Thomas M Kosloff1*�, David Elton1�, Jiang Tao2� kunye noWade M Bannister2�
Contents
Abstract
imvelaphi: Kukhona ingxabano ejikeleze umngcipheko wokuxhaphaza, oqhele ukusetyenziswa ngabaculi bezonyango, ngokubhekiselele ekuhlanganisweni kwawo kunye ne-vertebrobasilar system (VBA). Injongo yale sifundo yayikuthelekisa imibutho phakathi kokunakekelwa kwe-chiropractic kunye ne-VBA ngesifo sokunakekelwa kwezilwanyana (CPP) kunye nokunyangwa kwe-VBA.
Iindlela: Uyilo lophononongo lwaluyi-case-control study of the commercial insured and Medicare Advantage (MA) amalungu esicwangciso sezempilo kubantu base-US phakathi kukaJanuwari 1, 2011 kunye noDisemba 31, 2013. Idatha yolawulo yayisetyenziselwa ukuchonga ukubonakaliswa kwe-chiropractic kunye nokhathalelo lwe-PCP. Uhlahlelo olwahlukileyo kusetyenziswa uhlengahlengiso olunemiqathango lwenziwe ukulungiselela abantu abakwi-inshorensi yorhwebo kunye nabemi be-MA. Uhlalutyo lwabemi bezorhwebo lwaphinda lwahlulwa ngokweminyaka (<45 iminyaka; ?iminyaka engama-45). Ulungelelwaniso lweOdds lubalwe ukulinganisa unxulumano ngamaxesha obungozi ahlukeneyo. Uhlalutyo lwesibini lwenkcazo lwenziwa ukufumanisa ukubaluleka kokusebenzisa ukutyelela kwe-chiropractic njenge-proxy yokuvezwa kunyango olukhohlisayo.
iziphumo: Kwakukho iimeko ze-1,829 ze-VBA ze-stroke (1,159 � yorhwebo; 670 � MA). Iziphumo zibonise ukuba akukho nxulumano lubalulekileyo phakathi kokutyelela kwe-chiropractic kunye ne-VBA stroke kubantu okanye kwiisampuli ezihlulwe ngobudala. Kuzo zombini iindawo zorhwebo kunye ne-MA, kwakukho unxulumano olubalulekileyo phakathi kokutyelela kwe-PCP kunye nesiganeko se-VBA sokubetha kungakhathaliseki ubude bexesha eliyingozi. Iziphumo zazifana neesampuli zeminyaka yobudala. Ukufunyaniswa kohlalutyo lwesibini lubonise ukuba ukutyelela kwe-chiropractic akuzange kuchaze ukubandakanywa kokuphathwa kakubi malunga nesinye kwisithathu seemeko ze-stroke kuluntu lwezorhwebo kunye ne-1 kuphela ye-2 yamatyala e-MA cohort.
Izigqibo: Asifumananga ubudlelwane obubalulekileyo phakathi kokuchasana nokunyamekela kwe-chiropractic kunye nomngcipheko we-VBA. Siya kugqiba ekubeni ukuphathwa kakubi kubangelwa isizathu sokuphazamiseka kweVBA. Ukubambisana okuhle phakathi kwe-PCP ukutyelela kunye ne-VBA isifo sinokuthi ngenxa yezigqibo zesigulane ukunyamekela iimpawu (intlungu kunye nentlungu yentamo) yokuchithwa kwamagciwane. Siya kugqiba ngokugqithisa ukuba ukusebenzisa i-chiropractic visyelelo njengendlela yokuchasana nokunyanzeliswa kunokubangela ukuqikelelwa okungathembekiyo kwamandla ombutho kunye nokuvela kwesibalo seVBA.
Internet: I-Chiropractic, ukunakekelwa kweprayimari, ukunyanzeliswa komlomo, i-Vertebrobasilar stroke, iziganeko ezimbi
Umthwalo weentlungu zentamo kunye nentloko okanye ukuthatha i-migraine phakathi kwabantu abadala baseUnited States kubalulekile. Idatha yophando ibonisa ukuba i-13% yabantu abadala babika intlungu yentlungu kwiinyanga ezili-3 zangaphambili [1]. Kunyaka nawuphi na unyaka, iintlungu zentamo zichaphazela i-30% ukuya ku-50% yabantu abadala kubantu bonke [2]. Amanani amaninzi ayexelwe ukuba angaphezulu kumazwe amancedo anokwenyama, njengama-USA, kunye neemeko eziphezulu zeentlungu ezithe zenziwa kwiofisi kunye nabasebenzi bezakhono [3]. Ngokufana nentlungu yentamo, ukusabalalisa kwentloko kuninzi. Ngethuba leyiphi na i-3-months-frame frame, i-headaches okanye i-migraines enokuthi ichaphazela umntu oyisibhozo kubantu abadala (1].
Intlungu yentamo sisizathu esixhaphake kakhulu sokufuna iinkonzo zokhathalelo lwempilo. Ngo-2004, i-16.4 yezigidi zokutyelelwa kwezigulane okanye i-1.5% yazo zonke iindawo zokhathalelo lwezempilo ezibhedlele kunye neeofisi zoogqirha, yayiyentlungu yentamo� [4]. Amashumi asibhozo ekhulwini (80%) otyelelo lwenzeka njengokhathalelo lwezigulane ezingalaliswanga kwiofisi kagqirha [4]. Ukusetyenziswa kwemithombo yokhathalelo lwempilo kunyango lwentloko nako kubalulekile. Ngo-2006, abantu abadala baye batyelela oogqirha abamalunga nezigidi ezili-11 ngenxa yokuxilongwa kwentloko, ngaphezu kwesigidi esi-1 sokutyelelwa kwezigulana ezingalaliswayo, ukutyelelwa kwesebe likaxakeka kwi-3.3 yezigidi, kunye ne-445 yamawaka esibhedlele.
E-United States, ukunakekelwa kwe-chiropractic kusetyenziswa rhoqo ngabantu abaneentamo kunye / okanye izikhalazo zentloko. Ucwaningo lwesizwe lwezonyango kwi-2003 lubonisa ukuba imeko yeentamo kunye nentlungu / ubuso bubuhlungu bubekwe ngokulandelanayo kwi-18.7% kunye ne-12% yezikhalazo eziphambili zezigulane [5]. Iingcali zonyango zihlala zisebenzisa unyango olusisigxina (SMT) ekulawuleni izigulana ezenza intamo kunye / okanye intloko [6], nokuba yedwa okanye idibene nezinye iindlela zokwelapha [7-10].
Nangona ubungqina be-syntheses bucebisa iinzuzo ze-SMT ngenxa yeentlungu zentamo [7-9,11-13] kunye neentlobo ezahlukeneyo zeentloko [10,12,14-16], amathuba okuba neziganeko ezinqabileyo kodwa ezimbi kakhulu (AE) ezilandela i-SMT yomlomo wesibeleko. inkxalabo yabaphandi [17,18], abaqeqeshi [19,20], imibutho yeengcali [21-23], abenzi bomgaqo-nkqubo [24,25] kunye noluntu [26,27]. Ngokukodwa, ukwenzeka kwesifo esichaphazela i-vertebrobasilar artery system (i-VBA stroke) iye yadibaniswa nokuphathwa komlomo wesibeleko. Upapasho lwamva nje [28] oluvavanya ukhuseleko lokhathalelo lwe-chiropractic luxelwe, �… ukuphindaphindwa kweziganeko ezimbi kakhulu zahluka phakathi kwe-5 imivimbo / i-100,000 yokukhwabanisa kwi-1.46 iziganeko ezibi kakhulu / i-10,000,000 kunye nokufa kwe-2.68 / 10,000,000. Olu qikelelo, nangona kunjalo, luvela kwiingxelo ze-anecdotal ze-retrospective kunye nedatha yamabango etyala, kwaye azivumeli izigqibo ezithembekileyo malunga nokuphindaphinda kwangempela kweengxaki ze-neurological emva kokuguqulwa komgogodla.
