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

Ulwaphulo-Inkqubo Yokuziphatha Ngamayeza Okwenyuka Kwezingozi E-El Paso, TX

by iicrosoft | Umqolo obuhlungu, Ubuhlungu obungapheliyo, Iimeko eziPhathwayo, Disc Disc, entanyeni Pain, Ukubuyiswa komzimba, Uvavanyo oluLungeleleneyo oluLungisiweyo, Izifundo zoPhando, istres, Unyango

Ukubandakanyeka kwingozi yemoto yimeko engathandekiyo enokubangela iintlobo ezahlukahlukeneyo zokuxhwaleka okanye ukulimala kunye nokukhokelela ekuphuhlisweni kweemeko ezinzima. Ukulimala ngokuzenzekelayo ngengozi, njenge-whiplash, kunokubonakaliswa yimpawu ezibuhlungu, kuquka intlungu yesifo esingapheliyo, nangona kunjalo, uphando olutsha lwangoku lufumene ukuba ukuxinzezeleka kwengqondo okubangelwa ukudibanisa ngokuzenzekelayo kunokubonakalisa iimpawu zomzimba. Ukuxinezeleka, ukuxhalaba, ukuxinezeleka kunye nesifo sengxaki yokuxinezeleka, okanye i-PTSD, iimeko eziqhelekileyo zengqondo ezingenzeka ngenxa yengozi yemoto.

Abaphandi ophando lwezophando baye baqinisekisa ukuba unyango oluthile lweengqondo luza kuba yinkqubo efanelekileyo yokukhathazeka kwengqondo kunye nemiba yengqondo engenzeka ibe yiphumo ngenxa yengozi yengozi yemoto. Ukongezelela, ukulimala kwengozi yemoto kungabangela uxinzelelo, ukuxhalabisa, ukuxinezeleka kunye ne-PTSD xa ingashiywa ingaphenduliwe ixesha elongezelelweyo. Injongo yeli nqaku apha ngasentla kukubonisa imiphumo yonyango-yokuziphatha, kunye nezinye iindlela zokonyango ezifana nokunyamekela kwe-chiropractic kunye nonyango. ukulimala kwengozi yemoto, njenge-whiplash.

Ukuzivocavoca kwe-Neck, Umsebenzi oPhezulu kunye noCognitive--Gedded-Treatment as Treatment for Adult Whiplash Izigulane ezine-Paeck Pain Pain: I-Design of Trial Control Reguted Trial

Name: El Paso Back Clinic | Spine Specialists - El Paso, TX
Price range: $$

Abstract

imvelaphi

Izigulane ezininzi zineentlungu ezingapheliyo entanyeni emva kokulimala kwe-whiplash. Ukuhlanganiswa kwengqondo, ukunyanga kokuziphatha kunye nokungenelela kwe-physiotherapy kuye kwabonakaliswa ukuba kusebenza ekulawuleni izigulane ezineengxaki ezinxulumene ne-whiplash. Injongo kukubonisa ukulungiswa kwetyala elilawulwa ngokungapheliyo (RCT) elijoliswe ekuhloleni ukusebenza komsebenzi ngamnye ohlangeneyo kunye nokuqonda kwengqondo ngokuziphatha ngokuzimela ngokubanzi, ngaphezu kwentshukumo yomsebenzi, intlungu, ukukhubazeka kunye Umgangatho wobomi kwizigulane ezineentlungu ezingapheliyo zentlungu emva kokulimala kwe-whiplash xa kuthelekiswa neqela elilawulayo elilinganayo elilinganiselwe kwinqanaba lokuqala kunye ne-4 kunye ne-12 inyanga emva kokuqala.

Izindlela / Ukuyila

Ukuyila i-center-two, isifundo se-RCT kunye noyilo lweqela elifanayo. Kubandakanywa izigulane zezigulane zentlungu engapheliyo kwiinyanga ezili-6, ezifunyenwe kwiikliniki ze-physiotherapy kunye nesiphedlele esibhedlele esibhedlele saseDenmark. Izigulane ziza kuba neengxaki kwiinkampani zolawulo (ubukhulu) okanye ulawulo lweentlungu kunye kunye nokuqeqeshwa (ukungenelela) iqela. Iqela lolawulo liya kufumana iiseshoni zemfundo ezine ekulawuleni ubuhlungu, ngelixa iqela lokungenelela liya kufumana iiseshoni zokufundisa iintlungu kunye neeseshoni zoqeqesho lwee-8 zenyanga kwiinyanga ze-4, kubandakanya ukukhokelwa kwimiyalelo ethile yentamo kunye neprogram yoqeqesho lwe-aerobic. Izigulane kunye ne-physiotherapists bayazi malunga nokwabiwa kunye nonyango, ngoxa abahloli bemiphumo kunye nabahlalutyi beenkcukacha baphuphuthekiswe. Amanyathelo okuphambili kweziphumo ziya kuba yiSiphumo soFundo lweziFundo esifutshane 36 (SF36), isishwankathelo sePhysical Component (PCS). Iziphumo eziPhezulu ziza kuba yi-Global Global Impact Effect (-5 kuya ku-5), Index Index (0-50), Isigulane sokuSebenza ngokuPhezulu (0-10), isixa semilinganiselo yesibalo sokubandezeleka (0-10), i-SF-36 yengqondo I-Summary Summary (MCS), isilinganisi se-TAMPA seKinesiophobia (17-68), Impembelelo yeSiganeko seSigane (0-45), i-EuroQol (0-1), uvavanyo lwe-craniocervical flexion (22 mmHg - 30 mmHg) uluhlu lweentshukumo. Izikali ze-SF36 zifunyenwe ngokusebenzisa iindlela eziqhelekileyo ezisisiseko kunye ne-PCS kunye ne-MCS enamanqaku athile we-50 kunye nokuphambuka okuqhelekileyo kwe-10.

ingxoxo

Iingcamango zolu cwaningo zixutyushwa, ngaphezu kwamandla kunye nobuthathaka.

Ukubhaliswa kovavanyo

Uphononongo lubhalisiwe kuyo Ukhathalelo lweeKlinikhi.gov isazisi NCT01431261.

imvelaphi

IBhodi yeSizwe yaseMdanethi yezeMpilo iqikelela ukuba izifundo ze-5-6,000 ngonyaka eDenmark zibandakanyeka engozini yemoto eyenza intlungu yentlungu. Ngokumalunga ne-43% yabo baya kuhlala benokukhubazeka ngokomzimba kunye neempawu ze-6 inyanga emva kwengozi [1]. Kubahlali baseSweden, kuquka iinkampani zomshuwalense yaseSweden, umthwalo wezoqoqosho ulinganiselwa kwi-320 yezigidi zeeYurophu [i-2], kwaye lo mthwalo unokufaniswa nekaDenmark. Uninzi lweziphumo zibonisa ukuba izigulane ezine-Whiplash-Associated Disorders (WAD) zibika iimpawu ezingapheliyo zentamo emnyaka omnye emva kokulimala [3]. Iingxaki eziphambili kwizigulane ze-whiplash ezineentlungu ezingapheliyo zentamo ziyizintlu zesifo somlomo kunye nokuqhutyelwa kwezinto ezingaqhelekanga, ukunciphisa ukunyakaza kwentamo nokuzinza, ukungazinzi ngengqondo ye-cervicocephalic inestesthetic sense, ngaphezu kweentlungu zengingqi kunye no-4,5]. Ukukhubazeka komlomo wesibeleko kubonakaliswe ngumsebenzi oncitshisiweyo wezintlungu ezizinzileyo zentamo.

Ngaphandle kwentlungu engapheliyo intamo, izigulane ezine-WAD zi nobunzima bokungasebenzi ngenxa yentlungu engapheliyo [6,7]. Oku kukuchaphazela umsebenzi wesimo kunye nempilo jikelele kwaye kunokubangela umgangatho wobomi obuthathaka. Ukongezelela, izigulane ze-WAD zingahlakulela intlungu engapheliyo ngokulandelelaniswa kwenkqubo ye-nervous [8,9], ukwehlisa umyinge weziphumo ezahlukeneyo zengqondo (uxinzelelo, ukubandayo, ukufudumala, ukutshukunyiswa kunye nezimo zombane) [10]. Oku kungabangelwa yintlungu yokubandezeleka kwentlungu [11] - ukulungiswa kwamacandelo [12]. Ngaphandle kokunxibelelwano oluphakathi, iqela le-WAD linokuba neendlela eziphambeneyo zokuxhatshazwa kunye nemisebenzi yokuqonda, xa kuthelekiswa nezigulane ezineentlungu ezingapheliyo entanyeni jikelele [13-15].

Izifundo zibonise ukuba ukuqeqeshwa ngokomzimba, kubandakanywa nezivivinyo ezizodwa ezijoliswe kwiimisipha ezinzulu zomzimba zomlomo wesibeleko, ziyasebenza ekunciphiseni ubuhlungu bentamo [16-18] kwizigulane ezinentlungu engapheliyo, nakuba kukho ukungafani ekuphenduleni uqeqesho ngaphandle zonke izigulane zibonisa utshintsho olukhulu. Umsebenzi wokuziphathelanisa nomzimba yindlela yokwenza unyango ngokugxila ekuqiniseni impilo yomzimba jikelele, ukunciphisa ukwesaba ukuhamba nokunyusa umsebenzi wengqondo [19,20]. Kukho ubungqina obaneleyo bexesha elide lokwenyango lwezinto eziphathekayo eziphathekayo, ngokukodwa kwizigulane zentlungu ezingapheliyo. Iiseshoni zezemfundo, apho kugxininiswe ekuqondeni iinkqubo ezibuhlungu ezinzima kunye nokuphuhliswa kweentlungu ezifanelekileyo kunye / okanye izicwangciso zokuziphatha, zibonise intlungu epheleleyo [6,21-26]. Uphononongo lubonise ukuba ukungenelela ngonxibelelwano lwezengqondo, ukunyanga kwimizimba kunye ne-physiotherapy kuquka ukusetyenziswa kwentamo kusebenza kakuhle ekulawuleni izigulane ze-WAD ezineentlungu ezingapheliyo zentlungu [27], njengoko kunconywa yi-Dutch clinical guidelines kwi-WAD [28]. Nangona kunjalo, izigqibo malunga nezikhokelo zixhomekeke kwiingcaphephe ezenziwe kwizigulane ezinezixhobo eziqhelekileyo okanye eziphantsi kwe-WAD [29]. Isiphetho esiqinileyo sagqalwa kwizigulane ze-WAD ezineentlungu ezingapheliyo kwi-Bone and Joint Decade 2000-2010 Task Force, echaza ukuba 'ngenxa yobungqina obuphikisanayo kunye nezifundo ezimbalwa eziphakamileyo, akukho zigqibo ezichanekileyo ezinokukhangela malunga neyona ndlela ingasebenzi ukungenelela kwamagulane anesifo esingapheliyo se-WAD "[29,30]. Ingcamango yonyango oludibeneyo kwizigulana ze-WAD ezineentlungu ezingapheliyo zisetyenzisiwe kwisilingo esilawulayo ngokungapheliyo [31]. Iziphumo zibonise ukuba ukudibanisa kweendlela ezingezizo ze-aerobic kunye neengcebiso eziqulethe imfundo yentlungu kunye nokuqinisekiswa nokukhuthazwa ukuqhubela phambili umsebenzi wokukhanya, kwavelisa iziphumo ezingcono kuneengcebiso kuphela ezigulane ezineenyanga ze-WAD 3 emva kwengozi. Izigulane zibonise ukuphuculwa kwintlungu ebuhlungu, intlungu ebuhlungu kunye nemisebenzi kwimisebenzi yemihla ngemihla kwiqela elithobela umzimba kunye neengcebiso, xa kuthelekiswa neengcebiso zodwa. Nangona kunjalo, ukuphuculwa kwabancinci kwaye kubonakala kwithuba elifutshane.

Le projekthi yenziwa kulindelo lokuba ukulungiswa kwezigulana ze-WAD ezineentlungu ezinganyangekiyo zentamo kufuneka zijolise kukungasebenzi kakuhle komlomo wesibeleko, uqeqesho lomsebenzi womzimba kunye nokuqonda kunye nolawulo lweentlungu ezingapheliyo kwindlela yonyango edibeneyo. Ungenelelo ngalunye lusekwe kwizifundo zangaphambili eziye zabonisa ukusebenza [6,18,20,32]. Olu phononongo lolokuqala ukubandakanya isiphumo sexesha elide lendlela edityanisiweyo kwizigulana ezinentlungu engapheliyo emva kwentlungu ye-whiplash. Njengoko kubonisiwe kumzobo? Umzobo1,1, imodeli yokuqonda kolu phononongo isekwe kwi-hypothesis yokuba uqeqesho (kubandakanya zombini intambo ekhokelwa ngokukodwa kunye noqeqesho lwe-aerobic) kunye nemfundo kulawulo lwentlungu (esekwe kwindlela yokuziphatha kwengqondo) Kungcono ukonyusa umgangatho wobomi babaguli, xa kuthelekiswa nemfundo kulawulo lwentlungu kuphela. Ukwandisa umgangatho wobomi wobomi kubandakanya ukwandisa ukusebenza komzimba kunye nenqanaba lomsebenzi womzimba, ukunciphisa uloyiko lokuhamba, ukunciphisa iimpawu zoxinzelelo lwasemva kwengozi, ukunciphisa iintlungu zentamo kunye nokwanda kwentamo. Iziphumo kulindeleke ukuba zifumaneke kwangoko emva konyango (okt iinyanga ezi-4; isiphumo sexesha elifutshane) nasemva konyaka omnye (isiphumo sexesha elide).

Umzobo we-1 Hypothesis we-Intervention Effect

Umzobo 1: I-hypothesis yempembelelo yokungenelela kwizigulane ezinentlungu engapheliyo kwentamo emva kwengozi ye-whiplash.

Ukusebenzisa isicwangciso esilungelelweyo (RCT), iinjongo zezifundo zihlolisise ukuphumelela: ukuqeqeshwa ngokomzimba, kuquka ukuqeqeshwa kwentamo kunye nokuqeqeshwa ngokubanzi kwe-aerobic, kunye nezemfundo ekulawuleni ubuhlungu (ngokusekelwe kwindlela yokuziphatha kwengqondo) ngokuchasene imfundo ekulawuleni ubuhlungu (esekelwe kwinkqubo yokuziphatha kwengqondo), elinganiselwe kumgangatho wobomi bomzimba, umsebenzi womzimba, intlungu yentamo kunye nemisamo yomsebenzi, ukwesaba ukunyakaza, iimpawu ezihamba phambili kunye nomgangatho wobomi, kwizigulane ezineentlungu ezingapheliyo entanyeni emva kokutshatyalaliswa kwe-whiplash.

Izindlela / Ukuyila

Uyilo lweMvavanyo

Isifundo siqhutywa eDenmark njenge-RCT kunye noyilo lweqela elifanayo. Iya kuba sisifundo samaziko amabini, ehlukaniswe yindawo yokuqesha. Izigulana ziya kwenziwa ngokungacwangciswanga kwiqela loLawulo lwePain (ulawulo) okanye iqela loLawulo lwePain kunye noQeqesho (ungenelelo). Njengoko kubonisiwe kuMzobo? Umzobo2,2, uphononongo luyilelwe ukubandakanya uvavanyo lwesekondari lwedatha yeenyanga ezili-12 emva kwesiseko; kuvavanyo lwesiphumo sokuqala luya kwenziwa kwangoko emva kwenkqubo yongenelelo kwiinyanga ezi-4 emva kwesiseko. Uphononongo lusebenzisa inkqubo yokufihla ulwabiwo, ukuqinisekisa ukuba iqela elabelwe isigulana alaziwa ngaphambi kokuba isiguli singene kufundo. Abavavanyi beziphumo kunye nabahlalutyi beenkcukacha baya kugcinwa bemfama kulwabiwo longenelelo okanye iqela lolawulo.

Umzobo we-2 Flowchart yezigulane kwiSifundo

Umzobo 2: I-Flowchart yezigulane kwisifundo.

izicwangciso

Abathathi-nxaxheba baya kugaywa kwiiklinikhi ze-physiotherapy eDenmark nakwiziko i-The Spine Centre laseMazantsi eDenmark, kwisibhedlele iLilleb lt ngesibhengezo kwiikliniki nasesibhedlele. Ukusebenzisa iiklinikhi ze-physiotherapy ezisasazeka kwiDenmark, izigulane ziya kufumana ukungenelela kwendawo. Iiklinikhi ze-physiotherapy eDenmark zifumana izigulana ngokudluliselwa kugqirha wazo jikelele. I-Spine Centre, iyunithi egxile ekunyangeni abaguli abane-musculoskeletal dysfunctions kunye nokunyanga abaguli kuphela, ifumana abaguli abathunyelwe kugqirha oqhelekileyo kunye / okanye oochwephesha.

UkuFunda kwabantu

Abantu abadala abangamakhulu amabini abaneminyaka yobudala eyi-18, abafumana unyango lwe-physiotherapy okanye abathunyelwe kunyango lwe-physiotherapy baya kugaywa kwakhona. Izigulana ukuze zifaneleke, kufuneka: iintlungu ezingapheliyo zentamo ubuncinci iinyanga ezi-6 zilandela ukwenzakala kwe-whiplash, ukunciphisa ukusebenza kwentamo yomzimba (Amanqaku okukhubazeka kweNeck Index, i-NDI, ubuncinci be-10), iintlungu ikakhulu kwingingqi yentamo, zigqityiwe naziphi na iimviwo zonyango / zemitha, ukukwazi ukufunda nokuqonda isiDanish kunye nokukwazi ukuthatha inxaxheba kwinkqubo yovavanyo. Iikhrayitheriya zokukhutshelwa ngaphandle zibandakanya: ii-neuropathies / i-radiculopathies (kuvavanywa ngokwezonyango ngu: Ukutshiza okuqinisekileyo, ukubamba komlomo wesibeleko kunye novavanyo lwe-plexus brachialis) [33], ukusilela kwemithambo-luvo (kuvavanywa ngokwesiqhelo kukliniki ngenkqubo yokuvavanya isifo esingaziwayo), ukuzibandakanya kwezonyango Unyango, ukuba kwimeko yokungazinzi kwezentlalo kunye / okanye ukusebenza, ukukhulelwa, ukwaphuka okwaziwayo, uxinzelelo ngokwe-Beck Depression Index (amanqaku> 29) [18,34,35], okanye ezinye iimeko zonyango ezikhoyo ezaziwayo ezinokuthi zithintele kakhulu ukuthatha inxaxheba inkqubo yokwenza umthambo. Abathathi-nxaxheba baya kucelwa ukuba bangafuni enye i-physiotherapy okanye unyango lwengqondo ngexesha lokufunda.

Ukungenelela

ulawulo

Iqela loLawulo lwePain (ulawulo) liza kufumana imfundo kwizicwangciso zokulawula ubuhlungu. Kuza kuba neeseshoni ze-4 zeeyure ze-11 / 2, ezibandakanya izihloko malunga neendlela zentlungu, ukwamukelwa kwentlungu, ukucwangcisa ukucwangcisa, nokucwangciswa kweenjongo, ngokusekelwe ekulawuleni ubuhlungu kunye neengqondo zonyango (21,26,36).

Ukungenelela

Ulawulo lwePain kunye noQeqesho (ukungenelelo) iqela liya kufumana imfundo efanayo kwintlawulo yobuhlungu njengaleyo kwiqela lolawulo kunye neeseshoni zonyango ze-8 (umyalelo emisebenzini yentamo kunye nokuqeqeshwa kwe-aerobic) ngexesha elifanayo leenyanga ezili-4 ubude. Ukuba unyango lwe-physiotherapist liqikelela ukuba unyango olongezelelweyo luyadingeka, unyango lunokunwetshwa ngeeseshoni ezininzi ze-2. Ukuqeqeshwa kwe-Neck: Ukunyangwa koqeqesho oluthile lwentamo kuya kuqhubela phambili kwiinqanaba ezahlukeneyo, ezichazwa ngamanqanaba athile omsebenzi wentamo. Kwiseshoni yokuqala yonyango, izigulane zivavanyelwe umsebenzi we-neuromuscular yomlomo wesiza ukuchonga iqela elithile apho uqala ukuqeqeshwa kwentamo. Inkqubo ethile yokuzilolonga iya kusetyenziselwa ukujolisa intamo ye-flexor kunye neentsundu ezidlulayo. Ikhono lokwenza i-neck collar muscle ye-necklar muscle ye-collarical region ibe yandisa ukunyusa amandla, ukunyamezela nokuzinza umsebenzi uqeqeshe ngokuqhubekayo ngokusebenzisa indlela yokuqeqeshwa kwe-craniocervical usebenzisa i-transplant feedback feedback [18,37]. Ukuzilolonga kwintamo-ukuhlobana kwamehlo, ukuxhoma kwentamo, ukulinganisela kunye nokunyamezela ukuqeqeshwa kwemisipha yentamo kuya kufakwa, njengoko kuboniswe ukunciphisa intlungu kunye nokuphucula ukulawula i-sensorimotor kwizigulane ezinentlungu yentlungu [17,38]. Uqeqesho lwe-Aerobic: I-trunk enkulu kunye nemisipha yomlenze iya kuqeqeshwa kunye nenkqubo yokuqeqesha ngokunyuka komzimba. Izigulane ziya kuvunyelwa ukhethe imisebenzi efana nokuhamba, ukuhamba ngebhayisikili, ukuhamba, ukubhukuda kunye nokugijima. Isiseko sokuqala ixesha lokuqeqeshwa sisetyenziswe ngamaxesha e-3 kwinqanaba elincinci, elingenakwandisa intlungu kwaye ijolise kwiqondo elilinganiselwe ukulinganisa (RPE) phakathi kwe-11 kunye ne-14 kwinqanaba le-Borg [39]. Ubude bokuqala boqeqesho lubekwe i-20% ngaphantsi kwexesha eliphakathi kwezilingo ezintathu. Iiseshoni zokuqeqesha zenziwa rhoqo ngosuku lwesibini kunye nemfuneko yokuba intlungu ayibubi, kwaye i-RPE iphakathi kwe-9 ne-14. Idayari yoqeqesho isetyenziswe. Ukuba izigulane azibuyiswanga kwakhona, kwaye zibike ixabiso le-RPE eliphakathi kwe-14 okanye ngaphantsi, ixesha lokusebenzisa ixesha elilandelayo (i-1 okanye iiveki ze-2) linyuswa ngama-2-5 imizuzu, ukuya kumlinganiselo we-30 imizuzu. Ukuba izinga le-RPE li-15 okanye ngaphezulu, ixesha lokusebenzisa liya kuncitshiswa kumlinganiselo we-RPE we-11 ukuya kwi-14 rhoqo kwiintsuku ezimbini (20,40]. Ngokusebenzisa le migaqo-nkqubo, uqeqesho luya kubalwa ngokwezigulane, ngokugxininisa ekusebenziseni okubonakalayo - ngenjongo yokwandisa izinga lomsebenzi jikelele kunye nokuqina.

Ukuthotyelwa kwamagulane kuya kulawulwa ngokubhaliswa kokuthatha inxaxheba kwiqela kunye nelelo lokungenelela. Izigulane kwiqela lokulawula ziya kuqwalaselwa ukuba zigqibile ulawulo lweentlungu ukuba ziye kwi 3 kwiiseshoni ze-4. Izigulane kwiqela lokungenelela ziya kuqwalaselwa ukuba zigqityiwe ukuba isigulane siye kwi-3 ubuncinci kwiiseshoni zolawulo lweentlungu ze-4 kwaye ubuncinane be-5 kwiiseshoni ze-8 zokuqeqesha. Uqeqesho lwekhaya lomguli ngamnye ngomzimba lwentamo kunye nokuqeqeshwa kwe-aerobic kuya kubhalwa nguye kwi-logbook. Ukuthotyelwa kwe-75% yoqeqesho lwekhaya olucwangcisiweyo kuya kuthathwa njengolugqibelele ukungenelela.

Physiotherapists

I-physiotherapists abaza kuthatha inxaxheba baya kuqashwa ngokusebenzisa isimemezelo kwi-Danish Physiotherapy Journal. Inkqubo yokubandakanya iquka: kuba ngumzimba oqeqeshiwe, osebenza kwikliniki kwaye ubuncinane ubuncinane iminyaka emibili yamava osebenza njengesifo-physiotherapist, beye kwikhosi kwi-intervention echaziweyo kwaye baphonononga uvavanyo oluhambelana nalo.

Izisiphumo

Ngokwesiseko ulwazi lwabathathi-nxaxheba malunga nobudala, isini, ubude kunye nobunzima, uhlobo lwengozi, amayeza, ukukhula kweempawu kwezi nyanga zimbini zidlulileyo (imeko ekuyo, ukuphucula, ukuwohloka), ulindelo lonyango, ingqesho kunye nenqanaba lezemfundo ziya kubhaliswa. Njengomgangatho wesiphumo esiphambili, iZiphumo zoFundo lweFomu eFutshane 36 (SF36) - Isishwankathelo seCandelo loMzimba (PCS) siya kusetyenziswa [41,42]. Izikali ze-PCS zifunyenwe kusetyenziswa iindlela ezisekwe ngokwesiqhelo [43,44] ngamanqaku aphakathi ama-50 ngophambuko oluqhelekileyo lwe-10. Iziphumo eziphambili ngokubhekisele ekubeni nefuthe, ziya kubalwa njengotshintsho olusuka kwisiseko [45]. Iziphumo zesekondari zinedatha kuzo zombini iimvavanyo zeklinikhi kunye neziphumo ezichazwe kwizigulana. Itheyibhile? Uluhlu lwe-11 lubonisa iimvavanyo zeklinikhi zokulinganisa ungenelelo kulawulo lwe-neuromuscular yezihlunu zomlomo wesibeleko, umsebenzi wesibeleko kunye ne-allodynia yomatshini. Itheyibhile? Itheyibhile22 ibonisa iziphumo ezinxulumene nesigulana ezivela kumaphepha emibuzo asetyenziselwa ukuvavanya isiphumo sonyango, iintlungu zentamo kunye nomsebenzi, iintlungu eziphazamisayo, uloyiko lokuhamba, uxinzelelo lwasemva kwengozi kunye nomgangatho wobomi kunye neenguqulelo ezinokubakho kunyango.

Iziphumo ze-1 Iziphumo zezonyango ezisetyenziselwa ukulingana kweempembelelo zonyango

Ithebula 1: Iziphumo zezonyango ezisetyenziselwa ukulinganisa umphumo wonyango kwiqhinga le-muscle, i-function and treatment guides.

Ithebhile ye2 Isigulane esibhaliweyo Iziphumo ezisetyenziselwa ukulingwa kweMiphumo yokuPhathwa

Ithebula 2: Izigulane zibike iziphumo ezisetyenziselwa ukulinganiswa kwempembelelo yonyango kwiintlungu kunye nomsebenzi.

Izigulane ziya kuvavanywa kwisiseko, i-4 kunye ne-12 inyanga emva kokuqala, ngaphandle kwe-GPE, eya kulandelwa kuphela i-4 kunye ne-12 inyanga emva kokuqala.

Amandla kunye nokulinganisa ubungakanani beSampula

Amandla kunye nobungakanani besampulu yokubala kusekwe kwisiphumo sokuqala, kuba yi-SF36-PCS 4 iinyanga emva kwesiseko. Kwisampulu ezimbini ezidityanisiweyo t-Uvavanyo lwentsingiselo eqhelekileyo enamanqanaba amabini okubaluleka kwe-0.05, uthatha i-SD eqhelekileyo ye-10, ubungakanani besampulu yama-86 kwiqela ngalinye kufuneka ifumane amandla ubuncinci be-90% ukuya fumana iqela elithetha umahluko wamanqaku ama-5 e-PCS [45]; owona mandla yi-90.3%, kwaye isampulu yesayizi yesampulu efezekisa amandla ayi-90% ngama-85.03 kwiqela ngalinye. Ukulungelelanisa ukurhoxiswa kwe-15% ngexesha lokufunda kweenyanga ze-4, siya kubandakanya abaguli be-100 kwiqela ngalinye. Kubuntununtunu, kwasetyenziswa iimeko ezintathu: okokuqala, silindele ukuba zonke izigulana ezi-2 ukuya kwi-100 zigqibe ukulingwa, siya kuba namandla aneleyo (> 80%) ukufumana iqela elithetha umahluko njengasezantsi kwamanqaku e-4 PCS; Okwesibini, siya kuba nakho ukufumana inani elibalulekileyo ngokwamanani e-5 PCS yamandla aneleyo (> 80%) kunye ne-SD edibeneyo yamanqaku e-12 PCS. Okwesithathu kwaye ekugqibeleni, ukuba sijolise kwiqela kuthetha umahluko wamanqaku e-5 e-PCS, ene-SD edityanisiweyo ye-10, siya kuba namandla aneleyo (> 80%) enezigulana ezingama-64 kuphela kwiqela ngalinye. Nangona kunjalo, ngenxa yezizathu zokuhamba, izigulana ezitsha azisayi kubandakanywa kufundo lweenyanga ezingama-24 emva kokuba kufakwe isiguli sokuqala.

Ukurhoxiswa, ukunikezwa kunye neNkqubo yokuPhula

Emva kokuvavanywa kokuqala, abathathi-nxaxheba bayabelwa ngokukhawuleza kwiqela lolawulo okanye iqela lokungenelela. Ulandelelwano olulandelelweyo lwenziwa ngokusetyenziswa kweSAS (iSAS 9.2 TS level 1 M0) isofthiwe yesalathisi kwaye iboniswe yiziko le 1: Ulwabiwo lwe-1 usebenzisa ubukhulu bebhloko be2, 4, kunye ne-6. Ulwabiwo lwabiwo luza kufihlwa kumphenyi obhalisa nokuvavanya abathathi-nxaxheba kwiimvulophu ezibhalwe ngokulandelelana, eziphathekayo, ezitywinwe kunye nezifakwe kwi-envelopes. I-aluminium foil ngaphakathi kwimvulophu izakusetyenziswa ukunika imvulophu engapheliyo ekukhanyeni okukhulu. Emva kokutyhila umxholo wemvulophu, zombini izigulane kunye ne-physiotherapists bayazi malunga nokwabiwa kunye nonyango olufanayo. Iziphumo zabahloli kunye nabahlalutyi beenkcukacha zigcinwe ziphofu. Ngaphambi kokuvavanya iziphumo, izigulane ziya kucelwa ngumncedisi wophando ukuba angakhankanyi unyango abaye babelwe.

Uhlalutyo lweSatisati

Lonke uhlalutyo lwedatha oluphambili luya kwenziwa ngokungqinelana nesicwangciso sokumiselwa kwangaphambili; Lonke uhlalutyo luya kwenziwa kusetyenziswa isoftware ye-SAS (v. 9.2 Service Pack 4; SAS Institute Inc., Cary, NC, USA). Zonke iinkcukacha-manani ezichazayo kunye neemvavanyo zichazwe ngokungqinelana neengcebiso 'zokuphucula ubungakanani kunye nokucaca kophando lwezempilo' (EQUATOR) uthungelwano; okt, iindlela ezahlukeneyo zengxelo YOKUTHUTHA [46]. Idatha iya kuhlalutywa kusetyenziswa uhlalutyo lwezinto ezimbini ze-Covariance (ANCOVA), kunye neqela kunye nomba weSini, kusetyenziswa ixabiso elisisiseko njenge-covariate ukunciphisa ukwahluka okungahleliwe, kunye nokunyusa amandla ezobalo. Ngaphandle kokuba kuchazwe ngenye indlela, iziphumo ziya kubonakaliswa njengomahluko phakathi kweqela elithetha ngama-95% amaxesha okuzithemba (ii-CIs) kunye namaxabiso e-p ahambelana nawo, ngokusekwe kwinkqubo ye-General Linear Model (GLM). Lonke uhlalutyo luyakwenziwa kusetyenziswa i-Statistical Package yeeSayensi zeNtlalo (inguqulelo 19.0.0, IBM, e-USA) kunye nenkqubo ye-SAS (v. 9.2; SAS Institute Inc., Cary, NC, USA). Uhlalutyo lweendlela ezimbini zokwahluka (ANOVA) ngamanyathelo aphindaphindiweyo (Imodeli edibeneyo) iya kwenziwa ukuvavanya umahluko ngokuhamba kwexesha phakathi kongenelelo kunye namaqela olawulo; ukusebenzisana: Iqela Ixesha. Inqanaba le-alpha le-0.05 liya kuthathelwa ingqalelo njengobalulekileyo ngokweenkcukacha-manani (p <0.05, emacala amabini). Abahlalutyi beenkcukacha baya kuba yimfama kumangenelelo abelwe ukuhlalutya okuphambili.

Iziphumo eziphambili zeziphumo eziphambili nezesekondari ziya kusetyenziswa ukuthelekisa ulawulo kunye namaqela angenelelo. Uhlalutyo lwamanqaku luya kwenziwa ngokusekelwe kumgaqo-nkqubo wokunyanga, oko kukuthi izigulane ziya kuhlaziywa kwiqela leyeza apho bebelwe khona ngokulandelelana. Kuhlalutyo oluphambili, idata elahlekileyo iya kutshintshwa kunye ne-'Baseline Observation Carried Forward 'ubuchule, kunye nobuzwe obunobuninzi obuya kusebenza.

Okwesibini, ukubalisa iziphumo ekuthotyelweni, uhlalutyo lwe-'protocol 'luya kusetyenziswa ngokunjalo. Inani labantu 'ngeprotocol' kwizigulane 'zigqityile' ukungenelela apho zabiwe, ngokwemiqathango echazwe kwicandelo lokungenelela ngasentla.

Imilinganiselo yokuziphatha

Ikomiti yeSayensi yezoLungisa eSithili saseDenmark idlulise isifundo (S-20100069). Uphononongo oluhambelana neSibhengezo saseHelsinki 2008 [47] ngokuzalisekisa zonke iingcebiso eziphathekayo.

Bonke izifundo baya kufumana ulwazi malunga nenjongo kunye nomxholo weprojekthi kwaye banike imvume yabo yomlomo kunye ebhaliweyo ukuba bathathe inxaxheba, kunye nokukhupha ukuphuma kweprojekthi ngaliphi na ixesha.

UDkt Jimenez White Coat

Insight of Dr. Alex Jimenez

Ukulawula uxinzelelo, ukuxhalaba, ukuxinezeleka kunye neempawu zengxaki yokudandatheka kwengxaki, okanye i-PTSD, emva kokubandakanyeka engozini yemoto kunzima, ingakumbi ukuba eso siganeko sabangelwa ngumzimba kunye nokulimala okanye kwandisa imeko ekhoyo ngaphambili. Kwiimeko ezininzi, uxinzelelo lwengqondo kunye neengxaki zengqondo ezibangelwa sisiganeko sinokubangelwa yimpawu ezibuhlungu. E-El Paso, TX, amaninzi amanqwelana kunye ne-PTSD etyelele kwiklinikhi yam emva kokubonakalisa iimpawu ezimbi kunobungozi bokudalwa kwengozi yangaphambili. Ukhathalelo lwe-Chiropractic lunokunika izigulane ukuphathwa koxinzelelo olufanelekileyo olufunekayo ukuphucula iimpawu zabo zomzimba neemvakalelo. Ukunyamekela kwe-Chiropractic kungaphatha iindlela ezahlukeneyo zokulimala kwengozi, kuquka ne-whiplash, ukulimala kwentloko nentamo, i-disni heritiated kunye nokulimala kwangemva.

ingxoxo

Olu pho nonongo luya kunceda ekuqondeni okungcono ukunyanga izigulane ezinentlungu engapheliyo kwentamo emva kwengozi ye-whiplash. Ulwazi olukule sifundo lunokusetyenziswa kwiinkqubo zonyango, njengoko isifundo sisekelwe kwinkqubo ye-multimodal, ebonisa indlela, nangona kungabikho kobubungqina obukhoyo, ngokuqhelekileyo kusetyenziswa kwisimo se-physiotherapy. Uphononongo lungabandakanywa nokuphononongwa ngokuchanekileyo oko kukuncedisa ukuhlaziya ulwazi malunga nala manani kunye nokuphucula unyango olusisekelwe kubungqina.

Ukushicilela uyilo lwesifundo ngaphambi kokuba kwenziwe isifundo kwaye iziphumo ezifumanekayo zinemivuzo emininzi. Ivumela uyilo ukuba lugqitywe ngaphandle kokuba luthonyelwe ziziphumo. Oku kunokukunceda ekuthintela ukunyaniseka njengoko ukuphambuka kwi-design yasekuqaleni kuchongwa. Ezinye iiprojekti zophando ziya kuba nethuba lokulandela indlela efanayo ngokubhekiselele kubemi, ukungenelela, ukulawula kunye nemilinganiselo yesiphumo. Imingeni yesi sifundo ihambelana nokuqulunqwa kwamanyathelo angenelelo, ukunyanga abantu abangaqhelekanga, ukucacisa nokubeka imilinganiselo yemigangatho echaphazelekayo ebantwini abaneempawu ezihlala ixesha elide kunye nokuba nesibalo esivela kwizicwangciso ezimbini zeeklinikhi ezahlukeneyo. Ukumiselwa kwamanyathelo athatyathwa ngokufundisa abachaphazelekayo be-physiotherapists kwiklasi yokufundisa. Ubuninzi bobuhlali buya kuthathwa ngokubaluleka ngokungqongqo kunye neendlela zokungabandakanywa kunye nokubeka esweni impawu ezisisiseko zezigulane, kunye nokwahlukana phakathi kwamaqela ngokubhekiselele kwezinye iimpembelelo kunokungenelela / ukulawula kuya kubakho ukuhlalutya izibalo. Olu lwakhiwo lophando luyilwe njengesakhiwo 'sokongezwa': zombini amaqela athola imfundo yentlungu; iqela lokungenelela lifumana uqeqesho olongezelelweyo lomzimba, kubandakanywa ukusetyenziswa kwemisamo ethile kunye nokuqeqesha ngokubanzi. Namhlanje kukho ubungqina obaneleyo malunga nomphumo wonyango kwizigulane ezinentlungu engapheliyo entanyeni emva kwengozi ye-whiplash. Zonke izigulane ezithatha inxaxheba ziya kubhekiselwa kunyango (ukulawula okanye ukungenelela), njengoko sicinga ukuba ayikho indlela yokuziphatha ukuze singanikezeli uhlobo lonyango, okt randomising group control to list list. Ukwakhiwa kwe-add-on kukhethwa njengesisombululo esisebenzayo kwisimo [48].

Kwizigulana ze-whiplash ezineentlungu ezingapheliyo, ezona ndlela zokuphendula zikhubazekileyo (kwisigulana ngasinye, hayi kwiqela xa lilonke) zithathwa njengeSigulana esiSebenzayo esiSebenzayo kunye nenqanaba lokulinganisa inani leentlungu ezikhathazayo [49]. Ngokusebenzisa ezi kunye ne-NDI (eyona nto isetyenziswa rhoqo ekukhubazekeni intamo) njengemilinganiselo yesiphumo sesibini, kulindeleke ukuba utshintsho olunxulumene nesigulana kwiintlungu kunye nokukhubazeka lungavavanywa. Abemi baya kugaywa kwaye baphathwe ngeendlela ezimbini ezahlukeneyo zeklinikhi: iklinikhi yokunyanga ngaphandle ye-The Spine Centre, isibhedlele iLilleb lt kunye neeklinikhi ezininzi zabucala ze-physiotherapy. Ukuthintela nayiphi na impembelelo kuseto olwahlukileyo kwimilinganiselo yesiphumo, abemi baya kubhlokelwa ngokungacwangciswanga okunxulumene noseto, bakhusele ukuhanjiswa ngokulinganayo kwabathathi-nxaxheba kwiseti nganye ukuya kumaqela amabini ongenelelo.

Ukugqithisa inzala

Ababhali bavakalisa ukuba abanalo inxaxheba.

Imirhumo yabalobi

IRH yalungisa le mibhalo. I-IRH, i-BJK kunye ne-KS ithathe inxaxheba kwiplani yesifundo. Yonke inxaxheba ekuyilo. RC, IRH; I-BJK kunye ne-KS bathathe inxaxheba kumandla kunye nokulinganisa ubungakanani besampula kunye nokuchaza uhlalutyo lwamanani kunye nokwabiwa kwenkqubo kunye neenkqubo zokurhweba. Bonke abalobi bafunde kwaye bavumile umbhalo wesigqi wokugqibela. USuzanne Capell unike uncedo lokubhala kunye nokulungiswa kweelwimi.

Imbali yokuPasa

Umlando wokupapashwa kwangaphambili kweli phepha unokufumaneka apha: www.biomedcentral.com/1471-2474/12/274/prepub

Imibulelo

Olu phofu lufumene inkxaso-mali kwi-Fund Fund yaseDenmark yaseDenmark, i-Danish Rheumatism Association, iSiseko soPhando se-Danish Association of Physiotherapy, i-Fund yePhysiotherapy kwi-Private Practice, kunye ne-Danish Society of Polio kunye ne-Accident Victims (PTU). ). I-Unit ye-Musculoskeletal Statistics kwi-Parker Institute ixhaswa zizibonelelo ezivela kwi-Oak Foundation. USuzanne Capell unike uncedo lokubhala kunye nokulungiswa kweelwimi.

Ulingo lubhalisiwe kuyo Ukhathalelo lweeKlinikhi.gov isazisi NCT01431261.

Uvavanyo oluLungeleleneyo oluLungisiweyo lweChnitive-Behavioral Treatment for the Treatment of PTSD kumxholo weWiflash engapheliyo

Abstract

iinjongo

Izifo ezinxulumene neWiflash (i-WAD) ziqhelekileyo kwaye zibandakanya ukukhubazeka ngokomzimba nangokwengqondo. Uphando lubonisile ukuba iimpawu zokunyamezela emva kokuhamba kwengqondo zihambelana neziphumo eziphuculweyo zokuphucula kunye neziphumo zonyango. I-traum-focal-cognitive-behavioral therapy (TF-CBT) ibonise ukusebenza ngokulinganayo kwiisampuli zentlungu ezingapheliyo. Nangona kunjalo, kuze kube yimhla, akubangakho iimvavanyo zekliniki ngaphakathi kwe-WAD. Ngaloo ndlela, esi sifundo siya kubika malunga nokusebenza kwe-TF-CBT kubantu abajongene nemigangatho ye-WAD engapheliyo kunye ne-posttraumatic disorder disorder (PTSD).

indlela yokwenza

Abafundi abangamashumi amabini anesithandathu bebanjelwe ngokukhawuleza kwi-TF-CBT okanye ulawulo lokulinda, kunye nemiphumo yonyango yahlolwa kwi-posttreatment kunye ne-6-inyanga yokulandelelwano ngokusebenzisa i-interview interview klinikhi, imibuzo yokuphendula ingxelo, kunye nemilinganiselo yokunyuka kweengqondo kunye neentlungu bundu.

iziphumo

Ukunciphisa kweempawu ezibonakalayo kwiimpawu ze-PTSD zifunyenwe kwiqela le-TF-CBT xa kuthelekiswa noluhlu lwabalindelwe kwi-postassessment, kunye neenzuzo ezongezelelweyo eziphawulwe ekulandeleni. Ukunyangwa kwe-PTSD kwadibaniswa kunye nokuphuculwa kweempawu zentlalo ekukhubazekeni kwentamo, ngokomzimba, emoyeni, nakwizenhlalakahle kunye nokusebenza komzimba kwiimeko ezixinzelelekileyo, ngoxa utshintsho oluncinci lufunyenwe kwiintlungu zentlungu.

ingxoxo

Olu pho nonongo lunikeza inkxaso yokusebenza kwe-TF-CBT ukujolisa iimpawu ze-PTSD kwi-WAD engapheliyo. Ukufumanisa ukuba unyango lwe-PTSD lubangele ukuphuculwa kokukhubazeka kwentamo kunye nomgangatho wobomi kunye noshintsho kwimimandla ebandayo yobunzima bugqamisa indlela edibeneyo kunye neendlela ezihambelanayo eziphantsi kwe-WAD kunye ne-PTSD. Iziphumo zonyango zezinto ezifunyenweyo kunye nezikhokelo zophando ezizayo zixutyushwa.

Ukuququmbela, ukubandakanyeka engozini yemoto yimeko engathandekiyo enokubangela iintlobo ezahlukahlukeneyo zokubandezeleka okanye ukulimala kunye nokukhokelela ekuphuhlisweni kweemeko ezihlaselayo. Nangona kunjalo, uxinzelelo, ukuxhalaba, ukuxinezeleka kunye nesifo sengxaki yokuxinwa kwengxaki, okanye i-PTSD, iimeko eziqhelekileyo zengqondo ezingenzeka ngenxa yengozi yemoto. Ngokweziphumo zophando, iimpawu zomzimba kunye noxinzelelo lwengqondo ezinokubambisana kunye nokunyanga kokuzilimaza ngokwasemzimbeni nangokomzwelo kunokunceda izigulane zifikelele kwimpilo kunye nokuphila kakuhle. Ulwazi oluchazwe kwiziko leSizwe loLwazi lweBiotechnology (NCBI). Ubungakanani beenkcukacha zethu zikhawulelwe kwi-chiropractic kunye nokulimala kwemigudu kunye nemeko. Ukuxoxa ngesihloko, nceda ukhululeke ukucela uDkt Jimenez okanye uqhagamshelane nathi 915-850-0900 .

Ikhutshwe nguDkt. Alex Jimenez

Imixholo eyongezelelweyo: Ubunzima bokubuyisela

Ngokwezibalo, malunga ne-80% yabantu baya kuba neempawu zentlungu emva koko kanye ngexesha lokuphila kwabo. Umqolo obuhlungu isikhalazo esiqhelekileyo esinokubangelwa ngenxa yeemeko ezahlukeneyo kunye / okanye iimeko. Ngokuphindaphindiweyo amaxesha, ukuguqulwa kwemvelo komgudu kunye nomdala kunokubangela intlungu emva. Iidiski zeHerniated kwenzeka xa i-disc, i-gel-like centre ye-disc intervertebral iqhubezela ngeengqungquthela kwijikelezo zayo zangaphandle, ukuxilisa nokucaphukisa izimpande zentliziyo. Iingxoxo ze-Disc zivame ukuqhutyelwa kwi-back back, okanye i-lumbar spine, kodwa nazo zingenzeka kunye nomlenze womlomo wesibeleko okanye intamo. Ukufakelwa kwamathambo afunyenwe kwinqanaba eliphantsi ngenxa yokulimala kunye / okanye imeko ehlaseleyo ingakhokelela kwimpawu ze-sciatica.

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

Ucaphulo

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Vala i-Accordion

Ukungenelela kweengxaki zokuKhuseleko kweZingozi ze-Auto Accident e-El Paso, TX

by iicrosoft | Umqolo obuhlungu, Chiropractic, entanyeni Pain, Ukubuyiswa komzimba, Uvavanyo oluLungeleleneyo oluLungisiweyo, istres, Unyango

Xa uye wabandakanyeka ungquzulwano lwemoto, ukulimala kwengozi ngenxa yeso siganeko akunakho ukuhlala kubangelwa ngumzimba. Uxinzelelo lwengqondo ngenxa yengozi okanye ukulimala kwimpembelelo yengozi yemoto inokuba yinto eninzi kakhulu, inokukhokelela kwiintlobo ezininzi zeempawu ezibuhlungu. Ukuba olo xinzelelo aluphathwa ngokukhawuleza, lunokubangela ukuphuhliswa kweemeko zengqondo. Ukuxinezeleka, ukuxhalaba, ukuxinezeleka kunye neemeko ezinzima, i-PTSD, okanye i-post stress traumatic disorder, ezinye zezinto eziqhelekileyo zengqondo ongaphetha ukuhlangabezana nazo emva kwengozi yemoto.

Ukuxhalabisa kunye noyiko olubi

Kwiimeko ezininzi, ixhoba lengozi yemoto inokuhlakulela uloyiko olungenangqondo ngenxa yeso siganeko. Njengokuba kunjalo, uninzi lwaba bantu baxela ukuba banamaxhala malunga nokubuyela emva kwevili kwakhona. Kubo, uloyiko lokuba kwenye ingozi lunokubangela ukuba baphephe ukuqhuba ngokupheleleyo. Abanye abantu abaninzi nangoku, uloyiko olungenangqondo lokuhlaselwa kukuphakuzela ngelixa usendleleni inokuba ngunobangela wokuba bathintele ukuqhuba ngokupheleleyo. Ukuba unxunguphalo kunye noloyiko olungenangqondo olubangelwa kukudakumba ngokweemvakalelo kwengozi yemoto luba mandundu, inokumenza umntu angaqhubeki eqhuba kwakhona.

ukudakumba

Kwakhona kunokwenzeka ukuba abantu abaye babandakanyeka engozini yemoto ukuphuhlisa uxinzelelo emva kwesi siganeko. Ekugqibeleni, uvuselela ukukhathazeka kwengqondo ngenxa yexinzelelo lomzimba. Kukho iimpawu ezininzi zokudakumba oza kuzibona ngokulula. Ezi ziquka iingxaki zokulala, ukulahlekelwa ngumdla kunye neentloko. Njengoko kuya kuba nzima, kunjalo, unokuphela ukuziva uhlungu okanye ungenathemba lonke ixesha, oku kunokubangela ukuba kubekho iimpawu ezimbi.

I-Post Traumatic Distress Disorder (PTSD)

Kunokwenzeka kakhulu kubantu abathintekayo kwingozi yemoto ukuba bahlupheke ngenxa yokugula kwengxaki yokuxinzelela, okanye i-PTSD. Ngokutsho kweZiko leSizwe le-PTSD, ubuninzi beepesenti ze-9 zabantu abafumana ukulimala kweengozi zengozi baqukumbela kwi-PTSD. Ukongezelela, ubuncinane i-14 ekhulwini labasindileyo bemoto abafuna ukunyamekela ngempilo yengqondo bafumana i-PTSD.

Uphando oluphando olutsha lubonise ukuba ukungenelela kwengqondo kunokuba kubalulekile kwimpilo yakho njengonyango lwenkcubeko, ingakumbi ukuba unesifo sengxaki yokukhathazeka, okanye iPTSD. Abaphandi baye babonisa ukuba ukunakekelwa kwe-chiropractic kunokukhokelela ekuqhubekeni okukhulu kwimeko yengqondo yomzimba yesigulane sempilo kunye nokuphila kakuhle.

