i-MCID leyo kuye kwafunyanwa ukuba yi-3.5 [65], 5 [66], kunye ne-7.5 [45] amanqaku kwizigulana ezineentlungu zentamo, 8.5 [33] amanqaku kwizigulana ezine-radiculopathy yomlomo wesibeleko, kunye ne-3.5 [44] amanqaku kwizigulana ezinomxube, iintlungu zentamo ezingachazwanga. Nangona kunjalo, kufanele kuqatshelwe ukuba omabini la maqela enze ukuphuculwa kweklinikhi. Ukongeza, i-NNT icebisa ukuba zonke izigulana ezine ziphathwe ngokunyanzelwa, endaweni yokuhlanganisa, esinye isigulana sifezekisa ukuncitshiswa kwentlungu kwiinyanga ezintathu zokulandelwa.

 

Amandla kunye nobuthathaka beSifundo

 

Ukubandakanywa kwe-12 yokwelapha iipilisi zangasese ze-8 kwii-6 zizwe ezihlukeneyo zendawo ziphucula uwonke jikelele lweziphumo zethu. Nangona ukungafani okuphawulekayo kwaqatshelwa kwiinyanga ze-3, awaziwa ukuba ezi zinzuzo ziza kuzinyelwa kwixesha elide. Ukongezelela, sasebenzisa i-high-speed, ubuchule bokusetyenziswa kwezinto eziphantsi kwe-amplitude eziqeshisa i-bidirectional zitshintsha ngokujikeleza kunye nokuguqulela kanye kunye ne-Maitland esekelwe kwi-grade IV ye-AP; Ngaloo ndlela, asinakuqiniseka ukuba ezi ziphumo zizaliseka kwezinye iindidi zobugcisa bokunyanga. Abanye banokuba bathi iqela elifanisayo lingazange lifumane ukungenelela okwaneleyo. Sifuna ukulinganisela ukuqiniswa kwangaphakathi nangaphandle ukwenzela ukuba unyango olumiselweyo kumaqela amabini kwaye lunikezela inkcazo ecacileyo yeendlela ezisetyenzisiweyo eziza kuvumela ukuphindaphinda. Ukongezelela, asizange senze imilinganiselo embi embi kwaye sabuza kuphela malunga nezimbini ezinobungozi ezinkulu. Omnye umda wukuthi siquke iziphumo ezininzi zesibini. Ukukhethwa kwamathambo malunga nokuba yiyiphi inqubo abacinga ukuba iya kuba yinto ephakamileyo ayiqokelelwanga kwaye ingaba nefuthe kwiziphumo.

 

Amandla kunye nobuthathaka ngokuphathelele kwezinye izifundo: Ulwahlulo olubalulekileyo kwiziphumo

 

Jull et al. [I-11] yabonakalisa ukonyango ngonyango olwenziwe ngonyango kunye nokusebenza ngokulawulwa kwe-CH; Nangona kunjalo, le phakheji yonyango ibandakanya ukuhlanganiswa nokuphathwa. Uphononongo lwangoku lunokuba lunobungqina bokuba ukuphathwa kwezigulane ezine-CH kufuneka kufake uhlobo oluthile lokuxhaphaza nangona kunjalo kudla ukuba kucetyiswa ukuba ukuphathwa komlomo kuphephe ngenxa yemingcipheko yeziganeko ezimbi (67, 68]. Ukongezelela, kuboniswe ukuba abantu abafumana ukunyanzeliswa kwemisipha ngentlungu yentamo kunye neentloko ababa nako ukufumana unxephezelo lwe-vertebrobasilar kunokuba bafumana unyango ngugqirha wabo wezonyango [69]. Ukongezelela, emva kokuphonononga iingxelo ze-134, i-Puentedura et al. kugqiba ukuba ngokukhetha ngokufanelekileyo izigulane ngokujonga ngokucophelela iiflegi ezibomvu kunye nokuchasene, uninzi lweziganeko ezimbi ezinxulumene nokunyanzeliswa komlomo zingenakuthintela [70].

 

Iintsingiselo zezifundo: Iingcaciso ezikhoyo kunye nefuthe kwiiNtsholongwane kunye nabaPolisi

 

Ngokusekelwe kwiziphumo zeengcali zamatyala kufuneka ziqwalasele ukubandakanya ukunyanzeliswa komgudu wabantu abane-CH. Ukuphononongwa ngokutsha kwenkqubo ekhoyo kwangoko kufumaneke ukuququzelela kunye nokuphathwa kakuhle ukuba kusebenze ukuphathwa kwezigulane ezine-CH kodwa akakwazanga ukufumanisa ukuba yiyiphi indlela ephakamileyo [8]. Ukongezelela, izikhokelo zeklinikhi zichaze ukuba ukuphathwa, ukuxhotyiswa kunye nokusebenza konke kwakunempumelelo ekulawuleni izigulane ezine-CH; Nangona kunjalo, isikhokelo asizange senze iziphakamiso malunga nokuphakama kweendlela. [71] Iziphumo zangoku zinokunceda abalobi beengxelo ezichanekileyo kunye nezikhokelo zekliniki ekunikezeni iingcebiso ezithile malunga nokusetyenziswa kobuthakathaka bomgudu kule ndawo.

 

Imibuzo engaphenduliweyo kunye nophando lwexesha elizayo

 

Iindlela ezisisiseko zokuba kutheni ukuphathwa gadalala kunokuba neziphumo zophuculo olukhulu kuhlala kucacisiwe. Kuye kwacetyiswa ukuba ukufuduka kwe-velocity ephezulu ye-vertebrae kunye nexesha lokunyanzeliswa elingaphantsi kwama-200 ms linokutshintsha amazinga okukhutshwa afanelekileyo [72] ngokukhuthaza ama-mechanoreceptors kunye ne-proprioceptors, ngaloo ndlela utshintshe ama-alpha motorneuron amanqanaba okuxhamla kunye nemisebenzi ye-muscle elandelayo [72-74]. Ukunyanzeliswa kunokuphinda kukhuthaze ii-receptors kwimisipha enzulu ye-paraspinal, kunye nokuququzelela kunokuba nakho ukubhexesha ukwamkela izihlunu ezingaphezulu [75]. I-Biomechanical [76, 77], umnqonqo okanye i-segmental [78, 79] kunye nokuhla okuphakathi kwendlela yokuthintela iintlungu [80 83] ziimodeli ezichazayo ezinokubakho kwiziphumo ze-hypoalgesic eziqwalaselweyo emva kolawulo. Kutshanje, iimpembelelo ze-biomechanical of manipulation beziphantsi koqwalaselo lwenzululwazi [84], kwaye kuyacaca ukuba izibonelelo zeklinikhi ezifunyenwe kwisifundo sethu zinxulunyaniswa nempendulo ye-neurophysiological ebandakanya isishwankathelo semvakalelo yokwexeshana kwiphondo lomqolo wentambo yomqolo [78]; Nangona kunjalo, le modeli icetywayo ngoku ixhaswa kuphela kwiziphumo ezivela okwexeshana, iintlungu ezibangelwa luvavanyo kwizifundo ezisempilweni [85, 86], hayi abaguli abane-CH. Izifundo ezizayo kufuneka zivavanye iindlela ezahlukeneyo zonyango olusebenzisa iidosi ezahlukeneyo kwaye zibandakanye nokulandela unyaka omnye. Ngaphaya koko, izifundo ezizayo ezivavanya iimpembelelo ze-neurophysiological zoxinzelelo kunye nokuququzelela kuya kubaluleka ekumiseleni ukuba kutheni kunokubakho okanye kungabikho mahluko kwiziphumo zonyango phakathi kwezi zonyango zimbini.

 

isiphelo

 

Iziphumo zophononongo yangoku kwabonisa ukuba izigulane CH abafumene izakhi wesibeleko kunye thoracic abanamava izinciphiso kakhulu mkhulu ngamandla yintloko ebuhlungu, ukukhubazeka, intloko ebuhlungu kwamaza, ubude intloko ebuhlungu, kunye namayeza inani xa kuthelekiswa neqela ezafumana ukubizwa kunye nokusebenzisa; Ngaphezu koko, iziphumo zagcinwa kwiinyanga ze-3 zokulandela. Ucwaningo lwexesha elizayo lufanele luhlolisise ukusebenza kweentlobo ezahlukeneyo kunye nemilinganiselo yokuphathwa kunye nokuquka ukulandelelana kwexesha elide.

 

Imibulelo

 

Akukho namnye wabalobi abafumene naliphi na inkxaso-mali yale sifundo. Ababhali banqwenela ukubonga bonke abathathi-nxaxheba besifundo.

 

Imihlathi

 

  • Injongo yokunyanzela: UDkt. James Dunning nguMongameli we-American Academy of Treatment Therapy (AAMT). I-AAMT inikeza iinkqubo zokuqeqesha i-postgraduate ku-spinal manipulation, u-spinal mobilization, ukunyanzelwa kwesigxina, ukuchithwa kwamagqabi, ukuququzelela ukuphela, ukuxhaswa kwezixhobo ezincedisayo kunye nokuzivocavoca kwezilwanyana eziphathekayo, i-osteopaths kunye noogqirha. Drs. UJames Dunning, uRaymond Butts, uThomas Perreault, kunye noFiras Mourad ngabaqeqeshi abaphezulu be-AAMT. Abanye abalobi bavakalisa ukuba abanalo inxaxheba.
  • Igalelo lababhali: I-JRD ithathe inxaxheba ekukhuleni, ukuyila, ukufumana idatha, ukuhlalutya kwamanani kunye nokuqulunqwa kombhalo wesandla. I-RB kunye ne-IY bathathe inxaxheba ekudalweni, ukuqokelela idatha, ukuhlaziywa kwamanani kunye nokuhlaziywa kwincwadi yesandla. I-FM ithathe inxaxheba ekuvelweni, ukuhlalutya izibalo, ukuchazwa kwedatha nokuhlaziywa kwincwadi yesandla. UMH uthathe inxaxheba ekukhulelweni, ukuyila nokuhlaziywa kwembhalo. I-CF kunye no-JC babandakanyeka kuhlalutyo lwamanani, ukutolika kwedatha, nokuhlaziywa okubalulekileyo kwincwadi yesibrari ngokubaluleka kokubhaliweyo kwengqiqo. I-TS, i-JD, i-DB, kunye ne-TH babandakanyeka ekuqokelelwa kwedatha nokuhlaziywa kwincwadi yesandla. Bonke abalobi bafunde kwaye bavumile umbhalo wesigqi wokugqibela.

 

I ngcaciso

 

Ncbi.nlm.nih.gov/pmc/articles/PMC4744384/

 

Ukuququmbela,Intlungu yentloko ebangelwa yintloko yesibini ngenxa yemeko yezempilo ecaleni kwezakhiwo ezijikeleze umqolo wesibeleko, okanye intamo, kunokubangela iimpawu ezibuhlungu nezidimazayo ezinokuchaphazela umgangatho wobomi besigulana. Ukunyanzeliswa komgudu kunye nokuhlanganiswa kungasetyenziselwa ngokukhuselekileyo nangokufanelekileyo ukunceda ukuphucula iimpawu zentloko ye-cervicogenic. Ulwazi olukhankanyiweyo kwiZiko leLizwe leNgcaciso yeBiotechnology (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

 

 

Green-Call-Now-Button-24H-150x150-2-3.png

 

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.

 

umfanekiso webhlogi weendaba eziphambili zephepha lephepha

 

ISIHLOKO ESIBALULEKILEYO: Ukwelashwa kweMigraine Pain

 

 

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

 

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Vala i-Accordion
Izikhokelo Zonyango Zonyango E-El Paso, TX

Izikhokelo Zonyango Zonyango E-El Paso, TX

by | Chiropractic, Uvavanyo oluLungeleleneyo oluLungisiweyo

Intlungu yentloko yenye yezona zizathu ezigqithisileyo zokutyelela iofisi. Uninzi lwabantu lubafumana ngethuba elithile ebomini babo kwaye lunokuchaphazela nabani na, kungakhathaliseki ubudala, ubuhlanga kunye nesini. I-International Headache Society, okanye i-IHS, ikwahlula intloko njengento ephambili, xa ingabangelwa enye inzakalo kunye / okanye imeko, okanye kwesekondari, xa kukho isizathu esiphezu kwabo. Ukusuka migraines ukuqoqa intloko kunye nentloko yexinzelelo, abantu abaneziintlungu zentlungu rhoqo bangakufumana kunzima ukuthatha inxaxheba kwimisebenzi yabo yemihla ngemihla. Abaninzi bezonyango baphatha intlungu yentloko, nangona kunjalo, ukunakekelwa kwe-chiropractic kuye kwaba yindlela ekhethwa yonyango ekhethiweyo kwimicimbi eyahlukeneyo yempilo. Injongo yale nqaku ilandelayo kukubonisa izikhokelo ezisekelwe kwisiseko sokunyangwa kwe-chiropractic yabantu abadala abaneentloko.

 

Izikhokelo ezisekelwe kwiNgcebiso yeChirpractic Treatment of Adult with Headache

 

Abstract

 

  • Injongo: Injongo yale ncwadi yesandla kukubonelela ngeengcebiso-zengcebiso zenkqubela ye-chiropractic unyango lwentloko kubantu abadala.
  • Iindlela: Uphando lweencwadi oluchanekileyo lwezilingo zokulawulwa kweekliniki ezipapashwe ngo-Agasti 2009 ezifanelekileyo malunga nokusebenza kwe-chiropractic zenziwa ngokusetyenziswa kweenkcukacha MEDLINE; EMBASE; Ulwalamano kunye noNyango oluPheleleyo; I-Index Yoluhlu lweeNcwadi zoLondolozo kunye neZempilo zoLuntu; Umqulu, iNkqubo, kunye neNyango yoLwazi lweZonyango; Alt HealthWatch; Inkcazo yeTyhurthikhi; kunye neTranskrit Cochrane. Inombolo, umgangatho, kunye nokuhambelana kweziphumo zacatshangelwa ukuba zinike amandla obanzi obubungqina (ezinamandla, ezilinganayo, ezilinganiselweyo, ezingqinelaniyo) kunye nokwenza iziphakamiso zendlela.
  • iziphumo: Amanqaku angamashumi amabini ananye adibanisa imigaqo yokufakwa kunye kwaye isetyenziselwa ukuphuhlisa iziphakamiso. Ubu bungqina abuzange budlule kwizinga elilinganayo. Ukulungiswa kwemigudu, ukuguqulwa kwemisipha kunye nokungenelela kwamanyathelo ahlukeneyo okubandakanya ukusikwa kwamathambo kunconywa ukuphathwa kwezigulane ezine-episodic okanye ezingapheliyo. Ukuxilongwa kwentloko, ukunyanzeliswa komgudu akunakunconywa kulawulo lwe-headache type-headache. Isiphakamiso asikwazi ukucwangciswa okanye ngokuchasene nokusetyenziswa komgudu wokugulisa izigulane ezinezifo zentlungu ezingapheliyo. Ukunyuka kwe-craniocervical ingabangela inzuzo yokulawula ixesha elide lwezigulane ezineentloko ze-episodic okanye ezingapheliyo. Ukunyangwa kwentloko, ukunyanzeliswa komgudu kunconywa. Ukuhlanganiswa okuhlangeneyo okanye ukunyamezela intamo ye-flexor umzimba kunokuphucula iimpawu. Akukho nzuzo eqhubekayo yokuhlanganisa ukuhlanganiswa ngokubambisana kunye nokunyaniseka kwentamo ye-flexor exercises kwizigulane ezinentloko ye-cervicogenic. Iziganeko ezimbi azizange zibhekiswe kwizilingo ezininzi zeeklinikhi; kwaye ukuba bekunjalo, kwakungekho namnye okanye bebancinane.
  • Izigqibo: Ubungqina bubonisa ukuba ukunakekelwa kwe-chiropractic, kuquka ukunyanzeliswa kwempompo, kuphucula i-migraine
    kunye nentloko yomlomo. Uhlobo, ubude, umlinganiselo, kunye nobude bonyango (s) kufuneka kusekelwe kwizikhokelo zesikhokelo, amava eenkliniki kunye neziphumo. Ububungqina bokusetyenziswa kwegulana njengendlela yokungenelela kwodwa kwizigulane ezineentloko zentlobo-ntloko zihlala zilingana. (J Uluhlu lwePhysiol Ther 2011; 34: 274-289)
  • Iimpawu eziPhambili zeNkcazo: Ukunyanzeliswa komgudu; Iziphazamiso zeMigraine; Intambo-Thayipha intloko; Intloko yesifo; Isikhokelo sokuSebenza; Chiropractic

 

UDkt Jimenez White Coat

Insight of Dr. Alex Jimenez

Intloko, okanye iintlungu zentloko, kuquka i-migraine nezinye iintlobo zeentloko, yenye yezona ntlobo eziqhelekileyo zentlungu ebhaliweyo phakathi kwabantu bonke. Ezi zinokuthi zenzeke kwelinye okanye kumacala omabini entloko, zinokuthi zixhomekeke kwindawo ethile okanye ziyakwazi ukuhamba ngaphaya kwentloko ukusuka kwindawo enye. Nangona iimpawu zentloko ziyahlukahluka ngokuxhomekeka kwintlobo yesifo se ntloko kunye nangenxa yemvelaphi yenkxalabo yempilo, iintloko zithathwa njengesingxoxwa ngokubanzi kungakhathaliseki ubunzima kunye nefom. Intloko, okanye intlungu yentloko, inokwenzeka ngenxa yesiphumo sokuguqulwa kwamagqabi, okanye i-subluxation, kunye nobude bomgudu. Ngokusebenzisa ukuguqulwa komgogodla kunye nokunyanzeliswa kwemigaqo, ukunyamekelwa kwe-chiropractic kungaphumelela kwaye kuphumelele ukulungisa umgudu, ukunciphisa uxinzelelo kunye noxinzelelo kwizakhiwo ezijikelezayo zomgudu, ekugqibeleni kukunceda ukuphucula impawu zentlungu yesifo kunye nempilo yonke kunye nokuphila kakuhle.

 

Intloko yinto eqhelekileyo kubantu abadala. Iintsholongwane eziphindaphindiweyo zichaphazela kakubi ubomi bentsapho, umsebenzi wezenhlalakahle kunye nomsebenzi womsebenzi. [1,2] Ehlabathini lonke, ngokweMpilo Yehlabathi Yehlabathi, i-migraine yedwa ngu-19th phakathi kwazo zonke izizathu zonyaka ezihlala nezikhubazo. Intloko yesithathu phakathi kwezizathu zokufuna unyango lwe-chiropractic eNyakatho Melika. [3]

 

Ukuxilongwa ngokuchanekileyo kubalulekile ekuphatheni nasekunyangeni, kwaye uluhlu olubanzi lweentlobo zeentloko zichazwe kwiSizwe soBume beZizwe eziPhephayo zeNtloko 2 (I-International Headache Society [IHS]). [4] Iindidi zenzelwe uklinikhi kunye nokusetyenziswa kophando. Iintsholongwane eziqhelekileyo, uhlobo lokuxhatshazwa kunye ne-migraine, zibhekwa njengeentloko eziphambili okanye zizifo ezingapheliyo. I-epradic migraine okanye i-head-type-headaches iyenzeka ngaphantsi kweentsuku ze-15 ngenyanga, kanti iintsuku ezingapheliyo zivela ngaphezu kwe-15 ngeenyanga ubuncinane kwi-3 (migraine) okanye kwi-6 inyanga (intloko yesifo senwele). [4] iingxaki zekliniki ezingundoqo entloko okanye entanyeni enokuthi ibe yi-episodic okanye ingapheliyo. Iintsholongwane ze-Cervicogen ziyakuthi ziphathwe ngamakhanda asekondari kwaye zibandakanya iintlungu ezibhekiswe kumthombo entanyeni kwaye zibonwe kwi-1 okanye kwimimandla engaphezulu. I-IHS iyaqaphela intloko yesifo somlomo njengengxaki ehlukileyo, [4] kunye nobungqina bokuba intloko ingabangelwa yintlungu yesifo okanye i-lesion esekelwe kwimbali kunye nempawu zekliniki (imbali yentlungu, ukunyanzeliswa kwentlungu, ukunciphisa intlobo yesondlo, Ukunyamezela kwentamo, kungabandakanyi intlungu ye-myoyedwa yedwa) kufanelekileyo ukuxilongwa kodwa akukho nxamnye nolu hlobo kwiincwadi. [4,5] Xa ubuhlungu be-myofasha kuphela yimbangela, isigulane kufuneka siphathwe njengento enentloko yokuxhaphaza. [4]

 

Iimodalities ezonyango ezisetyenziselwa izigulane zokunyamekela izigulane ezinentloko ziquka ukunyanzelisa umlenze, ukuxhobisa, ukuxhaswa kwezixhobo zomnxeba, imfundo malunga neendlela zokuphila eziguquguqukayo, iindlela zokhathaza umzimba, ukufudumala / imvula, ukusilalisa, ukunyanga kwezicubu ezincinci ezifana nokunyanga, kunye nokomeleza nokwelula. Kukho ukulindela okukhulayo kwimisebenzi yezempilo, kubandakanya i-chiropractic, ukufumana nokusebenzisa ulwazi olusekelwe kuphando, kuthatha iakhawunti eyaneleyo yobungqina bobuphando obufumanekayo ukuzisa ulwazi lwekliniki. Ngenxa yoko, injongo yeCanada Chiropractic Association (CCA) kunye neCanada Federation of Chiropractic Regulatory and Education Accrediting Boards (Project) Iprojekthi yeZikhokelo zoLwazi lweKlinikhi kukuphuhlisa izikhokelo zokusebenza ngokusekelwe kubungqina obukhoyo. Injongo yale ncwadi yesandla kukubonelela ngeengcebiso-zengcebiso zenkqubela ye-chiropractic unyango lwentloko kubantu abadala.

 

tindlela

 

IKomiti yoPhuhliso lweZikhokelo (GDC) icwangcisele kwaye ilungelelanise iinkqubo ezicwangcisiweyo zokukhangela, ukuhluza, ukuphonononga, ukuhlalutya, kunye nokutolika. Iindlela ezi zihambayo ziyangqinelana neendlela ezicetywayo �UVandlakanyo lweziKhokelo zoPhando noVavanyo� intsebenziswano (www.agreecollaboration.org). Esi sikhokelo sisixhobo esixhasayo seengcali. Akujoliswanga njengomgangatho wokhathalelo. Isikhokelo siqhagamshela ubungqina obukhoyo obupapashiweyo kunyango lwaseklinikhi kwaye lilungu le-1 kuphela lendlela enolwazi-kubungqina kukhathalelo lwezigulana.

 

Imithombo Yedatha kunye noPhando

 

Uphando oluchanekileyo kunye nokuvavanywa kweencwadi zonyango luqhutywe kusetyenziswa iindlela eziphakanyiswe yiQumrhu leCocrane Cooperation Back Review Group [6] kunye no-Oxman noGuatt. [7] Isicwangciso sophando saphuhliswa kwi-MEDLINE ngokuhlola iMeSH ngokumalunga ne-chiropractic kunye nongenelelo oluthile kwaye kamva ukuguqulwa kwezinye iinkcukacha. Isicwangciso sophando lweencwadi sasininzi ngokubanzi. Ulwaphulo lwe-Chiropractic luchazwe njengoluhlobo oluqhelekileyo lwezonyango ezisetyenziswe ngabagcisa kwaye aluzange lubekwe kumanyathelo okunyango awanikezwa kuphela ngabaphathi bezonyango. Inetha elibanzi lalingelwa ukuquka unyango olunokulawulwa kwinkathalo ye-chiropractic kunye nalawo angeniswe nakwiimeko zokunyamekelwa ngabanye abaqeqeshi bempilo kwiphando oluthile lophando (IsiHlomelo A). Ukuguqulwa kwamagqabi kuye kwachazwa njenge-high-speed velocity low-amplitude eyenzelwa intsipho. Ukungabikho kwonyango kwakuquka iinkqubo ezingummangaliso okanye iinkqubo ze-neurostimulation, i-pharmacotherapy, ii-injections ze-toxin ye-botulin, i-cognitive okanye i-behavioral treatments, kunye ne-acupuncture.

 

Uphando loncwadi lwagqitywa ukusukela ngo-Epreli ukuya kuMeyi 2006, kwahlaziywa ngo-2007 (isigaba 1), kwahlaziywa kwakhona ngo-Agasti 2009 (isigaba 2). Indawo yolwazi ekhangelwe ibandakanya iMEDLINE; ULAWULO; Amanyeneyo kunye noNyango oluDibeneyo; Isalathiso sokuQokelelwa kuNcwadi lwaBongikazi kunye neAllied Health Literature; Incwadana yemigaqo, eNye indlela, kunye neNkqubo yoLwazi lweNdalo; I-AltWatchWatch; Isalathiso kuLwazi lweChiropractic; kunye neThala leencwadi laseCochrane (Isihlomelo A). Ukukhangela kwakubandakanya amanqaku apapashwe ngesiNgesi okanye ngesiNgesi. Icebo lokukhangela lalilinganiselwe kubantu abadala (? Iminyaka eli-18); nangona izifundo zophando kunye neenqobo zokubandakanya isifundo ezibandakanya uluhlu olubanzi lweminyaka, njengabantu abadala kunye nolutsha, zafunyanwa kusetyenziswa isicwangciso sokukhangela. Uluhlu lweereferensi ezibonelelwe kuvavanyo olucwangcisiweyo (i-SRs) ziye zajongwa kwakhona yi-GDC ukunciphisa amanqaku afanelekileyo ukuba aphoswe.

 

Iingqinisiso zokuKhethwa koBungqina

 

Iziphumo zokukhangela zavavanywa ngombane, kwaye kusetyenziswa amanqanaba amaninzi (Isihlomelo B): inqanaba 1A (isihloko), 1B (abstract); Inqanaba 2A (isicatshulwa esipheleleyo), i-2B (indlela yokubhaliweyo epheleleyo, ukufaneleka); kunye nenqanaba 3 (isicatshulwa esigcwele-sokugqibela sokuvavanywa kwe-GDC njengeengcali zomxholo weklinikhi). Izicatshulwa eziphindiweyo zisusiwe, kwaye amanqaku afanelekileyo afunyenwe njenge-elektroniki kunye / okanye iikopi ezikhutshiweyo zohlalutyo oluneenkcukacha. Abavavanyi abohlukeneyo, besebenzisa iikhrayitheriya ezifanayo, bagqibezela izikrini zoncwadi ngo-2007 nango-2009 ngenxa yexesha eliphakathi kokhangelo.

 

Izilingo zonyango kuphela ezilawulwayo (i-CCTs); izilingo ezilawulwa ngokungahleliyo, ezilawulwayo (RCTs); nokuphononongwa ngokuchanekileyo (i-SRs) kukhethwe njengobungqina obunesi sikhokelo esivumelana nemigangatho ekhoyo yokutolika iziphumo zekliniki. I-GDC ayizange ifake iiphononongo zezifundo, uchungechunge lwamacandelo, okanye iingxelo zecala ngenxa yobume babo obungalawulwayo kunye nekhwalithi ebonakalayo ephantsi ye-methodological vs CCTs. Le ndlela ihambelana neendlela ezihlaziyiweyo ze-SRs ezipapashwe yiQela leComrane Review Review. [8] Ukuba ezininzi ii-SRs zapapashwa ngababhali abafanayo kwisihloko esinikeziwe, kuphela ukushicilelwa kwangoko kwabalwa kwaye kusetyenziswa ubungqina bokubambisana. Ukuphononongwa ngokuchanekileyo kwe-SRs kwachithwa ngaphandle ukuphepha ukubalwa kabini kweziphumo zophando.

 

Uvavanyo lweeNcwadi kunye nokuThetha

 

Ukulinganiswa komgangatho wee-CCTs okanye ii-RCTs kubandakanya iikhrayitheriya ze-11 eziphendulwe ngu-ewe (amanqaku 1) okanye u-hayi (amanqaku 0) / andazi (amanqaku 0) (1 Table). I-GDC ibhale i-2 eyongezelelweyo yeenqobo zomdla: (1) Ukusetyenziswa kwabaphandi kweendlela zokuqonda isifo ze-IHS kubhaliso lwezifundo kunye (2) novavanyo lweziphumo ebezingalindelekanga (1 Table, iikholamu L kunye M). Ukusetyenziswa kweekhrayitheriya ze-IHS [4] kwakufanelekile kule nkqubo yesiKhokelo sokuziQhelanisa neKlinikhi (CPG) ukuqinisekisa ubungqina bokuqonda isifo ngaphakathi nakulo lonke uphando lwezifundo. Izifundo azifakwanga ukuba iikhrayitheriya zokuqonda isifo ze-IHS khange zisetyenziswe ngabaphandi ukuze kufakwe isifundo kufundo (Isihlomelo C); kwaye ukuba ngaphambi kwe-2004, ngaphambi kokuba i-cervicogenic headache ifakwe kwi-IHS, i-criteria ye-diagnostic yeCervicogenic Headache International Study Group [9] ayizange isetyenziswe. Iziphumo ebezingalindelekanga ziye zaqwalaselwa njengommeli wobungozi obunokubakho kunyango. Akukho zinto zokulinganisa zisetyenzisiweyo kwiikhrayitheriya zomntu ngamnye, kwaye ukulinganiswa komgangatho kunokwenzeka ukusuka ku-0 kuye ku-11. Zombini iimfama zezifundo kunye nababoneleli ngononophelo babalinganiswa kumanqaku ophando yi-GDC, kuba ezi zinto zidwelisiwe kwisixhobo sokulinganisa umgangatho. [6] Iindlela ze-GDC azikhange zilungelelanise okanye zitshintshe isixhobo sokureyitha. Isizathu sale ndlela yayikukuba iindlela ezithile zonyango (umzekelo, amandla ombane akhuthazayo [i-TENS], i-ultrasound) kunye noyilo lwesilingo sinokufikelela kwisigulana kunye / okanye ugqirha ongaboniyo. [10] I-GDC ayikuthintelanga kuvavanyo lwala mabhentshi omgangatho ukuba eneneni zichazwe kwizifundo zeklinikhi zonyango lweengxaki zentloko. I-GDC ikwaqwalasele ngaphandle kobuchule bayo ukuguqula, ngaphandle kokuqinisekisa, isixhobo esisetyenziswa ngokubanzi sokuvavanya uncwadi lweklinikhi. [6] Izixhobo ezitsha zophando kuhlalutyo kunye nenqanaba loncwadi lonyango olusebenzayo, nangona kunjalo, ziyafuneka ngokungxamisekileyo kwaye ziyaqwalaselwa njengendawo yophando lwexesha elizayo kwicandelo lengxoxo elingezantsi.

 

Uluhlu lwe-1 Ratings of Qualitative Trials of Trials Trials of Physical Treatment for the Management of Disorders Disorders

 

Abavavanyi boncwadi babengabanikeli beprojekthi abahlukileyo kwi-GDC kwaye babengafakwanga nto ngaphandle kokufunda ababhali, amaziko, kunye nemithombo yeendaba. Amalungu amathathu e-GDC (MD, RR, kunye ne-LS) aqinisekisile iindlela zokulinganisa umgangatho ngokugqibezela uvavanyo lomgangatho kwiseti engacwangciswanga yamanqaku ali-10. [11-20] Inqanaba eliphezulu lesivumelwano laqinisekiswa kumanqanaba onke omgangatho. Ukugqitywa kwesivumelwano kuzo zonke izinto kufezekisiwe kwizifundo ezi-5: kwizinto ezili-10 kwezili-11 kwizifundo ezi-4 kunye nezinto eziyi-8 kwezili-11 kwisifundo esinye esishiyekileyo. Konke ukungangqinelani kusonjululwe ngokulula ngengxoxo kunye nokuvumelana yi-GDC (1 Table). Ngenxa ye-heterogeneity yeendlela zophando kwizilingo, akukho meta-analysis okanye i-statistical pooling yeziphumo zetyala ezenziweyo. Izilingo zokufumana amanqaku ngaphezulu kwesiqingatha senqanaba lilonke elinokubakho (okt,? 1) zithathwa njengomgangatho ophezulu. Izilingo zokufumana amanqaku ngo-6 ukuya ku-0 zithathwa njengomgangatho ophantsi. Izifundo ezineziphene ezikhulu zendlela okanye ukuphanda ngeendlela zonyango ezizodwa azifakwanga (umzekelo, unyango olungathathelwa ngqalelo njengefanelekileyo yi-GDC kukhathalelo lwe-chiropractic yezigulana ezinentloko; Isihlomelo 5.

