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 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.

 

 

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.

 

 

 

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.

 

 

ingxoxo

 

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.

 

ISIHLOKO ESIBALULEKILEYO: I-EXTRA EXTRA: Ungcono!

 

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