Ukhathalelo lweChiropractic ngokuKhuseleko kweZingozi zeMoto

Ukujongana nokulimala kwengozi yemoto, njenge-whiplash, nto leyo eyenza ukuxhalaba nokukhathazeka, ukungakhathazeki kunye ne-PTSD ngokukhethekileyo, ifuna icebo elizininzi. I-Chiropractic yindlela yokwenza unyango olongezelelweyo ejolise kukulimala kunye / okanye iimeko ze-musculoskelet and systemous nervous system. I-chiropractor isebenzisa ngokubanzi ukulungiswa kwemigudu kunye neendlela zokuphatha ngokuchanekileyo ukulungisa ngokugqithiseleyo ukuphazamiseka kwemigulane, okanye ukuhluthwa, okungabangela intlungu kunye nokuphazamiseka. Ngokukhulula uxinzelelo kunye nokuxhatshazwa kwemisipha, ugqirha we-chiropractic, okanye i-chiropractor, unokuncedisa ukunciphisa uxinzelelo noxinzelelo lwengqondo olungabangela ukukhathazeka komntu, ukwesaba okungenangqondo, ukudandatheka kunye ne-PTSD. Ukuba kukho olunye uncedo olufunekayo, i-chiropractor ingancomela izigulane kwizonyango zononophelo olungcono kakhulu ukunceda ngeempawu zabo. Injongo yale nqaku ilandelayo kukubonisa ukuxhaphaka kwe-PTSD kubantu abachaphazelekayo ukugqitywa kwezithuthi kwakunye nokubonisa indlela ukungenelela kwengqondo ekugqibeleni kunokunceda ukuphucula kunye nokulawula iimpawu zokuxinwa kwabantu abanokuziva emva kokuphazamiseka kwemoto.

Ukubikezelwa kweNgxaki yokuPhathwa kwengxaki yokuPhathwa kweNgxaki ngokuPhenduka ngokukhawuleza kwi-Trauma.

Abstract

Izingozi zezithuthi zithuthi zihlala zibangele i-sequelae emzimbeni nangokwengqondo. Iingcali zeengcali ezahlukeneyo zonyango zibandakanyeka kunyango lwamaxhoba angozi. Akukho nto eyaziwayo malunga nezinto ezinokuthi ziqikelele ukuphazamiseka kwengqondo, umz. I-Posttraumatic Stress Disorder (PTSD) emva kweengozi kunye nendlela iingxaki zengqondo zithinta ngayo unyango. Kwi-179 ekufundwayo ekukhethiweyo, abaye bavunywa ngengozi yezithuthi zengxowankulu baye bavavanywa iintsuku ezimbalwa emva kwengozi yokuxilongwa ngengqondo, ubunzima bokulimala kunye ne-psychopathology. Bonke babezonyango kwaye kwafuneka baphathwe ngenxa yokuphulwa kwethambo. Kwi-6-iinyanga zokuvavanya ukuvavanya i-152 (85%) yezigulane zaphinda zaxoxwa kwakhona. Kwizigulane, i-18.4% yazalisekisa imigaqo ye-Posttraumatic Stress Disorder (DSM-III-R) kwiinyanga ze-6 emva kwengozi. Izigulane ezenza i-PTSD zalimala ngakumbi kwaye zibonisa iimpawu ezininzi zokuxhalaba, ukuxinezeleka kunye ne-PTSD iintsuku ezimbalwa emva kwengozi kunezigulane ezingenasifo sengqondo. Abagulane nePTSD bahlala ixesha elide esibhedlele kunezinye izigulane. Uhlalutyo oluninzi lokuguqulwa kwembonakaliso luye lwabonisa ukuba ubude bokubhedlelelwa esibhedlele kubangelwa ikakhulu kwizinto ezahlukahlukeneyo ezifana nokukhawuleza kokulimala, ubunzima beengozi, ubuntu obusesikweni kunye ne-psychopathology. I-posttraumatic stress disorder iqhelekile emva kweengozi zezithuthi. Izigulane ngePTSD ekulandelelweni zingabonwa yizinto ezifunyanwe ukuvavanywa kwangaphambili. Ukungathandabuzeki kwe-psychological sequelae efana ne-PTSD kubangela ukuhlala esibhedlele ixesha elide kwaye ngenxa yoko kuneendleko ezingaphezulu kunezigulane ezingekho kwi-PTSD.

Ulwaphulo-olujoliswe kwiCandelo lokuThatha ukuChepha kweZenzo kunye nokuSebenza kwe-Whiplash engapheliyo: Iprotocol ye-Trimmed Controled Trial

Abstract

Intshayelelo: Ngenxa yesigxina somgwaqo, intlungu eqhubekayo kunye nokukhubazeka emva kokulimala kwe-whiplash ziqhelekileyo kwaye zenze iindleko ezinkulu zomntu kunye nezoqoqosho. Ukufikelela kwi-50% yabantu abafumana inxeba ye-whiplash abayi kuphinda bafumane ngokuzeleyo baze bafike kwi-30% baya kuhlala bekhatywe ngokukhawuleza kwimeko. Isizathu sokuba kutheni iimpawu eziqhubekayo ezidlulileyo kwisigaba esicacileyo kwaye zihlala zingapheliyo, kodwa mhlawumbi ziphumo ezivela kumanyathelo ahlukeneyo phakathi kokulimala kwesakhiwo, ukukhubazeka ngokomzimba, kunye neengqondo zengqondo nezengqondo. Izimpendulo zengqondo zihambelana nesiganeko esibuhlungu ngokwazo ziba yinto ebonakalayo ebonakalayo kwimeko ye-whiplash. Nangona kukho ukuqonda, kunolwazi olunqongophele malunga nokusebenza kweengongenelelo zengqondo, ngokukhutshwa yodwa okanye ngokudibanisa ne-physiotherapy, ekunciphiseni izimo zengqondo zengqondo kunye nezobuhlungu ezichaphazelekayo. Iziphumo zophononongo zophando zibonise iziphumo ezintle zokusetyenziswa kweengxaki zengqondo zengqondo yokugulisa ingqondo, ukukhathazeka nokukhubazeka kubantu abane-whiplash engapheliyo. Iziphumo zibonise ukuba indlela edibeneyo ayikwazanga ukunciphisa kuphela iimpawu zengqondo, kodwa intlungu kunye nokukhubazeka.
Iinjongo: Injongo ephambili yale nzingo elawulwayo ngokungapheliyo, kukuhlola uphando lwe-cognitive cognitive-tractatic disorder (PTSD), ekhutshwe yi-psychologist, kunye ne-physiotherapy ukuzivocavoca ukunciphisa intlungu kunye nokukhubazeka kwabantu abaneenkathazo ezingapheliyo kunye ne-post-traumatic disorder disorder (PTSD) . Ulingo lujolise ekuphandeni ukusebenza kwonyango oludibeneyo ekunciphiseni iimpawu zokuxinzelela emva kokukhathazeka, ukuxhalaba nokuxinezeleka.
Abathathi-nxaxheba noCwangciso: Inani elipheleleyo labathathi-nxaxheba abangama-108 abanesifo esinganyangekiyo esihambelana ne-whiplash (WAD) kwibanga II le> 3 iinyanga kunye <iminyaka emi-5 kunye ne-PTSD (efunyaniswe ne-Clinic Administrated PTSD Scale (CAPS) ngokwe-DSM-5) ukufunda. Abathathi-nxaxheba baya kuvavanywa ngokuhlolwa kweefowuni nangobuqu kwilebhu yophando yaseyunivesithi. Ungenelelo luya kwenzeka kumazantsi mpuma eQueensland, eOstreliya nakumazantsi eDenmark.
Ungenelelo: Iingcali zengqondo ziya kukhutshwa kanye ngeveki kwiiveki ze-10, kunye nabathathi-nxaxheba abaye banikezelwa ngokukhawuleza kwiprogram yokuziphatha kwengqondo okanye ukunyango oluxhasayo, bobabini bakhululwa yikliniki yeengqondo. Abathathi-nxaxheba baya kufumana iiseshoni ezilishumi zobugcisa-based based physiotherapy ukuqhutywa kwithuba leveki le-6.
Imilinganiselo yesiPhumo: Isiphumo esiphambili siphumo ukukhubazeka kwentamo (Inkcazo yokukhubazeka kweNeck). Iziphumo eziPhezulu zijolise kuyo: ubukhulu bentlungu; Ubukho kunye nobunzima be-PTSD (i-CAPS V kunye ne-PTSD Uluhlu lwe-5); uxinzelelo lweengqondo (ukuxinezeleka, ukuxinezeleka koxinzelelo lwe-21); ukusebenza komonde (SF-12, Tampa Scale of Kinesiophobia, kunye ne-Patient-Specific Functional Scale); kunye neentlungu ezizenzekelayo kunye neentlekele (Inkqubo yokuPhepha kweNkqubo yokuPhucula ubuNtu kunye noPhulo lweNkathazo yokuPhepha). Emva kweengqondo ze-psychotherapy (iiveki ze-10 emva kwe-randomisation) kunye ne-physiotherapy (iiveki ze-16 emva kwe-randomisation), kunye ne-6-inyanga kunye ne-12-inyanga yokulandela, umhloli oyimfama uya kulinganisa iziphumo.
Uhlalutyo: Konke ukuhlalutya kuya kwenziwa ngokusesikweni sokunyanga. Iziphumo eziphambili neziphambili ezilinganiswayo ziya kuhlaziywa zisebenzisa imizekelo yokuhlukumeza okuxubileyo kunye nemigangatho. Naliphi na umphumo wesayithi (i-Australia okanye iDenmark) iya kuhlolwa ngokuquka i-time-by-treatment-time-interaction term in the models of mixing. Ukuguqulwa kwesiphumo kuya kuhlolwa kuphela kwisiphumo esiphambili se-Index ye-Disability Disability Index.
Ingxoxo: Olu pho nonongo luya kunika uvavanyo oluchanekileyo lwemiphumo yokufaka ulwaphulo olujoliswe kwingxaki yokuziphatha kwengqondo kwi-physiotherapy umzimba kubantu abane-WAD engapheliyo kunye ne-PTSD. Olu phofu lunokuchaphazela ukulawulwa kweklinikhi yenzakalo ye-whiplash kwaye iya kuba neklinikhi yokusebenza ngokukhawuleza e-Australia, eDenmark kunye noluntu olubanzi lwamazwe ngamazwe. Uphononongo luya kuba nefuthe kubo bobabini bezempilo kunye ne-inshorensi yomgaqo-nkqubo kwizigqibo zabo malunga nokukhetha unyango kunye nenkxaso-mali.

intshayelelo

Intlungu eqhubekayo kunye nokukhubazeka emva kokulimala kwe-whiplash ngenxa ye-traffic accident (RTC) eqhelekileyo kwaye ivelise iindleko ezinkulu zomntu kunye nezoqoqosho. Ukufikelela kwi-50% yabantu abafumana inzakalo ye-whiplash abayi kuphinda bafumane ngokuzeleyo baze bafike kwi-30% baya kuhlala bemodare ukukhubazeka kakhulu ngemeko [1-3]. Ingqalelo encinane yimiba yempilo yengqondo ehamba nale meko. Ubuninzi beengxaki zengqondo kuboniswe ukuba yi-25% ye-PTSD, i-31% yeNgqungquthela enkulu yoxinzelelo kunye ne-20% ye-General Distress Concerning Disorder [4-6]. I-akhawunti ye-Whiplash yokonzakala ngobuninzi babo nawaphi na amabango angenisweyo kunye neendleko ezinkulu ezithe zenziwa kwiQumrhu lika-Queensland lenkampani yesithathu eyanyanzelekileyo [7]. E-Australia, ukulimala kwe-Whiplash kubandakanya malunga ne-75% yazo yonke inokulimala ye-RTC [8] ngeendleko ezipheleleyo ezingaphezu kwe-$ 950 M ngonyaka (9], ezidlula iindleko zombini womgudu kunye nokulimala kwengqondo ebuhlungu [7]. EDenmark, i-whiplash ixabisa i-300 yezigidi ze-USD ngonyaka xa ukulahleka komsebenzi kufakwe [10].

Intlungu yesikhumba iyimpawu ezikhawulayo zabanye abalandela ukulimala kwe-whiplash. Ngoku kwamkelwa ngokuqhelekileyo ukuba kukho ukulimala kokuqala komnxeba omnye entanyeni entanyeni [11] nangona isakhiwo esithile esilimazile kwizigulane ngabanye kunzima ukuchonga kwiinkqubo zamagcisa zamanje. Isizathu sokuba kutheni iimpawu eziqhubekayo ezidlulileyo kwisigxina esisigxina kwaye zihlala zingapheliyo zicaca kodwa ziphumo zivela kwiintsebenziswano eziyinkimbinkimbi phakathi kokulimala kwesakhiwo, ukukhubazeka ngokomzimba, izinto zengqondo kunye neengqondo [12]. Nangona kunjalo kuyacaca ukuba i-WAD engapheliyo yimeko engapheliyo kunye neyinkimbinkimbi ebandakanya ukukhubazeka okungokwenyama, njengokulahleka kwentshukumo, ukuphazamiseka kwindlela yokuhamba kunye nokuphazamiseka kwengqondo [13] kwakunye neentlungu ezinxulumene nengqondo ezinjengezokuphazamiseka [14, 15], isixhosa [16] , ukukhusela umsebenzi kunye nokuzinyameka kolawulo lweentlungu [17]. Ukongezelela uphando olutshanje luye lwabonisa ukuba iimpawu zoxinzelelo zengcinezelo okanye uxinzelelo oluneemeko ziqhelekileyo [18-20]. Ngaloo ndlela kuya kubonakala kunengqiqo ukuba ukungenelela okujoliswe kokubonakalayo ngokomzimba nangokwengqondo kwimeko ye-whiplash kuya kuba yinzuzo.

Ngokuchasene neemeko ezininzi eziqhelekileyo zeentlungu ze-musculoskeletal (umz. Iimpendulo zengqondo ezinxulumene nesiganeko esibuhlungu ngokwaso, iimpawu zoxinzelelo lwasemva koxinzelelo, ziyavela njengezinto ezibalulekileyo ezongeziweyo zengqondo kwimeko ye-whiplash. Idatha yamva nje ibonisa ukuba iimpawu zoxinzelelo lwasemva koxinzelelo zixhaphakile kubantu abaye bafumana ukulimala kwe-whiplash emva kweengozi zemoto [18, 20, 21]. Ubukho bokuqala beempawu zoxinzelelo lwasemva koxinzelelo kubonisiwe ukuba bunxulunyaniswa nokubuyiswa kokusebenza okungalunganga kokulimala [13, 18]. Idatha yamva nje esuka kwilabhoratri yethu ibonakalisile ukuba kulandela ukulimala kwe-whiplash i-17% yabantu iya kulandela umkhondo weempawu zokuqala zoxinzelelo / ezinzima zesttraumatic eziqhubeka ubuncinci iinyanga ze-12 kunye ne-43% ziya kulandela umkhondo weempawu zokuqala eziphakathi ezinciphileyo kodwa zihlala ubuncinci ukuya kumodareyitha (amanqanaba enklinikhi) amanqanaba ubuncinci iinyanga ezili-12 (ubude besifundo) [4]. Jonga uMzobo 1. La manani abalulekile njengoko ayafana nokuxhaphaka kwe-PTSD kubantu abangeniswe esibhedlele kulandela ukonzakala Okubi kakhulu kwemoto [22].

Idatha ye-1 Idatha esuka kwi-Whiplash Abangenayo abachaphazelekayo

Umzobo 1: Idatha evela kwi-155 whiplash yabathathi-nxaxheba abonzakeleyo abalinganiswa kwi-1, 3, 6 & 12 inyanga emva kwengozi. I-Posttraumatic Stress Diagnostic Scale (PDS) yalinganiswa ngexesha ngalinye. Imodeli esekwe kwindlela esekwe kwinqanaba elichongiweyo 3 yeendlela zeklinikhi (trajectories). 1. Ukunganyangeki okungapheliyo / okunzima (17%) 2. Ukufumana kwakhona: amanqanaba okuqala aphakathi koxinzelelo lwasemva koxinzelelo ancipha ukuya kumanqanaba aphakathi / aphakathi. 3. Ukunyamezela: iimpawu ezingenanto kwi2. Amanqaku eempawu zePDS asikiweyo: 1 10 mnene, 11 20 ngokulinganayo, 21 35.

Nangona i-WAD engapheliyo yinkinga yempilo ebonakalayo inani lezilingo ezishicilelwe ngokungahleliwe (RCTs) lilinganiselwe [23]. Ukuphononongwa ngokuchanekileyo kwenkqubo kugqityiwe ukuba kukho ubungqina bokuba iinkqubo zokuzilolonga zisebenza ngokuthobekileyo ekunciphiseni iintlungu ezinxulumene ne-whiplash, ubuncinci kwixesha elifutshane [23]. Umzekelo, uStewart et al [24] ubonise inqaku le-2 kuphela (kwisikali se-10) kuncipha kumanqanaba entlungu kwangoko emva kweeveki ezi-6 zongenelelo ngononophelo olusebenzayo olunamathele kwiinqununu ze-CBT ezinxulumene nentlungu kodwa kungabikho ziphumo zibalulekileyo Ukulandelwa kwexesha elide kweenyanga ezi-6 ne-12. Kwi-RCT yokuqala eqhutyelwe kwilabhoratri yethu (epapashwe kwi-2007), indlela ethe kratya yokuzivocavoca intamo nayo yahambisa kuphela iimpembelelo, kuba iintlungu kunye namanqaku okukhubazeka ancipha ngamanani afanelekileyo ekliniki (8 14% kwi-Neck Index Index) xa xa kuthelekiswa neseshoni enye yengcebiso [25].

Ukuphononongwa ngokuchanekileyo kwanokugqitywa ukuba kukho ubungqina obuphikisanayo malunga nokusebenza kweengongenelelo zengqondo ezithunyelwa yedwa okanye ngokudibanisa ne-physiotherapy [23]. Izifundo ezibandakanyiweyo ekuhlaziyweni zazingumgangatho ogqithisileyo kwaye zisetyenziswa kakhulu kwi-CBT kwindlela ethile ukujongana neengxabano ezinxulumene nobuhlungu kunye noxinzelelo [26, 27]. Akukho zifundo ezijoliswe ngqo kwiimpawu ze-PTSD.

Yiyo loo nto isindululo esibonakala sisengqiqweni songenelelo ekujoliseni imeko yengqondo kunye neentlungu ezinxulumene ne-WAD engapheliyo ayisebenzi njengoko bekulindelekile. Olu lindelo lusekwe kwiziphumo ezilungileyo ngakumbi ngeendlela ezinjalo kwezinye iimeko zentlungu yesisculoskeletal ezifana ne-back back [28].

Kwimizamo yokuqonda ukuba kutheni iindlela zokuzivocavoca zingasebenzi kakuhle kwi-WAD engapheliyo, sithathe i-NHMRC (570884) yezilingo ezilawulwa ngokungekho mthethweni ezibandakanya ukuguqulwa kweempawu ze-PTSD kunye nokuphazamiseka kwemizwa. Kolu lukhulu (n = 186) luvavanyo oluninzi, uhlalutyo lokuqala lubonisa ukuba kuphela iipesenti ezingama-30 zezigulana ezine-WAD ezingapheliyo kunye nokuchongwa kwe-PTSD ezinotshintsho olufanelekileyo lwezonyango kwiNeck Disability Index amanqaku (> 10% yotshintsho) xa kuthelekiswa ne-70% yezigulana ze-WAD ngaphandle kwe-PTSD kulandela inkqubo yokubuyisela kwimeko yesiqhelo. Bonke kubandakanya abathathi-nxaxheba baxela amanqanaba aphakathi okanye aphezulu entlungu kunye nokukhubazeka okubonisa ukuba ubukho bokubambisana kwe-PTSD kuthintela impendulo elungileyo kulungiso lomzimba. Asinakufumana siphumo sokuguqula naluphi na utshintsho lweemvakalelo. Iziphumo zolu phononongo zisikhokelela ekubeni siphakamise ukuba ukunyanga i-PTSD kuqala kwaye emva koko kumiselwe ukubuyisela kwimeko yesiqhelo umzimba kuya kuba ngongenelelo olusebenzayo ukuphucula iziphumo zempilo ye-WAD engapheliyo.

I-CBT egxininiswe ngolu hlobo yonyango olusebenza kakuhle kwiimpawu ze-PTSD [i-29] kunye nezikhokelo ze-Australia zonyango lwe-Stress Disorder Disorder kunye ne-PTSD icebisa ukuba i-CBT enokuxhatshazwa ngabanye kufuneka ibonelelwe ngabantu abanezimo [30]. Kukho idatha efumanekayo ukubonisa ukuba i-CBT egxininiswe ngengozi inokuthi ibe nefuthe kungekhona kwiimpawu ze-PTSD kodwa nakwiintlungu nokukhubazeka. Iziphumo zoviwo olusandul 'uvavanyo lwangoku zihlolisise ubudlelwane obunxulumene phakathi kwe-PTSD kunye nentlungu engapheliyo kwi-323 abasinde kwizingozi [31]. Iziphumo zibonise ukugcinwa ngokubandezeleka kweentlungu ezinzima kunye neempawu zoxinzelelo ezingemva kwe-5 emva kokulimala kwithuba emva kweenyanga eziyi-6 ukulimala kwithuba (ingxaki engapheliyo), iimpawu ze-PTSD zichaphazeleke kakhulu kwiintlungu kodwa kungekudala. Nangona esi sifundo asizange sigxininise ngokukodwa kwi-whiplash ukwenzakala, sibonelela ukuba ukujongana neempawu ze-PTSD kwisigaba esingapheliyo se-WAD kunokuvumela ukuba kunciphise amanqanaba entlungu ngaleyo ndlela kuququzelele iimpembelelo ezinokuba zibuhlungu / ukukhubazeka ezijoliswe kubaphathi ezifana nokuzilolonga kunye ne-CBT ejoliswe entlungu.

Ngokusekelwe kwiziphumo zethu zokubambisana kwe-PTSD kunye ne-WAD, senze isifundo esincinci sokuqhubela phambili ngenjongo yokuvavanya imiphumo ye-CBT ejoliswe ngengozi kwiimeko zengqondo, intlungu kunye nokukhubazeka kubantu abane-WAD engapheliyo [32]. Abafundi abangamashumi amabini anesithandathu abane-WAD abangapheliyo kunye nokuxilongwa kwe-PTSD babethelwe ngoncedo unyango (n = 13) okanye akukho-Intervention (n = 13). Iqela lonyango lenze iiseshini ze-10 zeveki zengxowankulu ye-CBT ye-PTSD. Ukuvavanywa kwe-PTSD ukuxilongwa, iimpawu zeengqondo, ukukhubazeka, kunye neempawu zentlungu zenziwe kwinqanaba lokuqala kunye nokuvavanywa (emva kweeveki ze-10-12). Ukulandela ukungenelela kwonyango, kwakungekho nje ukunciphisa okuphawulekayo kwiimpawu zengqondo (ubunzima be-PTSD); iinombolo zidibana nenkqubo yokuxilonga i-PTSD; ukuxinezeleka, ukuxhalaba kunye neengxaki zokuxinwa) kodwa kunye nokunciphisa okukhulu kwintlungu nokukhubazeka kunye nokuphuculwa komsebenzi ngokomzimba, intlungu yomzimba kunye nendima yenyama ye-SF36 (Itheyibhile 1).

1 Table. Iziphumo zovavanyo lomqhubi wolu vavanyo

	I-CBT egxininisekile	Akukho Ulawulo lokungenelela
Index Index (0-100) *
Isiseko	43.7 (15)	42.8 (14.3)
Ukungenelela kweposi	38.7 (12.6)	43.9 (12.9)
Umsebenzi we-SF-36 ngokwasemzimbeni
Isiseko	55.8 (25.9)	55.4 (28.2)
Ukungenelela kweposi	61.5 (20.1)	51.1 (26.3)
I-SF -36 Intlungu yomzimba
Isiseko	31.2 (17.2)	22.6 (15.5)
Ukungenelela kweposi	41.8 (18)	28.2 (15.8)
I-Posttraumatic Stress Disorder Diagnosis (SCID-IV)
Isiseko	I = 13 (100%)	I = 13 (100%)
Ukungenelela kweposi	I = 5 (39.5%)	I = 12 (92.3%)

* amanqaku aphezulu = amabi; Amanqaku aphezulu = ngcono

Iziphumo zolu pho nonongo lubonisa ukuba i-CBT egxininiswe ngogonyamelo kwabanikezelayo abane-WAD engapheliyo ineempembelelo, kungekhona nje kwiimeko zengqondo kodwa nakwiintlungu nokukhubazeka iimpawu ezikhawulayo zalo mqathango. Nangona utshintsho oluthethayo lwe-5% lwalunxwemeni ngokwemfuno yekliniki [33], ubungakanani befuthe lokuguqulwa kwe-UN lwalulinganisela (d = 0.4) kwaye lubonisa isithembiso somphumo omkhulu kwisayizi enkulu yesampula [34]. Nangona kunjalo iziphumo zolu vavanyo lwezamehlo zibonisa ukuba i-CBT yodwa ingabikho ngokwaneleyo ukulawulwa ngempumelelo kwe-WAD engapheliyo kwaye ngenxa yesi sizathu silingo lwethu olucetywayo luya kudibanisa le ndlela ngokusebenza. Ezi ziphumo zikwaphulwa komhlaba kwindawo yokulawulwa kwe-whiplash kwaye kubalulekile ukuba bavavanywa ngokutsha kwi-design epheleleyo.

Isishwankathelo, sele sibonise ukuba abantu abane-WAD abangapheliyo kunye neempawu ze-PTSD ezilinganayo aziphenduli ngokusesikweni sokuncedisa ukulungiswa ngokomzimba njengabantu abangenazo iimpawu ze-PTSD [25]. Uphononongo olusandul 'uvavanyo lwangoku nje lubonisa ukuba i-CBT egxininiswe ngengozi inomphumo onobuncedo kwisimo sengqondo kunye nentlungu nokukhubazeka. Siphakamisa ukuba ngokuphambi kwe-PTSD, iimpawu ze-PTSD kunye nokukhubazeka okuhambisanayo kuya kunciphisa ukuvumela ukungenelela ukuba kusebenze ngakumbi kunokuba kubonwe kuze kube yimini [24, 25]. Ngako-ke uphando lwethu olucetywayo luya kujongana nalolu gaba oluchongiweyo ngolwazi ngokuba ngowokuqala ukuvavanya ukuphumelela kokungenelela kwe-CBT ejoliswe ngengozi elandelelweyo elandelwe ngumsebenzi we-WAD ongapheliyo.

Injongo ephambili yale projekthi kukuphanda ukuphumelela kwe-CBT ejoliswe ngogonyamelo kunye nokuzivocavoca ukunciphisa intlungu nokukhubazeka kwabantu abane-whiplash engapheliyo ne-PTSD. Iinjongo zesekondari kukuphanda ukuphumelela kwe-CBT ejoliswe ngogonyamelo kunye nokuzivocavoca ukunciphisa iimpawu zokuxinwa kwe-posttraumatic, uxinzelelo kunye nokuxinezeleka, nokuphanda ukuphumelela kwe-CBT ejolise ngengozi yodwa kwiimpawu zengcinezelo yokuhamba kwengqondo kunye nentlungu / ukukhubazeka.

Olu lingo kulindeleke ukuba luqale ngoJuni 2015 kwaye lugqitywe ngoDisemba 2018.

uyilo

Olu pho nonongo luya kuba luvavanyo olulawulwa ngokungahleliwe oluvavanya iiveki ezili-10 ze-CBT ezijolise kwintlungu xa kuthelekiswa neeveki ezili-10 zonyango oluxhaswayo, ngasinye silandelwa yiprogram ye-6 yeveki. Iziphumo ziya kulinganiswa ngeeveki ezili-10, iiveki ezili-16, iinyanga ezi-6 kunye ne-12 emva kwenkqubo. Abantu abangama-108 abanesifo esinganyangekiyo se-whiplash (> iinyanga ezi-3, iminyaka emi-5 ubude bexesha) kunye ne-PTSD (DSM-5 efunyaniswe ine-CAPS) iya kubhaliswa kuphononongo. Iziphumo zokulinganisa abavavanyi ziya kuba yimfama kulwabiwo lwamaqela onyango abelweyo. Umgaqo-nkqubo uhambelana nezikhokelo ze-CONSORT.

Umzobo we-2 Study Design

tindlela

nxaxheba

Inani elipheleleyo labathathi-nxaxheba abangama-108 abane-whiplash engahambelaniyo nengxaki (WAD) yebanga II (ubude beempawu> iinyanga ezi-3 kunye <iminyaka emi-5) kunye ne-PTSD iya kuqeshwa eSoutheast Queensland nase-Zealand, eDenmark. Abathathi-nxaxheba baya kugaywa ngokusebenzisa:

Izibhengezo (irejista yezempilo yesizwe yaseDenmark, iphephandaba, i-newsletter kunye ne-intanethi): abathathi-nxaxheba abanokubamenywa ukuba baqhagamshelane nabasebenzi beprojekthi.
I-Physiotherapy kunye neZigqirha zonyango ngokubanzi: uphando luya kuphakanyiswa kwi-physiotherapy kunye neeklinikhi zonyango apho abasebenzi beprojekthi sele benalo ubudlelwane. Izigulane ezithathwa ukuba zifanelekile ukufakwa ziza kunikwa iphepha leenkcukacha malunga neprojekthi kwaye bamenywa ukuba badibane nabasebenzi beprojekthi ngokuthe ngqo.

Kukho inkqubo emibini yokumisela ukufakwa kwesi sifundo: intetho yangaphambili ye-intanethi / ye-intanethi yalandelwa ukuhlolwa kweemvavanyo zonyango. Udliwano-ndlebe lokuqala luya kubona ixesha lokulimala kwe-whiplash (i-criteria yokungeniswa) kunye neentlungu ezilinganayo ngokusekelwe kwizikolo ze-NA, kunye neendlela zokungabikho zokukhutshwa. Ubunzima be-PTSD buza kusekelwe kwizikolo ze-PCL-5 ezinokuzithengisa, ezifuna ubuncinane amanqaku athile ngokumachiza kunye namanqaku amancinci ka-30 ngokubanzi. Inkcazo yeprojekthi iya kunikwa onke amavavolontiya kwinqanaba lokuqala loqhagamshelwano. Amavolontiya abonwa njengokuba afanelekileyo aya kumenywa ukuba aye kwi-clinical examination screen. Ukuba ngaphezulu kweeveki ezine kudlulela phakathi kwintlanganiso yodliwano-dliwano lwesefoni kunye nokuhlolwa kwekliniki kunokuba amanyathelo we-NA kunye ne-PCL-5 aya kulawulwa kwakhona.

Ngaphambi kokuba kwenziwe uvavanyo lokuhlola iikliniki, izavolontiya ziya kunikwa ulwazi ngolwazi-nxaxheba kwaye zacelwa ukuba zizalise amaxwebhu emvume enolwazi. Ngexesha loviwo lokuphonononga, abathathi-nxaxheba abanobudlelwane obunzima bokubambisana nokufana nokukhula kwe-spinal pathology baya kuqwalaselwa kwaye bangafakwa ngaphandle kokuthatha inxaxheba. Ukukhusela i-pathology enzulu, uvavanyo lokuxilongwa luya kwenziwa emva kwe-Motor Accident Authority ye-NSW Whiplash Guidelines [35]. Uhlolo lokuhlola luya kubandakanya udliwano-ndlebe lwengcali kunye nomncedisi wophando oya kulawulo lwe-PTSD ye-PNDX ye-5 (CAPS 5) ukucacisa ubungqina kunye nobukhulu be-PTSD [36]. Umncedisi wophando uya kuqinisekisa ukungabikho kwemigqaliselo yokungabikho njengembali edlulileyo okanye ukunikezwa kwangoku kwengqondo yengqondo, ukuphazamiseka kwengqondo, ukuphazamiseka kwengqondo kunye nokusetyenziswa kakubi kweziyobisi ngokweziyobisi. Ukuba abathathi-nxaxheba baxela ukuxilongwa kweenkqubo zokungabandakanywa kwicandelo elichaphazelekayo le-SCID-ndiya kusebenzisa ukucacisa ukuxilongwa.

Ngexesha lesikrini sokuqala okanye ngexesha lonyango, ukuba umntu othabatha inxaxheba ubonwa njengoyena mntu usemngciphekweni wokuzenzakalisa okanye wokuzibulala, uya kuthunyelwa kukhathalelo olufanelekileyo ngokwemigangatho yobungcali yoochwephesha bengqondo. Abathathi-nxaxheba abahlangabezana neekhrayitheriya zokubandakanywa (i-NDI> 30% kunye nokuchongwa kwe-PTSD) baya kuvavanywa kuwo onke amanyathelo esiphumo seziphumo ezisisiseko. Kungenzeka ukuba amavolontiya amenyiwe ukuba aye kuvavanyo lweklinikhi lokuvavanywa ngekhe ahlangabezane neekhrayitheriya zokubandakanywa (i-NDI> 30% kunye nokuchongwa kwe-PTSD) kwaye ke ayizukubandakanywa ekuthatheni inxaxheba. Amavolontiya aya kwaziswa ngeli thuba ngexesha lodliwanondlebe ngomnxeba nangexesha lenkqubo yemvume enolwazi. Udliwanondlebe luya kurekhodwa kwaye ukhetho olungenahleliwe luya kuvavanywa ngokungqinelana

Iingqinisiso zokufakwa

I-WAD yeBakala lesi-II (i-37] engapheliyo kwimizuzu engama-3 ubuncinane kodwa ingaphantsi kwe-5 iminyaka
Ubuncinci iintlungu eziphakathi kunye nokukhubazeka (> 30% kwi-NDI)
Ukuxilongwa kwe-PTSD (DSM-5, APA, 2013) usebenzisa i-CAPS 5
Umdala phakathi kwe-18 kunye ne-70 yeminyaka ubudala
Unolwazi lwesiNgesi okanye isiDanish (ngokuxhomekeke kwilizwe lokuthatha inxaxheba)

Iimpawu zokungabikho

Eyaziwayo okanye okhankanywayo obunzulu bokugulisa umthambo (isib. Izidumbu ze-metastatic, ezivuthayo okanye ezikhuselekileyo zomgudu)
Ukuchithwa okanye ukuchithwa ngexesha lokulimala (WAD Grade IV)
Iingcambu zeengcambu zilahla (ubuncinci i-2 yezibonakaliso ezilandelayo: ukutshatyalaliswa / ukutshintsha kwe-reflex / ukulahlekelwa kwintlupheko ehambelana nomnye wamagulane)
Ugqirha lomlingo kwiinyanga ezidlulileyo ze-12
Imbali okanye intetho yangoku ye-psychosis, i-bipolar disorder, i-brain disorder disorder okanye ukuxinezeleka okukhulu.

Usayizi wesampula

Sinesithakazelo ekufumaneni ulwahlulo olubalulekileyo lwezempilo phakathi kokungenelela okubini, kuba iinkalo zokuqala zecandelo ngalinye lilingana ngokulingana nesiphumo se-randomisation. Ukusukela kwisibini-test test-test isampuli ye-86 (43 ngeqela) liya kunika amandla e-80% ukufumana umahluko omkhulu kwi-alpha 0.05 phakathi kweqela lithetha iindlela ze-10 kwinqanaba le-100 NA (ngokuthatha i-SD ye-16, ngokusekelwe kwidata lethu lomqhubi kunye nedatha kwizilingo zamva nje). Iimpembelelo ezincinci kunokuba zingenakwenzeka ukuba ziqwalaselwe njengekliniki. Ukuvumela ukulahleka kwe-20% ukulandelwa ngeenyanga ze-12, siya kubafuna abathathi-nxaxheba be-54 ngeliqela lonyango.

Ukungenelela

Ukurhoxiswa

Abathathi-nxaxheba baya kunikwa igalelo kwinqanaba leyeza. Ishedyuli yokurhoxiswa iya kuveliswa yi-biostatistician. I-Randomisation iya kuba ngamabhulokhi avumelekileyo angaphambukiyo kwi-4 kwi-8. Iimvulophu ezifakwe ngokulandeleleneyo, ezibhaliweyo, ezivulekileyo ziza kusetyenziswa ukufihla i-randomisation. Ulwabiwo lweqela luya kwenziwa ngokukhawuleza emva kokugqitywa kwamanyathelo okusekwa ngumboneleli ozimeleyo (ongaboniyo uphando). Lo mncedisi uphando oya kulungiselela onke amaxesha okuqeshwa kunye nabaphengululi abayimfama kuzo zonke iziphumo zempatho. Abathathi-nxaxheba baya kufundiswa ukuba bangabonakali iinkcukacha malunga nenkatho yabo kumviwo ukuze bancedise ukuphazamisa. Izigulane ziya kulungiswa ukufumana unyango lwabo lokuqala kwiveki enye yokurhweba.

Iqela lokungenelela - I-Traum-focal-cognitive-therapy (CBT)

Ungenelelo lwengqondo olujolise kwiimpawu ze-PTSD luya kubandakanya iiseshoni ezili-10 zeeveki ezingama-60-90 zeeseshoni ezijolise ngokukodwa kwi-CBT esekwe kwizikhokelo ze-Australia zonyango lwabantu abadala abane-Acute Stress Disorder kunye ne-PTSD [38] (jonga 2 Table). Iseshoni yokuqala iya kugxila ekuboneleleni ngemfundo yengqondo ngokubhekisele kwiimpawu eziqhelekileyo ze-PTSD, ukugcina izinto kunye nokubonelela ngesiseko sezinto ezahlukeneyo zonyango. Iiseshoni ezimbini nezithathu ziya kuqhubeka nokukhulisa ulwazi lwesigulana seempawu ze-PTSD kwaye zifundise iindlela zokulawula uxinzelelo kubandakanya ukuphefumla okunzulu kunye nokuphumla kwezihlunu okuqhubekayo. Uhlengahlengiso lwengqondo olubandakanya ukucel'umngeni kwiingcinga ezingancediyo kunye ezingenangqondo kunye neenkolelo ziya kuqala kwiseshoni yesithathu kwaye ziqhubeke kulo lonke unyango. Abathathi-nxaxheba baya kuqala ukubonakaliswa ixesha elide kwiseshoni yesine eya kuthi ibhangqwe ngokuphumla kunye nomceli mngeni wokuqonda. Iseshoni yesithandathu iya kwazisa ukubonakaliswa okuhleliweyo kwi-vivo. Ukuphinda uthintelo kuya kubandakanywa kwiiseshoni ezimbini zokugqibela [12]. Abathathi-nxaxheba baya kucelwa ukuba bagqibezele umkhuba wasekhaya ngexesha leseshoni yabo eya kurekhodwa kwaye iziswe kwiseshoni elandelayo. Unyango luya kuhanjiswa ngoochwephesha ababhalisiweyo ngoqeqesho lwasemva kwesidanga sokuqala kunye namava ahambisa ungenelelo olujolise kwingxaki yomothuko.

Ithebula 2. Inkcazo yeprogram ye-CBT

iKhusi	isishwankathelo
1	Isingeniso kunye nesizathu
2	Uqeqesho lokuphumula
3	Uqeqesho lokuphumula kunye nobunzima beengcamango
4 and 5	Inkcazo engumngcipheko kunye nexesha elide
6	Ukubonakaliswa kwexesha elide kunye nokuchaswa kwe-vivo
7 and 8	Ukubonakaliswa kwexesha elide kunye nokuvezwa kwe-vivo
9	Ukuphinda uthintele
10	Ukuphindaphinda ukukhusela nokuphela kokonyango

Iqela lolawulo - Uncedo lweNyango

Iseshoni yokuqala iya kubandakanya imfundo malunga noxinzelelo kunye nenkcazelo yonyango loxhasayo. Iiseshoni ezilandelayo ziya kubandakanya iingxoxo zeengxaki zangoku kunye nezakhono zokusombulula iingxaki. Ukusetyenziswa kwekhaya kuya kubandakanya ukugcinwa kwedayari kweengxaki zangoku kunye nemizwelo. Ulwaphulo oluncedisayo luya kuphesela ngokukhawuleza ukukhutshwa, ukulungiswa kwengqondo okanye ukuphathwa koxinzelelo. Ukuba iziphumo zolu vavanyo ziyakuthandeka kwaye abathathi-nxaxheba abangenakwenziwa ngolu hlobo lokungenelela banokuxilongwa kwe-PTSD kwi-12 inyanga yokulandelelana, baya kunikwa ukuthunyelwa kwi-psychologist klinikhi.

Iprogram yo kuHlola

Ukulandela iseshoni ye-10 yeeseshoni zonyango (inxaxheba okanye ukulawula), Bonke abathathi-nxaxheba baya kuthatha inxaxheba kwinkqubo efanayo yokuzilolonga. Iprogram yovavanyo lweveki ye-6 iya kwenziwa phantsi kwesigqeba kwi-physiotherapist (iiseshoni ze-2 nganye kwiiveki ezine zokuqala; kunye neseshoni ye-1 ngeveki 5 kunye neveki ye6) kwaye iya kubandakanya iindlela ezithile zokuphucula ukuhamba nokulawula kwentamo kunye namabhinqa emigxala kunye nokusebenza okufanelekileyo kunye nokulungelelanisa (jonga i-Table 3). Ukuzivocavoca kuya kulungiswa ngumzimba we-physiotherapist ngamnye ngamnye.

Inkqubo iqala ngovavanyo lweklinikhi yeentloko zomlomo wesibeleko kunye nemisipha ye-axio-scapular-girding kwaye iquka iimvavanyo ezivavanya amandla okufumana izihlunu ngendlela edibeneyo, iimvavanyo zokulinganisela, i-parentesthesia ye-colervical kunye nokulawula ukunyakaza kwamehlo kunye neemvavanyo zokunyamezela komzimba Amanqanaba aphantsi okuqhekeza ngokuzithandela. Iimpazamo ezithile ezichongiweyo zibhekiswe kwiprogram yokuqhuba umsebenzi ejongene nokuqhutyelwa phambili yi-physiotherapist. Le nkqubo yonyango yenkcazo ichazwe ngokubanzi [15] kwaye igxininise ekusebenzeni nasekuphuculeni ukulungelelaniswa nokunyamezela amandla entanyeni ye-flexor, i-extensor kunye ne-scapular muscle kwimisebenzi ethile kunye nemisebenzi esebenzayo, kunye neprogram eneenkcukacha ezijoliswe kwi-postural control inkqubo, kubandakanywa nezenzo zokulinganisela, ukuqhutyelwa kwintloko yokufudukela kwintloko kunye nokuzivocavoca ukulawula ukuhamba kwamehlo.

Abathathi-nxaxheba baya kwenza imithambo ekhaya, kanye ngemini. Incwadi yelog iya kugqitywa ngabathathi-nxaxheba ukurekhoda ukuthotyelwa kwemithambo. Kwangelo xesha, i-physiotherapist iya kukhokelela kwizifundo ukuba zibuyele kwimisebenzi yesiqhelo.

Iiphysiotherapists ziya kuhambelana nemigaqo-nkqubo yokuziphatha ngexesha lokuqeqesha kunye nokulawulwa kwazo zonke izixhobo [26]. Imigaqo-mpawu yokuziphatha kwengqondo iquka ukukhuthazwa kokuthengwa kwekhono ngokufakela imodeli, ukubeka iinjongo eziqhubekayo, ukubeka iliso kwinkqubela phambili, kunye nokuqiniswa okubonakalayo kwenkqubela phambili. Ukuzithemba kuya kukhuthazwa ngokukhuthaza izifundo ukuba zenze ingxaki yokusombulula iingxaki kunokuba zifune ukuqinisekiswa kunye neengcebiso, ngokukhuthaza iziphumo ezifanelekileyo ezifanelekileyo kunye nokukhuthaza ukuziqinisa. Umsebenzi wemihla ngemihla ekhaya uya kukhuthazwa kwaye uhlolwe usebenzisa idayari. Imiyalelo yokusebenzisa imiyalelo iya kubonelelwa.

3 Table. Ubume benkqubo yesenzo

Iveki	Iiseshoni ngeveki	amacandelo
1	2	Isiseko kunye novavanyo lokulandelela ukukhokela ukumiselwa kokuqala kunye nenkqubela phambili yenkqubo Zilolonge ukuphucula imisipha yomlomo wesibeleko kunye ne-scapular, kinaesthesia kunye nebhalansi Imfundo neengcebiso Inkqubo yasekhaya yemihla ngemihla kubandakanya ukuzilolonga kunye nokwanda okuhleliweyo kwemisebenzi yomzimba Imigaqo ye-CBT enjengokumiselwa kweenjongo, ukomeleza okusetyenziswa zii-physiotherapists Session Ukukhupha iseshoni ukomeleza inkqubela phambili kunye nesicwangciso somsebenzi oqhubekayo
2	2
3	2
4	2
5	1
6	1

Izisiphumo

Kuvavanyo lokuqala, iimpawu zobuqu ezifana nobudala, ubulili, izinga lemfundo, isimo sembuyekezo, usuku lwengozi kunye nolwazi malunga neempawu ze-whiplash ziya kuqokelelwa. Amanyathelo okulandela ezi zilandelayo aya kuhlolwa ngumbono ongenamfama kwinqanaba, iiveki ze-10, iiveki ze-16, iinyanga ze-6 kunye neenyanga ze-12 zithuba emva kokuhlaziywa.

Inkcazo yokukhubazeka kweNeck (i-NDI) iya kuba yiprayimari yesiphumo esiphambili [21]. I-IN ingumlinganiselo ochanekileyo kunye nenyathelo elithembekileyo yentlungu yokukhubazeka ephakamileyo yentsimbi [21] kwaye icetyiswa ukuba isebenziswe nguMbutho wePlastiki kunye neCandelo lamaKhosi eMinyaka yeeNtshontsho (7) kunye neNgqungquthela ye-Whiplash yamazwe ngamazwe [11, 16].

Amanyathelo omphumo wesibini afaka:

Umlinganiselo wentlungu ephezulu kwiveki ephelileyo (i-0-10 isikali) [39]
Umlinganiselo wesantya uxinzelelo kwiiyure zokugqibela ze-24 (isikali se-0-10) [39]
Umbono wezigulana ngokubuyela kwimeko yesiqhelo (-5 ukuya kuthi ga kwisikali se-5) [39]
Ugqirha ulawulo lwe-PTSD kwisi5 (CAPS 5) [40].
Uluhlu lokuhlola lwe-PTSD (i-PCL-5) [41]
Ukuxinezeleka Uxinzelelo lwe-stress-21 (DASS-21) [42]
Umlinganiselo wesizukulwana wezinga lempilo (SF-12) [43]
Umlinganiselo owenziwe ngumonde wokukhubazeka (Isigulane-esisodwa seSikhathi esisebenzayo) [44]
Amanyathelo okwenyama (intlupheko yomlomo wesibeleko, umlenze wexinzelelo, uxinzelelo lwentlungu ebandayo)
Ubunzima bokuPhathwa kweNhlungu (PCS) [45]
I-Questionnaire ye-Self-Efficiency Questionnaire (PSEQ) [46]
I-Tampa Scale yeKinesiophobia (TSK) [47]

Ukulindela kwempembelelo yonyango oluxhamlayo kuya kulinganiswa kunye ne-Credibility Expectancy Questionnaire (CEQ) [48] kwiveki yokuqala kunye neyokugqibela yonyango ngalinye. Ukusebenzisana okusebenzayo njengoko kuchazwe ngumxhasi kunye nodokotela (psych okanye physio) kuya kulandelwa kwiveki yokuqala neyokugqibela kwonyango ngalinye usebenzisa i-Working Alliance Inventory (WAI) [49].

Ukubeka iliso kwiSayithi zeZonyango

Iindawo zonyango ziya kufumaneka kwiindawo ezinokufumaneka lula kwizithuthi zikawonkewonke. Iimvavanyo ziya kwenziwa ukuba zinezo zengqondo kunye neeseshoni zoqeqesho ezigcinwe kwisayithi enye. Ngaphambi kokuqala kwetyala, izazi zeengqondo kunye ne-physiotherapists kwisayithi nganye yonyango ziya kunikwa umgaqo-nkqubo ochaphazelekayo. Iingcali zengqondo ziza kuqeqeshwa ukuphumeza inkqubo ye-CBT kunye neyeza ezixhaswa ngabaphandi abakhulu kwiindibano zocweyo zomhla. Iiphysiotherapists ziya kuqeqeshwa ngabaphandi abakhulu ukuphumeza inkqubo yoqeqesho kwinkqubo yokusebenzela enye.

Ngaphambi kokuba uqalise uvavanyo, amaziko anikezela ngeenkonzo ezahlukeneyo kunye nabagqirha baya kunikelwa ikopi yenkqubo yesilingo kunye nonyango. Zomibini zonyango zonyango ziya kuqhutywa ngokulandelelana kwenkqubo. Iingcali ziyakufuneka ukuba zirekhode iseshoni nganye kwaye zizalise uluhlu lokutshekisha kwi-protocol. Isampuli esingahleliyo kwezi rekhodi kunye nohlalutyo luza kuvavanywa kwaye kubekwe esweni oluqhubekayo olunikezwa yingcali yeengqondo kwiqela lophando. Imizimba ye-Physiotherapy iya kusekelwe kwisilingo sokuqala sokuvavanya kwi-WAD engapheliyo [25]. Ukuphicothwa kweeseshini ze-physiotherapy kuya kwenziwa kabini ngexesha lokungenelela ngongcali ophando oluphezulu kule ndawo. Ukunikezelwa kuza kwenzeka phakathi kwengqondo kunye ne-physiotherapist ukuqhubeka nokunyamekela.

Iziganeko ezimbi

Ngaphandle kwekomiti yokuziphatha eqhelekileyo enikezelwe ngamalungiselelo okunika ingxelo ngemiphumo emibi, izacatshulwa ziya kucelwa ukuba zibike naziphi na iziganeko ezimbi kwiiNtloko zoPhando. Kwakhona kwi-16 iveki yokulandelelana, ulwazi malunga nemiphumo emibi yonyango iya kufunwa kuzo zonke izifundo usebenzisa imibuzo evulekile. Kwi-6 kunye ne-12 ilandelelwano lweenyanga, idatha ephathelele kwinani lokubuhlungu kwentlungu, kunye nenani lonxibelelwano lwezempilo luya kuqokelelwa.