 

Umgangatho wokuvavanywa kwee-SRs ubandakanye iikhrayitheriya ezili-9 eziphendulwe nguewe (inqaku 1) okanye hayi (amanqaku 0) / andazi (amanqaku 0) kunye nempendulo esemgangathweni yento J no iimpazamo, iziphoso ezincinci, okanye major iimpazamo Itheyibhile 2). Ukulinganiswa okunokwenzeka kususela kwi-0 kuye kwi-9. Ukuchongwa komgangatho wobunzululwazi we-SRs ngeziphene ezinkulu, iziphene ezingephi, okanye akukho ziphene, njengoko zidwelisiwe kwikholamu J (2 Table), yayisekwe kwiimpendulo zabalinganiswa boncwadi kwizinto ezili-9 zangaphambili . Ezi paramitha zilandelayo zisetyenziselwe ukufumana umgangatho wobunzululwazi we-SR: ukuba akukho / andazi ukuba impendulo isetyenzisiwe, i-SR inokuba neziphene ezincinci. Nangona kunjalo, ukuba Akukho nto yayisetyenzisiwe kwizinto B, D, F, okanye H, uphononongo lwalunokuba neziphene ezinkulu. [21] Uphengululo olucwangcisiweyo lokufumana amanqaku ngaphezulu kwesiqingatha senqanaba lilonke elinokubakho (okt,? 5) ngaphandle kweziphene okanye ezincinci zilinganisiwe njengomgangatho ophezulu. Uphengululo olucwangcisiweyo lokufumana amanqaku ama-4 okanye ngaphantsi kunye / okanye ngeziphene ezinkulu azifakwanga.

 

Uluhlu lwe-2 Ratings of Qualitative Ratings of Reviews Reviews

 

Uphengululo luchazwe njengolucwangcisiweyo ukuba zibandakanya indlela ecacileyo nephindaphindwayo yokukhangela kunye nokuhlalutya uncwadi kwaye ukuba ukubandakanywa kunye neendlela zokuthintela izifundo zichaziwe. Iindlela, iikhrayitheriya zokubandakanywa, iindlela zomgangatho wokufunda, amanqaku ezifundo ezibandakanyiweyo, iindlela zokwenza idatha, kunye neziphumo zavavanywa. IiRaters ziphumeze isivumelwano esipheleleyo sazo zonke izinto zokulinganisela ii-7 SRs [22-28] kunye nezinto ezisi-7 kwezili-9 ze-2s ezongezelelweyo ze-SRs. [29,30] Ukungangqinelani kuthathwe njengokuncinci kwaye kusonjululwa ngokulula ngovavanyo lweGDC kunye nemvumelwano (Itheyibhile 2 ).

 

Ukuphuculwa kweNcomelo zokuSebenza

 

I-GDC isichazela ubungqina obuchaphazela unyango lwe-chiropractic lwezigulane zentloko. Isishwankathelo esicacisiweyo samanqaku afanelekileyo siya kufakwa kwi-website ye-CCA / Federation Clinic Practice Guidelines.

 

Izilingo ezilawulwe ngokungaqhelekanga, ezilawulwayo kunye neziphumo zazo zafunyaniswa ukuzisa iingcebiso zonyango. Ukunika ubungqina obuninzi bobubungqina (obuqinileyo, obunokulinganisela, obunqamlekileyo, obuphikisanayo, okanye abukho ubungqina), [6] i-GDC iqwalasele inani, umgangatho, kunye nokuhambelana kweziphumo zophando (Ithebula 3). Ubungqina obuqinileyo babucingelwa kuphela xa ii-RCT ezininzi eziphezulu zixhasa ukufunyaniswa kwabanye abaphandi kwezinye izicwangciso. Kuphela ii-SRs eziphezulu zifundwa ngokumalunga nomzimba wobungqina kunye nokwazisa iingcebiso zonyango. I-GDC iqwalasele indlela yokwenza unyango ukuba incedise (s) xa ixhaswa ubuncinci bezinga lobungqina.

 

Ithebula 3 Amandla oBungqina

 

Iziphakamiso zokusebenza zenziwe zidibeneyo kwiintlanganiso zendibano zokusebenza.

 

iziphumo

 

Ithebhile ye-4 Literature Isishwankathelo sobungakanani Ukulinganisa koBungqina bokungenelela kwiMigraine Headache okanye ngaphandle kweAura

 

IThebhile ye-5 Inkcazo yeSishwankathelo kunye nokulinganisa koMgangatho woBungqina boNgeniso loNgeniso-Uhlobo lweentloko

 

IThebhile ye-6 Inkcazo yeSishwankathelo kunye noHlelo lweMigangatho yoBungqina bokungenelela kwiCervicogenic Headache

 

Uluhlu lweZibrari ze7 Isishwankathelo kunye noHlelo lweMigangatho yeeNkqubo eziPhezulu zoNyango lweZinyango zoLawulo lweeNtloko zengxaki

 

Iincwadi

 

Ukususela ekuphandweni kwincwadi, ekuqaleni i-6206 icatshulwa. Amanqaku angamashumi amabini ananye adibanisa imfuno yokugqibela yokufakwa kwaye yaqwalaselwa ekuphuhliseni iziphakamiso zenkqubo (ii-16 CCT / RCTs [11-20,31-36] kunye ne-5 SRs [24-27,29]). Ukulinganiselwa komgangatho wezinto ezifakiwe kufakwe kwiiTables 1 kunye ne-2. Isihlomelo Ithebula le-3 dwelisa amanqaku angabandakanywa ekuhlolweni kokugqibela yi-GDC kunye nezizathu zokukhutshwa kwabo. Ukungabikho kweso sifundo kunye neengcali eziyimfama kunye neengcaciso ezingenelisekiso zokuqulunqwa kwemali ziqhelwaniswe ngokukhawuleza kwendlela yokulawulwa kwezilingo. Iintlobo zeentloko ezivandlakanywe kwezi zilingo zibandakanya i-migraine (Itheyibhile 4), intloko yesifo senwele (Itheyibhile 5), kunye nentloko ye-headervogen (Ithebula 6). Ngenxa yoko, ezi ntlobo zentloko kuphela zimelelwe ubungqina kunye nokwenza iziphakamiso kule CPG. Ubu bungqina bemiqulu ye-SRs banikezwa kwiThebhile 7.

 

Zenza iziNcomelo: unyango lwe-Migraine

 

  • Ukunyanzeliswa komgudu kunconywa ukuba kulawulo lwezigulane ezine-episodic okanye ezingapheliyo kunye nokungahambi. Le ngcebiso isekelwe kwizifundo ezisetyenziswe ngonyango lwe-1 kumaxesha e-2 ngeveki kwii-8 iiveki (inqanaba lobubungqina, lingqinelana). Omnye we-RCT ophezulu, [20] 1 ophezulu we-RCT, [17] kunye ne-1 ephezulu ye-SR [24] ukuxhasa ukusetyenziswa kwamagulane okugulisa izigulane ezine-episodic okanye ezingapheliyo (miguel 4 ne-7).
  • Ukuxilongwa kwe-weekly unyango kunconywa ukunciphisa i-episodic freraine frequency kunye nokuphucula iimpawu ezichaphazelekayo ezinokudibaniswa nentlungu yentloko (ubungqina bezinga, ubungqinelana). Omnye we-RCT ophezulu [16] uxhasa le nkcazo yezithethe (Ithebula 4). Abaphandi basebenzisa i-45-minute massage ngokugxila kwisakhelo se-neuromuscular kunye ne-trigger kwinqanaba, emagxeni, entanyeni, nasentloko.
  • Ukunakekelwa kwamanqanaba ahlukeneyo (uqeqesho, ukuphumula, uxinzelelo kunye nokucebisa okunomsoco, unyango lwe-massage) Kunconywa ukulawula izigulane ezine-episodic okanye ezingapheliyo. Khangela njengoko kufanelekileyo (inqanaba lobubungqina, i-moderation). Omnye we-RCT ophezulu [32] uxhasa ukuphumelela kwe-multi-modal intervention interdisciplinary for migraine (Ithebhile 4). Ukungenelela kubeka phambili indlela yokulawula jikelele equkethe ukusetyenziswa, imfundo, utshintsho lwezinto zokuphila, kunye nokulawulwa kobuqu.
  • Kukho idatha engenakwaneleyo yeklinikhi yokucebisa okanye ukusetyenziswa kokusetyenziswa komzimba kuphela okanye ukusetyenziswa ngokudibeneyo kunye nemithi yokwelapha ye-multimodal yokuphathwa kwezigulane ezine-episodic okanye ezingapheliyo imithraine (uvavanyo lwe-aerobic, intlobo yesibindi sokunyakaza [cROM], okanye ukuthambisa umzimba wonke). Iikhompyutyana ze-CCT ezisezantsi (13,33,34] zinegalelo kwesi siphelo (Itheyibhile 4).

 

Ziqhelise iziNcomelo: Intambo-Thayipha intloko

 

  • Ukunyanzeliswa komthwalo ophantsi we-craniocervical (umz., I-Thera-Band, iiNkqubo zokuZilolonga eziHlukeneyo; I-Hygenic Corporation, iAkron, i-OH) iyacetyiswa ixesha elide (umz. ukumodareyitha). Elinye i-RCT ekumgangatho ophezulu [6] ibonise ukuba ukuhlanganiswa okunyanzeliswa kancinci kunciphise kakhulu iimpawu zentloko-yentloko ebuhlungu kwizigulana ngexesha elide (Itheyibhile 36).
  • Ukunyanzeliswa kwemisipha akunakunconywa ukulawula izigulane ezine-headache-headache-headache (inqanaba lobubungqina, i-moderation). Kukho ubungqina obunokulinganisela ukuba ukunyanzeliswa kwemisipha emva kokuba unyango olusisigxina lonyango aluboneli ngenye inzuzo kwizigulane ezineentloko zesifo. Omnye we-RCT ophezulu [12] (Ithebhile 5) kunye nemibiko echazwe kwi-4 SRs [24-27] (Itheyibhile 7) ibonisa ukuba akukho nzuzo yokunyanzeliswa kwemigudu yezigulane ezineentloko zeentlobo zesifo se-episodic.
  • Isiphakamiso asikwazi ukwenza okanye ukusetyenziswa kokusetyenziswa kwemigudu (amaxesha e-2 ngeveki kwii-6 iiveki) kwizigulane ezinezintlungu ezingapheliyo. Abalobi be-1 RCT [11] babalwa njengomgangatho ophezulu ngethuluzi lovavanyo lomgangatho [6] (Itheyibhile 1), kunye nesishwankathelo solu pho nonongo kwi-2 SRs [24,26] kukhombisa ukuba ukunyanzeliswa komgudu kunokusebenza ngokufanelekileyo kwintloko yesifo sengqondo. Nangona kunjalo, i-GDC ibona i-RCT [11] nzima ukuyichaza kwaye ayifanelekanga (iThebhile 5). Icandelo lingalawulwa ngokungahambisani ngokungalingani kwinani leenkcukacha zogqirha zezifundo phakathi kwamacandelo okufunda (umz., Ukutyelela kwe-12 kwizifundo kwi-tissue ye-tissue andrapy kunye ne-spinal manipulation group vs i-2 ukutyelela izifundo kwiqela le-amitriptyline). Ayikho indlela yokwazi ukuba iqondo elifana nelinye leenkcukacha kwiqela le-amitriptyline lingaba nefuthe kwiziphumo zophando. Ezi ngqalelo kunye nokutolika kwi-2 nezinye i-SRs [25,27] zinegalelo kule sigqibo (Itheyibhile 7).
  • Kukho ubungqina obaneleyo bokucetyiswa okanye ukuchasene nokusetyenziswa kwezinto ezihamba phambili, ukuxhaphaza kwezicubu, ukuxhaswa kweCyriax, okanye ukuqeqeshwa / ukuqeqeshwa ngokomzimba kwizigulane ezineentloko zesifo se-episodic okanye esingapheliyo. Izifundo ezintathu ezingenakuthelekiswa okungafaniyo [19,31,35] (Ithebhile 5), i-1 ye-RCT engamgangatho ophezulu, i- [14] kunye ne-1 SR [25] ifake kwisiphetho (Itheyibhile 7).

 

Ziqhelise iziNcomelo: Intloko yeCervicogenic

 

  • Ukunyanzeliswa komgudu kunconywa ukulawula izigulane ezineentloko zentloko. Esi siphakamiso sisekelwe kwi-1 yophando esetyenziswe ngamaxesha e-2 ngeveki kwiiveki ze-3 (inqanaba lobubungqina, i-moderation). Kwi-RCT ephezulu, uNilsson et al [18] (Itheyibhile 6) yabonisa umphumo ophezulu ophezulu wendlela yokugulisa umlenze we-stervicogenic headache. Ingqungquthela yobungqina ukusuka kwi-2 SRs [24,29] (Itheyibhile 7) isekela lo mbululo.
  • Ukuhlanganiswa okuhlangeneyo kunconywa ukulawulwa kwezigulane ezineentloko ze-cervicogenic (ubungqina bezinga, ubungqinelana). I-Jull et al [15] ihlolisise imiphumo ye-Maitland yokuhlanganiswa kwe-8 kwii-12 zonyango kwii-6 iiveki kwi-RCT ephezulu (Ithebula 6). Ukuququzelela kulandelelwano oluqhelekileyo lweklinikhi, apho ukukhethwa kwezinto ezincinci kunye nobuchule obuphezulu obusekelwe kwiimvavanyo zokuqala kunye nokuqhubela phambili kwezigulane zentsholongwane yezigulane. Iziphumo ezixhamlayo zaxelwa ukuba zintlungu zentloko, ubunzima, kunye nentlungu yentlungu kunye nokukhubazeka. Ingqungquthela yobungqina ukusuka kwi-2 SRs [24,29] (Itheyibhile 7) isekela lo mbululo.
  • Ukunyanzeliswa kwentamo ye-flexor umzimba kuyanconywa ukulawula izigulane ezineentloko ze-cervicogenic (ubungqina bezinga, ubungqinelana). Esi siphakamiso sisekelwe kuphando lwezihlandlo ze-2 imihla ngemihla kwiiveki ze-6. Akukho nzuzo eqhubekayo yokongeza ukuhlanganisa iminyango yomsila we-flexor kunye nokuhlanganiswa ngokubambisana kwentloko yesifo senhliziyo. Omnye we-RCT ophezulu [15] (Itheyibhile 6) kunye nokuqwalaselwa okunikeziwe kwi-2 SRs [24,29] (Itheyibhile 7) inkxaso le ngcebiso.

 

Safety

 

Iingcali zikhetha iindlela zonyango ngokubambisana nazo zonke iinkcukacha zeklinikhi ezikhoyo kwisigulana esinikiweyo. Kwii-16 ze-CCTs / i-RCTS [i-11-20,31-36] ibandakanyiwe emzimbeni wobungqina bale CPG, zifundo ezi-6 kuphela [11,12,15,20,32,36] ezivavanywe ngokwaneleyo okanye zaxoxa ngemiphumela yesigulana okanye ukhuseleko iiparameter (Itheyibhile 1, ikholamu M). Ngokubanzi, umngcipheko oxeliweyo ubuphantsi. Izilingo ezintathu zichaze ulwazi lokhuseleko lokunyanzeliswa komgogodla. [11,12,20] UBoline et al [11] uxele ukuba i-4.3% yezifundo yafumana ukuqina kwentamo emva kokuqunjelwa komqolo okuqala okwanyamalala kuwo onke amatyala emva kweeveki zokuqala ze-2 zonyango. Ukudakumba okanye ukwanda kwentloko emva kokunyanzeliswa komqolo (n = 2) yayizizizathu zokuyeka unyango olukhankanywe nguTuchin et al. [20] Akukho ziphumo ebezingalindelekanga eziye zafunyanwa zizo naziphi na izifundo ezifundwe nguBove et al [12] kusetyenziswa ukunyanzeliswa komqolo kunyango lwe-episodic tension-type headache. Uvavanyo lonyango lokuvavanya iziphumo ezinokubakho alunakubhalisa amanani afanelekileyo ezifundo ukuvavanya izehlo zeziganeko ezimbi ezinqabileyo. Ezinye iindlela zophando ziyafuneka ukuphuhlisa ukuqonda okupheleleyo kokulinganisela phakathi kwezibonelelo kunye nomngcipheko.

 

ingxoxo

 

Ukunyanzeliswa kwamagqabi kunye nezinye iindlela zokufundisa eziqhelekileyo ezisetyenziselwa kwi-chiropractic ziye zafundwa kwiiCCT eziliqela ezihambelana nokubhaliswa kwezifundo, ukucwangciswa kunye nomgangatho jikelele. Iimpawu zonyameko kunye neentloko zeentloko zimelelwe kwisiseko sobungqina be-migraine, iintlobo zeentlobo zesifo, kunye nentloko yesifo senhliziyo. Iziphumo eziphambili zezempilo zempilo zichazwe ngokuqhelekileyo ubukhulu beentloko, ubunzima, ubude, kunye nemilinganiselo yempilo. Ubungqina abukho ngaphezu kwezinga elilinganayo ngeli xesha.

 

Ubungqina buxhasa ukusetyenziswa kwe-spinal for the management of chiropractic izigulane ezine-migraine okanye iintloko zentliziyo kodwa zingabi ziintsholongwane. Ukunakekelwa kwemigraine, ukunakekelwa kwamanyathelo ahlukeneyo usebenzisa i-45-minute-massage yonyango kunye nokunakekelwa kwamaninzi (ukuzivocavoca, ukuphumula, kunye nokuxinwa kunye nokucebisa okunomsoco) kunokusebenza. Ngaphandle koko, ukuhlanganiswa ngokubambisana okanye ukunyanzelisa iminyango ye-flexor exercises kunconywa ukuba kuphuculwe iimpawu zentloko ye-cervicogenic. Kubonakala ngathi akukho nzuzo eqhubekayo yokuhlanganisa ukuhlanganiswa ngokubambisana kunye nokunyaniseka kwentamo ye-flexor exercises kwizigulane ezinentloko ye-cervicogenic. Ubungqina obuncinane buxhasa ukusetyenziswa kwe-craneocervical mobilization ephantsi kwexesha elide lolawulo lweentloko zentlungu.

 

Imida

 

Ukungaphumeleli kwesi sikhokelo kubandakanya ubungakanani kunye nomgangatho wobungqina obuxhasayo obunokufumaneka ngexesha lophando. Akukho zifundo zophando olusenyongweni olulandelayo olwenziwe ngokufanelekileyo kunye neziphumo zokufumana iziphumo zeklinikhi ezipapashwe ngokunyamekela kwezilwanyana zentloko. Izifundo ziyadingeka ukuqhubela phambili ukuqonda kwethu imigaqo ethile yesikhokelo kwintetho okanye ekudibaniseni kakuhle ukunyanga kwe-migraine, intloko yentlungu, intloko yesifo, okanye ezinye iintlobo zentloko ezinikezela kwiikliniki (umz., Iqela, i-postusumatic head-ache) . Olunye ukungahambi kwale ncwadana yenkcazo yolu xwebhu luxhomekeke kwizifundo zophando ezipapashwe ngamanqanaba amancinci amancinane (iifayile 4-6), iiprodigms zonyango zexesha elifutshane kunye nexesha lokulandelela. Izilingo zeekliniki ezenzelwe kakuhle kunye neenombolo ezaneleyo zezifundo, unyango lwexesha elide, kunye nezihlandlo zokulandelelana kufuneka zixhaswe ngemali ukunyamekela unyango lwe-chiropractic, kunye nokunyanzeliswa komgudu ngokukodwa, ekulawuleni izigulane ezineengxaki zentlungu. Njengoko naluphina uhlaziyo lweencwadi kunye nesicwangciso sezonyango zekliniki, ulwazi olusiseko kunye neencwadi ezishicilelweyo ziyavela. Izifundo ezinokuthi zazise lo msebenzi zingapapashwa emva kokupheliswa kwesi sifundo. [37-39]

 

Iingqwalasela malunga nophando lwexesha elizayo

 

Ingqiqo ye-GDC kukuba kukho isidingo sokuqhubela phambili izifundo ze-chiropractic nezigulane ezineengxaki zentlungu.

 

  • Uphando olungakumbi lwekhlinikhi lufunekayo. Uphando lwexesha elizayo ludinga ukucwangciswa kocwaningo kusetyenziswa ukuthelekiswa okusebenzayo kunye nokungaxhamli kunye / okanye iqela le-placebo ukuphucula ubungqina benkxaso yesigulane. Isigulane sokuphulukiswa kwamanyathelo angenelelo ekulawuleni iziphumo zokulindela kuyadingeka kwaye ihlolwe ngabaphandi kwi-chiropractic kwezinye iimeko ezibuhlungu. [10] Ukungabikho kwezifundo ezichongiweyo zibonisa umngeni wokwenza iziphakamiso zonyango olusisiseko. Zonke iifundo ezizayo kufuneka zenziwe ngendlela echanekileyo (umz., IMigangatho yokuHlanganiswa yoLingo lweZingxelo [UKUSETSHENZISWA] kunye nokuBika ngokuPheleleyo koVavanyo ngeZakhiwo ezingekho phantsi kweNkqubo [TREND]).
  • Ukunika ingxelo ngokuchanekileyo kwedata lokukhuseleko kuyadingeka kuphando lwe-chiropractic. Zonke izilingo zonyango kufuneka ziqokelele kwaye zixelile kwimiphumo emibi okanye zingonakalise nokuba akukho nanye ibonwa.
  • Ukuphuhlisa izixhobo zokuvelisa izixhobo zokuvavanya uphando lwezobisi. Ukukhunjulwa kusebenza ukulawula imiphumo yokulinda kunye nemiphumo engabonakaliyo yabathengi-ntsebenziswano kumxholo kumaqela okufunda. Ngokuqhelekileyo akunakwenzeka kwizifundo ezingaboniyo kunye nababoneleli ngeengxelo eziphumelelayo zonyango. Ngaphandle kokunciphisa ubunzima, ukuphazamiseka kwezifundo kunye nabanikezeli-nkathalo babalwa kumanqaku ophando yi-GDC, ekubeni ezi zinto zifakwe kwizixhobo zokulinganisela okuphezulu. [6] Izixhobo zophando eziphambili zokuhlalutya kunye nokulinganisa okulandelayo kwincwadi yokunyanga ezifunekayo ngokukhawuleza.
  • Ukuqhubela phambili uphando malunga neziphumo ezisebenzayo kwiinkqubo zokunakekelwa kweentloko ze-chiropractic. Esi sikhokelo sichaze ukuba uphando lweentloko lusetyenziso lwamanyathelo ahlukeneyo ekuhlaleni umphumo wonyango kwiziphumo zempilo. Ubuninzi beentloko, ubukhulu, kunye nobude ziphumo eziqhelekileyo ezisetyenziswayo (iifayile 4-6). Imizamo enzulu iyadingeka ukubandakanya amanyathelo okuphunyezwa okujoliswe ngesigulane kwi-chiropractic yophando ehambelanayo kunye nokuphuculwa kwimihla ngemihla kunye nokuqaliswa kweziqhelo ezibalulekileyo.
  • Iindleko-mpu melelo. Akukho ziphando zophando eziye zafunyanwa kwiindleko-mpu melelo yokugulisa umlenze ukuze unyango lweengxaki zentlungu. Iimvavanyo zeklinikhi zexesha elizayo zokunyanzelisa umgudu kufuneka zihlole iindleko-mpu melelo.

 

Ezinye iindlela zophando zifuneka ukuphuhlisa ukuqonda ngokupheleleyo ukulinganisela phakathi kweenzuzo kunye nobungozi. Le CPG ayinikezeli ukuhlaziywa kwazo zonke izifo zonyango. Nasiphi na ukushiya kubonisa izikhala kwiincwadi zeklinikhi. Uhlobo, ubude, umlinganiselo, kunye nobude bonyango kufuneka busekelwe kwizikhokelo zesikhokelo, amava okliniki, nolwazi lwesigulane kude kube namazinga aphezulu obubungqina obukhoyo.

 

izigqibo

 

Kukho ubungqina obunobungqina bokuxhasa ukunakekelwa kwe-chiropractic, kubandakanywa nokunyanzeliswa kwempompo, ukuphathwa kwe-migraine kunye neentloko zentliziyo. Uhlobo, ubude, umlinganiselo, kunye nobude bonyango (s) kufuneka kusekelwe kwizikhokelo zesikhokelo, amava eenkliniki kunye nolwazi lwesigulane. Ububungqina bokusetyenziswa kwegulana njengendlela yokungenelela kwodwa kwizigulane ezineentloko zentlobo-ntloko zihlala zilingana. Kufuneka uphando olungakumbi.
Izikhokelo zokuziqhelanisa zidibanisa obona bungqina bufumanekayo kwindlela elungileyo yokusebenza kweklinikhi kwaye zizinto ezi-1 kuphela zendlela enobungqina bokunikezela ngononophelo. Esi sikhokelo senzelwe ukuba sisixhobo sonikezelo lokhathalelo lwe-chiropractic kwizigulana ezinentloko ebuhlungu. Luxwebhu "oluphilayo" kwaye luxhomekeke ekuhlaziyweni ngokuvela kwedatha entsha. Ngapha koko, ayisiyonto ethatha indawo yamava oqeqesho kunye nobungcali. Olu xwebhu alwenzelwanga ukuba lusebenze njengomgangatho wokunyamekela. Endaweni yoko, isikhokelo singqina ukuzibophelela kobungcali ekuqhubeleni phambili ukuziqhelanisa nobungqina ngokuzibandakanya kutshintshiselwano lolwazi kunye nenkqubo yokudlulisa ukuxhasa ukuhamba kolwazi kuphando.

 

Izicelo eziSebenzayo

 

  • Esi sikhokelo sisisityebi sokuhanjiswa kwe-chiropractic kwizigulane ezineentloko.
  • Ukunyanzeliswa komgudu kunconywa ukulawula izigulane ezinomlenze we-migraine okanye i-headervogenic headaches.
  • Ukungenelela kwamanyathelo ahlukeneyo okubandakanya ukusilalisa kunokuncedisa izigulane nge-migraine.
  • Ukuhlanganiswa okuhlangeneyo okanye ukunyamezela kwintamo yesimo se-flexor kungenza ngcono iimpawu zentloko ye-cervicogenic.
  • Ukunyusa okuphantsi kwe-craniocervical ingabinokuphucula intloko yesifo.

 

Imibulelo

 

Ababhali bayabulela oku kulandelayo ngegalelo kwesi sikhokelo: URon Brady, DC; IGreyden Bridge, DC; UH James Duncan; UWanda Lee MacPhee, DC; UKeith Thomson, DC, ND; UDean Wright, DC; kunye noPeter Waite (aMalungu oMsebenzi oSebenza ngeZikhokelo zeKlinikhi). Ababhali bayabulela oku kulandelayo ngoncedo kuvavanyo lokuphandwa koncwadi lweSigaba XNUMX: USimon Dagenais, DC, PhD; kunye noThor Eglinton, MSc, RN. Ababhali bayabulela oku kulandelayo ngoncedo ngeSigaba II sophando loncwadi olongezelelweyo kunye nenqanaba lobungqina: Seema Bhatt, PhD; UMary-Doug Wright, uMLS. Ababhali bayabulela uKarin Sorra, PhD ngoncedo lokukhangela uncwadi, ukulinganiswa kobungqina kunye nenkxaso yokuhlela.

 

Imithombo Yenkxaso kunye Neengxabano Zomdla

 

Uxhasomali lunikezelwa yi-CCA, uMbutho woKhuselo waseCanada waseCanada, kunye nemiphondo ye-chiropractic evela kumaphondo ngaphandle kweBritish Columbia. Lo msebenzi wawuxhaswe yiCCA kunye neFree Federation. Akukho zintlukwano zomdla ezichazwe kulolu cwaningo.

 

Ukuququmbela, Intloko yesinye sezizathu eziqhelekileyo abantu bafuna unyango. Nangona abaninzi abanezonyango bezempilo banokuphatha unyango, ukunyamekelwa kwe-chiropractic yindlela ekhethwa yonyango ekhethiweyo esetyenziswa rhoqo ukuphatha imiba eyahlukahlukeneyo yempilo, kuquka iintlobo ezininzi zeentloko. Ngokwale nqaku apha ngasentla, ubungqina bubonisa ukuba ukunakekelwa kwe-chiropractic, kuquka ukulungiswa komgudu kunye nokusetyenziswa kwemigaqo, kunokuphucula intloko kunye ne-migraine. Ulwazi oluchazwe kwiziko leSizwe loLwazi lweBiotechnology (NCBI). Ubungakanani beenkcukacha zethu zikhawulelwe kwi-chiropractic kunye nokulimala kwemigudu kunye nemeko. Ukuxoxa ngesihloko, nceda ukhululeke ukucela uDkt Jimenez okanye uqhagamshelane nathi 915-850-0900 .

 

Ikhutshwe nguDkt. Alex Jimenez

 

Green-Call-Now-Button-24H-150x150-2-3.png

 

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.

 

umfanekiso webhlogi weendaba eziphambili zephepha lephepha

 

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

 

 

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

 

Ngenanto
Ucaphulo

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2. I-Stovner LJ, Andree C. Ukwanda kweentloko eYurophu: ukuhlaziywa kweprojekthi ye-Eurolight. I-Headache Pain Aug 2010; 11: 289-99.
3. I-ID ye-Coulter, i-Hurwitz EL, i-Adams AH, i-Genovese BJ, i-Hays R, uShekelle PG. Izigulisi zisebenzisa i-chiropractors eNyakatho Melika: ngubani na, kwaye kutheni bahlala benokhathalelo lwe-chiropractic? Isihlwele (Phila Pa 1976) 2002; 27 (3): 291-6 [ingxoxo 297-98].
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Vala i-Accordion
Inhlungu yeNtloko ye-Migraine I-Chiropractic Therapy e-El Paso, TX

Inhlungu yeNtloko ye-Migraine I-Chiropractic Therapy e-El Paso, TX

by | Chiropractic, Uvavanyo oluLungeleleneyo oluLungisiweyo

Intloko ze-Migraine zithathwa njengenye yezona zifo eziphazamisayo xa kuthelekiswa neminye imiba yempilo eqhelekileyo. Ngokuqhelekileyo kubangelwa ukuxinezeleka, iimpawu ze-migraines, kubandakanywa ubuhlungu beentloko ezidambisayo, ukuqonda ukukhanya nokuvakala kunye nesisongululo, sinokuchaphazela ngokuphawulekayo umgangatho wobomi wobomi. Nangona kunjalo, uphando olwenziwe uphando lufumene ukuba unyango lwe-chiropractic lunokunceda ukunciphisa ubukhulu kunye nobukhulu beentlungu zakho ze-migraine. Uninzi lweengcali zonyango luye lwabonisa ukuba ukuguqulwa kwamagqabi, okanye ukuxilongwa, kungabangela ukuba intlungu ibuhlungu. Injongo yendiqendu engezantsi kukubonisa imilinganiselo yempatho ye-chiropractic yonyango yokuguqula umlenze.

