Randomized Controlled Trial

Back Clinic Randomized Controlled Trial Chiropractic uye Functional Medicine Team. Chidzidzo umo vatori vechikamu vakakamurwa nemukana mumapoka akasiyana anoenzanisa marapirwo akasiyana kana kumwe kupindira. Kushandisa mukana wekuparadzanisa vanhu mumapoka zvinoreva kuti mapoka achafanana uye kuti migumisiro yemishonga yavanowana inogona kuenzaniswa zvakanyanya.

Panguva yekuedza, hazvizivikanwi kuti ndeupi kurapa kwakanakisisa. A Randomized Controlled Trial kana (RCT) kurongeka kunopa avo vatori vechikamu muchikwata chekuedza kana boka rinodzora. Sezvo chidzidzo ichi chiitwa, mutsauko unongotarisirwa kubva kuhutungamiri nemapoka ekuedza mumutambo unongorongedzwa usinganzwisisiki (RCT) ndiko kugadziriswa kwekugadziriswa kuri kuverengwa.

Advantages

Zviri nyore kupofumadza / mask kupfuura kuongorora zvidzidzo
Good randomization inosuka chero kusarura kwevanhu
Vanhu vevanhu vanobatanidzwa vanoonekwa zvakajeka
Migumisiro inogona kuongororwa nematunhu anozivikanwa anoverengeka

payakaipira

Hazviratidzi kukonzera
Dhura munguva uye mari
Kurasikirwa kwekutevera-kunonzi kunonzi kurapwa
Kuzvipira zvinoshandiswa: huwandu hwevanhu vanobatanidzwa hungave huri kumiririra yose

Kuti uwane mhinduro kumibvunzo ipi yaungave unayo ndapota fonera Dr. Jimenez pa915-850-0900

Kuchengetedza-Kuita Maitiro Okurapa Kwekukuvara Kwechigarire muEl Paso, TX

by spinedoctors | Kudzorera Pain, chisingaperi Pain, Mamiriro Ekutongwa, Herniated Disc, Neck Pain, Physical Rehabilitation, Randomized Controlled Trial, Research Studies, kushushikana, Mishonga

Kuita mhirizhonga yemotokari mamiriro asina kunaka anogona kukonzera kushungurudzika kwepanyama kana kukuvadza pamwe chete uye kutungamirira kukurudzirwa kwemamiriro ezvinhu akawanda anowedzera. Kukuvara kwepachiitiko chega, zvakadai se whiplash, kunogona kuratidzwa zviratidzo zvinorwadza, zvinosanganisira kurwadziwa kwehuro musingagumi, zvisinei, zvitsvakurudzo zvitsvakurudzo zvenguva pfupi zvakaona kuti kushungurudzika kunokonzerwa nekugadzirisa motokari kunogona kuratidza zviratidzo zvemuviri. Kushungurudzika, kuzvidya mwoyo, kuora mwoyo uye kunetseka kunokonzera kushungurudzika kwepfungwa, kana kuti PTSD, zvinowanzoitika panyaya dzepfungwa dzinogona kuitika semugumisiro wenjodzi yemotokari.

Vatsvakurudzi vezviongorori zvekutsvakurudza vakaonawo kuti kungwarira-maitiro ekurapa kunogona kuve kurapa kwakanaka kwekunetseka mupfungwa uye nyaya dzepfungwa dzingangodaro dzakagadzirwa semugumisiro wekukuvara kwemotokari. Uyezve, kukanganisa kwemotokari kunogona kukonzera kushungurudzika, kuzvidya mwoyo, kuora mwoyo uye kunyange PTSD kana ikasara isingateereri kwenguva yakareba. Chinangwa chechinyorwa chiri pasi apa ndechekuratidza zvinokonzerwa nekufungisisa-maitiro ehutachiona, pamwe chete nemamwe maitiro ekurapa sechiropractic nekurapa. nokuda kwekukuvara kwepamusoro, zvakadai se whiplash.

Neck Exercises, Physical and Cognitive Behavioral-Graded Activity Sekurapa Kwevanhu Vakwegura Kuputika Varwere vane Chronic Neck Pain: Chigadziro cheRandomized Controled Trial

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

ngovepo

kumashure

Varwere vazhinji vanotambura nekurwadziwa kwemutsipa usingaperi mushure mekukuvara kwe whiplash. Kusanganiswa kwekuziva, kugadzirisa utachiona uye kupindira kwepirotheotherapy kwakaratidzwa kuva kwakakosha mukutarisa kwevarwere vane chirwere chisingaperi chine chokuita nehuplash. Chinangwa ndechekupa kuronga kwekuongororwa kwakaitwa nemaitiro akasiyana-siyana (RCT) aine chinangwa chekuongorora kubudirira kwehutano hwemunhu uye hunoziva hutsika-hutsika hwekuita purogiramu yekuzvidzivirira kwezvakaitika zvehutano hunoita basa, pamwe nepamutsipa, kusuruvara, nekuremara hutano hwehupenyu kune varwere vane marwadzo asingagoneki mumutsipa achitevera whiplash kukuvara kana vachienzaniswa nehutano hweboka rinotaridzirwa pachiyero chekutanga uye 4 nemwedzi 12 mushure mekutanga.

Nzira / Kubwinya

Izvo zvakagadziriswa iviri-kati, RCT-kudzidza neboka rakafanana rakagadzirwa. Yakabatanidzwa inoputira varwere vane kurwadziwa kwehuro musingaperi kwemwedzi inopfuura 6, vakashandiswa kubva kuchipatara chemapiritsiotherapy uye nedhipatimendi rezvirwere vasiri varwere muDenmark. Varwere vacharamba vaine maitiro kune mamwe marwadzo ekutungamirira (control) boka kana kuwirirana kurwadza nekudzidziswa (kupindira) boka. Bhuku rinodzora richawana zvidzidzo zvina zvekudzivirira kurwadziwa, asi boka rinopindira richawana zvidzidzo zvakafanana zvekudzidzisa marwadzo pamwe ne8 kudzidzira kumunhu mumwe nomumwe kwemwedzi ye4, kusanganisira kutungamirirwa mune imwe nzira yekudzidzira kwemutsipa uye chirongwa chekudzidzisa aerobic. Varwere uye physiotherapists vanoziva kugoverwa uye kurapwa, asi vatsvakurudzo vekuongorora uye vatsvakurudzo ve data vakapofumadzwa. Mhedzisiro yemigumisiro yehutano ichava Mitsva Yekugadzirisa Chidzidzo Pfupi Pfupi 36 (SF36), Physical Component Summary (PCS). Secondary results will be Global Perceived Effect (-5 to + 5), Neck Disability Index (0-50), Patient Specific Functioning Scale (0-10), nhamba yepamusoro yehutano hwehutambudzo hwakaipa (0-10), SF-36 Mental Component Summary (MCS), TAMPA kuwanda kweKinesiophobia (17-68), Impact of Event Scale (0-45), EuroQol (0-1), chirwere checaniocervical test (22 mmHg - 30 mmHg) ruzhinji rwekufamba. Shamba ye SF36 inowanikwa kuburikidza nemaitiro-based based methods ne PCS uye MCS ine chikamu chinorema che 50 ine kuperevedza kwakakwana kwe10.

hurukuro

Maonero eyikudzidza anokurukurwa, kuwedzera kune simba uye kushaya simba.

Trial registration

Dzidzo yakanyoreswa www.ClinicalTrials.gov identifier NCT01431261.

kumashure

Danish National Board of Health inofungidzira kuti 5-6,000 zvidzidzo gore rimwe nerimwe muDenmark zvinobatanidzwa mutsaona yemotokari inokonzera kurwadziwa kwehuro. Panenge ne43% yevaya vacharamba vachikanganisa muviri uye zviratidzo zvemwedzi 6 mushure mekunge pangozi [1]. Kuvanhu veSweden, kusanganisira makambani eshuwarisi eSweden, mutoro wezvematongerwo enyika inenge mamiriyoni gumi nemamiriyoni ezana [320], uye mutoro uyu unogona kuenzaniswa neaDenmark. Zviongorori zvizhinji zvinoratidza kuti varwere vane Whiplash-Associated Disorders (WAD) mushumo unogara uine zviratidzo zvemutsipa gore rimwe mushure mekukuvara [2]. Dambudziko guru muhuplash varwere vane marwadzo asingagumi emutsipa vane chirwere chechirwere chisingaiti uye kusanganisa kushandiswa kwemaitiro, kuderedza mitsipa yekufamba uye kugadzikana, kusina kunaka kwekervicocephalic deepesthetic sense, kuwedzera kumunharaunda uye pamwe zvinorwadza [3]. Chirwere chescervical chinokonzerwa nekuderedzwa kwebasa rekudzikama kwakadzikama kwemutsipa.

Kunze kwekunetseka kwehuro musingagumi, varwere vane WAD vangangotambura nekusagadzikana kwemuviri sechikonzero chekutambudzika kwenguva refu [6,7]. Izvi zvinokonzera basa rekunyama uye hutano huripo uye zvinogona kukonzera hutsika husina kunaka hwehupenyu. Mukuwedzera, varwere veWAD vanogona kukura kurwadziwa kusingaperi kwakatevedzwa nekukurudzirwa kwehutachiona hwezvirwere [8,9], kuburitsa kwechikumbaridzo chezvinhu zvakasiyana-siyana zvinokonzerwa nemafungiro (kusviba, kutonhora, kupisa, kudedera uye mafungiro emagetsi) [10]. Izvi zvinogona kukonzerwa nehutachiona hwepakati hwekunetseka kunokonzera [11] - kurongazve kuronga [12]. Kunze kwekukurukurirana kwepakati, boka reWAD rinogona kuva nehurombo hwekugadzirisa matanho nemabasa ekuziva, nekuenzanisa nevarwere vane kurwadziwa kwehuro musingagumi [13-15].

Zvidzidzo zvakaratidza kuti kurovedza muviri, kusanganisira zviito zvakananga zvinotarisa zvakadzika mumashure emumucheto, zvinoshanda mukuderedza kurwadziwa kwemutsipa [16-18] kune varwere vane marwadzo asingagumi emutsipa, kunyangwe kune kuchinja mukupindurwa pakudzidziswa pasina murwere mumwe nomumwe anoratidza kuchinja kukuru. Basa romuviri-basa rakagadzirirwa inzira yekurapa nekutarisa kuwedzera muviri wakakwana mumuviri, kuderedza kutya kwekufamba uye kuwedzerwa mupfungwa mupfungwa [19,20]. Pane uchapupu husina kukwana hwehupenyu hurefu hwehutano hwehuviri hwepanyama uye hwekunzwisisa hutano hwekuita, kunyanya mune varwere vasingaperi vanorwadziwa nemutsipa. Zvidzidzo zvekudzidzisa, apo chinonyanya kukosha pakunzwisisa maitiro akaoma anorwadza asingagoneki uye kukura kwekutambudzika kwakakonzera kukunda uye / kana kugadzirisa maitiro ekuzvibata, vakaratidza kuderedzwa kunorwadza kwose [6,21-26]. Kuongorora kwakaratidza kuti kupindira nemusanganiswa wekuziva, hutachiona hwehutano ne physiotherapy kusanganisira mishonga inoshandisa mutsipa inoshanda mukutarisira kweVADV vane chirwere chisingaperi chisingarware [27], sezvakakurudzirwawo neDutch clinical mirayiridzo yeWAD [28]. Zvisinei, mhedziso pamusoro pemitungamiri inonyanya kushandiswa pane zvidzidzo zvakaitwa nevarwere vane acute kana zvishoma-inonzi WAD [29]. Mhedziso yakaoma yakagadzirirwa kuvarwere veWAD vane marwadzo asingagumi muT Bone ne Joint Decade 2000-2010 Task Force, vachiti, 'nekuda kwehupupuriro hunopesana uye zvishomanana zvidzidzo zvepamusoro, hapana mhedziso yakasimba inogona kutorwa pamusoro pekushanda -invasive interventions kune varwere vane WAD asingagumi "[29,30]. Pfungwa yekubatana pamwe chete nevarwere veWAD vane marwadzo asingagumi yakashandiswa mune rimwe dambudziko rekare rakarongedzwa [31]. Zvigumisiro zvakaratidza kuti kusanganiswa kwemaitiro asina kukodzera aerobic uye mazano ane dzidzo yepamusoro yehutambudzo nekusimbiswa uye kukurudzirwa kudzokerazve basa rekuedza, rakagadzirisa zvibereko zviri nani kupfuura mazano chete kune varwere vane mwedzi weWAD 3 mushure mekunge pangozi yacho. Vagari vakaratidza kuvandudzwa kwehutambu hwakanyanya, kurwadziwa kunetseka uye mabasa mumabasa ezuva nezuva muboka rekugamuchira maitiro uye mazano, zvichienzaniswa nemazano oga. Zvisinei, kuvandudzika kwaiva kwakanyanya uye kwaingoonekwa munguva pfupi.

Iyi purojekiti yakagadziriswa pane tarisiro yekuti kugadziriswa kwevarwere veWAD vane marwadzo asingagumi emutsipa inofanirwa kunongedza denderedzwa remuromo, kudzidziswa kwekuita kwemuviri uye kunzwisisa uye manejimendi ekurwadziwa kusingaperi mune yakasanganiswa nzira yekurapa. Kupindira kwega kwega kwakavakirwa pane zvekare zvidzidzo zvakaratidza kushanda [6,18,20,32]. Ichi chidzidzo ndechekutanga zvakare kusanganisira iyo yakareba-nguva mhedzisiro yenzira inosanganisirwa nevarwere vane maronda asingagumi emutsipa mushure me whiplash trauma. Sezvinoratidzwa muMufananidzo? Mufananidzo1,1, iyo yekufungidzira modhi mune ino ongororo yakavakirwa pane fungidziro yekuti kudzidziswa (kusanganisira zvese zvakanangana-zvakatungamirwa zvakanangana nemitsipa kurovedza uye kudzidziswa aerobic kudzidziswa) uye dzidzo mukutambudzika kwekutambudzika (zvichibva pane yekuziva maitiro maitiro) iri zvirinani pakuwedzera kwevarwere hupenyu hwemuviri, zvichienzaniswa nedzidzo mukutambudzika kwekurwadziwa chete. Kuwedzera hupenyu hwemuviri hunosanganisira kuwedzera kuwanda kwemuviri kushanda uye padanho rekurovedza muviri, kudzikira kwekutya kufamba, kudzikisira mushure mekushungurudzika zviratidzo zvekushushikana, kuderedza marwadzo emutsipa uye kuwedzera mutsipa mashandiro. Mhedzisiro yacho inofungidzirwa kuti ichawanikwa nekukurumidza mushure mekurapwa (kureva mwedzi mina; kuita kwenguva pfupi) uyezve mushure megore rimwe (kuita kwenguva refu).