Uphononongo oluninzi olucwangcisiweyo oluphanda umanyano phakathi kwestroke kunye ne-chiropractic manipulation yomlomo wesibeleko.baye babika ukuba idatha ayanelanga ukuvelisa izigqibo ezicacileyo malunga nokhuseleko lwayo [28-31]. Izifundo ezimbini zokulawula iimeko [32,33] zisetyenziselwa ukutyelela i-chiropractor njenge-proxy ye-SMT kuhlalutyo lwabo lwenkqubo yezempilo esemgangathweni yolwazi lwabantu base-Ontario (Canada). Olona phando lwakutsha nje [32] lukwaquke nendlela ye-case-crossover methodology, eyanciphisa umngcipheko wokungakhethi cala kwizinto ezididayo. Zomibini izifundo zokulawula iimeko zibike ingozi eyongeziweyo ye-VBA stroke ngokubambisana nokutyelela i-chiropractic kubantu abangaphantsi kweminyaka eyi-45 ubudala. UCassidy, kunye nabanye. [32] ufumene, nangona kunjalo, umbutho wawufana nokutyelela ugqirha oyintloko (PCP). Ngenxa yoko, iziphumo zolu phononongo zicebise ukuba umbutho phakathi kokhathalelo lwe-chiropractic kunye ne-stroke yayingeyosizathu. Ngokwahlukileyo kwezi zifundo, ezifumene umbutho obalulekileyo phakathi kokutyelela kwe-chiropractic kunye ne-VBA stroke kwizigulane ezincinci (<45 yrs.), Uhlalutyo lwe-case-based-series-series lucebise ukuba izigulane ze-VBA ze-stroke ziye zabonisana ne-chiropractor kunyaka ngaphambi kokuba I-stroke yayibadala (iminyaka yobudala eyi-57.6.) kunokuba kubhalwe ngaphambili [34].
Umsebenzi kaCassidy, et al. [32] ihlolwe ngokomgangatho njengenye yophando oluyilwe ngokuqinileyo lombutho phakathi kwe-chiropractic manipulative treatment kunye ne-VBA stroke [31]. Ngokolwazi lwethu, lo msebenzi awuzange uveliswe kuluntu lwase-US. Ke, eyona njongo yolu phononongo kukuphinda-phinda imeko yoyilo lwe-epidemiological epapashwe nguCassidy, et al. [32] ukuphanda umbutho phakathi kokunakekelwa kwe-chiropractic kunye ne-VBA stroke; kwaye uyiqhathanise nombutho phakathi kokhathalelo lwe-PCP yakutshanje kunye ne-VBA stroke kwiisampuli ze-US yorhwebo kunye ne-Medicare Advantage (MA) yabemi. Injongo yesibini yolu phononongo kukuvavanya usetyenziso lokuqesha utyelelo lwe-chiropractic njengomlinganiselo we-proxy wokuvezwa kukuguqulwa komgogodla.
Senze uphando lolawulo olusekelwe kumava amalungu esicwangciso sezempilo se-insured kunye ne-MA phakathi kwe-1 kaJanuwari 2011 kunye noDisemba 31, 2013. Iikhrayitheriya eziqhelekileyo zobulungu kwisicwangciso sezempilo sorhwebo okanye se-MA ziquka ukuhlala okanye ukusebenza kummandla apho ukhathalelo lwempilo lwanikezelwa ngumkhuseli. Abantu ngabanye kufuneka babe ne-Medicare Part A kunye neCandelo B ukujoyina isicwangciso se-MA. Isethi yedatha ibandakanya amalungu esicwangciso sezempilo abekwe kwi-49 ye-50 ithi. UMntla Dakota yayikuphela kweLizwe elalingamelwanga.
Zomibini iimeko kunye nedatha yokulawula zikhutshwe kumthombo ofanayo wabantu, ezibandakanya idatha yesicwangciso sezempilo sesizwe kwi-35,726,224 yorhwebo olulodwa kunye ne-3,188,825 amalungu ayingqayizivele e-MA. Kuba amalungu anokubhaliswa ngaphezu konyaka omnye, umndilili�Ubulungu bentengiso yonyaka ngamalungu angama-14.7 kunye nomyinge wonyaka wamalungu angama-1.4 amalungu angaphezu kwezigidi zeminyaka yokufunda, enokufaniswa ne ~ 5% yabantu base-United States esekelwe kwi-data evela kwi-US Census Bureau [35]. Idatha yebango lolawulo yasetyenziselwa ukuchonga amatyala, kunye neempawu zesifo kunye nokusetyenziswa kweenkonzo zezempilo.
Amatyala stroke kwakukho zonke izigulane wangeniswa kwisibhedlele inkathalo yayiyazi kunye vertebrobasilar (VBA) occlusion kunye stenosis imivumbo njengoko kuchaziwe yi-ICD-9 khowudi ye 433.0, 433.01, 433.20, kunye 433.21 ngexesha sifundo. Abafundi abanamalungu angaphezu kweyodwa kwi-VBA kuphazamiseka abafaki kwi-study. Kwimeko nganye yecroke, iminyaka emine kunye nokulawulwa ngokulinganayo kwezesini kwaye kwafundwa ngokungaqhelekanga kumalungu athile afanelekileyo. Bobabini amatyala kunye nokulawula behlelwe ngokulandelelana ngaphambi kokufanisana usebenzisa i-algorithm yokukrakra [36].
Umhla woluhlu lwachazwa njengomhla wokungeniswa kwesibalo seVBA. Naliphi na ukudibana ne-chiropractor okanye ugqirha wezonyango lokuqala (PCP) phambi komhla wokuqhotyoshelweyo kwakubhekwa njengento yokutyhila. Ukuvavanya impembelelo yonyango lwe-chiropractic kunye ne-PCP, ixesha elibi elikhethiweyo kulolu cwaningo ludlulileyo kwiintsuku ze-30 ngaphambi komhla we-index. Ukuhlalutya kwe-PCP, umhla wokungena kwirejista wawungabandakanywa kwixesha eliyingozi kuba izigulana zingabonisana ne-PCP emva kokuba zitshathwe. Isicwangciso sempilo esifanelekileyo siquka umda we-20 ukutyelela kwezilwanyana. Kwiimeko ezinqabileyo umqeshi omncinci unokukhetha ukhetho lokuvakashela i-12. Uhlalutyo lwangaphakathi (idatha engaboniswayo) ibonakalise ukuba i-5% yabasebenzi (abahwebi kunye ne-MA) bafikelele kwimida yabo yokutyelela i-chiropractic. Iziganeko zomqeshi ezingabandakanyi unyango lwe-chiropractic ziqikelelwe ukuba zincabile kangangokuthi bekungeke kube nempembelelo enokulinganiswa kuhlalutyo. Kwakungekho mingcele kwinani lokubuyiselwa kwe-PCP ngonyaka.
Iisethi ezimbini zokuhlalutya okufanayo zenziwa, enye yabemi boqhagamshelwano nabarhwebi kunye nenye ye-MA. Kwisihlu ngasinye sesicatshulwa, imodeli yokulungelelanisa imigaqo esetyenziswayo isetyenziselwa ukuhlolisisa umbutho phakathi kokungcola kunye neVBA. Ukulinganisa umbutho, siqikelele ukubaluleka komlinganiselo wokuba nesifo se-VBA kunye nomphumo wenani elipheleleyo leetyelelo ze-chiropractic kunye nohambo lwe-PCP kwixesha eliyingozi. Ukuhlalutya kwenziwa kwiinkqubo ezahlukahlukeneyo ezinobungozi, kubandakanywa olunye usuku, iintsuku ezintathu, iintsuku ezisixhenxe, iintsuku ze-14 kunye neentsuku ze-30 zombini ukutyelela kwe-chiropractic kunye ne-PCP. Iziphumo zohlalutyo lwe-chiropractic kunye ne-PCP ziye zafaniswa zifumanisa ubungqina bengozi obuninzi bokubetha izigulane ngokutyelela i-chiropractic ngexesha
ixesha lengozi. Uphando lwangaphambili luye lwabonisa ukuba izigulane ezininzi ezifumana i-vertebral artery dissection zingaphantsi kweminyaka eyi-45. Ngoko ke, ukuze kuphandwe impembelelo yokuvezwa kwabantu kwiminyaka eyahlukeneyo, uhlalutyo oluhlukeneyo lwenziwa kwizigulane ezihlulwe ngokweminyaka (ngaphantsi kweminyaka eyi-45). kunye neminyaka engama-45 ukuya phezulu) kuphononongo lwabemi borhwebo. Inani lotyelelo kwixesha lengozi langeniswa njengotshintsho oluqhubekayo kwimodeli yolungiselelo. Uvavanyo lwe-chi square lwalusetyenziselwa ukuhlalutya umlinganiselo we-co-morbidities kwiimeko xa kuthelekiswa nolawulo.