 

Unyango lwe-Chiropractic Spinal Manipulative Therapy for Migraine: aBathathu, abaXhobileyo, abangatshatanga? Abangaboniyo, i-Placebo, iTrone elawulwa ngokungaQhelekanga

 

Abstract

 

  • Imvelaphi kunye nenjongo: Ukuphanda i-efficacy ye-chiropractic ye-spinal manipulative therapy (CSMT) ye-migraineurs.
  • Iindlela: Le nto yayiza kubakho abathathu abaxhobileyo, abangatshatanga abangaboniyo, i-placebo, isilingo esilawulwa ngokungahleliwe (RCT) seenyanga ezili-17 ezibandakanya i-104 migraineurs kunye nokuhlaselwa okungenani kwe-migraine ngenyanga. I-RCT yaqhutywa kwisibhedlele iAkershus University, eOslo, eNorway. Unyango olusebenzayo lwalune-CSMT, ngelixa i-placebo yayisisinyanzelo sokuqhubela phambili komda we-scapula kunye / okanye nommandla wobukhazikhazi. Iqela lolawulo liqhubekile nolawulo lwazo oluqhelekileyo lweyeza. I-RCT ibandakanya inyanga enye ebalekayo? Kwi, iinyanga ezi-1 zongenelelo kunye namanyathelo esiphumo ekupheleni kongenelelo olo nakwiinyanga ezi-3, 3 ne-6 ezilandelelweyo. Indawo yokugqibela yayinani leentsuku ze-migraine ngenyanga, ngelixa amanqaku okuphela kwesibini yayilixesha le-migraine, amandla e-migraine kunye nesalathiso sentloko, kunye nokusetyenziswa kwamayeza.
  • iziphumo: Iintsuku ze-Migraine zancitshiswa kakhulu kuwo omathathu amaqela ukusuka kwisiseko ukuya kwiposi yonyango (P <0.001). Iziphumo ziyaqhubeka kwiqela le-CSMT kunye ne-placebo kuwo onke amaxesha okulandela, ngelixa iqela lolawulo libuyela kwisiseko. Ukuncitshiswa kweentsuku ze-migraine kwakungahlukanga kangako phakathi kwamaqela (P> 0.025 yokunxibelelana). Ixesha le-Migraine kunye nesalathiso seentloko zancitshiswa kakhulu kwi-CSMT kuneqela lolawulo ukuya esiphelweni sokulandela? (P = 0.02 kunye P = 0.04 yokunxibelelana, ngokulandelanayo). Iziganeko ezimbi zazimbalwa, zincinci kwaye zidlulile. Ukumfama kwagcinwa ngamandla kwi-RCT.
  • Izigqibo: Kuyenzeka ukuba uqhube i-RCT yonyango kunye ne-placebo efihliweyo. Iziphumo ze-CSMT eziqwalaselwe kwisifundo sethu mhlawumbi kungenxa yempendulo ye-placebo.
  • Internet: i-chiropractic, i-headache, i-migraine, ilingo elilawulwa ngononophelo, unyango olusisigxina

 

UDkt-Jimenez_White-Coat_01.png

Insight of Dr. Alex Jimenez

Intlungu yentlungu kunye neentloko ziyesithathu isizathu esivakalayo abantu bafuna unyango lwe-chiropractic. Uninzi lweengxelo zophando lubonise ukuba unyango lwe-chiropractic unyango olusisigxina lugqirha olukhuselekileyo nolunefuthe lwenyango ye-migraines. Ukunyamekela kwe-Chiropractic inokulungisa ngokuchanekileyo nayiphi na impazamo yokuguqulwa kwamagciwane, okanye i-subluxation, efunyenwe kunye nobude bomgudu, oboniswe ukuba ngumthombo wokubamba intloko. Ukongezelela, ukuguqulwa komgudu kunye nokusetyenziswa kwemigaqo kunokuncedisa ukunciphisa uxinzelelo noxinzelelo lwe-muscle ngokunciphisa inani loxinzelelo olubekwe kwiinkqubo eziyinkimbinkimbi zomgudu ngenxa yesiphumo sokuguqulwa kwamagqabi, okanye ukuxilongwa. Ngokuguqula umgudu kunye nokunciphisa uxinzelelo kunye nokuxhatshazwa kwemisipha, ukunakekelwa kwe-chiropractic kunokuphucula iimpawu zentsholongwane kunye nokunciphisa ixesha labo.

 

intshayelelo

 

Iindleko zentlalo noqoqosho ze-migraine zikhulu kakhulu ngenxa yokuxhaphaka okuphezulu kunye nokukhubazeka ngexesha lokuhlaselwa [1, 2, 3]. Unyango olunamandla lwe-pharmacological luhlala lukhetho lokuqala kunyango lwe-migraine kubantu abadala. I-Migraineurs ngokuhlaselwa rhoqo, ukungonelanga kwesiphumo kunye / okanye ukuphikiswa kunyango olunamandla ngabagqatswa abanokubakho kunyango lweprophylactic. Unyango lwe-Migraine prophylactic ludla ngokuba yi-pharmacological, kodwa unyango olusesikweni aluyinto engaqhelekanga, ngakumbi ukuba unyango lwe-pharmacological luyasilela okanye ukuba isigulana sifuna ukunqanda amayeza [4]. Uphando lucebise ukuba unyango lwe-spinal manipulative unyango lunokukhuthaza iinkqubo ze-neural inhibitory kumanqanaba ahlukeneyo omqolo womqolo kuba inokuvula iindlela ezahlukeneyo zokuhla kumbindi [5, 6, 7, 8, 9, 10].

 

Izilingo ezilawulwa ngokungenamthetho ze-Pharmacological (RCTs) zihlala ziphindwe kabini, kodwa oku akunakwenzeka kwi-RCTs yonyango, njengoko ugqirha ongenelelayo engenakumfanyekiswa. Okwangoku akukho sivumelwano malunga nenkqubo ye-sham kwi-RCTs yonyango olingisa indawo ye-placebo kwii-RCTs ze-pharmacological [11]. Ukungabikho kwenkqubo efanelekileyo ye-sham ngumqobo omkhulu kuzo zonke i-RCTs zonyango zangaphambili [12, 13]. Kungekudala, senze inkqubo ye-sham chiropractic spinal manipulative therapy (CSMT), apho abathathi-nxaxheba abane-migraine bengakwazanga ukwahlula phakathi kwe-CSMT yokwenyani kunye ne-sham emva kovavanyo ngalunye lwe-12 kwisithuba senyanga esi-3 [14].

 

Iinjongo zokuqala zolu phononongo yayikukuqhuba incwadana yokunyanga emithathu, exhobileyo, engaboniyo, i-RCT ye-placebo ye-migraineurs enemigangatho yendlela efanayo naleyo ye-RCTs ye-pharmacological.

 

Injongo yesibini yayikuhlola ukuphumelela kwe-CSMT ngokubhekiselele ekutshatsheni kwe-sham (placebo) kunye ne-CSMT ngokuchasene nokulawula, okt abathathi-nxaxheba abaqhubeka nokuphathwa kwabo ngokuqhelekileyo kwemithi.

 

tindlela

 

IsiCwangciso soFundo

 

Uphononongo lwalunezixhobo ezithathu ezixhobileyo, ezingatshatanga, ezingaboniyo, i-placebo RCT ngaphezulu kweenyanga ezili-17. I-RCT ibandakanya isiseko senyanga enye ye-1, iiseshoni zonyango ze-12 ngaphezulu kweenyanga ze-3 ngamanyathelo okulandela emva kongenelelo, i-3, i-6 kunye ne-12 inyanga kamva.

 

Abathathi-nxaxheba babekho, phambi kokuba kusetyenziswe isiseko, ngokulandelelana ngokulinganayo kumaqela amathathu: i-CSMT, indawo ye-placebo (ukunyanzeliswa kwe-sham) kunye nokulawula (baqhubeka nokuphathwa kwabo ngokuqhelekileyo kwezemithi).

 

Uyilo lwesifundo luhambelana neziphakamiso ze-International Headache Society (IHS) kunye ne-CONSORT (iSithasiselo S1) [1, 15, 16]. IKomiti yesiFunda yaseNorway ye-Ethics Research Ethics kunye neNorway Social Science Data Services ivume le projekthi. I-RCT ibhaliswe kwiClinikiTrials.gov (i-ID engeyiyo: NCT01741714). Iprotocol epheleleyo yesilingo ishicilelwe ngaphambili [17].

 

nxaxheba

 

Abathathi-nxaxheba baqeshwe ukususela ngoJanuwari ukuya kuSeptemba 2013 ngokukodwa ngeSebe le-Neurology, kwisibhedlele sase-Akershus University. Abanye abathathi-nxaxheba baphinde baqeshwe ngabaSebenzi abaPhezulu baseAkershus nase-Oslo Counties okanye ntengiso yeendaba. Bonke abathathi-nxaxheba bafumene ulwazi oluposisiwe malunga neprojekthi elandelwa ngudliwano-ntanethi.

 

Abathathi-nxaxheba abafanelekileyo babengama-migraineurs aneminyaka eli-18 ukuya kwengama-70 ubudala benokuhlaselwa kube kanye ngenyanga kwaye bavunyelwa ukuba babenengxaki yokuchaphazeleka kwentloko kodwa kungabikho zintloko ziphambili. Bonke abathathi-nxaxheba bafunyaniswe ukuba ngugqirha wezonyango onamava okuxilongwa kwentloko ngexesha lodliwanondlebe kunye noHlulelo lwaMazwe ngaMazwe lweNgxaki zeNtloko? II (ICHD? II)

 

Iikhrayitheriya zokukhutshelwa ngaphandle zazichasene nonyango lomqolo, i-spinal radiculopathy, ukukhulelwa, uxinzelelo kunye ne-CSMT kwiinyanga ezili-12 ezidlulileyo. Abathathi-nxaxheba abafumana unyango olusebenzayo [18], batshintshe unyango lwabo lwe-migraine okanye bakhulelwa ngexesha le-RCT baxelelwa ukuba baya kurhoxiswa kuphononongo ngelo xesha kwaye bathathwe njengophumileyo. Abathathi-nxaxheba bavunyelwe ukuba baqhubeke kwaye batshintshe amayeza e-migraine abukhali ngalo lonke ixesha lokufunda.

 

Abathathi-nxaxheba abafanelekile bamenywa kwingxoxo-ndlebe kunye novavanyo lomzimba kuquka nophando olunzulu lomgca wecala lomhlaza (AC). Abathathi-nxaxheba abangabandakanyiyo kwi-CSMT okanye iqela le-placebo banombuzo opheleleyo weemviwo zengqondo.

 

Randomization kunye neMasking

 

Emva kokufunyanwa kwemvume ebhaliweyo, abathathi-nxaxheba babekwa ngokulinganayo kwesinye sezixhobo zokufunda ezintathu ngokuzoba iqashiso elinye. Amaqashiso atywinwe ngenani kunye neengalo ezintathu zokufunda zahlulwahlulwa zangamacandelwana amane ngokobudala kunye nesini, okt 18 39 okanye 40-70 iminyaka, kunye namadoda okanye abasetyhini.

 

Emva kweseshoni nganye yonyango, abathathi-nxaxheba kwi-CSMT kunye neqela le-placebo bagcwalisa iphepha lemibuzo malunga nokuba bakholelwa na ukuba unyango lwe-CSMT lufunyenwe, kwaye baqiniseke kangakanani ukuba unyango olusebenzayo lufunyenwe kwinqanaba le-0-10 yenani lamanani, apho i-10 imele ukuqiniseka okuqinisekileyo [14].

 

Zomibini i-randomization kunye ne-questionnaire eyimfama yenziwa kuphela yinkampani yangaphandle.

 

Ngoncedo

 

Iqela le-CSMT lafumana unyango lwe-spinal manipulative esebenzisa indlela kaGonstead, unxibelelwano oluthile, isantya esiphezulu, isantya esiphantsi, isinqe esifutshane somqolo ongenaso nesithuba sokulungiswa kohlengahlengiso olwalujolise kukungasebenzi kakuhle komqolo (indlela epheleleyo yomqolo) njengoko kufunyaniswe ngumgangatho Uvavanyo lwe-chiropractic kwiseshoni nganye yonyango nganye [19].

 

Iqela le-placebo lifumene ubuqhetseba be-sham, unxibelelwano olubanzi olungachazwanga ngokuthe ngqo, isantya esisezantsi, islow? Amplitude sham push maneuver in a non-mandional and non- therapeutic directional line of the lateral edge of the scapula and / or gluteal region [14 ]. Lonke unxibelelwano olunganyangiyo lwenziwa ngaphandle kwekholamu yomqolo kunye nokudibanisa okwaneleyo kunye nangaphandle kwethishu yethishu ethambileyo ukuze kungabikho mingxunya idibeneyo yenzekileyo. Ezinye iindlela zokusebenzisa ngobuqhetseba zazibekiwe ngaphambili kwaye zatshintshana ngokulinganayo phakathi kwabathathi-nxaxheba be-placebo ngokomgaqo olandelwayo ngexesha lokunyanga ngeveki le-12 ukomeleza ubunyani besifundo. Inkqubo ye-placebo ichazwe ngokweenkcukacha kwinkqubo yolingo ekhoyo [17].

 

Iseshoni ngasinye sokungenelela sagcina i-15 min kunye namaqela omabini anamava afanayo kunye novavanyo lokunyakaza ngaphambi kokuba emva kokungenelela. Ayikho enye ingenelelo okanye iingcebiso ezinikwe abathathi-nxaxheba ngexesha lokuvavanya. La mabini maqela athola ukungenelela kwisibhedlele saseAkershus kwiYunivesithi ye-chiropractor (one-experience).

 

Iqela lolawulo laqhubeka nokuphathwa kwabo ngokwemvelo ngaphandle kokufumana ukungenelela kwangoku kwincwadi yecandelo lophando.

 

Iziphumo

 

Abathathi-nxaxheba bazalise i-diary heading diagnosis heading kulo lonke uphando kwaye babuyisela rhoqo ngenyanga [20]. Kwimeko yeidayari ezingasetyenziswanga okanye idatha elahlekileyo, abathathi-nxaxheba baqhagamshelana ngefowuni ukukhusela ukuthotyelwa.

 

Isiphelo sokugqibela sasinani leentsuku ze-migraine ngenyanga (iintsuku ezingama-30 / inyanga). Ubuncinci i-25% yokuncitshiswa kweentsuku ze-migraine ukusuka kwisiseko ukuya esiphelweni songenelelo, kunye nenqanaba elifanayo eligcinwe kwi-3, 6 kunye ne-12 yeenyanga ezilandelwayo kulindeleke kwiqela le-CSMT.

 

Amanqaku okuphela kwesekondari yayilixesha le-migraine, amandla e-migraine kunye ne-index index (HI), kunye nokusetyenziswa kwamayeza. Ubuncinci i-25% yokuncitshiswa kwexesha, amandla kunye ne-HI, kwaye ubuncinci i-50% yokuncitshiswa kokusetyenziswa kwamayeza kulindeleke ukusuka kwisiseko ukuya esiphelweni songenelelo, kwinqanaba elifanayo eligcinwe kwi-3, 6 kunye ne-12 yeenyanga ezilandelelweyo kwiqela le-CSMT.

 

Akukho lutshintsho lwalulindelwe kwindawo yokuphela kunye neyesibini kwindawo ye-placebo kunye neqela lolawulo.

 

Usuku lwe-migraine luchazwe njengosuku apho i-migraine ene-aura, i-migraine ngaphandle kwe-aura okanye i-migraine enokwenzeka yenzekile. Uhlaselo lwe-Migraine oluhlala ixesha elide> i-24 h yabalwa njengolo hlaselo lunye ngaphandle kokuba iintlungu ziyekelele? Ukuba isiguli silele ngexesha lokuhlaselwa kwe-migraine kwaye savuka ngaphandle kwe-migraine, ngokungqinelana ne-ICHD? III?, Ixesha lokuhlaselwa lalibhalwa njengeqhubeka kude kube lixesha lokuvuka [48]. Ubuncinci bexesha lokuhlaselwa kwe-migraine yayiyi-21 h ngaphandle kokuba kwasetyenziswa i-triptan okanye ichiza eliqukethe i-ergotamine, kwimeko apho sachaza ubuncinci bexesha. I-HI ibalwe njengentsingiselo yeentsuku ze-migraine ngenyanga (iintsuku ezingama-22) - kuthetha ubude be-migraine (h / ngosuku) - kuthetha ukuba namandla (4 30 amanani okulinganisa amanani).

 

Indawo zokugqibela kunye nezesekondari amanqaku akhethwe ngokusekwe kwiQela loMsebenzi le-IHS Clinical Trial Subcommittee's trial trial guidelines [1, 15]. Ngokusekwe kuphononongo lwangaphambili kwi-migraine, ukuncitshiswa kwe-25% kwathathelwa ingqalelo njengoluqikelelo lokugcina [12, 13].

 

Uhlalutyo lweziphumo lubalwe ngeentsuku ezingama-30 emva kweseshoni yokungenelela yokugqibela kunye neentsuku ezingama-30 emva kwexesha lokulandela, okt i-3, 6 kunye ne-12 inyanga ngokwahlukeneyo.

 

Zonke iziganeko ezimbi (ii-AEs) zarekhodwa emva kokungenelela nganye ngokuhambelana neengcebiso ze-CONSORT kunye ne-IHS Task Force kwi-AE kwimvavanyo ye-migraine [16, 23].

 

Uhlalutyo lweSatisati

 

Sisekelwe ekubaleni kwamandla kwiphando olutshanje lwe-topiramate kwi-migraineurs [24]. Sifumanisa umlinganiselo ophakathi kokunciphisa inani le-migraine ngeentsuku phakathi kwendawo esebenzayo kunye ne-placebo, kunye phakathi kwamaqela asebenzayo kunye nolawulo lweentsuku ze-2.5, kunye ne-SD ye-2.5 yokunciphisa iqela ngalinye. Njengoko uhlalutyo oluphambili lubandakanya ukuqhathaniswa kweqela ezimbini, izinga lokubaluleka libekwe kwi-0.025. Ngenxa yamandla e-80%, ubungakanani beesampuli zezigulane ze-20 zafuneka kwiqela ngalinye ukuba zibone ukuhlukana okukhulu ekunciphiseni iintsuku ze-2.5.

 

Iimpawu zesigulana kwisiseko zaziswa njengeendlela kunye ne-SD okanye ii-frequency kunye neepesenti kwiqela ngalinye kwaye kuthelekiswa neesampulu ezizimeleyo zovavanyo kunye? Uvavanyo lwe-2.

 

Iiprofayili zexesha lokuphela kwamanqaku athelekiswa phakathi kwamaqela. Ngenxa yokuphindaphindwa kwemilinganiselo kwisigulana ngasinye, iimodeli ezixubeneyo ezixubeneyo ezenza ukwahluka ngaphakathi kuye kwaqikelelwa kuwo onke amanqaku. Iziphumo ezizinzileyo zexesha (elingelolayini), ulwabiwo lweqela kunye nokunxibelelana phakathi kwezi zimbini zibandakanyiwe. Iziphumo ezingaqhelekanga kwizigulana kunye namathambeka angenisiwe kwimodeli. Njengoko iintsalela bezitsaliwe, i-bootstrap inference isekwe kwiisampulu ezili-1000 ezisebenzisanayo. Ukuthelekisa ngababini kwenziwa ngokufumana ixesha elichaseneyo lamaqela kwiqela ngalinye ngexesha ngalinye elinamaxabiso ahambelana ne-P kunye nama-95% amaxesha okuzithemba. Ukusetyenziswa kwamayeza phakathi kwamaqela kwaxelwa ngeedosi ezithetha nge-SD, kwaye amaqela athelekiswa novavanyo oluzimeleyo lweesampulu. Idosi ichazwe njengolawulo olunye lwe-triptan okanye i-ergotamine; Iparacetamol 1000 mg codeine; iziyobisi ezichasayo ezingasebenziyo (tolfenamic acid, 200 mg; diclofenac, 50 mg; aspirin, 1000 mg; ibuprofen, 600 mg; naproxen, 500 mg); kunye ne-morphinomimetics (tramadol, 50 mg). Akukho namnye kwizigulana otshintshe ingalo yokufunda kwaye akukho namnye ophumayo oye wazaliswa kwidayari zentloko emva kokurhoxa kufundo. Yiyo loo nto, kuphela kuvavanyo lomgaqo olandelwayo olufanelekileyo.

 

Uhlalutyo lwalumfanyekisiwe kulwabiwo lonyango kwaye lwenziwa kwi-SPSS v22 (IBM Corporation, Armonk, NY, USA) kunye ne-STATA v14 (JSB) (StataCorp LP, Station Station, TX, USA). Inqanaba elibalulekileyo le-0.025 lisetyenziselwe indawo yokugqibela, ngelixa kwenye indawo inqanaba le-0.05 lalisetyenziswa.

 

Zokuziphatha

 

Izikhokelo zeeklinikhi ezilungileyo zalandelwa [25]. Ulwazi olumlomo nolwabhaliweyo malunga neprojekthi lunikeziwe kwangaphambili kokufakwa kunye nokwabiwa kweqela. Imvume ebhaliweyo yafunyanwa kubo bonke abathathi-nxaxheba. Abathathi-nxaxheba kwi-placebo kunye neqela lolawulo bathenjiswe unyango lwe-CSMT emva kwe-RCT, ukuba ingenelelo elisebenzayo lufunyenwe lusebenza. I-inshurensi yanikezwa ngeNorway System of Compensation kwaMagulane (Isiguliso seMpilo esiLawulayo), umzimba ozimeleyo wesizwe ohlawula izigulane ezenzakaliswe ngonyango olunikezelwa inkonzo yezempilo yaseNorway. Umgaqo wokumisa uchazwe ukuba uhoxise abathathi-nxaxheba beli phofu ngokuhambelana neengcebiso kwiNTSHONO YOKUKHUTSHELWA kweNgxelo yoLungiso lweHarms [26]. Zonke ii-AE zajongwa ngexesha lokungenelela kwaye zenzeke njengoko zenzeke ngokulandela iziphakamiso ze-CONSORT kunye ne-IHS Task Force kwi-AE kwimvavanyo ye-migraine [16, 23]. Kwimeko enzima ye-AE, umntu othabatha inxaxheba uza kuhoxiswa ekufundeni aze abhekiswe kwiSebe eliPhezulu okanye kwisibhedlele esiphuthumayo ngokubhekiselele kumcimbi. Umphenyi (AC) wayefumaneka ngefowuni ephathekayo nanini na ixesha kulo lonke ixesha lokunyanga.

 

iziphumo

 

Umzobo 1 bonisa itshathi yokuhamba ye-104 migraineurs ebandakanyiwe kufundo. Isiseko kunye neempawu zedemografi zazifana ngokwamaqela amathathu (1 Table).

 

Umzobo we-1 Isatifiketi soMgca wokuFunda

Umzobo 1: Uluhlu lokufunda.

 

Itheyibhile ye1 Isiseko seMbali kunye neenkcukacha zeZliniki

 

Izisiphumo

 

Iziphumo kuwo onke amanqaku okuphela zinikezelwe ku Ikhiwane. 2a d kunye neeTheyibhile 2, 3, 4.

 

Umzobo 2

Umzobo 2: (a) Iintsuku zentloko; (b) ubude bentloko; (c) ukuqina kwentloko; (d) isalathiso sentloko. Iiprofayili zexesha kwiziphelo zaseprayimari nezasesekondari? Iindlela, iindlela kunye neempazamo kwimigca zimele ama-95% amaxesha okuzithemba. BL, isiseko; ulawulo, iqela lolawulo ( ); I-CSMT, unyango lwe-chiropractic ye-spinal manipulative therapy (?); i-placebo, ubuqhetseba (?); PT, unyango? 3 m, 3? Inyanga elandelayo? Ukulandela kwe-6 m, 6? Ukulandela kwe-12 m, 12? I-VAS, isikali se-analogue ebonakalayo.

 

Itafile ze-2 Ukunyanzelisa ii-coefficients kunye ne-SE

 

Itheyibhile ye3 kunye ne-SD

 

Itheyibhile ye4 I-SD Amanani amayeza

 

Inqaku lokuphela kweprayimari. Iintsuku ze-Migraine zancitshiswa kakhulu kuwo onke amaqela ukusuka kwisiseko ukuya kwiposi yonyango (P <0.001). Iziphumo zaqhubeka kwi-CSMT kunye namaqela e-placebo kwi-3, 6 kunye ne-12 iinyanga zilandelelana, ngelixa iintsuku ze-migraine zibuyiselwe kwinqanaba lokuqala kwiqela lolawulo (Ikhiwane. 2a). Imodeli exubeneyo emxinwa ayibonisanga umahluko opheleleyo otshintsho kwiintsuku ze-migraine phakathi kwe-CSMT kunye namaqela e-placebo (P = 0.04) okanye phakathi kwe-CSMT kunye neqela lolawulo (P = 0.06; 2 Table). Nangona kunjalo, ukuthelekiswa kwamacala amabini ngamaxesha athile kubonise umahluko obonakalayo phakathi kwe-CSMT kunye neqela lolawulo ngawo onke amaxesha amanqaku aqala ngeposi? Unyango (3 Table).

 

Amanqaku okuphela kwesekondari. Kwakukho ukuncitshiswa okubonakalayo ukusuka kwisiseko ukuya kuposi? Kunyango kubude bemigraine, amandla kunye ne-HI kwi-CSMT (P = 0.003, P = 0.002 kunye neP <0.001, ngokwahlukeneyo) kunye ne-placebo (P <0.001, P = 0.001 kunye neP < 0.001, ngokwahlukeneyo) amaqela, kwaye isiphumo saqhubeka kwi-3, 6 kunye ne-12 iinyanga zilandela?

 

Ukwahlukana okubalulekileyo phakathi kwe-CSMT kunye namaqela okulawula kwakutshintsho kwisigidi semigraine (P = 0.02) nakwi-HI (P = 0.04; Ithebula 2).

 

Kwiinyanga ezili-12 ezilandelwayo, utshintsho ekusebenziseni iparacetamol lwalusezantsi kakhulu kwiqela le-CSMT xa kuthelekiswa ne-placebo (P = 0.04) kunye nolawulo (P = 0.03) amaqela (4 Table).

 

Ukufumba. Emva kweseshoni nganye yokungenelela eyi-12,> i-80% yabathathi-nxaxheba bakholelwa ukuba bayifumene i-CSMT ngaphandle kokunikezelwa kweqela. Umlinganiso wobungakanani bokukholelwa ukuba unyango lwe-CSMT lwafunyanwa yayiyi-10 kuzo zonke iiseshoni zonyango kuwo omabini amaqela (yonke i-P <0.001).

 

Imiphumo emibi. Inani elipheleleyo lama-703 eeseshoni zongenelelo ezingama-770 zavavanywa kwii-AEs (355 kwiqela le-CSMT kunye ne-348 kwiqela le-placebo). Izizathu zovavanyo lwe-AE oluphosakeleyo ziye zayekwa okanye zaphoswa ziiseshoni zongenelelo. Ii-AEs beziphindaphindeka rhoqo kwi-CSMT kuneeseshoni zongenelelo lwe-placebo (83/355 vs. 32/348; P <0.001). Ithenda yengingqi yayiyeyona i-AE ixhaphakileyo exelwe yi-11.3% (95% CI, 8.4-15.0) kwiqela le-CSMT kunye ne-6.9% (95% CI, 4.7-10.1) kwiqela le-placebo, ngelixa ukudinwa kusuku lokungenelela nentlungu yentamo. zichazwe nge-8.5% kunye ne-2.0% (95% CI, 6.0-11.8 kunye ne-1.0 4.0), kunye ne-1.4% kunye ne-0.3% (95% CI, 0.6 3.3 kunye ne-0.1 1.9) ngokwahlukeneyo. Zonke ezinye ii-AEs (iintlungu ezisezantsi, ubuso obungenanjongo, isicaphucaphu, ukuhlaselwa kwe-migraine kunye nokudinwa kwiingalo) zazinqabile (<1%). Akukho zi-AE zinzima okanye zinobungozi ezichaziweyo.

 

ingxoxo

 

Kulwazi lwethu, le yincwadi yokuqala yonyango i-RCT enempumelelo ebhalwe ngamehlo. I-RCT ye-placebo ivavanye ukusebenza kwe-CSMT kunyango lwe-migraine ngokuchasene ne-placebo (sham chiropractic) kunye nolawulo (unyango lwe-pharmacological yesiqhelo). Iziphumo zabonisa ukuba iintsuku ze-migraine zancitshiswa kakhulu kuwo omathathu amaqela ukusuka kwisiseko ukuya kunyango? Iziphumo ziyaqhubeka kwi-CSMT kunye neqela le-placebo kuwo onke amaxesha alandelayo, ngelixa iqela lolawulo libuyela kwisiseko. Ii-AEs zazithambile kwaye zidlulile, ngokuhambelana nezifundo zangaphambili.

 

Uyilo lokufunda lubambelele kwizindululo ze-RCTs ze-pharmacological njengoko zinikezwe yi-IHS kunye ne-CONSORT [1, 15, 16]. Unyango? Unyango lwe-RCTs lunemiqobo emithathu xa kuthelekiswa nee-RCTs zeekhemesti. Okokuqala, akunakwenzeka ukumfamekisa umphandi ngokunxulumene nonyango olusetyenzisiweyo. Okwesibini, imvumelwano yonyango lwe-inert placebo iyasilela [11]. Okwesithathu, iinzame zangaphambili zokubandakanya iqela le-placebo lishiye ukuqinisekisa ukungaboni, ngenxa yoko, kuhlala kungaziwa nokuba unyango olusebenzayo kunye ne-placebo lwalufihliwe [27]. Ngenxa yale mingeni sagqiba ekubeni siqhube i-RCT exhobileyo, engatshatanga, eyayibandakanya iqela elilawulayo eliqhubeka nonyango oluqhelekileyo lonyango ukuze sifumane umqondiso wobukhulu bempendulo ye-placebo.

 

Kucetyisiwe ukuba, kwii-RCTs ze-placebo ezingaboniyo kabini, yi-50% kuphela eya kukholelwa ukuba ifumana unyango olusebenzayo kwiqela ngalinye, ukuba ukungaboni kakuhle kulungile. Nangona kunjalo, oku akunakuba yinyani kwi-RCTs yonyango, kuba amandla asebenzayo kunye ne-placebo ashukumisayo anokubakho ngakumbi kunethebhulethi [28]. Umphandi omnye unciphisa ukungafani komphenyi ngokunika ulwazi olufanayo kubo bonke abathathi-nxaxheba kwaye kuyacetyiswa ngokubanzi ukuba ungenelelo lwe-placebo kufuneka lufane nonyango olusebenzayo ngokwenkqubo, ixesha lokunyanga kunye nexesha elichithwe nomphenyi ukuvumela ulindelo olufanayo kuwo omabini amaqela [28]. Ukubaluleka kokumfamekisa ngempumelelo kuyagxininiswa yinto yokuba zonke i-RCTs zonyango zangaphambili kwi-headache zine-placebo. Ke, siyakholelwa ukuba iziphumo zethu ezixoxwe ngezantsi zisebenza kwinqanaba elifanayo ne-RCT ye-pharmacological [14].

 

Idatha enokuthenjwa ithembeke ngakumbi kunedatha ebuyayo ngokubhekisele ekukhetheni ukukhumbula; nangona kunjalo, ukungathobeli kunokuba ngumceli mngeni, ngakumbi ekupheleni kwesifundo. Siyakholelwa ekubeni unxibelelwano rhoqo phakathi kwabathathi-nxaxheba kunye nomphenyi, kubandakanya unxibelelwano lwenyanga nenyanga kwixesha lokulandela, mhlawumbi kugcinwe ukuthotyelwa okuphezulu kwisifundo sethu sonke.

 

Nangona isampulu yethu yokufunda yaphela ngabathathi-nxaxheba abangama-104 kula maqela mathathu, ukubalwa kwamandla kunye nenqanaba eliphezulu lokugqitywa kwenkxaso yedatha ephunyeziweyo isemthethweni kubemi abaphandiweyo. Indlela yeGonstead isetyenziswa yi-59% ye-chiropractors [19] kwaye, ngenxa yoko, iziphumo ziyafumaneka ngokubanzi kulo msebenzi. Ukuqinisekiswa kwesifo sesinye sezona zinto zisomeleleyo njengoko phantse bonke abathathi-nxaxheba babesele befunyaniswe yi-neurologist ngokwe-ICHD? II [2]. Ngokuchasene ne-RCTs yangaphambili ye-chiropractic migraine ebithathe abathathi-nxaxheba ngamajelo eendaba njengamaphephandaba kunye nentengiso kanomathotholo [12], uninzi lwabathathi-nxaxheba bethu baqeshwa kwiSebe le-Neurology, kwisibhedlele i-Akershus University, bebonisa ukuba i-migraineurs inokuhlaselwa rhoqo kunzima ukunyanga kunabantu ngokubanzi, njengoko babethunyelwe nguGqirha Jikelele kunye / okanye noqheliso lweeurologist. Ke ngoko, isifundo sethu simele ikakhulu iklinikhi yenqanaba labemi, kwaye isiphumo sinokuba sahlukile ukuba abathathi-nxaxheba babebanjiwe kubemi ngokubanzi. Ipesenti yentlungu yentamo ifunyenwe iphezulu kwizigulana ezine-migraine [29] kwaye, ke, ipesenti ephezulu yeentlungu zomqolo ezingafunekiyo kwisifundo sethu inokuba yinto ephikisayo ebonwe kwiintsuku ze-migraine.