Uhlalutyo lweSatisati

Isifundo se-biostatistician siya kuhlalutya idatha ngendlela ephosakeleyo. Konke ukuhlalutya kuya kwenziwa ngenjongo yokuphatha isiseko. Iziphumo eziphambili nezesekondari ezilinganiselwe kwiiveki ze-10, iiveki ze-16, iinyanga ze-6, kunye neenyanga ze-12 ziya kuhlaziywa ngokusebenzisa imodeli yokuhlukumeza edibeneyo kunye neendlela eziza kubandakanywa amanqaku asemgangathweni abo njengesivumelwano, izifundo njengemiphumo engahleliyo kunye nemeko yonyango njengoko izinto. I-Diagnostics izakusetyenziswa ukuhlolisisa iingcinga, kubandakanywa ukuhambelana kwamanani. Ubungakanani bemibala buya kubalwa kuwo onke amanyathelo kunye nobukhulu be0.2 njengento encinci, i-0.5 kunye ne-0.8 enkulu. I-Alpha iya kusekwa kwi-0.05. Nawuphi na umphumo wesayithi (i-Qld okanye iDenmark) iya kuvavanywa ngokubandakanya indawo yexesha lokusebenzisana kweqela-nge-time kwiimodeli ezixutywayo. Ukuguqulwa kwesiphumo kuya kuhlolwa kuphela kwisiphumo esiphambili se-NA.

Inkxaso

Ulingo luxhaswa ngemali nge-NHMRC Project grant 1059310.
IBhunga leProjekthi ye-Danish Victims Fund i-14-910-00013

Okubalulekileyo

Le projekthi ijongene nengxaki ebaluleke kakhulu kwimpilo yabantu. I-Whiplash ngumthwalo omkhulu wempilo kwi-Australia kunye nakwamanye amazwe apho kukho izithuthi. Iindlela ezisetyenziswayo ezikhoyo zokulawulwa kwe-WAD ezingapheliyo ziboniswe ukuba zisebenza ngokukhawuleza. Esinye isizathu sokuba oku kungenziwa ngenxa yokungabikho kokuqwalaselwa kwindlela esetyenziswayo ngokusesikweni kwengqondo yezigulane ezilinzakeleyo. Olu pho nonongo luya kunika uvavanyo oluchanekileyo lwemiphumo yokufaka i-CBT egxininisekile ekusebenziseni abantu abane-WAD engapheliyo ne-PTSD.

Olu phofu lunokuchaphazela ukulawulwa kweklinikhi yengozi ye-whiplash kwaye iya kuba nekliniki yokusebenza ngokukhawuleza. Nakuphi na ukungenelela okuya kuphucula iziphumo zempilo kubantu abane-whiplash esingapheliyo kuya kuba nefuthe elide kwiAstreliya nakwamanye amazwe. Uphononongo lwethu luya kuba nefuthe kubo bobabini bezempilo kunye nabasebenzi bomshuwalense kwizigqibo zabo malunga nokukhetha unyango kunye nenkxaso-mali. Uphando lwe-WHO International Clinical Trials Registry Platform Research Portal kwi-2 / 3 / 13 ayibonakali nolu vavanyo olucwangcisiweyo okanye olugqityiweyo oluya kuphinda luphindwe umsebenzi wethu.

Ukungquzulana kweNtshisekelo

Ababhali bavakalisa ukuba akukho mpikiswano.

Indima yeengxaki zengqondo kwi-Recover from Common Whiplash

Abstract

Kuyakwamkelwa ngokubanzi ukuba izinto zengqondo zihlobene nokuziphatha kokugula kwaye kukho ubungqina bokuba banokuchaphazela izinga lokubuyiswa kwezifo ezibangelwa yintlungu. Amandla okuxinwa kwengqondo, iimpawu ze-somatic, kwaye ngokuzenzekelayo ahlolwe ukukhubazeka kwengqondo ukuqikelela ukuba ukuphulukana okukhawulezileyo kwi-whiplash efanayo kuqhutyelwe uphando olulandelayo. Izigulane ze-78 ezilandelelanayo ezibhekiselele kwi-7.2 (SD 4.5) iintsuku emva kokuba zenze i-whiplash efanayo kwiingozi zeemoto zahlolwa ukunyamezela kwengqondo, ukukhathazeka okungathandekiyo, iimpawu zobuntu, izikhalazo ze-somatic, kunye nokuphazamiseka kwengqondo kunye novavanyo oluninzi oluqhelekileyo. Kwiinyanga ze-6 kamva izigulane ze-57 zafunyanwa ngokupheleleyo kwaye i-21 yayineempawu eziqhubekayo. Amanqaku amaqela eenguqu ezizimeleyo ezivandlakanywe kumviwo-siseko aqikelelwe. Uhlalutyo olwenziwe ngokukhawuleza lubonisa ukuba izinto zengqondo, ukungathinteki kakubi, kunye neempawu zobuntu zazingabalulekanga ekuqaliseni isiphumo. Nangona kunjalo, ubuhlungu bokuqala buhlungu entanyeni, ukukhubazeka okunxulumene nokulimala, kunye nobudala bezinto ezibalulekileyo zokuqikelela ukuziphatha kwezifo. Esi sifundo, esasisekelwe kwisampula esingalindelekanga kwaye esaqwalasela ezinye izinto ezinokuthi ziqikelele kunye neemeko zengqondo, azixhasayo iziphumo ezidlulileyo ukuba iziganeko zengqondo ziqikelela ukuziphatha kwezigulane kwizigulane zentsholongwane.

UDkt Jimenez White Coat

Insight of Dr. Alex Jimenez

Ukubandakanyeka engozini yemoto kunokuba yinto ephazamisayo kunoma ubani. Ukuxhatshazwa ngokwenyama kunye neengxaki zemali, ukukhathazeka ngokomzwelo, ingozi yemoto ingafaka umthwalo onzima kulabo bantu abaye bafumana, ngakumbi ukuba ukulimala kwengozi yemoto kuqale ukuthatha inkokhelo engqondweni. Izigulane ezininzi zivakashela iofisi ye-chiropractic ngokuxhalabisa, ukwesaba okungenangqondo, ukudandatheka kunye ne-PTSD emva kokubandakanyeka kwingozi yemoto. Ukufunda ukuthembela kwakhona ukufumana ukunakekelwa kwe-chiropractic kunokuba ngumngeni, kodwa ngokulungelelanisa nokusebenza kakuhle kwemilenze kunye nokunyanzeliswa kwemisebenzi, abasebenzi bethu banokunika izigulane ngengqondo yokhuseleko abayidingayo ukuqhubeka unyango kunye nokufezekisa impilo kunye nokuphila kakuhle.

Ukuququmbela,Iingozi zeemoto zinokubangela ukonzakala komzimba kunye neemeko, ezinje nge-whiplash, iintlungu zomqolo kunye nentloko, kunye nemicimbi yezemali, nangona kunjalo, ukonzakala kwengozi yemoto kunye neengxaki zinokukhokelela kuxinzelelo lweemvakalelo. Ngokwezifundo zophando ezisekwe kubungqina, njengale ingentla, uxinzelelo lweemvakalelo luye lwadityaniswa neempawu ezingapheliyo zentlungu. Ngethamsanqa, abaphandi baye baqhuba uphando oluninzi ukubonisa indlela ukungenelela kwengqondo, njengokunakekelwa kwe-chiropractic, kunokunceda ukunciphisa uxinzelelo lweemvakalelo kunye nokuphucula iimpawu ezibuhlungu. 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

Imixholo eyongezelelweyo: Ubunzima bokubuyisela

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

Ucaphulo

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Vala i-Accordion

Ukuphumelela kwengqiqo kwi-Herniated Discs ne-Sciatica e-El Paso, TX

by iicrosoft | Iimeko eziPhathwayo, Disc Disc, Ukubuyiswa komzimba, Uvavanyo oluLungeleleneyo oluLungisiweyo, Unyango lokuthotywa koMnqonqo, istres, Unyango

Intlungu engapheliyo emva kwexesha yimbini yesibini ebangela ukukhubazeka eUnited States. Ngokumalunga neepesenti ze-80 zabemi ziya kuba nobuhlungu ubuncinane kanye kanye ngexesha lokuphila kwabo. Eyona nto ibangele iimbandezelo ezingapheliyo zentlungu ziquka: disni, sciatica, ukulimala ekuphakanyiseni izinto ezinzima okanye nayiphi na enye inkunkuma engasetyenziswanga. Nangona kunjalo, abantu bahlala besabela ngendlela eyahlukileyo kwimpawu zabo. Ezi mpendulo ezahlukileyo zibangelwa zizimo zengqondo kunye nemibono yengqondo.

Ubunzima Bokubuya Kwangaphantsi Nengqondo

Uxinzelelo lunxulunyaniswa nentlungu eyandayo kodwa iinkolelo zakho zempilo kunye neendlela zokujamelana nazo zinokuchaphazela umbono wakho wentlungu ngokunjalo. Kungenxa yokuba ukuba semngciphekweni kwengqondo kunokutshintsha ingqondo yakho kwaye kuqinise iintlungu. Ukongeza, iintlungu ngokwazo zinokuphinda zisebenze kwingqondo. Xa iintlungu ziqhubeka, umsebenzi ohambelana nengqondo utshintsha ukusuka kwiisekethe zentlungu ukuya kwiisekethi ezenza iimvakalelo. Kungenxa yoko le nto kukholelwa ukuba uxinzelelo, unxunguphalo kunye noxinzelelo kunokubangela kunye nokuba mandundu kweentlungu ezingapheliyo.

UkuLawula iSithwathwa seNtsholongwane engapheliyo

Ngethamsanqa, iindlela ezininzi zokulawula uxinzelelo kunye neendlela zinokunceda ukuphucula iintlungu ezisezantsi ezingapheliyo. Ingqondo yonyango oluqhelekileyo kunye nobungqina obuhle obuxhasayo ekuphuculeni nasekulawuleni iintlungu ezingapheliyo.Uphononongo olutshanje lubonise ukuba ukunciphisa uxinzelelo lwengqondo, okanye i-MBSR, kuquka ukucamngca kwengqondo kunye nokunye ukungenelela kwengqondo, kunokunceda ukunciphisa intlungu emva kunye nokuphucula ukulawula kwengqondo ngokwandisa ukuhamba kwegazi kwingqondo engaphambili. Ukuziqhelanisa nokukhumbula kubandakanya ukusebenza kwendlela yokuphumla kwengqondo ngokungazihoyi ngengqondo "incoko" kwaye ujonge ukuphefumla kwakho. TherapyUkunyanga ngokuziphatha, okanye i-CBT kunokuba luncedo kwiintlungu ezingapheliyo zentlungu. Ukunyanga kokuziphatha kwengqondo kunokuthintela ukwenzakala okungapheliyo ekuqhubekeni ukuya kwiintlungu ezingapheliyo zentlungu. I-Hypnosis inokunceda ekunciphiseni iintlungu ezingapheliyo zangasemva. Nangona kunjalo, i-CBT kunye ne-hypnosis zinobungqina obuthathaka bokuxhasa ukusebenza kwazo kwintlungu ebuhlungu.

Ingqondo Ngakumbi

Nangona kusenokubonakala ngathi iintlungu ezingapheliyo zangasemva zonke “zisentloko yakho”, izifundo zophando zibonise ukuba uxinzelelo lunokuchaphazela iimpawu ezibuhlungu. Ingqondo ibandakanya i- matter, ngakumbi xa ucinga ukuba matter yomzimba Ingqondo idlala indima enkulu kutshintsho lwengqondo. Oku kuyinyani ngakumbi xa kuziwa kutshintsho olusekwe kwingqondo olunxulumene nentlungu esezantsi. Injongo yale nqaku ingezantsi kukubonisa ukusebenza kokucamngca kwengqondo kwiintlungu ezingapheliyo zentlungu.

Ukuphumelela Kwengqondo Ukucamngca Ngezibuhlungu kunye Nobunjani boBomi bezilwelisi ezine-Down Low Back Pain

Abstract

Imvelaphi kunye nenjongo: Ukubuyiselwa kwezigulane ezinentlungu engapheliyo ye-back-back (LBP) kuxhomekeke kwiimeko ezininzi zomzimba nezengqondo. Ngako oko, abalobi bajolise ukuhlolisisa ukuphumelela kwengqondo ekusetyenzisweni kokunciphisa uxinzelelo (MBSR) njengongenelelo lwengqondo kumgangatho wobomi kunye neentlungu zesiguli sezilwanyana ezine-LBP engapheliyo (NSCLBP).
Iindlela: Izigulane ezisibhozo ezisibhozo ezifunyaniswa njengeNSCLBP ngugqirha kwaye zinikezelwe ngokuzenzekelayo ukunyamekela (MBSR + unyango lwangonyango) kunye neqela lolawulo (unyango lwangonyango kuphela). Izifundo ezihlolwe kumaxesha e-3; ngaphambi, emva kweeveki ze-4 emva kokungenelela kwe-Mac Gil ubuhlungu kunye nomgangatho omfutshane wemilinganiselo yokuphila. Iinkcukacha ezifunyenwe kwisampuli yokugqibela ehlaziywa ngu-ANCOVA usebenzisa i-software ye-SPSS.
iziphumo: Iziphumo zabonisa ukuba i-MBSR yayisebenza ngokunciphisa ubunzima beentlungu kunye nezigulana ezenza iiseshoni ze-8 zokucamngca zichaze iintlungu ezisezantsi kakhulu kunezigulana ezifumana ukhathalelo lonyango oluqhelekileyo. Kwakukho isiphumo esibalulekileyo phakathi kweqela lesifundo (F [1, 45] = 16.45, P <0.001) kunye (F [1, 45] = 21.51, P <0.001) kumgangatho wobomi wobomi kwaye (F [1 , 45] = 13.80, P <0.001) kunye (F [1, 45] = 25.07, P <0.001) umgangatho wobomi bengqondo ngokulandelelana.
Isiphelo: I-MBSR njengonyango lwengqondo yomzimba olubandakanya ukutshitshiswa komzimba, ukucinga nokuhlala nokucamngca ukuhamba ngokufanelekileyo kwongenelelo ngoncedo lokunciphisa ubuhlungu ubunzima kunye nokuphucula umgangatho wenyama kunye nengqondo yobomi bezigulane zesini kunye ne-NSCLBP.
Internet: Ubuhlungu obungapheliyo obubuyisela emuva, ukukhathazeka ngokusekelwe ekunciphiseni uxinzelelo, intlungu, umgangatho wobomi, iSF-12

intshayelelo

Kwiintlungu ezingacacanga ezisezantsi (i-NSLBP) iintlungu azihambelani neemeko ezinje ngokuqhekeka, i-spondylitis, ukwenzakala ngokuthe ngqo, okanye i-neoplastic, isifo esosulelayo, i-vascular, i-metabolic, okanye i-endocrine enxulumene nayo nangona ingunobangela wokuthintelwa kwimisebenzi yemihla ngemihla ngenxa yokwenyani intlungu okanye uloyiko lwentlungu. [1] Ngelishwa, uninzi lwezigulana ze-LBP (80-90%) zinengxaki ye-LBP engacacanga ekhokelela ekukhubazekeni okunxulumene nentlungu kunye nokusikelwa umda kwimisebenzi yemihla ngemihla. [1,2] I-LBP engapheliyo ayixhaphakanga nje kuphela, kodwa ikwangumthombo omkhulu ukukhubazeka ngokwasemzimbeni, ukukhubazeka kwendima, kunye nokuwohloka kwempilo-ntle kunye nomgangatho wobomi. [1]

Ngaphambi komzekelo owamkelekileyo we-biopsychosocial, i-model ye-biomedical ilawulwa yonke ingqondo yokugula malunga neminyaka eyi-300 kwaye ihlala ilawulwa ngcamango eyaziwayo. Okokuqala kucetyiswa ngu-Engel (1977) umzekelo we-biopsychosocial uvuma iinkqubo ze-biological kodwa ugxininisa ukubaluleka kweemeko zengqondo kunye nengqondo kwiintlungu. Isango elidumileyo lokulawula i-theory yentlungu [3] kwakhona icebisa ukuba ingqondo idlala indima enkulu kwiintlungu ezibonakalayo ngokuchasene nokuba ngummkeli ongenabuhlungu. Bakucebisa ukuba iingqondo zithintele okanye ziphuculise ukuhamba kweemvakalelo zentlungu kwaye zichaphazele indlela ekugqibeleni ubuchopho buphendula ngayo ukuvuselela okubuhlungu. [4] Ukuba iinjongo zengqondo zingatshintsha indlela ubuchopho buqhutyelwa ngayo intlungu kwaye luba negalelo elikhulu lokungenelela kwengqondo ukuze kuveliswe iintlungu ezivela kwingqondo.

IKabat-Zinn's et al. (1986) uchaze inkqubo yokunciphisa iintlungu kwiphepha lakhe ngengqondo kunye nokucamngca. Inkqubo yokunciphisa iintlungu yenzeke sisimo sengqondo se-ofan sokujonga okungafunekiyo xa sisiba sikhulu kwicandelo lokwazisa kunye nokujonga kunye neqela elifanayo leenkqubo ezihamba nazo kodwa ezizimeleyo ezinokukhokelela kuvavanyo kunye neelebheli zemvakalelo ezibuhlungu, njenge Ukwenzakalisa. Yiyo ke, ngo- uncoupling uvakalelo ngokwasemzimbeni, ukusuka kumava emvakalelo kunye nokuqonda kwentlungu, isiguli siyakwazi ukunciphisa iintlungu. [5] Iinkcazo zezigulana zokuphazamiseka kwintlungu, ezichonga iindlela zokulwa nokusetyenziswa gwenxa kwintlungu kunye nokuphakanyiswa kokuqaqanjelwa kwentlungu ekhokelela kutshintsho lokuziphatha yimizekelo yendlela iintlungu ezingahambelani ngayo neemvakalelo, ukuqonda, kunye nemvakalelo [Umzobo 1]. Ke ngoku kutshanje ezi ngcamango zitsale abaphandi abaliqela abasebenza kwiintlungu.

Umzobo 1: Umzobo weConsort.

Ukucamngca kwengqondo kuyingcambu yefilosofi yaseBuddhist Vipassana kunye nokuziqhelanisa kwaye yenziwe ngokuzimela ngaphandle kwengqondo yengqondo kwiinkcubeko zaseNtshona. [6,7,8,9] Kungekudala eNetherlands Veehof et al. uqhube uphononongo oluhlelekile lweengxelo ezilawulwayo ezingenakulawulwa kwindlela yokusebenza kwamanyathelo afanelekileyo njengokwinkqubo yokunciphisa uxinzelelo lwengqondo, ukwamukelwa kunye nokuzinikela ukuzinyamezela. Iziphumo eziprayimari ezilinganisiweyo zibuhlungu kunye noxinzelelo. Iziphumo eziqhelekileyo zilinganiswe ukuxhalaba, ukuphila ngokwenyama kunye nomgangatho wobomi. [10] Izifundo ezingamashumi amabini namibini izifundo ezilawulwa ngandlela-thile eziqhutywe ngekliniki ngaphandle kokungahambi kakuhle kunye nezifundo ezingalawulwayo zibandakanyiwe zizonke izigulane ze-1235 ezineentlungu ezingapheliyo. Ubungakanani besiphumo kwiintlungu (0.37) zifunyenwe kwizifundo ezilawulwayo. Impembelelo ekudakaleni kwakuyi-0.32). Ababhali baphetha ngokuthi ukungenelela kwe-ACT kunye neengqondo zinempembelelo efanayo nezinye iindlela zokungenelela ezinokwenziwa kwengqondo kunye nokuba ezi zininzi zongenelelo zingenokuba yindlela efanelekileyo okanye idibeneyo kwimiba ekhoyo yangoku. UChesa noSerretti baphinde baqhube olunye uphononongo olwenziwe kwi-10 yokungenelela kwengqondo. [I-11] Iziphumo eziphambili kukuba oku kungenelela kwenzile imiphumo emincinci ngaphandle kokunciphisa intlungu engapheliyo kunye neempawu zokudandatheka. Xa kuthelekiswa namaqela alawulayo asebenzayo (inkxaso kunye nemfundo) akukho miphumo eyongeziweyo eyongeziweyo.

Ngesishwankathelo, kukho imfuno yophando olongezelelweyo kwimiphumo ethile yeengqondo ezizicingayo ezibuhlungu obungapheliyo. Ngokubhekiselele njengoko umphandi olwazi ukusebenza kwengqondo engakhange ahlolwe ngobunjani bobomi bezigulane ezingapheliyo e-Iran. Ababhali bajolise ukuhlolisisa impembelelo yokucutha kwengqondo esekelwe ekunciphiseni uxinzelelo (MBSR) inkqubo eyenzelwe ulawulo lweentlungu kwiqondo lobomi kunye nentlungu yesampula ehamba ngokufanayo kunye ne-LBP engapheliyo (NSCLBP) ngokuqhathaniswa neqela lokunakekelwa kwezempilo.

tindlela

Sampling

Ngaphandle kweesampulu zokuqala zabasetyhini abaneminyaka engama-30 45 (n = 155) abafumanise ukuba yi-NSLBP engapheliyo ngoogqirha kumaziko e-physiotherapy e-Ardebil-Iran ubuncinci kwiinyanga ezi-6 ngaphambili. Kuphela ngama-88 kuphela afezekisa iikhrayitheriya zokufakwa kwaye anike imvume yokuthatha inxaxheba kwinkqubo yophando. Izigulana zabelwa ngokungacwangciswanga kumaqela amancinci ukuba zifumane i-MBSR kunye nonyango oluqhelekileyo (iqela lokulinga) kunye nokhathalelo oluqhelekileyo lonyango (iqela lolawulo). Ezinye izigulana ziye zehla ngexesha nasemva konyango. Isampulu yokugqibela yophando enamabhinqa angama-48.

Iingqinisiso zokufakwa

Ubudala beminyaka engama-30 ukuya kwengama-45
Ukuba unyango lwezonyango ezifana ne-physiotherapy kunye neyeza
Ingxaki yonyango-imbali ye-NSCLBP kunye nentlungu eqhubekayo ubuncinane ubuncinane kweenyanga ze-6
Ulwimi - isiPersi
Ubulili - isetyhini
Imfundo-efundiswa ubuncinci ukuya esikolweni esiphakeme
Imvume kunye nokuzimisela kwezinye iindlela zokuphelisa iintlungu.

Iimpawu zokungabikho

Imbali yokuhlinzwa komgudu
Ukudibana nezinye izifo ezingapheliyo
I-Psychotherapy kwiminyaka yokugqibela ye-2 ngaphandle
Ukungabikho kwiinyanga ezilandelayo ze-3.

Isindululo sophando esivunyiweyo yikomiti yesayensi yeYunivesithi yasePanjab, isebe lezengqondo kunye nazo zonke izigulana ezisayine imvume yokuthatha inxaxheba kolu phando. Uphononongo luvunyiwe eIndiya (eyunivesithi apho umphandi enze khona i-PhD), kodwa lwenziwa e-Iran kuba umphandi uvela e-Iran kwasekuqaleni kwaye bekukho ingxaki yolwimi nenkcubeko. Ukuvunywa kweKomiti yeenqobo ezisesikweni yeziko le-physiotherapy e-Ardebil kwafunyanwa e-Iran nako ukwenza uphando.

uyilo

Uphononongo lusebenzise uyilo lokulinga lwangaphambi kokuthunyelwa kwexesha lokuvavanya ukuvavanya ukusebenza kwe-MBSR kumaxesha ama-3 (phambi-emva kweeveki-4 emva kwenkqubo). Inkqubo ye-MBSR yalawula iseshoni enye ngeveki yokuchaza ubuchule, ukuziqhelanisa, kunye nengxelo kunye nokwabelana ngamava abo kwiiveki ze-8 ecaleni kwe-30 45 min yokuziqhelanisa nekhaya mihla le [Itheyibhile 1]. Ungenelelo lwenziwa kumaqela amathathu kubandakanya abathathi-nxaxheba abangama-7 9 kwiqela ngalinye. Inkqubo yokwenza inkqubo yayisekwe kwimigca ye-quid ebonelelwe yi-Kabat-Zinn, Morone (2008a, 2008b no-2007) [6,12,13,14] kunye nolunye uhlengahlengiso olwenzelwe abaguli ababandakanyekayo kuphononongo. Iqela lolawulo alibonelelwanga naluphi na uhlobo longenelelo kwiprojekthi yophando. Ngenxa yoko, bafumana iindlela eziqhelekileyo kukhathalelo lwempilo kubandakanya i-physiotherapy kunye namayeza.

Itheyibhile ye1 Content yee-MBSR Sessions

Ithebula 1: Umxholo weeseshoni ze-MBSR.

Ukungenelela

Iiseshoni ezenziwa kwiklinikhi yabucala yomzimba kufutshane namaziko e-physiotherapy. Iiseshoni zithathe iiveki ezisibhozo, kwaye iseshoni nganye yathatha i-8 min. Ukucamngca kuguqula ulwazi lwezigulana ngeendlela zokuphefumla kunye nengqondo. Ungenelelo lwenziwa kumaqela amancinci kubandakanya abathathi-nxaxheba abangama-90 7 kwiqela ngalinye. Itheyibhile 9 yeenkcukacha zomxholo weseshoni obulungiselelwe ngokwencwadi kunye nezifundo zangaphambili. [1]

U vavanyo

Iphetshana elizaliswe zizigulana phambi kokungenelela, emva kokungenelela kunye neveki ze-4 emva kokungenelela. I-receptor yamaziko e-physiotherapy yenza uvavanyo. Abafumana i-receptors baqeqeshwe ngaphambi kokuba baqhube uvavanyo, kwaye babengaboniyo kwiingcamango zesifundo. Ezi zilandelayo zisetyenziselwa uvavanyo lwabathathi-nxaxheba:

Umbuzo weMicGill Pain Questionnaire

Icandelo eliphambili leli nqanaba liqukethe izichazi ezichazayo ze-15, i-11 sensory kuqukwa: Ukuqothulwa, ukuThunjulwa, ukuBetha, ukuCima, ukuCima, ukuGnawing, Ukutshisa, Ukutshisa, ukuPhepha, ukuThengisa, ukuCima, kunye nokuzibandakanya ezine okubandakanya: Ukukhathala, ukukhathala, ukugula , Ukwesaba, ukukhawuleza, okukrakra, ezichazwe zizigulane ngokuxhomekeka kwazo kwinqanaba elinesine (0 = akukho, 1 = ludityaniswe, 2 = elilinganayo, 3 = elibi), elivumela izikolo ezintathu. Amanqaku athile kunye neempembelelo abalwa ngokufaka i-sensory kunye nemilinganiselo yezinto ezichaphazelekayo ngokwahlukeneyo, kwaye amanqaku amanqaku isisom yala manqaku amabini angentla apha. Kule sifundo, sasisetyenzisile isalathisi sokulinganiswa kweentlungu kunye nezikolo ezipheleleyo. Adelmanesh et al., [15] yaguqulelwa kwaye yaqinisekisa i-Iran inguqu yale mibuzo.

Umgangatho woBomi (SF-12)

Umgangatho wobomi ovavanywa yiSF Survey Health Survey. [12] Yaphuhliswa njengendlela efutshane, ngokukhawuleza ukugqibezela kwi-SF-16v36 yeNgcaciso yezezeMpilo kunye nokulinganisa ezempilo ezisibhozo ezakhayo. Ukwakhiwa kuku: Ukusebenza ngokomzimba; indima yomzimba; intlungu; impilo jikelele; bukhulu; ukusebenza kwentlalo; indima; kunye nengqondo yengqondo. Izinto zineempendulo ezintlanu zokuphendula (umzekelo: Zonke ixesha, ixesha elininzi, ixesha elithile, ixesha elincinane, akukho nanye ixesha), ngaphandle kwemibuzo emibini apho kukho izigqibo ezintathu zokuphendula ( i-domain functioning domain). Izinto ezine zitshintshiwe. Izibalo eziqingqiweyo eziqingqiweyo kwiimithombo ezisibhozo ziguqulwa ukuguqula amanqaku aphantsi kunako konke kwaye amanqaku aphezulu kakhulu kwi-2. Amanqaku aphezulu abhekisela kwimpilo engcono kunye nenhlalakahle. Ifom yefom ye-SF-100 isebenzisa ixesha elidlulileyo lweeveki ze12 zangaphambili. [4]

Inguqulelo yeIran ye-SF-12 eMontazeri et al. (2011) uphononongo lubonakalise ukungqinelana kwangaphakathi okwanelisayo kuwo omabini la manyathelo wesishwankathelo, lawo yiPhysical Component Summary (PCS) kunye neSishwankathelo seNgqondo yeNgqondo (i-MCS); ICronbach? ye-PCS-12 kunye ne-MCS-12 yayiyi-0.73 kunye ne-0.72, ngokwahlukeneyo. Ukuthelekiswa kweqela okwaziwayo kubonise ukuba i-SF-12 ikhethe kakuhle phakathi kwamadoda nabasetyhini kunye nabo bahlukileyo ngokweminyaka nakwimeko yemfundo (P <0.001) 2.5. [17]

Uhlalutyo lweSatisati

I-SPSS 20 (Armonk, NY: IBM Corp) isetyenziswe ukuhlalutya idatha. Ukuhlalutya okuchazayo kuthetha, ukuphambuka okuqhelekileyo (SD) esetyenziswayo. Ukwenza i-ANCOVA, amanqaku aqala ukusetyenziswa njengama-covariates.

iziphumo

Iminyaka yobudala yayingu-40.3, SD = 8.2. I-45% yamabhinqa yayisebenza kwaye abanye babengumfazi wendlu. I-38% yabantwana ababini, i-55% umntwana omnye kunye nabanye babenabantwana. Bonke babetshatile kwaye bavela kwiintsapho ezinomvuzo ophakathi. I-9.8% yezigulane zazisa izinga eliphantsi lomzimba lobomi, kwaye ezinye ziphantsi (i-54.8%) kwaye zilinganise (36.4%). Oku kwakuyi-12.4%, i-40% kunye ne-47.6% ephantsi kakhulu, ephantsi kunye namanqanaba aphakathi komgangatho wengqondo ebomi kwizigulane ezithathiweyo kwisifundo sethu (n = 48). Intetho kunye ne-SD yezigulane kwi-MBSR kunye neqela lokulawula libonisa ukwehla kwintlungu kunye nokwanda kwimiqobo yobomi kunye nengokomzimba [Itafile 2].

Itheyibhile ye2 Ethethayo kunye ne-SD yezigulane

Ithebula 2: Kuthetha kunye ne-SD yezigulane zintlungu, ingqondo yengqondo kunye nomzimba wobomi kwisiseko, emva kokungenelela kunye neveki ze-4 emva kokungenelela.

Iziphumo zokufanisa

Ubuhlungu. Iziphumo zibonise ukuba emva kokuhlengahlengiswa kwamanqaku okuqala, bekukho isiphumo esibalulekileyo phakathi kweqela lezinto (F [1, 45] = 110.4, P <0.001) kunye (F [1, 45] = 115.8, P <0.001) . Amanqaku ovavanyo olwenziwe emva kovavanyo acebisa ukuba ungenelelo lube nefuthe ekwandiseni amanqaku ezigulana ze-NSCLBP ezifumene i-MBSR xa kuthelekiswa nabo babekwiqela lolawulo kwaye bengakhange bafumane naluphina unyango lomzimba wengqondo [Itheyibhile 3].

Ithebhile 3 Isiphumo sokuthelekiswa kobuhlungu kunye nobunzima boBomi

Ithebula 3: Isiphumo sokuthelekisa intlungu kunye nomgangatho wobomi be-MBSR kunye neqela lokulawula emva kokungenelela (ixesha le-1) kunye neveki ze-4 emva kokungenelela (ixesha le-2).

Umgangatho wobomi. Iziphumo zibonisa ukuba emva kohlengahlengiso lwamanqaku angaphambili, bekukho isiphumo esibalulekileyo phakathi kweqela lezinto (F [1, 45] = 16.45, P <0.001) kunye (F [1, 45] = 21.51, P <0.001) . Amanqaku ovavanyo olwenziwe emva kovavanyo acebisa ukuba ungenelelo lube nefuthe ekunyuseni umgangatho wokuphila kwamanqaku ezigulana ze-NSCLBP ezifumene i-MBSR xa kuthelekiswa nalabo babekwiqela lolawulo kwaye bengakhange bafumane naluphina unyango lomzimba wengqondo [3 Table ].

Iziphumo zikwabonisa ukuba emva kokuhlengahlengisa amanqaku okuqala, bekukho isiphumo esibalulekileyo phakathi kweqela lezinto (F [1, 45] = 13.80, P <0.001) kunye (F [1, 45] = 25.07, P <0.001 ). Amanqaku ovavanyo olwenziwe emva kovavanyo acebisa ukuba ungenelelo lube nefuthe ekwandiseni umgangatho wobomi bamanqaku ezigulana ze-NSCLBP ezifumene i-MBSR xa kuthelekiswa nabo babekwiqela lolawulo kwaye bengakhange bafumane naluphi na unyango lwengqondo [Itheyibhile 3].

UDkt Jimenez White Coat

Insight of Dr. Alex Jimenez

Ingqondo yinkqubo yengqondo ebandakanya ukuvula indlela yokuphumla kwengqondo ngokungakhathaleli ngabom "incoko" yengqondo, ukuzisa ingqalelo yamava akhoyo okwangoku kunye nokujonga ukuphefumla kwakho. Ingqondo inokufezekiswa ngokwenza ukucamngca kunye neendlela zolawulo loxinzelelo kunye nobuchule. Ngokwezifundo zophando, ukuqonda kuyindlela efanelekileyo yonyango enokukunceda ukunciphisa iintlungu ezingapheliyo. Abaphandi baye bafanisa ukunciphisa ukunciphisa uxinzelelo lwengqondo, okanye i-MBSR, kunye nonyango lokuziphatha ngokuziphatha ukuze baqonde ukuba ngaba oku kungenelela kwengqondo kunokuphucula iintlungu ezingapheliyo. Inqaku elilandelayo liye laqhutyelwa ukucacisa ukuba ukucamngca ngengqondo kuyindlela efanelekileyo yokwenza unyango lweentlungu ezingapheliyo. Iziphumo zophando zombini zazithembisa, zibonisa ukuba ingqondo inokusebenza ngakumbi kwiintlungu ezingapheliyo emva kweendlela zonyango kunye nokusetyenziswa kweziyobisi kunye / okanye amayeza.

ingxoxo

Iziphumo zibonise ukuba iqela lokulinga elithotyelwe kwi-MBSR libonise ukuphucula okubalulekileyo kwintlungu yabo yonke, ubunzima bomzimba kunye nengqondo yamanqaku okuphila ngenxa yoqeqesho olufunyenweyo xa kuthelekiswa neqela lolawulo elifumana unyango oluqhelekileyo kuphela. Inkqubo yanciphisa ukuqonda kwentlungu kunye nokuphucula umgangatho wobomi kunye nengqondo yobomi kunye nefuthe kwiqela lokulinga ngokucacileyo ngokuthelekisa ukhathalelo oluqhelekileyo lonyango. UBaranoff et al., 2013, [18] Nykl cek kunye Kuijpers, 2008, [19] kunye Morone (2) et al., 2008 [20] ingxelo efanayo iziphumo.

Kabat-Zinn okqhubekayo. ikholelwa ukuba inkqubo yokunciphisa iintlungu yenzeke ngo- uncoupling uvakalelo lomzimba, ukusuka kumava emvakalelo kunye nokuqonda kweentlungu, isigulana siyakwazi ukunciphisa iintlungu. [21] Kwisifundo esikhoyo, abathathi-nxaxheba badibanisa izinto ezahlukeneyo zamava entlungu. Ukuzilolonga ngokuphefumla kuphazamisa iingqondo zabo kwintlungu yokuphefumla kunye nokuphila okunengqondo kubenze bazi malunga neendlela zokulwa maladaptive.

Kwiiseshoni zokuqala, ulwazi olunikeziweyo malunga nezinto ezisemgangathweni zengqiqo, ukuchaza ingqondo yokuxhasa iingcinga ezibandakanya ukungabi nxamnye nombono, iimvakalelo okanye iimvakalelo njengoko ziphakama, umonde, ukungaqiniseki, uvelwano, ukwamukelwa kunye nenzululwazi kwabanika ubulumko kwaye bakholelwa ukuba babandezeleka kwiingcamango ezibuhlungu ngaphezu kweentlungu ngokwazo.

Ngapha koko, ngexesha lokuvavanywa komzimba bafunda ukubona imeko yabo yokwenyani, njengoko yayinjalo, ngaphandle kokuzama ukutshintsha inyani. Ukwamkela imeko yabo yokugula okungapheliyo kwabanceda babona ezinye izinto ezinokubakho kwindima yabo yezentlalo kunye neemvakalelo. Ngapha koko ukuziqhelanisa nokuskena komzimba kubancede batshintsha ubudlelwane kunye nomzimba kunye nentlungu. Ngamava ngokuthe ngqo ekuskeneni umzimba, umntu uyakuqonda ukunxibelelana phakathi kwemeko yengqondo nomzimba, ngaloo ndlela kwandisa ukuzilawula kwabaguli kubomi babo. Iindlela zokuphila ezinengqondo zikwaphucule umgangatho wobomi babo ngokubafundisa ukuba baqwalasele ngakumbi iimfuno zabo zemihla ngemihla, ezikhokelele kumava eemvakalelo ezintle, ezinje ngoxolo novuyo, ukuzithemba nokuzithemba. Ngapha koko, babexabisa izinto ezintle. Nje ukuba bafunde ukubona iintlungu eziqhubayo ngokungagungqiyo kwaye bajonga ezinye iimvakalelo emzimbeni wabo, basebenzise imigaqo-nkqubo efanayo ngeendlela zokuphila ezinengqondo kubomi babo bemihla ngemihla. Ngenxa yoko, bafunde ukulawula impilo yabo kwaye baqala ukubandakanyeka kwimisebenzi yabo ngengqondo.

Izifundo zophando ezifana ne-Plews-Ogan et al., [22] iGrossman et al., [23] kunye neSephton et al., (2007) [24] yabonisa ukuphumelela kwenkqubo yokucamngca kwengqondo ebomini yobomi bezigulane imeko zobuhlungu obungapheliyo.

isiphelo

Konke ndawonye umphumo wale sifundo kunye nezifundo zangaphambili zigqamile ukusebenza kwonyango olongezelelweyo kunye nolunye uhlobo lwezigulane ezine-LBP ezingapheliyo. Ngokubhekiselele kwendima enkulu ebomgangatho wobomi kwimpilo yobungcali kunye nobuqu bomntu obumba i-psychotherapies esebenzayo ngokukodwa ekuphuculeni umgangatho wobomi bezigulane ezine-LBP ezingapheliyo ezicetyiswa ngababhali.

Olu pho nonongo lubandakanyeka nemida emininzi njengokhathalelo oluqhelekileyo oluqhelekileyo olufunyenwe zizigulane. Iiseshoni ze-physiotherapy ezinikezelweyo okanye iindlela kunye neyeza ezichazwe ngamagqirha ahlukeneyo ngendlela eyahlukileyo. Nangona ezinye izigulane ngokuqhelekileyo i-dose ingagqityi iiseshoni ze-physiotherapy. Ubungakanani besampula bekuncinci kwaye bekuncinci kumaziko amathathu. Oku kuphakanyisiwe kubaphandi bexesha elizayo ukuba baqhube isifundo ngokuqwalasela iimpawu eziphathekayo ezifana ne-MRI, i-NMR kunye nemiqondiso ye-neurologic ukuvavanya ukuphumelela kwe-MBSR ukunciphisa intlungu yesifo.

Ekugqibeleni, ubungqina obuninzi obunikwe ubungqina obuninzi obunokulandelelwa kwexesha elide kufuneka kwenziwe ukwenzela ukwandisa isisindo sokwelapha kunye nexabiso le-MBSR njengenxalenye yonyango elongezelelweyo eliyindlela yokukhusela kunye nokuvuselela phakathi kwezigulane ze-CLBP.

Ukwamkela

Siyabulela kwizigulane ezazinxulumene nathi. UDkt. Afzalifard kunye nabasebenzi bamaziko e-physiotherapy aseArdebil.

Imihlathi

Umthombo wenkxaso: Nil.
Ukugqubana kwemidla: Akukho nto ipapashwe.

Ukuququmbela,Ukucinga lolona nyango luxhaphakileyo nobona bungqina buxhasayo ekuphuculeni nasekulawuleni iintlungu ezingapheliyo. Ukungenelela kwengqondo, njengokunciphisa uxinzelelo lwengqondo kunye nonyango lokuziphatha, kubonise ukuba kuyasebenza kwiintlungu ezingapheliyo zentlungu. Ngapha koko, ukucamngca ngengqondo kukwabonakalisiwe ukunceda ukuphucula kunye nokulawula iintlungu ezingapheliyo zangasemva ezibangelwa luxinzelelo. Nangona kunjalo, ezinye izifundo zophando zisafuneka ukumisela isiphumo esomeleleyo sokungenelela kwengqondo kunye nentlungu engapheliyo. 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 apha 915-850-0900 .

Ikhutshwe nguDkt. Alex Jimenez

Imixholo eyongezelelweyo: Ubunzima bokubuyisela

Ngokwezibalo, malunga ne-80% yabantu baya kuba neempawu zentlungu emva koko kanye ngexesha lokuphila kwabo. Intlungu ebuyayo yinkxalabo eqhelekileyo enokubangelwa 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

IINGXELO EZIBALULEKILEYO: UKUPHATHA KWE-EXTRA: Ukukhetha i-Chiropractic? | Familia Dominguez | Izigulane | El Paso, TX I-Chiropractor

Ngenanto

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Vala i-Accordion

Iimiphumo zoNyango wokuLawula uxinzelelo lwe-Down Back Pain e-El Paso, TX

by iicrosoft | Chiropractic, Ukubuyiswa komzimba, Uvavanyo oluLungeleleneyo oluLungisiweyo, istres, Unyango

Ukunyamekela kwe-Chiropractic yindlela ekhethwa yonyango eyaziwayo eqhelekileyo isetyenziselwa ukuhlukana kweemeko kunye / okanye iimeko, kubandakanywa iintlungu eziphantsi kunye ne-sciatica. Kakade ke, akuyiyo yonke intlungu ebonakalayo kwaye ayiyiyo yonke into ebangela umzimba. Ukuxinezeleka, uxinzelelo kunye nokuxinezeleka kuthinta izigidi zabantu ngonyaka. Nangona izigulane ezininzi zifuna unyango lweziyobisi zonyango ukuba ziphathwe ngempilo yabo yengqondo, abanye bangakwazi ukulawula nokunyanga iimpawu zabo ngendlela epheleleyo. Ukunyamekela kwe-Chiropractic yinkqubo yokulawula uxinzelelo oluyimpumelelo enokukunceda ukunciphisa iimpawu ezinxulumene noxinzelelo, njengentlungu ephantsi ye-back and sciatica.

Ukuxinezeleka Kukuthintela njani uMzimba?

Kukho iindidi ze-3 zokubandezeleka: umzimba, ukusingqongileyo kunye nemvakalelo.

Ukuxinezeleka komzimba: Kubangelwa ukungabikho kokulala, izifo, ukuxhwaleka okanye ukulimala, kunye nokutya okungafanelekanga.
Uxinzelelo lwendalo: Ebangelwa ngomsindo omkhulu (ngokukhawuleza okanye oqhubekayo), ukungcola kunye neziganeko zehlabathi, ezifana nemfazwe nezopolitiko.
Ukuxinezeleka ngokomzwelo: Kubangelwe iintlobo ezahlukeneyo zezobomi, ezifana nezindlu ezihambayo, ukuqala umsebenzi omtsha kunye nokusebenzisana rhoqo. Ngokwahlukileyo kwezinye iindidi ezimbini zokuxinzezeleka, kunjalo, abantu banokulawula ukunyamezeleka kwabo. Oko kunokuxhomekeka kwisimo sengqondo somntu.

Ukuxinezeleka kunokuchaphazela umzimba womntu ngezindlela ezahlukeneyo, kokubili ngokuqinisekileyo nangokubi, ngokomzimba nangokomzwelo. Nangona uxinzelelo lwexesha elifutshane lunokuba luncedo, ukunyamezeleka kwexesha elide kunokubangela ezininzi iinkalo zempilo zengqondo kunye nomzimba. Ukunyamezela kusebenze impendulo "yokulwa okanye indiza", indlela ekhuselekileyo eyenziwa ngumonakalo onobubele ukulungiselela umzimba ukuba ubone ingozi ngokunyusa izinga lentliziyo kunye nokuphefumla kunye neengqondo, ngokomzekelo, ukukhanya kwamehlo kunokuba nzima. Emva kokuba uxinzelelo luyekile, inkqubo yesantya ephakathi ibuyisela umyalezo kumzimba kwaye iivitals zibuyela kwindawo evamile.

Kwimizekelo emininzi, inkqubo ye-nervous central ingakwazi ukubuyisela umqondiso kumzimba xa kufike ixesha lokubuyela kwindawo ekhululekile. Abantu abaninzi banamava okuqhubekayo, okuxinzelelekileyo, okubhekiswa njengengcinezelo engapheliyo. Isiganeko esithathayo sithatha umthwalo kumzimba womntu. Olu hlobo loxinzelelo lunokubakhokelela ekubandezelekeni, ukuxhalaba, ukunyaniseka nokudandatheka.

Ukulawula Ukunyamezela Kwakho

Ingcinezelo engapheliyo ingabangela iimpawu ezibuhlungu, ezinjengentlungu ephantsi ye-back and sciatica, enokubangela uxinzelelo olungakumbi. Ubuhlungu ngokubanzi bubangela iingxaki zengqondo, ezifana nokuxhalaba nokuxinezeleka, iinkqubo zokucinga, kunye nokungakwazi ukugxila. Abantu abaneengcinezelo ezingapheliyo abaneempawu ezibuhlungu banokuziva behluleka ukwenza kunye nokuzibandakanya kwimisebenzi eqhelekileyo.

Ulwaphulo lokuphathwa kwengcinezelo lunokunceda abantu baphuculwe kunye nokulawula uxinzelelo lwabo olungapheliyo kunye neempawu ezihambelana nazo. Ukunyamekela kwe-Chiropractic kunokukunceda ukunciphisa intlungu kunye nokuxhatshazwa kwemisipha, ukunciphisa ukunyamezela. Inkqubo yesiseko yomnatha nayo inokuzuza kwimiphumo yonyango lwe-chiropractic. Inkqubo ye-nervous central, okanye i-CNS, inceda ukulawula isimo sengqondo, kunye nempilo egcweleyo kunye nokuphila kakuhle, oko kuthetha ukuba inkqubo enokulinganisela ye-nervous inokukunceda ekuphuculeni intlalo jikelele.

Iinzuzo zoKhathalelo lweChiropractic

Ukunyamekela kwe-Chiropractic yindlela yokwelapha epheleleyo, eyenzelwe ukubuyisela umzimba kummandla wasezantsi kufuneka ugcine izihlunu kunye namaqela asebenza kakuhle. Ukuxinzezeleka kwengcinezelo kunokubangela ukuxhatshazwa kwemisipha ngasemva, ekugqibeleni kukukhokelela ekugqibeleni komzimba. Ukuchithwa kwe-spin, okanye ukuhluthwa, kunokufaka isandla kwiimpawu ezininzi, kubandakanya isicathulo kunye nokuhlanza, iintloko kunye ne-migraines, uxinzelelo kunye nemiba yokutya. I-chiropractor isetyenziselwa ukulungiswa kwemigudu kunye neendlela zokunyusa ukukhupha ukunyanzelisa nokunciphisa ukuvuvukala emlanjeni ukuphucula umsebenzo wamanzi kunye nokuvumela umzimba ukuba uziphilise ngokwasemvelo. Ukunciphisa intlungu kunokugqibeleni kuncedise ukunciphisa uxinzelelo kunye nokuphucula impilo nempilo. Ukunyamekela kwe-Chiropractic kungabandakanya ukuxilwa kunye nokucebisa ukunceda ukulawula uxinzelelo, ukuxhalabisa nokuxinezeleka.

Indlela yokuThatha iNkathazo

Uninzi lwezonyango ziza kusetyenziswa iindlela zonyango kunye nobuchule, njengokonyango lwangokwenyama, isenzo kunye nesondlo sokutya, ukuqhubela phambili ukwandisa ukuphathwa kwengcinezelo yokunyamekela kwe-chiropractic. Ezi zinguqu zendlela yokuphila zichaphazela yonke indawo yokuphila kwakho. Ukongezelela, injongo yendiqendu engezantsi kukubonakalisa impembelelo yokunciphisa uxinzelelo lwengqondo ngokubhekiselele kwindlela yokhathazeka kwengqondo nokuziphatha kunye nokunyamekela ngokuqhelekileyo ukuxinezeleka kunye neempawu ezinxulumene neentlungu ezingapheliyo kunye ne-sciatica.

Iimiphumo zoKucinwa koxinzelelo lwengqondo -Candelo lokuThuthukiswa kwengxaki kunye noKhathalelo lweZenzo kunye nokuNakekelwa koNcedo kwiNtshukumo yokuBala kunye nokuLawulwa kwemiSebenzi phakathi kwabantu abadala abaneNtsholongwane engaphantsi kweNtsholongwane.

Abstract

ukubaluleka

Ukunciphisa ukunyamezeleka kwengqondo (MBSR) ayizange ihlolwe ngokugqithiseleyo kubantu abadala nabasemgangathweni abaneentlungu ezingapheliyo.

injongo

Ukuvavanya ukuphumelela kweentlungu ezingapheliyo emva kwe-MBSR kunye nokunyamekela okuqhelekileyo (UC) kunye neyonyango yokuziphatha (CBT).

Ukuyila, Ukubeka, kunye nabathathi-nxaxheba

I-Randomised, i-interviewer-blind, trial elawulwayo kwinkqubo yokunakekelwa kwempilo e-Washington State yabantu abadala abangama-342 abaneminyaka engama-20-70 ubudala kunye ne-CLBP ababhalise phakathi kukaSeptemba 2012 no-Ephreli 2014 kwaye banikezelwa ngokulandelelana kwi-MBSR (n = 116), i-CBT (n = 113), okanye i-UC (n = 113).