Uhlalutyo lwesibini lwenziwa ukuvavanya ukufaneleka kokusebenzisa ukutyelela kwe-chiropractic njenge-proxy ye-spinal manipulation. I-database yezohwebo kunye ne-MA zabuzwa ukuba zichonge ubungakanani beemeko ze-VBA stroke kunye nolawulo oluhambelanayo apho ubuncinci ikhowudi yenkqubo yonyango ye-chiropractic spinal manipulative (CPT 98940 � 98942) okanye ayizange irekhodwe. Uhlalutyo luphinde lwabala ukusetyenziswa kwenye ikhowudi yonyango ye-manual (CPT 97140), enokuthi iqeshwe ngama-chiropractors njengenye indlela yokunika ingxelo yokuguqulwa komgogodla.
IBhodi yokuHlola iNkampani ye-New England (NEIRB) inqume ukuba olu phofu lukhululekile ekuphononongweni kokuziphatha.
Isampula yesifundo sorhwebo sasiquka iimeko ze-1,159 VBA zesigxina malunga nexesha elinesithathu kunye ne-4,633 yobudala kunye nokulawulwa kwezesini ezihambelanayo. Umyinge weminyaka yezigulane kwakuyiminyaka eyi-65.1 kwaye i-64.8% yezigulane zaziduna (Itheyibhile 1). Isantya soxhaphalo lwe-VBA ngesibalo sabantu abashishini be-0.0032%.
Kwakukho iimeko ze-670 ze-stroke kunye ne-2,680 zokulawula ezihambelanayo ezifakwe kwi-MA. Iminyaka yesigulane esinesigxina yayingu-76.1 iminyaka kwaye i-58.6% yezigulane zaziyindoda (Itheyibhile 2). Kwabemi be-MA, izinga lokusasazeka kwe-VBA isifo yi-0.021%.
Amabango ngexesha lonyaka omnye ngaphambi komhla wesalathisi acatshulwa ukuchonga ukuphazamiseka kwe-comorbid. Zomibini iimeko zorhwebo kunye ne-MA zinepesenti eziphezulu ze-comorbidities, kunye ne-71.5% yamatyala kwisifundo sorhwebo kunye ne-88.5% yamatyala kwingxelo ye-MA ebika ubuncinane enye yeemeko ze-comorbid (Itheyibhile 3). Iimeko ezintandathu ze-commorbid ezinomdla ngokukodwa zachongwa, kubandakanywa nesifo soxinzelelo lwegazi (ICD-9 401�404), ischemic.isifo senhliziyo (ICD-9 410�414), isifo se-pulmonary circulation (ICD-9 415�417), ezinye iintlobo zesifo senhliziyo (ICD-9 420�429), i-hypercholesterolemia ecocekileyo (ICD-9 272.0) kunye nezifo zezinye amadlala e-endocrine (ICD-9 249�250). Kwakukho ulwahlulo olubalulekileyo lwezibalo (p = <0.05) phakathi kwamaqela amaninzi e-comorbidities. Ubungakanani obukhulu beengxaki ze-comorbid (p = <0.0001) zichazwe kwiimeko zorhwebo kunye ne-MA kwi-hyper-tensive disease, isifo senhliziyo kunye nokuphazamiseka kwe-endocrine (Itheyibhile 3). Iimeko zorhwebo nazo zibonise inxalenye enkulu yezifo zokujikeleza kwemiphunga, ebaluleke kakhulu ngokwezibalo (p = 0.0008). Kwakungekho mahluko ubalulekileyo kwi-hypercholesterolemia emsulwa nokuba yezorhwebo okanye ye-MA yabemi. Ngokubanzi, amatyala kuzo zombini iindawo zorhwebo kunye ne-MA abantu babenokwenzeka kakhulu (p = <0.0001) ukuba ubuncinane babe ne-co- morbid condition.
Ezi ziphumo zibonise ukuba kukho umbutho okhoyo phakathi kokutyelela kwe-PCP kunye nesiganeko se-VBA sokubetha kungakhathaliseki ubudala okanye ubude bexesha eliyingozi. Umbutho oqinileyo wafunyanwa kwezo ndwendwelo kufutshane nomhla wesalathisi (OKANYE 11.56; 95% CI 6.32-21.21) kuzo zonke izigulane ezine-PCP ukutyelela ngaphakathi kwe-0�1 ixesha lobungozi kwisampulu yorhwebo. Kwakukho umngcipheko wokunyuka kwe-VBA ehambelana nokutyelela kwe-PCP nganye kwiintsuku ze-30 ngaphambi komhla we-index yezigulane ze-MA (OKANYE 1.51; 95% CI 1.32-1.73) kunye nezigulane zorhwebo (OR 2.01; 95% CI 1.77-2.29) .
Ukufunyaniswa kohlalutyo lwesibini kubonise ukuba i-1159 yamatyala e-stroke evela kuluntu lwezorhwebo � kwakukho i-19 epheleleyo yeemeko ze-stroke ezinxulumene nokutyelela kwe-chiropractic apho i-13 (68%) inamaxwebhu amabango abonisa i-SMT ye-chiropractic. Kwiqela elilawulayo leqela lezorhwebo, i-62 ye-4633 yolawulo yayinamabango alo naluphi na uhlobo lokutyelela kwe-chiropractic kunye ne-47 ye-4633 yokulawula inamabango e-SMT. Kwiqela lolawulo lwezorhwebo, i-47 ye-62 yokutyelela kwe-DC (76%) iquka i-SMT kwidatha yamabango. Kuphela i-1 ye-2 yeemeko ze-stroke kuluntu lwe-MA lubandakanya i-SMT kwiinkcukacha zamabango. Kwiqela le-MA, i-21 ye-24 yokulawula ukutyelela i-chiropractic (88%) iquka i-SMT kwidatha yamabango (Itheyibhile 9).
Akukho nanye yeemeko zestroke kulo naliphi na inani labantu elibandakanya i-CPT 97140 njengethathela indawo yeekhowudi zonyango ezixhaphakileyo ze-chiropractic (98940). Kumaqela olawulo, kukho iimeko ezintathu apho i-CPT 98942 ichazwe ngaphandle kwe-CPT 97140 � 98940 kuluntu lwezorhwebo. Ikhowudi ye-CPT 98942 ayizange ichazwe kwiqela lolawulo lwe-MA.
Injongo ephambili yolu phononongo lwangoku yayikukuphanda umbutho phakathi konyango lwe-chiropractic manipulative kunye ne-VBA stroke kwisampula yabemi base-US. Olu phononongo luyilwe emva koyilo lolawulo lwetyala olwenziwa ngaphambili kubemi baseCanada [32]. Idatha yolawulo lwababhalisileyo kwi-inshurensi enkulu yezempilo yesizwe yahlalutywa ukuba ihlolisise ukwenzeka kwe-VBA stroke ngamaxesha ahlukeneyo okuvezwa kokunakekelwa kwe-chiropractic xa kuthelekiswa nokunakekelwa kwe-PCP.
Ngokungafaniyo noCassidy et al. [32] kunye nezinye izifundo zokulawula iimeko [33,37,38], iziphumo zethu zibonise ukuba akukho nxulumano olubalulekileyo phakathi kwe-VBA stroke kunye nokutyelela i-chiropractic. Le yayiyimeko yorhwebo kunye nabemi be-MA. Ngokuchaseneyo nezifundo ezimbini zolawulo lwangaphambili [32,33], oku kungabikho kobudlelwane kwafunyaniswa ukuba kungakhathaliseki ubudala. Nangona, iziphumo zethu (Itheyibhile 8) zenze iimbali kwiingxelo zangaphambili ukuba i-VBA isifo senziwa rhoqo kwizigulane ezingaphantsi kweminyaka eyi-45. Ukongezelela, iziphumo ezivela kwisifundo samanje azizange zichonge impembelelo yexesha elifanelekileyo. Kwakungekho nhlangano ebalulekileyo, xa idatha ibanele ukubala uqikelelo, phakathi kokutyelela kwe-chiropractic kunye nokushaywa yintlungu kungakhathaliseki ukuba yingozi kangakanani (ixesha lokutyelela ngokutsha kwi-chiropractor kunye nokuvela kwesibalo).
Kukho izizathu ezininzi ezinokubakho zokungafani kweziphumo kunye nezifundo zolawulo zangaphambili ezifanayo. Abancinci (<45 yrs.) Iqela lezorhwebo elifumene ukhathalelo lwe-chiropractic kwisifundo sethu lalinamatyala ambalwa abonakalayo. Ixesha le-0�30 leentsuku zengozi libandakanya kuphela iimeko ezi-2 ze-VBA zestroke. Kwakungekho ziganeko ze-stroke kwamanye amaxesha obungozi kulo luntu. Ngokwahlukileyo, izifundo zangaphambili zichaze iimeko ezaneleyo zokubala uqikelelo lwengozi kwixesha elininzi lobungozi [32,33].