Mufananidzo 1 Hypothesis yeKupindira Kwekuita

Mufananidzo 1: Kuongororwa kwekupindira kwechirwere kune varwere vane kurwadziwa kwemutsipa musingaperi mushure mekuputika kwechiplash.

Kushandisa chirongwa chinotungamirirwa neRCT, chinangwa chechidzidzo ichi ndechekuongorora kubudirira kwe: kupiwa maitiro ekudzidzira muviri, kusanganisira mimwe mitambo yekudzidzira uye kudzidzira kukurukura kwemaitiro, pamwe chete nedzidzo muhutano hwekugadziriswa (zvichienderana nekunzwisisa kugadzirisa nzira) dzidzo muhutano hutungamiri (hunoenderana nehutano hwekuita nenzira), yakaenzana nehutano hwehupenyu hwemunhu, basa remuviri, kurwadziwa kwemutsipa uye mitsipa, kutya kwekufamba, zvirwere zvinotambudza uye zviratidzo zvehupenyu, kune varwere vane chirwere chisingaperi mushure mekuputika kwechikwata.

Nzira / Kubwinya

Trial Design

Chidzidzo chinoitwa muDenmark seRCT ine yakafanana boka dhizaini. Icho chichava mbiri-yepakati kudzidza, yakashongedzwa nenzvimbo yekushandira. Varwere vanozoitwa zvakasarudzika kune iro rePain Management boka (kutonga) kana iro rePain Management uye Yekudzidzisa boka (kupindira). Sezvinoratidzwa muMufananidzo? Figure2,2, chidzidzo chakagadzirirwa kuisa yechipiri data kuongororwa kwemwedzi gumi nemaviri mushure mekutanga; iyo yekutanga mhedzisiro yekuongorora ichaitwa nekukurumidza mushure mekupindira chirongwa 12 mwedzi mushure mekutanga. Chidzidzo ichi chinoshandisa nzira yekuviga yekugovera, kuona kuti boka rakapihwa murwere harizivikanwe murwere asati apinda muchidzidzo. Vanoongorora mhedzisiro uye vanoongorora dhata vachachengetwa vakapofomadzwa kune kugoverwa kwekupindira kana kudzora boka.

Mufananidzo 2 Flowchart yevarwere muChidzidzo

Mufananidzo 2: Flowchart yevarwere vari muchidzidzo.

Settings

Vatori vechikamu vanozotorwa kubva kumakiriniki epa physiotherapy kuDenmark uye kubva kuThe Spine Center yeSouthern Denmark, Chipatara Lilleb lt kuburikidza nechiziviso kumakiriniki uye neChipatara. Uchishandisa physiotherapy makiriniki akapararira muDenmark, varwere vanozogamuchira kupindira imomo. Iwo makiriniki e physiotherapy kuDenmark anogamuchira varwere kuburikidza nekutumira kubva kune avo vese varapi. Iyo Spine Center, chikamu chinoshanda mukurapa varwere vane musculoskeletal dysfunctions uye kungorapa kunze-varwere, inogamuchira varwere vanotaurwa kubva kuvazhinji varapi uye / kana chiropractors.

Kudzidza Vanhu

Makumi maviri evakuru vane makore mashoma emakore gumi nemasere, vachiwana kurapwa kwepoyotherapy kana kuendeswa kunorapwa kuchirapa kuchanyoreswa. Kune varwere kuti vakwanise, vanofanirwa kuve ne: kusingaperi kwemutsipa kurwadziwa kweinenge mwedzi mitanhatu zvichitevera whiplash kukuvara, yakaderedzwa panyama mutsipa mashandiro (Neck Disability Index mamaki, NDI, eashoma e18), kurwadziwa kunyanya munharaunda yemutsipa, kupera chero bvunzo dzekurapa / radiological, kugona kuverenga uye kunzwisisa chiDanish uye kugona kutora chikamu muchirongwa chekurovedza muviri. Maitiro ekuregedza anosanganisira: neuropathies / radiculopathies (kiriniki yakaedzwa ne: yakanaka Spurling, kervical traction uye plexus brachialis bvunzo) [6], kushomeka kwemitsipa (kuyedzwa senge zvakajairika kiriniki maitiro kuburikidza nehurongwa hwekuongorora kweasina kuzivikanwa hutachiona), kuita mune yekuyedza kurapwa kurapwa, kuve mune isina kugadzikana munharaunda uye / kana kushanda mamiriro, nhumbu, kuzivikanwa kutsemuka, kushushikana maererano neBeck Depression Index (mamaki> 10) [33], kana zvimwe zvinozivikanwa zviripo zviripo mamiriro ezvehutano ayo anogona kutadzisa zvakanyanya kutora chikamu chirongwa chekuekisesaiza. Vatori vechikamu vachabvunzwa kuti vasatsvage imwe physiotherapy kana kurapwa kwekuziva panguva yekudzidza.

Kupindira

masimba

The Pain Management (control) boka richawana dzidzo muhutano hwekurwadziwa. Pachave nezvikamu zve 4 zvemaawa 11 / 2, zvichivhara nyaya pamusoro pematambudziko, kubvuma kurwadziwa, maitiro ekugadzirisa, nekugadzirisa zvinangwa, zvichibva pamarwadzo ekurwadziwa uye cognitive therapy concepts [21,26,36].

Kupindira

Iro Pain Management pamwe nekudzidzisa (kupindira) boka richawana dzidzo yakafanana mukurwadziwa kwemarwadzo sevaya vari muboka rinodzora pamwe nemisangano yezvokurapa ye8 (murayiridzo mumutsipa wekudzivirira uye aerobic kudzidzisa) pamwe chete nenguva yerefu yeCXMUMX. Kana chirwere chinonzi physiotherapist chichifungidzira kuti mamwe marapirwo anodiwa, kurapwa kunogona kuwedzerwa ne 4 zvimwe zvirongwa. Neck training: Kuchengetedzwa kwemutsipa-yakanyatsodzidzira kuchafambira mberi kuburikidza nezvikamu zvakasiyana, izvo zvinorondedzerwa nehutano hwemutsipa. Pakutanga kwechirongwa chekurapa, varwere vanoongororwa nekervical neuromuscular function kuti vazive nzvimbo yakatarwa yokuti utange kudzidziswa kwemutsipa. Chimwe chirongwa chekuita maitiro chaiwo chinogadziriswa chinoshandiswa kutarisa mutsipa flexor uye kuwedzera kwemisungo. Iko kukwanisa kuita yakadzika yemudzimai mushonga wepervical flexor musumbu wepamusoro wechikanda chepamusoro kuti uwedzere simba ravo, kutsungirira uye kugadzikana basa rakadzidziswa zvishoma nezvishoma kuburikidza neyo nzira yekudzidzira inonzi craniocervical uchishandisa biopressure feedback transducer [2]. Kudzidzira kwemutsipa-maziso ekubatanidza, mitsipa mikoko, kuenzanisa uye kutsungirira kudzidziswa kwemitsipa yemutsipa kuchabatanidzwawo zvakare, sezvo yakaratidzwa kuderedza marwadzo uye kuvandudza kutarisa kwemajeri muvarwere vane urombo hwemutsipa hwemutsipa [18,37]. Kudzidziswa kweAerobic: Ikoko huru uye mitsipa yemakumbo ichadzidziswa nehurongwa hwekudzidzisa muviri zvishoma nezvishoma. Varwere vachabvumirwa kusarudza mabasa akadai sokufamba, mabhasikoro, kufambisa kufamba, kushambira, uye kutamba. Nheyo yekutanga yekudzidzisa nguva yakagadzirirwa nekushandisa nguva dze17,38 pahutano hwakasununguka, izvo hazviwedzere kurwadziwa uye zvinangwa panzvimbo yakaratidzwa inodiwa (RPE) pakati pe3 ne11 paBorg scale [14]. Nguva yekutanga yekurovedzwa yakagadzirirwa 39% pasi pevhareji yenguva yezviedzo zvitatu. Kudzidzira zvirongwa zvinoitwa zuva rimwe nerimwe repiri nechinhu chinotarisirwa kuti kurwadziwa kusanyanya kuipa, uye kuti RPE iri pakati pe20 ne9. Bhuku rekudzidzisa rinoshandiswa. Kana varwere vasingadzokizve, uye vaudzai muvhareji weRPE kukosha kwe14 kana kuti pasi, nguva yekushandisa yeiyo nguva (14 kana masvondo e1) yakawedzerwa ne 2-2 maminitsi, kusvika pahuwandu hwemaminitsi 5. Kana rutivi rweRPE rwuri 30 kana rwakawedzerwa, nguva yezvedzidzo ichaderedzwa kusvika pahuwandu hweRPE chikwata che15 kusvika ku11 mavhiki maviri [14]. Nokushandisa aya maitiro ekufambisa, kurovedzwa kuchagadziriswa nemumwe murwere, nechinangwa chekuedza kushandiswa - nechinangwa chekuwedzera murwere wekuita basa remuviri uye kufanana.

Kugadziriswa kwevarwere kuchagoverwa nekunyora kwekuita kwavo mukutungamira neboka rinopindira. Varwere vari muboka rinodzora vachaonekwa sevakapedza chirwere chekutambudzika kana vakambopinda 3 kunze kwezvikamu zve 4. Anotsungirira muboka rekupindira achaonekwa seve apedza kana murwere akapinda mushoma we3 kunze kwemasangano ekugadzirisa marwadzo e4 uye zvishoma zvishoma 5 kunze kwezvikamu zvekudzidzisa 8. Dzidzo yeimba yega yega yega yekudzidzira kwemutsipa uye yekudzidzisa aerobic icharemberedzwa naiye mune logbook. Kuwirirana ne 75% yehutano hwekudzidzisa kumba ichaonekwa sekupedzisa kupindira.

Physiotherapists

Vaya vanobatana nepinetiotherapists vachabatanidzwa kuburikidza nechiziviso muDanish Physiotherapy Journal. Izvi zvinosanganisira: kuva mudzidzirapist anokwanisa, kushanda kuchipatara nekuve nemakore maviri emakore ekushanda kwechiitiko semupiotherapist, ave akapinda mune imwe nzira mukunyoreswa kunotsanangurwa uye akapedza kuongorora kwakabatana.

Migumisiro yeMitemo

Pakutanga ruzivo rwevatori vechikamu nezvezera, murume kana murume, kureba uye huremu, mhando yenjodzi, mishonga, kuvandudzwa kwezviratidzo mumwedzi miviri yapfuura (chinzvimbo, kuwedzera, kuwedzera), tarisiro yekurapwa, basa uye chinzvimbo chedzidzo zvichanyoreswa. Seyakanyanya mhedzisiro chiyero, Chiremba Zvabuda Kudzidza Pfupi Fomu 36 (SF36) - Panyama Chikamu Chikamu Pfupiso (PCS) ichashandiswa [41,42]. Zviyero zvePCS zvakawanikwa uchishandisa zvakajairika-nzira nzira [43,44] ine chirevo chinorehwa makumi mashanu nekutsauka kwakajairika kwe 50. Mhedzisiro yekutanga zvine chekuita nekuve nemhedzisiro, ichaverengerwa sekushandurwa kubva kune yekutanga [10]. Sekondari mhedzisiro ine dhata pane ese maviri emakiriniki bvunzo uye murwere-zvataurwa zvabuda Tafura? Tafura45 inopa zviyero zvemakiriniki zvekuyera kupindira kweiyo neuromuscular control yemutsipa wechibereko, wechibereko basa uye zvemagetsi allodynia. Tafura? Tafura11 inopa mhedzisiro-inoenderana nemurwere kubva kumibvunzo yakashandiswa kuyedza maitiro ekurapa, kurwadziwa kwemutsipa uye basa, kurwadziwa kunetsekana, kutya kufamba, kushushikana kwepashure nekushungurudzika uye hupenyu hwehupenyu uye zvinogona kurapwa marongero.

Tafura 1 Zvibereko zveMakiriniki Anoshandiswa kuenzanisa Kurapa Kwakaitwa

Tafura 1: Zvitsva zvezvipatara zvinoshandiswa pakuyera kwehutano hwehutano pamusana wemagetsi, basa nekurapa modifiers.

Dhiwani 2 Mutevedzeri Anoratidzwa Mitezo Inoshandiswa Kuongororwa Kwechirwere Chiito

Tafura 2: Mwoyo murefu wakarondedzera zviitiko zvinoshandiswa pakuyera kwehutano hwehutano pamarwadzo nekushanda.

Varwere vachaongororwa panotangira, 4 uye 12 mwedzi mushure mekutanga, kunze kweGPE, iyo inongorongedzwa 4 nemwedzi 12 mushure mekutanga.

Simba uye Kuenzanisa Kukura Kwemuenzaniso

Simba uye muyero saizi yekuverenga zvinovakirwa pane yekutanga mhedzisiro, iri SF36-PCS 4 mwedzi mushure mekutanga. Kune maviri-sampuro yakaunganidzwa t-kuyedzwa kweyakajairika zvinoreva musiyano ine maviri-mativi akakosha nhanho ye0.05, tichifungidzira zvakajairika SD yegumi, saizi yekuenzanisira ye10 paboka rimwe nerimwe inodiwa kuwana simba rinosvika 86% kusvika tsvaga boka rinoreva musiyano wemapoinzi mashanu ePCS [90]; iro simba chairo riri 5%, uye chidimbu chemuenzaniso saizi iyo inowana simba re 45% iri 90.3 paboka. Kuti tigadzirise inofungidzirwa kuti 90% kubvisa panguva yekudzidza kwemwedzi mina, isu tinosanganisira varwere zana muboka rega rega. Nezvekunzwisisa, zviitiko zvitatu zvakashandiswa: kutanga, tichifungidzira kuti vese 85.03 - 15 varwere vanopedzisa kuyedza, tichava nesimba rakakwana (> 4%) kuona boka rinoreva musiyano wakaderera se100 PCS mapoinzi; chepiri, isu tichakwanisa kuona huwandu hunoverengeka boka hunoreva mutsauko wemapoinzi mashanu ePCS ane simba rakakwana (> 2%) kunyangwe iine SD yakaunganidzwa yemapoinzi gumi nemaviri ePCS. Yetatu uye pakupedzisira, kana isu takanangana neboka rinoreva mutsauko wemashanu maPC PCs, ine yakaunganidzwa SD yegumi, tichava nesimba rakakwana (> 100%) iine varwere makumi matanhatu nevatanhatu chete muboka rega rega. Zvisinei, nekuda kwezvikonzero, varwere vatsva havachazoverengerwa muchidzidzo mwedzi makumi maviri nemana mushure mekunge murwere wekutanga abatanidzwa.