 

Incwadana yesithathu ye-pragmatic chiropractic? Unyango lwe-RCTs kusetyenziswa ubuchule obahlukileyo obenziwe ngaphambili kwimigraineurs [12, 30, 31, 32]. I-RCT yase-Australia ibonakalise ngaphakathi kweqela ukunciphisa i-migraine frequency, ubude kunye namandla e-40%, 43% kunye ne-36%, ngokwahlukeneyo, kwiinyanga ezi-2 ezilandelwayo [30]. Uphononongo lwaseMelika lufumene imvama ye-migraine kunye namandla okunciphisa ngaphakathi kweqela nge-33% kunye ne-42%, ngokwahlukeneyo, kwinyanga eyi-1 yokulandela [31]. Olunye uphando lwase-Australia, eyayikukuphela kwe-RCT yokubandakanya iqela elilawulayo, okt i-ultrasound efumanekileyo, yafumana ngaphakathi ukunciphisa iqela lokuphindaphindeka kwemigraine kunye nobude be-35% kunye ne-40%, ngokwahlukeneyo, kwiinyanga ezi-2 ezilandelelanayo kwiqela le-CSMT, xa kuthelekiswa nokuncitshiswa kweqela ngaphakathi kwe-17% kunye ne-20% kwiqela lolawulo, ngokwahlukeneyo [32]. Ukuncitshiswa kweentsuku ze-migraine kwakufana nokwethu (i-40%) kwiqela le-CSMT ukusuka kwisiseko ukuya kwiinyanga ezi-3 ezilandelelweyo, ngelixa ubude be-migraine kunye nokuqina bekuncitshisiwe kwiinyanga ezi-3 zokulandela, okt i-21% kunye ne-14%, ngokwahlukeneyo. Ukuthelekiswa kwexesha elide akunakwenzeka njengoko kungekho kwizifundo zangaphambili ezibandakanya ixesha elilandelelweyo lokulandela. Uyilo lwethu lwesifundo kubandakanya ukusebenza okuqinisekileyo kwangaphakathi kusivumela ukuba sitolike isiphumo esibonwe njengempendulo ye-placebo.

 

I-RCT yethu yayinee-AE ezimbalwa xa kuthelekiswa nezifundo zonyango zangaphambili, kodwa ezinje ngokuhamba kancinci kunye nobumnene [33, 34, 35, 36, 37, 38, 39]. Nangona kunjalo, yayingaxhotyiswanga ngokwaneleyo ukufumana i-AEs ezinqabileyo. Xa kuthelekiswa, ii-AEs kwi-pharmacological migraine prophylactic placebo RCTs zixhaphakile kubandakanya ii-AEs ezingezozobulali nezingezizo [40, 41].

 

isiphelo

 

Ukumfamekisa kwaqiniswa ngamandla kuyo yonke i-RCT, ii-AE zazimbalwa kwaye zinobulali, kwaye isiphumo kwiqela le-CSMT kunye ne-placebo mhlawumbi yayiyimpendulo ye-placebo. Ngenxa yokuba abanye abantu abanganyamezeliyo abanyamezeli amayeza ngenxa ye-AEs okanye ukuphazamiseka kwengqondo, i-CSMT inokuqwalaselwa kwiimeko apho ezinye iindlela zonyango zingasebenzi okanye zinganyamezelwa kakuhle.

 

Ukuchazwa kweengxabano zomdla

 

Bonke abalobi baye bagqiba iKomidi yeSizwe ye-Medical Journal Abahleli befomu yokubhengeza ifom kunye nokuvakalisa akukho mali okanye ezinye iimbambano zomdla.

 

Ukuxhasa ulwazi

 

Ncbi.nlm.nih.gov/pmc/articles/PMC5214068/#ene13166-tbl-0001

 

Imibulelo

 

Ababhali bafuna ukuvakalisa umbulelo ongazenzisiyo kwisibhedlele iAkershus University, esibonelele ngobubele ngezixhobo zophando, kunye neKliniki yeChiropractor 1, eOslo, eNorway, neyenze lonke uvavanyo lwe-x ray. Olu phononongo luxhaswe zizibonelelo ezivela kwi-Extrastiftelsen, i-Norwegian Chiropractic Association, i-Akershus University Hospital kunye neYunivesithi yase-Oslo eNorway.

 

Ukuququmbela, Iimpawu ezityhafisayo ze-migraines, kubandakanya iintlungu zentloko kunye nobuntununtunu bokukhanya kunye nesandi kunye nesicaphucaphu, kunokuchaphazela umgangatho wobomi bomntu, ngethamsanqa, ukhathalelo lwe-chiropractic lubonakalisiwe lukhetho olukhuselekileyo nolusebenzayo kunyango lwentloko. intlungu. Ngaphaya koko, inqaku elingentla libonakalisile ukuba i-migraineurs ifumene iimpawu ezincitshisiweyo kunye neentsuku ze-migraine ngenxa yokhathalelo lwe-chiropractic. Ingcaciso ebhekiswe kwiZiko leLizwe leNgcaciso yeBiotechnology Information (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

 

Green-Call-Now-Button-24H-150x150-2-3.png

 

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.

 

umfanekiso webhlogi weendaba eziphambili zephepha lephepha

 

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

 

 

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

 

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Vala i-Accordion
I-Psychology, Intloko, I-Back Pain, Ubuhlungu obungapheliyo kunye neChiropractic e-El Paso, TX

I-Psychology, Intloko, I-Back Pain, Ubuhlungu obungapheliyo kunye neChiropractic e-El Paso, TX

by | Umqolo obuhlungu, Chiropractic, Ubuhlungu obungapheliyo, Migraine, Ukubuyiswa komzimba, Uvavanyo oluLungeleleneyo oluLungisiweyo, istres, Unyango

Wonke umntu ufumana iintlungu ngexesha elide. Ubunzima bubuhlungu obungokwenyama obubangelwa kukulimala okanye ukugula. Xa udonsa umsizi okanye usike umnwe wakho, umzekelo, isignali ithunyelwa ngeengcambu zentsholongwane kwingqondo, ekutshengeni ukuba into ephosakeleyo emzimbeni. Ubuhlungu buyahlukahluka kuwo wonke umntu kwaye kukho iindlela ezininzi zokuvakalelwa nokuchaza intlungu. Emva kokulimala okanye ukugula kugula, intlungu iya kuphelisa, nangona kunjalo, kwenzeka ntoni ukuba intlungu iyaqhubeka nangemva kokuphilisa?

 

Ubuhlungu obungapheliyo ngokuqhelekileyo ichazwa njengaluphi na ubuhlungu obuhlala ngaphezu kweeveki ze-12. Ubuhlungu obungapheliyo bunokuvela kwi-mild to severe and can be the result of injuries before or surgery, migraine kunye nentloko, isifo samathambo, umonakalo wemisipha, ukusuleleka kunye ne-fibromyalgia. Ubuhlungu obungapheliyo buyakuchaphazela isimo sengqondo somntu kunye nengqondo, okwenza kube nzima ukukhupha iimpawu. Uphando lwaphando lubonise ukuba ukungenelela kwengqondo kunokuncedisa inkqubo yokubuyisela ubuhlungu obungapheliyo. Abasebenzi abaninzi bezempilo, njengogqirha we-chiropractic, banokubonelela ngononophelo lwe-chiropractic kunye nokungenelela kwengqondo ukunceda ukubuyisela impilo kunye nokuphila kakuhle kwezigulane zabo. Injongo yale nqaku ilandelayo kukubonisa inxaxheba yongenelelo lweengqondo ekulawuleni izigulane ezinentlungu engapheliyo, kuquka intloko yesifo kunye nentlungu.

 

 

Inxaxheba Yongenelelo lweengqondo kwi-Management of Patients with Pain Pain

 

Abstract

 

Intlungu engapheliyo inokuqondwa ngcono ngokwembono ye-biopsychosocial apho iintlungu zijongwa njengamava antsonkothileyo, anezinto ezininzi ezivela kulwalamano olunamandla lwesimo somzimba, iingcinga, iimvakalelo, isimilo, kunye nefuthe lenkcubeko. Umbono we-biopsychosocial ujolise ekujongeni iintlungu ezingapheliyo njengesifo kunesifo, ngenxa yoko ukuqonda ukuba ngamava aphantsi kwaye iindlela zonyango zijolise kulawulo, endaweni yokunyanga, kwentlungu engapheliyo. Iindlela zangoku zengqondo kulawulo lweentlungu ezingapheliyo zibandakanya ungenelelo olujolise ekufezekiseni ukwanda kolawulo lwakho, utshintsho kwindlela yokuziphatha, kunye notshintsho lwengqondo kunokuba ususe ngqo indawo ebuhlungu. Izibonelelo zokubandakanya unyango lwengqondo kwiindlela ezahlukeneyo zokulawula iintlungu ezingapheliyo zibandakanya, kodwa azikhawulelwanga, ukunyusa ukuzilawula kweentlungu, ukuphucula izixhobo zokujamelana neentlungu, ukunciphisa ukukhubazeka okunxulumene nentlungu, kunye nokunciphisa uxinzelelo lweemvakalelo ngeendlela ezahlukeneyo zokuzilawula, zokuziphatha, kunye neendlela zokuqonda. Ngokumiliselwa kolu tshintsho, iingcali zengqondo zinokunceda abaguli bazive ngaphezulu kumyalelo wolawulo lweentlungu zabo kwaye babenze bakwazi ukuhlala ubomi obuqhelekileyo kangangoko kunokwenzeka ngaphandle kwentlungu. Ngaphaya koko, izakhono ezifundwe ngongenelelo lwengqondo zixhobisa kwaye zenza ukuba izigulana zibe ngabathathi-nxaxheba abakhutheleyo kulawulo lokugula kwabo kwaye baxhokonxe izakhono ezixabisekileyo ezinokuqeshwa zizigulana kubomi babo bonke.

 

Internet: ukuphathwa kabuhlungu obungapheliyo, iingqondo zengqondo, unyango lweentlungu ezahlukeneyo, unyango lwezengqondo zokuziphatha

 

UDkt Jimenez White Coat

Insight of Dr. Alex Jimenez

Ubuhlungu obungapheliyo sele buzimisele ukuchaphazela impilo yengqondo yabantu abaneempawu eziqhubekayo, ekugqibeleni ukutshintsha isimo sabo sengqondo nesimo sengqondo. Ukongezelela, izigulane ezineemeko ezidityanisiweyo, kuquka ukuxinezeleka, uxinzelelo kunye nokudakumba, zingenza unyango lunzima. Indima yenkathalo ye-chiropractic kukubuyisela kunye nokugcina nokulungelelanisa ukulungelelaniswa kokuqala komgudu ngokusebenzisa ukuguqulwa komgudu kunye nokusetyenziswa kwamandla. Ukunyamekela kwe-Chiropractic kuvumela umzimba ukuba uphilise ngokwawo ngaphandle kwemfuno yeziyobisi / amachiza kunye nokungenelela okucwangcisiweyo, nangona oku kungathunyelwa kwi-chiroprarensi ukuba kuyimfuneko. Nangona kunjalo, ukunakekelwa kwe-chiropractic kugxile kumzimba ngokubanzi, kunokuba kubekho ukulimala omnye kunye / okanye imeko kunye neempawu zayo. Ukuguqulwa kwamagqabi kunye nokusetyenziswa kwamanyathelo, phakathi kwezinye iindlela zonyango kunye nezindlela eziqhelekileyo ezisetyenziselwa yicroperractor, zifuna ukuqonda ngesimo sengqondo nesimo sengqondo somguli ukwenzela ukuba ubonelele ngokufanelekileyo impilo nempilo. Izigulane ezityelela kwiklinikhi yam ngokuxinezeleka kwemizimba yazo zihlala zikwazi ukufumana iingxaki zengqondo ngenxa yoko. Ngako oko, ukunakekelwa kwe-chiropractic kungabangela ukungenelela kwengqondo kwindlela yokulawula ubuhlungu obungapheliyo, kunye nezo ziboniswe ngezantsi.

 

intshayelelo

 

Intlungu ngamava omntu okuyo yonke indawo. Kuqikelelwa ukuba malunga ne-20% 35% yabantu abadala abafumana iintlungu ezingapheliyo. [1,2] I-National Institute of Nursing Research inika ingxelo yokuba iintlungu zichaphazela abantu abaninzi baseMelika kunesifo seswekile, isifo sentliziyo, kunye nomhlaza zidityanisiwe. [3] Ubuhlungu bukhankanywe njengesona sizathu siphambili sokufuna unyango e-United States. [4] Ngapha koko, ukuthomalalisa iintlungu lolwesibini unyango olumiselweyo kwii-ofisi zoogqirha nakumagumbi angxamisekileyo. [5] Ukuqinisa ngakumbi ukubaluleka kovavanyo olwaneleyo lwentlungu, iKhomishini edibeneyo yokuVunywa kweMibutho yoKhathalelo lwezeMpilo ikhuphe umyalelo wokuba iintlungu zivavanywe njengophawu lwesihlanu olubalulekileyo ngexesha lotyelelo lwezonyango. [6]

 

Umbutho waMazwe ngaMazwe woFundo lweNtlungu (IASP) uchaza iintlungu njenge- amava angathandekiyo eemvakalelo kunye neemvakalelo ezinxulunyaniswa nokwenzeka ngqo okanye ukubakho kwethishu, okanye kuchazwe ngokwaloo monakalo . Inkcazo ye-IASP igxininisa ubunjani obuninzi kunye nokuzithoba kwintlungu, amava anzima ahlukeneyo kumntu ngamnye. Ubuhlungu obungapheliyo buhlala buhlulwa kwintlungu ebuhlungu ngokusekwe kukunganyamezeleki okanye ukuzingisa, iindlela zayo zokulondolozwa komzimba, kunye / okanye nefuthe elibi kubomi bomntu. Ngokubanzi, kuyamkelwa ukuba iintlungu eziqhubeka ngaphezulu kwexesha elilindelweyo lokunyanga izicubu kulandela ukwenzakala okanye utyando kuthathwa njengentlungu engapheliyo. Nangona kunjalo, ixesha elibekiweyo elilindelweyo lokuphilisa liyahluka kwaye kuhlala kunzima ukuqiniseka ngalo. Ukulungiselela ukwahlulwahlulwa ngokulula, izikhokelo ezithile zibonisa ukuba iintlungu eziqhubayo ngaphaya kwenyanga ye-7 3 yexesha kuthathwa njengentlungu engapheliyo. [6] Nangona kunjalo, ukuhlelwa kwentlungu esekwe kuphela kubude kuyasebenza ngokungqongqo kwaye, kwezinye iimeko, inqobo yokuchasana. Ngokuqhelekileyo, izinto ezongezelelweyo ezifana ne-etiology, ubunzima beentlungu, kunye nefuthe ziqwalaselwa kunye nexesha lokuhlukanisa ubuhlungu obungapheliyo. Enye indlela yokubonakalisa ubuhlungu obungapheliyo isekelwe kwindlela yokugcinwa komzimba; Oko kukuthi, iintlungu ekucingelwa ukuba ziyavela ngenxa yolungelelwaniso kunye nolungelelwaniso oluphambili. Iimeko eziqhelekileyo zentlungu zibandakanya ukuphazamiseka kwemisipha, iimeko zentlungu ye-neuropathic, iintlungu zentloko, iintlungu zomhlaza kunye nentlungu yokubona. Ngokubanzi ngakumbi, iimeko zentlungu zinokuba ikakhulu zi-nociceptive (ukuvelisa iintlungu zoomatshini okanye zeekhemikhali), i-neuropathic (ebangelwa ngumonakalo wemithambo-luvo), okanye embindini (okubangelwa kukungasebenzi kakuhle kwii-neurons zenkqubo ye-nervous system). [7]

 

Ngelishwa, amava entlungu ahlala ebonakaliswa kukungaziphathi kakuhle ngokwasemzimbeni, ngokwasengqondweni, ngokwasentlalweni nakwezemali. Ubuhlungu obungapheliyo buye babonwa njengesona sizathu siphambili sokukhubazeka ixesha elide kubemi baseMelika abasebenzayo. [9] Ngenxa yokuba iintlungu ezingapheliyo zichaphazela umntu kwimimandla emininzi yobukho bakhe ikwangumthwalo omkhulu wemali kuluntu lwethu. Iindleko ezichanekileyo nezingangqalanga zentlungu ziqikelelwa ukuba zisuka kwi-125 yezigidigidi ukuya kwi-215 yezigidigidi, ngonyaka. [10,11] Iziphumo ezixhaphakileyo zentlungu engapheliyo zibandakanya ukwanda kweengxelo zoxinzelelo (umzekelo, ukudakumba, unxunguphalo, kunye nokudana), ukwanda kwamazinga okukhubazeka okunxulumene nentlungu, utshintsho olunxulumene nentlungu ekuqondeni, kunye nokunciphisa umgangatho wobomi. Ke, iintlungu ezingapheliyo zinokuqondwa ngcono ngokwembono ye-biopsychosocial apho iintlungu zijongwa njengamava antsonkothileyo, anezinto ezininzi ezivela kulwalamano olunamandla lwesimo somzimba, iingcinga, iimvakalelo, isimilo, kunye nefuthe lenkcubeko.

 

Ulawulo lwezinhlungu

 

Ngenxa yokuxhaphaka kweentlungu kunye nobukhulu bayo, i-regimen yolawulo lwentlungu efanelekileyo iya kubanzi, idibanise kunye neyodwa. Iindlela ezikhoyo zolawulo lweentlungu ezingapheliyo ziye zagqithisa ukunciphisa nokunciphisa ngokukhawuleza, ngokomzimba, okanye kwi-pharmacological unyango. Iindlela ezikhoyo ziyabona ukubaluleka kwesikhokelo sokhathazwa kwamanyathelo ahlukeneyo ekujoliswe kuzo ekujoliswe kwimiba yeentlungu kodwa kunye neengqinisiso zokuqonda, kunye nezizathu ezinokuthi zithintekayo kunye kunye neempembelelo ezifanayo. Ulawulo oluqhelekileyo lweentlungu ezingapheliyo ziquka ukunyangwa kwamaqela amaninzi afana nokuhlanganiswa kwama-analgesics, unyango lomzimba, unyango lwendlela yokuziphatha, kunye neyeza zengqondo. Indlela yokwenza i-multimodal ngokufanelekileyo ngokwaneleyo kwaye iqondise ngokufanelekileyo ulawulo lweentlungu kwiimodeli, ukuziphatha, ukuqonda, kunye namazinga asebenzayo. Ezi ndlela ziye zaboniswa ukuba zikhokele kwiziphumo eziphambili kunye nezihlala zihlala zihlala ziquka iingxelo zentlungu, imizwa, ukubuyiswa kwemisebenzi yansuku zonke, isimo somsebenzi, kunye neyeza okanye ukusetyenziswa kwezempilo; Iindlela zokwenziwa kweemimandla ziye zaboniswa ukuba zindleko ezininzi kuneendlela ezingenjalo. [12,13] Ugxininiso lwolu hlalutyo luya kubakho ngokucacileyo ukulungelelanisa iingenelo zengqondo kwindlela yokulawula intlungu engapheliyo.

 

UDkt. Jimenez wenza unyango lomzimba kwisigulane.

 

Izigulana ziya kuthi ekuqaleni zibonise iofisi kagqirha ekunyangeni unyango okanye unyango lwezifo zabo / iintlungu ezibuhlungu. Kwizigulana ezininzi, kuxhomekeke kwi-etiology kunye ne-pathology yeentlungu zabo kunye neempembelelo ze-biopsychosocial kumava entlungu, iintlungu eziqaqambileyo ziya kusombulula ngokuhamba kwexesha, okanye ukulandela unyango olujolise ekujoliseni unobangela wentlungu okanye ukuhanjiswa kwayo. Nangona kunjalo, ezinye izigulana azizukufezekisa ukusonjululwa kwentlungu yabo ngaphandle kongenelelo oluninzi lwezonyango kunye nolongezelelo kwaye ziya kutshintsha zisuka kwintlungu ebuhlungu iye kwimeko yeentlungu ezinganyangekiyo. Umzekelo, uphando lubonakalisile ukuba malunga ne-30% yezigulana ezibonisa ugqirha wabo wokunyamekela kwizikhalazo ezinxulumene nentlungu ebuhlungu iya kuqhubeka nokufumana iintlungu kwaye, kwabanye abaninzi, ukusikelwa umda kwemisebenzi kunye nokubandezeleka kwiinyanga ezili-12 kamva. [14] Njengoko iintlungu kunye neziphumo zalo ziyaqhubeka nokukhula kwaye zibonakalise kwimiba eyahlukeneyo yobomi, iintlungu ezingapheliyo zinokuba ikakhulu yingxaki ye-biopsychosocial, apho uninzi lweempawu zebhayopsychosocial zinokuthi ziqhubele phambili kwaye zigcine iintlungu, oko ke kuqhubeka nefuthe elibi kubomi bomntu ochaphazelekayo. Kule ndawo apho irejimeni yonyango yoqobo inokwahluka ukubandakanya ezinye izinto zonyango, kubandakanya neendlela zengqondo zokulawula iintlungu.

 

Iindlela zengqondo zolawulo lweentlungu ezingapheliyo ekuqaleni zafumana ukuthandwa ekupheleni kweminyaka yama-1960 ngokuvela kweMelzack kunye neWall s gate-control theory of pain [15] kunye ne- neuromatrix theory of pain . [16] Ngokufutshane, ezi ngcamango zibonisa ukuba iinkqubo zengqondo nezomzimba ziyasebenzisana ukuze zichaphazele ukuqonda, ukuhambisa, kunye nokuvavanya iintlungu, kwaye ziyayiqonda impembelelo yezi nkqubo njengezinto zolondolozo ezichaphazelekayo kwimeko yeentlungu ezingapheliyo okanye ezinde. Ngokukwanjalo, ezi ngcamango zisebenza njengezinto eziphambili zokufaka utshintsho kwindlela ebalaseleyo nengalunganga kunyango lwentlungu, enye ilawulwa kakhulu ziimbono zebhayiloji ngokungqongqo. Iiklinikhi kunye nezigulana ngokufanayo zifumene ukwandiswa okwandayo kunye noxabiso ngobunzima bokulungiswa kwentlungu kunye nokugcinwa; Ngenxa yoko, ukwamkelwa kunye nokukhethwa kweembono ezahlukeneyo zemeko yentlungu kwasekwa. Okwangoku, imodeli ye-biopsychosocial yeentlungu, mhlawumbi, yeyona ndlela yamkelekileyo eyamkelekileyo yokuqonda iintlungu. [17] Umbono we-biopsychosocial ujolise ekujongeni iintlungu ezingapheliyo njengesifo kunesifo, ngaloo ndlela ukuqonda ukuba ngamava e-subjective kwaye iindlela zonyango zijolise kulawulo, endaweni yokunyanga, kwentlungu engapheliyo. [17] Njengoko ukusetyenziswa kwendlela ebanzi kunye neyona ndlela ibanzi yokulawula iintlungu ezingapheliyo kuye kwabonakala, ungenelelo olusekwe kwengqondo lubone ukunyuka okuphawulekayo ekuthandeni nasekuqondweni njengonyango olongezelelekileyo. Iindidi zongenelelo lwengqondo eziqeshwe njengenxalenye yenkqubo yonyango yeentlungu ezininzi ziyahluka ngokokuziqhelanisa nonyango, i-etiology yeentlungu, kunye neempawu zesigulana. Ngokufanayo, uphando malunga nokusebenza kwamanyathelo angenelelo lwengqondo kwiintlungu ezingapheliyo kubonise ukuhluka, nangona kuthembisa, iziphumo kwiimpawu eziphambili ezifundwayo. Olu gqabantshintshi luza kuchaza ngokufutshane iindlela zonyango ezisetyenziselwa unyango olusebenzayo kunye nokusebenza kwazo ngokufanelekileyo kwiziphumo eziphambili.

 

Izindlela zengqondo zangoku eziphathekayo ekulawuleni iintlungu ezingapheliyo ziquka ukungenelela okujolise ekuphumezeni ukulawulwa kwezinto ezizimeleyo, ukuguquka kokuziphatha, kunye nokuguqulwa kwengqondo kunokuba kupheliswe ngokuthe ngqo indawo yeentlungu. Ngaloo ndlela, bajolise kwizinto eziphathekayo zokuziphatha, iimvakalelo kunye neengcamango zentlungu engapheliyo kunye nezinto ezibangela ukugcinwa kwayo. Ukwaziswa kwesi sikhokelo esinikwe nguHoffman et al [18] kunye no-Kerns et al, [19] oku kulandelwa rhoqo kwiindawo zonyango ezisekelwe kwengqondo zihlaziywa: ubuchule be-psychophysiological, iindlela zokuziphatha zonyango, unyango lwendlela yokuziphatha kunye nokungenelela okusekelwe.

 

Iingcaphephe zengqondo

 

Biofeedback

 

I-Biofeedback yindlela yokufunda apho izigulane zifunda ukutolika impendulo (ngohlobo lwengcaciso yomzimba) malunga nemisebenzi ethile yempilo. Ngokomzekelo, isigulane sinokusebenzisa izixhobo ze-biofeedback ukufunda ukuqaphela iziganeko zomthambo emzimbeni wazo kwaye emva koko zifunde ukukhulula ezo ndawo ukunciphisa uxinzelelo lwe-muscular. Impendulo inikezwa ngezixhobo ezahlukeneyo zokulinganisela ezinokunika ulwazi malunga nomsebenzi wombane wengqondo, uxinzelelo lwegazi, ukuhamba kwegazi, ithoni ye-muscle, umsebenzi we-electrodermal, izinga leentliziyo, kunye nokushisa kwesikhumba, phakathi kweminye imisebenzi yomzimba ngokukhawuleza. Injongo ye-biofeedback iyayifumana isigulane ukuba ifunde indlela yokuqalisa inkqubo yokuzilawula ngokwasemzimbeni ngokuphumeza ukulawula ngokuzithandela malunga nezimpendulo ezithile zomzimba ekugqibeleni ukwandisa ukuguquguquka komzimba ngokuqonda ngokubanzi nokuqeqeshwa okuthe ngqo. Ngako oko isigulane siza kusebenzisa izakhono ezizodwa zokulawula ukuzama ukunciphisa umcimbi ongathandekiyo (umz., Intlungu) okanye ukuphendulwa kwemizimba engathandekiyo (umzekelo, ukuphendula uxinzelelo). Iingcali ezininzi zeengqondo ziqeqeshwe kwiinkqubo ze-biofeedback kwaye zibonelela ngeenkonzo njengenxalenye yonyango. I-Biofeedback iye yonyulwa njengomsebenzi onobungqina beentlungu ezinxulumene nentloko kunye ne-temporomandibular disorders (TMD). [20] Ukuhlalutya kwe-meta-uphando lwe-55 kuveze ukuba ukungenelela kwe-biofeedback (kubandakanya iindlela ezahlukeneyo ze-biofeedback) kwanikezela ukuphucula okubalulekileyo malunga nokuvama kokuhlaselwa kwe-migraine kunye nemibono yokulawulwa kwentloko ukuzinyameka xa kuqhathaniswa nezimo zolawulo. [I-21] Izifundo zinike inkxaso yenkxaso ye-biofeedback ye-TMD, nangona uphuculo oluthe xaxa malunga nentlungu kunye nokukhubazeka okuchaphazelekayo sele kufunyenwe kwiiprotokholi ezidibanisa i-biofeedback kunye nengqiqo ukuqeqeshwa kwezakhono zokuziphatha, phantsi kwengcinga yokuba indlela yokusebenzisana yonyango ngokubanzi ichaza i-gamut yeengxaki ze-biopsychosocial ezingadibana nazo ngenxa ye-TMD. [22]

 

Indlela yokuziphatha

 

Uqeqesho lokuphumula

 

Ngokuqhelekileyo yamkelwa ukuba uxinzelelo luyinto ebalulekileyo ekubandakanyekeni kunye nokugcinwa kweentlungu ezingapheliyo. [16,23] Ukuxinwa kwengxaki kunokuba yinto engqongileyo, ngokomzimba, okanye ngokwengqondo nangokwemvakalelo, nangona kunjalo ezi ndlela zihambelana ngokugqithiseleyo. Ukugxilwa koqeqesho lokuphumula kukunciphisa amanqanaba omgudu (ngokomzimba nangokwengqondo) ngokusebenza kwenkqubo ye-nervympathetic ne-nervous system kunye nokufumana ukuqonda okubanzi malunga namaziko kunye nokusebenza kwengqondo, ngaleyo ndlela kufezekiswe ukunciphisa intlungu kunye nokwandisa ukulawula iintlungu. Izigulane ziyakwazi ukufundiswa iindlela ezininzi zokuziphucula kwaye zizenzele ngokwazo okanye ngokubambisana, kunye nezixhobo ezixhasayo kwezinye iindlela zokuziphatha zobuhlungu nokuziphatha. Ezi zilandelayo zichazwe ngokufutshane iinkqubo zokuphumula eziqhelekileyo ezifundiswa ngabafundi beengqondo.

 

Ukuphefumla. Ukuphefumula ngokufayo kuyindlela yobomi bokuphucula apho izigulane ziyalwa ukuba zisebenzise izihlunu zesithsaba sazo ngokuchasene nezihlunu zesifuba saso ukuze zibandakanye ukuziloba. Ukuphefumula ngokuqhawula isithintelo kuvumela imiphunga ukuba yande (egqitywe ukwandiswa kwesisu ngexesha lokutshatyalaliswa) kwaye ngoko kwandisa ukondla kwe-oksijini. [24]

 

Ukuphumla kwemisipha yokuqhubekayo (PMR). I-PMR ibonakaliswe ngokubandakanya ukudibanisa kwemisipha kunye nokuzilalisa kwemisipha ethile okanye amaqela emisipha kuwo wonke umzimba. [25] Isigulane siyalwa ngokuqhelekileyo ukuba sihlanganyele ekusebenziseni uxhaphalo / ukuphumula ngendlela elandelanayo kude kube zonke iindawo zomzimba ziye zaqwalaselwa.

 

Uqeqesho lwe-Autogenic (AT). I-AT yindlela yokuzihlaziya ngokuzilawulayo apho isigulane siphinda ibinzana ngokubambisana nokubonisa ukukhupha isimo sokuphumla. [26,27] Le ndlela idibanisa ukuxilongo, ukubonakala, kunye nobuchule bokuphefumla.

 

Ukubonakalisa / ukujonga umfanekiso. Le ndlela ikhuthaza izigulane ukuba zisebenzise zonke iingqondo zabo ekucingeni indawo ecacileyo, ephilileyo kunye nekhuselekileyo ukuphumeza indlela yokuphumla kunye nokuphazamiseka kwiintlungu kunye neengcamango ezinxulumene nentlungu kunye nokuvakalelwa. [27]

 

Ngokudibeneyo, iindlela zokuphumla zifunyenwe ziluncedo kulawulo lweentlobo ngeentlobo zeemeko zentlungu engapheliyo kunye nolawulo lweentlungu ezibalulekileyo (umzekelo, umgangatho wobomi onxulumene nempilo). [28-31 ] Iindlela zokuphumla zihlala zenziwa ngokudibene nezinye iindlela zolawulo lwentlungu, kwaye kukho ukugqagqana okubonakalayo kwiindlela zokucinga zokuphumla kunye ne-biofeedback, umzekelo.