Enye into ebangela ukubahluko phakathi kweziphumo zichaphazela ukuchaneka kwedatha yesibhedlele yesibhedlele e-US kunye ne-Ontario, Canada. Umthombo wabemi kwiPhondo le-Ontario waqatshelwa, ngokukodwa, kwi-Database ye-Discharge Abstract Database (iDAD). I-DAD ibandakanya ukukhutshwa kwezibhedlele kunye nokuhlaselwa ngokukhawuleza kwintlupheko eye yafumana uvavanyo oluchanekileyo ngerekhodi yezokwelapha i-coder [39]. Kwona nto ihamba phambili ngayo, ukuziphatha okufanayo kwekhwalithi kwakungasetyenziswanga rhoqo kwiibheno zedatha yesibhedlele esetyenziswe ekuboniseni uluntu kwisifundo sethu.
Isizathu esongezelelweyo sokungafani kwiziphumo sinokubangelwa ukungafani komlinganiselo wokutyelela kwe-chiropractic apho i-SMT kuthiwa yenziwe. Uphononongo lwethu lubonise ukuba i-SMT ayizange ichazwe yi-chiropractors ngaphezu kwe-30% yeemeko zorhwebo. Kuyavakala ukuba inani leemeko kuphononongo lwangaphambili nalo alizange �ndakanya i-SMT njengongenelelo. Ukwahlukahlukana phakathi kwezifundo kwimeko yamatyala okunika ingxelo nge-SMT inokuchaphazela ukubalwa koqikelelo lwemingcipheko.
Kwakhona, kwakukho inani elaneleyo lamatyala anesifo somlomo kunye / okanye intloko efunyaniswayo kwisifundo sethu. Ngoko ke, isampula yoluntu isenokubandakanya iimeko ezingaphantsi kwamacala apho ukuphathwa komlomo kwenzelwa.
Iziphumo zethu zazihambelana neziphumo zangaphambili [32,33] ekuboniseni ubudlelwane obubalulekileyo phakathi kokutyelela kwe-PCP kunye ne-VBA stroke. Umlinganiselo wokungalingani kulo naluphi na utyelelo lwe-PCP lonyuka ngokumangalisayo ukusuka kwi-1�30 iintsuku ukuya kwi-1�1 usuku (Iitheyibhile 6 kunye ne-7). Oku kufunyaniswayo kuhambelana ne-hypothesis yokuba izigulane ziyakwazi ukubona i-PCP yeempawu ezinxulumene ne-vertebral artery dissection kufuphi nomhla wesalathisi se-stroke yabo yangempela. Ekubeni akunakwenzeka ukuba iinkonzo ezinikezelwa yi-PCPs zibangele i-VBA strokes, umbutho�Ukuhanjelwa kwe-PCP yakutsha kunye ne-VBA isifo sinokubangela ukuba umngcipheko wasemngciphekweni wemvelo wemeko [32].
Injongo yesibini yesi sifundo sethu kwakukuhlola ukusetyenziswa kokubakho ukuhanjelwa kwe-chiropractic njengesiqhelo se-SMT. Iziphumo zethu zibonisa ukuba kukho umngcipheko omkhulu wokubambisana nokusebenzisa le ndlela, eyona nto yayingabonakalisa amandla obudlelwane. Ngaphantsi kwe-70% yamatyala e-stroke (ezoshishino kunye nee-MA) ezinxulumene nokunyamekela kwe-chiropractic ziquka i-SMT. Uhlobo oluthile lwabahambeli be-chiropractic luquka ii-SMT kumaqela okulawula (yorhwebo = 76%; MA = 88%).
Kukho izizathu ezicacileyo ezixhasa ezi ziphumo. Uhlalutyo lwangaphakathi lwamabango eenkcukacha (angaboniswa) ngokufanelekileyo lubonisa ukuba uhambo oluthile lunenani eliqhelekileyo elinxulumene nesiganeko sokunyamekela. Ukutyelela omnye kunokubandakanya uvavanyo ngaphandle kwonyango olunjenge-SMT. Ngaphezulu; I-SMT inokuthi ibhekwe njengonqatshelwe ngenxa yeempawu kunye neempawu ze-artebral dissection (VAD) kunye / okanye i-stroke. Oku kunokuchaza inani elikhulu le-SMT enikezelwe kumaqela olawulo kumabini ezoshishino kunye nama-MA.
Ngokubanzi, iziphumo zethu zikhulisa ukuzithemba kwiziphumo zophando lwangaphambili [32], olugqityileyo kungekho mngcipheko ogqithisileyo wokunakekelwa kwe-VBA kunye nokunyamekelwa kwe-chiropractic efaniswa nokunyamekela. Ukongeza, iziphumo zethu zibonisa ukuba akukho mngcipheko omkhulu we-VBA isifo esihambisana nokunyamekelwa kwe-chiropractic. Ukongezelela, ukufunyaniswa kwethu kukugqithise iziphene ekusebenziseni uguquko oluthile (ukutyelela i-chiropractic) ukuqikelela umngcipheko we-VBA ngesifo ngokubambisana nokungenelela okuthe ngqo (ukunyanzelisa).
Ufundisiso lwethu lwaluneqela lamandla kunye neentsilelo. Zombini iimeko kunye neenkcukacha zolawulo zithathwe kumthombo ofanayo wabantu, eziquka idatha yesicwangciso sezempilo sesizwe malunga nezigidi ezingama-36.yorhwebo kunye 3 million amalungu MA. Itotali yamatyala e-1,829 achongiwe, okwenza le nto inkulu kakhulu - uphando lokulawula ukuphanda umbutho phakathi kokuphathwa kwe-chiropractic kunye ne-VBA stroke. Ngenxa yobume belizwe lonke kunye nobungakanani besampulu enkulu, uphononongo lwethu lunokunciphisa umngcipheko wokuthambekela okunxulumene nezinto zejografi. Nangona kunjalo, kwakukho umngcipheko wokukhetha ukukhetha ngenxa yedatha ephuma kwi-inshurensi yezempilo enye � kubandakanywa isimo sengeniso, ukuthatha inxaxheba kwabasebenzi, kunye namakhonkco kubaboneleli bezempilo kunye nezibhedlele.
Isifundo sethu silandele ngokulandelelana indlela yokwenza indlela ebeyichazwe ngaphambili [32], ngaloo ndlela ivumela ukuthelekiswa okuthembekileyo.
Uphando lwangoku luhlalutye idatha yeemeko ezininzi eziye zachongwa njengezinto ezinokutshintsha ezinokubangela umngcipheko wokuqala ukubetha kweschemic [40]. Umahluko phakathi kwamaqela wawubalulekile ngokwezibalo kuninzi lwee-comorbidities. Ulwazi alufumanekanga malunga nokuziphatha okuhambelana nomzekelo, ukutshaya kunye nobunzima bomzimba. Ngaphandle kwesifo esixinzelelekileyo, kukho izizathu zokubuza ukubaluleka kweklinikhi kwezi meko xa kwenzeka ukubetha kwe-ischemic ngenxa ye-artebral artery dissection. Isifundo esikhulu esimalunga nelinye ilizwe saphanda umanyano phakathi kwezinto ezinomngcipheko we-vascular (imbali yesifo se-vascular, uxinzelelo lwegazi, ukutshaya, i-hypercholesterolemia, isifo seswekile, kunye nokutyeba kakhulu / ukutyeba kakhulu) kwesifo se-ischemic kunye nokuvela komthambo womlomo wesibeleko [41]. Uxinzelelo lwegazi kuphela lwalunombutho olungileyo (amathuba okulinganisa i-1.67; i-95% yexesha lokuzithemba, i-1.32 ukuya kwi-2.1; P <0.0001) kunye ne-artery dissection.
Ngelixa isiphumo sezinye ii-confounders ezingenakulinganiswa asinakuthotywa, kukho isizathu sokukrokrela ukungabikho kwezi datha akuzange kucinywe kwiziphumo. UCassidy, kunye nabanye. abafumananga mahluko abalulekileyo kwiziphumo uyilo lwabo lwe-case-crossover, olunika ulawulo olungcono lwezinto ezididayo ezingaziwayo, kunye neziphumo zophononongo lwabo lolawulo lwetyala [32].