Randomisation, Allocation uye Blinding Process

Mushure mokuongorora kwekutanga, vatori vechikamu vanowanzopiwa kune rimwe boka rekutungamirira kana boka rinopindira. Izvozvo zvinoshandiswa zvinoshandiswa uchishandisa SAS (SAS 9.2 TS yezinga 1 M0) purogiramu yepurogiramu uye yakarongedzwa nechepakati ne 1: 1 kugoverwa uchishandisa masimba akasiyana-siyana e2, 4, uye 6. Kugoverwa kwekugoverwa kuchavanzwa kubva kumutsvakurudzi anyoresa nekuongorora vatori vechikamu mu sequentially count, opaque, akaiswa chisimbiso uye akachengetwa mavulopu. Aluminium mapiritsi mukati mevhopupepe inoshandiswa kupa iyo envelope isingakwanisi kujekesa zvikuru. Mushure mokuzarura zvinyorwa zvevupurupu, vose varwere uye physiotherapists vanoziva kugoverwa uye kurapa kwakakodzera. Mhedzisiro vataridzi uye vatsvakurudzi ve data asi zvakadaro vakachengetwa mapofu. Pamberi pemigumisiro yemigumisiro, varwere vachabvunzwa nemubatsiri wekutsvakurudza kusataura nezvekurapa kwavakapiwa.

Nhamba yekuongorora

Ese ekutanga data ongororo ichaitwa zvinoenderana neyakagara-yakasimbiswa ongororo chirongwa; ongororo dzese dzinozoitwa uchishandisa SAS software (v. 9.2 Service Pack 4; SAS Institute Inc., Cary, NC, USA). Ese manhamba ekutsanangura uye bvunzo zvinotaurwa zvichiteerana nezvakakurudzirwa ne'Kunatsiridza iyo QUAlity uye Transparency Yehutano Ongororo '(EQUATOR) network; kureva, akasiyana mafomati eCONSORT chirevo [46]. Dhata ichaongororwa kuchishandiswa maviri-chinhu Ongororo yeCovariance (ANCOVA), ine chinhu cheGroup uye chinhu cheGender, ichishandisa kukosha kwekutanga secovariate kudzikisira kusiana kwakasiyana, uye kuwedzera simba rehuwandu. Kunze kwekunge zvataurwa neimwe nzira, mhedzisiro inoratidzwa semusiyano uripakati peboka unoreva ne95% nguva dzekutenda (CIs) uye dzakabatana p-tsika, zvichibva pane General Linear Model (GLM) maitiro. Ongororo dzese dzichaitwa pachishandiswa Statistical Package yeSocial Sayenzi (vhezheni 19.0.0, IBM, USA) pamwe neiyo SAS system (v. 9.2; SAS Institute Inc., Cary, NC, USA). Kuongororwa kwenzira mbiri dzekusiyana (ANOVA) nematanho akadzokororwa (Akasanganiswa modhi) ichaitwa kuyedza musiyano pamusoro penguva pakati pekupindira nemapoka ekutonga; kutaurirana: Boka Nguva. Iyo alpha-nhanho ye0.05 inozotorwa seinonyanya kukosha (p <0.05, maviri-mativi). Vanoongorora dhata vanozopofomadzwa kune zvakagadziriswa zvekutanga zvekuongorora.

Nheyo yepamusoro yezvikamu zvekutanga uye zvechipiri ichashandiswa kuenzanisa kutonga uye mapoka ekupindira. Nhamba idzi dzinotsanangurwa dzichaitwa kuburikidza nechinangwa-che-kubata-chirevo, kureva varwere vachabvunzurudzwa muboka rekurapa ravakarongedzerwa. Muchikamu chekuongorora, deta isipo ichagadziriswa ne "inowanikwa uye inojeka" yeBaseline Observation Carried Forward '(BOCF) nzira, uye nokuda kwekunzwisisika uyewo maitiro akawanda ekugadzirisa maitiro achashandiswa.

Chechipiri, kurondedzera migumisiro yekutevedza, 'purogiramu yeprotocol' ichashandiswawo zvakare. Nhamba ye 'protocol' yevashandi avo 'vakapedzisa' kupindira kwavakapiwa, maererano nemitemo inotsanangurwa muchikamu chinopindira pamusoro apa.

Kufungisisa Maitiro

Sangano reScientific Ethical Committee yeSouth Denmark rakagamuchira chidzidzo (S-20100069). Chidzidzo chacho chakaenderana neThe Declaration of Helsinki 2008 [47] nokuzadzisa mazano ose ehutano.

Vose vateereri vachagamuchira ruzivo pamusoro pechinangwa uye zviri mukati meprojekti uye vanopa mvumo yavo yepamuromo uye yakanyorwa kuti vatore chikamu, pamwe nekukwanisa kubvisa purojekiti chero nguva.

Dr Jimenez White Coat

Dr. Alex Jimenez's Insight

Kugadzirisa kushungurudzika, kuzvidya mwoyo, kuora mwoyo uye zviratidzo zvekupedzisira kunetseka mupfungwa, kana PTSD, mushure memubatanidzwa wemotokari kunogona kuva kwakaoma, kunyanya kana chiitiko chacho chichikonzera kushungurudzika uye kukuvadzwa mumuviri kana kukura mamiriro ezvinhu akambovapo. Muzviitiko zvakawanda, kushungurudzika mupfungwa uye nyaya dzepfungwa dzinokonzerwa nechiitiko ichocho chinogona kuva chikonzero chezviratidzo zvinorwadza. MuEl Paso, TX, veterans vakawanda vane PTSD vanoshanyira kliniki yangu mushure mekuratidzira zvirwere zvinowedzera kuipa kwepakuvara kwepakuvhiya yemoto. Chiropractic kuchengetedza inogona kupa varwere zvakakodzera kukanganisa kushandiswa kwemamiriro ezvinhu avo vanoda kuvandudza zviratidzo zvavo zvepanyama uye zvepfungwa. Chiropractic kuchengetedza inogonawo kugadzirisa zvakasiyana-siyana zvekukuvara kwemotokari, kusanganisira whiplash, kukuvara kwemusoro uye yemutsipa, disc and herniated disk.

hurukuro

Ichi chidzidzo chichaita kuti pave nekunzwisiswa kwakanakisisa kwekurapa varwere vane kurwadziwa kwemutsipa musingagoni kutevera njodzi ye whiplash. Idzi ruzivo rwechidzidzo ichi runogona kushandiswa muchirongwa chechipatara, sezvo chidzidzo chacho chinovakirwa pane nzira yehutano, kuratidzira nzira, iyo pasinei nekushayikwa kwezvino kwehuchapupu, inowanzoshandiswa muchipatara chemapiritsiotherapy. Chidzidzo chacho chingave chakabatanidzwa mukugadzirisa kwakarongeka nenzira iyoyo zvichibatsira pakuvandudza ruzivo pamusoro pehuwandu hwevanhu uye kuwedzera humwe uchapupu hunotungamirirwa.

Kubudisa zvinyorwa zvekudzidza kusati kwaitwa chidzidzo uye zvigumisiro zvakawanikwa zvine zvigaro zvakawanda. Inobvumira kugadzirwa kunopedzeredzwa kunze kwekukanganiswa nemigumisiro. Izvi zvinogona kubatsira mukudzivisa kukanganisa sezvo kupotsa kubva pakusikwa kwepakutanga kunogona kuonekwa. Mamwe mapurogiramu ekutsvakurudza achave nemukana wekutevera nzira yakadaro maererano nehuwandu hwevanhu, zvigadziriswa, maitirwo uye zviyero zvinogadzirwa. Zvinetso zvekudzidza uku zvakabatana nekuisa maitiro ekugadzirisa, kuporesa vanhu vasiri vanhu vanofananidza, kutsanangura nekugadzirisa zvakakosha zvinogadzirisa matanho evanhu vane zviratidzo zvekugara kwenguva refu uye kuva nehuwandu kubva kumagariro maviri akasiyana-siyana emakiriniki. Kuenzanisa kwekugadzirisa kunowanikwa nekudzidzisa avo vanobatanidza physiotherapists mune dzidzo yekudzidzisa. Kubatana kwevanhu vanobatanidzwa kuchagadziriswa nekunyatsorongeka kwekutsvaga uye kuregererwa kwekutora uye nokuongorora maitiro ekutanga evarwere, nekusiyana pakati pemapoka zvichienderana nezvimwe zvinopesana kupfuura kupindira / kutonga kuchave kuikwanisika kuongorora nhamba. Iyi yekutsvakurudza inoitwa se "add-on" yakagadzirwa: mapoka maviri aya anowana dzidzo yehurombo; boka rinopindira rinowana humwe huro hwekudzidzisa, kusanganisira hutano hwakanaka hwemitsipa uye kudzidziswa kwakawanda. Nhasi kune huwandu hwehutano hwehutano hwehutano hwevarwere vane marwadzo asingagumi emutsipa achitevera njodzi ye whiplash. Vose varwere vanobatana vachaendeswa kune kurapwa (kutungamirira kana kupindira), sezvatinofunga kuti hazvina maturo kuti tisaipa mamwe maitiro ekurapwa, kureva randomising boka rekutungamirira kudivi rekumirira. Kuwedzera-pane kugadzirwa kunosarudzwa se pragmatic workable solution mumamiriro ezvinhu akadaro [48].

Kune whiplash varwere vane kurwadziwa kusingaperi, matanho ekuremara anoteerera (kune mumwe murwere, kwete weboka rese) anoonekwa sePatient Specific Functional Scale uye huwandu hwehuwandu hwehurombo hunoshungurudza [49]. Nekushandisa izvi uye NDI (iyo inowanzo shandiswa mutsipa kuremara chiyero) seyechipiri mhedzisiro matanho, inofungidzirwa kuti murwere-akakodzera shanduko mukurwadziwa nekuremara inogona kuongororwa. Vagari vachatorwa kubva nekurapwa pazvirongwa zviviri zvakasiyana zvekiriniki: kiriniki yekunze-yevarwere yeThe Spine Center, Chipatara Lilleb lt uye akati wandei makiriniki epamoyootherapy. Kuti udzivise chero pesvedzero yezvimiro zvakasiyana pamatanho emhedzisiro, huwandu hwevanhu huchavharidzirwa zvine mutsindo zvine chekuita nezvirongwa, zvichichengetedza kugoverwa zvakaenzana kwevatori vechikamu kubva pane yega mamiriro kusvika kumapoka maviri ekupindira.

Kukwikwidzana Kufarira

Vanyori vanotaura kuti havana kukwikwidzana.

Zvipo zvevanyori

IRH yakanyora gwaro racho. IRH, BJK naKS vakapinda muchirongwa chekudzidza. Zvose zvakabatanidzwa pakugadzira. RC, IRH; BJK naKS vakabatanidzwa musimba uye kuenzanisa kukura kwekuverenga uye mukutsanangura kuongororwa kwenhamba pamwe chete nekugoverwa uye kuronga nzira. Vose vanyori vanoverenga uye vanobvumirana nemashoko ekupedzisira. Suzanne Capell akapa rubatsiro rwekunyora nekugadzirisa mitauro.

Pre-Publication History

Nhoroondo yekutanga kushandurwa kwepepa iyi inogona kuwanikwa pano: www.biomedcentral.com/1471-2474/12/274/prepub

KUTENDA

Chidzidzo ichi chakagamuchira mari kubva kune Research Research kuMahara yeSweden Denmark, Danish Rheumatism Association, Research Foundation yeDanish Association of Physiotherapy, yeFund for Physiotherapy mu Private Practice, uye Danish Society yePolio uye Accident Victims (PTU). ). I Musculoskeletal Statistics Unit paParker Institute inotsigirwa nezvipo kubva kuW Oak Foundation. Suzanne Capell akapa rubatsiro rwekunyora uye kururamisa mutauro.

Mhosva yacho yakanyoreswa www.ClinicalTrials.gov identifier NCT01431261.

A Randomized Controled Trial yeCognitive-Behavioral Therapy for the Treatment of PTSD mumamiriro ezvinhu eWiflash Chronic

ngovepo

zvinangwa

Matambudziko eWhiplash-associated (WAD) akajairika uye anosanganisira kusimba kwepanyama uye kwepfungwa. Kutsvakurudza kwakaratidza kuti kuenderera mberi kwemashure ekunyanyisa kunetseka kunosanganiswa nevarombo vanoita basa rekugadzirisa uye zvirwere zvekurapa. Chirwere chepfungwa-chinokonzera kugadzirisa-behavioral therapy (TF-CBT) yakaratidza kubudirira kunononoka muzvirwere zvinorwadza zvisingaperi. Zvisinei, kusvika pakusangana, pakange pasina kuve nekliniki miedzo mukati meWAD. Nokudaro, chidzidzo ichi chichati chiti kubudirira kweTF-CBT kune vanhu vanopinda maitiro evanhu vemazuva ano WAD uye posttraumatic stress disorder (PTSD).

nzira

Vadzidzi makumi maviri nevatanhatu vaiendeswa kune dzimwe nyika kuTF-CBT kana kutora mashizha ekuchengetedza, uye mishonga yekurapa yakaongororwa pamushure pemazuva uye 6-mwedzi yekutevera uchishandisa sangano rekuchengetedzwa kwekliniki, kuzvitaurira mhinduro dzemibvunzo, uye zviyero zvehupenyu hunomutsa uye hurombo zvikumbaridzo.

Results

Zvinyorwa zvishoma zvakakonzera kuderedzwa kwezviratidzo zvePTSD zvakawanikwa muboka reTF-CBT richienzaniswa nevakamiririri vekutsvaga, pakuwedzera kumwe kuwanikwa pane kutevera. Kurapa kwePTSD kwaibatanidzawo nehutano hunobudirira hunoita mukuremara kwemutsipa, mumuviri, mupfungwa, uye mumagariro evanhu uye zvehuviri hwezvemagariro ekutambudza zvinyorwa, asi kushanduka kwakanyanya kwakawanikwa mumarwadzo ekurwadziwa.

hurukuro

Ichi chidzidzo chinopa rubatsiro rwekubudirira kweTF-CBT kutarisa PTSD zviratidzo mukati mekusagadzikana kweWAD. Kuwana kuti kurapwa kwePTSD kwakaguma nekuvandudzika mukuremara kwemutsipa uye mararamiro ehupenyu uye kuchinja mumarwadzo ekutonhora kunotonhora kunosimbisa nzira dzakaoma uye inopindirana iyo inoshandisa zvose WAD nePTSD. Chirongwa chekliniki chinoshandiswa pane zvakawanikwa uye kutsvaga kutsvakurudza mazano zvinokurukurwa.