 

Unyango loPhatha

 

Unyango lokuziphatha olusebenzayo lwentlungu engapheliyo lukhokelwa yimigaqo-nkqubo yoqobo esebenzayo ecetyiswe nguSkinner [32] kwaye icokisiwe yiFordyce [33] ukuze isebenze kulawulo lweentlungu. Iimpawu eziphambili zomzekelo wokusebenza kwemeko yokusebenza njengoko inxulumene nentlungu ebambekayo yokuba isimilo sentlungu ekugqibeleni sinokuthi siguquke kwaye sigcinwe njengezibonakalisayo iintlungu ezingapheliyo ngenxa yokuqiniswa okuqinisekileyo okanye okungalunganga kwendlela yokuziphatha enikiweyo kunye nesohlwayo sokuziqhelanisa ngakumbi. Ukuziphatha kabuhlungu. Ukuba ukomeleza kunye neziphumo ezilandelayo zenzeka rhoqo, zinokubangela imeko yokuziphatha, oko ke kwandise ukubakho kokuphindaphinda indlela yokuziphatha kwixa elizayo. Ke ngoko, isimilo esimiselweyo senzeka njengemveliso yokufunda yeziphumo (zokwenyani okanye ezilindelweyo) zokuzibandakanya kwindlela oziphethe ngayo. Umzekelo wokuziphatha okuqhubekekayo kukuqhubeka nokusetyenziswa kwamayeza behavior indlela yokuziphatha ebangelwa kukufunda ngemibutho ephindaphindwayo ethatha amayeza ilandelwa kukususwa kwemvakalelo yokuvava (iintlungu). Ngokufanayo, iimpawu zokuziphatha zentlungu (umz., Intetho yomlomo wentlungu, amanqanaba omsebenzi asezantsi) unokuba yimeko yokuziphatha enokuthi iqhubekekise iintlungu ezingapheliyo kunye nokulandelelana kwayo. Unyango olukhokelwa yimigaqo yokuziphatha esebenzayo lujolise ekucimeni isimilo esibuhlungu ngokuziphatha okufanayo ngemigaqo yokufunda enokuthi isekwe yiyo. Ngokubanzi, izinto zonyango zonyango olusebenzayo zibandakanya ukwenziwa okuhleliweyo, iishedyuli zamayeza ezinamaxesha, kunye nokusetyenziswa kwemigaqo yokuqinisa ukonyusa isimilo esihle kunye nokunciphisa indlela yokuziphatha ebuhlungu.

 

Ukusebenza ngokusetyenzisiweyo. Iingcali zengqondo zikwazi ukuphumeza iinkqubo zengqesho ezidityanisiweyo zezigulane ezingapheliyo eziye zanciphisa amanqanaba omsebenzi wazo (ukwandisa amathuba okwenyuka komzimba) kwaye emva koko zifumana amanqanaba aphakamileyo entlungu xa eqhuba umsebenzi. Izigulane ziyalelwe ukuba ziphule ngokukhuselekileyo umjikelezo wokungahambi kunye nokuhlaziywa ngokubandakanyeka kwintsebenzo ngendlela elawulwayo kunye nexesha elingapheliyo. Ngale ndlela, izigulane zinokunyusa ngokukhawuleza ubude bexesha kunye nobukhulu bomsebenzi ukuphucula ukusebenza. Iingcali zengqondo zijongene nenkqubela phambili kwaye zibonelela ngokufanelekileyo ukuthotyelwa, ukulungiswa kweengcamango okanye ukuchazwa kakuhle kweentlungu ezibangelwa ngumsebenzi, apho kufanelekile, kunye neengxaki zokusombulula izithintelo zokuthobela. Le ndlela ihlala ihlanganiswe kwiinkqubo zonyango zolawulo lwentlungu.

 

Iishedyuli zamachiza ezithatha ixesha. Ingcali yeengqondo ingaba ngumboneleli obalulekileyo wokunakekelwa kwezempilo ekujongeni ulawulo lweemithi zentlungu. Kwezinye iimeko, oogqirha beengqondo banethuba lokuqhagamshelana ngokuthe rhoqo kunye nezigulane kunezigulane kunabanogqirha kwaye ngoko banokubambisana njengabalingani abalulekileyo beendlela zokwenza unyango oludibeneyo. Iingcali zengqondo ziza kuseka iishedyuli zamachiza ezithatha ixesha lokunciphisa amathuba okuxhomekeka kwimizi yeentlungu zokufumana ulawulo olufanelekileyo kwiintlungu. Ukongezelela, izazi zeengqondo zixhotyiswe ukubandakanya izigulane kwiingxoxo ezibalulekileyo malunga nokubaluleka kokunamathela ngokufanelekileyo kumachiza kunye neengcebiso zonyango kunye nokuxazulula iingxaki ezinokuthintela ukulandelwa ngokukhuselekileyo.

 

Uloyiko lokuphepha. Umzekelo wokugwema ukwesaba okungapheliyo ukusetyenziswa kwentlungu yintlungu engapheliyo (i-LBP). [34] Lo mzekelo uthatha kakhulu kwimigaqo yokuziphatha esebenzayo ichazwe ngaphambili. Ngokwenene, imodeli yokugwema ukwesaba ithi xa ubuhlungu obukhulu buchazwa ngokuphindaphindiweyo njengengozi yengozi okanye iimpawu zokulimala kabuhlungu, izigulane zingasengozini yokuzibandakanya ekukhuseleni ukuziphatha okukhuselekayo kunye neengcamango ezomeleza ngakumbi inkolelo yokuba intlungu uphawu lweengozi kunye nokuqhubela phambili ukuhlaziywa komzimba. Njengoko umjikelezo uyaqhubeka, ukuphepha kungadala kwiintlobo zeentlobo zomsebenzi kwaye kubangele ukungathandabuzeki kwemvakalelo ebonakalayo ebonakaliswe ngokuchazwa ngokukrakra kweengqondo zomzimba. Uphando luye lwabonisa ukuba inqanaba eliphezulu leentlungu elixhatshazwayo lidibene nokugcinwa komjikelezo. [35] Unyango olujoliswe ekugqibeleni umjikelezo wokugwema ukwesaba uqeshe imisebenzi eyoyikisayo ekuqinisekiseni ukuba ukwesaba, okubangelwa yimingcipheko yokuthatha inxaxheba kwimisebenzi . Ukubhengezwa ngokubanzi kuqhutyelwa nge-psychoeducation malunga neentlungu kunye neengcamango zokuhlaziywa kwengqondo ezijolise kwiingcamango eziphathekayo kunye nokulindela ngemisebenzi kunye nentlungu. Iingcali zengqondo zisesimweni esihle kakhulu sokwenza ezi ntlobo zongenelelo ezilinganisa ngokugqithiseleyo unyango oluqhelekileyo elisetyenziselwa unyango lweengxaki ezithile zokuxhalabisa.

 

Nangona unyango olusondeleyo lwezonyango luye lwaboniswa ukuba luncedo ekwenzeni unyango lweengxaki zesifo seengingqi i-CR (i-CRPS-1) [i-36] kunye ne-LBP [37] kwimilo yecala elilodwa, isilingo esiphezulu esilinganiselwe ngokulandelanayo esilinganiselwe unyango lwamayeza kunye neenkqubo ezahlukeneyo zonyango lwenkqubo kunye neenkqubo ezahlukeneyo zonyango lwenkqubo yodwa kunye neqela lokulawula uluhlu lubone ukuba ezi zimbini zonyango zenzeke ekuphuculeni okubonakalayo kwimilinganiselo yempatho yentlungu, ukwesaba ukunyakaza / ukulimala, intlungu, Ukudakumba, kunye nomgangatho womsebenzi. [I-38] Iziphumo ezivela kulolu vavanyo zibonisa ukuba ukungenelela kokubambisana kwakunxulumene nokusebenza ngonyango olubalulekileyo kangangokuthi unyango olungabonakaliyo olubonakalayo aluzange lubonakale lubangele ukufumana unyango olongezelelweyo. [38] Inqaku elisixwayisayo ekuchazeni kwezi Iziphumo zigqamisa ukuba ilingo elilawulwa ngokungahleliwe (RCT) libandakanya iintlobo ezahlukeneyo zentlungu engapheliyo e ixutywe ngaphaya kwe-LBP kunye ne-CRPS-1 kwaye ayizange ibandakanye kuphela izigulane ezinamaqondo aphakamileyo enkwantya-ntlungu; ukungenelela kwaziswa kwakhona kwiifom zeqela kunokuba zifomathi zomntu ngamnye. Nangona unyango lwe-in-vivo lungcono kakhulu ekunciphiseni ubuhlungu obuyingozi kunye nemibono yokulimala kwemisebenzi, ukunyangwa kwezinto ezibonakalayo kubonakala ngathi kusebenza njengongenelelo lokusebenza okuphuculweyo ekuphuculeni ukukhubazeka okusebenzayo kunye nezikhalazo eziphambili. [39] Olunye uvavanyo lweklinikhi lufanisa ukuphumelela kwonyango- Ulwahlulo olusekelweyo (TBC) lonyango lonyango kuphela kwi-TBC longezwe ngemisebenzi eyenziwe ngokucwangcisiweyo okanye ukubonakaliswa ngokubaluleka kwezigulane ezine-LBP ezinobunzima kunye nobunzima. [Iziphumo ze-40] zibonise ukuba akukho ntohluko kwi-4-iveki kunye neziphumo zeenyanga ze-6 zokunciphisa ukukhubazeka , ubunzima beentlungu, ukukhathazeka kwentlungu, kunye nokuphazamiseka komzimba phakathi kwamacandelo enyango, nangona ukunyanzeliswa kwamagunya kunye ne-TBC kwenza ukuba kuncitshiswe kuninzi kwiinkonzo zokugwema ukwesaba ukwenziwa kwiinyanga ze-6. alukho kwiziphumo eziphuculweyo malunga namanyathelo afana nokuphuhliswa kwe-chr I-LBP ye-oni ngaphaya kophuculo olwenziwe ngeTBC yedwa. [40]

 

Iindlela zokuziphatha

 

Ungenelelo ngononophelo lweendlela zokuziphatha (i-CBT) zongenelelo lweentlungu ezingapheliyo zisebenzisa imigaqo-nkqubo yengqondo ukwenza utshintsho olusebenzayo kwizimo zezigulana, ukuqonda okanye kuvavanyo, kunye neemvakalelo. Olu ngenelelo luhlala luqulathe imfundo esisiseko yengqondo malunga nentlungu kunye nesigulo esithile seempawu zesigulana, izinto ezininzi zokuziphatha, uqeqesho lwezakhono, iindlela zokusombulula iingxaki, kunye necandelo lokuhlengahlengisa ukuqonda, nangona olona nyango lonyango luhluka ngokoklinikhi. Izinto zokuziphatha zinokubandakanya izakhono ezahlukeneyo zokuphumla (njengoko zijongwa kwicandelo lendlela yokuziphatha), imiyalelo yokuhamba ngenqanaba / ukwenziwa okuhleliweyo, iindlela zokuziphatha, kunye nokukhuthaza ukuqala kwakhona kwemisebenzi yomzimba ukuba kukho imbali ebalulekileyo yokuthintela umsebenzi kunye nokubekwa kwimeko yesiqhelo emva koko. Eyona njongo iphambili kuqeqesho lwezakhono kukuchonga izicwangciso zokuziphatha gwenxa (umz., Ukonakalisa, ukuthintela) isigulana esisebenzisana naso ekusebenziseni iindlela zokuguqula imeko (umzekelo, ukusetyenziswa kweengxelo ezizezakho, inkxaso yezentlalo). Njengenqaku lesilumkiso, inqanaba apho isicwangciso-buchule silungelelanisa okanye singalunganga kwaye ukusebenza okuqondakalayo kwezicwangciso ezithile zokulwa ziyahluka ukusuka komnye umntu ukuya komnye. [41] Ngalo lonke unyango, iindlela zokusombulula iingxaki ziyahlonitshwa ukunceda abaguli kwiinzame zabo zokunamathela kunye nokubanceda ukuba bandise ukusebenza kwabo. Uhlengahlengiso lwengqondo lubandakanya ukwamkelwa kokungalunganga okwenziwayo sisigulana, ukwenza umngeni kukuchongwa okungalunganga okuchongiweyo, kunye nohlengahlengiso lweengcinga ukuze zivelise ezinye. Ngokuziqhelanisa nohlengahlengiso lokuqonda, abaguli baya bekwazi ngakumbi ukuqonda indlela iimvakalelo zabo, ukuqonda, kunye nokutolika okuzilungisa ngayo iintlungu zabo kwicala elilungileyo nelingalunganga. Ngenxa yoko, kucingelwa ukuba abaguli baya kufumana umbono omkhulu wokulawula iintlungu zabo, babe nakho ukulawula indlela abaziphethe ngayo kunye neengcinga zabo njengoko zinxulumene nentlungu, kwaye babe nakho ukuvavanya ngokuchanekileyo intsingiselo abayinikezela kwintlungu yabo. . Izinto ezongezelelweyo ngamanye amaxesha zibandakanyiwe kungenelelo lwe-CBT lubandakanya uqeqesho lwezakhono zentlalo, uqeqesho kunxibelelwano, kunye neendlela ezibanzi kulawulo loxinzelelo. Ukuhamba ngongenelelo lwe-CBT ejolise kwintlungu, uninzi lwezigulana ziyaxhamla kuphuculo ngokubhekisele kwimpilo yabo yeemvakalelo kunye nokusebenza, kwaye ekugqibeleni umgangatho wabo wobomi onxulumene nempilo.

 

UDkt. Alex Jimenez usebenza ngokuzivocavoca umzimba kunye nokuzilolonga.

 

Ungenelelo lwe-CBT luhanjiswa ngaphakathi kwenkxaso kunye novelwano oluzama ukuqonda iintlungu zesigulana ngokwembono ye-biopsychosocial kwaye ngendlela edibeneyo. Oochwephesha babona indima yabo 'njengabafundisi-ntsapho' okanye 'abaqeqeshi'kwaye umyalezo odluliselwe kwizigulana kukufunda ukulawula ngcono iintlungu zabo nokuphucula ukusebenza kwabo kwemihla ngemihla kunye nomgangatho wobomi ngokuchasene nokujolisa okanye ukuphelisa iintlungu. Injongo ephambili kukunyusa ukuqonda kwezigulana ngeentlungu zabo kunye neenzame zabo zokulawula iintlungu kunye nokulandelelana kwazo ngendlela ekhuselekileyo neguqukayo; Ke ngoko, ukufundisa abaguli ukuba babeke esweni indlela abaziphethe ngayo, iingcinga zabo, kunye neemvakalelo yinto ebalulekileyo kunyango kunye nesicwangciso esiliqili sokwenza ukusebenza ngempumelelo. Ukongeza, i-Therapist izama ukukhuthaza indawo enethemba, enyanisekileyo nenokhuthazo apho isigulana sinokuba nobuchule ngakumbi ekuqondeni nasekufundeni kwimpumelelo yabo nasekufundeni nasekuphuculeni kwimizamo engaphumelelanga. Ngale ndlela, abanyangi kunye nezigulana basebenza kunye ekuchongeni impumelelo yesigulana, izithintelo ekubambeleleni kunyango, kunye nokuphuhlisa ulondolozo kunye nokubuyela kwisicwangciso sokuthintela kwimeko eyakhayo, yokusebenzisana kunye nokuthembeka. Inqaku elinomtsalane kwindlela yokuziphatha kwengqondo kukuxhasa isigulana njengomthathi-nxaxheba okhutheleyo ekuvuseleleni iintlungu okanye kwinkqubo yolawulo.

 

Uphando lufumene ukuba i-CBT ibe yonyango olusebenzayo lwentlungu engapheliyo kunye ne-sequelae yayo njengoko ibonakaliswe ngenguqu ebonakalayo kwimimandla eyahlukeneyo (oko kukuthi, amanyathelo okuvalelwa kwintlungu, ukukhathazeka / ukuchaphazeleka, ukuphathwa kwengqondo kunye nokuhlola, ukuziphatha kweentlungu kunye nenqanaba lomsebenzi kunye nomsebenzi wendima yentlalo ) xa kuthelekiswa neemeko zokulawula uluhlu lokulinda. [42] Xa kuthelekiswa namanye amachiza asebenzayo okanye izimo zokulawula, i-CBT ibangele ukuphucula okuphawulekayo, kunye nemiphumo encinci (ubungakanani bomzimba ~ 0.50), ngokubhekisele kumava obuhlungu, ukuxilongwa kwengqondo kunye nokuhlolwa , kunye nomsebenzi wendima yentlalontle. [42] Uhlalutyo olutshanje lwe-meta-uphando lweziphumo ze-52 eziqhathaniswa nophatho lwezonyango (BT) kunye ne-CBT malunga nokuphathwa njengemiqathango yokulawula yesiqhelo kunye neemeko zolawulo olusebenzayo kumaxesha athile ahlukeneyo. [43] Le meta-analysis bagqiba ukuba idatha yabo ayizange iboleke inkxaso ye-BT ngaphaya kokuphuculwa kwintlungu ngokukhawuleza emva kokonyango xa kuthelekiswa nonyango njengeemeko zolawulo eziqhelekileyo. [43] Ngokubhekiselele kwi-CB T, baqukumbele ukuba i-CBT inciphise imiphumo emihle yintlungu yokukhubazeka, kunye nomoya; Nangona kunjalo, akukho idatha ekhoyo ekhoyo ukuphanda impembelelo ethile yenkcazo yonyango kwiziphumo ezikhethiweyo. [43] Ngokubanzi, kubonakala ukuba ii-CBT kunye ne-BT zindlela zokwenza unyango olufanelekileyo ukuphucula imizwa; iziphumo ezihlala zizinzileyo kwiindawo zokulandelela iinkcukacha. Nangona kunjalo, njengoko kuboniswe ngophando oluthile kunye nokuhlaziywa kweemeta, into ebalulekileyo ekuqwalaseleni ukuphumelela kwe-CBT yokulawulwa kwentlungu engapheliyo ijoliswe kwimibandela yokubonelela ngokufanelekileyo, ukungabikho kwamacandelo okunyanga ofanayo, ukungafani kokunikezelwa kwamanyango kunye nokunyango abantu kunye nokuhlukahluka kwimiba yeziphumo zentshisekelo kuzo zonke izilingo zophando. [13] Ukugqithisa ngakumbi ukuchazwa kokufunyaniswa kwempumelelo yimimiselo yesigulane kunye neenguqu ezongezelelweyo ezingasichaphazela ngokuzimeleyo iziphumo zonyango.

 

Izindlela eziMkelweyo

 

Iindlela ezisekwe ekwamkelweni zihlala zichongwa njengonyango lwesithathu lwendlela yokuziphatha ngokuziphatha. Ukwamkelwa kunye nokuzibophelela kunyango (UMTHETHO) yeyona nto ixhaphakileyo kwizonyango zengqondo ezamkelweyo. UMTHETHO ugxininisa ukubaluleka kokuququzelela inkqubela yomthengi ekufikeleleni kubomi obuxabiseke ngakumbi nobonelisayo ngokwandisa ukuguquguquka kwengqondo kunokugxila ngokungqongqo kulwakhiwo ngokutsha lokuqonda. [44] Kwimeko yeentlungu ezingapheliyo, i-ACT ijolise kwiindlela zokulawula ezingasebenziyo kunye nokuthintelwa kwamava ngokukhuthaza ubuchule obumisela ukuguquguquka kwengqondo. Ezi nkqubo zintandathu zingumthetho zibandakanya: ukwamkelwa, ukuqonda okungalunganga, ukubakho, ubuqu bakho njengomxholo, amaxabiso kunye nokuzimisela. [45] Ngokufutshane, ukwamkelwa kukhuthaza izigulana ezinganyangekiyo ukuba zamkele iintlungu kunye nokulandelelana kwazo kunokuba zizame ukuyitshintsha, ngokwenza njalo ukukhuthaza isigulana ukuba siyeke umlo olilize ojolise ekuphelisweni kwentlungu yabo. Ukuchaphazeleka kwengqondo (deliteralization) yeendlela zokuqesha ziqeshelwe ukuguqula ukusebenza kweengcinga endaweni yokunciphisa ukuhamba kwabo okanye ukulungisa umxholo wabo. Ngale ndlela, ukuchasana kwengqondo kunokutshintsha nje intsingiselo engathandekiyo okanye ukusebenza kweengcinga ezingalunganga kwaye ngaloo ndlela kunciphise ukunamathela kunye nokuphendula okulandelayo kokuziphatha kunye nokuziphatha kwezi ngcinga. Inkqubo engundoqo yokubakho igxininisa ukusebenzisana okungagwebanga phakathi kweengcinga zakho kunye nezizimeleyo kunye neziganeko. Amaxabiso asetyenziswa njengezikhokelo zokukhetha isimilo kunye nokutolikwa okubonakaliswa ngala maxabiso umntu azabalazela ukuwenza kubomi bemihla ngemihla. Okokugqibela, ngokwenza isenzo sokuzibophelela, abaguli banokuqonda utshintsho kwindlela yokuziphatha elungelelaniswe nexabiso lomntu ngamnye. Ke, UMTHETHO usebenzisa imigaqo-siseko emithandathu ngokudibeneyo kunye nomnye ukuthatha indlela ebanzi yokwandisa ukuguquguquka kwengqondo kunye nokunciphisa ukubandezeleka. Izigulana ziyakhuthazwa ukuba zijonge iintlungu ngokungaphephekiyo kwaye zamkelwe ngendlela engagwetywanga ukuze ziqhubeke nokufumana intsingiselo ebomini ngaphandle kobukho beentlungu. Iinkqubo ezingundoqo ezinxulumeneyo zibonisa umzekelo wokuqonda nokwamkela iinkqubo nokuzinikela kunye neenkqubo zokutshintsha indlela yokuziphatha. [45]

 

Iziphumo zophando malunga nokusebenza kweendlela ezisekelwe kwi-ACT zokulawula ubuhlungu obungapheliyo zi thembisa, nangona kunjalo zifunwa ukuhlolwa okuqhubekayo. I-RCT ngokuthelekisa UMTHETHO nomqathango wokulawula uluhlu kubhengeze ukuphuculwa okukhulu kwiintlungu ezonakalisa ukukhubazeka, ukunyaniseka kweentlungu, ukwaneliseka komphefumlo, ukwesaba ukunyakaza, kunye noxinzelelo lwengqondo olugcinwe kwi-7 inyanga yokulandelelana. [46] Ilingo elikhulu lichazwe Ukuphucula intlungu, ukuxinezeleka, ukuxhalaba, ukukhubazeka, ukutyelela, unyango lwezempilo, isimo somsebenzi kunye nokusebenza ngokomzimba. [47] Ukuhlaziywa kwe-meta-uphendlo yakutshanje ekuphononongeni ukungenelela okusukeleyo (UMTHETHO nokunciphisa uxinzelelo lwengqondo) kwizigulane ezinentlungu engapheliyo yafumanisa ukuba, ngokuqhelekileyo, iindlela zokubamkela ezisekelweyo zikhokelela kwiziphumo ezilungileyo kwizigulane ezinentlungu engapheliyo. [48] Ngokukodwa, ukuhlalutya kweemeta kubonakalise ubuncinci kumgangatho ophakathi kwintlungu, ukuxinezeleka, ukuxhalaba, ukukhathazeka ngokwenyama kunye nomgangatho wobomi , kunye nemiphumo emincinci efunyenweyo xa ukuhlolwa kweeklinikhi ezilawulwayo kwakungabandakanywa kwaye i-RCT kuphela ifakiwe kwi-analysis. [48] Ezinye iindlela zokunikwa uphando lweengcamango zengqondo-yokuziphatha kunye nokunyangwa kwengqondo ngokusekelwe kwengqondo, nangona uphando lwezobugcisa ekusebenzeni kwezi zonyango zokulawulwa kweentlungu ezingapheliyo zisencinane.

 

Lindele

 

Into ebalulekileyo engahoywanga ngokubanzi exhaphakileyo kuzo zonke iindlela zonyango kukuqwalaselwa kokulindelwe sisigulana kwimpumelelo yonyango. Ngaphandle kwenkqubela phambili ekwakhiweni nasekuhanjisweni kwonyango olusebenzayo oluninzi lweentlungu ezingapheliyo, kugxininiswe kancinci ekubonakaliseni ukubaluleka kokulindelwa kwimpumelelo nasekugxileni kwimizamo yokuphucula okulindelwe zizigulana. Ukwamkelwa ukuba i-placebo yeentlungu ibonakaliswa ziipropathi ezisebenzayo ezikhokelela kuthembeko olunokuthenjwa, olubonakalayo, kunye nolunokulinganiswa kunye nemixhaso ye-neurobiological okwangoku okwangoku kuphando lwentlungu. Izifundo ezininzi ziye zaqinisekisa ukuba, xa inyanzeliswa ngendlela eyonyusa ulindelo (ngokusebenzisa ubuqili bolindelo olucacileyo kunye / okanye imeko), i-analgesic placebos inokubangela utshintsho olubonakalayo nolulinganisekayo kwimbono yeentlungu kwinqanaba lokuzixela kunye ne-neurological inqanaba lokulungisa iintlungu. [49,50] I-analgesic placebos ichazwe ngokubanzi njengonyango olulinganisiweyo okanye iinkqubo ezenzeka kwimeko yengqondo kunye nefuthe kumava omntu kunye / okanye kwi-physiology. [51] Ukuqondwa kwangoku kwe-placebo kugxininisa ukubaluleka kwemeko yengqondo kunye ne-placebos efakwe ngaphakathi. Isiseko semeko yengqondo kunye nesiko lonyango kulindelwe zizigulana. Ke ngoko, ayimangalisi into yokuba isiphumo se-placebo sibetheleleke phantse kulo lonke unyango; Kananjalo, oogqirha kunye nezigulana ngokufanayo ziya kuthi zixhamle ekuqapheleni ukuba kukho indawo eyongezelelweyo apho unyango lwangoku lusondela kwiintlungu ezinokuphuculwa.

 

Kucetyisiwe ukuba iziphumo ezilindelweyo zezona mpembelelo ziphambili zokuqhuba utshintsho olufunyenweyo ngeendlela ezahlukeneyo zoqeqesho lokuphumla, i-hypnosis, unyango lokuvezwa, kunye neendlela ezininzi zonyango ezijolise kukuqonda. Ngaloo ndlela, indlela efanelekileyo yokulawulwa kweentlungu ezingapheliyo zixhomekeke kumandla okulindela izigulane kwimpumelelo. Ngelishwa, amaxesha amaninzi, ababoneleli ngezempilo bayakhathala ukujongana ngqo nokugxininisa ukubaluleka kokulindelwa zizigulana njengezinto ezibandakanyekayo ezinegalelo kulawulo oluyimpumelelo lweentlungu ezingapheliyo. I-zeitgeist kuluntu lwethu kukuba ukunyanga ukunyanga kwezifo ezenza ukuba ulindelo ngokubanzi lokuba iintlungu (nokuba zintlungu ezingapheliyo) kufuneka zisuswe ngenkqubela phambili kwezonyango. Konke oku kulindelwe ngokuqhelekileyo kushiya abaguli abaninzi bedidekile ziziphumo zonyango ezikhoyo kwaye banegalelo kuphando olungapheliyo lwe- cure . Ukufumana i- cure ngaphandle kokulawula ngokubhekisele kwiimeko zeentlungu ezingapheliyo. Kwimeko-bume yethu yangoku, apho iintlungu ezinganyangekiyo zixhaphaza izigidi zabantu baseMelika minyaka le, inomdla wethu ukubethelela kwaye siqhubeke nokukhuthaza ukutshintsha kwengcinga endaweni yoko kugxile kulawulo olusebenzayo lweentlungu ezingapheliyo. Indlela esebenzayo nethembisayo yokufezekisa oku kukwenza uninzi lwezinto ezilindelwe zizigulana (ezizizo) kunye nokufundisa abaguli abaziintlungu kunye noluntu ngokubanzi (iipesenti ezingama-20 zabo baya kuthi babe zizigulana eziqaqanjelwa) kwixesha elizayo ngokubhekisele kulawulo lwentlungu. Mhlawumbi oku kunokwenzeka ekuqaleni ngoku, ngemfundo esekwe kubungqina ngokubhekisele kwi-placebo kunye neziphumo zonyango ezingacacanga ezinokuthi izigulana zikwazi ukulungisa iinkolelo ezingachazwanga ngaphambili. Emva koko oogqirha banokujolisa ekuphuculeni okulindelweyo kwizigulana ngaphakathi kwimeko zonyango (ngendlela eyiyo) kunye nokunciphisa ukulindela okungenathemba okuthintela impumelelo yonyango, ke ngoko, ukufunda ukuphucula unyango lwabo lwangoku ngeendlela ezininzi ezikhokelwa kukongamela ekuphuculeni indawo ye-placebo inokuvelisa, nkqu kunyango olusebenzayo . Iingcali zengqondo ziyakwazi ukujongana nale micimbi kunye nezigulana zabo kwaye zibancede babe ngabameli bempumelelo yabo yonyango.

 

Abaququzeleli Bemizwelo Yobunzima

 

Umba osoloko ulucelomngeni kulawulo lweentlungu ezingapheliyo kukuxhaphaka ngokungathandabuzekiyo koxinzelelo lweemvakalelo. Uphando lubonakalisile ukuba uxinzelelo kunye noxinzelelo lokuphazamiseka lonyuka laphindaphindeka kathathu phakathi kwezigulana ezinganyangekiyo kunabantu ngokubanzi. [52,53] Rhoqo, izigulana eziqaqanjelwa zizifo zengqondo zibizwa ngokuba "zizigulana ezinzima" ngababoneleli bezempilo, mhlawumbi kunciphisa ukhathalelo abalulufumanayo. Izigulana ezinedepression zineziphumo ezibi zokudakumba kunye nonyango lwentlungu, xa kuthelekiswa nezigulana ezinesifo esisodwa okanye uxinzelelo. [54,55] Iingcali zengqondo zikulungele ngokumangalisayo ukujongana uninzi lwezifo zengqondo ezidla ngokudibana nabantu abaziintlungu ezingapheliyo kwaye ke ngoko ziphucula iintlungu. Iziphumo zonyango kunye nokunciphisa ukubandezeleka ngokweemvakalelo kwezigulana. Iingcali zengqondo zinokujongana neempawu eziphambili (umzekelo, i-anhedonia, inkuthazo ephantsi, izithintelo ekusombululeni iingxaki) zoxinzelelo eziphazamisa ukuthatha inxaxheba kunyango kunye noxinzelelo lweemvakalelo. Ngapha koko, ngaphandle kokuphazamiseka kwengqondo, iingcali zengqondo zinokunceda izigulana ezinganyangekiyo ziqhubele phambili kwindima ebalulekileyo abanokuthi bayenze (umzekelo, ukuphulukana nomsebenzi, ukukhubazeka), ubunzima phakathi kwabantu abanokudibana nabo (umz., Umbono wokuzahlula oziswa yintlungu), kunye Ukubandezeleka ngokweemvakalelo (umzekelo, ixhala, umsindo, usizi, ukuphoxeka) kuyanyanzeleka kumava abo. Ke, iingcali zengqondo zinokuchaphazela ngokuqinisekileyo ikhosi yonyango ngokunciphisa ifuthe lokudibana neemvakalelo ekujongwa kuzo njengenxalenye yonyango.

 

isiphelo

 

Izinzuzo zokubandakanya unyango lweengqondo kwiindlela ezahlukeneyo zokulawula ubuhlungu obungapheliyo zininzi. Ezi zibandakanya, kodwa azikhawulelwanga, ukunyusa ukuphathwa kweentlungu, ukuphucula izixhobo ezinokubangela iintlungu, ukukhubazeka okunxulumene nentlungu, kunye nokunciphisa uxinzelelo lwengqondo olwenziwe ngeendlela ezahlukeneyo zokuzilawula, ukuziphatha, nokuqonda ubuchule. Ngokuphunyezwa kwezi nguqu, isazi sengqondo singakwazi ukunceda ngokuphumelelayo izigulane zivakale ngakumbi kumyalelo wokulawulwa kweentlungu kwaye zenze ukuba baphile ngokuqhelekileyo ubomi ngokusemandleni nangona kukho intlungu. Ngaphezu koko, izakhono ezifunyenwe ngongenelelo lwangokwengqondo nokuxhobisa izigulane ukuba zibe ngabathathi-nxaxheba ekulawuleni izifo zabo kwaye zibandakanye izakhono ezibalulekileyo izigulane ezingasebenzisa ubomi babo bonke. Iinkonzo ezongezelelweyo zeendlela ezidibeneyo kunye neendlela ezipheleleyo ekulawuleni ubuhlungu obungapheliyo zingabandakanya ukunyuka kwamazinga okubuyela emsebenzini, ukunciphisa iindleko zonyango lwempilo, kunye nokukhula komgangatho wokuphila kwezilwanyana kwizigulane kwihlabathi lonke.

