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.
Contents
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
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 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 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.
Ithebula 1: Iziphumo zezonyango ezisetyenziselwa ukulinganisa umphumo wonyango kwiqhinga le-muscle, i-function and treatment guides.
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.
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.
ISIHLOKO ESIBALULEKILEYO: Ukulawula uxinzelelo lomsebenzi
IINGCUKACHA EZIBALULEKILEYO: UKUPHATHA KWE-EXTRA: I-Car Accident Injury Treatment El Paso, TX I-Chiropractor
Ngenanto
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