Mukupedzisa, kubatanidzwa mutsaona yemotokari ndeimwe mamiriro ezvinhu asina kunaka anogona kukonzera kushungurudzika kwepanyama kana kukuvadza pamwe chete uye kutungamirira kukurudzirwa kwemamiriro ezvinhu akawanda anowedzera. Zvisinei, kushungurudzika, kuzvidya mwoyo, kuora mwoyo uye kunetseka kunokonzera kushungurudzika kwepfungwa, kana PTSD, zvinowanzoitika mupfungwa dzepfungwa dzinogona kuitika semugumisiro wenjodzi yemotokari. Maererano neongororo dzekutsvakurudza, zviratidzo zvepanyama uye kushushikana kwepfungwa kungave kwakanyatsobatana uye kurapa zvose zvisikwa zvepanyama uye zvepfungwa zvinogona kubatsira varwere kuti vawane hutano hwakakwana uye hukama hwakanaka. Mashoko anotsanangurwa kubva kuNational Center for Biotechnology Information (NCBI). Kuwanda kweruzivo rwedu kunogumira kune chiropractic pamwe nekukuvara kwepamuviri nemamiriro. Kuti ukurukure nyaya yacho, ndapota ivai vakasununguka kubvunza Dr. Jimenez kana kuti tibvunzei kwatiri 915-850-0900 .

Yakarongedzwa naDkt Alex Jimenez

Zvimwe Zvinyorwa: Kubva Painini

Maererano nehuwandu, inenge 80% yevanhu ichaona zviratidzo zvekurwadziwa shure shure kamwechete munguva yeupenyu hwavo hwose. Kutambudzika shure ndiko kunyunyuta kunowanzoitika kunogona kuguma nekuda kwekukuvara kwakasiyana siyana uye / kana mamiriro. Kazhinji kacho, kuora kwechimiro chemupaka nezera kunogona kukonzera marwadzo kumashure. Herniated discs inoitika apo ganda rakanyorova, segel-like re intervertebral disc rinodonha nekubvarura mukati maro, rinenge riri kunze kwekatekete, kubvongodza nekugumbura midzi midzi. Dhizinesi dzinozivikanwa dzinowanzoitika kumucheto kumashure, kana kuti nhengo dzomukati, asi dzinogonawo kuitika pamucheto wepervical, kana mutsipa. Kuiswa kwemitsipa inowanikwa mucheka shure nekuda kwekukuvara uye / kana mamiriro akaoma kunogona kutungamirira kune zviratidzo zve sciatica.

blog chinyorwa chekartoon paperboy makuru makuru

NHAURWA INOKOSHA INOKOSHA: Kutarisira Kushungurudzika Kwebasa

ZVIMWE ZVINOKOSHA ZVINOKOSHA: KUDZIDZA KUNYANYA: Kutsaona Kwemotokari Kurapa El Paso, TX Chiropractor

Hazvina kuchena

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Close Accordion

Kufungisisa Kwepfungwa Kwekukuvara Kwekuzvipira Kwekugadzirira muEl Paso, TX

by spinedoctors | Kudzorera Pain, Chiropractic, Neck Pain, Physical Rehabilitation, Randomized Controlled Trial, kushushikana, Mishonga

Paunenge wakabatanidzwa mune kuparara kwemotokari, iyo ngozi yekukuvadza yemotokari inokonzerwa nechiitiko chacho inogona kunge isingaiti nguva dzose chikonzero chepanyama. Kushungurudzika kwepfungwa kunokonzerwa nekushungurudzika kana kukuvara kubva pamigumisiro yengozi yemotokari ingangowanzova yakawanda, inogona kutungamirira kune zviratidzo zvakasiyana-siyana zvinorwadza. Kana kushungurudzika kwakadaro kusingatariswi pakarepo, kunogona kukonzera kukura kwehutano hwepfungwa. Kushungurudzika, kuzvidya mwoyo, kuora mwoyo uye mumatambudziko akakomba, PTSD, kana kuti kunetseka kunokonzera kushungurudzika kwepfungwa, ndezvimwe zvepfungwa dzakajairika zvepfungwa iwe ungazoguma uchingana mushure mokunge uine njodzi yemotokari.

Kufunganya uye Kutya Kunotyisa

Muzviitiko zvakati, akabatwa netsaona yemotokari anogona kutanga kutya zvisina musoro nekuda kwechiitiko ichi. Sezvineiwo, vazhinji veava vanhu vanotaura vachisangana nekushushikana nezvekudzokera kumashure kwegumbo zvakare. Kwavari, kutya kuve mune imwe tsaona kunogona kuvakonzera kunzvenga kutyaira zvachose. Kune vamwe vanhu vazhinji vachiri, kutya kusina musoro kwekutambura nekuvhunduka kurwisa vachiri munzira kunogona kuve chikonzero chekuti vadzivise kutyaira zvachose. Kana kushushikana uye kutya zvisina musoro zvichikonzerwa nekushushikana kwepfungwa yetsaona yemotokari ikawedzera, zvinogona kuodza moyo zvachose munhu kubva pakutyaira zvekare.

kusuruvara

Izvo zvinogona zvakare kune vanhu vakambobatanidzwa mumotokari yemotokari kukudziridza kuora mwoyo kunotevera chiitiko chacho. Pakupedzisira, iwe unomuka uchiona kushungurudzika kwepfungwa sekuguma kwekutambudzika. Pane zviratidzo zvakawanda zvekuora mwoyo iwe unogona kuona nyore nyore. Izvi zvinosanganisira zvinetso nehope, kurasikirwa nechido chako, uye musoro. Sezvazvinowedzera kuipa, zvisinei, unogona kuguma uchinzwa usiri kana usisina tariro nguva yose, iyo inogona kutungamirira kukura kwezviratidzo.

Post Inoshungurudza Kushungurudzika Kwepfungwa (PTSD)

Zvinonyanya kukosha kune vanhu vanobatanidzwa mumatambudziko emotokari kuti vatambure kubva mumamiriro ekudengenyeka mupfungwa, kana PTSD. Maererano neNational Center For PTSD, zvakanyanya se9 muzana yevanhu vanoona njodzi dzemotokari vanopedzisira vachitambura nePTSD. Uyezve, zvishoma ne14 muzana yevakaparara mumotokari vanopfurikidza vanotsvaka kutarisira utano hwepfungwa vari kutarisana nePTSD.

Tsvakurudzo itsva yekutsvakurudza yakaratidza kuti kupindira kwepfungwa kunogona kunge kwakakosha kuhutano hwako sehutano hwechirongwa, kunyanya kana uine dambudziko rinotambudza chirwere, kana PTSD. Vatsvakurudzi vakaratidza kuti chiropractic kuchengetedza inogona kutungamirira pakufambira mberi kwakanyanya mupfungwa-mumuviri kushungurudza chikamu chehutano hwehutano uye hukama hwakanaka.

Chiropractic Care for Auto Accident Injuries

Kutaura nezvekukuvara kwepamberi yemotokari, yakadai se whiplash, iyo inokonzerawo kuzvidya mwoyo nekusava nehanya, kuora mwoyo uye kunyanya PTSD, inoda urongwa hwakasiyana-siyana. Chiropractic ndiyo imwe nzira yekurapa inoshandiswa iyo inotarisa kukuvara uye / kana mamiriro ehutachiona uye nervous system. A chiropractor anowanzoshandisa kushandiswa kwepelinha uye nzira dzekushandisa kuti unyatsoruramisa maronda emusana, kana kuti kuderedzwa, izvo zvinogona kukonzera marwadzo uye kusagadzikana. Nokusunungura kushungurudzika uye kushungurudzika kwemisipha, chiremba wechiropractic, kana chiropractor, inogona kubatsira kuderedza kushushikana uye kushungurudzika mupfungwa kunogona kukonzera kushungurudzika kwomumwe munhu, kusava nehanya kutya, kuora mwoyo uye PTSD. Kana mamwe rubatsiro achidikanwa, chiropractor inogona kukurudzira varwere kune unyanzvi hwehutano hwakanaka kuti avabatsire nezviratidzo zvavo. Chinangwa chenyaya inotevera ndechekuratidza kupararira kwePTSD kune vanhu vanobatanidzwa mu kutengesa kwenzira pamwe nekuratidza kuti kupindira kwepfungwa kunogona sei kubatsira kuvandudza pamwe nekugadzirisa zviratidzo zvekunetseka zvinogona kuitika vanhu mushure mekuparara kwemotokari.

Kufanotaura kwePas Traumatic Kushungurudzika Kwepfungwa Nokugadzirisa Kwakaitika Pakugadzikana: A Tarisiro Yokudzidza Mukugadzirisa Kwemigwagwa Yevatengesi

ngovepo

Nzira dzomugwagwa dzomumigwagwa dzinowanzokonzera muviri wakakura uye wepfungwa sequelae. Nyanzvi dzehutano dzakasiyana-siyana dzinobatanidzwa mukurapa kwevanhu vanenge vafa. Chinyanyozivikanwa pamusoro pezvinhu zvinogona kufanotaura kushungurudzika kwepfungwa, semuenzaniso Posttraumatic Stress Disorder (PTSD) mushure mezviitiko uye matambudziko emagariro anokanganisa sei kurapwa. Mune chinangwa chekudzidza 179 chisina kusarudzwa, zvakagamuchirwa chibvumirano chemigwagwa yemugwagwa yakakonzerwa nengozi yakaongororwa mazuva mashomanana mushure menguva yekurapa kwepfungwa, kusuruvara kwekukuvara uye psychopathology. Vose vaiva varwere uye vaifanira kurapwa nekuda kwefupa rakatyoka. Pamwedzi we6 kutevera-up-up 152 (85%) yevarwere vakabvunzurudzwa zvakare. Pakati pevarwere, 18.4% yakazadzisa zvinonzi Posttraumatic Stress Disorder (DSM-III-R) mukati memwedzi ye6 mushure mekunge pangozi. Varwere vakagadzira PTSD vakakuvara zvikuru uye vakaratidza zviratidzo zvakawanda zvekuzvidya mwoyo, kuora mwoyo uye PTSD mazuva mashomanana mushure mengozi kunze kwevarwere vasina chirwere chepfungwa. Varwere vane PTSD vakagara kwenguva refu muchipatara kupfuura vamwe varwere. Kuongorora kwakawanda kwekutaridzika kwakaratidza kuti urefu hwehutapi hwakakonzerwa zvikuru nekusiyana kwezvinhu zvakadai sekuoma kwekukuvadza, kuoma kwechiitiko, kubata kwepakutanga uye psychopathology. Posttraumatic stress disorder inowanzoitika mushure mezviitiko zvemigwagwa yemigwagwa. Varwere vane PTSD pane kutevera vanogona kuonekwa nekuwana kubva kuongororwa kwokutanga. Kusapomerwa kwepfungwa sequelae yakadai sePTSD inokonzera nguva yakawanda muchechi uye saka zvinodhura kupfuura kune vasiri varwere vePTSD.

Kutambudza-Kunyoresa Kugadzirisa Maitiro Akanaka Kurapa uye Kuita Zvemhando yeHirma Whiplash: Chirevo cheRandomized Controlled Trial

ngovepo

Nhanganyaya: Sezvo mugumisiro wemugwagwa unoparara, kurwadziwa kunoramba kuripo nekuremara kunotevera kushungurudzwa kwechiplash kunowanzosvibisa uye kunowedzera huwandu hwehupenyu hwevanhu uye hwehupfumi. Kusvikira ku50% yevanhu vanoona kukuvadzwa kwechiplash hakuzombotombogadziri uye kusvika ku30% icharamba yakatarisa kuti iremerere zvakanyanya nemamiriro acho ezvinhu. Chikonzero chekuti sei zviratidzo zvinoramba zvichiri kupfurikidza nechokuita ku-sub-acute stage uye hazvizivikanwi, asi zvichida migumisiro kubva mukubatana kwakakomba pakati pekukuvara kwemaitiro, kushaya muviri, uye pfungwa dzepfungwa uye dzepfungwa. Mhinduro dzepfungwa dzakabatana nechiitiko chinoshungurudza pachako chiri kuwedzera kuve chichizivikanwe muchiputi. Pasinei nokucherechedza uku, kune ruzivo rwakakosha pamusoro pekubudirira kwepfungwa dzepfungwa, zvinogona kuendeswa dzoga kana kusanganiswa ne physiotherapy, mukuderedza hutano hwepanyama uye hune hutano hwehupenyu husingaperi. Purogiramu yekudzidza yakawanikwa yakaratidza migumisiro yakaisvonaka yekushandiswa kwekutambudzika-kwakanyatsofunga nezvekuita maitiro ekurapa kurapa pfungwa, kurwadziwa nekuremara kune vanhu vane chirwere chisingaperi. Migumisiro yakaratidza kuti nzira yakabatana yaisagona kugadzirisa chete zviratidzo zvepfungwa, asiwo kurwadziwa nekuremara.
Zvinangwa: Icho chinangwa chikuru chekutsvaga kwakarongeka, kuongororwa ndekutsvaga kubudirira kwehutano hunosanganiswa-hunongororwa hutano hwehutano hwehutano hwehutano, hunoendeswa nemunhu wepfungwa, uye physiotherapy maitiro kuitira kuderedza marwadzo nekuremara kwevanhu vane chirwere chisingaperi chisingararami uye mushure mekutambudzika kwepfungwa dambudziko (PTSD) . Dare iri rinotarisira kuongorora kubudirira kwehutano hwakakosha mukuderedza kushungurudzika kwemashure matambudziko, kusazvidya mwoyo uye kuora mwoyo.
Vatori vechikamu uye Kuronga: Vazhinji vevatori vechikamu 108 vane chisingaperi whiplash-inosanganisirwa kusagadzikana (WAD) giredhi II ye> 3 mwedzi uye <5 makore emakore uye PTSD (yakawanikwa neClinician Administered PTSD Scale (CAPS) zvinoenderana neDSM-5) ichatorwa ku kudzidza. Vatori vechikamu vanozoongororwa kuburikidza nekuongorora kwefoni uye ivo pachavo kuyunivhesiti yekutsvaira murabhoritari. Kupindira kuchaitika kumaodzanyemba kwakadziva kumabvazuva kweQueensland, Australia nekumaodzanyemba kweDenmark.
Kupindira: Psychological therapy ichaendeswa kamwechete pavhiki pamasvondo e10, pamwe nevatori vechikamu vachitaridzirwa kamwe-kamwe nenyaya yekutambudza-yakananga kugadzirisa maitiro kana chirwere chinotsigira, zvose zvakapiwa nekliniki yepfungwa. Vadzidzi vanozogamuchira zvirongwa gumi zveuchapupu-based physiotherapy maitiro anopiwa pane imwe nguva ye6.
Matanho Ekubuda: Icho chikuru chekugadzirisa chiyero ndechokuremara kwemutsipa (Neck Disability Index). Secondary results focus on: pain intensity; kuvapo uye kuoma kwePTSD (CAPS V uye PTSD Checklist 5); kufungidzira mupfungwa (Kuora mwoyo, Kuzvidya mwoyo Stress Scale 21); murwere anoonekwa basa (SF-12, Tampa Scale yeKinesiophobia, uye Murefu-Anonyanya Kuita Maitiro Anoshanda); uye kurwadziwa-kunyanya kuzviita uye kukanganisa (Pain Self-Efficacy Questionnaire uye Painstastrophizing Scale). Mushure mokunge psychotherapy (masvondo e10 mushure mekuita randomisation) uye physiotherapy (masvondo e16 mushure mekuita randomisation), uyewo pamwedzi we 6 uye 12-mwedzi unozotevera, munhu anoona ari bofu achayera zvikamu.
Kuongorora: Zvose zvinongororwa zvichaitwa pachinangwa chekubata. Mhedzisiro yepamusoro uye yechipiri inotaridzirwa ichaongororwa uchishandiswa nheyo dzakasanganiswa uye dzakagadziriswa zvekutonga. Chero chiitiko chesaiti (Australia kana Denmark) chichaongororwa nekubatanidza nzvimbo-ne--rapi boka-nenguva-kushandira mutauro mumasanganiswa ekuenzanisa maitiro. Migumisiro yokugadzirisa ichaongororwa chete kune zvakabuda mugumisiro weNeck Disability Index.
Kukurukurirana: Ichi chidzidzo chichapa tsananguro yekutsvaga kwemigumisiro yekuwedzera kushungurudza-kunongedza kugadzirisa maitiro ekurapa kuchipatara ku physiotherapy muviri kune vanhu vane chirwere chisingaperi cheWAD nePTSD. Ichi chidzidzo chinogona kukonzera kukiriniki yekuchengetwa kwechiplash kukuvara uye ichave nekukurumidza kuchipatara kuAustralia, Denmark nedzimwe nyika dzakawanda. Kudzidza kuchave kune zvinorehwa nehutano nehuturi hwevanhu vanoita sarudzo mukuita kwavo zvisarudzo maererano nekusarudzwa kwemishonga uye mari.