 

Umfanekiso womqeqeshi unikezela ngcebiso isigulane kwisigulane.

 

Imihlathi

 

Ukwazisa: Akukho zintlukwano zomdla zavakaliswa ngokumalunga kweli phepha.

 

Ukuququmbela, ukungenelela kwengqondo kungasetyenziswa ngokufanelekileyo ekuncediseni iimpawu zentlungu engapheliyo kunye nokusetyenziswa kwamanyathelo enyango, njengokhathalelo lwe-chiropractic. Ukongezelela, uphando olusentla lubonise indlela iindlela ezithile zokungenelela kwengqondo ezinokuphucula iziphumo zempatho yokuphathwa kabuhlungu obungapheliyo. Ulwazi oluchazwe kwiziko leSizwe loLwazi lweBiotechnology (NCBI). Ubungakanani beenkcukacha zethu zikhawulelwe kwi-chiropractic kwakunye nokulimala kwemigudu kunye nemeko. Ukuxoxa ngesihloko, nceda ukhululeke ukucela uDkt Jimenez okanye uqhagamshelane nathi 915-850-0900 .

 

Ikhutshwe nguDkt. Alex Jimenez

 

Green-Call-Now-Button-24H-150x150-2-3.png

 

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.

 

umfanekiso webhlogi weendaba eziphambili zephepha lephepha

 

ISIHLOKO ESIBALULEKILEYO: Ukulawula uxinzelelo lomsebenzi

 

 

IINGCUKACHA EZIBALULEKILEYO: UKUPHATHA KWE-EXTRA: I-Car Accident Injury Treatment El Paso, TX I-Chiropractor

 

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Vala i-Accordion
Ukunyamekela Ingqalelo kwiNtsholongwane engapheliyo e-El Paso, TX

Ukunyamekela Ingqalelo kwiNtsholongwane engapheliyo e-El Paso, TX

by | Chiropractic, Iimeko eziPhathwayo, Ukubuyiswa komzimba, Uvavanyo oluLungeleleneyo oluLungisiweyo, istres, Unyango

Ukuba uye wafumana intloko, awuyedwa. Ngokumalunga ne-9 kubantu base-10 baseUnited States abanesifo sengqondo. Nangona ezinye ziphakathi, ezinye zihlala zikhona, ezinye ziphazamisekile kwaye ziphazamiseka, kwaye ezinye zibangele ubuhlungu kunye neentlungu, ukugqithisa intlungu intloko yempendulo ngokukhawuleza. Kodwa, unokuyiphucula njani intlekele entle?

 

Uphando luye lwabonisa ukuba ukunakekelwa kwe-chiropractic yindlela efanelekileyo yokwenza unyango kwiintlobo ezininzi zeentloko. Ingxelo ye-2014 kwi-Journal of Manipulative and Physiological Therapeutics (i-JMPT) yafumanisa ukuba ukulungiswa komgudu kunye nokusetyenziswa kwamanyathelo asetyenziswe ekunyamekelweni kwe-chiropractic kuphuculwe amanyathelo okuphumelela unyango lweentlungu ezingapheliyo kunye nentlungu kunye nokuphucula izibonelelo zeendlela ezahlukeneyo zonyango. intlungu yentamo. Ngaphezu koko, uphando lwe-JNPT lwe-2011 lufumene ukuba ukunakekelwa kwe-chiropractic kungaphucula nokunciphisa ubukhulu bexesha neyamenza kunye nentloko yomlomo.

 

Ukunyamekelwa kweCrospractic Kukhusela njani iintloko zeentloko?

 

Ukunyamekela kwe-Chiropractic kugxile kunyango lwezinto ezahlukeneyo zokulimala kunye / okanye iimeko ze-musculoskelet kunye ne-system ye-nervous, kubandakanywa nentloko. I-chiropractor isebenzisa ukulungiswa kwemisipha kunye neendlela zokusebenzisa umyalelo ukulungisa ngokuchanekileyo ukulungelelaniswa komgudu. Ukugqithiswa, okanye ukuguqulwa kwamagqabi, kuboniswe ukuba kubangele iimpawu, ezifana nentamo kunye umqolo obuhlungu, kunye nentloko kunye neyamenza. Umgudu olinganiselayo unokuphucula umgudu womgudu kunye nokunciphisa uxinzelelo lwezakhiwo. Ukongezelela, ugqirha we-chiropractic unokukunceda ukuphatha iintloko kunye nezinye iimpawu ezibuhlungu ngokubonelela ngeengcebiso zondlo, ukunika iingcebiso nge-posture kunye ne-ergonomics kunye nokukhuthaza ukuphathwa kwengcinezelo nokusebenzisa iingcebiso. Ukhathalelo lwe-Chiropractic ekugqibeleni lunokubangela ukuxhatshazwa kwemisipha kunye nezakhiwo ezijikelezileyo zomgudu, ukubuyisela umsebenzi wesiqalo somqala.

 

UDkt. Alex Jimenez wenza utshintsho lwe-chiropractic kwisigulane.

 

UDkt. Alex Jimenez unikeza iingcebiso ngomzimba wokunyamezela.

 

Ukongezelela, ukunakekelwa kwe-chiropractic kunokunyanga ngokufanelekileyo kunye nempembelelo yempilo yeminwe, kuquka iimpawu zentamo kunye neentlungu ezisezantsi emva kweengcingo ze-colervical and lumbar herniated, phakathi kwezinye ukulimala kunye / okanye iimeko. I-chiropractor iyayiqonda indlela ukuguqulwa kwamagqabi, okanye ukuhlukumeza, kunokuchaphazela imimandla eyahlukeneyo yomzimba kwaye baya kuyiphatha umzimba ngokupheleleyo kunokuba bajolise kwiimpawu kuphela. Ukwelashwa kwe-Chiropractic kunokunceda umzimba womntu ngokuqhelekileyo uphinde ubuyisele impilo yakhe yokuqala kunye nokuphila kakuhle.

 

Umqeqeshi kunye nokusebenzisana nesigulane kwiziko lokuvuselela.

 

Kuyaziwa ukuba ukhathalelo lwe-chiropractic lusebenza kakuhle kwiintlobo zengozi kunye / okanye iimeko, nangona kunjalo, kwiminyaka embalwa edlulileyo, uphando lufumene ukuba i-chiropractic inokuphucula impilo yethu ngokulawula uxinzelelo lwethu. Uninzi lweziphumo zophando lwangoku nje lubonise ukuba unyango lwe-chiropractic lunokuguqula ukusebenza komzimba, kuthintela izinga lentliziyo kunye nokunciphisa uxinzelelo lwegazi. Uphando lwe-2011 oluvela eJapan lubonise ukuba i-chiropractic inokuba nomthelela omkhulu kumzimba wakho kunokuba ukholelwa.

 

Ukuxinezeleka kuyisalathiso esibalulekileyo sempilo, kwaye iimpawu zentlungu ezingapheliyo zinokuchaphazela kakhulu impilo. Abaphandi baseJapan bafuna ukujonga ukuba i-chiropractic ingakwazi ukuguqula amanqanaba okuxinwa kwi-12 amadoda kunye nabasetyhini abaneentlungu kunye nentloko. Kodwa izazinzulu zaseJapan zafuna ukufumana umfanekiso ogqithiseleyo wendlela yokuguqula umlenze kunye nokunyanzeliswa kwemigudu yokuchaphazeleka kwindlela yokuphazamisa inkqubo, ngoko ke basebenzisa i-PET ukujonga ukujonga umsebenzi weengqondo kunye novavanyo lwe-salvia ukujonga utshintsho lwe-hormone.

 

Emva kokunyamekela kwe-chiropractic, izigulane zatshintshile umsebenzi wengqondo kwimimandla yengqondo ejongene nokucubungula intlungu kunye nokunyamezela. Baye banciphisa kakhulu amanqanaba e-cortisol, ebonisa ukunyuka kwengxaki. Abathathi-nxaxheba bavakalisa amanqaku aphantsi entlungu kunye nomgangatho omkhulu wobomi emva kokunyanga. Ukongeniswa kwengqondo, njengokhathalelo lwe-chiropractic, ziindlela zokulawula uxinzelelo kunye nokusebenza. Ukuxinzezeleka kwengcinezelo kunokukhokelela kwimibandela yempilo eyahlukeneyo, kuquka intlungu kunye nentlungu yangemva kunye nentloko kunye ne-migraine. Ezinye iindlela zokuqwalasela ingqalelo zinokunceda ngokukhuselekileyo kwaye ngempumelelo ziphucule iimpawu. Injongo yale nqaku elandelayo kukubonisa ukungenelela kolunye ukungenelela kwengqondo, eyaziwa ngokuba yi-mindiness-based reduction reduction, kwi-intensive pain and quality of life kwizigulane ezaye zafumanisa ukuba zintloko.

 

Ukuphumelela kweengqondo ezisekelwe kwiNgqondo ekunciphiseni ubuhlungu kwi-Intenance Pain Intelligence and quality Quality of Life in patients with headacheache

 

Abstract

 

Injongo yale ngxowa-mali yayikukuqinisekisa ukuphuculwa kwe-Mindfulness-Based Based Stress reduction (MBSR) ekuboneni ubunzima obubuhlungu kunye nomgangatho wobomi kwizigulane ezinentloko engapheliyo. Ngaloo ndlela, izigulane ezingama-40 ezixhomekeke kwi-diagnosis ye-neurologist kunye neendlela zokuxilonga ze-International Headache Society (IHS) ze-migraine kunye nesifo esingapheliyo-intloko-intlobo zonyulwa kwaye zinikezelwa ngokulandelelana iqela lokungenelela kunye neqela lokulawula, ngokulandelana. Abathathi-nxaxheba bazalise i-Pain kunye nekhwalithi yobomi (SF-36). Iqela lokungenelela elibhalise kwiprogram ye-MBSR yeeveki ezisibhozo ezibandakanya ukucamngca nokusebenza kwimihla ngemihla, ngeveki, kwiseshoni ye-90-imizuzu. Uphuhliso lokuhlaziywa kwe-covariance kunye nokupheliswa kovavanyo lwangaphambi kokuvavanya lubonise kakhulu ukuphucula intlungu kunye nomgangatho wobomi kwinqanaba lokungenelela xa kuthelekiswa neqela lolawulo. Iziphumo ezivela kulolu cwaningo zibonise ukuba i-MBSR ingasetyenziselwa ukungenelela kwe-pharmacological ukungenelela komgangatho wobomi nokuphuhliswa kwezicwangciso zokujamelana nentlungu kwizigulane ezineentloko ezingapheliyo. Yaye ingasetyenziselwa ukudibanisa namanye amachiza afana ne-pharmotherapy.

 

Internet: ubuhlungu obungapheliyo, intloko ye-migraine, ingqondo, umgangatho wobomi, intloko yesifo

 

UDkt Jimenez White Coat

Insight of Dr. Alex Jimenez

Intsholongwane engapheliyo impawu eziphazamisayo ezichaphazela abantu abaninzi. Kukho iintlobo ezininzi ezahlukeneyo zeentloko, nangona kunjalo, uninzi lwazo luhlala luba nesisombululo esifanayo. Ukuxinzezeleka kwengcinezelo kunokubangela imiba eyahlukahlukeneyo yempilo engabinokulawulwa kakuhle, kuquka ukuxhatshazwa kwemisipha, engakhokelela ekugqibeleni komgudu, okanye ngezinye izibonakaliso, ezifana nentlungu kunye nentlungu, intloko kunye nemigraines. Izindlela zokulawulwa kwengcinezelo kunye nobuchule zingakunceda ekuphuculeni nasekulawuleni iimpawu ezinxulumene noxinzelelo. Ukungenelela kwengqondo njengokhathalelo lwe-chiropractic kunye nokunciphisa uxinzelelo lokuxinwa kwengqondo kuye kwazimisela ukunceda ngokukhawuleza ukunciphisa uxinzelelo kunye nokunciphisa iimpawu zentloko ezingapheliyo.

 

intshayelelo

 

Intloko yenye yezona zikhalazo zixhaphakileyo kwiiklinikhi zabantu abadala kunye neekliniki. Uninzi lwazo iintloko zi-migraine kunye noxinzelelo lwentloko (uKurt & Kaplan, 2008). Intloko yahlulwa yangamacandelo amabini eentloko eziphambili okanye eziziiprayimari neziziisekondari. Iipesenti ezingama-2013 zeentloko zentloko ziintloko eziphambili, phakathi kwazo i-migraine kunye neentloko zentlungu ziintlobo eziqhelekileyo (i-International Headache Society [IHS], 4). Ngokwenkcazo, intloko ebuhlungu ye-migraine ihlala ingahambelani kwaye ishukuma kwindalo kwaye ihlala iiyure ezi-72 ukuya kwezingama-2013. Iimpawu ezinxulumene noko zibandakanya isicaphucaphu, ukugabha, ukonyusa ubuntununtunu ekukhanyeni, isandi kunye nentlungu, kwaye inyuka ngokubanzi ngokwanda komzimba. Kwakhona, uxinzelelo lwentloko lubonakaliswa ngamazwe amabini, iintlungu ezingafakwanga, uxinzelelo okanye ukuqina, iintlungu ezingacacanga, njengebhandeji okanye umnqwazi, kunye nokuqhubekeka kwentlungu ethambileyo ukuya kokuphakathi, kuthintela imisebenzi yobomi bemihla ngemihla (IHS, XNUMX).

 

UStovner et al. (2007) kusetyenziswa iikhrayitheriya zokuchonga i-IHS, kuqikelelwa ukuba yipesenti yabantu abadala abanesifo esisebenzayo esentloko malunga ne-46% yentloko ngokubanzi, i-42% yentloko yentloko yoxinzelelo. Oku kuphakamisa ukuba izehlo kunye nokuxhaphaka kwentloko yentloko yoxinzelelo kuphezulu kakhulu kunokuba bekuxelwe kwangaphambili. Kuqikelelwa ukuba malunga ne-12 ukuya kwi-18 yeepesenti yabantu abanemigraines (Stovner & Andree, 2010). Abasetyhini kunokwenzeka ukuba bafumane i-migraines xa kuthelekiswa namadoda, ukuxhaphaka kwe-migraine kumalunga ne-6% yamadoda kunye ne-18% yabasetyhini (Tozer et al., 2006).

 

I-Migraine kunye noxinzelelo lwentloko yentloko ziqhelekileyo kwaye zibhalwe kakuhle kwiimpendulo zengqondo nezomzimba (Menken, Munsat, & Toole, 2000). I-Migraine ngamaxesha athile kwaye iyadodobalisa iintlungu ezingapheliyo kwaye inefuthe elibi kumgangatho wobomi, ubudlelwane kunye nemveliso. Umbutho wezeMpilo weHlabathi (i-WHO) ubhengeze ukuba i-migraine ebaluleke kakhulu njengesinye sezifo ezibuthathaka kakhulu kwinqanaba le-2013 (IHS, 2000; Menken et al., XNUMX).

 

Ngaphandle kophuhliso lwamayeza amaninzi kunyango kunye nokuthintela uhlaselo lwe-migraine, uninzi lwezigulana luzifumanisa zingasebenzi kwaye ezinye zifumanise ukuba azifanelekanga ngenxa yeziphumo ebezingalindelekanga kunye neziphumo ebezingalindelekanga zihlala zikhokelela ekuphelisweni kwangoko kwonyango. Ngenxa yoko, umdla omkhulu kuphuhliso lonyango lwe-non-pharmacologic unokujongwa (I-Mulleners, Haan, Dekker, & Ferrari, 2010).

 

Izinto zebhayoloji zizodwa azinako ukuchaza ukuba sesichengeni kwamava entloko, ukuqala kohlaselo kunye nezifundo zalo, ukonyuka kokuhlaselwa kwentloko, ukukhubazeka okunxulumene nentloko kunye nomgangatho wobomi kwizigulana ezineentloko ezingapheliyo. Iziganeko zobomi ezigwenxa (njengento yengqondo) zihlala zaziwa njengeyona nto iphambili kuphuhliso kunye nokuqaqanjelwa kwentloko (Nash & Thebarge, 2006).

 

Inkqubo yokunciphisa uxinzelelo lwengqondo (MBSR) iphakathi kwezonyango, eziye zafundwa kumashumi amabini adlulileyo kwiintlungu ezingapheliyo. I-MBSR iphuculwe yiKabat-Zinn kwaye isetyenziswe kuluhlu olubanzi lwabemi abaneengxaki ezinxulumene noxinzelelo kunye nentlungu engapheliyo (Kabat-Zinn, 1990). Ngokukodwa kule minyaka idlulileyo, uninzi lwezifundo luye lwenziwa ukuvavanya iziphumo zonyango lwe-MBSR. Uninzi lwezifundo lubonakalisile iziphumo ezibonakalayo ze-MBSR kwiimeko ezahlukeneyo zengqondo kubandakanya nokuncitshiswa kweempawu zengqondo zoxinzelelo, unxunguphalo, isisu, uxinzelelo kunye noxinzelelo (Bohlmeijer, Prenger, Taal, & Cuijpers, 2010; Carlson, Speca, Patel, & Goodey, 2003; Grossman, Niemann, Schmidt, & Walach, 2004; Jain et al., 2007; Kabat-Zinn, 1982; Kabat-Zinn, Lipworth, & Burney, 1985; Kabat-Zinn et al., 1992; Teasdale okqhubekayo. , 2002), iintlungu (Flugel et al., 2010; Kabat-Zinn, 1982; Kabat-Zinn et al., 1985; La Cour & Petersen, 2015; Rosenzweig et al., 2010; Zeidan, Gordon, Merchant, & Goolkasian , 2010) kunye nomgangatho wobomi (Brown & Ryan, 2003; Carlson et al., 2003; Flugel et al., 2010; Kabat-Zinn, 1982; La Cour & Petersen, 2015; Morgan, Ransford, Morgan, Driban, & UWang, 2013; URosenzweig et al., 2010).

 

UBohlmeijer et al. (2010) wenza uhlalutyo lweemeta kwizifundo ezisibhozo ezilawulwa ngokungenamkhethe kwiziphumo zenkqubo ye-MBSR, wagqiba kwelokuba i-MBSR ineziphumo ezincinci kuxinzelelo, uxinzelelo kunye noxinzelelo lwengqondo kubantu abanezifo ezinganyangekiyo. Kwakhona uGrossman et al. (2004) kuhlalutyo lwe-meta lwe-20 olulawulwayo kunye nolawulo olungalawulwayo kwiziphumo zenkqubo ye-MBSR kwimpilo yomzimba kunye nengqondo yeesampulu zonyango nezingezizo ezonyango, ifumene ubungakanani besiphumo sokumodareyitha kwizifundo ezilawulwayo kwimpilo yengqondo. Akukho bungakanani besiphumo seempawu ezithile ezinje ngoxinzelelo kunye noxinzelelo oxeliweyo. Olona hlaziyo lutshanje lubandakanya izifundo ze-16 ezilawulwayo nezingalawulwayo, Olu hlaziyo luthi ukungenelela kwe-MBSR kunciphisa ukuqina kwentlungu, kwaye uninzi lwezifundo ezilawulwayo (6 ze-8) zibonisa ukunciphisa okuphezulu kwintlungu yokungenelela kweqela xa kuthelekiswa neqela lolawulo (UReiner, uTibi, & ILipsitz, 2013).

 

Kwesinye isifundo, abaphandi bafumene ubungakanani besiphumo sezinto ezithile zomgangatho wobomi umzekelo ubungakanani bempilo kunye nentlungu yomzimba, ubungakanani besiphumo esingabalulekanga kwiintlungu kunye nesiphumo esiphakathi ukuya kubukhulu obukhulu bexhala kunye noxinzelelo (La Cour & Petersen, 2015) . Kwisifundo esenziwe nguRosenzweig et al. (2010) kwizigulana ezineentlungu ezingapheliyo kubandakanya nezo ziphathwa yimigraine, bekukho umahluko omkhulu kubunzima beentlungu, ukusikelwa umda okunxulumene nentlungu phakathi kwezigulana. Nangona kunjalo, abo banesifo se-migraine bafumana ukuphucuka okuphantsi kwintlungu kunye neenkalo ezahlukeneyo zomgangatho wobomi. Ngokubanzi, amaqela ahlukeneyo entlungu engapheliyo abonisa ukuphucuka okubonakalayo kubunzima beentlungu kunye nokusikelwa umda okunxulumene neentlungu kwesi sifundo. Ezinye izifundo ezimbini zaqhutywa yiKabat-Zinn kunye nokusebenzisa iindlela ze-MBSR zokunyanga abaguli abaneentlungu ezingapheliyo, kubandakanya nenani lezigulana ezineentloko ezingapheliyo. Uhlalutyo lweenkcukacha-manani lubonise ukuncipha okukhulu kwintlungu, ukuphazamiseka kwentlungu nemisebenzi yansuku zonke, iimpawu zonyango kunye neempawu zengqondo, uxinzelelo kunye nokudakumba, ukubonwa komzimba, ukuphazamiseka kwentlungu nemisebenzi yemihla ngemihla, ukusetyenziswa kweziyobisi kunye nokunyusa ukuzithemba (Kabat-Zinn, 1982; Kabat-Zinn et al., 1985).

 

Ngenxa yentlungu kunye nokulahlekelwa komsebenzi kunye nokuveliswa komsebenzi wokunciphisa nokunyusa ukunyamekelwa kwempilo, ukuphathwa kwentloko engapheliyo kubeka iindleko kumntu ngamnye kunye noluntu, kubonakala ukuba intloko engapheliyo yinkinga enkulu yempilo kwaye ifumene iindlela zokulawula nokuphatha le ngxaki ingaba luleka kakhulu. Injongo ephambili yale sifundo kwakukuphonononga ukuphumelela kwe-MBSR ngaphezu kwe-pharmacotherapy eqhelekileyo kwisampula yoluntu lwezigulane ezineentloko ezingapheliyo ukubonisa ukuphumelela kwale ndlela njengendlela yokulawulwa kwintlungu nokuphucula umgangatho wobomi kwizigulane ezintle iintloko.

 

tindlela

 

Abathathi-nxaxheba kunye neNkqubo

 

Olu luvavanyo olulawulwa ngokungakhethiyo lwamaqela amabini yoyilo lokufunda emva kokuvavanywa. Kwafunyanwa imvume kwiKomiti yeeNqobo eziseSikweni yeYunivesithi yaseZahedan yezeNzululwazi yezoNyango. Abathathi-nxaxheba bakhethe ngokusebenzisa isampulu ngendlela elula evela kwizigulana ezinganyangekiyo yimigraine kunye noxinzelelo lwentloko, ezifunyenwe sisazi ngezigulo zengqondo kunye nonyango lwengqondo kusetyenziswa iindlela zokuqonda isifo ze-IHS-ezibhekiswe kwizibhedlele zaseyunivesithi yaseZahedan University of Medical Science, Zahedan-Iran.

 

Emva kokuvavanya isigulane ngasinye ukuhlangabezana neenkqubo zokungeniswa kunye nokuthintela intlanganiso-ndlebe, i-40 kwizigulane eziphambili ezisibhozo ezisixhenxe ezineenkathazo ezingapheli zikhethiweyo kwaye zenziwa ngamanqaku ngamaqela alinganayo angenelelo kunye nokulawula. Bobabini ulawulo kunye namaqela angenelelo athola i-pharmacotherapy eqhelekileyo phantsi kolawulo lwe-neurologist. Ngexesha leeseshoni zonyango zifundo ezintathu, ngenxa yokungabi nako kweendlela zokuhlala okanye zokungabikho, ukukhethwa ngaphandle okanye kungabandakanywa kwisifundo.

 

Iingqinisiso zokufakwa

 

  • (1) Imvume ekwazisiweyo ukuthatha inxaxheba kwiiseshoni.
  • (2) Ubuncinane beminyaka yobudala be-18.
  • (3) Isiqinisekiso esiphantsi semfundo esikolweni esiphakathi.
  • (4) Ukuxilongwa kwintsholongwane engapheliyo (i-primary migraine engapheliyo kunye nentloko yeentlobo zentlungu) yi-neurologist kunye ne-IHS.
  • (5) i-15 okanye iintsuku ezingaphezulu kwinyanga ngaphezulu kweenyanga ze-3 kunye neenyanga ezi-6 zembali zemigraines kunye nentloko yesifo

 

Iimpawu zokungabikho

 

  • (1) Abafundi abangafuni ukuqhubeka nokuthatha inxaxheba kwisifundo okanye ukushiya isifundo nangaliphi na isizathu.
  • (2) Ezinye iingxaki zentlungu ezingapheliyo.
  • (3) Iingxaki zengqondo, i-delirium kunye neengcinga.
  • (4) Iziganeko zobunzima bobuchule obuphazamisana nomsebenzi weqela.
  • (5) Ukusetyenziswa kakubi kweziyobisi kunye neziyobisi.
  • (6) Ukukhathazeka kwemizwa

 

Amaqela angenelelo

 

Iiseshoni zonyango (MBSR) zenziwa kwi-1.5 kwiiyure ze-2 ngeveki kumalungu enkxaso yokungena (izidakamizwa kunye ne-MBSR); Nangona kungekho MBSR eyenziwa kwiqela lokulawula (izidakamizwa eziqhelekileyo ezisetyenzisiweyo) kude kube sekupheleni kophando. I-MBSR yenziwa ngeeveki ze-8. Kule sifundo, inkqubo ye-MBSR yeseshoni ye-8 (Chaskalon, 2011) isetyenzisiwe. Ukwenza ukucamngca ekhaya xa uqeqesho lwabathathi-nxaxheba kwiiseshoni, amanyathelo afanelekileyo anikezelwe kwiCD kunye ncwadana. Ukuba kukho nayiphi na yezifundo ezingazange zithathe inxaxheba kwiseshoni okanye kwiiseshoni, ekuqaleni kwiseseshoni elandelayo umgqirha uza kunika amanqaku ebhaliweyo kwiiseshoni kwizifundo, ngaphezu kokuphinda iseshwankathelo seseshoni esedlule. Inkqubo ye-MBSR kunye neengxoxo zanikezelwa kwizigulane kwiiseshoni ezisibhozo ziquka: ukuqonda intlungu kunye neengxaki ze-etiology, xubusha ngobudlelwane obuxinzelelekileyo, umsindo kunye nemvakalelo enentlungu, Ukuqonda iingcamango ezizenzekelayo, iingcamango ezingenangqondo kunye nokuvakalelwa, ukufaka ingcamango ye-Acceptance, ukuphefumla indawo indawo yokuphefumla, imizuzu emithathu yokuphefumla, ukuqhubezela umoya, iziganeko ezimnandi kunye ezimbi, imihla ngemihla, ukusebenziselwa ukuziphatha, ukuqikelela izinto eziqhelekileyo, ukukhangela umzimba, Ukubona nokuvalelwa, ukucamngca, ukuhamba ngokuqiqa, ukubhala iingcamango ezinxulumene nengqiqo kunye nokuxoxa ngendlela ukugcina oko kuphuhliswe kulo lonke ikhosi, xubusha izicwangciso kunye nezizathu ezifanelekileyo zokugcina umgangatho. Izigulana nazo zafumana ulwazi malunga nokufunda indlela yokufumanisa nayiphi na ikamva elizayo kwakhona kunye nezicwangciso kunye nezicwangciso zokusekwa ngokukhawuleza kweempawu zentlungu kunye nokuzimelela kwiimeko ezintsha.

 

Iqela lo Lawulo

 

Izigulane ezazingenangqondo kwiqela lolawulo zazihlala zihamba ngokuqhelekileyo kwi-pharmacotherapy (kubandakanywa neziyobisi ezingekho mbandela) nge-neurologist yazo ukuya ekupheleni kophando.

 

Izixhobo

 

Izixhobo ezibini eziphambili zisetyenzisiwe kuvavanyo lwaphambi kunye nasemva kovavanyo lokuqokelela idatha, ukongeza kwifom yedatha yabantu. I-log ye-headache yayisetyenziselwa ukumisela ubungakanani bentlungu kusetyenziswa iindawo ezintathu: (1) amanqaku angama-10 okulinganisa isikali, (2) inani leeyure zentlungu ngosuku kunye (3) nobunzima beentlungu ngenyanga. Icandelo ngalinye linikwe amanqaku ukusuka kwi-0 ukuya kwi-100, elona nqanaba liphezulu li-100. Kuba isigulana ngasinye silinganisa ubungakanani bentlungu ebuzwayo kwiphepha lemibuzo, ukuthembeka kunye nokuthembeka akuqwalaselwa. Enye yayiyifom yemibuzo emfutshane engama-36 (SF-36). Ikhweshine liyasebenza kumaqela ahlukeneyo ubudala kunye nezifo ezahlukeneyo. Ukunyaniseka nokunyaniseka kwiphepha lemibuzo kwavunywa nguWare et al (Ware, Osinski, Dewey, & Gandek, 2000). I-SF-36 ivavanya ukuqonda komgangatho wobomi kwii-8 subscales zibandakanya: ukusebenza komzimba (PF), ukuthintelwa kwendima ngenxa yempilo yomzimba (RP), iintlungu zomzimba (PB), impilo ngokubanzi (GH), amandla kunye namandla (VT ), Ukusebenza kwezentlalo (SF), ukuthintelwa kwendima ngenxa yeengxaki zemvakalelo (RE) kunye nefuthe lezempilo (AH). Esi sixhobo sinezikali ezibini zesishwankathelo sePhysical Component Summary (PCS) kunye neMental Component Summary (MCS) amanqaku. Isikali ngasinye sifunyenwe ukusuka kwi-0 ukuya kwi-100, elona nqanaba liphezulu lokusebenza linqanaba le-100. Ukunyaniseka kunye nokuthembeka kwe-SF-36 kuvavanywe kubemi baseIran. Ukungqinelana okungaphakathi kokuphakathi kwakuphakathi kwe-0.70 kunye ne-0.85 yee-subscales ze-8 kunye ne-coefficients zokuphinda uvavanywe phakathi kwe-0.49 kunye ne-0.79 ngekhefu leveki enye (iMontazeri, iGoshtasebi, iVahdaninia, kunye neGandek, 2005).

 

Uhlalutyo lweenkcukacha

 

Ukuhlalutya idatha, ngaphezu kokusetyenziswa kwezibonakaliso ezichazayo, ukuthelekisa iziphumo zengenelelo kunye namaqela okulawula, ukuhlaziywa kwe-covariance kusetyenziswe ukuchonga ukusebenza kunye nokususwa kweziphumo zokuvavanywa kwangaphambili kwi-95% inqanaba lokuzithemba.

 

Phume phakathi

 

Ngexesha leeseshoni zonyango zifundo ezintathu, ngenxa yokungabi nako kweendlela zokuhlala okanye zokungabikho, ukukhethwa ngaphandle okanye kungabandakanywa kwisifundo. Iingamashumi amathathu nesikhombisa eziphuma kwizigulane ze-40 zigqityiwe ngokufundiswa kwangoku kwaye i-data edibeneyo yahlaziywa.

 

iziphumo

 

Uhlalutyo lokulinganisa ukusabalaliswa kwabantu phakathi kwamacandelo amabini lwenziwa ngokusetyenziswa kwe-chi-square kunye novavanyo oluzimeleyo. Idatha yoluntu yamabini omabili uboniswa kwiThebhile 1. Ukusasazwa kweminyaka, iminyaka yemfundo, isini kunye nesimo somtshato kwakufana kwiqela ngalinye.

 

Itheyibhile ye1 Uhlobo lwabantu abachaphazelekayo

Ithebula 1: Iimpawu zobuntu zabathathi-nxaxheba.

 

Itheyibhile 2 ibonisa iziphumo zohlalutyo lwe-covariance (ANCOVA). Uvavanyo lukaLevene lwalungabalulekanga, F (1, 35) = 2.78, P = 0.105, ebonisa ukuba ubungqingqwa bokungafani kwabantu bavunyelwe. Oku kufumanisa kubonisa ukuba umahluko kumaqela alinganayo kwaye akukho mahluko waqwalaselwayo phakathi kwamaqela amabini.