Iziphumo zethu zibonisa indlela engaqhelekanga ngayo i-VBA stroke kwi-MA cohort (i-prevalence = 0.021%) kwaye � nangakumbi � kuluntu lwezorhwebo (ukuxhaphaka = 0.0032%). Ngenxa yoko, eminye imida yolu phononongo inxulumene nokunqaba kokunika ingxelo ngeziganeko zestroke ze-VBA. Nangona inani elikhulu lamatyala, idatha yayinganelanga ukubala uqikelelo kunye namaxesha okuzithemba kwimilinganiselo esixhenxe yokuvezwa (i-4 yorhwebo kunye ne-3 MA) yokutyelela i-chiropractic. Ukongezelela, asikwazanga ukubala uqikelelo olukhethekileyo lwentloko kunye nokuxilongwa kweentlungu zentamo ngenxa yamanani amancinci. Amaxesha okuzithemba anxulunyaniswa noqikelelo athande ukuba banzi enza iziphumo zingachaneki [42].
Kwakukho imida enxulumene nokusetyenziswa kwedatha yamabango olawulo. �Izinto ezingeloncedo ekusetyenzisweni kwedatha yesibini ngeenjongo zophando ziquka: iiyantlukwano kwiikhowudi ukusuka kwisibhedlele ukuya kwisibhedlele okanye ukusuka kwisebe ukuya kwelinye isebe, iimpazamo ekufakweni kweekhowudi kunye nokungaphelelanga kweekhowudi, umzekelo kubukho bezinye izifo. Iimpazamo ezingalindelekanga ekufakweni kweekhowudi kunye nokubhaliswa koxilongo lokukhutshwa kunokunciphisa kwaye kunciphise uqikelelo lombutho wobalo� [43]. Ukurekhodwa kweekhowudi zokuxilonga zokuphuma esibhedlele ezingaqinisekanga ngenxa ye-stroke zibonakaliswe zingachanekanga kangako xa kuthelekiswa nophononongo lwetshathi [44,45] kunye nokubhaliswa kwezigulane eziqinisekisiweyo.[43,46]. Cassidy, et al. [32] uqhube uhlalutyo lobuzwe ukuqonda umphumo wokuxilongwa okungaxilwanga. Izigqibo zabo azizange zitshintshe xa iziphumo zokungaziphathi kakubi zicatshulwa ukuba ziyahanjiswa ngokufanayo phakathi kwamatyala e-chiropractic kunye ne-PCP.
Isithintelo esithile ekusebenziseni idatha yamabango olawulo kukunqongophala kolwazi lomxholo ojikeleze ukudibana kwekliniki phakathi kwe-chiropractors/PCPs kunye nezigulane zabo. Iimpawu zembali ezichaza ukwenzeka / ukungabikho kokwenzakala kwamva nje okanye imisebenzi echazwe kwimeko yezifundo [47-51] njengezinto ezinokuthi zibe yingozi kwi-VBA stroke azifumaneki kwiidatha zamabango. Ukuzithemba kwakuphantsi malunga nokukwazi kwedatha yamabango ukubonelela ngengxelo echanekileyo nepheleleyo yezinye iingxaki zempilo, eziye zachazwa kwimeko yoyilo lolawulo olunxulunyaniswa nokuvela kwe-VBA stroke, umzekelo, i-migraine [52] okanye usulelo lwakutsha nje [53] . Iimpawu kunye neziphumo zovavanyo lomzimba ezinokuthi zivumele ukuhlelwa okungaphezulu kwamatyala akuchazwanga kwidatha yamabango.
Ukunikwa kwengxelo yeenkqubo zeklinikhi kusetyenziswa iikhowudi zangoku zesigama senkqubo (CPT) zibonise iintsilelo ezongezelelweyo malunga nokuchaneka nokutolikwa kwedatha yolawulo. Omnye umqobo okhoyo ibikukunqongophala kokucaciswa kwe-anatomic okuhambelana nokusetyenziswa kweekhowudi zenkqubo esemgangathweni kwidatha yamabango. Iikhowudi zonyango lwe-Chiropractic manipulative (CPT 98940 � 98942) zenzelwe ukuchaza inani lemimandla yomgogodla efumana ukuguqulwa. Abachongi imimandla ethile yomqolo esetyenziswayo.
Kwakhona, iinkcukacha zonyango ezichaza uhlobo (s) lokuxhaphaza alufumanekanga. Xa i-SMT ibonakaliswe, iibango zedatha azikwazanga ukubandlulula phakathi kobuchule bezinto ezibandakanya ukugxilwa okanye ukunyanzelisa ukujikeleza, ukusetyenziswa kwamanyathelo okungafaniyo, isib. ubuchule abubandakanyi oxinzelelo olufanayo lwezinto eziphilayo ezinxulumene nohlobo lokuxhaphaza (ukuphakama kwe-amplitude ephantsi) ephandwe njengengozi yokubeka ingozi kwi-VBA isifo [54-56]. Kubonakala ngathi kunokwenzeka ukuba uphando lwe-VBA yophando lwe-VBA luya kuxhamla kwiinkcazo ezicacileyo zoluhlobo oluthile lokuphathwa.
Ngaphezu koko, iimpendulo zesigulane ukunyamekela � kubandakanywa naziphi na iziganeko ezimbi ezibonisa ukuba i-vertebral artery dissection okanye iimpawu ezinjenge-stroke-ayifumanekanga kwiseti yedatha esetyenziselwa isifundo samanje.
Ukungabikho kokwenza uphicotho olunzulu lweketshikhi yekliniki, akunakwenzeka ukuba wazi kwiinkcukacha zedatha oko kwenzeka ngokwenene kwiinkonzo zeklinikhi. Ukuqhubela phambili, amanqaku eetshathi angazigqibekanga okanye ahluleke ukuchaza ngokucacileyo uhlobo lwongenelelo [57]. Ngako oko, iikhowudi zokunyanzelisa zimelela
amanyathelo, nangona kulandelelaniswa okuthe ngqo, ngaphandle kokusebenzisa nje ukutshatyalaliswa kwintsholongwane.
Uphononongo lwethu lwalukhawulelwe ekuphindaphindweni koyilo lolawulo oluchazwe nguCassidy, et al. [32]. Ngenxa yezizathu zepragmatic, asizange sizame ukwenza i-case-crossover design. Ngelixa ukongezwa koyilo lwe-case-crossover bekunokubonelela ngolawulo olungcono lwezinto ezididayo, uCassidy, et al. [32] ibonise iziphumo zifana nokulawulwa kwamatyala kunye nezifundo ze-crossover.
Iziphumo zolu phando lolawulo lwetyala kunye nophando lwangaphambili lugxininisa imfuneko yokucinga ngokutsha ngendlela yokuqhuba ngcono uphando lwexesha elizayo. Abaphandi kufuneka bafune ukunqanda ukusetyenziswa kwemilinganiselo okanye basebenzise amanyathelo angathanga ngqo akhoyo. Kunoko, kugxininiswe ekubambeni idatha malunga neentlobo zeenkonzo kwaye kungekhona uhlobo lomboneleli wezempilo.
Ngokuhambelana nale ndlela, kubalulekile ukuba abaphandi bafikelele kwidatha yeemeko (umzekelo, kwiirekhodi zezempilo ze-elektroniki), ezinokuthi zenziwe ngokuhlalutya idatha esemgangathweni iinkqubo zekhompyutha [58]. Ukufunyanwa kweempawu zokudibana nonyango � kubandakanywa imbali, ukuxilongwa, ukungenelela, kunye neziganeko ezimbi � kunokubonelela ngesiseko sophando olusebenzayo ngakumbi. Ngenxa yokunqaba kwe-VBA stroke, iiseti ezinkulu zedatha (umz., iirejistri) eziqulethe ezi zinto ziya kuba yimfuneko ukuze kuphunyezwe amandla aneleyo okwenza izigqibo ezithembekileyo.
Kuze iinzame zophando zivelise iziphumo ezicacileyo, umgaqo-nkqubo wokunakekelwa kwempilo kunye nezigwebo zokwenza iikliniki zichazwe kakuhle ngobungqina malunga nokusebenza kakuhle, ukukhetha iindlela zokwelapha (kunye neendlela ezingekho mbambiso zonyango) kunye neempawu zesigulane ngasinye [20].