ziviso

Kushungurudzika kusingagumi nekuremara kunotevera kuputika kukuvadzwa semugumisiro wenzira yemugwagwa (RTC) yakajairika uye inowedzera mari yakawanda yevanhu uye yehupfumi. Kusvikira ku50% yevanhu vanoona kukuvadzwa kwechiplash hazombofi zvakakwana uye kusvika ku30% icharamba yakatarisa kuti iremere zvakanyanya nemamiriro ezvinhu [1-3]. Zvishoma zvinonzwisisika ndezvehutano hwepfungwa dzinofambisa chirwere ichi. Kuwanda kwehutano hwepfungwa kwakaratidzwa kuva 25% yePTSD, 31% yeGreat Depression Episode uye 20% yeGenalized Anxiety Disorder [4-6]. Whiplash kukuvadza nhoroondo nokuda kwehuwandu hwezvimwe zvipi zvayo zvakatumirwa pamwe chete nemari yakawanda inowanikwa muQueensland yechitatu yekambani chirongwa [7]. MuAustralia, kukuvara kweWhiplash kunosanganisira anenge 75% yezvisikwa zvose zveRRC zvinoponesa [8] pamwe nezvose zvinodarika zvinodarika $ 950 M pagore [9], zvinopfuura mari yepelinha uye kukuvadzwa kwehupombwe [7]. MuDenmark, whiplash inodhura inofungidzirwa 300 Mamiriyoni USD pagore kana kurasikirwa nebasa kunosanganiswa [10].

Kusuruvara kwemakumbo ikadhidheni chiratidzo chevanhu vanotevera shuplash kukuvara. Iko zvino inowanzogamuchirwa kuti pane kukuvara kwepachiviri chekutanga kune imwe mhando kumutsipa [11] kunyange zvazvo chimiro chairo chakakonzerwa nevarwere mumwe nomumwe chiri chakaoma kuchipatara kuziva nemaitiro ezvino ekufungidzira. Chikonzero chekuti sei zviratidzo zvinoramba zvichiri kupfurikidza nechokuita pane zvinyorwa zvisinganzwisisiki asi hazvisi pachena asi zvinokonzerwa nekubatana kwakakomba pakati pekukuvara kwemuumbi, kushaya muviri, kwepfungwa uye zvepfungwa (12]. Zvisinei, zvakajeka kuti chisingagumi WAD chinokanganisa uye chakaoma chiitiko chinosanganisira kukanganisika kwepanyama sekufambisa kurasikirwa, mararamiro ekufambisa uye kushungurudzika kwepfungwa [13] pamwe nekurwadziwa kwakagadzikana kwepfungwa zvakadai sekuparadza [14, 15], kinesiophobia [16] , kudzivisa mabasa uye kusazvidzivirira kwekutambudzika kwepfungwa [17]. Pakawedzerwa zvidzidzo zvitsva zvakaratidza kuti zviratidzo zvekutsungirira zvinokonzera kushungurudza kana chiitiko chinosangana nematambudziko chinowanzo [18-20]. Nokudaro zvingaita sezvinonzwisisika kuti kupindira kunobatanidza zviratidzo zvepanyama uye zvepfungwa zvechiplash chiitiko zvaizobatsira.

Kusiyana neakawanda anozivikanwa masculoskeletal marwadzo mamiriro (semuenzaniso kurwadziwa kwepashure, kusagadzikana kwemutsipa) whiplash inoenderana nemarwadzo emutsipa inowanzoitika zvichitevera chiitiko chinotyisa, iko kuparara kwemotokari. Mhinduro dzezvepfungwa dzakanangana nechiitiko chinotyisa pachacho, posttraumatic kushungurudzika zviratidzo, zviri kubuda sechinhu chakakosha chekuwedzera kwepfungwa mune whiplash mamiriro. Zvazvino dhata zvinoratidza kuti post-traumatic kushungurudzika zviratidzo kwakapararira kune vanhu vakatsigira whiplash kukuvara zvichitevera tsaona dzemotokari [18, 20, 21]. Iko kuvapo kwekutanga kwe posttraumatic kushungurudzika zviratidzo kwakaratidzirwa kuve kwakabatana nehurombo hwekushanda kupora kubva mukukuvara [13, 18]. Dzazvino dhata kubva murabhoritari yedu dzakaratidza kuti zvichitevera whiplash kukuvara 17% yevanhu vachatevera nzira yekutanga ine mwero / yakaoma posttraumatic kushungurudzika zviratidzo zvinoramba zviripo kwemwedzi ingangosvika gumi nemaviri uye 12% ichatevera nzira yekudzikisira yekutanga zviratidzo zvinoderera asi zvinoramba zviri nyoro kusvika pakuenzanisa (sub-kiriniki) nhanho kwemwedzi ingangosvika gumi nemiviri (iyo nguva yekudzidza) [43]. Ona Mufananidzo 12. Aya manhamba akakosha sezvo akafanana nekupararira kwePTSD mune vanhu vakabvumirwa kuchipatara zvichitevera kukuvara kwakanyanya kuwedzera kwemotokari [4].

Mufananidzo 1 Data kubva kuWhiplash Vakakuvadzwa Vadzidzi

Mufananidzo 1: Dhata kubva ku155 whiplash yakakuvara vatori vechikamu yakayerwa pa1, 3, 6 & 12 mwedzi yapfuura-tsaona. Iyo Posttraumatic Stress Diagnostic Scale (PDS) yakayerwa panguva imwe neimwe poindi. Boka rakateedzana trajectory modelling yakaratidza 3 yakasarudzika kiriniki nzira (trajectories). 1. Chisingaperi zvine mwero / chakakomba (17%) 2. Kudzoreredza: yekutanga mwero mwero wepashure kwekutambudzika kunodzikira kusvika pamwero munyoro / wepakati. 3.Kushingairira: zviratidzo zvisina basa mukati me2. PDS chiratidzo mamaki Kucheka-offs: 1 munyoro, 10 11 zvine mwero, 20 21.

Kunyangwe chisingaperi WAD chiri chakakomba chinetso chehutano huwandu hweakaburitswa akasarudzika akadzivirirwa miedzo (RCTs) ishoma kwazvo [23]. Ongororo yakarongeka yazvino yakapedzisa kuti kune humbowo hunoratidza kuti zvirongwa zvekurovedza muviri zvine hunyanzvi mukugadzirisa marwadzo ane hukama ne whiplash, zvirinani pamusoro penguva pfupi [23]. Semuenzaniso, Stewart et al [24] yakaratidza chete poindi yechipiri (pachiyero chegumi) inodzikira mumatanho ekurwadziwa nekukurumidza mushure memavhiki matanhatu ekushanda kwemaitiro ekugadzirisa maitiro aitevedzera kune vakuru vane hukama neCBT asi pasina chakakosha chakakonzera mhedzisiro. kwenguva refu yekutevera-kwe2 uye 10 mwedzi. Mukutanga RCT yakaitwa murabhoritari yedu (yakaburitswa muna 6), imwe mutsipa yakanangana nemaitiro ekurovedza muviri yakaunzawo zvimisikidzo zvidiki, mukurwadziwa uye kuremara zvikoro zvakadzikira nemari dzechipatara dzakaringana (6 12% paNeck kuremara Index) apo uchienzaniswa nesangano rimwe chete rezano [2007].

Kuongorora kwakarongeka kwakagumisawo kuti pane uchapupu hunopesana pamusoro pekubudirira kwepfungwa dzepfungwa dzakapiwa oga kana kuti pamwe chete ne physiotherapy [23]. Zvidzidzo zvakabatanidzwa mukudzokorora kwaive kwehutano hwakasiyana uye huzhinji hunoshandiswa CBT mune mamwe maitiro kutarisana nemarwadzo ehutano akabatana uye kushushikana [26, 27]. Hapana chidzidzo chakanyatsotarisa zviratidzo zvePTSD.

Nokudaro chirevo chinoratidzika sechinhu chinonzwisisika chekupindira kunongedza zvinhu zvepanyama uye zvinorwadza zvepfungwa zvechirwere cheWAD chisingashandisi pamwe chete zvingafungidzirwa. Izvi zvinotarisirwa zvinoenderana nezvakanaka zvinoitika nenzira dzakadai dzemamwe marwadzo emusculoskeletal senge akadzikira kumashure [28].

Mukuyedza kunzwisisa kuti nei maitiro ekuvandudza maitiro asiri akakosha kune chisingaperi WAD, takatora NHMRC (570884) yakabhadharwa muyedzo yakarongedzwa kutongwa iyo yaisanganisira maitiro ekugadzirisa ezviratidzo zvePTSD uye kushungurudzika kwekunzwa. Mune ino yakakura (n = 186) multicentre muedzo, ongororo yekutanga inoratidza kuti chete 30% yevarwere vane chisingaperi WAD uye kuongororwa kwePTSD vaive neshanduko inoenderana nekiriniki muNeck Disability Index scores (> 10% shanduko) ichienzaniswa ne70% yevarwere veWAD. pasina PTSD inotevera chirongwa chekuvandudza muviri. Vese vaisanganisira vatori vechikamu vakataura zvine mwero kana hukuru huwandu hwehurombo uye hurema hunoratidza kuti kuvapo kwekubatana kwePTSD kunodzivirira mhinduro yakanaka mukugadzirisa kwepanyama. Hatina kukwanisa kuwana shanduko yekuchinja kweshanduko. Mhedzisiro yeichi chidzidzo inotitungamira kuti tifunge kuti kutanga kurapa PTSD uyezve kutanga kugadziridza kwemuviri kunozove kupindira kunoshanda kugadzirisa nhare dzehutano hweWAD isingaperi.

Chirwere chetachiona cheBBCT chinonyatsoshanda kurapwa kwePTSD zviratidzo [29] uye mazano eAustralia ekurapwa kweApress Stress Disorder uye PTSD inorumbidza kuti CBT inotarisirwa kunetseka inofanira kupiwa kuvanhu vane mamiriro ezvinhu aya [30]. Iko kune deta inowanika kuratidza kuti CBT-inotarisa CBT inogona kunge inobatsira kwete kwete chete pazviratidzo zvePTSD asiwo pamarwadzo nekuremara. Zvigumisiro zvekutsvakurudza kwemazuva ano zvichitsvaga hukama hwehutano pakati pePTSD uye hurombo husingagumi muvanopona 323 dzezviitiko [31]. Zvigumisiro zvakaratidza kuwirirana kwehutambu hwakanyanya uye shure kwekudzivirira zviratidzo zvekumanikidzwa mumazuva e5 mushure mekukuvadzwa asi nemwedzi ye6 mushure mekukuvara (chisingatarisirwi gadziriro), zviratidzo zvePTSD zvakakonzera zvikuru pamarwadzo asi kwete zvakasiyana. Kunyange zvazvo izvi zvidzidzo zvisingatauri zvakananga pamusoro pekuputika kwechiplash, zvinoratidza kuti kutarisa zviratidzo zvePTSD mumugariro usingagumi weWAD kunogona kubvumira kuderera mumatambudziko ekutambudzika nekudaro zvichiita kuti zvinokonzerwa nekurwadziwa kana kuremara zvinosvika kune vatungamiri sekuita basa uye CBT inotarisa.

Kubva pane zvatakawana zvekubatana kwePTSD neWAD, takaitisa zvidzidzo zvishoma zvepayenzi nechinangwa chekuedza kuve nemigumisiro yekushungurudzwa kwepabonde kwe CBT pane zvepfungwa, kurwadziwa nekuremara kune vanhu vane chirwere chisingagumi WAD [32]. Vadzidzi makumi maviri nematanhatu vane WAD asingagumi uye kuongororwa kwePTSD vakangoerekana vapiwa kurapwa (n = 13) kana kwete-Intervention (n = 13) kutonga. Bhuku rekurapa rakapiwa 10 masangano evhiki nevhiki ekutambudza-CBT yePTSD. Kuongororwa kwePTSD kuongororwa, zviratidzo zvepfungwa, kuremara, uye zvirwere zvakagadzirwa pamusana pekutanga uye kuongorora (mavhiki e10-12). Kutevedzera kupindira kwehutano, pakanga pasina kungowedzera kuderedza zviratidzo zvepfungwa (PTSD zviratidzo zvakasimba; nhamba dzinosangana nemirairo yekuongororwa yePTSD; kuora mwoyo, kuzvidya mwoyo uye kushungurudzika kwezvikoro) asiwo kuderera kukuru mukurwadziwa nekuremara nekuvandudzwa kwebasa remuviri, kurwadziwa mumuviri uye nhengo dzezvinhu zveSF36 (Table Table 1).