Ngoncedo

I-CBT (uqeqesho ukutshintsha iingcamango ezinxulumene nentlungu kunye nokuziphatha) kunye ne-MBSR (ukuqeqeshwa ngokucamngca kwengqondo kunye ne yoga) zanikelwa kwii-8 zamahora e-2 ngeeyure. I-UC ibandakanye nayiphi na inxaxheba abathatha inxaxheba.

IziPhumo eziPhambili kunye neMilinganiselo

Iziphumo zaseprayimari yayiyipesenti yabathathi-nxaxheba enentsingiselo yeklinikhi (? 30%) yokuphuculwa kwesiseko kwimilinganiselo yokusebenza (iphepha lemibuzo elikhubazekileyo lokukhubazeka iRoland [RDQ]; uluhlu lwe-0 ukuya kwi-23) nakwiingxelo zokuqaqanjelwa ziintlungu zangasemva (0 ukuya kwisikali se-10 ) kwiiveki ezingama-26. Iziphumo zavavanywa kwakhona kwi-4, 8, kunye ne-52 iiveki.

iziphumo

Phakathi kwabathathi-nxaxheba abangama-342 (iminyaka yobudala, iminyaka engama-49 (uluhlu, 20-70); 225 (66%) abasetyhini; kuthetha ubude beentlungu zangasemva, iminyaka eyi-7.3 (uluhlu lweenyanga ezi-3 ukuya kwiminyaka engama-50), <60% waya kwi-6 okanye nangaphezulu Iiseshoni eziyi-8, i-294 (i-86.0%) igqibe isifundo kwiiveki ezingama-26 kwaye i-290 (84.8%) igqibe isifundo kwiiveki ezingama-52. Kuhlalutyo lokufuna ukunyanga, kwiiveki ezingama-26, ipesenteji yabathathi-nxaxheba enenkqubela phambili ebonakalayo kwi-RDQ yayiphezulu I-MBSR (61%) kunye ne-CBT (58%) kune-UC (44%) (iyonke P = 0.04; MBSR xa ithelekiswa ne-UC: RR [95% CI] = 1.37 [1.06 ukuya ku-1.77]; I-MBSR xa ithelekiswa ne-CBT: 0.95 [0.77 ukuya kwi-1.18]; I-CBT xa ithelekiswa ne-UC: 1.31 [1.01 ukuya ku-1.69]. Ipesenteji yabathathi-nxaxheba abanenkqubela phambili eklinikhi yokuphucula iintlungu yayingu-44% kwi-MBSR kunye ne-45% kwi-CBT, kuthelekiswa ne-27% kwi-UC (iyonke P = 0.01; MBSR kuthelekiswa UC: 1.64 [1.15 ukuya ku-2.34]; I-MBSR xa ithelekiswa ne-CBT: 1.03 [0.78 ukuya ku-1.36]; I-CBT xa ithelekiswa ne-UC: 1.69 [1.18 ukuya ku-2.41]). Iziphumo ze-MBSR zaqhubeka notshintsho oluncinci kwiiveki ezingama-52 kuzo zombini iziphumo zokuqala.

Izigqibo kunye nokuBheka

Phakathi kwabantu abadala abaneentlungu ezingapheliyo zangemva, unyango nge-MBSR kunye ne-CBT, xa kuthelekiswa ne-UC, kubangele ukuphucula ngakumbi kwiintlungu zangemva kunye nokusebenza kwemida kwiiveki ze-26, kungekho mvelaphi ephawulekayo kwiziphumo phakathi kwe-MBSR kunye ne-CBT. Ezi ziphumo zibonisa ukuba i-MBSR ingaba yindlela yokwenza unyango olufanelekileyo kwizigulane ezinentlungu engapheliyo.

intshayelelo

Iintlungu ezibuya emva kweyona nto ibangela imbembelelo yokukhubazeka e-US [1]. Nangona kukho iindlela ezininzi zokonyango kunye nokunyuka kweenkonzo zonyango ezixhomekeke kule ngxaki, isimo sokusebenza kwabantu abaneentlungu e-US siye sahlaselwa [2, 3]. Kukho imfuneko yonyango kunye nokusebenza okubonakalayo okusemngciphekweni ophantsi kwaye unokukwazi ukufumaneka ngokubanzi.

Iimpawu zengqondo zidlala indima ebalulekileyo kwiintlungu kunye nokukhubazeka komzimba kunye nengqondo [4]. Ngapha koko, i-4 ye-8 ye-non-pharmacologic yonyango ekhuthazwayo yeentlungu eziqhubekayo zangasemva zibandakanya i- mind-body components [4]. Enye yezi, unyango lokuqonda-ngokuziphatha (i-CBT), ibonakalise ukusebenza kweemeko ezahlukeneyo zentlungu engapheliyo [5 8] kwaye iyacetyiswa ngokubanzi kwizigulana ezineentlungu ezingapheliyo zentlungu (CLBP). Nangona kunjalo, ukufikelela kwesigulana kwi-CBT kulinganiselwe. Ukunciphisa uxinzelelo lwengqondo (MBSR) [9], enye indlela ye- mind-body , ijolise ekwandiseni ulwazi kunye nokwamkelwa kwamava omzuzwana, kubandakanya ukungonwabi komzimba kunye neemvakalelo ezinzima. I-MBSR iya isanda ngokuxhaphaka kwaye iyafumaneka e-US ke, ukuba ibonakalisiwe iyingenelo kwi-CLBP, i-MBSR inokubonelela ngolunye ukhetho kunyango lwengqondo kwinani elikhulu lamaMelika anale meko. I-MBSR kunye nolunye ungenelelo olusekwe engqondweni lufunyenwe luncedo kuluhlu lweemeko, kubandakanya iintlungu ezingapheliyo [10-12]. Nangona kunjalo, inye kuphela uvavanyo olukhulu lwezonyango (RCT) oluvavanye i-MBSR ye-CLBP [13], kwaye olo vavanyo lwalunqunyelwe kubantu abadala.

Lo RCT uthelekisa i-MBSR kunye ne-CBT kunye nenkathalo evamile (UC). Sifumanisa ukuba abantu abadala abane-CLBP ngokungaqhelekanga kwi-MBSR baza kubonisa ukuphuculwa kancinci kunye nexesha elide kwimilinganiselo yokusebenza enxulumene nentlungu, emva kweentlungu ezibuhlungu, kunye nezinye iziphumo, xa kuthelekiswa nezo zikhethiweyo kwi-UC. Sifumanisa ukuba i-MBSR yayiza kuba ngaphezu kwe-CBT kuba iquka i-yoga, efunyenwe iphumelele kwi-CLBP [14].

tindlela

IsiCwangciso soFundo, ukuCwangcisa, kunye nabaNxaxheba

Sasipapashe ngaphambili i-Mind-Body Approach to Pain (MAP) protocol protocol [15]. Owona mthombo wabathathi-nxaxheba yayiliQela lezeMpilo (i-GH), inkqubo enkulu yokudityaniswa kwezempilo e-Washington State. Iileta ezichaza ukulingwa kunye nokumema ukuthatha inxaxheba zithunyelwe ngeposi kumalungu e-GH afezekise irekhodi yezobuchwephesha (i-EMR) yokubandakanywa / yokukhutshelwa, kunye neesampulu zabemi kuluntu olunikezelwa yi-GH. Abantu abaphendule kwizimemo bahlolwe kwaye babhaliswa ngomnxeba (Umzobo 1). Abathathi-nxaxheba abanokubakho baxelelwa ukuba baya kwenziwa ngokungacwangciswanga kwenye yeenkqubo ezimbini ezizezabo zisetyenziselwa iintlungu ezizisebenzisileyo eziye zafunyanwa ziluncedo ekunciphiseni iintlungu nokwenza ukuba kube lula ukwenza imisebenzi yemihla ngemihla okanye ukuqhubeka kononophelo oluqhelekileyo kunye ne- $ 50. Abo babelwe i-MBSR okanye i-CBT zange baziswe ngolwabiwo lwabo lonyango bade baye kwiseshoni yokuqala. Sithathe abathathi-nxaxheba kwizixeko ezi-6 kumaza ali-10 ahlukeneyo.

Umzobo we-1 Uhambo lwabathathi-nxaxheba ngokusebenzisa Uvavanyo

Umzobo 1: Ukuhamba kwamatriki ngokusebenzisa isilingo ngokuthelekiswa kwengqondo ekunciphiseni ukunyamezeleka kwengqondo kunye neyonyango yokuziphatha kunye nokunyamekela ngokuqhelekileyo iintlungu ezingapheliyo.

Sithathe abantu abangama-20 ukuya kwiminyaka engama-70 ubudala kunye neentlungu ezingachazwanga ezisezantsi eziqhubeka ubuncinci iinyanga ezintathu. Abantu abaneentlungu zangasemva ezinxulunyaniswa noxilongo oluthile (umzekelo, i-spinal stenosis), kunye nembuyekezo okanye imicimbi yokumangalelana, abanokuba nobunzima ekuthatheni inxaxheba (umzekelo, abangakwaziyo ukuthetha isiNgesi, abangakwaziyo ukuya kwiiklasi ngexesha elimiselweyo nendawo), okanye ngubani olinganisileyo inkathazo yokubandezeleka <3 kunye / okanye ukuphazamiseka kwentlungu kunye nemisebenzi <4 kwizikali ezi-3-0 azifakwanga. Iikhrayitheriya zokubandakanywa kunye nokukhutshelwa kwavavanywa kusetyenziswa idatha ye-EMR kunyaka ophelileyo (kubabhalisi be-GH) kunye nodliwanondlebe lokuhlola. Abathathi-nxaxheba babhaliswa phakathi kukaSeptemba 10 no-Epreli 2012. Ngenxa yokubhalisa kancinci, emva kokuba ababhalisi abangama-2014 babhalisile, sayeka ukungabandakanyi abantu abaneminyaka engama-99-64 ubudala, amalungu e-GH ngaphandle kotyelelo lwamva nje lwentlungu yomqolo, kunye nezigulana ezine-sciatica. Umgaqo olandelwayo uvunyiwe yiKomiti yoPhononongo lweziFundo zoLuntu yeGH. Bonke abathathi-nxaxheba banike imvume enolwazi.

Randomization

Ngokukhawuleza emva kokubonelela ngemvume kunye nokugqiba uvavanyo lokuqala, abathathi-nxaxheba babekwa ngokungalinganiyo ngokulinganayo kwi-MBSR, i-CBT, okanye i-UC. I-Randomization yahlulwa ngamanqaku esiseko (? 12 kuthelekiswa? 13, 0 23 isikali) yenye yamanyathelo esiphumo esiphambili, i-Roland Disability Questionnaire (RDQ) eguqulweyo [16]. Abathathi-nxaxheba babekwa ngokungacwangciswanga ngaphakathi kwezi strata kwiibhloko ze-3, 6, okanye ze-9. randomization.

Ngoncedo

Bonke abathathi-nxaxheba bafumana naluphi na unyango olwaluqhelekileyo olwamkelayo. Abo bangabonakaliyo kwi-UC bafumana i-$ 50 kodwa akukho qeqesho lwe-MBSR okanye i-CBT njengenxalenye yesifundo kwaye bekhululekile ukufuna nayiphi na unyango, ukuba ngaba, bafuna.

Ungenelelo lwaluthelekiswa nefomathi (iqela), ubude bexesha (iiyure ezingama-2 / iiveki zeeveki ezisi-8, nangona inkqubo ye-MBSR ikwabandakanya ukubuyela umva kweeyure eziyi-6), ukuphindaphinda (ngeveki), kunye nenani labathathi-nxaxheba kwiqela ngalinye. Iinkcukacha zongenelelo]. Ungenelelo ngalunye lwenziwa ngokomgaqo olandelwayo apho bonke abaqeqeshi baqeqeshwa khona. Abathathi-nxaxheba kuwo omabini ungenelelo banikwa iincwadi zomsebenzi, ii-CD ezimanyelwayo, kunye nemiyalelo yokuziqhelanisa nekhaya (umzekelo, ukucamngca, ukuskena umzimba, kunye neyoga kwi-MBSR; ukuphumla kunye nemifanekiso kwi-CBT). I-MBSR ihanjiswe ngabaqeqeshi be-15 nge-8 kwiminyaka eyi-5 yamava e-MBSR. Abathandathu babafundisi-ntsapho babefumene uqeqesho kwiziko lokuCamngca kwiYunivesithi yaseMassachusetts Medical School. I-CBT yahanjiswa yi-29 enelayisensi ye-Ph.D. Inqanaba leengqondo ezinamava kwiqela kunye ne-CBT nganye yeentlungu ezingapheliyo. Uluhlu lokutshekishwa kwamacandelo eprotocol yonyango agqityiwe ngumncedisi wophando kwiseshoni nganye kwaye aqwalaselwa qho ngeveki ngumphandi wophando ukuqinisekisa ukuba zonke izinto zonyango zisiwe. Ukongeza, iiseshoni zirekhodwe ngeaudiyo kwaye umphandi ofundayo wajonga ukubambelela komgaqo kumntu okanye ngokurekhodwa komsindo ubuncinci iseshoni yeqela ngalinye.

I-MBSR yamodareyithwa ngokusondeleyo emva kwenkqubo yoqobo ye-MBSR [9], ngokulungelelaniswa kwencwadana yemiyalelo ka-2009 ye-MBSR [18] ngumhlohli omkhulu we-MBSR. Inkqubo ye-MBSR ayijolisanga ngokukodwa kwimeko ethile enjengeentlungu. Zonke iiklasi zazibandakanya umxholo we-didactic kunye nokusebenza kwengqondo (ukuskena umzimba, i-yoga, ukucamngca [ukujonga iingcinga, iimvakalelo, kunye neemvakalelo kulo mzuzu wangoku ngaphandle kokuzama ukuzitshintsha, ukuhlala ngokucamngca ngokwazisa ngokuphefumla, ukuhamba ukucamngca]). Umgaqo-nkqubo we-CBT ubandakanya iindlela ze-CBT eziqhelekileyo ezisetyenziswa kwaye zifundelwa i-CLBP [8, 19-22]. Ungenelelo lubandakanya (1) imfundo malunga nentlungu engapheliyo, ubudlelwane phakathi kweengcinga kunye nokuphendula ngokweemvakalelo nangokwasemzimbeni, ucoceko lokulala, ukuthintela ukubuyela umva, kunye nokugcinwa kweenzuzo; kunye (2) nokuziqhelanisa nokuziqhelanisa notshintsho lweengcinga ezingasebenziyo, ukuseta kunye nokusebenzela ukufikelela kwiinjongo zokuziphatha, izakhono zokuphumla (ukuphefumla esiswini, ukuphumla kwezihlunu okuqhubekayo, imifanekiso ekhokelwayo), ukuhambahamba komsebenzi, kunye neendlela zokulwa nentlungu. Phakathi kweseshoni imisebenzi yayiquka ukufunda izahluko zeSikhokelo sokuSinda kwiNtlungu [21]. Ingqondo, ukucamngca, kunye neendlela zeyoga zabhalwa kwi-CBT; iindlela zokucela umngeni kwiingcinga ezingasebenziyo zabhalwa kwi-MBSR.

Ukulandelisa

I-interview interviewers efihliweyo kwiqela lonyango liqokelele idatha ngefowuni kwinqanaba lokuqala (phambi kwe-randomization) kunye ne-4 (unyango lwangaphakathi), i-8 (emva kokunyanga), i-26 (iphambili yokupasa), kunye nee-52 iiveki emva kwexesha. Abathathi-nxaxheba bahlawuliswa i-$ 20 kwintetho nganye.

Amanyathelo

Ulwazi lwentlupheko nolwasemva lwafunyanwa kwisiseko (Itheyibhile 1). Zonke iziphumo zephumela eziphambili zalawulwa ngexesha ngalinye; Iziphumo zesekondari zahlolisiswa ngamaxesha onke ngaphandle kweeveki ze-4.

Itheyibhile ye-1 Isiseko seMpawu zabathathi-nxaxheba

Ithebula 1: Impawu ezisisiseko zabathathi-nxaxheba ngecandelo leyeza.

IziPhumo eziziiPrayimari

Ukubuyela umva okunxulumene nobunzima bokusebenza kuye kwavavanywa yi-RDQ [16], yaguqulwa yaya kwi-23 (xa kuthelekiswa nezinto zokuqala ezingama-24) kunye nokubuza malunga neveki ephelileyo kunanamhlanje kuphela. Amanqaku aphezulu (uluhlu 0 23) abonisa umda omkhulu wokusebenza. I-RDQ yoqobo ibonakalise ukuthembeka, ubunyani, kunye novakalelo kutshintsho lweklinikhi [23]. Ukukhathazeka okubuhlungu kwiveki ephelileyo kulinganiswe ngomlinganiso we-0 10 (0 = ayikhathazi kwaphela, 10 = botherngokukhathaza kakhulu ). Uhlalutyo lwethu oluphambili luvavanye iipesenti zabathathi-nxaxheba ngokuphuculwa okunentsingiselo kwezonyango (? 30% yokuphuculwa kwesiseko) [24] kumlinganiso ngamnye. Uhlalutyo lwesekondari luthelekisa utshintsho olulungelelanisiweyo lwentsingiselo ukusuka kwisiseko phakathi kwamaqela.

Iziphumo eziPhezulu

Iimpawu zoxinzelelo zavavanywa yiPhepha leMibuzo lezeMpilo loMonde-8 (PHQ-8; uluhlu, 0 24; amanqaku aphezulu abonisa ubukhali obukhulu [25]. Ixhala lilinganisiwe kusetyenziswa inqaku le-2 yento ejikeleze uxinzelelo lokuPhazamiseka (i-GAD-2; uluhlu, 0 ;6; amanqaku aphezulu abonisa ubukhali obukhulu) [26]. Ubunzima beentlungu buhlolwe njengentsingiselo yokulinganiswa kwe-0-10 (ukuqaqanjelwa komqolo okwangoku kunye nokuqaqanjelwa ngumva kwinyanga ephelileyo; uluhlu, 0-10; amanqaku aphezulu abonisa ubungqongqo) kwi-Scated Chronic Pain Scale [27] . Isigulana esiBonisa ukuTshintshwa kweSikali soTshintsho [28] bacele abathathi-nxaxheba ukuba babeke umlinganiso wokuphuculwa kwabo kwintlungu kwinqanaba le-7-amanqaku (ehambe ngokupheleleyo, engcono, engcono, ethe kratya, ngokulinganayo, embi ngakumbi, kwaye embi kakhulu ). Imeko yempilo yomzimba kunye nengqondo yavavanywa kunye ne-12-yeFom yeFom yeFom yezeMpilo (SF-12) (0 isikali; amanqaku asezantsi abonisa imeko yezempilo ehlwempuzekileyo) [100]. Abathathi-nxaxheba baphinde babuzwa malunga nokusetyenziswa kwabo kwamayeza kunye nokuzilolongela iintlungu zangasemva kwiveki ephelileyo.

Amava amaninzi

Amava amaninzi atyunjwe ngexesha lexesha lokungenelela kunye nemibuzo yodliwano-ndlebe ngokulandelelana malunga nokuphazamiseka okukhulu, intlungu, okanye ukulimala okubangelwa ukungenelela.

Usayizi wesampula

Ubungakanani besampulu yabathathi-nxaxheba be-264 (i-88 kwiqela ngalinye) bakhethwa ukubonelela ngamandla afanelekileyo okufumana umahluko phakathi kwe-MBSR kunye ne-CBT kunye ne-UC kwiiveki ezingama-26. Ukubalwa kobungakanani besampulu bekusekwe kwiziphumo zophuculo olunentsingiselo lweklinikhi (? 30% ukusuka kwisiseko) kwi-RDQ [24]. Uqikelelo lokuphuculwa okubonakalayo kweklinikhi ngongenelelo kunye namaqela e-UC ayesekwe kuhlalutyo olungashicilelwanga lwedatha ukusuka kuvavanyo lwethu lwangaphambili lokuthanjiswa kwe-CLBP kuluntu olufanayo [30]. Ubungakanani besampulu banike amandla awaneleyo kuzo zombini iziphumo ezisisiseko. Ubungakanani besampulu obucwangcisiweyo bunike i-90% yamandla okufumana umahluko we-25% phakathi kwe-MBSR kunye ne-UC kwinxalenye yokuphuculwa okunentsingiselo kwi-RDQ, kunye ne-80% yamandla okufumana umahluko wama-20% phakathi kwe-MBSR kunye ne-CBT, ithatha i-30% yabathathi-nxaxheba be-UC. kunye ne-55% yabathathi-nxaxheba be-CBT babonisa ukuphucuka okunentsingiselo. Ukuphuculwa okubonakalayo kwintlungu yokubandezeleka, ubungakanani besampulu obucwangcisiweyo bunikwe? 80% yamandla okufumana umahluko we-21.8% phakathi kwe-MBSR kunye ne-UC, kunye ne-16.7% umahluko phakathi kwe-MBSR kunye ne-CBT, ithatha ukuba i-47.5% kwi-UC kunye ne-69.3% kwi-CBT ibonise ukuphucuka okunentsingiselo. .

Ukuvumela ukulahleka kwe-11% ukulandelelana, saceba ukufumana abathathi-nxaxheba be-297 (i-99 ngeqela). Ngenxa yokuba amaxabiso okulandelelana ayephantsi kunokuba kulindelwe, kwagqitywa umbane osongeziweyo. Ingqungquthela yabathathi-nxaxheba be-342 babengenangqiqo ukufezekisa ubungakanani beesampula ekujoliswe kuzo kwe-264 kunye nedatha epheleleyo yeziphumo kwiiveki ze-26.

Uhlalutyo lweSatisati

Ukulandela isicwangciso sohlalutyo esichazwe kwangaphambili [15], iyantlukwano phakathi kwamaqela amathathu kwisiphumo ngasinye esiphambili savavanywa ngokufaka imodeli yokuhlengahlengisa ebandakanya amanyathelo eziphumo kuwo onke amanqaku amane emva kwesiseko (4, 8, 26, kunye neeveki ezingama-52) . Imodeli eyahlukileyo yayilungelelene nesiphumo ngasinye seprayimari (i-RDQ kunye nokukhathazeka). Izalathi zexesha-lendawo, iqela elingenamkhethe, kunye nonxibelelwano phakathi kwezi zinto zixabisekileyo zibandakanyiwe kwimodeli nganye yokuqikelela iimpembelelo zongenelelo ngexesha ngalinye. Iimodeli zazilungile kusetyenziswa uqikelelo ngokubanzi lwee-equation (GEE) [31], ezenza ukuba ulungelelwaniso lube phakathi kwabantu. Iziphumo eziphambili zebhanari, sisebenzise imodeli yokuguqulwa kwePoisson eguqulweyo kunye nekhonkco yelog kunye nomlinganiso oqingqiweyo wokwahluka kwesandwich [32] ukuqikelela umngcipheko. Kumanyathelo aqhubekayo, sisebenzise iimodeli zokuhlengahlengisa ngokulandelelana ukuqikelela utshintsho lwentsingiselo ukusuka kwisiseko. Iimodeli ezihlengahlengisiweyo kubudala, isini, imfundo, ubude beentlungu (<1 unyaka ngokuchaseneyo? 1 unyaka ukusukela oko wafumana iveki ngaphandle kwentlungu yangasemva), kunye nenqaku lesiseko kumlinganiso wesiphumo. Ukuvavanywa kweziphumo eziziisekondari kulandele indlela yohlalutyo efanayo, nangona iimodeli zingabandakanyi amanqaku eeveki ezi-4 ngenxa yokuba iziphumo zesibini azikhange zivavanywe kwiiveki ezi-4.

Sasivavanya ukubaluleka kwenani lamanyathelo okungenelela kwinqanaba ngalinye ngexesha. Sagqiba isigqibo sokubheka i-MBSR ngempumelelo kuphela ukuba ukungafani kweqela kubalulekile kwi-26 yeveki yokuphela. Ukukhusela ekuchaseni ezininzi, sasebenzisa uFisher ukukhusela okungafaniyo okuphawulekayo okukuyo [33], okufuna ukuba ukuthelekiswa kokunyanga kwamanye amabini kwenziwa kuphela xa uvavanyo olupheleleyo lwe-omnibus luba luphawu oluthile.

Ngenxa yokuba amaxabiso ethu okulandelela ahlukile kumaqela ongenelelo kwaye ebephantsi kunoko bekulindelwe (Umzobo 1), sisebenzise indlela yokuchonga ukungaphenduli njengovavanyo lwethu oluphambili lokunika ingxelo ngokunokwenzeka ekuphenduleni. Indlela yokufaka imputation isebenzisa isakhelo semodeli yokuxutywa kwemodeli kusetyenziswa inyathelo le-2 ye-GEE ndlela [34]. Inyathelo lokuqala liqikelele imodeli ye-GEE echazwe ngaphambili ngesiphumo sokulungiswa kwedatha yecovariates, kodwa uhlengahlengiso ngakumbi kwiipateni zokungaphenduli. Sifake ezi zilandelayo zilahleko zesikhombisi esilahlekileyo: ukulahleka kwesinye isiphumo, ukungabikho kwesinye isiphumo kunye ne-CBT eyabelwe, ukulahleka kwesinye isiphumo kunye ne-MBSR eyabelwe, kunye nokulahleka? Amanqaku exesha) Isinyathelo sesibini siqikelele imodeli ye-GEE echazwe ngaphambili, kodwa yayiquka iziphumo ezichaziweyo ukusuka kwinqanaba 2 kulabo abanamaxesha okulandelela okulandelwayo. Sihlengahlengise uqikelelo lokwahluka kwiakhawunti ngokusebenzisa imilinganiselo yesiphumo esichaziweyo kwiziphumo ezingakhange zibonwe.

Lonke uhlalutyo lulandele indlela yokwenza unyango. Abathathi-nxaxheba babandakanywa kuhlalutyo ngokwabiwa kwe-randomization, ngaphandle kwenqanaba lokuthatha inxaxheba. Lonke uvavanyo kunye nexesha lokuzithemba lalinamacala amabini kwaye ukubaluleka kweenkcukacha-manani kwachazwa njengexabiso le-P? 2. Lonke uhlalutyo lwenziwa kusetyenziswa ubalo lwephakheji ye-R version 0.05 [3.0.2].

iziphumo

Umzobo 1 ubonakalisa ukuhamba kwabafundi abathatha inxaxheba kuphononongo. Phakathi kwabantu abayi-1,767 ababonisa umdla ekuthatheni inxaxheba kufundo kwaye bavavanyelwa ukufaneleka, i-342 yabhaliswa kwaye yenziwa ngokulandelelana. Izizathu eziphambili zokukhutshelwa ngaphandle kukungakwazi ukuya kwiiseshoni zonyango, iintlungu ezihlala ixesha elide <iinyanga ezi-3, kunye neentlungu ezincinci okanye ukuphazamiseka kwimisebenzi. Bonke kodwa abathathi-nxaxheba be-7 baqeshwa kwi-GH. Phantse i-90% yabathathi-nxaxheba i-MBSR kunye ne-CBT baya kwiseshoni ye-1 ubuncinci, kodwa yi-51% kuphela kwi-MBSR kunye ne-57% kwi-CBT eya okungenani iiseshoni ezi-6. Kuphela ngama-26% abo bangenangqondo kwi-MBSR abaye kwi-6-hour retreat. Amanqanaba okuphendula ngokulandelelana asukela kuma-89.2% kwiiveki ezi-4 ukuya kuma-84.8% kwiiveki ezingama-52, kwaye ebephezulu kwiqela le-UC.

Kwisiseko, amaqela onyango ayefana nakwimpawu zentlalo kunye neempawu zentlungu ngaphandle kwabafazi abaninzi kwi-UC kunye nabambalwa abaphumelele kwiikholeji kwi-MBSR (1 Table). Ngaphezulu kwe-75% uxele ubuncinci unyaka ukusukela ngeveki ngaphandle kwentlungu yangasemva kwaye uninzi lwentlungu luxeliweyo okungenani kwi-160 yeentsuku ezili-180 ezidlulileyo. Amanqaku e-RDQ (11.4) kunye neempawu zokukhathaza iintlungu (6.0) zibonise amanqanaba aphakathi obukhali. Iipesenti ezilishumi elinanye zichaze ukusebenzisa i-opioids kwintlungu yabo kwiveki ephelileyo. Iipesenti ezilishumi elinesixhenxe ubuncinci ubuncinci benqanaba lokudakumba (amanqaku e-PHQ-8? 10) kunye ne-18% ubuncinci banamanqanaba aphakathi oxinzelelo (amanqaku e-GAD-2? 3).

Iziphumo eziPrayimari

Kwiphepha lokugqibela eliphambili le-26-veki, amaqela ahluka kakhulu (P = 0.04) ngepesenti kunye nophuculo olunentsingiselo kwi-RDQ (MBSR 61%, UC 44%, CBT 58%; 2 Table). Abathathi-nxaxheba abangahleliyo kwi-MBSR babenamathuba amaninzi kunalawo angahleliwe ukuya kwi-UC ukubonisa uphuculo olunentsingiselo kwi-RDQ (RR = 1.37; 95% CI, 1.06 1.77), kodwa ayizange yahluke kakhulu kuleyo ye-CBT. Ukwahluka ngokubanzi phakathi kwamaqela ekuphuculweni okubonakalayo kweklinikhi kwintlungu yokukhathazeka kwiiveki ezingama-26 kwakubaluleke kakhulu (MBSR 44%, UC 27%, CBT 45%; P = 0.01). Abathathi-nxaxheba abangahleliyo kwi-MBSR babenokubonisa ukuphucuka okunentsingiselo xa kuthelekiswa ne-UC (RR = 1.64; 95% CI, 1.15 2.34), kodwa hayi xa kuthelekiswa ne-CBT (RR = 1.03; 95% CI, 0.78-1.36). Ukwahluka okuphawulekayo phakathi kwe-MBSR kunye ne-UC, kunye nokungafani okungafaniyo phakathi kwe-MBSR kunye ne-CBT, kwipesenti kunye nomsebenzi onentsingiselo kunye nokuphuculwa kweentlungu kuqhubeka kwiiveki ezingama-52, ezinobungozi obufanayo obufana nezo kwiiveki ezingama-26 (Itheyibhile 2a). I-CBT yayingaphezulu kwe-UC kwiziphumo ezibini eziphambili kwi-26, kodwa hayi i-52, iiveki. Iziphumo zonyango zazingabonakali ngaphambi kokuphela konyango (iiveki ezisibhozo). Ngokubanzi iziphumo ezifanayo zafunyanwa xa iziphumo zokuqala zahlalutywa njengezinto eziqhubekayo, nangona umahluko wawubalulekile ngokweeveki ze-8 kwaye iqela le-CBT liphucule ngaphezulu kweqela le-UC kwiiveki ezingama-8 (52 Table).

Iziphumo ze-2A eziPrayimari eziPrayimari

Ithebula 2A: Iziphumo zaseprayimari: Ipesenteji yabathathi-nxaxheba ngokuphuculwa kwentsholongwane enokwakheka kweentlungu ezingapheliyo kwiqela lonyango kunye neengozi ezinxulumene namaqela ezonyango (Uhlalutyo oluCwangcisiweyo oluhlaziyo).

Ithebula 2B: Iziphumo eziphambili eziphambili: Kuthetha (i-95% CI) utshintsho kwiintlungu ezingaphantsi ezingapheliyo kwiqela lonyango kwaye lithetha (i-95% CI) umahluko phakathi kwamacandelo ezonyango (Uhlalutyo oluCwangcisiweyo lokuhlaziywa).

Iziphumo eziPhezulu

Iziphumo zempilo yengqondo (ukuxinezeleka, ukuxhalabisa, i-SF-12 Ingxube Yengqondo) yahluke kakhulu kumaqela kwi-8 kunye ne-26, kodwa ingekho i-52, iiveki (Itheyibhile 3). Phakathi kwala manqanaba kunye namaxesha, abathathi-nxaxheba abangenakulinganiswa kwi-MBSR banokuphucula ngaphezu koo-RC kuphela kwi-UC kuphela kwixinzelelo kunye ne-SF-12 yeCental Component amanyathelo kwiiveki ze-8. Abathathi-nxaxheba abangenakulinganiswa kwi-CBT baphuculwe ngaphezu kwezo zintsholongwane kwi-MBSR ekudakaleni kwiiveki ze-8 kunye nexhala kwiiveki ze-26, kwaye ngaphezu kweqela le-UC kwi-8 kunye ne-26 kwiiveki kuzo zonke iindlela ezintathu.

Ithebula 3: Iziphumo ezisesekondari zeqela lonyango kunye nokuqhathaniswa kweqela-phakathi (Ukuhlaziywa kohlalutyo oluhlaziyo).

Amaqela ahluke kakhulu ekuphuculeni kwintlungu ebonakalayo kuyo onke amaxesha amathathu, ngokuphucula okukhulu kwi-MBSR kunye ne-CBT kunokuba ku-UC kwaye akukho mmahluko omkhulu phakathi kwe-MBSR kunye ne-CBT. Akukho nantlukwano epheleleyo kwimiphumo yonyango yabonwa kwi-SF-12 yePhysical score okanye amanqaku ayenziwa ngokuzenzekelayo ngamachiza ngenxa yentlungu. Amaqela ahluke kwii-26 kunye nee-52 iiveki ekuphuculweni kwehlabathi jikelele, kunye neqela le-MBSR kunye ne-CBT libika ukuphucula okukhulu kuneqela le-UC, kodwa lingafani nakakhulu.

Amava amaninzi

Abangamashumi amathathu be-103 (29%) abathathi-nxaxheba abaya kwixeshana ze-1 MBSR babike amava amaninzi (okwethutyana kwandisa intlungu nge yoga). Abathathi-nxaxheba be-100 (10%) abaye baye kwiseshoni enye ye-CBT kwiseshoni babika amava amaninzi (okwenzakala okwenzisayo okwethutyana kunye nokuphumula kwemizimba). Akukho ziganeko ezibi kakhulu ezichazwe.

UDkt Jimenez White Coat

Insight of Dr. Alex Jimenez

Ulwaphulo lolawulo lwengcinezelo lubandakanya ukudibanisa iindlela zokulawula uxinzelelo kunye nobuchule kunye nokuguquka kwendlela yokuphila ukunceda ukuphucula nokulawula uxinzelelo kunye neempawu ezihambelana nazo. Ngenxa yokuba wonke umntu uyasabela kwingcinezelo kwiindlela ezahlukeneyo, unyango loxinzelelo luya kuhluka ngokuxhomekeke kwimpawu ezithile umntu ahlangabezana nazo kwaye ngokubhekiselele kumgangatho wabo wobunzima. Ukunyamekela kwe-Chiropractic yinkqubo efanelekileyo yokuphathwa kwengcinezelo eyanceda ukunciphisa uxinzelelo olungapheliyo kunye neempawu ezichaphazelekayo ngokunciphisa intlungu kunye nokuxhatshazwa kwemisipha kwizakhiwo ezijikeleze umgudu. Ukungalungiswanga kwamagulane, okanye ukuxilongwa, kunokudala uxinzelelo kunye nezinye iimpawu, ezinjengentlungu ephantsi ye-back and sciatica. Ukongezelela, iziphumo zengqaku engentla zibonise ukuba ukunciphisa uxinzelelo lokukhathazeka kwengqondo, okanye i-MBSR, yinkqubo yokulawula uxinzelelo oluphezulu kubantu abadala abaneentlungu ezingapheliyo.

ingxoxo

Phakathi kwabantu abadala abane-CLBP, zombini i-MBSR kunye ne-CBT zikhokelela ekuphuculweni okukhulu kwintlungu yangemva kunye nokunciphisa ukusebenza kwi-26 kunye ne-52 iiveki, xa kuthelekiswa ne-UC. Kwakungekho nantlukwano ebonakalayo kwiziphumo phakathi kwe-MBSR kunye ne-CBT. Iziphumo zazingumodareyitha ngobukhulu, obuqhele ukwenziwa kunyango olusekwe kubungqina olucetyiswayo lwe-CLBP [4]. Ezi zibonelelo ziyamangalisa zinikwe ukuba kuphela yi-51% yezo zingenangqondo kwi-MBSR kunye ne-57% yabo balandelwe i-CBT? 6 yeeseshoni ezi-8.

Iziphumo zethu zihambelana nezigqibo zokuhlaziywa kwe-2011 [35] ukuba ukungenelela kwe-ceptcceptance-based such as MBSR ineempembelelo ezincedo kwimpilo yengqondo nangokwengqondo yezigulane ezineentlungu ezingapheliyo, ezifana nezo ze-CBT. Zihambelana kuphela nenye enye i-RCT enkulu ye-MBSR ye-CLBP [13], eyafumanisa ukuba i-MBSR, xa kuthelekiswa nexesha- kunye neqela lokulawula imfundo yezempilo ehambelana nexesha, kwaye inikezela ngezibonelelo zomsebenzi emva konyango (kodwa hayi Ukulandelwa kweenyanga ezi-6) kunye nentlungu eqhelekileyo ekulandeleni inyanga ezi-6 (kodwa hayi emva konyango). Umahluko ohlukeneyo phakathi kwetyala lethu kunye nelabo (ebelilinganiselwe kubantu abadala? Iminyaka engama-65 kwaye inemeko eyahlukileyo yokuthelekisa) inokuba noxanduva lokwahluka kweziphumo.

Nangona uvavanyo lwethu lungekho mqathango olawulayo ngenxa yokungabikho kwempembelelo yomqeqeshi kunye nokuthatha inxaxheba kweqela, i-CBT kunye ne-MBSR ziye zaboniswa ukuba zisebenza ngakumbi kunokuba zilawulwe kwaye zisebenze ngokungenelela kwiimeko zentlungu. Ukongezelela kwilingo labantu abadala asebekhulile nge-CLBP [14] efumene i-MBSR ukuba isebenze ngakumbi kunemeko yokulawulwa kwemfundo yezempilo, ukuhlaziywa kwe-CBT kwindlela esandul ekuphuculeni intlungu kunye nokukhubazeka ngokulandelelana kwexesha elide kunye nexesha elide [7]. Uphando olongezelelweyo lufunekayo ukuchonga amodareyitha kunye nabalamlamli beempembelelo ze-MBSR malunga nomsebenzi kunye nentlungu, ukuvavanya iingenelo ze-MBSR ngaphaya komnyaka omnye, kwaye zichonge ixabiso lentsebenzo. Uphando luyafuneka kwakhona ukuchonga izizathu zeseshoni ezingekho ukuhamba kunye nezindlela zokwandisa ukuhamba, kunye nokuchonga inani elincinane leeseshoni ezifunekayo.

Ukufumana kwethu ukunyuka kokusebenza kwe-MBSR kwiiveki ezingama-26-52 ezinxulumene nonyango lwasemva kokubini kwiziphumo zokuqala ezichaseneyo nokufunyenwe kwizifundo zethu zangaphambili zokucoca umzimba, ukubhucunga umzimba kunye neyoga eqhutywa kuluntu olunye nolingo lwanamhlanje [30, 36, 37 ]. Kwezi zifundo, iziphumo zonyango ziye zehla phakathi kokuphela konyango (i-8 ukuya kwi-12 iiveki) kunye nokulandelwa kwexesha elide (i-26 ukuya kwi-52 iiveki). Iziphumo ezihlala ixesha elide ze-CBT ze-CLBP zixeliwe [7, 38, 39]. Oku kuphakamisa ukuba unyango lomzimba olunjenge-MBSR kunye ne-CBT lunokubonelela abaguli ngezakhono ezihlala ixesha elide ezisebenzayo zokulawula iintlungu.

Kwakukho ukungafani phakathi kwe-CBT kunye ne-UC ngaphezu kwe-MBSR kunye ne-UC kumanyathelo okukhathazeka kwengqondo. I-CBT yayiphezulu kwi-MBSR kwinqanaba lexinzelelo kwiiveki ze-8, kodwa ukumahluko phakathi kwamaqela kwakuncinane. Ngenxa yokuba isampuli ayinakuxinezeleka kakhulu kwisiseko, uphando olongezelelweyo lufunekayo ukuthelekisa i-MBSR kwi-CBT kwimeko yesigulane esicinezelekileyo.

Imilinganiselo yale sifundo mayiyivunyelwe. Abafundi abathathi-nxaxheba babhalise kwinkqubo eyodwa yokunakekelwa kwezempilo kwaye bafunde ngokubanzi. Ubuninzi bokufumana iziphumo kwezinye izicwangciso kunye nabantu abaziwayo. Ngokumalunga ne-20% yabathathi-nxaxheba abangazange bafumaneke kwi-MBSR kunye ne-CBT balahlekelwa ukulandelelana. Sizama ukulungisa i-bias kwi-data engekhoyo ekuhlalutheni kwethu ngokusebenzisa iindlela zokubhaliweyo. Ekugqibeleni, ukufunyanwa kwezinto ezifunyenweyo kwi-CBT ezithunyelwe kumntu kunokuba ifomathi yeqela ayiziwa; I-CBT inokuphumelela xa ikhutshwa ngabanye [40]. Amandla okufundela afaka isampula enkulu kunye namandla afanelekileyo okufumana izibalo ukufumana iziphumo ezinokliniki, ukuhambelana okufutshane kwe-MBSR kunye ne-CBT ukungenelela kwifomathi, kunye nokulandelwa kwexesha elide.

izigqibo

Imibulelo

Inkxaso-mali / Inkxaso: Uphando oluchaziweyo kolu papasho luxhaswe liZiko leSizwe leMpilo eQinisekayo kunye neHlanganisiweyo yamaZiko ezeMpilo kaZwelonke phantsi kweNombolo yeBhaso R01AT006226. Umxholo luxanduva lwababhali kuphela kwaye ayimelanga izimvo ezisemthethweni zamaZiko ezeMpilo kaZwelonke.

Inxaxheba yomxhasi: Uphononongo oluthile aluzange lube nenxaxheba ekwakheni nasekuqhubeni isifundo; ukuqokelela, ulawulo, uhlalutyo, nokutolika kwedatha; ukulungiselela, ukuhlaziywa, okanye ukuvunywa kwincwadi yesandla; okanye isigqibo sokungenisa eso sikripthi sokushicilela.

Imihlathi

Ncbi.nlm.nih.gov/pmc/articles/PMC4914381/

I ngcaciso

UDaniel C. Cherkin, IQumrhu loPhando lwezeMpilo; Amasebe eNkonzo zezeMpilo kunye nonyango lwezeMpilo, kwiYunivesithi yaseWashington.
UKaren J. Sherman, iQumrhu loPhando lwezeMpilo; ISebe le-Epidemiology, iYunivesithi yaseWashington.
UBenjamin H. Balderson, i-Group Health Research Institute, iYunivesithi yaseWashington.
Andrea J. Cook, iQela loPhando lwezeMpilo; Isebe le-Biostatistics, iYunivesithi yaseWashington.
UMelissa L. Anderson, IQumrhu lePhando lwezeMpilo, iYunivesithi yaseWashington.
URene J. Hawkes, i-Group Health Research Institute, iYunivesithi yaseWashington.
UKelly E. Hansen, IQumrhu lePhando lwezeMpilo, iYunivesithi yaseWashington.
UJudith A. Turner, iSebe leZengqondo kunye neNzululwazi yeNtsebenzo kunye neMpilo yoLungiso, kwiYunivesithi yaseWashington.

Ukuququmbela,Ukhathalelo lwe-irchiropractic lubonwa njengonyango olusebenzayo lokunyanga uxinzelelo lweentlungu ezisezantsi kunye ne-sciatica. Kuba uxinzelelo olungapheliyo lunokubangela imicimbi eyahlukeneyo yezempilo ekuhambeni kwexesha, ukuphucula kunye nokulawula uxinzelelo ngokufanelekileyo kubalulekile ekufezekiseni impilo kunye nokuba sempilweni. Ukongeza, njengoko kubonisiwe kwinqaku elingentla ukuthelekisa iimpembelelo zokunciphisa uxinzelelo lwengqondo kunye nonyango lokuziphatha kunye nokunyamekela kwesiqhelo uxinzelelo olunxulumene nentlungu engapheliyo, ukunciphisa uxinzelelo kwengqondo, okanye i-MBSR, iyasebenza njengonyango lolawulo loxinzelelo . 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

Imixholo eyongezelelweyo: Ubunzima bokubuyisela

umfanekiso webhlogi weendaba eziphambili zephepha lephepha

ISIHLOKO ESIBALULEKILEYO: Ukulawula uxinzelelo lomsebenzi

IINGXELO EZIBALULEKILEYO: UKUPHATHA KWE-EXTRA: Ukukhetha i-Chiropractic? | Familia Dominguez | Izigulane | El Paso, TX I-Chiropractor

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Vala i-Accordion

Iindlela zokuLawula uxinzelelo kwi-Pain Pain e-El Paso, TX

by iicrosoft | Ubuhlungu obungapheliyo, Iimeko eziPhathwayo, Uvavanyo oluLungeleleneyo oluLungisiweyo, Unyango

Kwihlabathi lanamhlanje, kulula ukufumana iimeko zokuxinezeleka malunga. Kungakhathaliseki ukuba kubandakanya umsebenzi, iingxaki zemali, ukukhawuleza kwezempilo, iingxaki zolwalamano, ukukhuthazwa kweendaba kunye / okanye ezinye izinto, uxinzelelo lunokuqala ukujonga ubunzima kwimpilo yethu yonke kunye nokuphila kakuhle xa kungagcinwe kakuhle. Kananjalo, sivame ukuzenza uxinzelelo ngokwenza ukutya okunqongileyo kunye nokungabikho kokulala.

Ngapha koko, ngaphezulu kwesithathu kwisine sabantu eUnited States bafumana uxinzelelo rhoqo, apho isinye kwisithathu sabo bantu babonakalisa amanqanaba oxinzelelo njengo "gqithisileyo". Nangona uxinzelelo lwexesha elifutshane lunokuba luncedo, uxinzelelo lwexesha elide lunokukhokelela kwimicimbi eyahlukeneyo yezempilo. Uxinzelelo luthathelwe ingqalelo njengonobangela wezifo ezininzi, iingcali kwezempilo ziqikelela ukuba zinika isiqingatha seendleko ezinxulumene nokhathalelo lwempilo lwelizwe, ngokwe-US News & World Report.

Ukuxinezeleka Kuchaphazela njani iBhunga

Ukuxinezeleka kubonakalisa inkqubo yesantya evelisa ulwalamano, ukulungiselela ukuphendula okanye "ukulwa okanye ukuhamba," indlela yokukhusela eyilungisa umzimba ngenxa yengozi yokubangela intliziyo, umthamo wegazi kunye negazi. Oku kunciphisa igazi kude kwinkqubo yokutya kunye neengalo. Iimbumba ze-adrenal nazo zihambisa umxube okhethekileyo wamahomoni kunye neekhemikhali, kubandakanya i-adrenaline, i-epinephrine kunye ne-norepinephrin, enokuchaphazela impilo yabantu xa ihlala ifihliwe emzimbeni.

Kwakhona, uxinzelelo olungapheliyo lunokubangela ukuxhatshazwa kwemisipha. Ukuxhatshazwa kwemisipha okweqile entanyeni nasemva kungabangela ukugqithiswa komgudu, owaziwa njenge-subluxation, ekugqibeleni ukuphazamisa umsebenzi ofanelekileyo wesistim kunye nokwenza iimpawu umqolo obuhlungu kwaye sciatica. Ngethamsanqa, iindlela ezahlukeneyo zokulawula uxinzelelo, kubandakanya ukunakekelwa kwe-chiropractic nokucamngca kwengqondo, kunokukunceda ukunciphisa Ubuhlungu obungapheliyo, ngokuqhelekileyo idibene nokuxinezeleka okungapheliyo.

Ukunyamekela Ukunyamezela Ingqondo

Ukunyamekela kwe-Chiropractic yinto eyaziwayo, enye indlela yokwelapha esetyenziselwa ukunyanga iintlobo ezahlukeneyo zokulimala kunye neemeko ezinxulumene ne-musculoskeletal kunye ne-system ye-nervous.Ukulungisa ukungalunganga komgudu linyathelo lokuqala lokunciphisa uxinzelelo. Ukuba kukho i-subluxation emqolo, inkqubo ye-neva isenokungakwazi ukuthumela imiqondiso ngokufanelekileyo kuwo wonke umzimba. Ngokusebenzisa uhlengahlengiso lomqolo kunye nokusetyenziswa kwemanyuwali, ugqirha we-chiropractic unokulungelelanisa ngononophelo umqolo, ukhulule uxinzelelo lwezihlunu, uthomalalise iintlungu zomqolo kunye nokuphucula ukuhamba kwegazi, utshintsho olunokwazisa ingqondo ukuba icime impendulo "yokulwa okanye yokubaleka" umzimba ungabuyela kwimeko ekhululeke ngakumbi.

Ukongezelela, i-chiropractor inokuphinda icebise ukuguqulwa kwendlela yokuphila, kunye nokuguqulwa komgudu kunye nokusetyenziswa kweencwadi, ukukunceda ukunciphisa uxinzelelo. Ukuncedisa okunomsoco, ukulungiswa kokuvuselela, ukuxilongwa kwe-tissue massage, ubuchule bokuphucula kunye nokuguquka kwendawo yokucetyiswa yi-chiropractor ziinkqubo ezininzi zokulawula uxinzelelo ezinokukunceda ukuphucula iimpawu zentlungu engapheliyo ehambisana noxinzelelo. Inqaku elilandelayo lihlolisiso oluchanekileyo kunye nohlalutyo lweemeta olubonisa ukusetyenziswa kweempawu zengqondo zentlungu engapheliyo, kubandakanywa intlungu emva kunye ne-sciatica.