Iziphumo zethu kufuneka zijongwe kumxholo wolwazi lomzimba malunga nomngcipheko we-VBA stroke. Ngokwahlukileyo kwezinye izifundo zokulawula iimeko, asifumananga nxulumano lubalulekileyo phakathi kokuvezwa kukhathalelo lwe-chiropractic kunye nomngcipheko we-VBA stroke. Uhlalutyo lwethu lwesibini lubonise ngokucacileyo ukuba ukukhwabanisa kunokuthi kuchazwe okanye kuchazwe kulo lonke utyelelo lwe-chiropractic. Ngoko ke, ukusetyenziswa kokutyelela kwe-chiropractic njenge-proxy yokukhwabanisa akunakuthenjwa. Iziphumo zethu zongeza ubunzima kwimbono yokuba ukunakekelwa kwe-chiropractic yimbangela engenakwenzeka ye-VBA strokes. Nangona kunjalo, uphononongo lwangoku alubandakanyi ukunyanzelwa komlomo wesibeleko njengento enokwenzeka okanye into enegalelo ekuveleni kwe-VBA stroke.
I-DE ekhulelwe isifundo, kwaye ithatha inxaxheba ekuqulunqweni kwayo nasekuhlanganyeleni. I-JT ithathe inxaxheba ekuvelweni kweso sifundo, yenze uhlalutyo lwamanani kwaye yanceda ekuqulunqeni le mibhalo. U-TMK uthathe inxaxheba ekuyilweni nasekusebenziseni uvavanyo, kwaye wabhala iqulunqo lokuqala kunye nokuhlaziywa kwalo mbhalo. I-WMB ithathe inxaxheba ekusebenziseni uvavanyo kunye nohlalutyo lwamanani, kwaye yancedisa ukuqulunqa le mibhalo. Bonke ababhali babenegalelo ekuchazeni idatha. Bonke abalobi bafunde kwaye bavumile umbhalo wesigqi wokugqibela.
Impilo ye-1Optum � IiNkqubo zeklinikhi kwiQela leMpilo eliManyeneyo, i-11000 Optum Circle, i-Eden Prairie MN 55344, eU.SA. Impilo ye-2Optum � Uhlalutyo lwezonyango kwiQela leMpilo eliManyeneyo, i-11000 Optum Circle, i-Eden Prairie MN 55344, eU.SA.
Ifumene: 14 Oktobha 2014 Yamkelwa: 28 April 2015
Ishicilelwe kwi-intanethi: 16 Juni 2015
Ucaphulo
1. Paulse R, Hertz R. Umthwalo wentlungu phakathi kwabantu abadala eMelika. KwiPfizer Facts. Ulungiswe nguPfizer Inc. 2008. [http://www.pfizer.com/files/products/PF_Pain.pdf] Ufikeleleke ngoMeyi 14, 2014.
2. UCarroll L, uHogg-Johnson S, van der Velde G, uHaldeman S, uHolm L, uCarragee E, et al. I-Bone kunye ne-Joint Decade 2000�2010 Task Force kwi-Neck Pain kunye ne-Associated Disorders: Ikhosi kunye nezinto ezichazayo zentlungu yentamo
inani labantu ngokubanzi: iziphumo zeBone kunye ne-Joint Decade ye-2000�2010 Task Force kwiNeck Pain kunye ne-Associated Disorders. Umqolo (Phila Pa 1976).2008;33(4 Suppl):S75�82.
3. Hoy D, Protani M, De R, Buchbinder R. I-epidemiology yeentlungu zentamo. Eyona Practice Res Clin Rheumatol. 2010;24(6):783�92.
4. Jacobs J, Andersson G, Bell J, Weinstein S, Dormans J, Gnatz S, et al. Umlenze: intlungu ephantsi nasemva kwentamo. KwiMithwalo yeMisculoskeletal Diseases e-United States. Isahluko 2. Ehlelwe ngama-Bone kunye nama-Joint Decade e-USA
2002�2011. I-Rosemont, IL: I-American Academy of Orthopedic Surgeons; 2008:21�56.
5. Christensen M, Kollasch M, Hyland J, Rosner A. Isahluko 8 � Iimeko zesigulane. Kwi-Practice Analysis of Chiropractic: Ingxelo yeProjekthi, uHlalutyo loVavanyo, kunye nesishwankathelo sokuSebenza kweChiropractic ngaphakathi kwe-United States. Greeley, CO: IBhodi yeSizwe yaBahloli beChiropractic. 2010:95-120.
6. Christensen M, Kollasch M, Hyland J, Rosner A. Isahluko 9 � Imisebenzi yobungcali kunye neenkqubo zonyango. Uhlalutyo oluSebenzayo lweChiropractic: Ingxelo yeProjekthi, uHlalutyo loPhando, kunye nesiShwankathelo sokuSebenza
IChiropractic ngaphakathi eUnited States. Greeley, CO: IBhodi yeSizwe yaBahloli beChiropractic. 2010:121-136.
7. D�Sylva J, Miller J, Gross A, Burnie S, Goldsmith G, Graham N, et al. Unyango lwezandla kunye okanye ngaphandle kweendlela zonyango lomzimba kwiintlungu zentamo: uphononongo olucwangcisiweyo. Umntu Ther. 2010;15(4):415�33.
8. Gross A, Miller J, D�Sylva J, Burnie S, Goldsmith G, Graham N, et al. Ukuguqulwa okanye ukuhlanganiswa kweentlungu zentamo: Uphononongo lweCochrane. Umntu Ther. 2010;15(4):315�33.
9. Bryans R, Decina P, Descarreaux M, Duranleau M, Marcoux H, Potter B, et al. Izikhokelo ezisekelwe kubungqina bonyango lwe-chiropractic yabantu abadala abaneentlungu zentamo. J I-Manipulative Physiol Ther. 2014;37(1):42�63.
10. Bryans R, Descarreaux M, Duranleau M, Marcoux H, Potter B, Ruegg R, et al. Izikhokelo ezisekelwe kubungqina bonyango lwe-chiropractic yabantu abadala abanentloko. J I-Manipulative Physiol Ther. 2011;34(5):274�89.
11. Umntwana J, uCleland J, uEliott J, Teyhen D, Wainner R, Whitman J, et al. Intlungu yomzimba: izikhokelo zenkcubeko ezixhaswe kwiSigaba soBume beMisebenzi, ukukhubazeka kunye neMpilo kwi-Orthopedic
Icandelo le-American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38(9):A1�A34.
12. UClase C, u-Tsertsvadze A, iNkundla R, i-Hundt G, i-Clarke A, i-Sutcliffe P. Ukusebenza kliniki yokuphathwa kweengxaki ze-musculoskelet and non-musculoskeal: ukuhlaziywa okucwangcisiweyo kunye nokuhlaziywa kwe-UK
ingxelo yobungqina. I-Chiropr yoMntu. 2014; 22 (1): 12.
13. UVincent K, uMaigne J, uFischhoff C, uLanlo O, uDagenais S. Uphononongo olucwangcisiweyo lonyango lwezandla kwiintlungu ezingabonakaliyo zentamo. Joint Bone Spine. 2013;80(5):508�15.
14. I-Bronfort G, i-Assendelft W, i-Evans R, i-Haas M, i-Bouter L. Ukusebenza kwe-spinal manipulation ye-headache engapheliyo: ukuphononongwa ngokuchanekileyo. J I-Manipulative Physiol Ther. 2001;24(7):457�66.
15. UChaibi A, uTuchin P, uRussell M. Unyango lwe-Manual for migraine: ukuphononongwa ngokuchanekileyo. J Intlungu Yentloko. 2011;12(2):127�33.
16. U-Racicki S, uGerwin S, uDiclaudio S, uReinmann S, uDonaldson M. Ulawulo lwe-Conservative yonyango lomzimba lonyango lwentloko ye-cervicogenic: ukuphononongwa ngokuchanekileyo. J Man Manip Ther. 2013;21(2):113�24.
17. UCassidy J, uBronfort G, i-Hartvigsen J. Ngaba sifanele siyeke ukunyanzeliswa kwemisipha yentsholongwane yentlungu yentlungu? Akukho BMJ. 2012; 344, e3680.
18. I-Wand B, uHeine P, u-O�Connell N. Ngaba kufuneka silahle ukuguqulwa komqolo wesibeleko ngenxa yeentlungu zentamo? Ewe BMJ. 2012;344, e3679.
19. UMoloo J. Yintoni eyona ndlela efanelekileyo yokuLawula intlungu? I-NEJM Journal Jonga i-2012. [http://www.jwatch.org/jw201202090000004/2012/02/09/whats-best-proproach-managing-neck-pain] Kufumaneka ngo-Meyi 14, 2014.