 

Itheyibhile 2 Iziphumo ze-Covarice Analysis

Ithebula 2: Iziphumo zokuhlalutya kwe-covariance ukwenzela ukuphumelela kwe-MBSR ngeentlungu.

 

Iziphumo eziphambili zongenelelo lwe-MBSR zazibalulekile, F (1, 34) = 30.68, P = 0.001, ngokuyinxenye? 2 = 0.47, ebonisa ukuba ubunzima beentlungu babuphantsi emva kongenelelo lwe-MBSR (Kuthetha = 53.89, SD.E = 2.40) kunokuba iqela lolawulo (Kuthetha = 71.94, SD.E = 2.20). I-covariate (uvavanyo lwaphambi kovavanyo lwentlungu) lwalubalulekile, F (1, 34) = 73.41, P = 0.001, inxenye? 2 = 0.68, ebonisa ukuba inqanaba lentlungu ngaphambi kokungenelela kwe-MBSR kwaba nefuthe elibonakalayo kwinqanaba lentlungu . Ngamanye amagama, bekukho ubudlelwane obulungileyo kumanqaku entlungu phakathi kovavanyo lwangaphambi kovavanyo kunye novavanyo lwasemva kovavanyo. Ke ngoko, i-hypothesis yokuqala yophando iqinisekisiwe kwaye unyango lwe-MBSR ekuqineni okuqinisekileyo lwalusebenza kwizigulana ezinentloko engapheliyo kwaye lunokunciphisa ubukhulu beentlungu ezibonakalayo kwezi zigulana. Onke amaxabiso abalulekileyo axelwe kwi-p <0.05.

 

Iingcamango zesibini zale sifundo kukusebenza kwekhono le-MBSR kumgangatho wobomi kwizigulane ezinentloko engapheliyo. Ukuvavanya ukusebenza kobuchule be-MBSR ngobuninzi bobomi kwizigulane ezineentloko ezingapheliyo kunye nokuphelisa izinto eziphazamisayo kunye nomphumo wokuhlolwa kwangaphambili, ukuhlalutya kwedatha, uhlalutyo lwe-covariance oluninzi (MANCOVA) lobunzima bomgangatho usetyenziswa IThebhile 3 ibonisa iziphumo zokuhlalutya kwiqela lokungenelela.

 

Itheyibhile 3 Iziphumo zohlalutyo lweClavariance

Ithebula 3: Iziphumo zokuhlalutya kwe-covariance ukuphumelela kwe-MBSR kumgangatho wobomi.

 

IThebhile 3 ibonisa iziphumo zokuhlalutya kwe-covariance (MANCOVA). Ulwazi olulandelayo lufunekayo ukuqonda iziphumo ezivezwe kwiTable 3.

 

Uvavanyo lwebhokisi lwalungabalulekanga, F = 1.08, P = 0.320, ebonisa ukuba umahluko covariance matrices ayafana kumaqela amabini kwaye ke ngenxa yoko kucingelwa ukuba ngabantu abathandanayo bahlangana. Kwakhona F (10, 16) = 3.153, P = 0.020, Wilks Lambda = 0.33, ngokuyinxenye? 2 = 0.66, ebonisa umahluko obonakalayo phakathi kovavanyo lwangaphambi kwamaqela kumaqela axhomekeke kwizinto ezixhomekekileyo.

 

Uvavanyo lukaLevene lwalungabalulekanga kwezinye izinto ezixhomekekileyo kubandakanya [PF: F (1, 35) = 3.19, P = 0.083; Ubuninzi beRF: F (1, 35) = 1.92, P = 0.174; I-BP: F (1, 35) = 0.784, P = 0.382; GH: F (1, 35) = 0.659, P = 0.422; Ii-PCS: F (1, 35) = 2.371, P = 0.133; VT: F (1, 35) = 4.52, P = 0.141; AH: F (1, 35) = 1.03, P = 0.318], ebonisa ukuba ingcinga yokungafani kwabantu iyodwa yamkelwe kwizibonelelo zobomi kunye novavanyo lukaLevene lwalubalulekile kwezinye izinto ezixhomekekileyo kubandakanya [RE: F (1, 35) = 4.27, P = 0.046; I-SF: F (1, 35) = 4.82, P = 0.035; I-MCS: F (1, 35) = 11.69, P = 0.002], ebonisa ukuba ubungqangi bokungafani kwabantu bokungafaniyo kwaphulwe kwizibonelelo zomgangatho wobomi.

 

Iziphumo eziphambili zongenelelo lwe-MBSR zazibalulekile kwezinye izinto ezixhomekekileyo kubandakanya [RP: F (1, 25) = 5.67, P = 0.025, ngokuyinxenye? 2 = 0.18; BP: F (1, 25) = 12.62, P = 0.002, ngokuyinxenye? 2 = 0.34; GH: F (1, 25) = 9.44, P = 0.005, ngokuyinxenye? 2 = 0.28; Ii-PCS: F (1, 25) = 9.80, P = 0.004, inxenye? 2 = 0.28; VT: F (1, 25) = 12.60, P = 0.002, ngokuyinxenye? 2 = 0.34; AH: F (1, 25) = 39.85, P = 0.001, ngokuyinxenye? 2 = 0.61; I-MCS: F (1, 25) = 12.49, P = 0.002, 2? 0.33. = 61.62], ezi ziphumo zibonisa ukuba inkxaso-mali ye-RP, BP, GH, PCS, VT, AH, kunye ne-MCS zaziphezulu emva kongenelelo lwe-MBSR [RP: Kuthetha = 6.18, SD.E = 48.97; BP: Kuthetha = 2.98, SD.E = 48.77; GH: Kuthetha = 2.85, SD.E = 58.52; Ii-PCS: Kuthetha = 2.72, SD.E = 44.99; VT: Kuthetha = 2.81, SD.E = 52.60; AH: Kuthetha = 1.97, SD.E = 44.82; I-MCS: Kuthetha = 2.43, SD.E = 40.24] kuneqela lolawulo [RP: Kuthetha = 5.62, SD.E = 33.58; BP: Kuthetha = 2.71, SD.E = 36.05; GH: Kuthetha = 2.59, SD.E = 46.13; Ii-PCS: Kuthetha = 2.48, SD.E = 30.50; VT: Kuthetha = 2.56, SD.E = 34.49; AH: Kuthetha = 1.80, SD.E = 32.32; I-MCS: Kuthetha = 2.21, SD.E = XNUMX].

 

Nangona kunjalo, isiphumo esiphambili songenelelo lwe-MBSR lwalungabalulekanga kwezinye izinto ezixhomekekileyo kubandakanya [PF: F (1, 25) = 1.05, P = 0.314, ngokuyinxenye? 2 = 0.04; RE: F (1, 25) = 1.74, P = 0.199, ngokuyinxenye? 2 = 0.06; I-SF: F (1, 25) = 2.35, P = 0.138, inxenye? 2 = 0.09]. Ezi ziphumo zibonisa, nangona iindlela kwezi nkxaso zomgangatho wobomi beziphezulu [PF: Kuthetha = 75.43, SD.E = 1.54; RE: Kuthetha = 29.65, SD.E = 6.02; SF: Kuthetha = 51.96, SD.E = 2.63] kuneqela lolawulo [PF: Kuthetha = 73.43, SD.E = 1.40; RE: Kuthetha = 18.08, SD.E = 5.48; SF: Kuthetha = 46.09, SD.E = 2.40], Kodwa umahluko ophakathi wawungabalulekanga.

 

Isishwankathelo, uhlalutyo lwe-Covariance (MANCOVA) kwiziphumo zeTheyibhile 3 bonisa umahluko obalulekileyo ngokwezibalo kumanqaku enkxaso yemilinganiselo ngenxa yempilo yomzimba (RP), iintlungu zomzimba (BP), impilo ngokubanzi (GH), amandla kunye namandla (VT) ), Ukuchaphazela impilo (AH) kunye nobungakanani bemilinganiselo yempilo yomzimba (PCS) kunye nempilo yengqondo (MCS). Kwaye ikwabonisa ukuba bekungekho mahluko ubalulekileyo ngokwamanqanaba enkqubo yokusebenza komzimba (PF), umda kwindima ngenxa yeengxaki zemvakalelo (RE) kunye nokusebenza kwezentlalo (SF) kwiqela longenelelo. Onke amaxabiso abalulekileyo axelwe kwi-p <0.05.

 

ingxoxo

 

Olu pho nonongo lujolise ekuhloleni ukusebenza kwe-MBSR kwiintlungu ezibonakalayo kunye nomgangatho wobomi kwizigulane ezineentloko ezingapheliyo. Iziphumo zibonise ukuba unyango lwe-MBSR lwalusebenza kakhulu ekunciphiseni ubunzima bokuqonda. Iziphumo zophando lwangoku ziyahambelana neziphumo zabanye abaphandi ababesebenzisa indlela efanayo yokufumana iintlungu ezingapheliyo (umz. UFlugel et al., 2010; Kabat-Zinn, 1982; Kabat-Zinn et al., 1985; La Cour & Petersen , 2015; UReibel, uGreeson, uBrainard, kunye noRosenzweig, 2001; UReiner et al., 2013; URosenzweig et al., 2010; zeidan et al., 2010). Umzekelo, kwizifundo ezibini ezenziwa yiKabat-Zinn, apho inkqubo ye-MBSR yayisetyenziselwa ukunyanga abaguli abaneentlungu ezingapheliyo ngoogqirha, inani lezigulana ezineentloko ezingapheliyo zazifakiwe. Isifundo sokuqala kwezi zifundo zibini, sabonisa ukuncipha okukhulu kwintlungu, ukuphazamiseka kwentlungu nemisebenzi yemihla ngemihla, iimpawu zonyango kunye nokuphazamiseka kwengqondo, kubandakanya uxinzelelo kunye noxinzelelo (Kabat-Zinn, 1982). Iziphumo zesifundo sesibini zibonise ukunciphisa okukhulu kwintlungu, ukubonakala komzimba, uxinzelelo, uxinzelelo, ukuphazamiseka kwintlungu nemisebenzi yemihla ngemihla, iimpawu zonyango, ukusetyenziswa kwamayeza, kunye nokubonisa ukwanda kokuzithemba (Kabat-Zinn et al., 1985) .

 

Kwakhona, ukufunyaniswa kwezifundo ezikhoyo ngoku kuhambelana neziphumo zikaRosenzweig et al. (I-2010), iziphumo zabo zibonisa ukuba inkqubo ye-MBSR iphumelele ukunciphisa, intlungu yomzimba, umgangatho wobomi kunye nentlalo yengqondo yezigulane ezineentlungu ezininzi ezingapheliyo kunye neengqondo ziphumelela kwiimvakalelo zengqondo kunye neengqondo zengqondo yokujonga ngokuzilawula ngemisebenzi yokucamngca. Nangona iziphumo zikaRosenzweig et al. (I-2010) yabonisa ukuba phakathi kwezigulane ezineentlungu ezingapheliyo kwintsikelelo encinci ekunciphiseni ubuhlungu bomzimba nokuphucula umgangatho wobomi kwakuxhomekeke kwizigulane ezine-fibromyalgia, intloko engapheliyo. Kwenye uphando olwenziwa nguFlugel et al. (2010), nangona utshintsho olulungileyo luboniswa kwimizila kunye nobukhulu beentlungu, ukunciphisa intlungu kwakungabonakali.

 

Kwesinye isifundo, ubunzima beentlungu buncitshiswe kakhulu emva kokungenelela kwizigulane ezineentloko zentloko. Ukongeza, iqela le-MBSR libonise amanqaku aphezulu ngokwazisa kwengqondo xa kuthelekiswa neqela lolawulo (i-Omidi neZargar, 2014). Kwisifundo somqhubi wenqwelo moya ngu-Wells et al. (2014), iziphumo zabo zibonise ukuba i-MBSR ngonyango lwe-pharmacological inokwenzeka kwizigulana ezine-migraine. Nangona ubungakanani besampulu kolu phononongo lokuqhuba aluzange lubonelele ngamandla okufumana umahluko omkhulu kubukrakra beentlungu kunye nokuhamba rhoqo kwe-migraine, iziphumo zibonise ukuba ungenelelo olo lube nefuthe elihle kubude beentloko, ukukhubazeka, ukusebenza ngokwakho.

 

Ekuchazeni iziphumo zempumelelo yengqondo esekwe kunyango kunokuthiwa, iimodeli zengqondo yeentlungu ezingapheliyo ezinje ngemodeli yokuphepha uloyiko ibonise ukuba iindlela abantu abaziguqulela ngayo iimvakalelo zabo zentlungu kwaye baziphendule zibalulekile amava entlungu (Schutze, Rees, Preece, & Schutze, 2010). Ukuqaqanjelwa yintlungu kunxulunyaniswa kakhulu noloyiko kunye noxinzelelo olubangelwa ziintlungu, iindlela zokuqonda ezinokubangelwa luloyiko lwentlungu kwaye ukukhubazeka okunxulumene nentlungu kuyayanyaniswa kananjalo kuba uvavanyo olubi lokuqonda kwengqondo luchaza i-7 ukuya kwi-31% ye Umahluko wobunzima beentlungu. Ke ngoko, nawuphina umatshini onokuthi unciphise iintlungu okanye wenze utshintsho kwinkqubo yawo unokunciphisa ukubonwa kokuqina kweentlungu kunye nokukhubazeka okubangelwa koko. Schutz okqhubekayo. (2010) bathi ukuba nengqondo encinci kuyisiseko sentlungu eyonakalisayo. Ngapha koko, kubonakala ngathi utyekelo lomntu lokuzibandakanya kwiinkqubo ezizenzekelayo zokulungisa endaweni yeenkqubo ezisekwe kulwazi ngokuqwalaselwa kokungoneliseki okwaneleyo, kunye nokusilela kolwazi ngalo mzuzu wangoku (Kabat-Zinn, 1990), izakubangela abantu cinga ngakumbi ngentlungu kwaye ke ngoko wugqithise umngcipheko wayo. Ngaloo ndlela, ukunyamekela okuncinci kuvumela ukuphuhliswa kovavanyo lokuqonda okungahambi kakuhle kwintlungu (Kabat-Zinn, 1990).

 

Esinye isizathu esinokubakho kukuba ukwamkelwa kweentlungu kunye nokulungela utshintsho zonyusa iimvakalelo ezilungileyo, zikhokelela ekunciphiseni ubunzima beentlungu ngenxa yenkqubo ye-endocrine kunye nokuveliswa kweeopioid ezingapheliyo kunye nokunciphisa ukukhubazeka okunxulumene nentlungu okanye ukulungiselela abantu ukuba basebenzise Izicwangciso ezisebenzayo zokujongana nentlungu (Kratz, Davis, & Zautra, 2007). Esinye isizathu sokuchaza iziphumo zesifundo esikhoyo ekusebenzeni kwaso ekunciphiseni iintlungu inokuba inyani kukuba iintlungu ezingapheliyo ziyaphuhliswa ngenxa yenkqubo yokuphendula yoxinzelelo (UChrousos kunye neGolide, 1992). Isiphumo kukuphazamiseka kwenkqubo yomzimba neyengqondo. Ingqondo inokuvumela ukufikelela kwi-cortex yangaphambili kunye nokuyiphucula, indawo zengqondo ezidibanisa imisebenzi yomzimba kunye nengqondo (Shapiro et al., 1995). Isiphumo kukudalwa kokhuthazo oluncinci olucutha ubunzima kunye namava entlungu nangokwasemzimbeni. Ke, iintlungu zinamava njengeemvakalelo zentlungu yokwenyani endaweni yokuqatshelwa okungalunganga. Iziphumo kukuvalwa kwemijelo yeentlungu ezinokunciphisa iintlungu (i-Astin, 2004).

 

Ukucamngca kwengqondo kunciphisa iintlungu ngeendlela ezininzi zobuchopho kunye neendlela ezahlukeneyo ezinje ngokutshintsha kwengqwalaselo kwiindlela zokucamngca zinokuchukumisa zombini izinto ezibonakalayo kunye nezihambelana nokuqonda kwentlungu. Ngakolunye uhlangothi, ukunyamekela kunciphisa ukusetyenziswa kweengcamango kunye neemvakalelo ezihamba kunye nokuqonda intlungu kunye nokuqinisa intlungu. Kwakhona, ukucutha kwengqondo kunciphisa iimpawu zengqondo ezinje ngoxinzelelo kunye noxinzelelo kunye nokwandisa umsebenzi weparasympathetic, onokuthi ukhuthaze ukuphumla kwezihlunu ezinzulu ezinokunciphisa iintlungu. Okokugqibela, ukuba nengqondo kunokunciphisa uxinzelelo kunye noxinzelelo lwe-psychophysiologic activation ngokuqinisa imeko engalunganga kunye nezakhono zokuzilawula. Amanqanaba aphezulu okuqonda aqikelele amanqanaba asezantsi oxinzelelo, uxinzelelo, ukucinga okuyintlekele kunye nokukhubazeka. Olunye uphando lubonakalisile ukuba ingqondo inendima ebalulekileyo kulawulo lwengqondo kunye neemvakalelo, kwaye inokuba luncedo ekuvuseleleni iimeko ezimbi (Zeidan et al., 2011; Zeidan, Grant, Brown, McHaffie, & Coghill, 2012).

 

Injongo yesibini yolu phononongo yayikukuchonga ukusebenza kwenkqubo ye-MBSR kumgangatho wobomi kwizigulana ezinentloko engapheliyo. Olu phononongo lubonise ukuba olu nyango lwalusebenza ngokukuko kumgangatho wobungakanani bobomi, kubandakanya nokuthintelwa kwendima ngenxa yempilo, iintlungu zomzimba, impilo ngokubanzi, amandla kunye namandla, impilo yeemvakalelo kunye nezikali zomzimba nezengqondo. Nangona kunjalo, inkqubo ye-MBSR ayinakonyusa ngokubonakalayo umgangatho wobomi ekusebenzeni komzimba, ukuthintelwa kwendima ngenxa yeengxaki zeemvakalelo kunye nokusebenza kwentlalo. Kubonakala kubonakala kwizifundo zangaphambili nezangoku kunye nakwisifundo esikhoyo ukuba i-MBSR ayinampembelelo kwimisebenzi yomzimba neyentlalo. Oku kunokwenzeka ngenxa yokuba iimpembelelo kumanqanaba entlungu kwizigulana ezineentloko zincinci, kwaye olo tshintsho lucotha. Kwelinye icala, abaguli abaneentlungu ezingapheliyo bahlala befunda ukungahoyi iintlungu ukuze basebenze ngokwesiqhelo (ILa Cour & Petersen, 2015). Nangona kunjalo, utshintsho luye kwicala olifunayo kwaye lwandisile amanqaku athethwayo kwiqela longenelelo xa kuthelekiswa neqela lolawulo. Ezi zinto zifunyanisiweyo ziyahambelana neziphumo zangaphambili (Brown & Ryan, 2003; Carlson et al., 2003; Flugel et al., 2010; Kabat-Zinn, 1982; La Cour & Petersen, 2015; Morgan et al., 2013; Reibel et. al., 2001; URosenzweig et al., 2010).

 

Ngokubhekiselele kumxholo weeseshoni ze-MBSR, le nkqubo igxininisa ukusetyenziswa kweendlela zokunciphisa uxinzelelo, ukujongana nentlungu kunye nokwazisa imeko. Ukunikezela umlo nokwamkela imeko yangoku, ngaphandle kwesigwebo, ngowona mxholo uphambili wenkqubo (UFlugel et al., 2010). Ngapha koko, utshintsho ekwamkelweni ngaphandle komgwebo kunxulunyaniswa nokuphuculwa komgangatho wobomi (URosenzweig et al., 2010). I-MBSR ijolise ekwandiseni ulwazi ngalo mzuzu wangoku. Isicwangciso sonyango yindlela entsha kunye neyobuqu yokujongana noxinzelelo lomntu ngamnye. Uxinzelelo lwangaphandle luyinxalenye yobomi kwaye alunakutshintshwa, kodwa izakhono zokujamelana nendlela yokuphendula kuxinzelelo zinokutshintshwa (UFlugel et al., 2010). UMcCracken kunye no-velleman (ngo-2010) babonisa ukuba ukuguquguquka kwengqondo kunye nokuqonda okuphezulu kunxulunyaniswa nokubandezeleka okuncinci kunye nokukhubazeka kwizigulana. Izigulana ezineentlungu ezingapheliyo ezinamanqanaba aphezulu okuqonda zichaze uxinzelelo oluncinci, uxinzelelo, uxinzelelo kunye nentlungu kunye nokuphucula ukusebenza kunye nomgangatho wobomi. UMorgan et al. (2013) abaguli be-arthritis bafumana iziphumo ezifanayo, ukuze izigulana ezinamanqanaba aphezulu okuqonda zixele uxinzelelo oluphantsi, uxinzelelo kunye nokusebenza okuphezulu kunye nomgangatho wobomi. Njengoko kuphawuliwe ngasentla bekulindelwe ukuba ukunciphisa iintlungu kwizigulana kukhokelela ekunciphiseni uloyiko kunye noxinzelelo olunxulunyaniswa nentlungu kwaye ngaloo ndlela kunciphisa ukusebenza okunokubangela ukusikelwa umda. Iziphumo zophononongo oluninzi (Cho, Heiby, McCracken, Lee, & Moon, 2010; McCracken, Gauntlett-Gilbert, & Vowles, 2007; Rosenzweig et al., 2010; Schutz et al., 2010) qinisekisa oku kufunyanisiweyo. .

 

Ucwaningo oluninzi lwenziwe ukwenzela ukuvavanya ukuphumelela kweentlobo ezahlukeneyo zonyango olusekelwe kwingqondo kwiintlungu ezingapheliyo, kuquka nezigulane ezineentloko. Ngokungafani nolunye uphando oluhlolisise iisethi ezigulane zezigulane ezinentlungu engapheliyo, inzuzo yale sifundo kukuba, yenziwa kuphela kwizigulane ezineentloko ezingapheliyo.

 

Ekugqibeleni, kufanele kuvunywe ukuba kukho ukusikelwa umda kolu phononongo njengobungakanani besampulu encinci, ukunqongophala kwenkqubo yokulandela ixesha elide, ukusetyenziswa kwamayeza abathathi-nxaxheba kunye nonyango olungqongqo; kwaye ngaphandle kwemizamo yabaphandi, ukungabikho kwonyango olufanayo ngokupheleleyo kubo bonke abathathi-nxaxheba kunokuphazamisa iziphumo zovavanyo kwaye kwenze kube nzima ukwenza iziphumo ngokubanzi. Kuba isifundo esikhoyo kungokokuqala kohlobo lwaso kwizigulana ezinentloko engapheliyo e-Iran, kucetyiswa ukuba izifundo ezifanayo mazenziwe kule ndima, ngobukhulu besampulu ngangokunokwenzeka. Kwaye ezinye izifundo ziphanda ukuzinza kweziphumo zonyango kwixesha elide lokulandelwa kwexesha.

 

isiphelo

 

Ngokutsho kweziphumo zolu cwaningo kungagqitywa ukuba iindlela ze-MBSR ngokubanzi ziphumelele ekuboneni ubuhlungu obukhulu kunye nomgangatho wobomi bezigulane ezinentloko engapheliyo. Nangona kwakungabikho mmahluko ophawulekayo kwimimandla ethile yobomi bokuphila, njengokusebenza ngokomzimba, ukulinganiselwa kweengxaki ngenxa yeengxaki zengqondo kunye nokusebenza kwentlalo, kodwa utshintsho olubanzi kwintetho luthandelwe kwisifundo. Ngaloo ndlela ukuhlanganiswa kwonyango lwe-MBSR kunye neyeza lonyango oluqhelekileyo kwiprojekti yonyango yezigulane ezinentloko yesifo esingapheliyo kunokucetyiswa. Umphandi ukholelwa ukuba nangona kukho ukungaphumeleli kunye nokungaphumeleli kwenkqubo yophando lwangoku, olu phofu luza kuba yindlela entsha yokunyanga kwintsholongwane engapheliyo kwaye ingabonelela ngokutsha kwimihlaba yonyango.

 

Imibulelo

 

Olu phando lwaxhaswa (njengengqungquthela) inxalenye yeYunihedan University of Sciences yezoNyango. Sithanda ukubonga bonke abathathi-nxaxheba kwisifundo, abaphili beendawo, abasebenzi bezibhedlele- Ali -ebn-abitaleb, uKhatam-al-anbia kunye noAli asghar- ngenjongo yokuxhaswa nenkxaso yabo.

 

Ukuququmbela,Ukhathalelo lwe-irchiropractic yindlela ekhuselekileyo nesebenzayo yokunyanga esetyenzisiweyo ukunceda ukuphucula kunye nokulawula iimpawu zentloko ezingapheliyo ngokulungelelanisa ngobunono ulungelelwaniso lomqolo kunye nokubonelela ngeendlela zolawulo loxinzelelo. Kuba uxinzelelo luye lwayanyaniswa nemicimbi eyahlukeneyo yezempilo, kubandakanya ukuthotywa, okanye ukungalungelelani kakuhle komqolo, kunye nentloko engapheliyo, ukungenelela kwengqondo njengokukhathalela i-chiropractic kunye nokunciphisa uxinzelelo lwengqondo (MBSR) zibalulekile kwintloko engapheliyo. Ekugqibeleni, inqaku elingentla libonise ukuba i-MBSR ingasetyenziselwa ngokufanelekileyo ukungenelela kwengqondo kwintloko engapheliyo kunye nokuphucula impilo yonke kunye nokuphila kakuhle. Ulwazi olubhekiswe kwiZiko leLizwe leNgcaciso yeBiotechnology (NCBI). Ubungakanani bolwazi lwethu bukhawulelwe 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

 

Green-Call-Now-Button-24H-150x150-2-3.png

 

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.

 

umfanekiso webhlogi weendaba eziphambili zephepha lephepha

 

ISIHLOKO ESIBALULEKILEYO: Ukulawula uxinzelelo lomsebenzi

 

 

IINGCUKACHA EZIBALULEKILEYO: UKUPHATHA KWE-EXTRA: I-Car Accident Injury Treatment El Paso, TX I-Chiropractor

 

Ngenanto
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34. I-Teasdale J. D, uMoore R. G, uHayhurst H, uPapa M, uWilliam S, i-Segal ZV Ukwaziswa kwe-Metacognitive kunye nokuthintela ukuphindaphinda ukudakumba: ubungqina obunobungqina. J Qhagamshelana noClin Psychol. 2002;70(2):275�287. dx.doi.org/10.1037/0022-006X.70.2.275 . [Ipapashwe]
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36. Ware J. E, uKosinski M, uDewey J. E, uvavanyo lwezempilo lwe-SF-36: i-guidance manual kunye nesikhokelo senkcazelo. Umgangatho weMetric Inc; 2000.
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Vala i-Accordion
Ukuqwalasela Intloko kunye neNkcenkcesha yokuVika kweNtsholongwane e-El Paso, TX

Ukuqwalasela Intloko kunye neNkcenkcesha yokuVika kweNtsholongwane e-El Paso, TX

by | Iimeko eziPhathwayo, Disc Disc, Uvavanyo oluLungeleleneyo oluLungisiweyo, istres, Unyango

istres sisiphumo somzimba womntu "ukulwa okanye ukusabaleka" impendulo, indlela yokuzivikela kwangaphambili eyabangela inkqubo ye-nervous sympathetic system (SNS). Ukuxinezeleka kuyinkalo ebalulekileyo yokusinda. Xa izixinzelelo zivuselela ukulwa okanye ukuphendula kwendiza, umxube weekhemikhali kunye nama-hormone ufihliwe ekuphumeni kwegazi, okulungisa umzimba ngenxa yengozi ebonakalayo. Nangona ukuxinezeleka kwexesha elifutshane kunceda, nangona kunjalo, uxinzelelo lwangexesha elide lunokubangela iintlobo zempilo. Ngaphezu koko, uxinzelelo lwabantu banamhlanje luye lwatshintsha kwaye kunzima kakhulu kubantu ukuba baphathe uxinzelelo lwabo kwaye bahlale beqiqa.

 

Ukuxinezeleka Kukuthintela njani uMzimba?

 

Ingcinezelo inokufumaneka kwiindlela ezintathu ezahlukeneyo: imvakalelo; umzimba kunye nendawo. Ukuxinezeleka ngokomzwelo kubandakanya iimeko ezimbi ezichaphazela ingqondo kunye nokwenza izigqibo. Ukuxinezeleka komzimba kubandakanya ukungondleki okungafanelekanga nokungabikho kokulala. Kwaye ekugqibeleni, uxinzelelo lwendalo yenzeke ngokusekelwe kumava angaphandle. Xa ufumana naluphi na olu hlobo lweengcinezelo, inkqubo yokukhathazeka yomsindo iya kubangela ukuba uphendule "ukulwa okanye ukundiza", ukukhulula i-adrenaline kunye ne-cortisol ukwenyusa izinga lentliziyo nokuphakamisa iingqondo zethu ukusenza siqaphile ukuze sikwazi ukujamelana neemeko eziphambi kwethu .

 

Nangona kunjalo, ukuba iingxaki ezibonakalayo zihlala zikhona, ukulwa kwe-SNS okanye impendulo yendiza ihlala isasebenza. Ukuxinzeleleka kwengcinezelo kunokukhokelela kwimibandela yempilo eyahlukeneyo, njengokuxhalaba, ukuxinezeleka, ukuxhatshazwa kwemisipha, intlungu kunye nentlungu emva, iingxaki zokugaya, ukufumana ubunzima kunye neengxaki zokulala kunye nokukhunjulwa kwengqondo kunye nokugxininisa. Ukongeza, ukuxhatshazwa kwemisipha kunye nomgudu ngenxa yoxinzelelo kungabangela ukuguqulwa kwamagqabi, okanye ukuxilongwa, okungakhokelela ekukhohliseni i-disc.

 

Intloko kunye ne-Disc Herniation kwi-Stress

 

I-disc ye-herniated iyenzeka xa i-disc, i-gel-like centre ye-disc intervertebral iqhuba ikhefu kwisangqa sayo esingaphandle, i-cartilage ring, icatshulwa kwaye icinezele intambo yomgudu kunye / okanye iingcambu zentsholongwane. I-disc ye-Disc isenzeka ngokuqhelekileyo kwintonga yomlomo wesibeleko, okanye intanyeni, kunye ne-lumbar spine, okanye ngasemva. Iimpawu zeediski ze-herniated zixhomekeke kwindawo yokuxinwa kwintsipho. Intlungu yentlungu kunye nentlungu ehamba phambili ehamba kunye ne-numbness, ukuvutha kwamandla kunye nobuthathaka kwimigangatho ephezulu kunye nezantsi kunomnye wempawu eziqhelekileyo ezidibaniswa ne-disc. Intloko kunye ne-migraine nazo ziyimpawu eziqhelekileyo ezinxulumene noxinzelelo kunye neernied diss kunye nomgudu womlomo wesibeleko, ngenxa yokuxhatshazwa kwemisipha kunye nokungahambisani nomzimba.

 

Ukungenelela kwengqondo yokuLawula uxinzelelo

 

Ulawulo loxinzelelo lubalulekile ekuphuculeni kunye nasekugcineni impilo kunye nokuba sempilweni. Ngokwezifundo zophando, ukungenelela kwengqondo, njengokukhathalela i-chiropractic kunye nokunciphisa uxinzelelo kwengqondo (MBSR), phakathi kwabanye, kunokunceda ngokukhuselekileyo nangokufanelekileyo ukunciphisa uxinzelelo. Ukhathalelo lweChiropractic isebenzisa uhlengahlengiso lomqolo kunye neendlela zokwenza ngesandla ukubuyisela ngononophelo ulungelelwaniso lokuqala lomqolo, ukunciphisa iintlungu kunye nokuphazamiseka kunye nokunciphisa uxinzelelo lwemisipha. Ukongeza, i-chiropractor inokubandakanya ukuguqulwa kwendlela yokuphila ukuze uncede ngakumbi ekuphuculeni iimpawu zoxinzelelo. I-MBSR inokukunceda ukunciphisa uxinzelelo, uxinzelelo kunye noxinzelelo.