Ukucamngca Ukucamngca Ngeengxaki Ezingapheliyo: UkuHlola ngokuHlolo kunye nokuhlaziywa kweMeta

Abstract

imvelaphi: Izigulane ezingapheliyo zihlala zifuna unyango ngokucamngca ngengqiqo.
Injongo: Olu pho nonongo lujolise ekuveliseni ubungqina malunga nokusebenza ngokukhuselekileyo kunye nokukhusela kokungcungcutheka kwengqondo kwindlela yokunyangwa kwentlungu engapheliyo kubantu abadala.
Indlela: Senze uhlolo oluhlelekile kwiilingo ezilawulwa ngokungenamthetho (RCTs) kunye nokuhlaziya i-meta-esebenzisa i-Hartung-Knapp-Sidik-Jonkman indlela yokwenza imizekelo engafanelekanga. Ubungqina bobuchule buhlolwe ngokusetyenziswa kwe-GRADE. Iziphumo zazibandakanya intlungu, ukuxinezeleka, umgangatho wobomi kunye nokusetyenziswa kwe-analgesic.
iziphumo: IiRCT ezingamashumi amathathu nesibhozo zidibene neenqobo zokungena; ezisixhenxe zichazwe ngokukhuseleko. Sifumene ubungqina obuncinane bokucamngca kwengqondo kudibene nokuncipha okuncinci kwentlungu xa kuthelekiswa nazo zonke iintlobo zolawulo kwi-30 RCTs. Imiphumo ebalulekileyo yesistim yafunyanwa kwakhona kwiimpawu zokudandatheka kunye nomgangatho wobomi.
Izigqibo: Nangona ukucamngca kwengqondo kukuphucula intlungu kunye neempawu zokudandatheka kunye nomgangatho wobomi, kufuneka i-RCT edibeneyo eyenziwe kakuhle, ekhuselekileyo kunye neyokhulu ukubonelela ngokukhawuleza ukuphumelela kokucamngca ngengqondo ngenxa yobuhlungu obungapheliyo.
Izinto ezixhasayo zekhompyutha: Inguqulelo ye-intanethi yale nqaku (i-doi: 10.1007 / s12160-016-9844-2) iqulethe izinto ezongezelelweyo, ezifumaneka kubasebenzisi abagunyazisiweyo.
Internet: Ubuhlungu obungapheliyo, Ukuqonda, Ukucamngca, Ukuphonononga ngokuchanekileyo

intshayelelo

Ubuhlungu obungapheliyo, obuhlala buchazwa njengentlungu ehlala ixesha elide kuneenyanga ezi-3 okanye ezidlulileyo kwixesha eliqhelekileyo lokunyanga izicubu [1], kunokukhokelela kwiziphumo zonyango, ezentlalontle kunye nezoqoqosho, imiba yobudlelwane, imveliso elahlekileyo, kunye neendleko ezinkulu zokhathalelo lwempilo. IZiko lezeMpilo liyayamkela intlungu njengengxaki yempilo yoluntu ebiza ilizwe lethu ubuncinci i-560-635 yezigidigidi ngonyaka, kubandakanya iindleko zokhathalelo lwempilo kunye nemveliso elahlekileyo [2]. Ukuqhubela phambili, iintlungu ezingapheliyo zihlala zihamba kunye nokuphazamiseka kwengqondo njengokunyanga ngamayeza kunye nokudakumba okwenza unyango lube nzima [3]. Ukuxhaphaka okuphezulu kunye nohlobo lokuchasana kwintlungu engapheliyo, ngokudibeneyo kunye neziphumo ezibi zokuxhomekeka kwamayeza eentlungu, kukhokelele ekunyuseni umdla kwizicwangciso zonyango ezibandakanya unyango lokudibanisa okanye ezinye iindlela zonyango [4]. Enye yeendlela zokuziphatha ezisetyenziswa zizigulana kukucamngca ngengqondo. Ngokusekwe kwiindlela zakudala zokucamngca zaseMpuma, ingqondo iququzelela imeko yokuqwalaselwa. Iphawuleka ngokunika ingqalelo kumzuzu wangoku ngokuvuleka, ukwazi, kunye nokwamkelwa [5, 6]. Ukucamngca ngengqondo kucingelwa ukuba kusebenza ngokugxininisa engqondweni okwangoku kunye nokwandisa ulwazi lwendawo engaphandle kunye novakalelo lwangaphakathi, ukuvumela umntu ukuba abuyele umva kwaye enze amava kwakhona. Uphando lwangoku lusebenzisa i-neuroimaging yokucacisa iindlela ze-neurological ezisisiseko seziphumo zengqondo ezijolise kulwakhiwo lobuchopho njenge-posterior cingate cortex, ebonakala ngathi iyabandakanyeka ekusebenzeni ngokuzimela [7, 8]. Ukusetyenziswa kweklinikhi kwengqondo kubandakanya usetyenziso lweziyobisi gwenxa [9], ukuyeka icuba [10], ukunciphisa uxinzelelo [11], kunye nonyango lweentlungu ezingapheliyo [12-14].

Izifundo zokuqala kwengqondo kwizigulane ezibuhlungu zibonisa iziphumo ezithembisayo kwiimpawu zentlungu, ukuphazamiseka kwemizwelo, ukuxhalabisa, nokuxinezeleka, kunye nokusetyenziswa kweziyobisi ezinxulumene nobuhlungu [5]. Ukuphononongwa ngokubanzi kweziphumo kwiingcamango zengqondo zipapashwe kwiminyaka yamuva. Kulabo abavakalisa iziphumo zentlungu, ezininzi zijolise kwiintlobo ezithile zentlungu ezifana nentlungu ephantsi [13], i-fibromyalgia [15], okanye i-disordination disorder [16]. Ezinye zazingaphelelwanga kwi-RCTs [14, 17]. Kuye kubekho uphononongo olunzulu olunzulu olujoliswe kwizilingo ezilawulwayo zokungenelela kwengqondo yokubandezeleka okungapheliyo kuquka ukuhlaziywa [4] ebonisa ukuphuculwa kwimiqondiso ecinezelekileyo nokunyamezela, olunye uphononongo [18] ekukhunjuleni kwintlungu engapheliyo, i-fibromyalgia, kunye neentlungu ze-musculoskeletal ezibonisa iziphumo ezincinci zentlungu, kunye nokuphononongwa kwangoku [19] kwiimeko ezininzi zeentlungu ezithe zafumana ukuphucula intlungu, ukwamukelwa kwentlungu, umgangatho wobomi kunye nesimo sokusebenza. Ababhali balezi ngxelo bavakalisa ukukhathazeka ukuba kukho ubungqina obuncinane bokungenelela kokungenelela kwengqondo kwizigulane ezinentlungu engapheliyo ngenxa yeendlela zokwenza izinto. Baphetha ukuba uphando olongezelelweyo oluphezulu luyimfuneko ngaphambi kokuba kuphakanyiswe ukucamngca kwengqondo malunga neempawu zentlungu ezingapheliyo.

Injongo yale sifundo kwakukuqhuba ukuhlaziywa ngendlela echanekileyo kunye nokuhlaziywa kweemitha zengqondo kunye nokukhusela kokucamngca kwengqondo, njengesigqibo okanye i-monotherapy ukuphatha abantu abaneentlungu ezingapheliyo ngenxa ye-migraine, intloko yesifo, intlungu emva, i-osteoarthritis, okanye intlungu ye-neuralgic xa kuthelekiswa unyango njengesiqhelo, uluhlu lokulinda, akukho unyango, okanye ezinye iindlela zokhathalela. Ubuhlungu beyona miphumo ephambili, kwaye iziphumo ezizimbini ziquka ukudakumba, umgangatho wobomi kunye nokusetyenziswa kwe-analgesic. Umgaqo-nkqubo wokuhlaziywa ngokuchanekileyo ubhalisiwe kwi-registry yehlabathi jikelele ukuhlolwa kweenkqubo (PROSPERO 2015: CRD42015025052).

tindlela

Isicwangciso soPhando

Sikhangele kwiziseko zedatha ze-elektroniki ze-PubMed, i-Cumulative Index to Nursing and Allied Health Literature (CINAHL), iPsycINFO, kunye neCochrane Central Register yeZilingo ezilawulwayo (CENTRAL) kwizilingo ezilawulwa ngolwimi lwesiNgesi ukusuka kuJuni ka-2016. Sidibanise iimeko zentlungu kunye amagama ayilwayo ngala magama alandelayo okuphendla kwengqondo: Ukucinga] [Mesh]) okanye Ukucamngca] [Mesh] okanye ingqondo ? Na okanye anapanasati okanye iZen okanye iPranayama okanye iSudarshan okanye iKriya okanye i-zazen okanye i-shambhala okanye i-buddhis * .Ukongeza kolu phando kunye nokumbiwa kwemigca ekubhekiswa kuyo kuzo zonke izifundo ezibandakanyiweyo, sibhekisa kuvavanyo lwangaphambili olucwangcisiweyo kwaye sabuyisa zonke izifundo ezibandakanyiweyo .

Ulungelelwaniso olufanelekileyo

Iqela elifanayo, i-RCT yabantu okanye iqoqo labantu abadala abavakalisa iintlungu ezingapheliyo zifakiwe. Izifundo apho umbhali echaze ubuhlungu obungapheliyo kunye nezifundo kwizigulana ezivakalisa intlungu ubuncinane beenyanga ezili-3 zifakiwe. Izifundo zafuneka ukuba zibandakanye ukucamngca ngengqondo, njengokuba isilungiselelo okanye i-monotherapy; uphando olwenziwe ngongoma olunzulu lwe-yoga, tai chi, qigong, kunye nobuchule bokucamngca ngaphandle kokubhekisela kwengqondo. Ukungenelela kwengqondo engazange ifune ukucamngca ngokusemthethweni, njengokwamkelwa kunye nokuzibophelela ngonyango (UMTHETHO) nawo akhankanywe. Izifundo kuphela ezichaze amanyathelo entlungu okanye utshintsho ekusetshenzisweni kwe-analgesic zifakiwe. Ukukhutshiswa kunye neenkomfa eziye zafakwa ngaphandle.

Iinkqubo

Abavavanyi babini abazimeleyo bahlolwe izihloko kunye nezicatshulwa zokufumana) ukulandela iseshoni yokulinga ukuqinisekisa ukutolikwa okufanayo kwenqubo yokubandakanywa kunye nokukhuphela. Izicatshulwa ezigwetywe njengokufanelekile ngomntu omnye okanye bobabini abavavanyi bafunyanwa njengombhalo opheleleyo. Ushicilelo olupheleleyo lwetekisi emva koko lwaphononongwa ngokuchasene neenqobo zokufaka ezichaziweyo. Ukuhamba kwezicatshulwa kuyo yonke le nkqubo kwabhalwa kwiziko ledatha le-elektroniki, kwaye izizathu zokukhutshelwa kupapasho olupheleleyo. Ukukhutshwa kwedatha kwaqhutywa kabini. Umngcipheko wokhetho wavavanywa kusetyenziswa iCchrane Risk yesixhobo seBias [20]. Olunye ucalucalulo olunxulumene ne-USPSTF yeekhrayitheriya zoThintelo lweeNkonzo zoThintelo (USPSTF) zokuqinisekiswa kwangaphakathi kwezifundo ezibandakanyiweyo kuvavanyiwe [21, 22]. Ezi nqobo zisetyenziselwe ukukala umgangatho wobungqina njengobulungileyo, obulungileyo, okanye obuhlwempuzekileyo kwisifundo ngasinye kubandakanya.

Iinkqubo zeMeta-Analytics

Xa idatha eyoneleyo yayifumaneka kwaye i-heterogeneity ye-statistical yayingaphantsi kwemingcele ekuvunyelwene ngayo [20], senze uhlalutyo lweemeta ukubonakalisa iziphumo zokusebenza kuzo zonke kubandakanya izifundo kwiziphumo zomdla kwaye sibonisa indawo yehlathi kuhlalutyo oluphambili lweemeta. Sisebenzise indlela yeHartung-Knapp-Sidik-Jonkman yeziphumo ezingahleliwe zohlalutyo lweemeta kusetyenziswa iindlela ezingalungelelaniswanga kunye nemilinganiselo yokusasazeka [23-25]. Ukufunda ukuphonononga iziphumo ezininzi zentlungu, sisebenzise imilinganiselo ethile yeentlungu, ezinje ngePhepha lemibuzo leMcGill Pain (MPQ) kuhlalutyo oluphambili lweemeta endaweni yesifo esibuhlungu se-SF-36, kunye nomndilili okanye amanyathelo obuhlungu ngokubanzi kunamanyathelo okuma njengentlungu ngexesha lovavanyo. Ngenxa yenani elincinci leziganeko ezimbi ezichaziweyo, uhlalutyo lobungakanani aluzange lwenziwe. Senze uhlalutyo lwamagqabantshintshi kunye ne-meta-regressions ukujongana nokuba ngaba kukho umahluko kubungakanani bezinto phakathi kweendlela zongenelelo ezahlukeneyo, abantu, okanye xa zisetyenziswa njenge-monotherapy ngokuchaseneyo nonyango olusebenzayo. Umgangatho womzimba wobungqina wavavanywa kusetyenziswa indlela ye-GRADE [22, 26] apho ukumiselwa okuphezulu, okuphakathi, okuphantsi, okanye okuphantsi kakhulu kwenziwa kwisiphumo ngasinye esikhulu [27].

iziphumo

Inkcazo yeZifundo ezifakiwe

Sichonge izikhalazo ezingama-744 ngophendlo lwedatha ye-elektroniki kunye neerekhodi ezili-11 ezongezelelweyo ezichongiweyo kweminye imithombo (jonga umfanekiso 1). Imibhalo epheleleyo yafunyanwa kwizicatshulwa ezingama-125 ezichongiweyo njengezinokuthi zifaneleke ngabavavanyi abazimeleyo; Ii-RCT ze-38 zidibene neekhrayitheriya zokufakwa. Iinkcukacha zeempawu zokufunda zibonisiwe kwiTheyibhile? 1 kunye nefuthe kwizifundo ezizodwa zibonisiwe kwiTheyibhile? 2.

Itheyibhile ye1 Iinkalo zezifundo ezifakiwe

Ithebula 1: Iinkalo zezifundo ezifakiwe.

Itheyibhile ye-2 Imiphumo yezifundo ezizimeleyo

Ithebula 2: Iimpembelelo zezifundo ngamnye.

Ngokupheleleyo, izifundo ezibelwe abaxhamli be-3536; Isampula ubukhulu besuka kwi-19 ukuya kwi-342. Izifundo ezilishumi elinesibini zachaza ukubalwa kwamandla okuqala kunye nesayizi yeesampula ekujoliswe kuyo, izifundo ezilishumi azizange zichaze ulwazi malunga nokubala kwamandla, kwaye izifundo ezintathu zazingabonakali ekubaleni kwamandla okubala. Izifundo ezilishumi zichazwe kwakukho amandla aneleyo; Ababhali baqwalasela ezi zifundo. Uninzi lwezifundo lwaqhutywa eNyakatho yeMerika okanye eYurophu. Ixesha elidlulileyo labathathi-nxaxheba lusetyenziswa kwi-30 (SD, 9.08) ukuya kwi-78 iminyaka (i-SD, i-7.1.

Iziganeko zonyango zichazwe ziquka i-fibromyalgia kwizifundo ezisibhozo kunye nentlungu emva kwizifundo ezisibhozo. (Izigaba azihambelani ngokuthe ngqo; ezinye iifundo ziquka izigulane ezineemeko ezahlukeneyo.) I-Osteoarthritis yaxelwa kwizifundo ezimbini kunye ne-rheumatoid arthritis emithathu. Intloko ye-Migraine yaxelwa kwizifundo ezintathu kunye nolunye uhlobo lweentloko ezifundweni ezintlanu. Izifundo ezintathu zichazwe isifo sengqondo sesifo esilumkileyo (IBS). Izifundo ezisibhozo zivakalise ezinye izizathu zentlungu kunye nezifundo ezintathu azichazi imeko yonyango okanye umthombo wentlungu engapheliyo.

Ubungakanani bexesha lokungenelela luvela kwi-3 ukuya kwiiveki ze-12; Uninzi lwongenelelo (izifundo ze-29) zaziyiiveki ze-8 ubude. Izifundo ezingamashumi amabini nanye zaqhutyelwa ekunciphiseni uxinzelelo lokuxinwa kwengqondo (MBSR) kunye neyesithandathu kwi -rapy-based cognitive therapy (MBCT). Izifundo ezongezelelweyo ezilishumi elinanye zibikwe iziphumo kwezinye iindidi zokuqeqeshwa kwengqondo. I-RCT yeshumi elinesithathu ihlinzekele ukungenelela kwengqondo njenge-monotherapy, kwaye ishumi elinesibhozo sisebenzise ukungenelela kwengqondo njengoluphi unyango oluchanekileyo, olucacisa ukuba bonke abathathi-nxaxheba bafumene oku ngaphezu kweminye unyango njengamachiza. Izifundo ezisixhenxe zazingacacanga malunga nokuba ukungenelela kwengqondo kwakuyi-monotherapy okanye unyango oluthile. I-RCT ezilishumi elinesihlanu zasebenzisa unyango njengesiqhelo njengabaqhathanisayo, abathathu abasebenzisa iifomati ezingabonakaliyo, kunye namaqela asetyenziswe imfundo / inkxaso asetyenzisiweyo. Ngaphandle kwezi fomati eziqhelekileyo, olunye uphando lusetyenziswa ukulawulwa kwengcinezelo, ukusilalisa, ukungenelela kweentlungu ezininzi, ukuphumula / ukunweba, kunye nolwazi olunempilo / idayari zokutya njengoko zifana; Izifundo ezimbini zasebenzisa i-cognitive-behavioral therapy. Uphando oluninzi lwaba neengalo ezimbini.

Umgangatho woFundo kunye neengozi zeBhasi

Umgangatho wokufunda kwisifundo ngasinye ubandakanyiwe ubonakalisiwe kwiTheyibhile? 1. Izifundo ezilishumi elinanye zifumene inqanaba le- good esemgangathweni [28-38]. Izifundo ezilishumi elinesine zagwetywa ukuba zikumgangatho ofanelekileyo, ikakhulu ngenxa yokungacaci kweminye yeendlela [39-52]. Izifundo ezilishumi elinesithathu zagwetywa njengezintlupheko; ishumi ikakhulu ngenxa yemicimbi enokuphelela kwengxelo yesiphumo sokungafumaneki okanye esilahlekileyo sokunyanga (ITT) uhlalutyo kunye / okanye ngaphantsi kwama-80% okulandela [53-62] kwaye ezintathu ngenxa yeendlela ezingacacanga [63-65]. Iinkcukacha zokulinganiswa komgangatho kunye nomngcipheko wokukhetha kwisifundo ngasinye kubandakanyiwe kubonisiwe kwizixhobo ezongezelelweyo ze-1.

Amanyathelo

Izifundo zibike iinkqubo zesifo sengqondo ezifana ne-Visual Analog Scale, i-SF-36 intlungu ehlala phantsi, kunye ne-Questionnaire ye-McGill Pain Questionnaire. Amanyathelo omphumo wesibini afaka iimpawu zoxinzelelo (umzekelo, i-Beck Depression Inventory, i-Questionnaire yeMpilo yePilati yeMpilo), umgangatho wobomi obunempilo kunye nengqondo (umz., I-SF-36 engxenyeni yengqondo kunye nenyama), kunye nokukhubazeka / ukukhubazeka okusebenzayo (umzekelo, uRoland-Morris Imibuzo yokukhubazeka, iShean Disability Scale).

Impendulo Yonyango Yengxaki Ezingapheliyo

Ii-RCT ezingamashumi amathathu zichaze idatha yeziphumo eziqhubekayo kwizikali ezivavanya iintlungu ezingapheliyo [29, 31-33, 36, 39-49, 51-60, 62-64, 66].

Izifundo ezisibhozo zahlangabezana neekhrayitheriya zokubandakanywa kovavanyo kodwa azange zibe negalelo kuhlalutyo lwe-meta kuba khange banike ingxelo yedatha enokubakho [28, 30, 34, 35, 38, 50, 61, 65]. Iimpawu zabo zokufunda zibonisiwe kwiTheyibhile? 1, kunye neziphumo zenqanaba lokufunda kunye nezizathu zokuba zazingekho kuhlalutyo oluhlanganisiweyo zibonisiwe kwiTheyibhile? 2.

Isikali seentlungu kunye nabathelekisi bahluka ukusuka kufundo ukuya kufundo. Ixesha lokulandela eliphakathi yayili-12 iiveki, zinoluhlu lwe-4 ukuya kwi-60 iiveki. Umzobo? 2 bonisa iziphumo zohlalutyo lweemeta kusetyenziswa idatha kolona landiso lude kwisifundo ngasinye. Uhlalutyo oluhlanganisiweyo lubonisa impembelelo ebalulekileyo yokucamngca kwengqondo xa kuthelekiswa nonyango njengesiqhelo, ulawulo lokuhamba, kunye namaqela emfundo / enkxaso (SMD, 0.32; 95% CI, 0.09, 0.54; 30 RCTs). Ubunzulu be-heterogeneity bufunyenwe (I 2 = 77.6%). Kwakungekho bungqina bokupapashwa (Begg sp = 0.26; Uvavanyo lwe-Egger p = 0.09). Ukuphanda ukuba ngaba uqikelelo lonyango lomelele na xa kungabandakanywa izifundo ezikumgangatho ophantsi kunye nokuphonononga imvelaphi enokubakho ye-heterogeneity enkulu, siqhube uhlalutyo lobuntununtunu kubandakanya kuphela izifundo ezifanelekileyo okanye ezilungileyo. Ukuphuculwa kuhlala kubalulekile, ubungakanani besiphumo babuncinci (SMD, 0.19; 95% CI, 0.03, 0.34; 19 RCTs), kwaye kwakungekho heterogeneity encinci (I 2 = 50.5%). I-Meta-regressions ibonise ukuba utshintsho kwiziphumo zentlungu elungileyo- (p = 0.42) kunye nomgangatho olungileyo (p = 0.13) izifundo bezingahlukanga kangako kutshintsho kwizifundo ezikumgangatho ophantsi.

Umzobo 2 Ingqondo Imiphumo yokucamngca kwi-Pain Pain

Umzobo 2: Ingcinga yokucamngca ngengqondo kwiintlungu ezingapheliyo.

Kuhlalutyo lweqela, isiphumo besingabalulekanga ngokweenkcukacha kwiiveki ezili-12 okanye ngaphantsi (SMD, 0.25; 95% CI,? 0.13, 0.63; 15 RCTs; I 2 = 82.6%) kodwa ibalulekile kwixesha lokulandela emva kweeveki ezili-12 ( I-SMD, 0.31; 95% CI, 0.04, 0.59; 14 RCTs, I 2 = 69.0%). Uvavanyo lweBegg lwalungabalulekanga ngokweenkcukacha-manani (p = 0.16) kodwa uvavanyo luka-Egger lwabonisa ubungqina benkcazo yokupapashwa (p = 0.04). Umgangatho wobungqina bokuba ukucamngca ngengqondo kunxulunyaniswa nokwehla kweentlungu ezingapheliyo xa kuthelekiswa nolawulo kuphantsi ngokubanzi kunye nokulandelwa kwexesha elifutshane kunye nexesha elide ngenxa yokungahambelani, ukungafani, kunye nokukhetha ukupapashwa. Itheyibhile eneenkcukacha ibonisa umgangatho wobungqina bokufumana iziphumo kwisiphumo ngasinye esikhulu kwiZinto eziNgezelelweyo ze-Elektroniki 2.

Ukuze sikwazi ukubonisa iziphumo ezinokliniki, sibala utshintsho lweepesenti kwiimpawu zentlungu ukusuka kwisiseko ukuya ekulandeleni ukucamngca kwengqondo kunye namaqela okuthelekisa kwisifundo ngasinye kwaye ubonise iziphumo kwiTable 2. Emva koko sabala inani elipheleleyo lokutshintsha kweepesenti zokucamngca ngokwamaqondo xa kuthelekiswa namaqela okuthelekisa kwiziphumo zokucamngca kwintlungu ekulandeleleni okude. Iipesenti zotshintsho olutshintsho kwiintlungu zokucamngca ngamaqela? Ubuninzi, 0.19). Ixabiso le-p lomahluko phakathi kwamaqela lalibalulekile (p = 0.91).

ukudakumba

Iziphumo zoxinzelelo zichazwe kwii-12 RCTs [29, 31, 33, 34, 45, 46, 48, 49, 51-53, 56]. Ngokubanzi, ukucamngca kunciphise amanqaku oxinzelelo xa kuthelekiswa nonyango njengesiqhelo, inkxaso, imfundo, ulawulo loxinzelelo, kunye namaqela okulawula uluhlu lokulinda (SMD, 0.15; 95% CI, 0.03, 0.26; 12 RCTs; I 2 = 0%). Akukho heterogeneity ifunyenweyo. Umgangatho wobungqina ukalwe njengophakamileyo ngenxa yokunqongophala kwe-heterogeneity, iziphumo zokufunda ezingaguquguqukiyo, kunye nokuchaneka kwesiphumo (amaxesha amancinci okuzithemba).

Umgangatho woBomi

Izifundo ezilishumi elinesithandathu zichaze umgangatho wobomi obunxulumene nempilo yengqondo; Iziphumo zokucamngca ngengqondo zazibalulekile kuhlalutyo oluhlanganisiweyo xa kuthelekiswa nonyango njengesiqhelo, amaqela enkxaso, imfundo, ulawulo loxinzelelo, kunye nolawulo lokulinda (SMD, 0.49; 95% CI, 0.22, 0.76; I 2, 74.9%). [32-34, 45-49, 52, 54, 56, 59, 60, 62-64]. Izifundo ezilishumi elinesithandathu zilinganise umgangatho wobomi obunxulumene nempilo [32 [34, 36, 45-49, 52, 54, 56, 60, 62-64]. Uhlalutyo oluhlanganisiweyo lubonise umphumo obalulekileyo wokucamngca kwengqondo xa kuthelekiswa nonyango njengesiqhelo, amaqela enkxaso, imfundo, ulawulo loxinzelelo, kunye nolawulo lokulinda (SMD, 0.34; 95% CI, 0.03, 0.65; I 2, 79.2%). Zombini uhlalutyo lomgangatho wobomi lubone ukungalingani okukhulu, kwaye umgangatho wobungqina ulinganiswe njengemodareyitha yempilo yengqondo (amathuba amancinci okuzithemba, iziphumo ezingqinelanayo) kunye nezantsi kumgangatho wobomi obunxulumene nempilo.

Ukukhubazeka okusebenzayo (iMilinganiselo yokukhubazeka)

Izifundo ezine zichaze amanqaku okukhubazeka anokukhuselwa kwiPhepha lemibuzo likaRoland-Morris lokuKhubazeka kunye neSheehan yokuKhubazeka [33, 36, 47, 55]. Ukwahlula phakathi kokuqonda kunye namaqela othelekiso ekulandeleleni bekungabalulekanga ngokweenkcukacha (SMD, 0.30; 95% CI,? 0.02, 0.62; I 2 = 1.7%), nangona iziphumo zisondela kubaluleka. Akukho heterogeneity ifunyenweyo. Umgangatho wobungqina walinganiswa uphantsi ngenxa yokungaqwalaselwa kunye nesayizi encinci yesampulu.

Usetyenziso lobuchule

Zine kuphela izifundo ezixeliweyo zokusebenzisa ii-analgesics njengesiphumo. Kuphononongo lwe-MBSR kunyango lwentlungu engapheliyo ngenxa yesifo sokungaphumeleli sasemva kwesifo [55], kwi-12 yeeveki ezilandelelanayo, iilogs zamayeza e-analgesic zeqela elingenelelayo libonisa ukwehla kokusetyenziswa kwe-analgesic xa kuthelekiswa nezo zikwiqela lolawulo ( 1.5 (SD = 1.8) vs. 0.4 (SD = 1.1), p = <0.001). Uphononongo lokucamngca ngengqondo kunye nonyango lokuziphatha ngokuziphatha kunye nokunyamekela okuqhelekileyo kweentlungu ezisezantsi [35] uxele ukuba i-morphine elinganayo yedosi (mg / ngosuku) yeeopioid yayingahlukanga kakhulu phakathi kwamaqela kuzo zombini iiveki ze-8 kunye ne-26. Ngokufanayo, ukulingwa kwe-MBSR yeentlungu zangasemva [38] akufumananga mahluko ubalulekileyo phakathi kwamaqela ekusebenziseni ngokwakho amayeza eentlungu. Ekugqibeleni, ukuvavanywa kwengqondo ekuphuculeni ukubuyisela ingqondo (OKUNYE) kwintlungu engapheliyo ye-etiologies eyahlukeneyo [44] ifumene abathathi-nxaxheba abangenelelo ngokungenakwenzeka ukuba bangasayi kufikelela kwiinkqubo zokusetyenziswa kwe-opioid kwangoko emva kwonyango (p = 0.05); Nangona kunjalo, ezi ziphumo azange zigcinwe ekulandeleni inyanga-3.

Iziganeko ezimbi

I-7 kuphela ye-38 iquka ii-RCT ezichazwe kwiziganeko ezimbi. Zine zithi akukho ziganeko ezimbi ezenzekayo [36, 47, 50, 57]; Omnye wachaza ukuba abathathi-nxaxheba ababini bafumana iimvakalelo ezinqwenelekayo zomsindo ngentlungu yabo kwaye ababini abathathi-nxaxheba bafumana uxhalaba olukhulu [46]; Izifundo ezimbini zizaliswe iziphumo ezinobungozi obucothayo kwi-yoga kunye nokuphumla kwe-muscle [35, 38].

Iimpawu zoFundo zoModareli

Iimeta-regressions zaqhutywa ukuze zichonge ukuba ngaba utshintsho kwiziphumo zentlungu zichanekile ngendlela eyahlukileyo ngamacandelo amaninzi. Akukho nto eyahlukileyo kwimpumelelo phakathi kwe-MBSR (izifundo ze-16) kunye ne-MBCT (izifundo ze-4; p = 0.68) okanye ezinye iintlobo zokungenelela kwengqondo (izifundo ze-10; p = 0.68). Xa kuthelekiswa ne-MBSR (izifundo ze-16) kuzo zonke ezinye iindlela zokungenelela (izifundo ze-14), kwakungekho nomehluko kwimpumelelo (p = 0.45). Njengoko kuchaziwe ngcaciso engentla, iimeko zonyango zichazwe ziquka i-fibromyalgia, intlungu emva, i-arthritis, intloko yesifo, kunye nesifo sengqondo se-brit (syndrome). Iimeta-regressions ezingaphakamisanga ukungafani phakathi kwentloko (izifundo ezithandathu) kunye nezinye iimeko (p = 0.93), intlungu emva (izifundo ezisibhozo) nezinye iimeko (p = 0.15), kunye ne-fibromyalgia (izifundo ezisibhozo) nezinye iimeko (p = 0.29 ). Ukubunjwa kwezesini (% yindoda) kwakungekho nxulumano kunye nentlungu (p = 0.26). Ubude obude beprogram yongenelelo buvela kwi-3 ukuya kwiiveki ze-12 (ithetha iiveki ze-8). I-Meta-regression ayizange iphakamise ukungalingani phakathi kokungenelela kwamanqanaba aphezulu kunye ne-medium- (p = 0.16) okanye ukungenelela okuphantsi (p = 0.44). Akukho mahluko ochanekileyo kwintlungu phakathi kokunyangwa kweyeza kunye ne-monotherapy (p = 0.62) okanye phakathi kwonyango kunye nokungenelela apho oku kungacacanga (p = 0.10) yafunyanwa. Ekugqibeleni, kwakungenohluko oluchanekileyo kwimpumelelo enoba ngaba i-comparator yonyango njengesiqhelo, uluhlu lokulinda, okanye olunye uncedo (p = 0.21).

UDkt Jimenez White Coat

Insight of Dr. Alex Jimenez

Ukuxinzezeleka kwengcinezelo ngumcimbi omkhulu eMelika kwaye uye waba nempembelelo enobungozi kwimpilo yonke kunye nokuphila kwabantu baseMerika. Ukuxinezeleka kunokuchaphazela indawo ezahlukeneyo zomzimba. Ukuxinezeleka kunokunyusa izinga lentliziyo kwaye kubangela ukuphefumula ngokukhawuleza, okanye ukuxhatshazwa kwe-hyperventilation, kunye nokuxhatshazwa kwemisipha. Ukongezelela, uxinzelelo lubangela "ukulwa okanye ukusabaleka" impendulo, nto leyo eyenza inkqubo yentsholongwane yomsindo ukukhulula umxube wamahomoni kunye neekhemikhali emzimbeni. Ngenhlanhla, ukunakekelwa kwe-chiropractic kunokukunceda ekulawuleni uxinzelelo. Ukwelashwa kwe-Chiropractic kusebenze isistim se-parasympathetic eyancipha "ukulwa okanye ukuphendula". Ukongezelela, ukunakekelwa kwe-chiropractic kunokunceda ukunciphisa uxinzelelo lomzimba, ukuphucula iimpawu zentlungu engapheliyo.

ingxoxo

Ngokomlinganiselo, ukucamngca kwengqondo kwahlanganiswa nempembelelo encinci yeempawu zentlungu ephuculweyo xa kuthelekiswa nonyango njengesiqhelo, ukulawula okungahambiyo, kunye nezemfundo / amaqela enkxaso kwi-meta-analysis of 30. Nangona kunjalo, bekukho ubungqina benkcenkceshe enkulu phakathi kwezifundo kunye nokukhishwa kwenkcazo enokubangela ukuba kubekho ubungqina obuphantsi. Ukusebenza kokucamngca kwengqondo kwintlungu ayizange ihluke ngohlobo lwongenelelo, imeko yonyango, okanye ubude okanye ubukhulu bongenelelo. Ukucamngca ngengqiqo kwahlanganiswa nophuculo olulinganisekileyo ekudakaleni, umgangatho wempilo obunxulumene nempilo kunye nomgangatho wobomi obunxulumene nempilo. Ubuninzi bobubungqina obuphakamileyo bokudakumba, ukulinganisela umgangatho wobomi bengqondo, kunye nokuphantsi komgangatho wobomi obunxulumene nempilo. Izifundo ezine kuphela ezichazwe ngenguqu ekusetshenzisweni kwe-analgesic; iziphumo zaxutyushwa. Iziganeko ezimbi kwii-RCT ezibandakanyiweyo zazingabonakali kwaye azibizi, kodwa uninzi lwezifundo aluzange ziqokelele iinkcukacha ezichaphazelekayo.

Olu hlalutyo luneendlela eziningana zokwenza izinto: ukucwangciswa kophando lwephambili, ukukhethwa kuphando lokuphinda kunye nolwazi oluchanekileyo lwenkcazelo yolwazi, uphando olunzulu lweenkcukacha ze-elektroniki, umngcipheko wokuvavanya i-bias, kunye novavanyo olunzulu lobungqina obusetyenziswe ukwenza uhlolo lwezigqibo. Omnye umda wukuthi asizange sidibanise nabalobi bokufunda; Iziphumo ezichazwe ekuhlaziyweni zisekelwe kwidatha epapashwe. Sifake iifomati ezingenayo i-data eyaneleyo yokuphonononga umgangatho wokufunda. Ukongeza, sifaka kuphela izifundo ezipapashwe ngesiNgesi.

Izifundo ezibandakanyiweyo zinemiqathango emininzi. Izifundo ezingamashumi amathathu nesibhozo ziphakanyiswe njengezinga elibi, ngokuyininzi ngenxa yokungabi nalutho lwe-ITT, ukulandelelana kakubi, okanye ukunika ingxelo engafanelekanga yezindlela zokwenza okungahambiyo kunye nokufihla ukwabiwa. Ababhali bezifundo ezilishumi babika amandla angenamanani okubala ukuba bafumane ukungafani kwiziphumo zentlungu phakathi kokucamngca kwengqondo kunye nomfanisi; Ababhali baqwalasela ezi zifundo. Ezinye izifundo ezilishumi azizange zibike ukubala kwamandla. Ubungakanani besampula babuncinane; Izifundo ze-15 zihleli ngaphantsi kwabathathi-nxaxheba be-50.

Iimfuno ze-RCT ezicwangcisiweyo, ezilungeleleneyo kunye ezinkulu zifunekayo ukuze kuphuhliswe ubungqina bobuchule obungakwazi ukunikela ngokukhawuleza ukuqikelela kokusebenza kwayo. Izifundo kufuneka zibhalise iisampula ezinkulu ngokwaneleyo ukufumanisa ukungqinelana kwamanani kwiziphumo kwaye kufuneka zilandelelanise nabathathi-nxaxheba kwi-6 kwiinyanga ze-12 ukwenzela ukuvavanya imiphumo yexesha elide lokucamngca. Ukuhambelana nokusebenza kwengqondo kunye nokusetyenziswa kwamanye amayeza kufuneka kuhlolwe rhoqo. Impawu zokungenelela, kubandakanywa iqondo elithe gqithwayo, alisayi kusekwa ngokuthe ngqo. Ukuze kuhlolwe iziphumo ezithile zongenelelo, uphando lufanele lube nolwaphulo-oluhambelana nokulawula. Iimvavanyo ezincinci zingaqhutyelwa ukuphendula le mibuzo. Ezinye iziphumo ezingaphandle kwendawo yokuphononongwa kungabalulekile ukuhlola. Njengoko iimpembelelo zengqondo zinxulumene nokuhlolwa kweentlungu, kunokunceda kwiilingo ezizayo ukugxila kwiziphumo eziphambili kwiimpawu ezinxulumene nentlungu enjengomgangatho wobomi, ukuphazamiseka okubangelwa intlungu, ukunyamezela intlungu, imiba kunye neengxaki ezinxulumene nazo. ezinjenge-opioid. Iimpapasho zexesha elizayo kwii-RCT zokucamngca ngengqiqo kufuneka zihambelane neMigangatho yokuHlanganiswa kweeMvavanyo (IMISEBENZI).

Iingxelo ezintathu ze-RCT ezibhekiselele kwiziganeko ezincinci ezinokungcamngca ngengqiqo. Nangona kunjalo, i-7 kuphela ye-38 iquka ii-RCT ezichazwe ukuba iziganeko ezimbi zihlolwe kwaye ziqokelelwe. Ngaloo ndlela umgangatho wobungqina kwiziganeko ezimbi ezichazwe kwii-RCT aziwanelanga ukuhlolwa okubanzi. Ukunikezelwa kwengxelo yeziganeko ezimbi ngexesha lokucamngca, kubandakanya i-psychosis [67], iilingo ezizayo kufuneka ziqokelele ngokutsha iirekhodi ezichaphazelekayo. Ukongezelela, ukuphononongwa ngokuchanekileyo kwezifundo zokuqwalasela kunye neengxelo zengxelo ziza kubangela ukukhanya okongeziweyo kwiziganeko ezimbi ngexesha lokucamngca ngengqiqo.

Uphando olongezelelweyo oluhlolisayo umphumo wokucamngca ngengqondo kwiintlungu ezingapheliyo kufuneka kugxininise ekuqondeni okungcono nokuba kukho ubuncinane ubuncinane okanye ixesha lokucamngca ukuze liphumelele. Nangona uphando lwangoku luye lwavelisa iziphumo ezintle zokukhumbula ingqondo, ezi ziphumo ziba ziincinci ukuya kumyinge kwaye zisekelwe kumzimba wobungqina obungcono, owona mgangatho. Indlela ekhoyo yokuqhubela phambili uphando malunga nentlungu engapheliyo kukuba kukuphucula iinkcazo zengenelelo kunye neyokulawula, ukuchonga iziphumo ezahlukileyo zezicwangciso ezahlukeneyo zokungenelela okunzima, kwaye usebenze kumgangatho oqhelekileyo wokuvavanya inzuzo yokwelapha [68]. Izilingo eziphezulu zeentloko eziqhathanisa ukungenelela kwengqondo yolu hlobo olufanayo kodwa ngokuhlukahluka kwamacandelo okanye umthamo kunokuba luncedo ukukhupha amanqaku afanelekileyo kula macandelo [69].

Ngokufana neengxelo ezidlulileyo kule ndawo, sigqiba ekubeni nangona ukunyanzeliswa kwengqondo kunengqondo kubonisa ukuphuculwa okubalulekileyo kwintlungu engapheliyo, ukuxinezeleka, kunye nomgangatho wobomi, ubuthathaka emzimbeni wobungqina bubathintela izigqibo eziqinileyo. Ububungqina obukhoyo abuzange banikeze imiphumo eqhubekayo kwiziphumo zentlungu, kwaye zifundo ezimbalwa zifumaneke kwiindlela zokucamngca ngengqondo ngaphandle kwe-MBSR. Ubungqina bobuchule bokungenelela kwengqondo ekunciphiseni ubuhlungu obungapheliyo buphantsi. Kwakukho ubungqina obuphezulu obuphezulu bokucamngca ngengqiqo ekudandathekeni kunye nemiphumo yempilo yengqondo ehambelana nomgangatho. Olu hlaziyo luhambelana neengxelo zangaphambilini ezigqityiweyo ukuba kukho i-RCT enokwakheka kakuhle, echanekileyo, kunye ne-RCT emikhulu efunekayo ukuze kuphuhliswe ubungqina bobuchule obuya kunika ngokuthe ngqiqweni ukuqikelela kokusebenza kwengcamango engqondweni. Okwangoku, ubuhlungu obungapheliyo buqhubeka bubangela umthwalo omkhulu kuluntu kunye nabantu ngabanye. Indlela yokwelapha intsha yokulawula ubuhlungu obungapheliyo njengokucamngca kwengqondo kuya kuba yamkelwa zizigulane ezibuhlungu.

I-Electronic Supplementary Material

Ncbi.nlm.nih.gov/pmc/articles/PMC5368208/

Ukuthotyelwa kweMigangatho yokuHlola

Inkxaso kunye neNkcazo

Ukuhlaziywa okucwangcisiweyo kuye kwaxhaswa ngeSebe lezoKhuselo zeZiko loBugcisa kwiMpilo yeNgqondo kunye neNgxaki yeBrain Injury (inkontileka yenombolo 14-539.2). Iziphumo kunye nezigqibo ezikule ngqangi zizo zabalobi kwaye akumele zimelele iimvo zeSebe lezoKhuselo zeZiko loBugcisa kwiZempilo ze-Psychological and Traumatic Brain Injury.

Ababhali beNkcazo yoLwaphulo lweNtshisekelo kunye nokuHlonipha kwiMigangatho yamaGunya abaPhezulu

Ababhali i-Hilton, i-Hempel, i-Ewing, i-Apaydin, i-Xenakis, i-Newberry, uClalaiaco, i-Maher, i-Shanman, i-Sorbero, noMaglione bayakuxela ukuba abanakho ukulwa. Zonke iinkqubo, kubandakanywa nenkqubo yemvume enolwazi, zenziwa ngokuhambelana nemigangatho yokuziphatha yekomiti ejongene nokuzama kweziluntu (iziko kunye nelizwe) kunye ne-Helsinki Declaration ye-1975, njengoko ihlaziywe kwi-2000.

Ukuqukumbela, uxinzelelo luya kuthintela ekugqibeleni impilo yethu yonke kunye nokuphila kakuhle ukuba ingalawulwa kakuhle. Ngethamsanqa, iindlela ezininzi zokulawula uxinzelelo, kubandakanya ukunakekelwa kwe-chiropractic kunye nokucamngca kwengqondo, kunokukunceda ukunciphisa uxinzelelo kunye nokuphucula intlungu engapheliyo enokuxinzezeleka. Ukwelashwa kwe-Chiropractic yindlela ebalulekileyo yokulawulwa kwengcinezelo kuba iyakwazi ukuzolalisa "ukulwa okanye ukusabaleka" impendulo ehambelana nokucinezeleka okungapheliyo. Le nqaku apha ngasentla ibonise nendlela ukucamngca kwengqondo kungabakho ubuchule obuphambili bokulawulwa kwengcinezelo yokuphucula impilo kunye nokuphila kakuhle. 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

Imixholo eyongezelelweyo: Ubunzima bokubuyisela

umfanekiso webhlogi weendaba eziphambili zephepha lephepha

ISIHLOKO ESIBALULEKILEYO: Ukulawula uxinzelelo lomsebenzi

IINGXELO EZIBALULEKILEYO: UKUPHATHA KWE-EXTRA: Ukukhetha i-Chiropractic? | Familia Dominguez | Izigulane | El Paso, TX I-Chiropractor

Ngenanto

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Vala i-Accordion

Ulawulo lwe-Chiropractic nokuLawula uxinzelelo lwe-Back Pain e-El Paso, TX

by iicrosoft | Umqolo obuhlungu, Chiropractic, Uvavanyo oluLungeleleneyo oluLungisiweyo, Unyango

Ukuxinezeleka kuyinyaniso yokuphila kwangoku. Kwiindawo apho iiyure zomsebenzi zanda kwaye amajelo asasaza ukuphazamisa iingqondo zethu kunye nenhlekelele enkulu ye-regent, akumangalisi ukuba kutheni abantu abaninzi banamazinga aphezulu okuxinezeleka rhoqo. Ngethamsanqa, abaqeqeshi abaninzi bezempilo bayaphumelela iindlela zokulawula uxinzelelo kunye nobuchule njengenxalenye yonyango lomgula. Nangona uxinzelelo luyimpendulo engokwemvelo eyenza ukulungelelanisa umzimba ngomngcipheko, uxinzelelo oluqhubekayo lunokuba nemiphumo emibi emzimbeni, obangela iimpawu zentlungu emva sciatica. Kodwa, kutheni ukuxinezeleka kakhulu kunokuchaphazela umzimba womntu?

Okokuqala, kubalulekile ukuqonda indlela umzimba obona ngayo uxinzelelo. Kukho ezintathu "iziteshi" ezisisiseko esizibona ngayo uxinzelelo: indawo, umzimba kunye neemvakalelo. Ukucinezelwa kwengqongqo kunokuba kuchaze; Ukuba uhamba endleleni ephumlileyo uze uvale ibhantshi elikhulu kufuphi, umzimba wakho uya kuqonda ukuba njengengozi esheshayo. Lo ngumxinzelelo wokusingqongileyo. Ukungcola kungomnye umzekelo wokuxinzezeleka kweemeko zendalo kuba uphazamisa ngaphandle komzimba xa umntu ebonakala kuyo.

Ukuxinezeleka ngomzimba kubandakanya izifo, ukungabikho kokulala kunye / okanye ukutya okungafanelekanga. Ukuxinezeleka ngokomzwelo kuyahluke, kuba kubandakanya indlela ubuchopho bethu buchaza izinto ezithile. Ngokomzekelo, ukuba umntu osebenza naye unomdla, unokugxininiswa. Imiba enjengokuthi, "uyandithukuthela ngesizathu esithile" okanye "kufuneka babe neentsasa ezinjengeentsasa", kunokubonakala ngathi uxinzelelo lwengqondo. Yintoni ekhethekileyo ngoxinzelelo lwengqondo, nangona kunjalo, kukuba sinokulawulwa kwindlela esinokufumana ngayo, ngakumbi kunokuba iimeko zendalo okanye izixinzelelo zomzimba.

Ngoku ukuba siqonda indlela umzimba onokuqonda ngayo ukuxinezeleka ngeendlela ezahlukeneyo, sinokuxoxa malunga nokuba ziphi iingxaki eziqhubekayo zinobuchule kwimpilo yethu yonke kunye nokuphila kakuhle. Xa umzimba ubeka phantsi koxinzelelo, ngokusebenzisa naziphi na iziteshi ezikhankanywe ngasentla, ukulwa komzimba okanye ukuphendula kwendiza kubangelwa. Inkqubo yomdla, okanye i-SNS, ivuselela, leyo eyenza intliziyo ibethe ngokukhawuleza kwaye yonke imizimba yomzimba iba namandla. Le yindlela yokukhusela eseleyo kwimihla yokuqala; Yiloo sizathu esiye saphila namhlanje, kunokuba sonke sifumane isidlo sasemini sabasweleyo abalambileyo kwintlango.

Ngelishwa, imbambano yangempela kukuba ebudeni bexesha langoku, abantu bahlala bexinezelekile kwaye umzimba womntu awukwazi ukwahlula phakathi kwesongelo esichengileyo kunye nombandela olula wentlalo. Kwiminyaka emininzi uphando lwezophando luqhutyelwe ukuqikelela umphumo wokuxinezeleka okungapheliyo emzimbeni womntu, kunye neziphumo ezinjengexinzelelo lwengqondo, ukwanda komngcipheko wesifo senhliziyo kunye nomonakalo kwimizimba yesisu kunye neempawu zentlungu yesifo kunye ne-sciatica.

Ngokwamanye amanyathelo okuphanda, ukuhlanganisa iindlela zokulawula uxinzelelo kunye neendlela ezahlukeneyo zonyango kunokunceda ukuphucula ngakumbi iimpawu kwaye kunokukhuthaza ukuphucula ngokukhawuleza. Ukunyamekela kwe-Chiropractic yindlela ekhethwa yonyango eyaziwayo yokusetyenziswa kwonyango kunye neemeko zesistim kunye neentsholongwane. Ngenxa yokuba unyango lwe-chiropractic lugxininise emthonjeni, ingcambu yesimiso se-nervous, i-chiropractic inokukunceda nokuxinezeleka. Phakathi kweempembelelo zokuxinezeleka kuluhlu, oluya kuthi lukhokelela ekugqithiseni okanye ukuchithwa kwempahla. Ukuguqulwa kwamagqabi kunye nokunyanzeliswa kwemigaqo kunokuncedisa ukuxhatshazwa kwemisipha, okuye kwanciphisa ubunzima kwimimandla ethile yomgudu kwaye kunceda ukunciphisa i-subluxation. Umgudu olinganiselayo uyinto ebalulekileyo yokusingatha uxinzelelo lomntu. Njengoko kuthethwe ngaphambili, ukutya okufanelekileyo kunye nokulala ngokwaneleyo kuyona nto ibaluleke kakhulu ekulawuleni uxinzelelo, okona unyango lwe-chiropractic unikezela ngcebiso yokuguqula indlela yokuphila yokuphucula amanqanaba okuxinwa kwesifo kunye nokunciphisa iimpawu zabo.

Injongo yendiqendu engezantsi kukubonisa inkqubo yophando yophuhliso eyenzelwe ukuthelekisa iyeza elongezelelweyo kunye neyezinye iinkqubo eziqhelekileyo zengqondo ubuhlungu obungapheliyo. Ulingo olulawulwa ngokungenamthetho luqhutywe ngenyameko kwaye iinkcukacha ezenziwe emva kovavanyo zophando zibhalwe ngezantsi. Njengoko kunye nezinye izifundo zophando, ulwazi olungaphezulu-ubungqina olusisiseko lungafuneka ukuba lunqume ngempumelelo umphumo wokulawulwa kwengcinezelo unyango lweentlungu zentlungu.