20. I-Schneider M, i-Weinstein S, i-Chimes G. Ukuguqulwa komlomo wesibeleko ngenxa yeentlungu zentamo. PM&R. 2012;4(8):606�12.
21. Biller J, Sacco R, Albuquerque F, iDemaerschalk B, Fayad P, Long P, et al. Ukuchasana komlomo wesibeleko kunye nentsebenziswano kunye noonyango olujongene nokunyanga komlomo: inkcazo yabasebenzi bezempilo kwi-American Heart Association / American Stroke Association. Stroke 2014, Epub ngaphambi kokuprinta.
22. Umbutho wase-American Chiropractic: I-ACA Impendulo kwi-AHA Isitatimende malunga nokuPhathwa kweNeck. 2014 (Aug 7). [http://www.acatoday.org/press_css.cfm? CID = 5534] Kufinyelelwe ngo-Agasti 15, 2014.
23. Umbutho weTherapy ofrapy waseMelika: I-APTA iphendula kwi-American Heart Association yamaphepha okunyanzelisa umlomo wesibeleko. 2014 (Aug 7). [http://www.apta.org/Media/Releases/Consumer/2014/8/7/] Kufumaneka ngo-Agasti 15, 2014.
24. Kardys JA. Isigwebo esibhengeza malunga nemvume enolwazi. Connecticut State Board of Chiropractic Examiners � State of Connecticut Department of Public Health. 2010. [http://www.ctchiro.com/upload/news/44_0.pdf]
Kufumaneka ngo-Meyi 14, 2014.
25. Wangler M, Fujikawa R, Hestb�k L, Michielsen T, Raven T, Thiel H, et al. Ukudala izikhokelo zaseYurophu kwi-Chiropractic Incident Reporting and Learning Systems (CIRLS): ukufaneleka kunye nesakhiwo. Umntu weChiropr
I-Therap. 2011; 19: 9.
26. I-Berger S: Ikhuselekile kangakanani iminyango enamandla eyenziwa ngabagqirha? IWashington Post 2014 (Jan. 6). [http://www.washingtonpost.com/national/health-science/how-safe-re-vigorous-n-panipulationsdone-by-properctors/2014/01/06/26870726-5cf7-11e3-bc56-c6ca94801fac_story .html] Kufumaneka ngoJanuwari 10, 2014.
27. Iqela lifuna ukuvinjelwa kwesigqeba malunga nokunyanzelwa kwentamo yonyango. Winnipeg Free Press 2012 (Oct 4). [http://www.winnipegfreepress.com/local/Group-wants-provincial-ban-on-nome-nani--p-pulation-bychiropractors-172692471.htm] Kufumaneke ngo-Meyi 14, 2014.
28. Gouveia L, Castanho P, Ferreira J. Ukhuseleko lokungenelela kwe-chiropractic: ukuphononongwa ngokuchanekileyo. Umqolo (Phila Pa 1976). 2009;34(11):E405�13.
29. I-Carlesso L, i-Gross A, i-Santaguida P, i-Burnie S, i-Voth S, i-Sadi J. Iziganeko ezichaphazelekayo ezinxulumene nokusetyenziswa kweentlobo zentliziyo kunye nokuhlanganiswa kwonyango lwe-neckpain kubantu abadala. Ther Man. 2010; 15 (5): 434 44.
30. Chung C, C�t� P, Stern P, L'Esp�rance G. Umbutho phakathi kokuphathwa komlomo wesibeleko kunye ne-carotid artery dissection: ukuphononongwa ngokuchanekileyo kweencwadi. I-J Manipulative Physiol Ther 2014, [i-Epub phambi koshicilelo].
31. UHaynes M, uVincent K, uFischhoff C, uBremner A, uLanlo O, uHankey G. Ukuvavanya umngcipheko we-stroke ekuphathweni kwentamo: ukuphononongwa ngokuchanekileyo. Int J Clin Pract. 2012;66(10):940�7.
32. Cassidy J, Boyle E, Cote P, He Y, Hogg-Johnson S, Silver F, et al. Umngcipheko we-vertebrobasilar stroke kunye nokhathalelo lwe-chiropractic: iziphumo zolawulo olusekelwe kuluntu kunye ne-case-crossover study. Umqolo (Phila Pa 1976).
2008;33 Suppl 4:S176�83.
33. URothwell D, uBondy S, uWilliams J. Ukuphathwa kweChiropractic kunye ne-stroke: isifundo solawulo olusekelwe kuluntu. Istroke. 2001;32(5):1054�60.
34. Choi S, Boyle E, C�t� P, Cassidy JD. I-case-based case-series yezigulane zase-Ontario eziphuhlisa i-vertebrobasilar artery stroke emva kokubona i-chiropractor. J I-Manipulative Physiol Ther. 2011;34(1):15�22.
35. ICensus Bureau yase-US: I-State kunye ne-County QuickFacts. Iinkcukacha ezithathwe kwi-Estimates Population, i-American Community Survey, Ubalo lwaBemi boLuntu kunye neZindlu, i-State and County County Unit Estimates, iBusiness County
Amaphetheni, Izibalo ezingabasebenzi, Ubalo loQoqosho, uphando lwabaQinisekisi beZimashishini, iiMvume zeZakhiwo. 2014 (umhla wama-Julayi 8). [http://quickfacts.census.gov/qfd/states/00000.html] Kufumaneke ngo-Agasti 19, 2014.
36. UKosanke J, Bergstralh E. GMatch Macro (inkqubo ye-SAS): Ikholeji yeMayo Clinic yeMithi. 2004. [http://www.mayo.edu/research/departments-divisions/department-health-science-research/division-biomedical-statisticsinformatics/software/locally-written-sas-macros ]Yenzeke ngoJuni 6, 2014.
37. USmith W, Johnston S, Skalabrin E, Weaver M, Azari P, Albers G, et al. Ukunyangwa kwe-Spinal manipulative yinto ezimeleyo yomngcipheko we-vertebral artery dissection. I-Neurology. 2003;60(9):1424�8.
38. Engelter S, Grond-Ginsbach C, Metso T, Metso A, Kloss M, Debette S, et al. I-Artery Artery Dissection kunye ne-Ischemic Stroke Iziguli Iqela lokuFunda: Umthambo wesifo somlomo wesibeletho: ukuxhwaleka kunye nezinye izinto ezinokubangela
events. Neurology. 2013;80(21):1950�7.
39. Ardal S, Baigent L, Bains N, Hay C, Lee P, Loomer S: Isixhobo somhlalutyi wezempilo. UMphathiswa wezeMpilo kunye neQela leZiphumo zezeMpilo zeXesha elide – uLawulo loLwazi. I-Ontario (CA) 2006 (ngoJanuwari) [http://www.health.gov.on.ca/transformation/providers/information/resources/analyst_toolkit.pdf]
Ifunyenwe nge-12 kaJanuwari, 2015.
40. Sacco RL, Benjamin EJ, Broderick JP, Dyken M, Easton JD, Feinberg WM, et al. INkomfa yoKhuseleko lweNtliziyo yaseMelika. IV. Ukuthintelwa kunye nokuvuselelwa kwe-stroke. Imiba yomngcipheko. Istroke. 1997;28(7):1507�17.
41. I-Debette S, iMetso T, i-Pezzini A, i-Abboud S, i-Metso A, i-Leys D, ne-al. I-Artery Artery Dissection kunye ne-Ischemic Stroke Patients (CADISP) IQela: Umbutho wezinto ezinomngcipheko we-vascular dissection ne-stroke ischemic
abantu abadala abaselula. Ukujikeleza. 2011;123(14):1537�44.
42. Guyatt G, Oxman A, Kunz R, Brozek J, Alonso-Coello P, Rind D, et al. Izikhokelo zeBANGA 6. Ukulinganisa umgangatho wobungqina � ukungachaneki. J Clin Epidemiol. 2011;64(12):1283�93.
43. UKrarup L, Boysen G, Janjua H, Prescott E, Truelsen T. Ukuqinisekiswa kokuxilongwa kwe-stroke kwiRejista yeSizwe yezigulane. I-Neuroepidemiology. 2007;28(3):150�4.
44. I-Goldstein L. Ukuchaneka kwekhowudi ye-ICD-9-CM yokuchongwa kwezigulane ezine-acute ischemic stroke: umphumo weekhowudi zokuguqula. Istroke. 1998;29(8):1602�4.