 

Xhumana Nathi namhlanje

 

Ukuba ufumana iimpawu zoxinzelelo ngeentloko okanye neyamenza kunye nentlungu nentlungu ehambelana ne-disniation, ukungenelela kwengqondo ezifana nokunyamekela kwe-chiropractic kungabakho unyango olukhuselekileyo nolunokwenza uxinzelelo lwakho. Iinkonzo zokulawula uxinzelelo lukaDkt. Alex Jimenez zingakunceda ukuba uphumelele kwimpilo kunye nokuphila kakuhle. Ukufuna ukungenelela okufanelekileyo kungakufumana uncedo olufanelekileyo. Injongo yale nqaku ilandelayo kukubonisa imiphumo yokunciphisa uxinzelelo lwengqondo kwizigulane ezineentlungu zentlungu. Musa ukuphatha nje iimpawu, ufike kumthombo wembambano.

 

Iimiphumo zengqondo ejoliswe kwiNkcazo yokuThuthukiswa kwengcinezelo kwiNgxaki yokuPhathwa kwengqondo kunye neZengqondo zengqondo kwizigulane zentlungu

 

Abstract

 

imvelaphi: Iinkqubo zokuphucula imeko yezempilo yezigulane ezinezifo ezinxulumene nentlungu, njengentloko, zihlala zisencinane. Ukunciphisa ukunyamezela kwengqondo (MBSR) yintsholongwane yengqondo ebonakala ngathi iyasebenza ekuphatheni ubuhlungu obungapheliyo noxinzelelo. Olu pho nonongo luhlolisise ukusebenza ngempumelelo kwe-MBSR kunyango loxinzelelo olubonakalayo kunye nempilo yengqondo yomxhasi onexinzelelo lwentloko.

 

Impahla nenkqubo: Olu pho nonongo luyilingo lonyango. Izigulane ezingama-60 ezineentlobo zesifo sengqondo ngokubhekiselele kwiCommittee Committee Classification Class (Substitute Classification Classification Committee) ziye zanikwa i-Traction As Usual (TAU) iqela okanye iqela lokuhlola (MBSR). Iqela le-MBSR lafumana iikholeji zeeveki ezisibhozo zeeveki kunye neeseshoni ze-12. Iiseshoni zisekelwe kwi-MBSR protocol. I-Symptom Inventory yeBrief (BSI) kunye ne-Stress Scale Scale (PSS) efunyenwe kwixesha langaphambili kunye nexesha lokuthunyelwa emva kwenyanga kunye nokulandelwa kweenyanga ze-3 kuzo zombini amaqela.

 

iziphumo: Iintsingiselo zamanqaku ewonke e-BSI (isalathiso sobukhali behlabathi; i-GSI) kwiqela le-MBSR yayingu-1.63 0.56 ngaphambi kongenelelo olwehliswe kakhulu lwaya kwi-0.73 0.46 kunye ne-0.93 0.34 emva kongenelelo nakwiiseshoni zokulandela, ngokulandelelana ( P <0.001). Ukongeza, iqela le-MBSR libonise amanqaku asezantsi kuxinzelelo olubonakalayo xa kuthelekiswa neqela lolawulo kuvavanyo lwasemva kwexesha. Intsingiselo yoxinzelelo olubonakalayo ngaphambi kongenelelo yayingu-16.96 2.53 kwaye yaguqulwa yaya kwi-12.7 2.69 kunye ne-13.5 2.33 emva kongenelelo nakwiiseshoni zokulandelelana, ngokulandelelana (P <0.001). Kwelinye icala, intsingiselo ye-GSI kwiqela le-TAU yayingu-1.77 0.50 kwangoko eyancitshiswa kakhulu yaya kwi-1.59 0.52 kunye ne-1.78 0.47 kuma-posttest kunye nokulandela, ngokulandelelana (P <0.001). Kwakhona, intsingiselo yoxinzelelo olubonakalayo kwiqela le-TAU kwi-pretest yayiyi-15.9 2.86 kwaye yatshintshelwa kwi-16.13 2.44 kunye ne-15.76 2.22 kutyelelo lokugqibela kunye nokulandela, ngokulandelelana (P <0.001).

 

Isiphelo: I-MBSR inokunciphisa uxinzelelo kunye nokuphucula impilo yengqondo jikelele kwizigulane ezineentlungu zentlungu.

 

Internet: Impilo yengqondo, intloko yesifo somzimba, ukunciphisa uxinzelelo lwengqondo (MBSR), ukuxinezeleka okubonakalayo, unyango njengesiqhelo (TAU)

 

UDkt Jimenez White Coat

Insight of Dr. Alex Jimenez

Ukunyamekela kwe-Chiropractic yinkqubo yokulawula uxinzelelo oluyimpumelelo ngoba igxininisa umgudu, oyisiseko senkqubo yesifo. I-Chiropractic isebenzisa ukulungiswa kwemigudu kunye neendlela ezisetyenziswayo zokubuyisela ngokucophelela ukulungelelaniswa komgudu ukuze kuvumele umzimba ukuba uziphilise ngokwawo. Ukungahambisani nokugqithiswa kwemisipha, okanye ukuxilongwa, kunokudala ukuxhatshazwa kwemisipha kunye nomlenze kwaye kukhokelela kwimibandela yempilo eyahlukeneyo, kuquka intloko yesifo kunye ne-migraine, kunye nokukhutshwa kwe-disc sciatica. Ukhathalelo lwe-Chiropractic lungabandakanya nokuguqulwa kwendlela yokuphila, njengokucebisa okunomsoco kunye nokusebenzisa iziphakamiso, ukuphucula imiphumo yazo. Ukunciphisa ukunyamezeleka kwengqondo kunokuncedisa ngokufanelekileyo ukuphathwa kwengcinezelo kunye neempawu.

 

intshayelelo

 

Intloko yentloko i-90% yeentloko zeentloko. Ngokumalunga ne-3% yabemi abaphethwe yintsholongwane yengqondo engapheliyo. [I-1] Intloko yeentloko zintlungu zihlala zihambelana nomgangatho osezantsi wobomi kunye namazinga aphezulu okungaxakeki kwengqondo. [2] Kwiminyaka yakutshanje, amaninzi amaninzi ahlalutya ukuvavanya unyango olusetyenziswa Namhlanje uye wabonisa ukuba unyango lwezonyango, olunokuba luncedo kwiintlungu ezinzima, alusebenzelanga ngentlungu engapheliyo kwaye kwaye, ngokwenene, kubangela iingxaki ezingaphezulu. Uninzi lwezonyango zentlungu zenzelwe kwaye luncedo kwiintlungu ezinzima kodwa xa zisetyenziselwa ixesha elide zingenza ezinye iingxaki ezifana nokusetyenziswa kakubi kweziyobisi kunye nokuphepha kwimisebenzi ebalulekileyo. [3] Into eqhelekileyo kwiinkalo ezininzi zonyango kukuba zigxininisa mhlawumbi ukuphepha intlungu okanye ukulwa ukunciphisa intlungu. Intlungu ekubandezelekeni kwintloko ingaxinwa. Iipilisi kunye neendlela zokulawula ubuhlungu kunokunyusa ukunyamezela kunye novelwano kwiintlungu. Ngoko ke, unyango olwandisa ukwamkelwa nokunyamezela intlungu, ngakumbi intlungu engapheliyo, isebenza kakuhle. Ukuphuculwa kwengcinezelo kwengqondo (MBSR) yintsholongwane yengqondo eyenza iphumelele ekuphuculeni ukusebenza komzimba kunye nentlalo yengqondo kwizigulane ezinentlungu engapheliyo. [4,5,6,7,8] Kwiminyaka emibini edlulileyo, i-Kabat-Zinn et al. e-US ngokuphumelelayo wayesebenzisa ingqondo ngokukhululeka kwentlungu kunye nokugula okuhambelana nentlungu. [9] Uphando olutshanje kwiindlela zokubamkela, ezifana nokukhumbula, kubonisa ukuphucula ukusebenza kwizigulane ezinentlungu engapheliyo. Ukuqwalasela ukuchukumisa intlungu ngokusebenzisa ulwazi olungenanto noluntu, kunye neemvakalelo kunye neengxaki, kunye nolwalamano oludityanisiweyo nolwalamano lwangaphakathi nangaphandle. [I-10] Izifundo zifumene ukuba inkqubo ye-MBSR inokunciphisa kakhulu ukugula kwezonyango ezinxulumene neentlungu ezingapheliyo ezifana ne-fibromyalgia, i-rheumatoid arthritis, engapheliyo Iintlungu zesifo se-musculoskelet, ubuhlungu obungapheliyo, kunye ne-multiple sclerosis. [7,11,12,13] I-MBSR ineentshintsho ezinkulu kwiintlungu, ukuxhalaba, ukuxinezeleka, izikhalazo zesigxina, ukunyamekela, ukuguqulwa, umgangatho wobuthongo, ukukhathala nokusebenza ngokomzimba. [6,14,15,16,17] Kodwa iiprogram zokuphucula imeko yezempilo yezigulane ezinezifo ezinxulumene nentlungu, njengentlungu yesifo senwele, zihlala zisencinane. Ngoko ke, isifundo senziwa ukuze kuhlolwe imiphumo ye-MBSR kwixinzelelo lokuqonda kunye nentsholongwane yempilo yengqondo kwizigulane ezineentlungu zentlungu.

 

Impahla nenkqubo

 

Olu vavanyo lweklinikhi olulawulwa ngokungenamthetho lwenziwa ngo-2012 kwiSibhedlele saseShahid Beheshti kwisiXeko saseKashan. Ikomidi lokuziphatha kophando leYunivesithi yaseKashan yezeNzululwazi yezoNyango yamkele olu phando (i-IRCT No: 2014061618106N1). Abathathi-nxaxheba kolu phando babandakanya abantu abadala abaneentloko zentloko ezixinzelelweyo ababethunyelwe ngoochwephesha bezengqondo kunye noochwephesha bezempilo eKashan. Iikhrayitheriya zokubandakanywa zezi zilandelayo: Ukuba noxinzelelo lwentloko ngokubhekisele kwiKomitana yoHlukelo lweNtloko yaMazwe ngaMazwe, ekulungele ukuthatha inxaxheba kuphononongo, ukungabinachaphaza kwezonyango ngengqondo yengqondo okanye ukuphazamiseka kwengqondo, kwaye ungenayo nembali yonyango lwengqondo ngexesha le-6 eyandulelayo iinyanga. Izigulana ezingakhange zigqibe ungenelelo kwaye zaphoswa ngaphezulu kweeseshoni ezimbini azifakwanga kwisifundo. Abathathi-nxaxheba, abasayine ifom yemvume enolwazi, bawagqibile amanyathelo njengobungqina. Ukuqikelela ubungakanani besampulu, sathetha kolunye uphononongo apho utshintsho lwamanqaku okudinwa yayiyi-62 9.5 kwixesha langaphambi kokunyangwa kunye ne-54.5 11.5 kwisithuba sasemva konyango. [18] Ke ukusebenzisa ubalo lwesampulu, abathathi-nxaxheba abangama-33 (abanomngcipheko wokutsala) kwiqela ngalinye? = 0.95 kunye no-1 ? = 0.9 zahlulwe. Emva kokubalwa kobungakanani besampulu, izigulana ezingama-66 ezineentloko zentloko ezixhalabisayo zikhethwe ngokusetyenziswa kwesampulu ngokuhambelana nenqobo yokufaka. Emva koko, abaguli babizwa kwaye bamenywa ukuba bathathe inxaxheba kolu phando. Ukuba isigulana sivumile ukuthatha inxaxheba, siye samenywa ukuba sibekho kwiseshoni yokwabelana ngesifundo kwaye ukuba akukho esinye isigulana esikhethwe ngokufanayo. Emva koko besebenzisa itafile yamanani engahleliwe, babelwa kwiqela lokulinga (MBSR) okanye kwiqela lolawulo elaliphatha njengesiqhelo. Okokugqibela, abaguli be-3 ababandakanywa kwiqela ngalinye kwaye abaguli abangama-60 babandakanywa (izigulana ezingama-30 kwiqela ngalinye). Iqela le-TAU lalinyangwa kuphela ngamayeza athomalalisa uxinzelelo kunye nolawulo lweklinikhi. Iqela le-MBSR lafumana uqeqesho lwe-MBSR ukongeza kwi-TAU. Izigulana ezikwiqela le-MBSR zaqeqeshwa kwiiveki ze-8 yingcali yezengqondo enesidanga se-PhD. Uluhlu olufutshane lweMpawu zoLuhlu lweeMpawu (i-BSI) kunye ne-Scale Scale Scale (PSS) zaye zenziwa ngaphambi kweseshoni yokuqala yonyango kwiqela le-MBSR, emva kweseshoni yesibhozo (posttest), kunye neenyanga ezi-3 emva kovavanyo (ukulandelelana) kuwo omabini la maqela. Iqela le-TAU lamenyelwa kwisibhedlele i-Shahid Beheshti ukuba lizalise amaphepha emibuzo. Umzobo 1 ubonisa iMigangatho eDityanisiweyo yoLingo lweeNgxelo (CONSORT) umzobo obonisa ukuhamba kwabafundi abathathe inxaxheba.

 

Umfanekiso wesigcawu se-1 CONSORT esichaza ukuhamba koBathathi-nxaxheba

Umzobo 1: I-diagram yesigxina ebonisa ukuhamba kwabafundi abathathi-nxaxheba.

 

Ukungenelela

 

Iqela longenelelo (MBSR) laqeqeshwa kwisibhedlele saseShahid Beheshti. Iiseshoni ezisibhozo zeveki (i-120 min) zabanjwa ngokomgaqo we-MBSR omiselweyo njengoko wawuphuhliswe yiKabat-Zinn. [11] Iiseshoni ezongeziweyo zabanjwa kubathathi-nxaxheba abaphose iseshoni enye okanye ezimbini. Ekupheleni koqeqesho kunye ne-3 iinyanga kamva (ukulandelelana), omabini amaqela e-MBSR kunye ne-TAU bamenyelwa kwisibhedlele i-Shahid Beheshti (indawo yovavanyo lwe-MBSR) kwaye bayalelwa ukuba bazalise amaphepha emibuzo. Ngexesha leeseshoni ze-MBSR, abathathi-nxaxheba baqeqeshwa ukuba bazi iingcinga zabo, iimvakalelo zabo, kunye neemvakalelo zomzimba ngaphandle kwesigwebo. Ukuzivocavoca umzimba kufundiswa njengeendlela ezimbini zokucamngca ngokusesikweni nangokungekho sesikweni. Uhlobo oluqhelekileyo lokuzilolonga lubandakanya ukucamngca ngokuhlala okuqeqeshiweyo, ukuskena umzimba kunye neyoga enengqondo Ukucamngca okungacwangciswanga, ingqalelo kunye nokwazisa kugxile kungekuphela kwimisebenzi yemihla ngemihla, kodwa nakwiingcinga, iimvakalelo, kunye novakalelo lomzimba nokuba zinengxaki kwaye zibuhlungu. Umxholo uphela weeseshoni ukhankanyiwe 1 Table.

 

Itafile ze-1 Agendas zeSeshoni ze-MBSR

Ithebula 1: Ama-ajenda kwiiseshoni zokunciphisa uxinzelelo lwengqondo.

 

Izixhobo zokulinganisa

 

ICandelo leNkcazo yeNqununu yamaZwe ngamaZwe eSikweni seNtloko

 

Intloko yalinganiswa ngesikali sedayari kwintloko yekhanda. [19] Izigulane zacelwa ukuba zirekhode idayari yobunzima be-diary kwisikali se-0-10. Ukungabikho kwintlungu kunye nentloko yokukhubaza ikhanda yabonwa yi-0 kunye ne-10, ngokulandelanayo. Intsikelelo yentlungu yesisu kwiveki yabalwa ngokuhlula isamba semilinganiselo ebunzima yi-7. Ngaphezu koko, intsingiselo yentlungu yesifo ngenyanga yayibalwa ngokuhlula isixa somlinganiselo we-30. Amanqaku amancinci kunye namanqanaba aphezulu obukhulu beentloko zi-0 kunye ne-10, ngokulandelanayo. Idayari yeentloko zanikwa izigulane ezihlanu kunye ne-neurologist kunye neengqondo zengqondo ziqinisekisile ukuqinisekiswa komxholo wesixhobo. [20] Ukulinganisa okuthembekileyo kwenguqu yasePersi yale nqanaba kubalwa njenge0.88. [20]

 

Isibonakaliso esifutshane Isixhobo sokuSebenza (BSI)

 

Iimpawu zengqondo zavavanywa kunye ne-BSI. [21] Uluhlu lweempahla luqukethe izinto ezingama-53 kunye neenkxaso ezi-9 ezivavanya iimpawu zengqondo. Into nganye inqaku phakathi kwe-0 kunye ne-4 (umzekelo: Ndinesicaphucaphu okanye ukuphazamiseka esiswini sam). I-BSI inesalathiso sobukhali sehlabathi (GSI) ifumene amanqaku amanqaku angama-53. Ukuthembeka kovavanyo kuye kwaxela amanqaku ayi-0.89. [22] Kwisifundo sethu, uqikelelo lwe-GSI test retest was .90 isekwe kwisampulu yezigulana ezingama-60 ezineentloko zentloko eziye zagqiba i-BSI.

 

I-Stress Scale Scale (PSS)

 

Uxinzelelo olubonakalayo lwavavanywa kusetyenziswa i-PSS, [21,23] isikali sento eyi-10 evavanya inqanaba lokungalawuleki kunye neemeko ezingalindelekanga zobomi kwinyanga ephelileyo (umzekelo: Uziva ngathi awukwazi ukulawula izinto ezibalulekileyo ebomini bakho ?). Abaphenduli baxela ukwanda kwento kwinyanga ephelileyo kwinqanaba le-5, ukusukela kwi-0 (zange) ukuya kwi-4 (rhoqo kakhulu). Amanqaku agqityiwe ngokufumana amanqaku aphindaphindiweyo ngezinto ezinezinto ezichanekileyo [4,5,7,8] kwaye kushwankathelwa onke amanqaku ezinto. Amanqaku amanqaku aqala ku-0-40. Amanqaku aphezulu abonisa amanqanaba aphezulu oxinzelelo. Ithatha ukuba abantu ngokuxhomekeke kwizixhobo zabo zokulwa bavavanya inqanaba lomngcipheko okanye imiceli mngeni. Amanqaku aphezulu abonisa inqanaba elikhulu loxinzelelo olubonakalayo. Ukuvavanywa okwaneleyo kokunyaniseka okungaguqukiyo kunye nokuguqula imeko kunye nokunyaniseka kocalucalulo kuye kwaxelwa. [19] Kwisifundo sethu, ii-alpha coefficients ze-alpha zokuvavanya ukungqinelana kwangaphakathi kweli nqanaba zibalwe zaba yi-0.88.

 

Uhlalutyo olwenziwe ngokuphindaphindiweyo lweentlukwano lwenziwe ukuthelekisa amaqela e-MBSR kunye ne-TAU kwiimilinganiselo zokuxinezeleka okubonakalayo kunye ne-GSI ekuxhasweni kwangaphambili, emva kokunyangwa, kunye nokulandelwa kweenyanga ze-3. Kwakhona, uvavanyo lwe-Chi-square lusetyenziselwa ukuthelekisa imimandla yabantu kumaqela amabini. P xabisa ngaphantsi kwe-0.05 ithathwa njengento ebalulekileyo kuyo yonke imvavanyo.

 

iziphumo

 

Phakathi kwezifundo ze-66, abathathi-nxaxheba be-2 abavela kwiqela le-MBSR babengabandakanywa ngenxa yokulahleka kweeseshoni ze-2. Kwakhona, abathathi-nxaxheba abathathu bebekelwe ngaphandle ngenxa yokuba bangagqiba imibuzo elandelayo emva kokuvavanya okanye ukulandelelana ukuba ngubani wabo ovela kwiqela le-MBSR kunye abathathu abathathi-nxaxheba beqela le-TAU. Itheyibhile 2 ibonise iimpawu zentlobo zezifundo kunye neziphumo zentshekhi yokukhangela. Iziphumo zovavanyo lwe-t ngokungafani phakathi kwe-MBSR kunye ne-TAU ngamaqela ahlukeneyo kunye novavanyo lwe-Chi-square kwezinye iinguqu zibonisa ukuba akukho mvelaphi ephawulekayo phakathi kokuguquguquka kwemimandla kumaqela amabini kwaye zezifundo zanikwa amaqela amabini.

 

Itafile ze-2 Iinkcukacha zobuntu beziGaba

Ithebula 2: Iziganeko zobuntu zezifundo a, b.

 

Itheyibhile 3 inikeza amanqaku athetha kunye nokuphambuka okuqhelekileyo kweengxaki ezixhomekeke kuzo (ukuxinzezeleka kwengqondo kunye ne-GSI) kunye nokuthelekiswa kwamanyathelo okuphumelela ngexesha lokutyala kwangaphambili, ixesha lokunyanga emva kwonyango, kunye nokulandelwa kweenyanga ze-3.

 

Itheyibhile ye-3, iMilinganiselo emiGangatho kunye nokuthelekiswa kweMiphumo yeZiphumo

Ithebula 3: Imilinganiselo, ukuphambuka okuqhelekileyo, kunye nokuthelekiswa kwamanyathelo okuphumelela ekuhambeni kwangaphambili, ukuthunyelwa emva kokuhamba, kunye namanqanaba okulandelelana kwi-MBSR kunye namaqela e-TAU, b.

 

Itheyibhile 3 ibonisa ukunciphisa ngakumbi uxinzelelo olufunyenweyo kunye ne-GSI kwiqela longenelelo (MBSR) xa kuthelekiswa neqela le-TAU, ngelixa ukunciphisa uxinzelelo olufunyenweyo kunye ne-GSI kungakhange kubonwe kwiqela le-TAU. Iziphumo ziveze isiphumo esibonakalayo sexesha kunye nokunxibelelana phakathi kwexesha kunye nohlobo lonyango kutshintsho lwamanqaku (P <0.001).

 

Amanani? 2 kunye no-3 okhoyo ngoku kuthetha ukuba bafumene uxinzelelo kunye namanqaku e-GSI kumaqela e-MBSR kunye ne-TAU kwinqanaba lokugqibela kunye nelokulandela.

 

Umfanekiso wesigcawu se-2 CONSORT esichaza ukuhamba koBathathi-nxaxheba

Umzobo 2: I-diagram yesigxina ebonisa ukuhamba kwabafundi abathathi-nxaxheba.

 

Umzobo we3 Iintlobo zengcinezelo ebonakalayo kwi-MBSR kunye namaqela okuLawula

Umzobo 3: Kuthetha ukuxinezeleka okubonakalayo kwi-MBSR kunye namaqela okulawula kwi-pretest, posttest, kunye nokulandelelana.

 

ingxoxo

 

Olu hlolisiso luqhathanise ukusebenza kakuhle kwe-MBSR kunye noTyango njenge-Usual (TAU) ekuxininisweni nasekukhathazeni impilo yengqondo yezigulane ezinentlungu yesifo. Nangona i-MBSR ibonwa njengonyango olusebenzayo lweempawu zengcinezelo kunye nentlungu, kukho isidingo sokuhlola ukusebenza kwayo kunyango lweengxaki zempilo yengqondo kwizigulane ezineentlungu zentlungu, esinye sezikhalazo eziqhelekileyo kubemi.

 

Ukufunyaniswa kweso sifundo kubonisa ukuphucula impilo yengqondo jikelele kwi-index ye-GSI ye-BSI. Kwisifundo esithile, ukuphucula okubalulekileyo ngongenelelo lwe-MBSR kwabikwa kuzo zonke iifom ze-36-Into eFutshane yeFom yeFom yeFom (SF-36). [I-20,24] Izifundo zabonisa ukunciphisa okukhulu kwiingxaki zengqondo kwi-Symptom Checklist-90-Revised (SCL- 90-R) i-subscale efana nokuxhalabisa nokuxinezeleka yi-MBSR emva kokungenelela kunye nokulandelelwa kwe-1-nyaka. [5] Reibel et al. Wabonisa i-MBSR kwizigulane ezinentlungu engapheliyo yabika ukwehla kwezimpawu zonyango ezifana nokuxhalaba, ukuxinezeleka kunye nentlungu. [5] Kuye kwaboniswa ukuba ukukhathazeka kwentloko kunye nokuxhalaba kuhamba kunye nokulahleka kwenkqubo yokulawulwa kwengqondo efana nokugcinwa kwengqalelo kunye nokukhumbula imemori. [25] Iimvakalelo ezinganakunokuthi zikhulise ukubandezeleka ezinxulumene nentlungu yokuqonda.

 

I-MBSR isebenzisa ezi ndlela zilandelayo zokuphucula imeko yengqondo yesigulana: Okokuqala, ukucamngca kukhokelela ekwandiseni ulwazi malunga nokwenzekayo mzuzu ngamnye, ngesimo sokwamkela, ngaphandle kokubanjwa ziingcinga, iimvakalelo kunye neendlela zokuziphatha. Ukwanda kolwazi emva koko kunika iindlela ezintsha zokuphendula nokumelana ngokunxulumene nesiqu sakho kunye nehlabathi elijikelezileyo. [3] Ingqondo ibeka imeko yokuzimela okukhulu kuneengcinga, iimvakalelo, kunye noluvo lomzimba njengentlungu. Ukuziqhelanisa nengqondo, abathengi abafundileyo bakhulisa i- observer self . Ngobu buchule, banokuzijonga iingcinga zabo kunye neemvakalelo zabo ngendlela engasebenziyo kunye nokungagwebi eyayikade ithintelwe ngaphambili, ezo zazithintela iingcinga kunye neemvakalelo ngaphambili ezazingaboniswanga kwaye zingagwetywa. Abaxhasi bafunda ukuqaphela iingcinga ngaphandle kokwenza oko, belawulwa ngabo, okanye bekholelwa kubo. [3]

 

Okwesibini, ukuqonda kunceda umxhasi ukuba aqhubeke nokunyamekela ekuthatheni amanyathelo kwiindlela ezibalulekayo ezibalulekileyo kubo. Uninzi lwabo bathengi abanentlungu engapheliyo bafuna ukuva iintlungu ngaphandle kokuphila ubomi obalulekileyo bokukhetha kwabo. Kodwa inkqubo ye-MBSR yawaqeqesha ukuba bahlanganyele kwisenzo esixabisekileyo naphezu kwentlungu. Izifundo zibonise ingqalelo kwaye iimvakalelo zengqondo zintlungu ebalulekileyo ekuqhubekekeni intlungu. [26] Iimpawu zengqondo kunye neengcamango zingayigxininisa intlungu kunye nokuxhalaba ngayo leyo inokuqinisa intlungu kunye nokuphazamisa izigulane imisebenzi. [27,28]

 

Okwesithathu, ukufunyaniswa kweziphumo ezithile kubonisa ukuba i-MBSR inokuguqula umsebenzi wengqondo ejongene nokuchaphazela ummiselo kunye neendawo ezilawula indlela esabela ngayo kwiimvakalelo ezixinzelelekileyo, kwaye oku kungenza ukuba imisebenzi yomzimba ifane nokuphefumula, intliziyo, [29,30] Ukuziqhelanisa nokuziphatha kwenza ukunciphisa iingcamango kunye neemvakalelo eziphazamisayo kunye nokuqinisa intlungu yokuqonda. [31] Kwakhona ukunyamekela kunganciphisa ukusebenza kwengqondo kwengqondo kunye nokukhathazeka kwemizwa ngokuqinisa amandla okuphinda ahlaziywe kunye nolawulo lomzwelo. [32]

 

Amandla kwesi sifundo kukusetyenziswa kwe-psychotherapy entsha esebenzayo ekunciphiseni uxinzelelo kwisikhalazo esingakhange sifunde, kodwa yinkinga yonyango eqhelekileyo. Impembelelo yesifundo sethu isebenzisa i-psychotherapy elula engenzi nto imfuno engqondweni kwaye isetyenziswe ngokukhawuleza njengekhono lokuphatha isigulane. Ngoko ke, abaqeqeshi bempilo bayalathana nesi sikhalazo kwaye isiguli siya kukwazi ukusebenzisa olu unyango. Kwakhona, i-MBSR iya kutshintsha indlela yokuphila yesigulane eyayiza kuba yinkxalabo yakhe yingxaki. Umlinganiselo ophambili wale sifundo kukungabikho koqhathaniso phakathi kwe-MBSR kunye ne-gold standard psychotherapies ezifana ne-ctnitive behavior treatment (CBT). Kucetyiswa ukuba izifundo zexesha elizayo kufuneka ziqhathanise ukuphumelela kwe-MBSR kunye nezinye iindlela zokuziphatha ezingokwenkcubeko nezokutsha kwizigulane ezineentloko zentlungu.

 

isiphelo

 

Isifundo sethu sisekela ingcamango yokuba izigulane ezinobungqina beentloko zentlungu zingakhuphula impilo yazo yengqondo ngokuthatha inxaxheba kwinkqubo ye-MBSR. Ngesishwankathelo, iziphumo zolu phando zibonisa ukuba i-MBSR inokunciphisa uxhalabo olunxulumene nentlungu kunye nokuphazamiseka kwimisebenzi yemihla ngemihla. Iimpawu ezikhethekileyo zokusebenzisa ingqondo ziqeqesho lula kwaye akukho mfuneko yokwenza izinto ezinengqondo ezinzima.

 

Inkxaso yemali kunye nenkxaso: Nil.

 

Iimbambano zomdla: Akukho zimbambano zomdla.

 

Umrhumo weMbhali

 

I-AO inegalelo ekuvelweni komsebenzi, uqhuba isifundo, kwaye uyavumelana nayo yonke imiba yomsebenzi. I-FZ inegalelo ekuqalisweni komsebenzi, ukuhlaziywa koqulunqo, ukuvunyelwa kwenguqu yokugqibela yesicatshulwa kunye nokuvunyelwa kuyo yonke imiba yomsebenzi.

 

Imibulelo

 

Ababhali bayabulela abasebenzi beSibhedlele saseShahid Beheshti kunye nabathathi-nxaxheba. Ababhali bavakalisa ukubonga kwabo kwiKhabat-Zinn kwiSiko soMqondo (i-CFM) kwiYunivesithi yaseMassachusetts enomusa wanika iikhompyutheni zekhompyutheni ze-MBSR.

 

Ukuququmbela,Ngelixa uxinzelelo lwexesha elifutshane luluncedo, uxinzelelo lwexesha elide lunokukhokelela kwimicimbi eyahlukeneyo yezempilo, kubandakanya uxinzelelo kunye noxinzelelo kunye nentamo kunye nentlungu yomqolo, intloko ebuhlungu kunye ne-disc herniation. Ngethamsanqa, ukungenelela kwengqondo, njengokukhathalela i-chiropractic kunye nokunciphisa uxinzelelo kwengqondo (MBSR) zikhuselekile kwaye zisebenza ngendlela efanelekileyo yokulawula uxinzelelo. Okokugqibela, inqaku elingentla libonise iziphumo ezisekwe kubungqina ukuba i-MBSR inokunciphisa uxinzelelo kunye nokuphucula impilo yengqondo kwizigulana ezinentloko yentloko. Ulwazi olukhankanyiweyo kwiZiko leLizwe leNgcaciso yeBiotechnology (NCBI). Ubungakanani bolwazi lwethu bukhawulelwe kwi-chiropractic kunye nokulimala komqolo kunye neemeko. Ukuxoxa ngesihloko, nceda ukhululeke ukubuza uGqirha Jimenez okanye unxibelelane nathi apha 915-850-0900 .

 

Ikhutshwe nguDkt. Alex Jimenez

 

Green-Call-Now-Button-24H-150x150-2-3.png

 

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.

 

umfanekiso webhlogi weendaba eziphambili zephepha lephepha

 

ISIHLOKO ESIBALULEKILEYO: Ukulawula uxinzelelo lomsebenzi

 

 

IINGCUKACHA EZIBALULEKILEYO: UKUPHATHA KWE-EXTRA: I-Car Accident Injury Treatment El Paso, TX I-Chiropractor

 

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