Tafura 1. Mhinduro dzejeri randomized control trial

	Kutambudza-kwakananga CBT	Kwete-kupindira
Neck Disability Index (0-100) *
Baseline	43.7 (15)	42.8 (14.3)
Post post intervention	38.7 (12.6)	43.9 (12.9)
SF-36 Kushanda Kwemuviri
Baseline	55.8 (25.9)	55.4 (28.2)
Post post intervention	61.5 (20.1)	51.1 (26.3)
SF -36 Marwadzo Emuviri
Baseline	31.2 (17.2)	22.6 (15.5)
Post post intervention	41.8 (18)	28.2 (15.8)
Posttraumatic Stress Disorder Diagnosis (SCID-IV)
Baseline	N = 13 (100%)	N = 13 (100%)
Post post intervention	N = 5 (39.5%)	N = 12 (92.3%)

* zvibodzwa zvakakwirira = zvakanyanyisa; Zvikoro zvepamusoro = zvirinani

Migumisiro yenyaya ino inoratidza kuti CBT inotaridzirwa kune vanhu vane chirwere chisingaperi chine WAD ine migumisiro yakanaka, kwete kungofanana nepfungwa dzepfungwa asiwo mukurwadziwa nekuremara kwekadhiinal zviratidzo zvechiitiko ichi. Kunyange zvazvo shanduko yechinangwa che5% yakanga iri pamagumo maererano nekliniki yehutano [33], kukosha kwekushandura kweIndi kwaive kwakanyatsokwana (d = 0.4) uye inoratidza chivimbiso chekuwedzera kwehukuru mune imwe hurukuro yekukura kwekukura [34]. Kunyange zvakadaro, kuongorora kwekutsvaga kwepayenzi kunoratidza kuti hutachiona hweBBCT hunoga huchakwanikana kuti huve nehutano hwakanaka hweHIV husingaperi uye nokuda kweizvi chikonzero chekuedzwa kwedu chichabatanidza nzira iyi nekuita basa. Izvozvi zvakawanikwa zvinogona kuputsa pasi munzvimbo yehuplash management uye zvakakosha kuti ivo zvino vava kuedzwa mukuzara kwakarongeka kwakarongeka.

Muchidimbu, tatove takaratidza kuti vanhu vane zvirwere zveWAD zvisingaperi uye zviratidzo zvePTSD zvisinganzwisisi hazvipinduri zvakare kuhutano hwekugadzirisa hutachiona sevaya vasina PTSD zviratidzo [25]. Nhoroondo yedu yepurogiramu yapfuura inoratidza kuti kushungurudza-kunofungidzirwa kweBBC kunobatsira pane zvose zvepfungwa uye marwadzo nekuremara. Tinokurudzira kuti kuburikidza nekugadzirisa kwekare zvirwere zvePTSD, zviratidzo zvePTSD uye kurwadziwa kwakagadziriswa kunoderedza kubvumira kuti maitiro ekugadzirisa ave akabudirira kupfuura akaonekwa kusvikira nhasi [24, 25]. Nokudaro tsvakurudzo yedu inotsvakurudzwa ichasangana nepfungwa iyi yakajeka muzivo kuburikidza kuva iwe wokutanga kuongorora kushanda kwekubatana kwekutengesa-kunotarirwa kweBCT kupindira kwakazotevera basa rekugara kwenguva refu WAD.

Chinangwa chikuru chegadziriro iyi ndechekutsvaga kubudirira kwehutano hwakagadzirirwa-CBT uye maitiro ekudzidzira kuti kuderedza marwadzo nekuremara kwevanhu vane chirwere chisingaperi chine chirwere chePTSD. Zvinangwa zvechipiri ndezvekutsvaga kubudirira kwehutano hwakakonzerwa neCBCT uye kuedza kuita kuti kuderedza zviratidzo zvekumanikidzwa kwepfungwa, kushungurudzika uye kuora mwoyo, nekutsvaga kubudirira kwehutano hweBBCT huri pane zviratidzo zvekumanikidzwa kwepfungwa uye kurwadziwa / kuremara.

Iyi dambudziko inotarisirwa kutanga muna June 2015 uye yakapedziswa naDecember 2018.

patani

Ichi chidzidzo chichava ongororo yakarongedzwa yakawanda-yepakati kuyedza kuyedza vhiki gumi dzekutambudzika-yakatarisana ne CBT ichienzaniswa nemavhiki gumi erapi yakatsigirwa, imwe neimwe ichiteverwa nehurongwa hwekurovedza muviri hwesvondo nhanhatu. Mhedzisiro ichaenzaniswa pamasvondo gumi, masvondo gumi nematanhatu, matanhatu nemwedzi gumi nemaviri post randomisation. Huwandu hwevanhu vane 10 vane chirwere chisingaperi chechiplash (> 10 mwedzi, <makore mashanu emakore) uye PTSD (DSM-6 inoonekwa neCAPS) ichanyoreswa muchidzidzo. Vaongorori vanoyera mhedzisiro vanozopofomadzwa kune yakapihwa kurapwa boka rekugoverwa. Iyo protocol inoenderana neCONSORT nhungamiro.

Mufananidzo 2 Chidzidzo Chekudzidza

nzira

Vakwikwidzi

Vazhinji vevatori vechikamu 108 vane chisingaperi whiplash inosangana nedambudziko (WAD) giredhi II (chiratidzo chechiratidzo> 3 mwedzi uye <makore mashanu) uye PTSD ichatorwa kubva kuSoutheast Queensland neZambia, Denmark. Vatori vechikamu vanozotorwa kuburikidza:

Zviziviso (iyo Danish yenyika rejistori rezvehutano, pepanhau, nhau yepanhau uye internet): vanogona kutora chikamu vanogona kukokwa kuti vauwane nevashandi vepurojekiti.
Physiotherapy uye General Medical Practices: chidzidzo chichasimudzirwa mu physiotherapy uye makiriniki ezvehutano apo vashandi veprojekti vatove neukama. Varwere vanofunga kuti vakakodzera kuiswa vachapiwa ruzivo rwezvemapurojekiti uye vakakokwa kuti vauye nevashandi veprojekiti zvakananga.

Pane nhanho mbiri-mbiri yekugadzirisa kuiswa kune iyi yekudzidza: kutanga maInternet / fungurudzo yefoni yakazotevera nekuongorora kuongororwa kwekliniki. Nhaurirano yokutanga ichaona nguva yehuplash kukuvadza (kuiswa kwekutsvaga) uye marwadzo akaenzana anobva kuU scores, uye zvingave zvingabviswa. Kufanana kwePTSD kuchave kwakavakirwa pazvikamu zvePCL-5 zvisingatarisirwi, zvinoda zvishoma chikamu chimwe chete nechiratidzo uye zvishoma zvishoma zve30 zvakakwana. Tsanangudzo yeprojekiti ichapiwa kune vose vanozvipira pane imwe nzvimbo yokutanga kuonana. Vazvipiri vanofunga kuti vanogona kukodzera vachakokwa kunopinda kuongororo yekuongorora zvipatara. Kana mavhiki anopfuura mana apfuura pakati pekukurukurirana kwefoni uye kuongororwa kwechipatara kudarika IU nePCL-5 zviyero zvinofanira kupiwa zvakare.

Usati watanga kuongororwa kwekliniki yekuongororwa, vanozvipira vachapiwa ruzivo rwevatori vechikamu uye vakakumbira kupedzisa zvinyorwa zvekubvumirana zvakagadziriswa. Pakati pekuongorora kuongorora, vatori vechikamu vane hutano hwakakosha hwehutano hwakadai sehutachiona hwemapfupa huchaonekwa uye huchabviswa kubva pakubatanidzwa. Kuti iongorore kuti chirwere chakakomba, chikwata chekuongorora chichaitwa chichitevera Motor Motor Accident ye NSW Whiplash Guidelines [35]. Kuongororwa kwekuongorora kunozobatanidza kubvunzurudza kwechirongwa chekutsvakurudza kwevatsvakurudzi avo vanozoshandisa chirwere cheCliniki Administered PTSD chikamu 5 (CAPS 5) kuti aone kuvepo nekuoma kwePTSD [36]. Mutsvagiri wekutsvakurudza achasimbisawo kusavapo kwemitemo yekuregererwa yakadai seyakaitika kare kana kuti mharidzo yezvino ye psychosis, bipolar disorder, organic brain disorder uye zvakanyanya kuora mwoyo kushandiswa kwezvinodhaka. Kana vatori venhau vanorondedzera kufungidzirwa kwezvinyorwa zvekuregererwa chikamu chakakosha cheSSC-Ichandishandiswa kujekesa kuongororwa.

Munguva yekutanga skrini kana panguva yekurapwa, kana munhu anenge atora chikamu achionekwa seari panjodzi huru yekuzvikuvadza kana kuzviuraya, vanozotumirwa kuchengetwa kwakaringana zvinoenderana nehunyanzvi hwema psychologist. Vatori vechikamu vanosangana nematanho ekubatanidza (NDI> 30% uye PTSD kuongororwa) vanozoongororwa pamatanho ese emhedzisiro yemhedzisiro yekutanga. Izvo zvinokwanisika kuti vanozvipira vakakokwa kuti vaende kunovhenekwa kukiriniki kuongororwa havangasangane neyakaiswa maitiro (NDI> 30% uye PTSD kuongororwa) uye nekudaro vanozobviswa pakuenderera mberi kutora chikamu. Vazvipiri vanozoziviswa nezve mukana uyu panguva yekubvunzurudzwa parunhare uyezve panguva yekubvumidzwa kwakaitwa. Iyo Bvunzurudzo icharekodwa uye sarudzo yakasarudzika ichaongororwa kusagadzikana

Inclusion Criteria

Chirwere cheWAD Gwaro repiri (pasina kushaya kwepfungwa kana kuputsika) [37] yenguva refu ye3 kwemwedzi asi kwenguva shoma ye5 yemakore
Zvirinani kurwadziwa zvine mwero nekuremara (> 30% pane iyo NDI)
Kuonekwa kwePTSD (DSM-5, APA, 2013) uchishandisa CAPS 5
Vakwegura pakati pe18 nemakore 70
Kudzidza muChirungu chakanyorwa kana Danish (zvichienderana nerudzi rwekubatanidzwa)

Kusagadziriswa Criteria

Anozivikanwa kana kuti akafungidzirwa zvakakomba mumapfupa emapfupa (semuviri wezvirwere, kupisa kana kushaya zvirwere zvepona)
Kugutsikana kuputsika kana kuparadzaniswa panguva yekukuvara (WAD Grade IV)
Nerve miviri inokanganisa (zvishoma nezvishoma 2 yezviratidzo zvinotevera: kushaya simba / reflex kuchinja / kurasikirwa kwepfungwa kunobatana nemukomana mumwechete wepelinha)
Kuvhiyiwa kwepamuviri mumwedzi yekupedzisira ye12
Nhoroondo kana ikozvino mharidzo ye psychosis, bipolar disorder, organic brain brain or severe depression.

Sample Size

Isu tinofarira kuona kusiyana kwechipatara chakakosha pakati pezvibvumirano zviviri, zvakapiwa kuti maonero ekutanga eboka rimwe nerimwe anowirirana zvakafanana sechikonzero chekusarudzwa. Kubva pamativi maviri-e-t-kuedzwa muenzaniso we 86 (43 neboka) huchapa 80 simba rekutsvaga kusiyana kukuru pane alpha 0.05 pakati peboka rinoreva mazita e10 pane 100 point NDI (achitora SD ye16, zvichibva pane data yedu yekufambisa uye data kubva kuzvinoitika miedzo). Migumisiro shoma kudarika iyi haigoni kuonekwa sechiremba inobatsira. Kubvumira kuti 20% kurasikirwa kutevedzwe nemwedzi ye12, tinoda vatori vechikamu 54 pamapoka ekurapa.

Kupindira

Randomisation

Vatori vechikamu vacharamba vachiendeswa kuchipatara boka. Iro randomisation purogiramu ichave yakagadzirwa nedzidzo yekusimudzira biostatistician. Randomisation ichange iine maitiro akavharirwa e4 kusvika ku8. Zvakabatanidzwa zvakaverengwa, zvakasimbiswa, zviputiro zvemafupa zvichashandiswa kuvanza randomisation. Kugoverwa kweboka kuchaitwa nokukurumidza mushure mokupedzwa kwezviyero zvepakutanga nemunhu anozvimirira (asina kuporeswa) mubatsiri wekutsvakurudza. Uyu mubatsiri wekutsvakurudza achagadzirira nguva dzose dzekugadzwa nevatapi vezvechiremba uye muongorori akaporeswa wezvose zvingagadziriswa. Vatori vechikamu vacharayirirwa kuti varege kubudisa tsanangudzo pamusoro pemishonga yavo kumuongorori kuitira kuti vabatsire nekupofumadza. Varwere vacharongwa kuti vagamuchire kurapwa kwavo kwekutanga mukati mevhiki imwe ye randomisation.

Kupindirana kweboka - Kutambudza-kwakananga Kuziva-behavioral therapy (CBT)

Kupindira kwepfungwa kunotarisa zviratidzo zvePTSD kunosanganisira gumi nevhiki masvondo makumi matanhatu kusvika masere makumi mapfumbamwe emisangano yemunhu mumwechete akaendesa kushungurudzika-akatarisana neCBT zvichibva paAustralia Mirayiridzo yekurapa kweVakuru vane Acute Stress Disorder uye PTSD [10] (ona Tafura 60). Session yekutanga ichatarisa pakupa psycho-dzidzo maererano nezviratidzo zvakajairika zvePTSD, kuchengetedza zvinhu uye kupa chikonzero chezvinhu zvakasiyana zvekurapa. Zvirongwa zviviri nezvitatu zvichaenderera mberi nekukudziridza ruzivo rwevarwere rwezviratidzo zvePTSD uye kudzidzisa maitiro ekugadzirisa kushushikana kusanganisira kufema kwakadzika uye kufambira mberi kwemhasuru kuzorora. Kugadziriswa kwekuziva uko kunosanganisira kupokana pfungwa dzisingabatsiri uye dzisina musoro uye zvitendero zvinotanga muchikamu chechitatu uye zvicharamba zvichirapwa. Vatori vechikamu vachatanga kuburitswa kwenguva yakareba muchikamu chechina chinozove chakapetwa nekuzorora uye kugona kunzwisisa. Chikamu chechitanhatu chichaunza kuiswa mukati-vivo kuratidzwa. Kudzokazve kudzivirira kuchabatanidzwawo muzvikamu zviviri zvekupedzisira [90]. Vatori vechikamu vanokumbirwa kupedzisa maitiro epamba pamusoro pesangano ravo rinozo nyorwa uye riunzwe kuchikamu chinotevera. Kurapa kunozoendeswa nevakanyoreswa vezvepfungwa vane postgraduate kiriniki yekudzidzira uye ruzivo rwunounza kushungurudzika-kwakanangana neCBT kupindira.