45. U-Liu L, u-Reeder B, u-Shuaib A, uMazagri R. Ukuqinisekiswa kokuxilongwa kwe-stroke kwiirekhodi zokukhutshwa kwesibhedlele e-Saskatchewan, eCanada: iimpembelelo zokucupha i-stroke. Cerebrovasc Dis. 1999;9(4):224�30.
46. U-Ellekjaer H, u-Holmen J, u-Kr�ger O, uTerent A. Ukuchongwa kwe-stroke yesiganeko eNorway: idatha yokukhutshwa kwesibhedlele xa kuthelekiswa nerejista ye-stroke esekelwe kuluntu. Istroke. 1999;30(1):56�60.
47. Braksiak R, Roberts D. Ukulimala kwepaki kunye nokufa. I-Emerg Med. 2002;39(1):65�72.
48. Dittrich R, Rohsbach D, Heidbreder A, Heuschmann P, Nassenstein I, Bachmann R, et al. I-Mild mechanical traumas yizinto ezinokuthi zibe yingozi kwi-artery dissection yomlomo wesibeleko. Cerebrovasc Dis. 2007;23(4):275�81.
49. UMas J, uBousser M, uHasboun D, iLaplane D. I-Extracranial vertebral artery dissection: ukuhlaziywa kwamatyala e-13. Istroke. 1987;18(6):1037�47.
50. I-Slankamenac P, i-Jesic A, i-Avramov P, i-Zivanovic Z, i-Covic S, i-Till V. I-multiple cervical artery dissection kumdlali we-volleyball. Arch Neuro. 2010;67(8):1024�5.
51. I-Weintraub M. I-Beauty parlor stroke syndrome: ingxelo yamatyala amahlanu. JAMA. 1993;269(16):2085�6.
52. Tzourio C, Benslamia L, Guilllon B, A�di S, Bertrand M, Berthet K, et al. I-Migraine kunye nomngcipheko we-artery dissection yomlomo wesibeleko: isifundo sokulawula imeko. I-Neurology. 2002;59(3):435�7.
53. UGuillon B, uBerthet K, uBenslamia L, uBertrand M, uBousser M, uTzourio C. Usulelo kunye nomngcipheko wokuqhekeka komthambo womlomo wesibeleko: isifundo sokulawula ityala. Istroke. 2003;34(7):e79�81.
54. I-Symons B, uLeonard TR, u-Herzog W. Amandla angaphakathi agcinwe ngumthambo we-vertebral ngexesha lonyango lwe-spinal manipulative. J Manip Physiol Ther.2002;25(8):504�10.
55. I-Wuest S, ii-Symons B, uLeonard T, u-Herzog W. Ingxelo yokuqala: i-biomechanics ye-vertebral artery segments C1-C6 ngexesha lokuguqulwa komgogodla wesibeleko. J Manip Physiol Ther. 2010;33(4):273�8.
56. I-Herzog W, uLeonard TR, i-Symons B, i-Tang C, i-Wuest S. I-Vertebral i-artery strains ngexesha le-high-speed, i-amplitude ephantsi yokuguqulwa komgogodla wesibeleko. J Electromyogr Kinesiol. 2012;22(5):747�51.
57. Amaziko e-Medicare kunye neMedicaid: Uvavanyo olupheleleyo lwereyithi yempazamo (CERT). 2015 (Jan. 15). [http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/CERT/index.html?redirect=/cert] Ifikeleleke ngoFebruwari 4, 2015.
58. I-Welsh E: Ukusebenzisana nedatha: usebenzisa i-NVivo kwinkqubo yokuhlaziya idatha. Iforum: Uphando oluntu olufanelekileyo lwe-Social 2002, 3 (2): Ubugcisa. 26 [http://nbnresolving.de/urn:nbn:de:0114-fqs0202260] Kufinyelelwe ngoFebhuwari 4, 2015.
Umgangatho wobuchule wokuSebenza *
Ulwazi olulapha ku "Isifundo seMeko yase-US: I-Chiropractic kunye neVertebrobasilar Stroke"Akujoliswanga ukuthatha indawo yobudlelwane obubodwa kunye nomntu oqeqeshiweyo wezempilo okanye ugqirha onelayisensi kwaye akusiyo isiluleko sonyango. Sikhuthaza ukuba wenze izigqibo zezempilo ngokusekelwe kuphando lwakho kunye nentsebenziswano kunye nochwepheshe bezempilo abaqeqeshiweyo.
Ulwazi lweBlog kunye neengxoxo zoMda
Umda wethu wolwazi ilinganiselwe kwiChiropractic, i-musculoskeletal, amayeza omzimba, impilo, igalelo le-etiological ukuphazamiseka kwe-viscerosomatic ngaphakathi kweentetho zeklinikhi, ezinxulumene ne-somatovisceral reflex clinical dynamics, i-subluxation complexes, imiba yezempilo ebuthathaka, kunye / okanye amanqaku amayeza asebenzayo, izihloko kunye neengxoxo.
Sibonelela kwaye sibonise intsebenziswano yeklinikhi neengcaphephe kumacandelo ahlukeneyo. Ingcali nganye ilawulwa ngumsebenzi wabo wobugcisa kunye negunya labo lokufumana iphepha-mvume. Sisebenzisa iiprothokholi ezisebenzayo zempilo kunye nempilo entle ukunyanga nokuxhasa ukhathalelo lokwenzakala okanye ukuphazamiseka kwenkqubo ye-musculoskeletal.
Iividiyo zethu, izithuba, izihloko, imixholo, kunye nokuqonda zibandakanya imiba yezonyango, imiba, kunye nezihloko eziyelelene kwaye zixhase ngokuthe ngqo okanye ngokungathanga ngqo umda wokuziqhelanisa wethu.
I-ofisi yethu izamile ngokufanelekileyo ukubonelela ngeengcaphulo ezixhasayo kwaye ichonge uphando olufanelekileyo lophando okanye izifundo ezixhasa izithuba zethu. Sinikezela ngeekopi zophando ezixhasayo ezifumanekayo kwiibhodi ezilawulayo nakuluntu ngesicelo.
Siyaqonda ukuba sigubungela imicimbi efuna inkcazo eyongezelelweyo yokuba inganceda njani kwisicwangciso esithile sokhathalelo okanye inkqubo yonyango; ke, ukuqhubeka nokuxoxa ngombandela ongentla, nceda ukhululeke ukubuza UDkt Alex Jimenez, DC, okanye qha ga mshelana nathi 915-850-0900.
Silapha ukunceda wena kunye nosapho lwakho.
Iintsikelelo
UDkt Alex Jimenez D.C., I-MSACP, RN*, I-CCST, IFMCP*, I-CIFM*, I-ATN*
email: qeqeshi@elpasofunctionalmedicine.com
Ilayisenisi njengoGqirha weChiropractic (DC) kwi Texas & New Mexico*
Texas DC Ilayisensi # TX5807, New Mexico DC Ilayisensi # I-NM-DC2182
Unikwe Ilayisensi njengoMongikazi oBhalisiweyo (RN*) in Florida
Florida License RN Ilayisensi # I-RN9617241 (Nombolo yolawulo. 3558029)
Ubume obubambeneyo: ILayisensi yeeNkcazo ezininzi: Ugunyaziswe Ukuziqhelanisa I-40 States*
UGqr. Alex Jimenez DC, MSACP, RN* CIFM*, IFMCP*, ATN*, CCST
Ikhadi lam loShishino lweDijithali
Ngaba ukubandakanya ukuvuselela imisipha yombane kunceda ukulawula intlungu, ukomeleza imisipha, ukwandisa umsebenzi womzimba, ukubuyisela ukulahleka ... Funda Okuninzi
Ngaba abantu abajongana ne-musculoskeletal trigger points bangafuna unyango olungasebenzisi utyando ukunciphisa iintlungu… Funda Okuninzi
Kubantu abanobunzima bokuhambahamba ngenxa yeentlungu, ukulahleka koluhlu lwe… Funda Okuninzi
Ngaba ukuqonda iminqweno yasebusuku kunokunceda abantu abahlala besitya ebusuku bacwangcise ukutya okwanelisayo… Funda Okuninzi
Abasebenzi bezempilo kwiklinikhi ye-chiropractic babonelela njani ngendlela yeklinikhi yokuqaphela ukuphazamiseka ... Funda Okuninzi
Ngaba umatshini wokubhexa ungabonelela ngokuzilolonga komzimba wonke kubantu abafuna ukuphucula ukomelela? Ukubheqa... Funda Okuninzi