Ukuthelekiswa kweyeza elongezelelweyo nelinye kunye neNengqondo yesiqhelo Amachiza oNyango obuhlungu obungapheliyo: Iprotocol yengqondo Izindlela zoMzimba kwiNtlungu (i-MAP)

Abstract

imvelaphi

Ingxelo yempilo kunye neyosebenzayo yabantu abaneentlungu ezibuhlungu e-United States ziye zancipha kwiminyaka yamuva, nangona iindleko zonyango zanda kakhulu ngenxa yolu ngxaki. Nangona izigulana zengqondo zengqondo ezifana neenkolelo ezinxulumene nobuhlungu, iingcamango kunye nokuziphatha okuxhatshazwayo kubonakaliswe njani ukuba izigulane ziphendule njani unyango lweentlungu zentlungu, ezimbalwa izigulane zifumana unyango olujongene nale miba. I-ctnitive-behavioral therapy (CBT), ejongene neengqondo zengqondo, ifumaneke ukuba iyasebenza kwiintlungu zangemva, kodwa ukufikelela kumayeza aqeqeshekileyo. Olunye ukhetho lwonyango olunokukwazi ukujongana neengxaki zengqondo, ukunciphisa uxinzelelo lwengqondo (MBSR), luyafumaneka ngokubanzi. I-MBSR ifunyenwe ibe luncedo kwizimo ezahlukahlukeneyo zengqondo nangokwenyama, kodwa ayizange ifundwe kakuhle kwisicelo esinezigulana ezingapheliyo. Kulo vavanyo, siya kufuna ukujonga ukuba i-MBSR iyindlela yokwenza unyango olusebenzayo kunye nexabiso elinempilo kubantu abanobuhlungu obungapheliyo, ukuthelekisa ukusebenza kwayo kunye nokuphumelela kweendleko xa kuthelekiswa ne-CBT kunye nokuphonononga ukuguquguquka kweengqondo ezingabelana nemiphumo ye-MBSR kwaye CBT kwiziphumo zesigulane.

Izindlela / Ukuyila

Kulo vavanyo, siza kubangela ukuba abantu abadala be-397 babe neentlungu ezingapheliyo ezibuhlungu kwi-CBT, i-MBSR okanye kwiindawo zokunyamekela eziqhelekileyo (i-99 ngeqela ngalinye). Ezi zombini zongenelelo ziya kuba neesibhozo zeeveki ze-2-iiyure zeeyure ezixhaswa ngumsebenzi wasekhaya. Umgaqo-nkqubo we-MBSR uquka ikhefu le-6 yeeyure. Abaxineli abaxhamliweyo kwizabelo zonyango baya kuvavanya iziphumo ze-5, i-10, i-26 kunye nee-52 kwiiveki emva kokugqithiselwa. Iziphumo eziphambili ziya kuba nemida echaphazelekayo enxulumene nobuhlungu (ngokusekelwe kwi-Questionnaire ye-Roland Disability) kunye neempawu eziphazamisayo (ezibalwe kwi-0 ukuya kwi-10 yokulinganisa inani lamanani) kwiiveki ze-26.

ingxoxo

Ukuba i-MBSR ifumaneka ukuba yindlela yokwenza unyango olusebenzayo kunye nexabiso elinempilo kwizigulane ezinentlungu engapheliyo, iya kuba yongezwa ngokubaluleka kumanyathelo athatywayo anganyaniseki ezifumanekayo kwizigulane ezinegalelo ezibonakalayo zengqondo.

UkuBhaliswa koTyala

Clinicaltrials.gov I sazisi: NCT01467843.

Internet: Intlungu ebuhlungu, Ukunyangwa kwengqondo-yokuziphatha, Ukucamngca kwengqondo

imvelaphi

Ukuchonga unyango oluchanekileyo lweentlungu ezingapheliyo (i-CLBP) luhlala lucelomngeni kubakliniki, abaphandi, abahlawuli kunye nezigulane. Phantse i $ 26 ibhiliyoni isetyenziswe minyaka yonke e-United States ngeendleko ezichanekileyo zokunyamekela unyango lwentlungu [1]. Kwi-2002, iindleko eziqikelelweyo zokuveliswa kwabasebenzi abalahlekileyo ngenxa yeentlungu zangemva ziyi-19.8 billion [2]. Nangona kukho iinketho ezininzi zokuvavanya nokuphulukisa intlungu, kunye nokunyuka kweenkonzo zonyango ezixhomekeke kule ngxaki, isimo sempilo kunye nesimo sabantu abanobuhlungu emva e-United States siphumelele [3]. Ngaphezu koko, bobabini banikezeli kunye nezigulane abanelisekanga ngesimo se-quo [4-6] kwaye baqhubeke befuna iindlela ezingcono zokonyango.

Kukho ubungqina obuninzi bokuthi izigulane zengqondo zesigulane, ezinjengeenkolelo ezinxulumene nentlungu, iingcinga kunye nokuziphatha kokuziphatha, kunokuba nefuthe elibalulekileyo kumava entlungu kunye nemiphumo ekusebenzeni [7]. Obu bungqina buqaqambisa ixabiso elinokubakho lonyango lweentlungu zangasemva ezijongana nengqondo nomzimba. Ngapha koko, unyango kwezine ezisibhozo ezingezizo ezamayeza ezicetyiswe yiAmerican College of Physicians kunye nezikhokelo zeAmerican Pain Society zokuqaqanjelwa ziintlungu ezingapheliyo zibandakanya mind body components [8]. Olunye lonyango, unyango lwengqondo-yokuziphatha (i-CBT), lubandakanya izinto zomntu ezinje ngoqeqesho lokuphumla kwaye kufunyaniswe ukuba kuyasebenza kwiingxaki ezahlukeneyo zentlungu, kubandakanya iintlungu zangasemva [9-13]. I-CBT iye yaba lolona nyango lusetyenziswa ngokubanzi kwizigulana ezinentlungu engapheliyo. Olunye unyango lwengqondo, ukunciphisa uxinzelelo kwengqondo (MBSR) [14,15], ijolise kwiindlela zokufundisa ukwandisa ingqondo. I-MBSR kunye nongenelelo olunxulumene nengqondo olusekwe kufunyenwe luncedo kuluhlu olubanzi lweemeko zempilo yengqondo nangokwasemzimbeni, kubandakanya iintlungu ezingapheliyo [14-19], kodwa azifundisiswanga kakuhle iintlungu ezingapheliyo zangasemva [20-24] . Zimbalwa kuphela izilingo ezincinci ezivavanye ukusebenza kwe-MBSR yeentlungu zangasemva [25,26] kwaye konke kuxeliwe ukuphuculwa kwentlungu [27] okanye ukwamkelwa kwezigulana zentlungu [28,29].

Uphando olongezelelweyo malunga nokusebenza ngokuthelekisayo kunye nokusebenza kweendleko zonyango lomntu ngamnye kufuneka lube yinto ephambili kuphando lwentlungu emva kwezi zizathu zilandelayo: (1) ifuthe elikhulu lomntu kunye noluntu lwentlungu engapheliyo, (2) ukusebenza ngokuthobekileyo okwangoku Unyango, (3) iziphumo ezilungileyo zezilingo ezimbalwa apho abaphandi bavavanye unyango lwengqondo kubantu abaneentlungu zangasemva kunye (4) nokukhula kokuthandwa kunye nokhuseleko, kunye nexabiso eliphantsi kakhulu, lonyango lwengqondo. Ukunceda ukuzalisa olu lwazi, siqhuba uvavanyo olungenamkhethe ukuvavanya ukusebenza, ukuthelekisa ukusebenza kunye nokusebenza kweendleko ze-MBSR kunye neqela le-CBT, xa kuthelekiswa nokhathalelo lwezonyango oluqhelekileyo kuphela, kwizigulana ezinentlungu engapheliyo.

Iinjongo ezicacileyo

Iinjongo zethu ezithile kunye neengcamango ezihambelanayo zichazwe ngezantsi.

1. Ukuchonga ukuba i-MBSR iyinto engqinelanayo ngokufanelekileyo kunyango lwangonyango lwabantu abane-CLBP
I-hypothesis 1: Abantu abathile abangenasiphelo kwikhosi ye-MBSR baya kubonisa i-short-term (i-8 kunye ne-26 iiveki) kunye nexesha elide (ii-52 kweeveki) ukuphuculwa kwezinto ezinxulumene nobuhlungu, ukukhathazeka okunye kunye nezinye iziphumo ezinxulumene nempilo kunezo zenzelwe ukunyamekela okuqhelekileyo kuphela .
2. Ukuthelekisa ukusebenza kwe-MBSR kunye neqela le-CBT ekunciphiseni umva umsebenzi ohambelana nomsebenzi kunye nentlungu ekhathazayo
I-hypothesis 2: I-MBSR iya kusebenza ngakumbi kuneqela le-CBT ekunciphiseni ukusikelwa umda kwemisebenzi enxulumene nentlungu kunye neentlungu eziphazamisayo kwixesha elifutshane kunye nelide. Isizathu sale hypothesis isekwe (1) ekusebenzeni ngokuthobekileyo kwe-CBT yeentlungu ezingapheliyo ezifumanekayo kwizifundo ezidlulileyo, (2) iziphumo ezilungileyo zophando lokuqala olunomda oluvavanya i-MBSR yentlungu engapheliyo kunye (3) nobungqina obukhulayo bokuba Inxalenye ebalulekileyo yoqeqesho lwe-MBSR (kodwa hayi uqeqesho lwe-CBT) yoga iyasebenza kwiintlungu ezingapheliyo.
3. Ukuchonga abalamlamli naluphi na umphumo we-MBSR kunye neqela le-CBT kwiintlungu ezinxulumene nentlungu kunye nentlungu ephazamisayo
I-hypothesis 3a: Imiphumo ye-MBSR kwimingcele yomsebenzi kunye neentlungu ezibuhlungu ziya kuxolelana ngokunyuka kwengqondo kunye nokwamkelwa intlungu.
I-hypothesis 3b: Imiphumo ye-CBT kwimingcele yomsebenzi kunye neentlungu ezixhalabisayo iya kuxoxwa ngenguqu kwiinkcukacha ezinxulumene nobuhlungu (kunciphisa ukuphazamiseka, inkolelo yokuba umntu ukhubazekile ngentlungu kunye neenkolelo ukuba intlungu ibonisa ukulimala, kunye nokunyuka ekulawuleni okubonakalayo kwintlungu nokuzimela ubuchule bokulawula intlungu) kunye nokutshintshwa kweziphathamandla zokuziphatha (ukwandiswa kokusetyenziswa kokuphumla, ukunyamezela komsebenzi kunye nokujongana nezitatimende kunye nokunciphisa ukusetyenziswa kokuphumla).
4. Ukuthelekisa indleko-ukuphumelela kwe-MBSR kunye neqela le-CBT njengoko isetyenziselwa ukunakekelwa ngokuqhelekileyo kubantu abaneentlungu ezingapheliyo
I-hypothesis 4: Bobabini i-MBSR kunye neqela le-CBT liya kuba neendleko ezifanelekileyo kwiinkathalo eziqhelekileyo.

Siza kuphinda sihlolisise ukuba ngaba izigulane ezithile zezigulane ziqikelela okanye ziyiphucula imiphumo yonyango. Ngokomzekelo, siza kuhlola ukuba izigulane ezinamaqondo aphezulu okudandatheka zingenakwenzeka ukuba ziphuculwe kunye ne-CBT kunye ne-MBSR okanye nokuba ngaba izigulane ziyakwazi ukufumana inzuzo kwi-CBT kunokusukela kwi-MBSR (oko kukuthi, ingaba inqanaba lokudakumba liyimodareyitha yemiphumo yonyango ).

Izindlela / Ukuyila

isishwankathelo

Senza uvavanyo lweklinikhi olungenamkhethe apho abantu abane-CLBP babelwe ngokungacwangciswanga kwiqela le-CBT, ikhosi yeqela le-MBSR okanye ukhathalelo oluqhelekileyo lodwa (Umzobo 1). Abathathi-nxaxheba baya kulandelwa iiveki ezingama-52 emva kokungeniswa. Abafowunelwa abafowunelwa abafihliweyo kwizabelo zonyango baya kuvavanya iziphumo ze-4, 8, 26 kunye ne-52 iiveki zasemva kwexesha. Iziphumo eziphambili esiza kuvavanya ukuba zinxulumene nokusilela kwimisebenzi kunye nentlungu ebuhlungu. Abathathi-nxaxheba baya kwaziswa ukuba abaphandi bophando bathelekisa iinkqubo ezimbini ezizisebenzisayo ezisetyenziselwa iintlungu ezizifumeneyo ziluncedo ekunciphiseni iintlungu nokwenza ukuba kube lula ukwenza imisebenzi yemihla ngemihla .

Umzobo 1: I-Flowchart yeprotocol yokulinga. I-CBT, unyango lwe-Cognitive-behavioral; MBSR, Ukuphuculwa kwengcinezelo kwengqondo.

Iprotocol yolu vavanyo ivunyiwe yiKomidi yokuHlola iNkcazo yeNtloko yeCandelo lokuBambisana kwezeMpilo (i-250681-22). Bonke abathathi-nxaxheba baya kufunwa ukuba banike imvume yabo enolwazi phambi kokubhalisa kule sifundo.

Sample Sample and Setting

Umthombo oyintloko wabathathi-nxaxheba kulolu vavanyo uya kuba yiNtsebenziswano yezeMpilo yeQela (GHC), umzekelo wenkampani, inhlangano engekho ngenzuzo yokunakekelwa kwempilo ekhonza kwi-600,000 ababhalise kwiindawo zabo zokunakekela eziphambili e-Washington. Njengoko kudingeke ukuba kufumaneke iinjongo zokuqesha, i-mail address ngqo izothunyelwa kubantu 20 kwiminyaka eyi-70 ubudala abahlala kwiindawo eziqhutywa yi-GHC.

Inkcazo yokungeniswa kunye noKhuseleko

Sigaya abantu ukusuka kwi-20 ukuya kwi-70 yeminyaka yobudala iintlungu zangasemva eziye zaqhubeka ubuncinci iinyanga ezintathu. Inkqubo yokubandakanywa kunye nokukhutshelwa yaphuhliswa ukwandisa ukubhaliswa kwezigulana ezifanelekileyo ngelixa kuvavanywa abaguli abaneentlungu ezisezantsi zohlobo oluthile (umzekelo, i-spinal stenosis) okanye imeko enzima okanye abanokuba nobunzima ekugqibeni amanyathelo okufunda okanye ungenelelo ( umzekelo, isifo sengqondo). Izizathu zokukhutshelwa ngaphandle kwamalungu e-GHC zichongwe ngokusekwe (3) kwedatha ezenzekelayo erekhodwe (kusetyenziswa ukuHanjiswa kwaMazwe ngaMazwe kweZifo, inkqubo yoHlolo lweSithoba), ngalo lonke ixesha lotyelelo kulo nyaka uphelileyo kunye (1) nodliwanondlebe lokufaneleka olwenziwe umnxeba. Amalungu angengawo e-GHC, izizathu zokukhutshelwa ngaphandle zachongwa ngesiseko sodliwanondlebe ngomnxeba. Uluhlu lwe-2 kunye nolwe-1 luluhlu lweekhrayitheriya zokubandakanywa kunye nokukhutshelwa ngokwahlukeneyo, kunye nengqiqo yenqobo nganye kunye nemithombo yolwazi.

Ukongeza, sifuna ukuba abathathi-nxaxheba bazimisele kwaye bakwazi ukuya kwiiklasi ze-CBT okanye ze-MBSR ngexesha lokungenelela kweveki ye-8 xa kunikwe enye yalezo zonyango, kwaye baphendule imibuzo emine yokulandelelana ukuze sikwazi ukuvavanya iziphumo.

Iinkqubo zokuBasa

Ngenxa yokuba ungenelelo ngoncedo lubandakanya iiklasi, sithatha abathathi-nxaxheba kwii-cohorts ezilishumi ezinabantu abangamashumi amane anesihlanu umntu ngamnye. Sithatha abathathi-nxaxheba kwimithombo emithathu ephambili: (1) Amalungu e-GHC athe enza utyelelo kubanikezeli benkathalelo yabo yokuqala yeentlungu ezisezantsi kwaye iintlungu zabo ziye zaqhubeka ubuncinci iinyanga ezi-3, (2) amalungu e-GHC angakhange atyelele umboneleli wabo ophambili wokukhathalela iintlungu zomqolo kodwa abaphakathi kweminyaka engama-20 nengama-70 ubudala nabaphendula kumyalezo we-GHC ongathunyelwanga ekujoliswe kuwo okanye kwintengiso yethu kwi-GHC s kabini ngemagazini yonyaka kunye (3) nabahlali baphakathi kweminyaka engama-20 nama-70. iminyaka abaphendula ngqo iposikhadi yokugaya iposi.

Kubantu ekujoliswe kubo be-GHC, umdwelisi wenkqubo uza kusebenzisa ulawulo lwe-GHC kunye neeklinikhi zedatha yokuchonga amalungu afanelekileyo anokundwendwelwa kwiinyanga ezi-3 ukuya kwezi-15 ezidlulileyo kumboneleli obangele uxilongo oluhambelana nentlungu engapheliyo. La malungu e-GHC athunyelwa ngeposi ileta kunye noluhlu lokuhlola oluchaza isifundo kunye neemfuno zokufaneleka. Amalungu anomdla wokutyikitya inxaxheba kwaye abuyisa ingxelo ebonisa ukuba bazimisele ukuqhagamshelana nabo. Ingcali yophando ke ibiza umntu onokuthi athathe inxaxheba ukuba abuze imibuzo; misela ukufaneleka; Ukucacisa umngcipheko, izibonelelo kunye nokuzinikela okulindelekileyo kuphononongo; kwaye ucele imvume enolwazi. Emva kokuba imvume enolwazi ifunyenwe kumntu lowo, kuvavanywa umnxeba osisiseko.

Kubantu abangabonakaliyo be-GHC (okokuthi, amalungu e-GHC ngaphandle kokutyelelwa ngeentlungu ezifunyenwe ngasemva kwi-3 kwiinyanga ze-15 kodwa abanokuthi babe neentlungu ezisezantsi), umprogram usebenzisa i-data yolwazi yezolawulo kunye neklinikhi ukuchonga amalungu angamalungu afanelekileyo ayifaki kwisampuli ekujoliswe kuyo kumhlathi olandelelweyo. La manani aquka namalungu e-GHC aphendula kwisibhengezo kumagazini weGHC. Izindlela ezifanayo ezisetyenziselwa uluntu olujoliswe kuzo zisetyenziselwa ukudibanisa kunye nokucoca abathathi-nxaxheba, ukufumana imvume yabo enolwazi kwaye uqokelele ulwazi olusisiseko.

Ngokubhekiselele kubemi beendawo, sithenge iintlobo zamagama kunye neeadesi zesampula esikhethwe ngabantu abangahlali kwindawo yethu yokuqesha abaphakathi kwe-20 kunye ne-70 yeminyaka ubudala. Abantu abakoluhlu bathumela iposi zeposi ezithe ngqo ezichaza ucwaningo kuquka ulwazi malunga nendlela yokuqhagamshelana nabasebenzi bokufunda ukuba banomdla ukuthatha inxaxheba. Xa umntu onomdla edibanise iqela lophando inkqubo efanayo ichazwe ngasentla ilandelwa.

Ukuqinisekisa ukuba bonke abathathi-nxaxheba abahlolwayo baqala ukufaneleka ngexesha leeklasi ziqala, abo bavuma ngaphezulu kweentsuku ze-14 ngaphambi kokuqala kwamacandelo okungenelela baya kuphinda bahlaziywe malunga ne-0 kwiintsuku ze-14 ngaphambi kweklasi yokuqala ukuqinisekisile ukufaneleka kwabo. Inkxalabo ebalulekileyo kukukhupha abantu abangenawo ubuncinci bokulinganisa ukulinganisa kweentlungu ezibuhlungu kunye nokuphazamiseka okuchaphazelekayo nemisebenzi. Abo bantu abahlala befanelekile kwaye banike imvume yabo yokugqibela yokunika ulwazi baya kulawulwa kwimibuzo yolubuzo.

Randomization

Emva kokugqiba uvavanyo lokuqala, abathathi-nxaxheba baya kulandelwa ngokulinganayo kwi-MBSR, i-CBT okanye iqela eliqhelekileyo lokunyamekela. Abo bangahleliwe kwiqela le-MBSR okanye le-CBT abayi kwaziswa ngohlobo lwabo lonyango bade bafike kwiiklasi zokuqala, eziza kwenzeka ngaxeshanye kwisakhiwo esinye. Iqela longenelelo liya kunikwa ngokwendlela yokulandelelana kweekhompyuter zamanani akhethiweyo kusetyenziswa inkqubo eqinisekisa ukuba ulwabiwo alunakutshintshwa emva kokungeniswa. Ukuqinisekisa ulungelelwaniso kwinto ephambili yokuxela kwangaphambili, ukungeniswa ngokungacwangciswanga kuya kulungiswa ngokusekwe kwisixhobo sethu sokulinganisa iziphumo: inguqulelo eguqulweyo yemibuzo yemibuzo yokukhubazeka iRoland (RDQ) [30,31]. Siza kuhlulahlula abathathi-nxaxheba kumaqela amabini okusikelwa umda kwimisebenzi: ukumodareyitha (amanqaku e-RDQ? 12 kwisikali se-0 ukuya kwi-23) kunye nokuphakama (amanqaku e-RDQ? 13). Abathathi-nxaxheba baya kwenziwa ngokungacwangciswanga kwezi ziqwengana kwiibhloko ezinobungakanani obahlukeneyo (ezintathu, ezintandathu okanye ezisithoba) ukuqinisekisa ulwabiwo lwabathathi-nxaxheba olulungelelanisiweyo kodwa olungalindelekanga. Ngexesha lokugaya, isifundo se-biostatistician siyakufumana ukubalwa kwabathathi-nxaxheba kwiqela ngalinye ukuze kuqinisekiswe ukuba ialgorithm eyenziwe kwangaphambili ye-randomization isebenza kakuhle.

Uphulo lo kufunda

Iibini zeeklasi ze-CBT kunye ne-MBSR ziquka iiveki ezisibhozo zeveki ze-2 zeeyure ezongezelelweyo ngemisebenzi yasekhaya.

Ukunciphisa Ukunyanzeliswa Kwengqondo

Ukunciphisa uxinzelelo lwengqondo, inkqubo yonyango eneminyaka engama-30 eyenziwe nguJon Kabat-Zinn, ichazwe kakuhle kuncwadi [32-34]. Ababhali bohlalutyo lwe-meta lwakutsha nje bafumanise ukuba i-MBSR ineziphumo ezilinganiselweyo zokuphucula impilo yomzimba kunye nengqondo yezigulana ezineemeko ezahlukeneyo zempilo [16]. Inkqubo yethu ye-MBSR ilandelwa ngokusondeleyo kwi-original kwaye ibandakanya iiklasi ezisibhozo ze-2 ngeyure (eshwankathelwe kwiTheyibhile 3), ukubuyela iiyure ezingama-6 phakathi kweeveki ezi-6 ukuya kwezi-7 ukuya kuthi ga kwimizuzu engama-45 ngosuku lokuziqhelanisa nekhaya. Umgaqo-nkqubo we-MBSR wahlengahlengiswa ngumqeqeshi ophakamileyo we-MBSR ovela kwi-2009 MBSR's manual manual esetyenziswe kwiDyunivesithi yaseMassachusetts [35]. Le ncwadana ivumela ubungakanani bendlela abafundisi abazisa ngayo ingqondo kunye nokusebenza kwabo kubathathi-nxaxheba. Izibonelelo kunye nezinto zokuziqhelanisa nekhaya zibekiwe emgangathweni kolu phando.

Itheyibhile ye3 Content ye-CBT kunye neeSigaba zeeklasi ze-MBSR

Ithebula 3: Isiqulatho se-cognitive-behavioral andrapy-based based stress-based sessions.

Abathathi-nxaxheba baya kunikwa ipakethi yolwazi ngexesha leklasi yokuqala ebandakanya inkcazo yezifundo kunye nolwazi lokunxibelelana nabo; Ulwazi malunga nengqondo, ukucamngca, izakhono zonxibelelwano kunye nefuthe loxinzelelo emzimbeni, iimvakalelo kunye nokuziphatha; imisebenzi yasekhaya; imibongo; kunye noluhlu lwamagama. Zonke iiseshoni ziya kubandakanya ukuzivocavoca kwengqondo, kwaye konke kodwa okokuqala kuya kubandakanya i-yoga okanye ezinye iindlela zokuhamba okunengqondo. Abathathi-nxaxheba baya kunikwa ukurekhodwa kweaudio yendlela yokusebenza kwengqondo kunye neyoga, eya kuthi ibhalwe ngabahlohli babo. Abathathi-nxaxheba baya kucelwa ukuba basebenzise iindlela ezixoxwe kwiklasi nganye mihla le ukuya kuthi ga kwimizuzu engama-45 ngalo lonke ixesha lokungenelela nasemva kokuphela kweeklasi. Baya kunikwa nokufundwa ukuba bagqibe phambi kweklasi nganye. Ixesha liya kunikezelwa kwiklasi nganye kuphononongwe imiceli mngeni abathathi-nxaxheba abanayo ekwenzeni oko bakufundileyo kwiiklasi zangaphambili kunye nomsebenzi wesikolo. Umhla wokuzikhethela wokuziqhelanisa ngoMgqibelo phakathi kweklasi yesithandathu neyesixhenxe uya kunikwa. Le retreat yeeyure ezi-6 iya kubanjwa nabathathi-nxaxheba bethule kwaye kuphela ngumhlohli othethayo. Oku kuya kunika abathathi-nxaxheba ithuba lokwenza nzulu oko bakufundileyo eklasini.

Unyango lweCognitive-Behavioral

I-CBT yeentlungu ezingapheliyo zichazwe kakuhle kwiincwadi kwaye zithotywe ngokuzithoba ukuba zenzeke ngokufanelekileyo ekuphuculeni iingxaki zentlungu ezingapheliyo [9-13]. Akukho ncedo olulinganisiweyo lwe-CBT olwenzela intlungu engapheliyo, nangona zonke iindlela zokungenelela kwe-CBT zisekelwe ekuthatyeleni ukuba ukuqonda kunye nokuziphatha okuchaphazela ukuguqulwa kwintlungu engapheliyo kwaye ukuqonda ukuziphatha kunye nokuziphatha okungabonakaliyo kungaqatshelwa kwaye kuguqulwe ukuphucula ukusebenza kwegulane [36]. I-CBT igxininisa iindlela ezisebenzayo, ezicwangcisiweyo ukufundisa izigulane indlela yokuchonga, ukubeka esweni nokutshintsha iingcamango ezingathandabuzekiyo, iimvakalelo kunye nokuziphatha, ngokugxila ekuncedeni izigulane ukuba zithole izakhono ezingasetyenziswa kwiintlobo zeengxaki kunye nentsebenziswano phakathi kwesigulane kunye neengcali. Uhlobo lweendlela lufundiswa, kubandakanya ukuqeqeshwa kwizakhono zokuxubusha ubuhlungu (umzekelo, ukusetyenziswa kweziganeko zokuzibamba kakuhle, ukuphazamiseka, ukuphumula kunye nokuxazulula iingxaki). I-CBT iphinda ikhuthaze ukusekwa nokusebenza kwiinjongo zokuziphatha.

Iifom zomntu ngamnye kunye neqela ziye zasetyenziswa kwi-CBT. IQela le-CBT lidla ngokuba yinto ebalulekileyo yeenkqubo zonyango zonyango ezininzi. Siza kusebenzisa ifomathi ye-CBT ifomathi kuba ifumaneke ukuba iphumelele [i-37-40], inokusebenza kakuhle kunezo zonyango kwaye inika izigulane ezineenzuzo ezinokuthi zidibaniswe nazo, kunye nenkxaso kunye nokukhuthazwa kwabanye amava kunye neengxaki. Ukongezelela, ukusebenzisa iifom zeqela zombini i-MBSR kunye ne-CBT kuya kuphelisa ifom yokungenelelo njengenkcazo enokwenzeka ngayo nayiphi na ingqinano ekhoyo phakathi kweendlela ezimbini zokwelapha.

Kolu phando, siqulunqe incwadi eneenkcukacha zonyango kunye nomxholo othile kwiseshoni nganye, kunye nencwadi yomsebenzi yomthathi-nxaxheba enezinto ezinokusetyenziswa kwiseshoni nganye. Siye saqulunqa incwadi yomsebenzi kunye neencwadi zomthathi-nxaxheba ngokusekelwe kwimithombo esele ipapashiwe nakwizinto esizisebenzisileyo kwizifundo zangaphambili [39-47].

Ungenelelo lwe-CBT (Itheyibhile 3) iya kubandakanya iiseshoni zeeyure ezi-2 ngeveki eziya kuthi zibonelele (1) ngemfundo malunga nendima yeengcinga ezizenzekelayo (umzekelo, ukuphazamisa) kunye neenkolelo (umzekelo, ukukwazi ukulawula iintlungu, ukwenzakala kulingana nokulimala) okuqhelekileyo kubantu abanokudakumba, unxunguphalo kunye / okanye iintlungu ezingapheliyo kunye (2) nokuziqhelanisa nokuziqhelanisa nokuvavanya umngeni kwiingcinga ezingalunganga, ukusetyenziswa kweendlela zokumisa iingcinga, ukusetyenziswa kweendlela zokuziphatha ezizizo kunye nokubeka iinjongo , iindlela zokuphumla kunye nokujamelana neentlungu. Ungenelelo luya kubandakanya imfundo malunga nokuhamba komsebenzi kunye nokucwangciswa kunye nokuphinda uphinde uthintele kunye nokugcinwa kweenzuzo. Abathathi-nxaxheba baya kunikwa ushicilelo lweaudio lokuzonwabisa kunye nokuzilolonga imifanekiso kwaye bacelwe ukuba babeke iinjongo ngokubhekisele kwindlela yabo yokuphumla. Ngexesha leseshoni nganye, abathathi-nxaxheba baya kugqibezela isicwangciso somsebenzi oza kwenziwa ukuze kwenziwe imisebenzi phakathi kweseshoni. Ezi zicwangciso ziya kusetyenziswa njengeelogo zokumisela iinjongo ezithile zekhaya kunye nokujonga imisebenzi egqityiweyo phakathi evekini ukuze ijongwe kwiseshoni yeveki elandelayo.

Ukunyamekela

Iqela lokhathalelo eliqhelekileyo liya kufumana naluphi na ukhathalelo lonyango abanokuthi balufumane ngesiqhelo ngexesha lokufunda. Ukunciphisa ukuphoxeka okunokwenzeka ngokungabinakho ukunyanga unyango lwengqondo, abathathi-nxaxheba kweli qela baya kufumana imbuyekezo eyi- $ 50.

Sites Class

Iiklasi ze-CBT kunye ne-MBSR ziya kubanjwa kwiindawo ezikufutshane neendawo zokuhlala kwamalungu e-GHC eWashington (Bellevue, Bellingham, Olympia, Seattle, Spokane kunye neTacoma).

Ba fundisi

Bonke abaqeqeshi be-MBSR baya kufumana uqeqesho olusemthethweni ekufundiseni i-MBSR kwiziko le-Mindfulness kwiYunivesithi yaseMassachusetts okanye uqeqesho olufanayo. Baya kuba bobugcisa bobuchule kunye nokuqeqesha umzimba (umzekelo, i-yoga), baya kufundisa i-MBSR ngaphambili kwaye baya kwenza ukuba ingqalelo ibalulekileyo ebomini babo. Ukungenelela kwe-CBT kuya kuqhutywa ngabagqirha bezengqondo zecliniki kunye namava adlulileyo ekuboneleleni nge-CBT kwizigulane ezineentlungu ezingapheliyo.

UkuQeqesha nokuLawulwa kwabaTitshala

Bonke abafundisi be-CBT baya kuqeqeshwa kwiprotocol yokufunda ngongenelelo lwe-CBT ngabaphandi bezonyango zengqondo (BHB kunye neJAT), abanamava kakhulu kulawulo lwe-CBT kwizigulana ezineentlungu ezingapheliyo. I-BHB iya kubeka iliso kubaqeqeshi be-CBT. Omnye wabaphenyi (i-KJS) uya kuqeqesha abafundisi be-MBSR kwi-MBSR protocol elawulwayo kwaye abaphathe. Umqeqeshi ngamnye uya kuzimasa iiseshoni zokubeka esweni ngeveki, eziza kubandakanya ukuxoxa ngamava amnandi, imicimbi emibi, iinkxalabo eziphakanyiswe ngumqeqeshi okanye abathathi-nxaxheba kunye nokunyaniseka komgaqo. Uluhlu lokuthembeka kunyango olubonisa izinto ezibalulekileyo kwiseshoni nganye zenzelwe zombini iingalo ze-CBT kunye ne-MBSR. Ingcali yophando eqeqeshiweyo iya kusebenzisa uluhlu lokujonga ukuthembeka ngexesha lokujonga bukhoma iseshoni nganye. Ingcali yophando iya kubonelela ngengxelo kumphathi ukuze aququzelele ukubekwa esweni kwabaqeqeshi qho ngeveki. Ukongeza, zonke iiseshoni ziya kurekhodwa ngerekhodi. Iisuphavayiza ziya kumamela isampulu engahleliwe kwaye zicele iinxalenye zeeseshoni kwaye ziya kuzijonga zisebenzisa uluhlu lokutshekisha lokunyaniseka. Ingxelo iya kunikwa abaqeqeshi ngexesha leseshoni yabo yokujonga veki. Ukunyaniseka kunyango kuya kujongwa kuwo omabini amaqela ongenelelo yi-KJS kunye ne-BHB ngoncedo lweengcali zophando. Ukongeza, baya kujonga kwaye bavavanye kuluhlu lokuthembeka isampulu engahleliyo yeeseshoni ezirekhodiweyo.

Ukugcinwa kwabathathi-nxaxheba kunye nokuxhomekeka kwiKhaya lokuSebenza

Abathathi-nxaxheba baya kufumana umnxeba wokukhumbuza phambi kweklasi yokuqala kunye nanini na balahlekelwa iklasi. Baya kucelwa ukuba barekhode umsebenzi wabo wemihla ngemihla kwiingodo zeveki. Imibuzo malunga nezenzo zabo zasekhaya ngeveki ezayo iya kufakwa kuzo zonke iintlanganiso zengxoxo-ndlebe. Ukugcina umdliwano-ndlebe unobungcali, iimbuzo zokunamathela ziya kubuzwa emva kokuba yonke idatha yesiphumo ibhalwe.

Amanyathelo

Siza kuvavanya ezahlukeneyo zeempawu ezisisiseko zabathathi-nxaxheba, kubandakanya neempawu zentlalontle, imbali ebuhlungu emva kunye nokulindelwa koncedo lonyango lwengqondo lomntu kwiintlungu zangasemva (Itheyibhile 4).

Siza kuvavanya isethi esiyintloko yeziphumo kwizigulane ezineengxaki zomgulane (umsebenzi ohambelana nomva, intlungu, imeko yezempilo jikelele, ukukhubazeka komsebenzi kunye nokwaneliseka kwesigulane) [48] ezihambelanayo neNkulumbiso ngeendlela, ukulinganisa, kunye nokuHlola koPhando kwiZiklinikhi Iimvavanyo zokuvavanywa kwizilingo zekliniki zonyango olungapheliyo kunye nokusebenza kakuhle [49]. Siza kulinganisa iziphumo zexeshana ezifutshane (i-8 kunye nee-26 iiveki) kunye neziphumo zexesha elide (iiveki ze-52). Siza kufaka i-short, i-4-iveki, ukuhlolwa kwangaphakathi kwemvume ukuvumela ukuhlalutya kwabalamli abaxhamliweyo kwimiphumo ye-MBSR kunye ne-CBT kwiziphumo eziphambili. Iipopu zokugqibela zezifundo ziiiveki ze-26. Abathathi-nxaxheba baya kuhlawulwa i-$ 20 nganye kwintlanganiso yophicotho-ndlebe elandelwayo ekugqibeleni ukunyusa izinga lokuphendula.

Imilinganiselo yesiPhumo esiPhambili

Amanyathelo esiphumo sokudibana aya kuba yimida enxulumene nokubuyela umva kunye neentlungu zangasemva ezixhalabisayo.

Ukuthintelwa kwemisebenzi enxulumene nomva kuya kulinganiswa ne-RDQ eguqulweyo, ebuza ukuba ingaba imisebenzi ethile ye-23 ithintelwe ngenxa yeentlungu zangasemva (ewe okanye hayi) [30]. Siphinde sayilungisa i-RDQ ukuze sibuze umbuzo malunga neveki ephelileyo kunokuba sithi "namhlanje". I-RDQ yoqobo ifunyenwe ithembekile, iyasebenza kwaye inovakalelo kutshintsho lweklinikhi [31,48,50-53], kwaye kufanelekile kulawulo lwefowuni kunye nokusetyenziswa kwezigulana ezinomda wokumodareyitha [50].

Ukukhathaza iintlungu zangasemva kuya kulinganiswa ngokubuza abathathi-nxaxheba ukuba babone ukuba zibuhlungu kangakanani iintlungu zabo zangasemva kwiveki ephelileyo kwisikali se-0 ukuya kwi-10 (0? =? ayisiyiyo kwaphela ingxaki ye-10 kunye ne-0? =? Botherngokukhathaza kakhulu). Kwisiseko sedatha ehlanganiswe kwiqela elifanayo lamalungu e-GHC aneentlungu zangasemva, sifumene le nyathelo lokuxhalaba ukuba lihambelane kakhulu nomlinganiso we-10 ukuya kwi-0.8 yentlungu (r? =? 0.9 ukuya ku-54; idatha engashicilelwanga (DCC kunye ne-KJS ) kunye namanyathelo okusebenza kunye neminye imilinganiselo yesiphumo [55] .Ukunyaniseka kwamanani okulinganisa amanani entlungu kuye kwabhalwa kakuhle, kwaye izikali ezinjalo zibonise ubuntununtunu ekufumaneni utshintsho kwintlungu emva konyango [XNUMX].

Siza kuhlalutya kwaye sinike ingxelo ngezi ziphumo ziphambili ngeendlela ezimbini. Okokuqala, ukulungiselela uhlalutyo lokugqibela lokugqibela, siya kuthelekisa iipesenti zabathathi-nxaxheba kumaqela amathathu onyango abafezekisa ukuphuculwa okunentsingiselo kwezonyango (? 30% yokuphuculwa kwesiseko) [56,57] ngexesha ngalinye (kunye nokulandelwa kweeveki ezingama-26 ukuba yindawo yokugqibela). Siza kuvavanya kamva, kuhlalutyo lwesiphumo sesibini, ulungelelwaniso lwentsingiselo ehlengahlengisiweyo phakathi kwamaqela kula manyathelo ngexesha lokulandela.

I ziphumo zoSondlo

Iziphumo zesibini esiza kuzilinganisa iimpawu ezixinezelekileyo, ukuxhalaba, ukuphazamiseka kwezinto ezinxulumene nentlungu, ukuphuculwa kwehlabathi jikelele kunye nokunyanga, ukusetyenziswa kwamachiza ngenxa yeentlungu zangemva, imeko yezempilo jikelele kunye neziphumo ezifanele.

Iimpawu ezixakekayo ziya kuhlolwa ngePhepha leMpilo yeMpilo-8 (PHQ-8) [58]. Ngaphandle kokupheliswa kombuzo malunga nokuzibulala, i-PHQ-8 iyafana ne-PHQ-9, efunyenwe inokuthenjwa, isebenzayo kwaye isabela ekutshintsheni [59,60].

Ukuxhalabisa kuya kulinganiswa kunye ne-2-Into e-Generalized Anxiety Disorder scale (GAD-2), ebonise ukuqonda okukhulu kunye nokuzikhethela ekufumaneni ingxaki yokukhathazeka jikelele kwiindawo zokunakekelwa kweprayimari [61,62].

Ukuphazanyiswa kwemisebenzi enxulumene nobuhlungu kunye nemisebenzi yemihla ngemihla kuya kuvavanywa kusetyenziswa izinto ezintathu kwi-Scated Chronic Pain Scale (GCPS). I-GCPS iqinisekisiwe kwaye yaboniswa ukuba ineepropathi zepsychometri elungileyo kuvavanyo lwabemi kunye nakwiisampulu ezinkulu zezigulana zononophelo lokuqala ezineentlungu [63,64]. Abathathi-nxaxheba baya kucelwa ukuba balinganise ezi zinto zintathu zilandelayo kwinqanaba le-0 ukuya kwi-10: iintlungu zabo zangasemva (iintlungu zangasemva zilungile ngoku), ezona ntlungu zabo zibuhlungu kwinyanga ephelileyo kunye nenqanaba labo leentlungu kwinyanga ephelileyo.

Ukuphuculwa kwehlabathi ngonyango kuya kulinganiswa ngePatient Global Impression of Change scale [65]. Lo mbuzo mnye ubuza abathathi-nxaxheba ukuba babeke umda kuphuculo lwabo kunyango kwinqanaba le-7-amanqaku asusela kuko konke kuphuculwe kakhulu ukuya kokubi kakhulu, kungekho lutshintsho lusetyenzisiweyo njengombindi. Ukulinganiswa kwehlabathi jikelele kokuphuculwa kwonyango kunika umlinganiselo wenzuzo yeklinikhi jikelele kunyango kwaye ithathwa njengenye yezona zinto ziphambili kwiziphumo zentlungu kwizilingo zekliniki [49].

Ukusetyenziswa kwamachiza kunye nokuzivocavoca ngentlungu emva kweveki edlulileyo kuya kuvavanywa nge-8-, 26- kunye ne-52-weekly questionnaires.

Iimeko eziqhelekileyo zempilo ziya kuhlolwa kunye ne-12-Into eFutshane yeSimo seMpilo yeFom (SF-12) [66], isixhobo esasetyenziswa ngokubanzi esinika amanqaku atshwankathelo kwimeko yempilo yengqondo nangokwengqondo. I-SF-12 iya kusetyenziselwa ukubala i-quality-adjusted years-life (QALYs) usebenzisa i-Survey Form Health Survey kwi-6 ubukhulu bokuhlalutya indleko [67].

Iziphumo ezifanelekileyo ziya kulinganiswa ngemibuzo evulelekileyo. Sifake imibuzo evulelekileyo kwizilingo zethu zangaphambili kwaye safumanisa ukuba zinika ukuqonda okuxabisekileyo kwiimvakalelo zabathathi-nxaxheba malunga nexabiso lezinto ezithile zongenelelo kunye nefuthe longenelelo kubomi babo. Siza kubandakanya imibuzo evulekileyo malunga nale micimbi ekupheleni kodliwanondlebe olulandelayo lwe-8-, 26- kunye ne-52 yeeveki.

Iimvavanyo ezisetyenziselwa ukuhlalutya umlamli

Ngengalo ye-MBSR, siza kuhlola iimpendulo zokubangela ukwanda kwengqiqo (ekulinganiselwe nge-Nonreactivity, Observing, Acting with Awareness, kunye ne-Noncudging subscals ye-Five Facet Mindfulness Questionnaire ifomu elifutshane [68-70] kunye nokwamkelwa kwentlungu ephakamileyo (kulinganiswa kunye I-Questionnaire Yokumkelwa Kwempendulo Engapheliyo [71,72]) kwiziphumo eziphambili. Kwiengalo ze-CBT, siya kuhlola iimpembelelo zokuphucula kwiinkonzo zentlungu kunye / okanye ii-appraisals (ezilinganiselwe kunye nePatient Self-Efficiency Questionnaire [73]; Uphando lweengxaki zobuhlungu 2-Into yokuLawula, ukukhubazeka, kunye nezicwangciso zokulimaza [74 -76]; kunye ne-Pain Catastrophizing Scale [77-80]) kunye nokutshintsha ekusebenziseni ubuchule bokubamba ubuhlungu (ukulinganiswa kobuhlungu obungapheliyo Ukujamelana ne-inventory 2-item item of relaxation kunye ne-Elemental Pacing scale [81,82] iziphumo. Nangona silindele ukuba iziphumo ze-MBSR kunye ne-CBT kwiziphumo ziza kuhanjiswa ngemibandela eyahlukeneyo, siya kuhlola iimiphumo zabo bonke abalamlamli abaza kubakho kwiziphumo kumabakala amayeza.

Iimvavanyo ezisetyenziselwa ukuhlaziywa kweendleko-ngempumelelo

Iindleko ezizodwa ziya kuqwalaselwa ngokusebenzisa iindleko zedatha ezikhishwe kwiirekhodi zonyango zekhompyutha zeenkonzo ezinxulumene nazo emva koko zinikezelwe okanye zihlawulwa yi-GHC kunye nemibiko yesigulane yenkathalo engagqithwanga yi-GHC. Iindleko ezichangekileyo ziqikelelwa kusetyenziswa i-questionnaire ye-Productivity and Trafficking Impression Questionnaire [83]. Ukusebenza kwongenelelo kuya kuvela kwi-SF-12 yesimo somgangatho wezempilo [84].

Uqoqo Lwedata, Ulawulo loMgangatho kunye noNgcaciso

Idatha iya kuqokelelwa kubathathi-nxaxheba ngabaqeqeshi beefowuni abaqeqeshiwe basebenzisa i-intanethi ye-intanethi yocwangco lwekhompyutha (i-CATI) yee-questionnaires ukwenzela ukunciphisa iimpazamo kunye nedata elahlekileyo. Imibuzo ngamava ngamacandelo athile angenelelo (umzekelo, i-yoga, ukucamngca, ukufundiswa kwezicwangciso zokuziphatha) eziya kuvula abaphandabuli kwiinkampani zonyango ziya kubuzwa ngexesha ngalinye emva kokuba zonke iziphumo zihlolwe. Siya kuzama ukufumana idatha yesiphumo kubo bonke abathathi-nxaxheba kwilingo, kubandakanywa nabangayi kubakho okanye bayeke kwiiklasi, abo bayeke ukubhaliswa kwisicwangciso sezempilo kunye nabasukayo. Abathathi-nxaxheba abangaphenduliyo kwiimvavanyo eziphindaphindiweyo zokufumana idatha yokulandelela ngefowuni baya kuthunyelwa i-questionnaire kubandakanya kuphela amanyathelo amabini aphambili kunye nokunika i-$ 10 yokuphendula.

Siza kuqokelela ulwazi kuwo onke amanqanaba okuqesha, ukurhoxiswa kwentsholongwane kunye nonyango ukuze sikwazi ukubika isigidimi sokuhamba ngokuhambelana neSIGQUBO (imiGangatho yokuHlanganiswa kweeNgxelo zokuPhendula) [85]. Ukugcina imfihlo yolwazi olunxulumene nesigulane kwisiseko seenkcukacha, iinombolo zokufunda ezizodwa ziya kusetyenziswa ukuchonga iziphumo zesigulane kunye nedatha yonyango. Inkqubo yokufunda isendaweni ukuqinisekisa ukuba bonke abasebenzi abafihliweyo baya kuhlala bexakeke kwiqela lonyango.

Ukukhuselwa kwabathathi-nxaxheba kunye noVavanyo loKhuseleko

Khuselo lwabathathi-nxaxheba

IBhodi yokuHlola iBakala yeGHC (i-IRB) ivume le sifundo.

Uhlolo loKhuseleko

Eli vavanyo liza kuhlolwa ngokukhuselwa yiBhodi yoLwazi lweNgcaciso kunye noKhuseleko (DSMB) oluqulunqwe ngunyango ojongene nokunyamekela okhunjulwayo kwi-mindfulness, i-biostatistician kunye neengcali zeengqondo ezinokliniki ezinamava ekuphatheni izigulane ezinentlungu engapheliyo.

Amava amaninzi

Siza kuqokelela idatha kumava amabi (AEs) kwimithombo eliqela: (1) iingxelo ezivela kubahlohli be-CBT kunye ne-MBSR zabo nabaphi na abathathi-nxaxheba abanomdla kubo; (2) udliwanondlebe olulandelayo lwe-CATI, 8- kunye nama-26 lweeveki apho abathathi-nxaxheba babuzwa malunga nawuphi na umonakalo abawuva ngexesha lonyango lwe-CBT okanye lwe-MBSR kunye naziphi na iingxaki ezinzulu zempilo ababenazo ngexesha elifanelekileyo; kunye (52) neengxelo ezizenzekelayo ezivela kubathathi-nxaxheba. Abaphenyi beeprojekthi kunye nomsebenzi we-GHC wokhathalelo oluphambili baya kuthi baphonononge iingxelo ze-AE kuyo yonke imithombo ngeveki. Naziphi na ii-AEs ezinzulu ziya kuxelwa ngokukhawuleza kwi-GHC IRB nakwiDSMB. Ii-AEs ezingekho nzulu ziya kurekhodwa kwaye zibandakanywe kwiingxelo eziqhelekileyo zeDSMB. Nakuphi na ukubhubha kwabathathi-nxaxheba abachongiweyo kuya kuxelwa kusihlalo weDSMB ngaphakathi kweentsuku ezisi-3 zokufunyanwa, nokuba kunjani na.

Imithetho yokumisa

Ulingo luya kugcinwa kuphela ukuba i-DSMB ikholelwa ukuba kukho ingozi engamkelekanga ye-AEs enkulu kwiyodwa okanye ngaphezulu kwezixhobo zonyango. Kule meko, i-DSMB inokugqiba isigqibo sokuphelisa enye yeengalo zetyala okanye lonke ulingo.

Imiba yeSatisati

Uluhlu lwesampula kunye nokungafani okubonakalayo

Ubungakanani besampulu yethu bakhethwa ukuqinisekisa amandla awaneleyo okufumana umahluko obalulekileyo ngokweenkcukacha manani phakathi kwala maqela mabini onyango lwengqondo kunye neqela lokhathalelo oluqhelekileyo, kunye namandla okufumana umahluko obalulekileyo ngokweenkcukacha-manani phakathi kwamaqela onyango amabini. Kuba siqwalasele umda kwimisebenzi yesigulana njengeyona nto ibaluleke kakhulu kwimilinganiselo yethu emibini yesiphumo, sisekele ukubalwa kobungakanani besampulu yethu kwi-RDQ eguqulweyo [30]. Sichaze ubungakanani besampulu yethu ngesiseko sepesenti yezigulana ezinokuphuculwa okunentsingiselo eklinikhi okulinganiswe ne-RDQ kuvavanyo lweeveki ezingama-26 (oko kukuthi, ubuncinci ama-30% ngokunxulumene nesiseko) [57].