Tafura 2. Kurongwa kwepurogiramu yeBBCT

chiitiko	tsananguro
1	Nhanganyaya uye maonero
2	Kudzidzira kurasikirwa
3	Kudzidzira kunonoka uye kugadzirisa zvinetso
4 uye 5	Kuziva njere uye kuwedzera kwenguva refu
6	Kuratidzwa kwenguva yakareba uye mu vivo exposure
7 uye 8	Kuratidzwa kwenguva yakareba uye mu-vivo kutarisana
9	Kudzokera kudzivirira
10	Kudzokorora kubvisa uye kupera kwekurapa

Chikamu Chekudzora - Kutsigira Therapy

Chikamu chekutanga chichabatanidza dzidzo pamusoro pekutambudzika uye tsanangudzo yemhando yekurapa inotsigira. Zvirongwa izvi zvinotevera zvinosanganisira kukurukurirana kwezvinetso zvemazuva ano uye unyanzvi hwokugadzirisa matambudziko. Musha unozoita huchabatanidza kuchengeta diary yezvinetso zvemazuva ano uye mafungiro anotaura. Chirongwa chekusimbisa chinonyanya kudzivisa kusvibiswa, kugadziriswa kwekufungisisa kana kushungurudza maitiro. Kana zviitiko zvekutongwa zvakakosha uye vatori vechikamu vanongorongedza kupindira uku vachiri nePTSD kuongororwa pamwedzi we12 kutevedza, vachagoverwa kutumira kune kliniki yepfungwa.

Kudzidzira Chirongwa

Kutevera 10 vhiki yepfungwa yekurapa maitiro (kupindira kana kutonga), Vose vatori vechikamu vachabatanidzwa muchirongwa chakafanana. Chirongwa cheC6-vhiki yekuvhima ichaitwa pasi pekutarisa kubva kune physiotherapist (2 sessions muvhiki imwe neimwe yekutanga kwevhiki uye 1 muchikamu chevhiki 5 uye vhiki ye6) uye ichaita zviratidzo zvakasiyana siyana zvekuvandudza kufamba nekudzivirira kwemutsipa uye mabhandi emapfudzi pamwe chete nekuzvibata uye kugadzirisa maitiro (ona Table 3). Izvo zvinodzidziswa zvichave zvakagadzirirwa ne physiotherapist kune mumwe nomumwe anenge aripo.

Purogiramu inotanga nekliniki yekuongororwa kwemisumbu yemukomana uye axio-scapular-girund musumbu uye inosanganisira miedzo inongedza mano ekuunganidza michina nenzira yakarongeka, miedzo yekuenzanisa, cervical kinaesthesia uye maziso ekufamba kwemaziso uye miedzo yekusuruvara kutsungirira pa kudzika kwemazinga ekuputika kwekuzvidira. Izvo zvakakanganisika zvinowanikwa zvinotaurirwa ne chirongwa chekudzidzira chinotarisirwa uye chakafambiswa ne physiotherapist. Iyi purogiramu chaiyo yehutano yakatsanangurwa muchidimbu [15] uye inoisa pfungwa pakuita nekuvandudza kugadziriswa uye kutsungirira simba remutsipa flexor, extensor uye zvinyoronyoro mumashandiro chaiwo uye mabasa anoshanda, uye purogiramu yakagadzirirwa inotungamirirwa kumashure sangano, kusanganisira kubhadhara maitiro, kushandiswa kwekutungamira maitiro uye kudzidzira kwekutarisa kwemaziso.

Vatori vechikamu vanozoita zvakare kurovedza kumba, kamwe pazuva. Bhuku rerogi richapedziswa nevatori vechikamu kuti vanyore kutevedzera zviitwa. Panguva imwecheteyo, iyo physiotherapist inotungamira ivo vanodzokera kuzvinhu zvakajairwa.

Physiotherapists achabatana nemafungiro ehutano-hutsika panguva yekudzidzira uye kutarisa kwezvinhu zvose [26]. Kuziva kwehutano hwehutano hwehutano hunosanganisira kukurudzirwa kweunyanzvi hwekushandisa kuburikidza nekuenzanisa, kuisa zvinangwa zvinowedzera, kuzviongorora-mberi kwekufambira mberi, nekusimbiswa kwakanaka kwekufambira mberi. Kuzvimirira kuchasimbiswa nekukurudzira nyaya kuti dzigadzirise matambudziko ekugadzirisa matambudziko panzvimbo yekutsvaga kuvimbiswa uye mazano, nekukurudzira zvinangwa zvezvinodiwa uye zvechokwadi, nekukurudzira kuzvitsigira. Basa rega rega rega pamusha richakurudzirwa nekuongororwa uchishandisa diary. Zvinyorwa uye zvakafananidzirwa zvidzidzo zvekushandisa zvichagoverwa.

Tafura 3. Chirongwa chepurogiramu yekuvhima

Vhiki	Zvidzidzo zvevhiki	zvinoriumba
1	2	Eline Baseline & yekutevera-kuongorora kuti utungamire yekutanga kuraira & kufambira mberi kwechirongwa Exercise yekuvandudza remuromo uye scapular mhasuru kutonga, kinaesthesia & chiyero Dzidzo nezano Program Chirongwa chezuva nezuva chemba chinosanganisira kurovedza muviri & kuwedzera kwakarongedzwa kwezviitiko zvemuviri Principles Mitemo yeCBT yakadai sekumisikidza zvinangwa, kusimbisa kunoshandiswa nevezvephysotherapists Kuburitsa musangano kusimbisa kufambira mberi uye kuronga kwekuenderera mberi kwechiitiko
2	2
3	2
4	2
5	1
6	1

Migumisiro yeMitemo

Pachidzidzo chekutanga chekutanga, maitiro evanhu akadai sezera, hutano, huwandu hwedzidzo, mamiriro ekubhadhara, zuva rezviitiko uye ruzivo pamusoro pezviratidzo zvechiplash zvichaunganidzwa. Izvi zvinotevera zviyero zvichaongororwa nemunhu anoona bofu pamusana pekutanga, vhiki dze10, mavhiki e16, mwedzi ye6 uye mwedzi 12 mushure mekunyorwa.

Iko Neck Disability Index (NDI) ichava inonyanya kuguma chiyero [21]. IY ndiyo chiyero chakakodzera uye chiyero chechokwadi chehutano hwehutano hwakagadzirwa nemutsipa [21] uye inokurudzirwa kuti ishandiswe neB Bone uye Joint Decade Neck Pain Task Force [7] uye munguva ichangopfuura yeWorld Whiplash Summit [11, 16].

Secondary results measures dzinosanganisira:

Ivhareji yepamusoro yehutano pamusoro pevhiki yapfuura (0-10 scale) [39]
Avhareji yepamusoro yepamusoro pamusoro pekupedzisira kwema 24 maawa (0-10 scale) [39]
Murwere wepasi rose pfungwa yekudzoreredza (-5 kusvika +5 chikero) [39]
Chiremba anoshanda PTSD chikamu 5 (CAPS 5) [40].
PTSD Checklist (PCL-5) [41]
Kuora mwoyo Kuzvidya mwoyo Kushungurudzika-21 (DASS-21) [42]
Chimiro chechimiro chehutano hwehutano (SF-12) [43]
Murwere-anokonzerwa nechiremara chekuremara (Murefu-Specific Functional Scale) [44]
Zviratidzo zvemuviri (cervical range of movement, kupera kwepamuviri, chirwere chinotonhora)
Pain Catastrophizing Scale (PCS) [45]
Pain Self Efficacy Questionnaire (PSEQ) [46]
Tampa Scale yeKinesiophobia (TSK) [47]

Zvinotarisirwa zvehutano hunobatsira huchaenzaniswa neKutenda Kwemaonero Ekutarisira (CEQ) [48] pakutanga uye vhiki yevhiki yekurapa kupi zvako. Kushandira pamwe sekuratidzwa kunoitwa muchengeti uye mushandi (psych kana physio) ichaenzaniswawo pakutanga nevhiki yekupedzisira yehutano hwega hwega uchishandisa Working Alliance Inventory (WAI) [49].

Kuongorora Kurapa Nzvimbo

Mishonga inorapwa ichawanikwa munzvimbo dzinowanikwa nyore nyore nekutakura vanhu. Miedzo ichaitwa kuti iite zvose zvepfungwa uye zvidzidzo zvinoshandiswa panzvimbo imwe chete. Usati watanga kusangana kwekutongwa, vanachiremba vepfungwa uye physiotherapists pane imwe nzvimbo yekurapa vachapiwa nehutano hwehutano hwehutano. Nyanzvi dzezvepfungwa dzichadzidziswa kuita chirongwa cheBBCT uye chirongwa chinotsigirwa nevatsvakurudzi vepamusoro pamasangano ezuva rimwechete. Physiotherapists ichadzidziswa nevatsvakurudzi vakuru kuti vashandise purogiramu yezvidzidzo pamusangano wezuva rimwechete.

Usati watanga mutsva, nhengo dzakasiyana-siyana dzekurapa masayenzi uye vanachiremba vachagoverwa kopi yemitambo yekuedza uye yekurapa. Zvose zvepfungwa dzepfungwa dzichaitwa maererano nezvakanyorwa mubhuku. Vanachiremba vachadikanwa kuti vanyore chidzidzo chega chega uye vagopedzisa ruongedzo rwekuteerera kune protocol. Muenzaniso unoshandiswa wezvinyorwa izvi uye zvinyorwa zvinongororwa zvichaongororwa uye zvinongoramba zvichitevedzwa zvakapiwa nachiremba wepfungwa pane boka rekutsvakurudza. Physiotherapy maitiro achave akavakirwa pamutambo wekare wekutengesa kweWAD chisingagumi [25]. Kuongororwa kwezvirongwa zve physiotherapy zvichaitwa kaviri panguva yekupindira kweimwe nyanzvi yepamusoro wepayenzi munharaunda iyi. Kupihwa kunozoitika pakati pepfungwa dzepfungwa uye physiotherapist kuti urambe uchienderera mberi kwekutarisira.

Zvakaipa Zviitiko

Kunze kwemaitiro anowanzogadzirisa komiti yakagadziriswa ekugadzirisa nezvekukanganisa kwakaipa, vashandi vachakumbirwa kutaurira chiitiko chipi zvacho chakaipa kune Vatsva Vakuru. Uyewo paC16 vhiki yekutevera, ruzivo pamusoro pemigumisiro yakaipa yekurapa ichatsvaga kubva kune zvidzidzo zvose uchishandisa mibvunzo yakasununguka. Pamwedzi we6 uye 12 kutevera, dhepfenyuro ine chokuita nenhamba yekudzoka kwemarwadzo emutsipa, uye nhamba yevashandi vehutano vanozounganidza zvakare.

Nhamba yekuongorora

Bhuku rekudzidza biostatistician richaongorora deta nenzira yakapofumadzwa. Zvose zvinongororwa zvichaitwa nechinangwa chekutora hwaro. Mhedziso yepamusoro uye yechipiri inowanikwa pamasvondo e10, masvondo e16, mwedzi we6, uye mwedzi ye12 ichaongororwa uchishandisa mienzaniso yakasiyana yakasanganiswa uye yakagadziriswa inozobatanidza maitiro avo ezvinyorwa zvese se covariate, zvidzidzo sechiitiko chisina kumira uye mamiriro ekurapa sezvakagadziriswa zvinhu. Diagnostics ichashandiswa kuongorora mafungiro, kusanganisira kuwirirana kwezvimwe zvakasiyana. Migumisiro yakakura ichaverengwa kune zvose zviyero nehukuru hukuru hwe0.2 hunofungidzirwa shoma, 0.5 mukati uye 0.8 huru. Alpha ichaiswa ku0.05. Chero chiitiko chesaiti (Qld kana Denmark) chichaongororwa nekubatanidza nzvimbo-ne-yekurapa boka-nenguva-kushandiswa kwemazwi kune mienzaniso yakavhenganiswa inoongorora. Migumisiro yokugadzirisa ichaongororwa chete pamusoro pezvinoitika zveN.

Mari

Mhosva yacho inobhadharwa neHNMRC Project grant 1059310.
Dare reDanish Victims Fund Project rinopa 14-910-00013

Zvinogona Kuitika

Iri purojekiti rinotaura nezvechinetso chekukosha kukuru kune hutano hwevanhu. Whiplash ine mutoro mukuru wehutano hweAustralia uye nyika dzose uko kune motokari. Nzira dziripo dzisingatarisirwi kuhutungamiri hweHIV husingaperi dzakaratidzwa kuti dzinongoshanda zvishoma. Chimwe chikonzero cheizvi chingave chikonzero nekuda kwekushaya hanya kwezvino maitiro kuhutano hwepfungwa hwechiplash vakakuvadzwa nevarwere. Ichi chidzidzo chichapa tsanangudzo yekutsvaga yemigumisiro yekuwedzera kushungurudza-kunotarisirwa CBT kushandiswa kune vanhu vane WAD asingagumi nePTSD.

Ichi chidzidzo chinogona kunge chichiita kuti zvipatisitiri zviongororwe zvekuputika nekuputika uye zvichave nekukurumidza kuchipatara. Kupindira chero kupi zvayo kunogona kuvandudza mararamiro ezvehutano kuvanhu vane chirwere chisingagumi chichava nemigumisiro yakareba muAustralia uye munyika yose. Kudzidza kwedu kuchave kune zvinorehwa nehutano nehutuvisi hwevanhu vanoita musarudzo mukuita kwavo zvisarudzo pamusoro pekusarudzwa kwehutano uye mari. Kutsvaga kweWIV International Clinical Trials Registry Platform Search Portal pa 2 / 3 / 13 yakaratidza kuti hapana chakarongerwa kana kupedzwa chirongwa chinogona kudzokorora basa redu.

Kurwisana kweShoko Chiziviso

Vanyori vanoti hapana kupesana kwechido.

Basa rezvepfungwa dzezvepfungwa mune zvekudzoka kubva kuWalla Whiplash

ngovepo

Zvinonyanya kugamuchirwa kuti pfungwa dzepfungwa dzakabatana dzakabatana nemararamiro ekurwara uye kune humwe uchapupu hwokuti hunogona kukanganisa mukana wekudzikinurwa kubva shure kwekushungurudzika kwezvirwere. Unyanzvi hwehupfungwa hwepfungwa, humwe hunozviratidza, uye hunotaridzika kuongorora kusagadzikana kwepfungwa kuti ufanotaura kuti kunonoka kugadziriswa kubva pane yakafanana whiplash kwakatsvakurudzwa mukutsvakurudza. 78 vakatevedzana varwere vakatumidzwa 7.2 (SD 4.5) mazuva mushure mekunge vashandura shuplash yakafanana mumatokari emotokari vakaongororwa nokuda kwepfungwa dzepfungwa, kusagadzikana kwehutsika, unhu hunoita, kunyunyuta kwemaonero, uye kukanganisika kwepfungwa kuburikidza nekuongororwa kwemasangano uye nemitemo yakawanda yakaenzana. Pakuongorora kwemwedzi 6 gare gare varwere ve57 vakadzorerwa zvizere uye 21 yakanga iine zviratidzo zvinoramba zvichiitika. Mazana 'emapoka ezvinyorwa zvakasarudzwa akaongororwa pachirongwa chekutanga chekutanga akaenzaniswa. Stepwise regression analysis yakaratidza kuti pfungwa dzepfungwa, hutsika husina kunaka, uye humwe unhu hwakanga husiri hukuru mukufanotaura zvaizoitika. Kunyange zvakadaro, kurwadziwa kwepakutanga kwakasimba, kukanganisa kunokonzera kushungurudzika kwepfungwa, uye makore zviitiko zvakakosha kufanotaura nezvekuita mararamiro. Ichi chidzidzo, chakange chakavakirwa pane sarudzo dzisina kuitika uye iyo yakaona zvimwe dzakawanda zvinokwanisika zvingaitika uye pamwe nehutano hwepfungwa, haitsigire zviwanikwa zvekare zvekuti pfungwa dzepfungwa dzinofanotaura nezvehutano hwehutano mumatambudziko anotevera.