Ngenxa yokuthelekiswa okuninzi, siya kusebenzisa uvavanyo olukhuselweyo olunqabileyo lwe-Fisher's [86], siqala sihlalutye ukuba ngaba kukho umahluko obonakalayo kuwo onke la maqela amathathu (kusetyenziswa i-omnibus? Ukuba sifumana umohluko, siya kuvavanya umahluko phakathi kwamaqela. Siza kudinga abathathi-nxaxheba abangama-2 (abangama-264 kwiqela ngalinye) ukufezekisa amandla angama-88% okufumana unyango lomntu wonke olwahlukileyo kunonophelo lwesiqhelo kwi-RDQ. Oku kucinga ukuba i-90% yeqela lokhathalelo eliqhelekileyo kunye ne-30% yeqela ngalinye lonyango lwengqondo liza kuba nokuphuculwa okunentsingiselo kwi-RDQ kwiiveki ezingama-55, amaqondo okuphucula afana nalawo siwabonayo kwinani elifanayo leentlungu kubantu Ukuvavanywa kolunye unyango kunye nolunye unyango kwiintlungu zangasemva [26]. Siza kuba namandla ubuncinci be-87% yokufumana umahluko obalulekileyo phakathi kwe-MBSR kunye ne-CBT kwi-RDQ ukuba i-MBSR ineepesenti ezingama-80 ezisebenza ngakumbi kune-CBT (Oko kukuthi, iipesenti ezingama-20 zeqela le-MBSR xa kuthelekiswa ne-75% yeqela le-CBT) .

Esinye isiphumo esisisiseko sokudibana nentlungu kukukhathaza amanqanaba. Ngobungakanani besampulu yabathathi-nxaxheba abangama-264, siya kuba namandla angama-80% okufumana umahluko phakathi kweqela lonyango lwengqondo kunye nokhathalelo oluqhelekileyo kwisikali sokukhathaza, sicinga ukuba i-47.5% yenkathalo yesiqhelo kunye ne-69.3% yengqondo nganye Iqela lonyango linama-30% okanye ukuphucuka okungaphezulu ukusuka kwisiseko kwinqanaba lokubandezeleka kobuhlungu. Siza kuba namandla ubuncinci be-80% yokufumana umahluko omkhulu phakathi kwe-MBSR kunye ne-CBT kwisikali sokukhathazeka ukuba i-MBSR ubuncinci yipesenti ye-16.7 yeepesenti isebenza ngakumbi kune-CBT (Oko kukuthi, i-87% yeqela le-MBSR ngokuchasene ne-69.3% ye-CBT iqela).

Xa sihlalutya iziphumo zokuqala njengamanyathelo aqhubekayo, siya kuba namandla angama-90% okufumana umahluko we-2.4-point phakathi kokhathalelo oluqhelekileyo kunye nonyango lwengqondo yomntu kumanqaku esikali e-RDQ eguqulweyo kunye nomehluko wenqaku le-1.1 phakathi kononophelo lwesiqhelo kunye nengqondo Unyango lomzimba kwisikali sokuqaqanjelwa sisifo (sithatha ukulinganisa okuqhelekileyo ukuthelekisa iindlela ezimbini ezizimeleyo ngokwahluka okulinganayo kunye ne-P enamacala amabini? Ukuthatha ukuba ilahleko ye-0.05% ilandelwe (ngaphezulu kancinci kunaleyo ifunyenwe kuvavanyo lwentlungu yethu yangaphambili), siceba ukufumana isampulu yabathathi-nxaxheba abangama-5.2 (abangama-2.4 kwiqela ngalinye).

Zombini ezi ziphumo zokuqala ziya kuvavanywa e-P?

Uhlalutyo lweSatisati

Uhlalutyo oluphambili

Ekuthelekiseni kwethu unyango olusekelwe kwimilinganiselo yempembelelo, siya kuhlalutya iziphumo ezivandlakanywe kuzo zonke iindawo zokulandelelana kwixesha elilodwa, ukulungelelanisa ukulungelelaniswa okunokwenzeka phakathi kwabantu kunye neengxoxo zeqela zonyango usebenzisa i-equity estimation equations [89]. Ngenxa yokuba asikwazi ukuqiqa ngokuphathelele ukungafani kweqela okanye ixesha eliqhelekileyo, siya kubandakanya ixesha lokusebenzisana phakathi kwamacandelo amayeza kunye neengongoma zexesha. Siceba ukulungelelanisa iinqununu zesiphumo sokuqala, ubulili kunye nobudala, kunye nezinye iimpawu ezisisiseko ezifunyenwe ukuba zihluke kakhulu ngeqela lonyango okanye kwiziphumo zokulandelelana, ukuphucula ukuchaneka kunye namandla eemvavanyo zethu. Siza kuqhuba uhlalutyo olulandelayo lweziphumo zomgangatho oqhubekayo kunye nesiphumo sibini (ukuguqulwa kwezinto ezibalulekileyo ukusuka kwinqanaba lokuqala), kuquka onke amanqaku okulandelelana (4, 8, 26 kunye nee-52 iiveki). Inyango ye-MBSR iya kuthathwa yimpumelelo kuphela xa kuthelekiswa kwexesha le-26 ngeeveki kubalulekile. Amanye amaxesha amanqaku aya kuthatyathwa njengolu vavanyo lwesekondari.

Siza kusebenzisa indlela yokuphulukisa injongo ekuhlaleni konke ukuhlalutya; oko kukuthi, ukuhlolwa kwabantu ngabanye kuya kuhlaziywa ngamaqela angenalutho, kungakhathaliseki ukuthatha inxaxheba kuyo nayiphi na iklasi. Olu hlalutyo lunciphisa ukunyanzelisa okuqhelekileyo ukuba kwenzeka xa abathathi-nxaxheba abangafumani unyango olwenziwe ngaphandle kokuhlalutya. Imodeli yokulawula iya kuba kwifom elandelayo jikelele:

Ifom yeFundo yoLuntu jikelele

apho yt impendulo ngexesha lokulandelwa t, isiseko lixabiso lokujonga kwangaphambili kwesiphumo sesiphumo, unyango lubandakanya ukwahluka kwedummy kumaqela e-MBSR kunye ne-CBT, ixesha luthotho lwezinto eziguquguqukayo ezibonisa amaxesha okulandela kunye no-z vector yee-covariates ezimele ezinye izinto ezihlengahlengisiweyo. (Qaphela ukuba? 1,? 2,? 3 kunye no-4 zizithwali.) Iqela elichazayo kule modeli liqela lokhathalelo eliqhelekileyo. Iziphumo ezibambekayo neziqhubekayo, siya kusebenzisa imisebenzi efanelekileyo yekhonkco (umzekelo, ilog yebhanari). Ngexesha ngalinye lokulandelela apho i-omnibus? Uvavanyo lwe-2 lubalulekile ngokwezibalo, siya kuqhubeka ukuvavanya ukuba ngaba kukho umahluko phakathi kwe-MBSR kunye nokhathalelo oluqhelekileyo ukujongana nenjongo ye-1 kunye umahluko phakathi kwe-MBSR kunye ne-CBT ukujongana nenjongo ye-2. Siza kunika ingxelo ngokuthelekisa i-CBT kunyango oluqhelekileyo. Xa ugqiba ukuba i-MBSR yonyango olusebenzayo lweentlungu zangasemva, siya kufuna ukuba injongo ye-1, uthelekiso lwe-MBSR kukhathalelo oluqhelekileyo, kufuneka lubonwe.

Ngokusekelwe izilingo yethu edlulileyo iqolo, silindele ubuncinane 89% olulandelayo-phezulu kwaye, ukuba kunjalo ngokwenene, uhlalutyo lwethu ephambili eya kujongwa iya kuba uhlalutyo yetyala epheleleyo, kuquka zonke iziphumo wabona follow-up. Nangona kunjalo, siya kulungelelanisa kuzo zonke ii-covariates ezisisiseko eziphambili zempembelelo, amathuba abo okulahleka kunye nokwahlukana phakathi kwamaqela enyango. Ngokulungelelanisa la ma covariate asisiseko, sicinga ukuba imiphumo ekhoyo ekhompyutheni yethu ayiphumelekanga ngokungahleliyo (enikezelwe ukuba idatha yesiseko ilandelelanisa iipateni zedatha), endaweni yokulahlekelwa ngokupheleleyo. Siza kuqhuba uhlalutyo lobuninzi ngokusebenzisa indlela yokubangela ukungabi naluphi na ukungaqiniseki ukuba iziphumo zethu zizinzileyo ukuze zihlawulele iimpembelelo zeenkcukacha ezahlukeneyo [90].

UMlamli uhlalutyo Ukuba i-MBSR okanye i-CBT ifumaneka ukuba isebenze (ngokunxulumene nokunakekelwa ngokuqhelekileyo kunye / okanye komnye nomnye) ekuphuculeni umphumo oyintloko kwii-26 okanye ii-52 iiveki, siya kuhamba kwiinjongo ze-3 ukuchonga abalamlamli bemiphumo ye-MBSR kunye neqela le-CBT kwi-RDQ kunye neentlungu ezibuhlungu. Siza kwenza ulandelelwano lwee-mediation luhlalutya ngokwahlukileyo kwiziphumo ezibini eziphambili (i-RDQ kunye neentlungu ezibuhlungu ezinomlinganiselo wezinga) kunye nomlinganiselo wecandelo lohlukeneyo wonyango (ukunyamekela ngokuqhelekileyo ngokubhekiselele kwi-CBT, ukunakekelwa okuqhelekileyo ngokubhekiselele kwi-MBSR kunye ne-CBT ngokubhekiselele kwi-MBSR). Siza kuhlalutya ukuhlalutya umlamli ohlukeneyo kwiziphumo ze-26 kunye ne-52-zeveki (ukuba i-MBSR okanye i-CBT ifumaneke ukuba isebenze ngaloo maxesha).

Emva koko, sichaza ngokweenkcukacha uhlalutyo lomlamli wexesha leeveki ezingama-26. Uhlalutyo olufanayo luya kwenziwa kwinqanaba leeveki ezingama-52. Siza kusebenzisa isakhelo sendlela esetyenziswa ngokubanzi kaBaron noKenny [91]. Nje ukuba sibonise unxibelelwano phakathi konyango kunye nesiphumo esiguqukayo ('isiphumo sisonke' sonyango kwisiphumo), inyathelo lesibini iya kuba kukubonisa unxibelelwano phakathi konyango kunye nomlamli ngamnye wokubeka. Siza kwakha imodeli yokuhlengahlengisa kumlamli ngamnye ngenqaku le-4- okanye le-8-leveki yomlamli njengokwahluka okuxhomekekileyo kunye nenqaku lokuqala kumlamli kunye nesalathisi sonyango njengezinto eziguquguqukayo ezizimeleyo. Siza kuluqhuba olu hlalutyo kumlamli ngamnye onokubakho kwaye siya kubandakanya njengabanokuba ngabalamli kweli nyathelo lilandelayo kuphela abo banexabiso le-P? 0.10 kulwalamano nonyango. Inyathelo lesithathu iya kuba kukubonisa ukuncitshiswa kwesiphumo sonyango kwisiphumo emva kokususa isiphumo sabalamli. Siza kwakha imodeli ye-multimediator inverse probable weighted (IPW) yokuhlehlisa [92]. Le ndlela izakusivumela ukuba siqikelele iziphumo zonyango ngqo emva kokulinganisa kwakhona amaqela onyango ngokubhekisele kubalamli. Ngokukodwa, siza kuqala ukumodareyitha ukubakho kweziphumo zonyango, zinikwe abalamli (Oko kukuthi, bonke abalamli abafunyenwe benxulunyaniswa nonyango kwinyathelo 2), kusetyenziswa ukuhlengahlengiswa kwempahla kunye nokulungelelanisa izinto ezinokubaphazamisa. Sisebenzisa le modeli, siya kufumana amathuba aqikelelweyo okuba umntu ngamnye afumane unyango oluqwalaselweyo, ngokunikwa ixabiso lomlamli eliqwalaselweyo. Siza kuthi emva koko sisebenzise uhlalutyo lokuhlengahlengiswa kwe-IPW ukumodareyitha iziphumo eziphambili kwimeko yonyango ngelixa silungelelanisa amanqanaba asisiseko esiphumo kunye nomlamli. Ukuthelekisa imodeli enobunzima kunye nemodeli engaphelelanga kuya kusivumela ukuba siqikelele ukuba zingakanani na iimpembelelo zonyango ngqo kwiziphumo ezinxulumene noko ezinokuchazwa ngumlamli ngamnye onokubakho. Ukubandakanywa kwinqanaba le-3 kubo bonke abalamli abafunyenwe kubalulekile kwinqanaba 2 kuya kusenza sikwazi ukuvavanya ukuba ngaba izinto ezithile esizicingelayo ziya kuthi ngokwahlukileyo zichaphazele iziphumo ze-MBSR xa ithelekiswa ne-CBT ngokwenyani ilamla iziphumo zonyango ngalunye ngaphandle kweziphumo. ezinye 'iinkqubo eziguquguqukayo'.

Uhlalutyo lweZindleko

Uluvo lokujonga iindleko zentlalontle (CUA) luyakwenziwa ukuthelekisa ukunyuka kweendleko zentlalo ezivezwe kwingalo nganye yonyango (iindleko zonyango ngqo ezihlawulwe yi-GHC kunye nomthathi-nxaxheba kunye neendleko zemveliso) kukusebenza okuneziphumo zokutshintsha kwabathathi-nxaxheba QALYs [ 93]. Olu hlalutyo luya kubakho kuphela kubathathi-nxaxheba abafundwayo abavela kwi-GHC. Le CUA inokusetyenziswa ngabenzi bomgaqo-nkqubo abachaphazelekayo kulwabiwo olubanzi lwezixhobo ezinxulumene nempilo [94,95]. Ngombono womhlawuli, iindleko zonyango ngqo (kubandakanya neendleko zongenelelo) ziya kuthelekiswa notshintsho kwii-QALY. Le CUA iyakusinceda ukuba siqonde ukuba iyavakala na into yokuba uqoqosho lwe-MBSR lube yinkonzo ebuyiselweyo phakathi kwabahlali. Inkqubo ye-bootstrap iya kusetyenziselwa ukuqikelela amaxesha okuzithemba [96]. Kuhlalutyo lwesibini olwenziwe ukuvavanya ubuntununtunu beziphumo kwiingcaciso ezahlukeneyo zeendleko zesiphumo, ezinje ngeengcinga ezahlukileyo zamaxabiso emivuzo asetyenziselwa ukuxabisa imveliso kunye nokubandakanywa kokusetyenziswa kwezixhobo zononophelo lwempilo olungahambelani nomva [97] kwixabiso elipheleleyo leendleko , iya kuqwalaselwa. Kuhlalutyo lwendleko-yokusebenza, siya kusebenzisa injongo yokunyanga nokulungisa iindleko zokusebenzisa ukhathalelo lwempilo kunyaka omnye wekhalenda ngaphambi kokubhaliswa kunye nezinto ezisisiseko ezinokuthi zinxulunyaniswe neqela lonyango okanye isiphumo, njengokusebenzisa amayeza, ukulawula abanokudideka. Silindele ukuba kuya kubakho idatha encinci yokulahleka, kodwa uhlalutyo lobuntununtunu (njengoko kuchaziwe apha ngasentla kwiziphumo eziphambili) luya kwenziwa ukuvavanya amanyathelo endleko.

UDkt Jimenez White Coat

Insight of Dr. Alex Jimenez

Ukugxininiswa yimpendulo yomzimba kwixinzelelo lomzimba okanye yengqondo. Imiba emininzi inokubangela uxinzelelo, okwenza ukuba kusebenze impendulo "yokulwa okanye indiza", indlela yokukhusela eyilungisa umzimba ngenxa yengozi ebonakalayo. Xa ugxininisekile, inkqubo ye-nervous sympathetic ivuselela kwaye ifihla intlangano edibeneyo yamahomoni kunye neekhemikhali. Ukuxinezeleka kwexesha elifutshane kunokuba luncedo, nangona uxinzelelo lwexesha elide ludibaniswe kwiintlobo zemicimbi yezempilo, kubandakanywa intlungu emva iimpawu ze-sciatica. Ngokweziphumo zophando, ukulawulwa koxinzelelo kuye kwaba yongeziweyo ebalulekileyo kwiindlela ezininzi zokonyango ngenxa yokunciphisa uxinzelelo kunokunceda ukuphucula imiphumo yesiphumo. Ukunyamekela kwe-Chiropractic isebenzisa utshintsho lomgudu kunye neendlela zokuhamba ngokubambisana kunye nokuguqulwa kwendlela yokuphila ukuze uphathe umlanjwane, ingcambu yesimiso se-nervous, kunye nokukhuthaza ukunciphisa amanqanaba oxinzelelo ngokutya okunempilo, ukuqina kunye nokulala.

ingxoxo

Kolu vavanyo, siya kufuna ukufumanisa ukuba indlela eyandayo yokujongana noxinzelelo ukuncitshiswa koxinzelelo-kukukhetha unyango olusebenzayo nolunendleko kubantu abaneentlungu ezingapheliyo. Ngenxa yokugxila kwayo engqondweni nasemzimbeni, i-MBSR inamandla okujongana nezinye zezinto zengqondo ezibaluleke kakhulu kwiziphumo ezibi. Kolu vavanyo, siya kuthelekisa ukusebenza kunye nokusebenza kweendleko ze-MBSR kunye ne-CBT, efunyenwe ukuba iyasebenza kwiintlungu zangasemva kodwa ayifumaneki ngokubanzi. Olu phononongo luza kuphinda luphonononge izinto eziguquguqukayo ezinokuthintela iziphumo ze-MBSR kunye ne-CBT kwiziphumo zesigulana. Ukuba i-MBSR ifunyenwe iyindlela efanelekileyo yokunyanga kunye nexabiso elifanelekileyo kubantu abaneentlungu ezingapheliyo, iya kuba lulongezo olubalulekileyo kunyango olufumanekayo kwizigulana ezinegalelo elibonakalayo lengqondo kule ngxaki.

Isimo sovavanyo

Ukuqashwa kwaqala ngo-Agasti 2012 kwaye yagqitywa ngo-Ephreli 2014.

izifinyezo

I-AE: Isiganeko esibi; I-CAM: Iyeza elongezelelweyo nelinye; I-CATI: Udliwanondlebe oluncediswa yikhompyuter; I-CBT: Unyango lwengqondo kunye nokuziphatha; I-CLBP: Iintlungu ezingapheliyo zangasemva; I-CUA: Uhlalutyo lweNdleko yokuSebenza; DSMB: Idatha kunye neBhodi yoKhuseleko; I-GHC: Intsebenziswano yeQela lezeMpilo; I-ICD-9: Ukwahlulahlulwa kwamazwe onke kwezifo uHlaziyo lwesiThoba; I-IPW: Ubunzima obunokwenzeka obunobunzima; I-IRB: IBhodi yokuHlola yamaZiko; I-MBSR: Ukunciphisa uxinzelelo kwengqondo; I-NCCAM: Iziko leLizwe leNyango eliNcedisayo kunye nelinye; QALY: Umgangatho wobomi wolungelelwaniso lomgangatho.

Ukugqithisa inzala

Ababhali bavakalisa ukuba abanalo inxaxheba.

Igalelo lababhali

DC kunye ne-KS evezwe yolu vavanyo. DC, i-KS, i-BB, i-JT, i-AC, i-BS, i-PH, i-RD kunye ne-RH inxaxheba ekucoceni ukucwangciswa kokufunda kunye nokusetyenziswa kweenkqubo kunye nokukhethwa kwamanyathelo okuphumelela. I-AC icwangcise izicwangciso zokuhlalutya izibalo. I-JT kunye ne-AC zicwangcise izicwangciso zokuhlalutya umlamli. BS, BB kunye ne-JT bavelise izinto zokungenelela kwe-CBT. I-PH icwangciswe izicwangciso zokuhlalutya indleko-ngempumelelo. DC iqulunqe le mibhalo. Bonke abalobi bathathe inxaxheba ekubhaliseni umbhalo wesandla baze bafunde kwaye bavumile isicatshulwa sokugqibela.

Imibulelo

IZiko leLizwe leNyango eliNcedisayo kunye neNye iyeza (i-NCCAM) libonelele ngenkxaso-mali kolu vavanyo (isibonelelo se-R01 AT006226). Uyilo lolu vavanyo lwaye lwaqwalaselwa kwaye lwamkelwa yiOfisi yeNCCAM yeMicimbi yezeKlinikhi kunye neMicimbi yoLawulo.

Ukuququmbela, okusingqongileyo, uxinzelelo lomzimba kunye neemvakalelo kunokubangela "ukulwa okanye ukuphendula ngenqwelomoya" ophetheyo ukulungiselela umzimba womntu ngengozi. Nangona uxinzelelo lubalulekile ekwandiseni ukusebenza kwethu, uxinzelelo olungapheliyo lunokuba nefuthe elibi ekuhambeni kwexesha, kubonakalisa iimpawu ezinxulumene nentlungu yasemva kunye ne-sciatica. Ukhathalelo lweChiropractic isebenzisa iindlela ezahlukeneyo zonyango, kunye neendlela zolawulo loxinzelelo kunye neendlela, ukunceda ukunciphisa uxinzelelo kunye nokuphucula kunye nokulawula iimpawu ezinxulumene nokulimala kunye / okanye iimeko zenkqubo ye-musculoskeletal kunye neenkqubo zovalo. Ulwazi lweBiotechnology (NCBI). Ubungakanani bolwazi lwethu lukhawulelwe kwi-chiropractic kunye nokulimala komqolo kunye neemeko. Ukuxoxa ngomxholo, nceda ukhululeke ukubuza uGqirha Jimenez okanye unxibelelane nathi apha 915-850-0900 .

Ikhutshwe nguDkt. Alex Jimenez

Imixholo eyongezelelweyo: Ubunzima bokubuyisela

umfanekiso webhlogi weendaba eziphambili zephepha lephepha

ISIHLOKO ESIBALULEKILEYO: I-EXTRA EXTRA: Ungcono!

EZINYE IINGCUKACHA EZIBALULEKILEYO: UKWENZISA: Ukulimala kwezemidlalo? | Vincent Garcia | Umonde | El Paso, TX I-Chiropractor

Ngenanto

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Ulawulo loxinzelelo kunye neentlungu ezisezantsi e-El Paso, TX

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Abantu bafumana uxinzelelo rhoqo. Ukusuka kwixhala malunga nemali okanye kwingqesho kwiingxaki kunye nezingane zakho okanye ezinye izinto ezibalulekileyo, kwanokukhathazeka malunga neemeko zehlabathi, ziyakwazi ukubhalisa njengezixinzelelo kubantu abaninzi. Ukuxinezeleka kubangela ukuba kube nzima (ngokukhawuleza) kunye nesiguli (ixesha elide) imiba yempilo, kuquka intlungu ephantsi, uphawu oluqhelekileyo oluxelwa rhoqo zizigulane ezininzi ezixinzelelekileyo. Ngenhlanhla, unyango oluninzi lweendlela, olubandakanya ukunakekelwa kwe-chiropractic, lunokunceda ekunciphiseni iimvakalelo kunye nemiphumo yokuxinezeleka, ekugqibeleni iholele abantu ngendlela yokulawula uxinzelelo olufanelekileyo.

Iimpawu zoxinzelelo

Ukuxinezeleka kukubangela ukulwa komzimba okanye ukuphendulwa kwendiza. I-adrenaline xa uva emva kokuva isandi esikhulu sisinye seziganeko eziseleyo zookhokho bethu, besaba ukuba isandi esikhulu sivela kwinto efuna ukuyidla.

Ukuxinezeleka kubangela ukuba utshintsho oluthile emzimbeni, luqala ngengqondo. Inqanaba lentliziyo landa kwaye liqala ukuhambisa igazi kwezinye iindawo. Ukuva nokubona amehlo kuya kuba nzima. Kwaye i-adrenal glands iqala ukufihla i-adrenaline njengendlela yokulungiselela umzimba ukuzikhandla ngokomzimba. Yiyo kanye oko "ukuphendula okanye ukuphendula impendulo" kuthetha.

Ukuba uhamba wedwa ebusuku kwaye uva iinyawo emva kwakho, ukulwa kwempendulo yendiza kunokusebenza ngokukhawuleza ekukhuselekeni kwakho. Nangona kunjalo, ukuba ufumana uxinzelelo olungapheliyo, olu hlobo lwempendulo oluthile lunegalelo kwimibandela yempilo eyahlukeneyo, njengengcinezelo ephezulu yegazi, isifo sikashukela, isistim somzimba esichengileyo kunye nomonakalo we-muscle. Kungenxa yokuba umzimba wakho awuqapheli ukuba kukho iintlobo ezahlukeneyo zoxinzelelo; Uyazi kuphela ukuba uxinzelelo lubonakalisa ingozi kwaye luyakwenza ngokufanelekileyo.

Ulawulo lweengxaki kunye noKhathalelo lweChiropractic

Ukunyamekela kwe-Chiropractic kunokunceda ukuphucula kunye nokulawula iimpawu ezininzi zokuxinezeleka. Oku kungenxa yokuba umgudu ngumngcipheko wesistim se-nervous. Ukuguqulwa kwamagqabi kunye nokunyanzeliswa kwezinto ezinokubamba ukukhawuleza ukulwa okanye ukuphendula kwendiza ngokuqalisa inkqubo ye-parasympathetic. Ukongezelela, i-chiropractic inokunciphisa intlungu kunye nokuxhatshazwa kwemisipha, ukuphucula ukujikeleza, kunye nokuchaneka kokuchaneka kwe-spinal. Ezi ngenelo zonke zidibanisa ukunciphisa iimpawu zokuxinezeleka, okunciphisa indlela ekugxininiswe ngayo isigulane.

Isicwangciso esilungileyo

Iingcali zogqirha zikhokela izigulane zabo ngokubambisana kweenkqubo zokulawula uxinzelelo, kubandakanywa utshintsho lokutya, ukuzivocavoca, ukucamngca kunye nokuphucula. Ukutya okunempilo kunokunceda umzimba uphathe i-assortment yemiba, kubandakanywa uxinzelelo. Ukulandela ukutya okunotye kwiziqhamo kunye nemifuno, iiprotheni ezixhambileyo kunye ne-carbohydrates eziyinkimbinkimbi, kunye nokutya okuncinciweyo kunye nokulungelelaniswa, kunokuphucula kakhulu impilo nempilo. Ukuzivocavoca ngumxhasi wokuxininisa osebenzayo. Amandla owenzayo ngokusebenzisa umthambo ukhulula ukuxhatshazwa kunye namandla okunyamezela. Iphinde ikhuphe i-endorphins, eyinceda ukuphakamisa imizwelo. I-Yoga yindlela ekhethekileyo yokwenza umsebenzi wokukhupha uxinzelelo.

Ukucamngca kungenziwa ngeendlela ezahlukeneyo kwaye kunokwenziwa ngabasebenzi abahlukahlukeneyo bezempilo. Kwabanye, ukubhalwa kwiphephancwadi luhlobo lokucamngca, ngelixa ezinye ziqhelekileyo kwisicwangciso sabo. Amaninzi amaninzi okuphumla ahlobene nokucamngca, njengokuphefumula, ukukhulula umxube weemisipha, nokuphulaphula umculo othobayo okanye izandi zendalo.

Ukuzivocavoca okulula kunokulula kwaye kunika uxolo olukhawulezayo. Qala ngokukhupha ngokukhawuleza nangakumbi ngempumlo yakho, ngelixa ubala ukuya ezintandathu kwaye ukwandisa isisu sakho. Gcina umoya wakho ngenani labane, ukhulule umphefumlo wakho emlonyeni, ubale ezintandathu. Phinda umjikelezo ezintathu ukuya kwezihlandlo ezihlanu.
Ukukhululwa kwemisipha ngeendlela ezaziwa ngokuba "ukuphumla kwemisipha". Fumana isikhundla esihle, nokuba uhleli ngeenyawo zakho emhlabathini, okanye ulala emhlane wakho. Sebenzela indlela yakho kwiqela ngalinye le-muscle, uqale kwizwane zakho okanye intloko yakho, uhlambe umsila ngokubala ezintlanu, uze ukhulule. Lindela imizuzu ye-30 uze uqhubeke kwiqela elilandelayo le-muscle. Ukuzibuza indlela yokwenza iimbandezelo zobuso bakho? Ngenxa yobuso, pha kamisa iilebe zakho zikhulu njengoko unako kwaye uzive uxinzelelo ebunzini lakho nangesikhumba. Ingxenye ebalulekileyo ebusweni bakho, gweba amehlo akho kwaye uphazamise impumlo yakho nomlomo. Ekugqibeleni, ngenxa yobuso obungaphantsi, qhawula amazinyo akho uze ubhuqe emacaleni omlomo wakho.
Izandi ezithobileyo ezifana nomculo wee-instrumental okanye izandi zendalo zenza ukhululeke umzimba kunye nengqondo.

Ukugcina indlela yokuphila ngokulinganiselayo ngelixa kudibanisa ukunyamekela kwe-chiropractic njengendlela isicwangciso sokulawula uxinzelelo yindlela efanelekileyo yokunceda ukuphucula kunye nokujamelana neempawu zoxinzelelo. Ukunciphisa uxinzelelo kunokukunceda ekugcineni ulondoloze impilo yakho yonke.

Ukuphuculwa kweengcinezelo kunye noCognitive-Behavioral Treatment for Chronic Pain Back Pain: Imiphumo efana neyengqondo, ukuxhatshazwa, ukuzenzekela kunye nokwamkeleka kwi-Trial Control Regulated Trial

Abstract

Unyango lwe-Cognitive-behaviour (CBT) lukholelwa ukuba luphucula iingxaki zentlungu engapheliyo ngokunciphisa isigulana esonakalisa kunye nokwandisa ukusebenza kwesigulana ekulawuleni iintlungu. Ukunciphisa uxinzelelo lwengqondo (MBSR) kukholelwa ukuba luncedo kwizigulana ezingapheliyo ngokunyusa ingqondo kunye nokwamkelwa kwentlungu. Nangona kunjalo, kuncinci okwaziwayo malunga nokuba ezi ndlela zonyango zinokuhambelana njani nokuba zichaphazeleka ngokwahlukeneyo yi-MBSR xa ithelekiswa ne-CBT. Kwilingo elilawulwa ngokungahleliwe ngokuthelekisa i-MBSR, i-CBT, kunye nokhathalelo oluqhelekileyo (i-UC) kubantu abadala abaneminyaka eyi-20-70 iminyaka eneentlungu ezingapheliyo zangasemva (CLBP) (N = 342), sivavanye (1) ubudlelwane obusisiseko phakathi kwamanyathelo entlekele, ubuqu -ukusebenza, ukwamkelwa kunye nengqondo; kunye (2) notshintsho kula manyathelo kumaqela onyango e-3. Kwisiseko, intlekele inxulunyaniswa nokuziphatha, ukwamkelwa, kunye nezinto ezi-3 zengqondo (ukungasebenzi kwakhona, ukungagwebi, kunye nokwenza ulwazi; onke amaxabiso e-P <0.01). Ukwamkelwa kwakudityaniswa ngokuqinisekileyo nokusebenza kakuhle (P <0.01) kunye nengqondo (P-amaxabiso <0.05) amanyathelo. Ukuphulukana nokwenzakala kunciphise unyango lwangaphambi konyango lwe-MBSR kune-CBT okanye i-UC (omnibus P = 0.002). Zombini unyango lwalusebenza ngokuthelekiswa ne-UC ekwehliseni intlekele kwiiveki ze-52 (omnibus P = 0.001). Kuzo zombini iisampulu ezingenamsebenzi kunye nesampulu yabathathi-nxaxheba abaye kwi-6 ye-8 MBSR okanye iiseshoni ze-CBT, umahluko phakathi kwe-MBSR kunye ne-CBT ukuya kuthi ga kwiiveki ze-52 zazimbalwa, zincinci ngobukhulu, kwaye zinentsingiselo enomdla ekliniki. Iziphumo zibonisa ukungqubana kumanqanaba entlekele, ukusebenza ngokuzimeleyo, ukwamkelwa, kunye nengqondo, kunye neziphumo ezifanayo ze-MBSR kunye ne-CBT kula manyathelo phakathi kwabantu abane-CLBP.

Internet: ubuhlungu obungapheliyo, ukuzinyameka, ukuqikelela, ukwamukelwa, ukuphazamiseka, i-CBT, i-MBSR

intshayelelo

[I-20] Ukungenelela kwengqondo (MBIs) kubonisa nokuthembisa izigulane ezineentlungu ezingapheliyo [12,14,25,44,65] kunye nokusetyenziswa kwazo ngabantu ukwanda. Ukuqonda iindlela zokwenziwa kwezonyango zengqondo zengxaki ezingapheliyo kunye neendlela eziqhelekileyo kule ndlela zonyango ezahlukeneyo zibaluleke kakhulu ekuphuculeni ukusebenza nokusebenza kakuhle kwezi zonyango. [27,52] Iinkqubo eziphambili zezenzo ze-CBT zeentlungu ezingapheliyo ziquka ukunciphisa ukuphazamisa nokwandisa ukuphumelela ukulawula intlungu. [6-8,56] Ukukhumbuza kwengqondo kuthathwa njengendlela ebalulekileyo yokutshintsha kwi-MBIs, [14,26,30] eyandisa ukwamkelwa kweentlungu. [16,21,27,38,59] Noko ke, into encinci iyaziwa malunga nemibutho phakathi kweentlungu ezonakalisayo, ukuzibhokoxa, ukwamkelwa, kunye nengqondo ngaphambi kokuba unyango lweengqondo okanye malunga nokungafani kwiziphumo ze-CBT ngokubhekiselele kuma-MBIs kule miba.

Kukho ubungqina obubonisa ukuba imibutho ebalulekileyo phakathi kwale ndlela yokuguqulwa kweendlela. Ubu bungqina malunga nobudlelwane phakathi kokuphazamiseka nokucengela ingxube. Ezinye izifundo [i-10,18,46] zifumene ubudlelwane obubi phakathi kwamanyathelo entlungu obuhlungu kunye nengqondo. Nangona kunjalo, abanye abafumananga ubudlelwane obalulekileyo [19] okanye imibutho (ukuchasana) phakathi kokuphazamiseka kunye neminye imiba yengqondo (engekho ukugweba, engekho ireactivity, kunye nokwenza ulwazi) kodwa ingabanye (umzekelo, ukugcina). Kwakhona kwabikwa ukuba kuhambelana kakubi kunye nokwamkelwa kweentlungu. [18] Kwisampuli yeklinikhi yentlungu, ukwamukelwa ngokubanzi kwamava engqondo kwintsebenziswano engathandabuzekiyo kunye nokuphazamiseka nokuchukumiseka ngokucokisekileyo. [15,22,60] Ubuhlungu bokuzibhokoxa buye kwaboniswa ukuba buhambelana kakuhle ukwamukelwa kunye nokungalunganga nokuphazamiseka. [19]

Ngokuqhubekayo ukuphakamisa ukuphazamiseka kwiindlela ezahlukeneyo zonyango lweengqondo zengqondo, ukunyuka kwengqondo [10] kunye nokwamkelwa [1,64] kuye kwafunyanwa emva kokunyangwa kwengxaki yokuziphatha, kunye nokunciphisa ukuphazamiseka kuye kwabonwa emva kweenkqubo zokulawulwa kwentlungu. I-17,24,37] Uphando oluncinane luye lwahlola iziphumo ze-MBIs kwiintlungu ezingapheliyo ekuziphatheni, nangona uphando olutsha lwamagqirha e-migraine lufumene ukwanda okongezelelekileyo ekuziphatheni ngokwaseMaciniseni-Based Based Stress Reduction (MBSR) ukuqeqeshwa kunokuba lunakekelwa rhoqo. [63] Asikwazanga ukufumanisa nayiphi na iinjongo zobudlelwane phakathi kwazo zonke ezi zigugu zendlela yokwelapha okanye utshintsho kuzo zonke ezi ziguquko kunye ne-CBT ngokubhekiselele kwi-MBI yokubuhlungu okungapheliyo.

Injongo yale sifundo kwakufuneka uphinde uphinde uphinde uphumelele uphando ngokusebenzisa idatha evela kwilingo elilawulwa ngokungenamthetho (RCT) ngokuthelekisa i-MBSR, i-CBT kunye nokunyamekela okuqhelekileyo (UC). ubuhlungu obungapheliyo (CLBP) [12] ukuhlolisisa: (1) ubudlelwane obusisiseko phakathi kwamanyathelo okukhumbula kunye nentlungu ephazamisayo, ukuzinyameka, nokwamkelwa; kunye (2) kunye nokutshintsha kwexesha elide kule miqathango kumaqela enyango ye-3. Ngokusekelwe kwimbono kunye nophando lwangaphambili, sasixubusha ukuba: (1) kwisiseko, ukuphazamiseka kuya kuhambelana ngokukwamkelwa, ukuzinyameka, kunye nobukhulu be-3 yokucingisisa (ukungabikho kwemisebenzi, ukungabikho kokugweba, ukusebenzisana nolwazi), kodwa ihambelana nomlinganiselo wokuqwalasela; (2) kwisiseko, ukwamukelwa kuya kuhambelaniseka ngokuzenzekelayo ngokuzimelela; kunye (3) ukusuka kwisiseko ukuya kwii-26 kunye ne-52 iiveki, ukwamkelwa kunye nengqiqo kuya kukwandisa ngakumbi nge-MBSR kunokuba ne-CBT kunye ne-UC, kwaye ukuphazamiseka kuya kunciphisa ngakumbi kwaye ukuzinyameza kuya kukwandisa ngakumbi nge-CBT kunokuba yi-MBSR kunye ne-UC.

tindlela

Ukubeka, abaNxaxheba kunye neNkqubo

Abathathi-nxaxheba ababebhalisile babhalise kwiqela le-RCT ngokuthelekisa iqela le-MBSR, iqela le-CBT, kunye ne-UC yokuqaqanjelwa okungapheliyo okuthe ngqo phakathi kukaSeptemba 2012 no-Epreli 2014. Ngaphambili sazichaza iinkcukacha zeendlela zokufunda, [13] Imigangatho edityanisiweyo yovavanyo lweNgxelo (UKUXHASA) idayagramu yokuhamba, [12] kunye neziphumo. [12] Ngamafutshane, abathathi-nxaxheba baqeshwa kwiQela lezeMpilo, inkqubo ehlangeneyo yokhathalelo lwempilo eWashington State, nasekuthumeleni ngeposi eziya kubahlali basekuhlaleni abakhonzwa liQela lezeMpilo. Iikhrayitheriya zokufaneleka zibandakanya iminyaka engama-20 ukuya kwengama-70, iintlungu zangasemva ubuncinci iinyanga ezi-3, ukukhathazwa sisigulana esibuhlungu kwiveki ephelileyo? 4 (isikali se-0 ukuya kwele-10), kunye nokuphazanyiswa kwentlungu yesigulana kunye nemisebenzi kwiveki ephelileyo? 3 Isikali se-0-10). Sisebenzise ukuhlelwa kwamazwe onke kwezifo, ukuvuselelwa kwethoba, uhlengahlengiso lweklinikhi (i-ICD-9-CM) i-43 yeekhowudi zokuqonda isifo ezivela kwiirekhodi zonyango ze-elektroniki (i-EMR) zotyelelo kunyaka ophelileyo kunye nokuhlolwa kweefowuni ukungabandakanyi abaguli abanezizathu ezithile zentlungu ephantsi. Iikhrayitheriya zokukhutshelwa ngaphandle kubandakanya ukukhulelwa, utyando lomqolo kwiminyaka emi-2 edlulileyo, imbuyekezo yokukhubazeka okanye ukumangalelwa, i-fibromyalgia okanye isifo somhlaza, enye imeko yonyango enkulu, iceba ukubona ingcali yezonyango ngentlungu yomqolo, ukungakwazi ukufunda okanye ukuthetha isiNgesi, kunye nokuthatha inxaxheba Unyango lwe- mind-body yeentlungu zangasemva kunyaka ophelileyo. Abathathi-nxaxheba abanokuthi baxelelwe ukuba baya kulungelelaniswa kwenye yeenkqubo ezimbini ezizisebenzisayo ezahlukileyo ezisetyenziselwa ukulawulwa kweentlungu eziye zafunyanwa ziluncedo ekunciphiseni iintlungu kwaye zenze kube lula ukwenza imisebenzi yemihla ngemihla okanye ukuqhubeka nokunakekelwa okuqhelekileyo. Abo babelwe i-MBSR okanye i-CBT babengazi ngonyango oluthile abaza kulufumana kude kube yiseshoni yokuqala yokungenelela. Isifundo samkelwe yibhodi yokuphononongwa kweziko lezeMpilo kwaye bonke abathathi-nxaxheba banikezela ngemvume enolwazi.

Abathathi-nxaxheba babengenamsebenzi kwi-MBSR, i-CBT, okanye iimeko ze-UC. Ukuhlengahlengiswa kwahlulwa ngokusekwe kwixabiso lesiseko sesiphumo sokuqala, inguqulelo eguqulweyo yePhepha lemibuzo le-Roland Disability (RDQ), [42] kumaqela ama-2 okubuyela umva okunxulumene nentlungu: amaqondo aphakathi (amanqaku e-RDQ? 12 kwi-0 - 23 Isikali) kunye nokuphakama (amanqaku e-RDQ? 13). Ukunciphisa ukuphoxeka okunokwenzeka ngokungabikho kwi-CBT okanye kwi-MBSR, abathathi-nxaxheba bafumane i-UC bafumana umvuzo we-50. Idatha yaqokelelwa kubathathi-nxaxheba kudliwanondlebe oluncediswa yikhompyuter ngabasebenzi bophando abaqeqeshiweyo. Bonke abathathi-nxaxheba bahlawulwa i- $ 20 kudliwanondlebe ngalunye olugqityiweyo.

Amanyathelo

Abathathi-nxaxheba banikezela ngolwazi oluchazayo kwiinkqubo zokuphonononga kunye nolwaphulo-ndlebe, kwaye bagqiba amanyathelo okufunda kwisiseko (phambi kokuhlaziywa kwe-randomization) kunye ne-8 (emva kokunyanga), i-26 (iphambili yokugqibela yokufunda), kunye nee-52 iiveki emva kokulandelelana. Abathathi-nxaxheba baphinde bagqibe i-subset yamanyathelo kwiiveki ze-4, kodwa ezi nkcukacha azizange zihlolwe kwingxelo ekhoyo.

Imilinganiselo echazayo kunye neeCarvariate

Ukuvavanywa kunye nodliwanondlebe olusisiseko kuvavanywa, phakathi kwezinye izinto ezingahloliswanga kwisifundo esikhoyo, iimpawu zentlalo (ubudala, isini, ubuhlanga, ubuhlanga, imfundo, inqanaba lomsebenzi); ubude beentlungu (ezichazwe njengobude bexesha ukusukela kwixesha le-1 okanye ngaphezulu kweeveki ngaphandle kweentlungu ezisezantsi); kunye nenani leentsuku zokuqaqanjelwa ngumqolo kwiinyanga ezi-6 ezidlulileyo. Kule ngxelo, sichaza isampuli kwisiseko samanyathelo kunye nakwiziphumo eziphambili kwi-RCT: iphepha lemibuzo lokukhubazeka iRoland-Morris (RDQ) [42] kunye nenani lamanani obuhlungu beentlungu ezisemva. I-RDQ, umlinganiso osetyenziswa ngokubanzi wezinto ezinqamlezileyo zomsebenzi ezinxulumene nentlungu, ubuza ukuba ingaba imisebenzi ethile engama-24 inikwe umda namhlanje ziintlungu zangasemva (ewe okanye hayi). [45] Sisebenzise ingxelo eguqulweyo ebandakanya izinto ezingama-23 [42] kwaye sabuza malunga neveki edlulileyo kunanamhlanje kuphela. Ukukhathazeka okubuhlungu kwangemva kwakulinganiswa ngabathathi-nxaxheba malunga nendlela ekukhathaza ngayo iintlungu zabo zangemva kwiveki ephelileyo kwi-0 ukuya kwi-10 yokulinganisa amanani (0 = Akukho konke ukuphazamisa bother kunye ne-10 = ngokukhathaza kakhulu). I-covariates yengxelo yangoku yayifana nezohlalutyo lwethu lwangaphambili lweziphumo zongenelelo kwiziphumo: [12] ubudala, isini, imfundo, kunye nobude beentlungu (ngaphantsi konyaka omnye kuthelekiswa nonyaka omnye okoko wafumana iveki e-1 ngaphandle kweentlungu ezisezantsi). Sigqibe kwelokuba i-priori yokulawula ezi zinto zixabisekileyo ngenxa yamandla abo okuchaphazela amanyathelo ezonyango, impendulo yabathathi-nxaxheba kunyango, kunye / okanye amathuba okufumana ulwazi olulandelayo.

Amanyathelo okuNokwenzeka iindlela zokuPhatha

Ingqiqo. Ingqondo ichazwe njengokwazisa okuvela ngenjongo, ukungakhathali kumzuzu wangoku. [29] Silawule izibonelelo ezi-4 zeFom ye-Facet Mindfulness-Short Short Form (FFMQ-SF): [5] Ukujonga (ukuqaphela amava angaphakathi nangaphandle; izinto ezi-4); Ukwenza ngokuQaphela (ukuya kwimisebenzi yangoku yomzuzu, ngokuchaseneyo nokuziphatha ngokuzenzekelayo ngelixa ingqalelo ijolise kwenye indawo; izinto ezi-5); Ukungasebenzi kwakhona (ukungasebenzi kwakhona kumava angaphakathi: ukuvumela iingcinga kunye neemvakalelo ukuba zivele kwaye zidlule ngaphandle kokuncamathisela okanye ukuthintela; Izinto ezi-5); kunye nokungagwebi (ukungagwebi amava angaphakathi: ukuzibandakanya kwimeko yokungavavanyi ngokubhekisele kwiingcinga, iimvakalelo, kunye neemvakalelo; isikali sento ezi-5; nangona kunjalo, umbuzo omnye [ Ndenza izigqibo malunga nokuba iingcinga zam zilungile okanye zimbi ] bengaqondanga akubuzwanga.). I-FFMQ-SF ibonakalise ukuba inokuthenjwa, iyasebenza kwaye inovakalelo kutshintsho. [5] Abathathi-nxaxheba bavavanye uluvo lwabo malunga nento eyinyani kubo ngokwendlela yabo yokucinga engqondweni kubomi babo bemihla ngemihla (isikali esivela ku-1 = -nanye okanye kunqabile ukuba yinyani ukuya ku-5 = siqhelo okanye siyinyani rhoqo). Kwinqanaba ngalinye, amanqaku abalwa njengentsingiselo yezinto eziphenduliweyo kwaye ke uluhlu olunokubakho lwalungu-1-5, ngamanqaku aphezulu abonisa amanqanaba aphezulu obungakanani bengqondo. Izifundo zangaphambili zisebenzise amanqaku apheleleyo endaweni yeendlela, kodwa sikhethe ukusebenzisa amanqaku anikwe ukukhululeka kokutolika.

Ubuhlungu bubuhlungu. Isikali sePain Catastrophizing Scale (PCS) yinto ye-13 yokuvavanya intlekele enxulumene nentlungu, kubandakanya ukuqaqamba, ukukhulisa nokungancedi. [50] Abathathi-nxaxheba balinganise inqanaba ababenazo iingcinga kunye neemvakalelo ezithile xa befumana iintlungu (isikali esivela ku-0 = asiyiyo kwaphela ukuya ku-4 = lonke ixesha ). Iimpendulo zento zishwankathelwe ukuvelisa amanqaku apheleleyo (uluhlu olunokubakho = 0-52). Amanqaku aphezulu abonisa ukuvumela okungakumbi kokucinga okuyintlekele ekuphenduleni kwintlungu.

Ukwamkela ubuhlungu. Iphepha lemibuzo lokwamkelwa kobuhlungu obungapheliyo-8 (CPAQ-8), uhlobo lwento eyi-8 yemibuzo engama-20 yokwamkelwa kobuhlungu obungapheliyo (CPAQ), ibonakalisiwe ukuba ithembekile kwaye iyasebenza. [22,23] Inezikali ezi-2: Umsebenzi wokuzibandakanya (i-AE; ukuzibandakanya kwimisebenzi yobomi ngendlela eqhelekileyo nangona iintlungu zisenzeka) kunye nokuzimisela kobuhlungu (PW; ukukhutshwa kwimizamo yokulawula okanye ukunqanda iintlungu). Abathathi-nxaxheba bakalwe izinto kwisikali ukusuka ku-0 ( ze ibeyinyani ) ukuya kwi-6 (kuhlala kuyinyani ). Iimpendulo zento zishwankathelwe ukwenza amanqaku kwiskali ngasinye (uluhlu olunokubakho lwe-0-24) kunye nephepha lemibuzo xa lilonke (uluhlu olunokubakho lwe-0-48). Amanqaku aphezulu abonisa ukuzibandakanya okukhulu / ukubakho kweentlungu / ukwamkelwa kwentlungu. Phambi kophando lubonisa ukuba i-2 subscales zilungelelaniswe ngokuphakathi kwaye nganye nganye yenza igalelo elizimeleyo kuqikelelo lohlengahlengiso kubantu abaneentlungu ezingapheliyo. [22]

Ubuhlungu bubuqu. I-Questionnaire ye-Pain Self-efficacy Questionnaire (PSEQ) inezinto ezili-10 zokuvavanya ukuzithemba komntu ngamnye kumandla abo okujamelana nentlungu kunye nokuzibandakanya kwimisebenzi ngaphandle kwentlungu yabo, nganye nganye ikalwe kwisikali esivela ku-0 = Akuqinisekanga kwaphela- kuye ku-6 = Ndiyazithemba ngokupheleleyo. [39] Ikhweshine ibonakalisiwe ichanekile, ithembekile, kwaye inovakalelo kutshintsho. [39] Amanqaku amanqaku afingqiwe ukuvelisa amanqaku apheleleyo (uluhlu olunokubakho 0-60); amanqaku aphezulu abonisa ukusebenza ngempumelelo okukhulu.

Ngoncedo

Amanyathelo okungenelela kwe-2 afaniswa nefomathi (iqela), ixesha, ubukhulu, kunye nenani labathathi-nxaxheba kwiqela eliqela. Bobabini ukungenelela kwe-MBSR kunye ne-CBT kuqukethe ii-8 ngeveki ze-2 iiyure zeeyure ezongezelelweyo ngemisebenzi yasekhaya. Ngongenelelo ngalunye, senza umqulu wencwadana yokufundisa kunye nenxaxheba yomfundi, zombini kunye nomxholo oqulathekileyo kunye neenkcukacha ezipheleleyo kwiiseshoni nganye. Ngongenelelo ngalunye, abathathi-nxaxheba banikezelwa imisebenzi yasekhaya kwaye kwakugxininiswe ekubandakanyeni umxholo wokungenelela kwimpilo yabo yemihla ngemihla. Abathathi-nxaxheba banikezwa izixhobo zokufunda ekhaya kunye neeCD kunye nomxholo ochaphazelekayo wesiqhelo sasekhaya (umz., Ukucamngca, ukuchonga umzimba, kunye negaga kwi-MBSR; ukuphucula kunye nokuzibonakalisa kwi-CBT). Thina sashicilele inkcazo ecacileyo yongenelelo lwamabini, [12,13] kodwa uchaze ngokufutshane apha.

MBSR

Ukungenelela kwe-MBSR kwanyanzeliswa ngokusondeleyo emva kwenkqubo yokuqala eyakhiwe yi-Kabat-Zinn [28] kwaye isekelwe kwinqununu yomfundisi we-2009 MBSR. [4] Yayinxalenye yeeseshoni zeveki ze-8 kunye nekhefu le-6 ukuhamba emva kweeyure ze-6th kunye ne-7th. Umgaqo-nkqubo wawuquka ukuqeqeshwa kokufunda ngokucamngca ngengqondo kunye ne yoga engqondweni. Zonke iiseshoni zazibandakanya ukusetyenziswa kwengqondo (umz., Ukukhangela umzimba, ukucamngca okuhleliyo) kunye nokunyamekela kwengqondo (ngokuqhelekileyo, i-yoga).

CBT

Iqela le-CBT protocol libandakanya iindlela ezisetyenziswa ngokubanzi kwi-CBT ye-CLBP [20,58] kwaye zisetyenziswe kwizifundo zangaphambili. [11,33,41,51,53-55,57,61] Ukungenelela kwakubandakanya: (1) imfundo malunga (a) nosizi olungapheliyo, (b) iingcamango ezingabonakaliyo (kuquka ukuphazamiseka) kunye neenkolelo (umzekelo, ukungakwazi ukulawula intlungu, ukulimala okulingana nomonakalo) oqhelekileyo phakathi kwabantu abaneentlungu ezingapheliyo, (c) ubudlelwane phakathi kweengcamango kunye nokuziphendulela ngokomzimba, (d) ukulala ucoceko, kunye (e) nokuphindaphinda ukukhuselwa nokugcinwa i ngeniso; kunye (kunye ne-2) ukufundiswa kunye nokuziqhelanisa ekuqaliseni nasekucebiseni iingcamango ezingenakuthandeka, ukuvelisa ama-appraisal angaphezulu achanekileyo kwaye anceda, ukubeka kunye nokusebenza kwiinjongo zokuziphatha, ukuphefumula esiswini kunye nokuqhubeka kokuphucula imisipha, iindlela zokuhamba, ukuyeka ukucinga nokuphazamiseka, ukujamelana neengxelo ze-self-statements, kunye nokujongana neentlungu eziphazamisayo. Akukho nanye kula macandelo afakwe kwi-intervention ye-MBSR, kwaye ukucinga, ukucamngca, kunye neendlela zogazo zazingekho kwi-CBT. Abathathi-nxaxheba be-CBT banikezwa nencwadi (I-Guide ye-Pain Survival Guide [53]) kwaye yacela ukuba ifunde izahluko ezithile phakathi kweeseshoni. Ngethuba nganye yeseshoni, abathathi-nxaxheba bazalise icebo lesenzo somntu malunga nemisebenzi yokwenza phakathi kweeseshoni.

Ukunyamekela

Izigulane ezabelwe u-UC azifumananga uqeqesho lwe-MBSR okanye i-CBT njengenxalenye yesifundo kwaye yamukelwa nayiphi na inkathalo yempilo ababeyifumana ngexesha lokufunda.

Abacebisi / AbaPhandi beNyango kunye noLondolozo loBulungisa

Njengokuba kwakunikwe ingxelo ngaphambili, [12] bonke abaqeqeshi be-8 MBSR bafumana uqeqesho olusemthethweni ekufundiseni i-MBSR kwiziko leNgqondo kwiYunivesithi yaseMassachusetts okanye uqeqesho olulinganayo kunye nolwazi olunzulu lwangaphambili olufundisa i-MBSR. Ukungenelela kwe-CBT kwenziwa yii-4 Ph.D.-level level psychologists abanamava aphelileyo anika i-CBT ngamnye kunye neqela kwiigulane ezinentlungu engapheliyo. Iinkcukacha zoqeqesho loqeqesho kunye nokujonga kunye nokunyaniseka kwonyango kubonelelwe ngaphambili. [12]

Uhlalutyo lweSatisati

Sasisebenzisa izibalo ezichazayo ukuba shwa nkathele impawu ezisisiseko esicatshulwa ngeqela lokungafani, ngokwahlukileyo kwisampula sonke esingenakulinganiswa kunye ne-exemption yabathathi-nxaxheba ababeya kwi-6 okanye ngaphezulu kwee-class intervention intervention (i-MBSR kunye namaqela e-CBT kuphela). Ukuhlolisisa imibutho phakathi kweendlela zokwelapha kumanyathelo okuqala, sabala i-Spearman rho yokudibanisa kwimiqathango nganye yamanyathelo.

Ukuqikelela ukutshintshwa kwexesha kwiindlela zokuguqulwa kweendlela, sakha imodeli yokuguqulwa komgca kunye noshintsho oluvela kwisiseko njengoluhlu oluxhomekeke kuyo, kwaye luquka zonke iindawo zonyango zengqesho (8, 26, kunye nee-52 iiveki) ngendlela efanayo. Imodeli eyahlukileyo yayiqikelelwa kumlinganiselo ngamnye wokunyanga. Ngokuhambelanayo nendlela yethu yokuhlalutya iziphumo kwi-RCT, [12] esilungelelanise iminyaka, ubulili, imfundo, kunye neemilinganiselo ezisezantsi zokubandezeleka kwexesha, intlungu ebuhlungu, i-RDQ eguqulelweyo, kunye nenkqubo yokwelapha inomlinganiselo wenzalo kulo mzekelo. Ukulinganisa umphumo wonyango (umahluko phakathi kwamaqela ekutshintsheni kwindlela yokwelapha) kwinqanaba ngalinye, imizekelo yayiquka imiphumo ebalulekileyo yeqela lezonyango (CBT, MBSR, kunye ne-UC) kunye nexesha (8, 26, kunye nee-52 iiveki) , kunye nemigqaliselo yokusebenzisana phakathi kwezi ziguquko. Sasisebenzisa ukulinganisela okulinganiselweyo (i-GEE) [i-67] ukuze ivumelane nemilinganiselo yokulawula, ukubala ngokulungelelaniswa okunokwenzeka phakathi kwamanyathelo aphindaphindiweyo ukusuka kumntu ngamnye. Ukunika ingxelo ngeengxaki ezibangelwa yimirhumo eyahlukileyo kumaqela enyango, uhlalutyo lwethu olusisiseko lusebenzisa indlela ye-model yohlobo lwe-2-GEE yokumisela ingcaciso engekho phantsi kwendlela yokwelapha. Le ndlela isebenzisa isakhelo somzekelo womxube we-non-ignorable non-response kwaye iguqule ukulinganiswa kokuhlukahlula kwiimpawu zemizekelo yokugqibela kwi-akhawunti ekusebenziseni idatha ebhaliweyo. [62] Nathi, njengoluhlalutyo lobuthakathaka, kuqhutywe ukuhlaziywa kwakhona kuphawulwe ngaphezu kwedatha efunyenwe ukuhlola ukuba kusetyenziswa idilesi ebhaliweyo ibe nefuthe elikhulu kwiziphumo kwaye ukuvumela ukuthelekiswa okuthe ngqo kwezinye iincwadi ezipapashwe.

Uhlalutyo oluphambili lubandakanya bonke abathathi-nxaxheba abangahleliyo, besebenzisa indlela yokunyanga abanomdla (i-ITT). Siphindaphinde ukuhlalutya okubuyiselwayo kusetyenziswa isampulu yabathathi-nxaxheba ababekhethwe ngokungacwangciswanga kwi-MBSR okanye kwi-CBT kwaye beza ubuncinci kwiiseshoni ze-6 ze-8 zonyango abalunikiweyo (-as-unyango- okanye uhlalutyo lomgaqo per). Ngeenjongo ezichazayo, kusetyenziswa iimodeli zokuhlengahlengiswa kwesampulu ye-ITT enedatha ebekiweyo, siqikelele amanqaku (kunye ne-95% yezithuba zokuzithemba [CI]) kwinkqubo yonyango eguquguqukayo ngexesha ngalinye elilungelelaniswe ubudala, isini, imfundo, kunye namaxabiso asisiseko yexesha leentlungu, ukuphazamiseka kwentlungu, kunye ne-RDQ eguqulweyo.

Ukubonelela ngemeko yokutolika iziphumo, sasebenzisa iimvavanyo ze-t kunye neemvavanyo ze-chi-square ukuthelekisa iimpawu ezisisiseko zabathathi-nxaxheba abazange bazalise ubuncinane i-6 yeeseshoni zokungenela ze-8 (i-MBSR kunye ne-CBT yamaqela). Saqhathanisa ukungenelela kokuthatha iqela ngeqela, usebenzisa uvavanyo lwe-chi-square ukuthelekisa ubungakanani benxaxheba abathathiweyo kwi-MBSR kunye ne-CBT abagqibe ubuncinane i-6 yeeseshoni ze-8.

Insight of Dr. Alex Jimenez

Uxinzelelo ngokuyintloko luyinxalenye yempendulo "yokulwa okanye ukubhabha" enceda umzimba ngokufanelekileyo ukulungiselela ingozi. Xa umzimba ungena kwimeko yoxinzelelo lwengqondo okanye lweemvakalelo okanye ukuxinezeleka ngenxa yeemeko ezingathandekiyo okanye ezinzima kakhulu, umxube ontsonkothileyo wamahomoni kunye neekhemikhali, ezinjengeadrenaline, icortisol kunye ne-norepinephrine, zikhutshelwa ukuze kulungiselelwe umzimba kunye nolungelelwaniso lomzimba. isenzo sengqondo.�Nangona uxinzelelo lwexesha elifutshane lusinika inani elifunekayo lomda ofunekayo ukuphucula ukusebenza kwethu ngokubanzi, uxinzelelo lwexesha elide luye lwadibaniswa nemibandela eyahlukeneyo yempilo, kubandakanywa intlungu ephantsi kunye ne-sciatica. Iindlela zokulawula uxinzelelo kunye nobuchule, kubandakanywa ukucamngca kunye nokunyamekela kwe-chiropractic, kuye kwaboniswa ukunceda ukuphucula iziphumo zonyango lweentlungu ezisezantsi kunye ne-sciatica. Inqaku elilandelayo lixubusha iindidi ezininzi zonyango lokulawula uxinzelelo kwaye lichaza umphumo wabo kwimpilo yonke kunye nokuphila kakuhle.

iziphumo

Iinkcukacha zeSampuli Sample

Njengoko kwakunikwe ingxelo ngaphambili, [12] phakathi kwabantu be-1,767 abavakalisa umdla kumfundi kwaye bahlolwe ukufaneleka, i-1,425 yayingabandakanywa (ngokuqhelekileyo ngenxa yentlungu engenayo ngaphezu kweenyanga ze-3 kwaye ayikwazi ukuza kwiiseshoni zokungenelela). Abantu abasele be-342 ababhalisile kwaye babenomsebenzi. Phakathi kwe-342 ngabantu abangenangqondo, i-298 (87.1%), i-294 (86.0%), kunye ne-290 (84.8%) izalise i-8-, i-26-, ne-52-iveki yokuvavanya, ngokulandelanayo.

Ithebula 1 ibonisa iimpawu zesampuli kwisiseko. Phakathi kwabo bonke abathathi-nxaxheba, iminyaka yobudala yayineminyaka eyi-49, i-66% yabafazi, kwaye i-79% ibike ukuba ibe neentlungu zentlungu ubuncinane ngaphandle kweveki engenabuhlungu. Ngokomyinge, amanqaku e-PHQ-8 ayesemngceleni wobuhlungu obunzima bokucindezeleka obunzima. [32] Amanqaku athethayo kwi-Scin Catastrophizing Scale (16-18) yayingaphantsi kwamanqaku ahlukeneyo aphakanyisiwe ukuba ahlasele (clinical, 24,47 3049) . Ubunzima bobuchule Ukuzilinganisa ubuchule bezinga eliphezulu kumlinganiselo (malunga neengcambu ze-5 kwizinga le-0-60) kwisampula sethu xa kuthelekiswa nezigulane zokunakekelwa eziphambili ezibhalwe kwi-RT yokuhlola i-CBT e-England, [33] kunye malunga neeplani ze-15 eziphakamileyo kunabantu abanobuhlungu obungapheliyo abahlala kwinkqubo yokulawulwa kwentlungu e-England. [17]

Phantse isiqingatha sabathathi-nxaxheba ngokungacwangciswanga kwi-MBSR (50.9%) okanye i-CBT (56.3%) baye kwiiseshoni ubuncinci ze-6 zonyango abalunikiweyo; Umahluko phakathi konyango wawungabalulekanga ngokwezibalo (uvavanyo lwe-chi-square, P = 0.42). Kwinqanaba lokuqala, abo babekwi-MBSR kunye ne-CBT abagqibe ubuncinci iiseshoni ze-6, xa kuthelekiswa nabo bangakhange, babebadala kakhulu (kuthetha [SD] = 52.2 [10.9] xa kuthelekiswa ne-46.5 [13.0] iminyaka) kwaye baxela amanqanaba asezantsi kakhulu Ubuhlungu obukhathazayo (kuthetha [SD] = 5.7 [1.3] xa kuthelekiswa no-6.4 [1.7]), ukukhubazeka (kuthetha [SD] RDQ = 10.8 [4.5] xa kuthelekiswa ne-12.7 [5.0]), uxinzelelo (kuthetha [SD] PHQ-8 = 5.2 [ 4.1] kuthelekiswa no-6.3 [4.3]), kunye nentlekele (kuthetha [SD] I-PCS = 15.9 [10.3] xa ithelekiswa ne-18.9 [9.8]), kunye neentlungu ezisebenza kakhulu (kuthetha [SD] PSEQ = 47.8 [8.3] xa kuthelekiswa nama-43.2 [ 10.3]) kunye nokwamkelwa kwentlungu (i-CPAQ-8 yamanqaku apheleleyo athetha [SD] = 31.3 [6.2] xa kuthelekiswa ne-29.0 [6.7]; I-CPAQ-8 yeNtlungu yokuThandeka kuthetha [SD] = 12.3 [4.1] xa kuthelekiswa ne-10.9 [4.8]) (zonke i-P Iimpawu-0.05). Khange zahluke kakhulu nakwezinye izinto eziguquguqukayo eziboniswe kwiTheyibhile 1.

Ubuncinane bokuBambisana phakathi kweendlela zokuPhatha kweMpawu

Itheyibhile 2 ibonisa unxibelelwano lwe-Spearman phakathi kwendlela yonyango yonyango kwisiseko. Iingcinga zethu malunga nolwalamano olusisiseko phakathi kwala manyathelo ziqinisekisiwe. Ukuphulukana nokudityaniswa kwakuhambelana ngokungalunganga kunye nemilinganiselo emi-3 yokuqonda (ukungasebenzi kwakhona rho =? 0.23, ukungagwebi rho =? 0.30, kunye nokwenza ulwazi nge-rho =? 0.21; onke amaxabiso e-P <0.01), kodwa engadibananga nobukhulu bokujonga Yengqondo (rho =? 0.01). Ukuphulukana nokudityaniswa kwakhona kwahambelana kakubi nokwamkelwa (amanqaku apheleleyo e-CPAQ-8 rho =? 0.55, Ukuthanda iintlungu subscale rho =? 0.47, Umsebenzi wokuzibandakanya subscale rho =? 0.40) kunye nentlungu yokusebenza ngokwakho (rho =? 0.57) (onke amaxabiso e-P <0.01). Okokugqibela, iintlungu zokuzihlaziya zadityaniswa ngokuqinisekileyo nokwamkelwa kwentlungu (amanqaku e-CPAQ-8 ewonke rho = 0.65, Ukuzinza kobuhlungu subscale rho = 0.46, Umsebenzi wokuzibandakanya subscale rho = 0.58; zonke ixabiso le-P <0.01).

Ulwahlulo lweqela leZonyango kwiinguqu kwiindlela zokunyangwa kwamanyathelo Phakathi kwabo bonke abathathi-nxaxheba abaRandi

Itheyibhile 3 ibonisa utshintsho olutshintshiweyo olusisiseko ukusuka kwisiseko kwiqela ngalinye lokufunda kunye neendlela eziguqulweyo zothetha umahluko phakathi kwamaqela onyango kwindlela yonyango kumanyathelo okulandelwa kwisampulu nganye. Umzobo 1 ubonisa amanqaku atshintshiweyo e-PCS kwiqela ngalinye ngexesha ngalinye. Ngokuchasene ne-hypothesis yethu yokuba ukonakalisa kuya kuncipha ngakumbi nge-CBT kune-MBSR, ukuphazamiseka (amanqaku e-PCS) kwehle kakhulu ukusuka kunyango lwangaphambi kokuya kunyango kwiqela le-MBSR kuneqela le-CBT (MBSR ngokuchasene ne-CBT ehlengahlengisiweyo kuthetha [95% CI] Umahluko kutshintsho =? 1.81 [? 3.60,? 0.01]). Ukutshabalalisa kwakhona kunciphise kakhulu kwi-MBSR kune-UC (MBSR xa kuthelekiswa ne-UC eguqulweyo kuthetha [95% CI] umahluko kutshintsho =? 3.30 [? 5.11,? 1.50]), kanti umahluko phakathi kwe-CBT ne-UC wawungabalulekanga. Kwiiveki ezingama-26, amaqela onyango awangahlukanga kangako kutshintsho olwenzakalisayo ukusuka kwisiseko. Nangona kunjalo, kwiiveki ezingama-52, zombini i-MBSR kunye namaqela e-CBT abonise ukwehla okukhulu kakhulu kuneqela le-UC, kwaye kwakungekho mahluko ubalulekileyo phakathi kwe-MBSR kunye ne-CBT.

Umzobo we-1 Ulungelelaniso uthetha izikolo ze-PCS

Umzobo 1: Ukulungiswa kuthetha ukuba i-Pain Catastrophizing Scale (PCS) amanqaku (kunye ne-95% yexesha lokuzithemba) kwisiseko (ngaphambili-randomization), iiveki ze-8 (emva kokunyanga), iiveki ze-26 kunye nee-52 iiveki kubafundi abathathi-nxaxheba kwi-CBT, MBSR kunye ne-UC. Iingqinisiso zendlela zichitshiyelwe kuminyaka inxaxheba, ubulili, imfundo, nokuba okanye ubuncinane ubuncinane be-1 kunyaka ngaphandle kwentlungu, kunye ne-RDQ kunye neentlungu ezixhalabisayo.

Umzobo 2 ubonakalisa amanqaku atshintshiweyo e-PSEQ kwiqela ngalinye ngexesha ngalinye. I-hypothesis yethu yokuba ukusebenza ngokwakho kuya kunyusa ngaphezulu nge-CBT kune-MBSR kunye ne-UC yayiqinisekisiwe ngokuyinxenye. Ukusebenza ngokuzimeleyo (amanqaku e-PSEQ) akonyuke kakhulu ngakumbi ukusuka kunyango lwangaphambi kokuya kunyango kunye ne-CBT kune-UC, kodwa hayi nge-CBT ehambelana neqela le-MBSR, elonyuke kakhulu ngaphezulu kweqela le-UC (uhlengahlengiso luthetha [95% CI] umahluko kutshintsho kwi-PSEQ ukusuka kwisiseko se-CBT xa kuthelekiswa ne-UC = 2.69 [0.96, 4.42]; I-CBT xa ithelekiswa ne-MBSR = 0.34 [? 1.43, 2.10]; I-MBSR ithelekiswa ne-UC = 3.03 [1.23, 4.82]) (3 Table). Uvavanyo lwe-omnibus lokwahluka ngokwamaqela kutshintsho olwenziwe ngamandla aluzange lubaluleke kwiiveki ezingama-26 okanye ezingama-52.

Umzobo we-2 Ulungelelaniso oluPhakamileyo lwe-PSEQ

Umzobo 2: Ukulungiswa kuthetha ukuba i-Pain Self-Efficiency Questionnaire (amanqaku e-PSEQ) kunye ne-95 yexesha lokuzithemba) kwinqanaba lokuqala (i-pre-randomization), iiveki ze-8 (emva kwonyango), iiveki ze-26 kunye nee-52 iiveki kubafundi abathathi-nxaxheba kwi-CBT, MBSR kunye ne-UC . Iingqinisiso zendlela zichitshiyelwe kuminyaka inxaxheba, ubulili, imfundo, nokuba okanye ubuncinane ubuncinane be-1 kunyaka ngaphandle kwentlungu, kunye ne-RDQ kunye neentlungu ezixhalabisayo.

Iingcamango zethu ukuba ukwamkelwa kuya kukwandisa ngakumbi nge-MBSR kunokuba i-CBT kunye ne-UC ngokungaqinisekanga. Uvavanyo olungabonakaliyo kumabakala ngamaqela aluzange lube luphawu lweCPAQ-8 elipheleleyo okanye uMsebenzi wokuThunywa kweMisebenzi kwixesha eliphi na ixesha (Itafile 3). Uvavanyo lwe-Pain Willingness subscale lwaluphawuleka kwiiveki ze-52 kuphela, xa zombini amaqela e-MBSR nee-CBT abonisa ukunyuka okukhulu xa kuthelekiswa no-UC, kodwa kungekhona xa kuthelekiswa nomnye nomnye (uguquko lithetha [95% CI] uguquko kwi-MBSR UC = 1.15 [0.05, 2.24]; CBT ngokubhekiselele kuUC = 1.23 [0.16, 2.30]).

Iingcamango zethu zokuthi ingqondo iya kwandisa ngakumbi nge-MBSR kunokuba i-CBT iqinisekiswe ngokukodwa. Bobabini amaqela e-MBSR kunye nee-CBT abonisa ukwanda okukhulu xa kuthelekiswa ne-UC kwi-FNMX ye-FNMX-SF. ukungafani kwindlela yokulandelelana kamva kwakungabalulekanga (Ithebhile 8, Umfanekiso 0.18). Kwakukho ukwanda okwenyuka kakhulu kwizinga elingabalulekanga kunye ne-MBSR kunye ne-CBT (uguquko lwentsingiselo [0.01% CI] uguquko = 0.36 [0.28, 0.10]) kunye phakathi kwe-MBSR kunye ne-UC (0.46 [3, 3]) kwiiveki ze-95, kodwa akukho mvelaphi ephawulekayo phakathi kwamaqela kwimizuzu yexesha elizayo (Umfanekiso 0.29). Uvavanyo olungabonakaliyo lwamahluko phakathi kwamaqela aluzange lube luphawu olubalulekileyo ekusebenzeni ngokuQaphela okanye ekuqwalaseleni izikali nangaliphi na ixesha.

Umzobo we-3 Ulungelelaniso olubhekiselele kwi-FFMQ-SF ye-Non Reactivity Scores

Umzobo 3: Ulungelelaniso lithetha i-Five Facet Mindfulness Questionnaire-Ifomu emfutshane (FFMQ-SF) Iziphumo ezingabonakaliyo (kunye ne-95% yexesha lokuzithemba) kwixesha lokuqala (i-pre-randomization), iiveki ze-8 (emva kokunyanga), iiveki ze-26 kunye nee-52 iiveki kubafundi abathathi-nxaxheba. kwi-CBT, MBSR, kunye ne-UC. Iingqinisiso zendlela zichitshiyelwe kuminyaka-nxaxheba, ubulili, imfundo, nokuba okanye ubuncinane ubuncinane be-1 kunyaka ngaphandle kwentlungu, kunye ne-RDQ kunye neentlungu ezixhalabisayo.

Umzobo we-4 Ulungelelwano olubhekiseleleyo olubhekiselele kwi-FFMQ-SF engabonanga

Umzobo 4: Ulungelelaniso lithetha i-Five Facet Mindfulness Questionnaire-Ifomu emfutshane (FFMQ-SF) Amanqaku angabalulekanga (kunye ne-95% yexesha lokuzithemba) kwixesha lokuqala (i-pre-randomization), iiveki ze-8 (emva kwonyango), iiveki ze-26 kunye nee-52 iiveki zabathathi-nxaxheba kwi-CBT, MBSR, kunye ne-UC. Iingqinisiso zendlela zichitshiyelwe kuminyaka-nxaxheba, ubulili, imfundo, nokuba okanye ubuncinane ubuncinane be-1 kunyaka ngaphandle kwentlungu, kunye ne-RDQ kunye neentlungu ezixhalabisayo.

Ukuhlalutya ukusetyenziswa ngokubhekiselele kunokuba kuthethwe kwedata kwenzelwe iziphumo ezifanayo, kunye ne-2 encinci. Ukwahlula phakathi kwe-MBSR kunye ne-CBT kwinguqu ekuhlaseleni kwiiveki ze-8, nangona kunjalo ngokulinganayo, kwakungasabonakali ngokubaluleka ngenxa yokutshintsha kwexesha lokuzithemba. Okwesibini, uvavanyo olungagqityiweyo lwe-CPAQ-8 Pain Willingness esikolweni kwiiveki ze-52 kwakungasabalulekiyo (P = 0.07).

Ulwahlulo lweqela leZonyango kwiinguqu kwiindlela zokunyangwa kwamanyathelo Amanyathelo phakathi kwabathathi-nxaxheba kwi-CBT okanye kwi-MBSR Abagqityiweyo kwiiSt.

Itheyibhile 4 ibonisa utshintsho olutshintshiweyo olusisiseko kunye nolungelelwaniso lwantlukwano phakathi kweqela kwindlela yonyango kwi-8, 26, kunye nee-52 iiveki zabathathi-nxaxheba ababekhe babekwa kwi-MBSR okanye kwi-CBT kwaye bagqiba i-6 okanye iiseshoni ezingaphezulu zonyango abalunikiweyo. Umahluko phakathi kwe-MBSR kunye ne-CBT wawufana nobukhulu kulawo akwisampulu ye-ITT. Kwakukho iiyantlukwano ezimbalwa kuphela kubalo lwamanani ngokuthelekisa. Ngokuchasene neziphumo kusetyenziswa isampulu ye-ITT, umahluko phakathi kwe-MBSR kunye ne-CBT kwintlekele (i-PCS) kwiiveki ze-8 yayingasabalulekanga ngokweenkcukacha kwaye kwiiveki ezingama-52, iqela le-CBT lenyuka kakhulu kuneliqela le-MBSR kwi-FFMQ-SF Ukujonga isikali (ulungelelwaniso lwentsingiselo umahluko kutshintsho ukusuka kwisiseko se-MBSR xa kuthelekiswa ne-CBT =? 0.30 [? 0.53,? 0.07]). Uhlalutyo lobuntununtunu kusetyenziswa okuqwalaselweyo kunedatha ebekiweyo ayivelisi mahluko unentsingiselo kwiziphumo.

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Kulo hlalutyo lweenkcukacha ezivela kwi-RCT ngokuthelekiswa kwe-MBSR, i-CBT, kunye ne-UC ye-CLBP, iingcinga zethu ukuba i-MBSR kunye ne-CBT iya kuphazamisa ngokwahlukileyo amanyathelo ekwakhiweyo ukuba kukho iindlela zokuphazamiseka ngokungaqinisekanga. Ngokomzekelo, i-hypothesis yokuba ukukhathazeka kuya kukwandisa ngakumbi nge-MBSR kunokuba i-CBT iqinisekiswe kuphela kwi-1 ye-4 yezinto ezilinganisiweyo zokuqwalasela ingqondo (ukungagwebi). Olunye uhlangothi, olusebenzayo nolwazi, lwandise ngakumbi nge-CBT kune-MBSR kwiiveki ze-26. Zombini ukungafani kwakuncinane. Ukunyamekela kwengqondo emva kokuba inkqubo yeentlungu ezihlukeneyo ze-CBT (10] ixelwe ngaphambili; iziphumo zethu zixhasa inkxaso ngakumbi ukuba i-MBSR kunye ne-CBT yokwenyuka kwengqondo kwixesha elifutshane. Asifumananga nemiphumo emide yexesha elide lonyango olunxulumene ne-UC ngokukhumbula.

Ngokuchasene ne-hypothesis, ukutshatyalaliswa kwehleko kwanciphise ixesha elide emva kokunyangwa nge-MBSR kunokuba ne-CBT. Nangona kunjalo, umahluko phakathi kwonyango luyincinci kwaye ayikho into ephawulekayo ekulandeleni emva koko. Bobabini unyango lwalusebenza ngokuthelekiswa ne-UC ekunciphiseni ukuphazamiseka kwiiveki ze-52. Nangona uphando lwangaphambili lubonakaliswe ukunciphisa ukuphazamiseka emva kokubambisana kwe-CBT [35,48,56,57] kunye neenkqubo zokulawulwa kwentlungu, i-[17,24,37] yethu yowokuqala ukubonisa ukuhla okufanayo kwimizi yonyango, kunye nemiphumo kuze kube ngu-1 ngonyaka.

Ukwandisa ukuzinyameka kuboniswe ukuba kuhambelana nokuphucula kwintlungu kunye nokusebenza, [6] kunye nomlamli obalulekileyo we-CBT. [56] Nangona kunjalo, ngokuchasene neengcinga zethu, intlungu yokuzibhokoxa ayizange ikhulise ngaphezulu nge-CBT ngaphezu kunye ne-MBSR naliphi na ixesha. Xa kuthelekiswa ne-UC, kukho ukunyuka okukhulu kakhulu ekuziphatheni ngokwabo kunye ne-MBSR kunye ne-CBT emva kokunyanga. Ezi ziphumo izibuko ezifunyenweyo zangaphambili zeziphumo ezintle ze-CBT, kuquka i-CBT yeqela leentlungu zentlungu, [33] ngokuzimelela. [3,56,57] Uphando oluncinane luhlolisise utshintsho olwenziwe emva kwe-MBIs ngenxa yobuthathaka obungapheliyo, nangona ukuzinyusa kwandisa MBSR kunokuba unyamekele ngokuqhelekileyo izigulane ezineemigraines kwisifundo somqhubi [63] kunye nokunye kunye ne-MBSR kunemfundo yempilo ye-CLBP kwi-RCT. [37] Iziphumo zethu zongeza ulwazi kule ndawo ngokubonisa ukuba i-MBSR ineenzuzo zesikhashana ngenxa yentlungu yokuzibhokoxa efana neyo-CBT.

Izifundo zangaphambili ezingalawulwayo zifunyenwe ukwanda kwenyameko kwenyameko emva kweqela le-CBT kunye ne-Acceptance kunye nokuzibophelela kweTradio64 (leyo leyo, ngokungafani ne-CBT yendabuko, ikhuthaza ukunyamezwa kweentlungu), kunye nokwamkelwa kokwandiswa emva kokunyangwa kobuhlungu obuninzi be-CBT-based. kuwo onke amaqela ngokuhamba kwexesha, kunye ne-1,2 kuphela ebonakalayo phakathi kweqela le-1 kumanqanaba okuwamkela i-3 kunye namaxesha okulandelwa kwe-3 (ukwanda okukhulu kunye ne-MBSR kunye ne-CBT kunokuba ne-UC kwi-Advocacy Pain Advent at weeks of 3). Oku kubonisa ukuba ukwamkelwa kunokunyuka ngaphezu kwexesha kungakhathaliseki unyango, nangona oku kufuneka kuqinisekiswe kwiphando elongezelelweyo.

Amathuba amabini anokuchaza iziphumo zethu ebezixeliwe ngaphambili malunga nokusebenza ngokufanayo kwe-MBSR kunye ne-CBT ye-CLBP: [12] (1) iziphumo zonyango kwiziphumo zibangelwe ezahlukeneyo, kodwa ngokulinganayo, iindlela zonyango, okanye (2) iimpembelelo ezifanayo kwiindlela ezifanayo zonyango. Iziphumo zethu zangoku zixhasa umbono wokugqibela. Zombini unyango zinokuphucula iintlungu, ukusebenza, kunye nezinye iziphumo ngeendlela ezahlukeneyo zokunciphisa ukubonwa kweentlungu zabo njengoyikiso nokuphazamisa kunye nokukhuthaza ukuthatha inxaxheba kwemisebenzi ngaphandle kwentlungu. I-MBSR kunye ne-CBT ziyahluka kumxholo, kodwa zombini zibandakanya iindlela zokuphumla (umzekelo, ukuphumla kwezihlunu kwi-CBT, ukucamngca kwi-MBSR, iindlela zokuphefumla kuzo zombini) kunye neendlela zokunciphisa ixabiso lesoyikiso lentlungu (imfundo kunye nohlengahlengiso lwengqondo kwi-CBT, ukwamkela amava ngaphandle Ukusebenza kwakhona okanye ukugweba kwi-MBSR). Ngaloo ndlela, nangona i-CBT igxininisa izakhono zokufunda ukulawula iintlungu kunye nokunciphisa iimpendulo ezingathandekiyo, kunye ne-MBSR igxininisa ingqondo kunye nokucamngca, zombini unyango lunokunceda izigulane zikhululeke, zingaphenduli kakubi kwiintlungu, kwaye zijonge iingcamango njengeenkqubo zengqondo kunokuba zichaneke ngokuchanekileyo, ke oko kukhokelela ekunciphiseni uxinzelelo lweemvakalelo, ukunqanda umsebenzi, kunye neentlungu ezikhathazayo.

Uhlalutyo lwethu luye lwabonakalisa ukungafani phakathi kwamanyathelo okwakhiwa okuhlukeneyo okukholelwa ukuba uhambelana nemiphumo ye-MBSR kunye ne-CBT kwiziphumo ezibuhlungu ezingapheliyo. Njengokuxilongwa, ngaphambi kokunyanga, iintlungu ezithintekayo zaxhatshazwa kakubi ngenxa yentlungu, ukuvunywa kwentlungu, kunye ne-3 ubukhulu bokucingisisa (ukungabikho komsebenzi, ukungabikho kokugweba, nokwenza ngokuqonda), kunye nokwamkelwa kwentlungu kudibaniswa ngokuqinisekileyo nentlungu nokusebenza. Ukwamkela ubuhlungu nokuzimelela kwaye kwadibaniswa ngokufanelekileyo kunye nemilinganiselo yokucinga. Iziphumo zethu zihambelana nokubonwa kwangaphambili kwemibutho engalunganga phakathi kwamanyathelo okuphazamisa nokwamkelwa, [15,19,60] ukungahambelani kwamanyathelo phakathi kwamanyathelo okuphazamisa nokukhumbuza, [10,46,18] kunye nemibutho enobulungisa phakathi kwamanyathelo okwamkelwa kweentlungu kunye nokuqonda. [19]

Njengeqela, kwinqanaba lokuba le miqathango ibonakalisa ukwakhiwa kwazo, ezi ziphumo zixhasa inkxaso yokuphazamiseka njengento ehambelana nxamnye nemithamo emibili ehambelana nokuthatha inxaxheba kwimisebenzi yesiko nangona intlungu kodwa ihluke ekugxininisweni kokuzama ukulawula intlungu: intlungu ukwamkelwa (ukuxhatshazwa kwimizamo yokulawula intlungu kunye nokuthatha inxaxheba kwimisebenzi nangona intlungu) kunye nokuzimelela (ukuzithemba ekukwazi ukulawula intlungu kwaye uthathe inxaxheba kwimisebenzi yesiko). Ukufana kwamanye amaphepha enemibuzo ixhasa ngakumbi le mbono kwaye inokuba negalelo kwimibutho ehlonelweyo. Ngokomzekelo, zombini iCPAQ-8 kunye ne-PSEQ iqulethe izinto malunga nokwenza imisebenzi eqhelekileyo nangona kukho intlungu. Ukongezelela, kukho isiseko kunye nesimo sengqiqo sokujonga ingozi (jolisa intlungu ngeempendulo ezingathandekiyo kunye nezimpendulo ezichaphazelekayo) njengoko kudibanisa ngokugqithisileyo (oko kukuthi, ukuqwashisa ngesenzo ngaphandle kokugweba okanye ukulungelelanisa), kunye nokujonga ingqalelo kunye, kodwa ngokungafaniyo, ukwamukelwa nokuzimelela. Kufuneka umsebenzi ogqityiweyo ukucacisa ubudlelwane phakathi kwezi zakhiwo zokufunda kunye nokulinganiswa kwamanyathelo abo (a) ezakhayo ezidibeneyo kodwa ezichaseneyo kunye neklinikhi ngokuchasene (b) nemiba eyahlukeneyo yokwakhiwa kweengqungquthela.

Kuhlala kunokwenzeka ukuba i-MBSR kunye ne-CBT ithintela ngokwahlukileyo abalamlamli abaluvavanyo abangahlolwayo kweli phofu. Iziphumo zethu zigqamisa imfuneko yokuqhubela phambili uphando ekufumaneni ngokucacileyo ukuba ngabalamlamli bemiphumo ye-MBSR kunye ne-CBT kwimiphumo eyahlukeneyo yeentlungu, ukuphuhlisa amanyathelo ahlola aba balamli ngokubanzi ngokucacileyo nangokufanelekileyo, ukuqonda kangcono ubudlelwane phakathi kweendlela zokuguqula iziphumo ezichaphazela iziphumo (umz. , ukunciphisa ukuphazamiseka kunokusombulula impembelelo yengqondo yokukhubazeka [10]), kunye nokuphucula unyango lweengqondo ukuze kuthintele ngempumelelo nangempumelelo ngempumelelo aba balamlileli. Uphando luyafuneka kwakhona ukuchonga iimpawu zesigulane ezinxulumene nokuphendula kwiinkqubo ezahlukeneyo zokusasazeka kwengqondo kwintlungu engapheliyo.

Uninzi lwezifundo zokunciphisa ingxoxo. Abathathi-nxaxheba babenamazinga aphantsi aphantsi koxinzelelo lwengqondo (umz., Ukuphazamiseka, ukudandatheka) kwaye safunda i-CBT yeqela, eliye labonisa ukuphumelela, [i-33,40,55] ukusetyenziswa kwemithombo, kunye neenzuzo zentlalo, kodwa ezingenakusebenza ngaphantsi kwe-CBT nganye. [36,66 ] Iziphumo zingenakuzalisa abantu abadandathekileyo (umz., Izigulane zentlungu zeeklinikhi), eza kuba neendawo ezininzi zokuphucula ukusebenza kwamanyathelo omzimba kunye nokunyuka okukhulu kwonyango ukuze kuthintele imilinganiselo, okanye ukuthelekisa i-MBSR nge-CBT nganye.

Kuphela sisiqingatha sabathathi-nxaxheba abakhethayo kwi-MBSR okanye kwi-CBT ukuya kwi-6 yeeseshoni ze-8 ubuncinci. Iziphumo zinokwahluka kwizifundo ezinamazinga aphezulu okubambelela kunyango; Nangona kunjalo, iziphumo zethu kuhlalutyo lwe- as-unyango ngokubanzi zibonise ezo zohlalutyo lwe-ITT. Ukubambelela kunyango kubonisiwe kunxulunyaniswa nezibonelelo ezivela kwi-CBT yazo zombini iintlungu ezingapheliyo zomqolo [31] kunye ne-MBSR. [9] Uphando luyafuneka ukuchonga iindlela zokunyusa ukuhamba kweeseshoni ze-MBSR kunye ne-CBT, kunye nokuchonga ukuba ngaba iimpembelelo zonyango kunyango lwendlela kunye neziphumo eziguqukayo ziyomelezwa ngokubambelela ngakumbi kunye nokusebenza.

Ekugqibeleni, amanyathelo ethu angeke athathe ngokufanelekileyo i-build constructed. Ngokomzekelo, iindlela zethu zokwamkela iingqondo kunye neentlungu zazinyathelo ezimfutshane zeendlela zokuqala; nangona ezi zifutshane zibonakalise ukuthembeka nokuqinisekiswa, amanyathelo okuqala okanye amanye amanyathelo alezi zakhiwo angazenza ngokwahlukileyo. U-Lauwerier et al. [34] phawula iingxaki eziliqela kunye neCPAQ-8 Pain Ukulinganisa ukulingana, kubandakanywa ngaphantsi kwemeko yentlungu yokuzithandela. Ukongezelela koko, ukwamkelwa kwentlungu kulandelwa ngokwahlukileyo kwiintlobo ezahlukeneyo zokumkela iintlungu, mhlawumbi kubonisa ukungafani kwezichaso. [34]

Ngesi sifundo, lo luhlolisiso lokuqala ukuhlolisana ubudlelwane phakathi kwamanyathelo eendlela eziphambili ze-MBSR kunye ne-CBT yokukhathazeka okungapheliyo-ukukhathazeka kunye neentlungu ezonakalisayo, ukuzibhokoxa, nokwamkelwa - nokuhlola utshintsho kule miqathango phakathi kwabathathi-nxaxheba kwi-RCT ngokuthelekiswa MBSR kunye ne-CBT yeentlungu ezingapheliyo. Imilinganiselo yokulimaza yayinxulumene ngokuthe ngqo kumanyathelo amanyathelo amanyathelo angamanyathelo athatywayo, ukuzinyameka, kunye nengqiqo. Kule sampulu yabantu ngabanqanaba eliphantsi loxinzelelo lwengqondo kwinqanaba lokuqala, i-MBSR kunye ne-CBT inemiphumo emfutshane kunye nexesha elide kule miqathango. Imilinganiselo yokuphazamiseka, ukwamukelwa, ukuzinyameka, kunye nokuqonda ingathatha imimandla eyahlukeneyo yokuqhubeka kweengcamango ezinokuqonda, ezichaphazelayo nezokuziphatha, kunye nokukhuselwa komsebenzi ekupheleni kwesigxina kunye nokuqhubeka nokuthatha inxaxheba kwimisebenzi eqhelekileyo kunye nokungabi ingxaki engqondweni kunye nefuthe ekusebenziseni intlungu kwenye. Bobabini i-MBSR kunye ne-CBT inokuba neenzuzo zonyango ngokunceda abantu abaneentsholongwane ezingapheliyo ezivela kwilapho zangaphambili ukuya ekupheleni. Iziphumo zethu zibonisa ukuba luncedo lokuhlambulula zombini amanyathelo kunye nemizekelo yeendlela zonyango lweengqondo zengqondo ukuze zenzeke ngokucacileyo kwaye zenzeke ngokufanelekileyo izinto zokwakha ezibalulekileyo ekulungelelaneni intlungu engapheliyo.

isishwankathelo

I-MBSR kunye ne-CBT inemiphumo efana nefutshane kunye nexesha elide kwiimilinganiselo zengqondo kunye neentlungu ezonakalisayo, ukuzibhokoxa kunye nokwamkelwa.

Imibulelo

Uphando oluchaziweyo kolu papasho luxhaswe liZiko leSizwe leMpilo eQinisekayo kunye neHlanganisiweyo yamaZiko ezeMpilo kaZwelonke phantsi kweNombolo yeBhaso R01AT006226. Iziphumo zokuqala ezinxulumene nolu phononongo zaziswa kwiposta kwintlanganiso ye-34th yonyaka ye-American Pain Society, ePalm Springs, ngoMeyi 2015 (Turner, J., Sherman, K., Anderson, M., Balderson, B., Cook, A., kunye noCherkin, D: Intlungu, ukusebenza ngokuzithemba, ukukhumbula, nokwamkelwa: Ubudlelwane kunye notshintsho phakathi kwabantu abafumana i-CBT, MBSR, okanye ukhathalelo oluqhelekileyo lwentlungu engapheliyo).

Imihlathi

Ukungqubuzana kwintetho yesithakazelo: UJudith Turner ufumana i-royalties evela ku-PAR, Inc. ngokuthengisa kwi-Pain Pain Coping Inventory (CPCI) kunye ne-CPCI / Survey ye-Pain Attitudes (SOPA). Abanye abalobi bangekho iingxabano zomdla.

Ukuququmbela, uxinzelelo luyingxenye yempendulo ebalulekileyo yokugcina umzimba wethu uphawule kwimeko yengozi, nangona kunjalo, uxinzelelo oluqhubekayo xa kungekho nengozi yangempela lunokuba ngumbandela wangempela kubantu abaninzi, ngakumbi xa kukho iimpawu zentlungu ephantsi, phakathi kwabanye bo nakala. Injongo yale nqaku apha ngasentla yayikukuqinisekisa ukuphumelela kokulawulwa kwengcinezelo kunyango lwentlungu ephantsi. Ekugqibeleni, ukuphathwa kwengcinezelo kwagqitywa ukuncedisa unyango. Ulwazi oluchazwe kwiziko leSizwe loLwazi lweBiotechnology (NCBI). Ubungakanani beenkcukacha zethu zikhawulelwe kwi-chiropractic kunye nokulimala kwemigudu kunye nemeko. Ukuxoxa ngesihloko, nceda ukhululeke ukucela uDkt Jimenez okanye uqhagamshelane nathi 915-850-0900 .

Ikhutshwe nguDkt. Alex Jimenez

Imixholo eyongezelelweyo: Ubunzima bokubuyisela

Ngokwezibalo, malunga ne-80% yabantu baya kuba neempawu zentlungu emva koko kanye ngexesha lokuphila kwabo. Intlungu ebuyayo yinkxalabo eqhelekileyo enokubangelwa ngenxa yeemeko ezahlukeneyo kunye / okanye iimeko. Ngokuphindaphindiweyo amaxesha, ukuguqulwa kwemvelo komgudu kunye nomdala kunokubangela intlungu emva. Iidiski ze-Herniated zenzeka xa i-disc, i-gel-like centre ye-disc intervertebral iqhubezela ukulila kwiindawo ezijikelezileyo, zingaphandle kwe-cartilage, icinezela kwaye ivuselele iingcambu zeengcambu. 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: I-EXTRA EXTRA: Ungcono!

EZINYE IINGCUKACHA EZIBALULEKILEYO: UKWENZISA: Ukulimala kwezemidlalo? | Vincent Garcia | Umonde | El Paso, TX I-Chiropractor

Ngenanto

Ucaphulo

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Ukuzivocavoca kwe-Neck, Umsebenzi oPhezulu kunye noCognitive--Gedded-Treatment as Treatment for Adult Whiplash Izigulane ezine-Paeck Pain Pain: I-Design of Trial Control Reguted Trial

Abstract

imvelaphi

Izindlela / Ukuyila

ingxoxo

Ukubhaliswa kovavanyo

imvelaphi

Izindlela / Ukuyila

Uyilo lweMvavanyo

izicwangciso

UkuFunda kwabantu

Ukungenelela

ulawulo

Ukungenelela

Physiotherapists

Izisiphumo

Amandla kunye nokulinganisa ubungakanani beSampula

Ukurhoxiswa, ukunikezwa kunye neNkqubo yokuPhula

Uhlalutyo lweSatisati

Imilinganiselo yokuziphatha

Insight of Dr. Alex Jimenez

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Ukugqithisa inzala

Imirhumo yabalobi

Imbali yokuPasa

Imibulelo

Uvavanyo oluLungeleleneyo oluLungisiweyo lweChnitive-Behavioral Treatment for the Treatment of PTSD kumxholo weWiflash engapheliyo

Abstract

iinjongo

indlela yokwenza

iziphumo

ingxoxo

Imixholo eyongezelelweyo: Ubunzima bokubuyisela

Ngenanto

Ucaphulo

Vala i-Accordion

Ukuxhalabisa kunye noyiko olubi

ukudakumba

I-Post Traumatic Distress Disorder (PTSD)

Ukhathalelo lweChiropractic ngokuKhuseleko kweZingozi zeMoto

Ukubikezelwa kweNgxaki yokuPhathwa kwengxaki yokuPhathwa kweNgxaki ngokuPhenduka ngokukhawuleza kwi-Trauma.

Abstract

Ulwaphulo-olujoliswe kwiCandelo lokuThatha ukuChepha kweZenzo kunye nokuSebenza kwe-Whiplash engapheliyo: Iprotocol ye-Trimmed Controled Trial

Abstract

intshayelelo

uyilo

tindlela

nxaxheba

Iingqinisiso zokufakwa

Iimpawu zokungabikho

Usayizi wesampula

Ukungenelela

Ukurhoxiswa

Iqela lokungenelela - I-Traum-focal-cognitive-therapy (CBT)

Iqela lolawulo - Uncedo lweNyango

Iprogram yo kuHlola

Izisiphumo

Ukubeka iliso kwiSayithi zeZonyango

Iziganeko ezimbi

Uhlalutyo lweSatisati

Inkxaso

Okubalulekileyo

Ukungquzulana kweNtshisekelo

Indima yeengxaki zengqondo kwi-Recover from Common Whiplash

Abstract

Insight of Dr. Alex Jimenez

Imixholo eyongezelelweyo: Ubunzima bokubuyisela

Ngenanto

Ucaphulo

Vala i-Accordion

Ubunzima Bokubuya Kwangaphantsi Nengqondo

UkuLawula iSithwathwa seNtsholongwane engapheliyo

Ingqondo Ngakumbi

Ukuphumelela Kwengqondo Ukucamngca Ngezibuhlungu kunye Nobunjani boBomi bezilwelisi ezine-Down Low Back Pain

Abstract

intshayelelo

tindlela