Dr Jimenez White Coat

Dr. Alex Jimenez's Insight

Kuita mutsaona yemotokari kunogona kuva nhamo inoshungurudza kune ani zvake. Kubva pakakuvadzwa mumuviri uye matambudziko emari, kumanikidzwa mupfungwa, ngozi yemotokari inogona kuisa mutoro unorema kune avo vakazviona, kunyanya kana kukuvara kwepakuvhiya kunotanga kutora mukana mupfungwa. Varwere vakawanda vanoshanyira chiropractic yangu ehofisi nekuzvidya mwoyo, kutya kwemanzwiro, kusaora mwoyo uye PTSD mushure mokunge vaita mhirizhonga yemotokari. Kudzidza kuvimbazve kugamuchira chiropractic kunogona kunge kwakaoma, asi kuburikidza nekuchenjerera uye kugadzirisa kugadzirisa kwepelinha nekugadzirisa manzwiro, vashandi vedu vanogona kupa varwere pfungwa yekuchengeteka inofanirwa kupfuurira kurapwa uye kubudirira kwehutano hwakanaka uye hukama.

Mukupedzisa,Tsaona dzemotokari dzinogona kukonzera kukuvara kwakasiyana siyana kwemuviri uye mamiriro, senge whiplash, kurwadziwa musana uye kutemwa nemusoro, pamwe nenyaya dzemari, zvisinei, kukuvara kwetsaona yemotokari uye matambudziko anogona zvakare kukonzera kushungurudzika mupfungwa. Maererano nehuchapupu-hwakavakirwa pakutsvagisa zvidzidzo, senge iri pamusoro, kushushikana kwepfungwa kwakabatana nezviratidzo zvehurombo zvisingaperi. Neraki, vaongorori vakaita akawanda ekutsvagisa zvidzidzo kuratidza kuti kupindira kwepfungwa, sekuchengetedza chiropractic, kunogona kubatsira kudzikisira kushungurudzika kwepfungwa uye kugadzirisa zviratidzo zvinorwadza. Ruzivo rwunotsanangurwa kubva kuNational Center yeBiotechnology Ruzivo (NCBI). Chiyero cheruzivo rwedu chinogumira kuchiropractic pamwe nekukuvara kwepamuviri nemamiriro. Kuti ukurukure nyaya yacho, ndapota inzwa wakasununguka kubvunza Dr. Jimenez kana kutibata nesu pa 915-850-0900 .

Yakarongedzwa naDkt Alex Jimenez

Zvimwe Zvinyorwa: Kubva Painini

blog chinyorwa chekartoon paperboy makuru makuru

NHAURWA INOKOSHA INOKOSHA: Kutarisira Kushungurudzika Kwebasa

ZVIMWE ZVINOKOSHA ZVINOKOSHA: KUDZIDZA KUNYANYA: Kutsaona Kwemotokari Kurapa El Paso, TX Chiropractor

Hazvina kuchena

References

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Close Accordion

Kubudirira kweMangariro paHerniated Discs & Sciatica muEl Paso, TX

by spinedoctors | Mamiriro Ekutongwa, Herniated Disc, Physical Rehabilitation, Randomized Controlled Trial, Spinal Decompression Treatments, kushushikana, Mishonga

Kusuruvara kunorwadza kumashure ndicho chikonzero chechipiri chinowanzokonzera kuremara muUnited States. Inenge 80 muzana yevanhu vanozoona kurwadziwa kamwechete kamwe chete munguva yeupenyu hwavo hwose. Zvimwe zvikonzero zvinowanzoitika zvekusingaperi kusarwa kwemarwadzo shure zvinosanganisira: herniated discs, sciatica, kukuvadzwa kubva pakusimudza zvinhu zvakaremara kana chero ipi zvayo isina kukanganisa kuora kwepamusoro. Zvisinei, vanhu vanowanzoita zvakasiyana nezviratidzo zvavo. Aya maitiro akasiyana anokonzerwa nemafungiro evanhu nezvepfungwa uye maonero.

Chisingatauri Chakatsika Pfungwa Uye Pfungwa

Kushungurudzika kwave kuchisanganiswa nekuwedzera kurwadziwa asi yako wega hutano hwekutenda uye nzira dzekugadzirisa zvinogona kukanganisa yako wega maonero ekurwadziwa futi. Izvi zvinodaro nekuti kusagadzikana kwepfungwa kunogona kushandura huropi hwako uye nekuwedzera kurwadziwa. Pamusoro pezvo, kurwadziwa kwacho pachezvako kunokwanisa kururamisa uropi. Kana marwadzo achienderera, chiitiko chehuropi chakabatana chinoshanduka kubva kumatunhu ekurwadziwa kuenda kumatunhu anoita manzwiro. Ndosaka zvichitendwa kuti kushushikana, kushushikana uye kushushikana kunogona kukonzera pamwe nekuwedzera kurwadziwa kusingaperi kwemarwadzo ekurwadziwa.

Kugadzirisa Dambudziko re Chronic Chronic Back Pain

Neraki, nzira dzinoverengeka dzekugadzirisa kushungurudzika uye matekinoroji anogona kubatsira kugadzirisa marwadzo ekurwadziwa asingaperi. Kungwarira ndiyo kurapwa kwakanyanya neuchapupu hwakanakisa hwekutsigira uye kugadzirisa kurwadziwa kusingaperi. nekuwedzera kwehuropi kuyerera kweropa kuenda kumberi kwemukati. Kudzidzira kufunga kunosanganisira kumisikidza nzira yekuzorodza huropi nekufunga nemaune "kutaura" nekutarisa pakufema kwako. Kuziva kurapa maitiro, kana CBT inogona zvakare kubatsira pakurwadziwa kusingaperi kwemusana. Kufungisisa maitiro ekurapa kunogona kudzivirira kukuvara kwakanyanya kubva kufambira mberi kune kusingaperi kwekurwadziwa kwepashure. Hypnosis inogona zvakare kubatsira kudzikamisa kusingaperi kwekurwadziwa kumashure. Nekudaro, CBT uye hypnosis vane humbowo husina kusimba hwekutsigira kugona kwavo pakurwadziwa shure.

Funga Pamusoro Penyaya

Saka nyangwe zvichiratidzika kunge maronda ekurwadziwa musana ese ari "mumusoro wako", zvidzidzo zvekutsvaga zvakaratidza kuti kushushikana kunogona kukanganisa zviratidzo zvinorwadza. huropi hunoita chinzvimbo chikuru mukuchinja kwepfungwa. Izvi zvinonyanya kuitika kana zvasvika kune shanduko-yakavakirwa shanduko inoenderana nekurwadziwa kwepashure kwekurwadziwa. Chinangwa chechinyorwa pazasi ndechekuratidzira kushanda kwekufunga kwekufungisisa pamarwadzo asingagumi ekurwadziwa shure.

Kubudirira kweMafungiro Kufungisisa Pamarwadzo Nehutano hweHupenyu hwevarwere vane Chronic Low Back Pain

ngovepo

Mamiriro uye chinangwa: Kudzorera kwevarwere vane chirwere chisingaperi chisingarware shure (LBP) kunonamirwa pane zvimwe zvinhu zvepanyama uye zvepfungwa. Nokudaro, vanyori vaine chinangwa chekuongorora kushanda kwepfungwa dzinovakirwa kunetseka kuderedza (MBSR) sekupindira kwepfungwa pamusoro pehupenyu hwehupenyu nekurwadziwa kwevarwere vechikadzi vane nonspecific chronic LBP (NSCLBP).
Nzira: Vane masere makumi masere nevasere vanorwara seNSCLBP nechiremba uye zvakarongerwa kuongororwa (MBSR + rubatsiro rwechiremba) uye boka rinodzora (rinowanzopiwa kurapwa chete). Zvidzidzo zvinongororwa mumafaira e3 nguva; kare, mushure memavhiki e4 mushure mokupindira naMac Gil kurwadziwa uye muhuhu hurefu hwehupenyu hwezviyero zvehupenyu. Dhiyabhorosi yakawanikwa kubva kumuenzaniso wokupedzisira wakaongororwa na ANCOVA uchishandisa SPSS software.
Results: Zvakawanikwa zvakaratidza kuti MBSR yaive inoshanda mukuderedza kurwadziwa kwakanyanya uye varwere vaiita zvikamu zvisere zvekufungisisa vakashuma kurwadziwa kwakanyanya kupfuura varwere vaingowana kurapwa kwese. Paive nemhedzisiro yakakosha yepakati penyaya yechinhu boka (F [8, 1] = 45, P <16.45) uye (F [0.001, 1] = 45, P <21.51) yehunhu hwepanyama hwehupenyu uye (F [0.001 , 1] = 45, P <13.80) uye (F [0.001, 1] = 45, P <25.07) hunhu hwepfungwa hwehupenyu zvichiteerana.
mhedziso: MBSR sechirongwa chepfungwa-kusanganisira kuongorora muviri, kugara uye kufamba kufungisisa kwakabatsira kupindira mukuderedza kunetseka kwakanyanya uye kuvandudzwa kwehutano hwepanyama uye hwepfungwa hwehupenyu hwevarwere vechikadzi neNSCLBP.
Keywords: Kusuruvara kusingadzoki shure, kufungidzira kunobva mukuderedza kupera, kurwadziwa, hupenyu hwehupenyu, SF-12

ziviso

Mukurwadziwa kusinganzwisisike kwakanyanya kumashure (NSLBP) kurwadziwa kwacho hakuna hukama nemamiriro akaita sekutyoka, spondylitis, kushungurudzika kwakananga, kana neoplastic, kutapukira, vascular, metabolic, kana endocrine zvine hukama kunyangwe chiri chikonzero chekudzikiswa mumabasa ezuva nezuva nekuda kweicho chaicho kurwadziwa kana kutya kurwadziwa. [1] Zvinosuruvarisa, vazhinji vevarwere veLBP (80-90%) vanotambura neLBP isina kunyatsojeka iyo inotungamira mukuremara kwakanangana nekurwadziwa uye kuremerwa mumabasa ezuva nezuva. [1,2] Chirwere cheLBP hachizi kungowanikwa chete, asi zvakare sosi yehukuru kuremara mumuviri, kukanganisika kwebasa, uye kuderera kwehutano hwepfungwa uye hupenyu hwehupenyu. [1]

Isati yave yakagamuchirwa yemuenzaniso wei biopsychosocial, muenzaniso wezvinyorwa zvehupenyu hwakakonzera zvirwere zvose zvekurwara kwemakore anoda kusvika 300 uye zvichiri kutonga mumanzwiro anozivikanwa. Chokutanga chinorongedzwa neIngel (1977) chimiro che biopsychosocial chinobvuma zvirongwa zvehupenyu asi zvakare inoratidza kukosha kwehupenyu uye hwepfungwa zvinorwadza. Gedhi rakakurumbira rinodzora dzidziso yekutambudzika [3] yakarongedzawo kuti uropi hunoita basa rinokurudzira mukurwadziwa kwekunzwisisa kunze kwekunge munhu asingagamuchiri kugamuchira zvirwere zvinorwadza. Vakaratidza kuti pfungwa dzepfungwa dzinogona kudzivisa kana kukudziridza manzwiro ekurwadziwa kwezvirwere uye zvinokonzera nzira iyo uropi inogadzirisa nayo pakukurudzira kunorwadza. [4] Kana pfungwa dzinoita zvingashandura nzira iyo uropi hunoitisa marwadzo zvino inobata simba guru rekupindira kwepfungwa kuti ribudise kuderedzwa zviratidzo zvinorwadza kubva muuropi.

Kabat-Zinn et al. (1986) akatsanangura maitiro ekuderedza marwadzo mupepa rake pamusoro pekufunga uye kufungisisa. Maitiro ekuderedzwa kwekutambudzika akaitika ne an mafungiro ekucherechedzwa kwekutarisa kune painonzwa kana ikave yakakurisa mumunda wekuziva uye kucherechedza neakafanana nharaunda inoenderana asi yakazvimiririra yekuziva maitiro ayo anotungamira mukuwongorora uye kunyorera kwekunzwa kunorwadza, se saka, ne uncoupling iyo yekunzwa kwemuviri, kubva pane yekushushikana uye nekuziva chiitiko chekurwadziwa, murwere anokwanisa kudzikisa marwadzo. [5] Tsananguro dzevarwere dzekuvhiringidzika kubva pakurwadziwa, kuratidza maladaptive ekugadzirisa maratidziro ekurwadziwa uye kwakasimudzira kuziva kwekurwadziwa kwekunzwa kunotungamira mukuchinja kwehunhu mienzaniso yekuti marwadzo haana kubatana sei nemanzwiro, kuziva, uye kunzwa [Mufananidzo 1]. Naizvozvo munguva pfupi yapfuura idzi dzidziso dzakakwezva vaongorori vakati wandei vari kushanda pakurwadziwa.

Mufananidzo 1: Mushati weConor.

Kunyatsofungisisa kufungisisa kunobva mumadzinza eBuddhist Vipassana uye maitiro uye ave akazvimiririra kugadziriswa mukati mekurapwa kwepfungwa mumagariro ekuMadokero. [6,7,8,9] Munguva pfupi iri kuWelbour Veehof et al. yakarongedza kurongeka kwezvidzidzo zvinochengetedzwa uye zvisina kudzora pamusoro pekugutsikana kwezvibvumirano zvakagadzirirwa-zvakadai sekufungisisa-kubva kunokonzera kuderedza chirongwa, kubvuma uye kuzvipira kurapa kurwadziwa kusingaperi. Zvibereko zvepamusoro zvakaenzana zvaiva kurwadza uye kuora mwoyo. Secondary results results measured, anxiety, physical well-being and quality of life. [10] Chidzidzo makumi maviri nemaviri chichiongororwa chechirongwa chekuongorora zvidzidzo zvekliniki zvakarongedzwa pasina mirayiridzo uye zvidzidzo zvisingatenderwi zvaisanganisira kuwandisa varwere ve1235 vane kurwadziwa kusingaperi. Chimiro chekukura pamarwadzo e (0.37) akawanikwa mune zvidzidzo zvinodzorwa. Mhedzisiro yekuora mwoyo yaiva (0.32). Vanyori vakapedzisa kuti maitiro eCIT uye mafungiro aiva nemigumisiro yakafanana kune mamwe mafungiro-maitiro ekurapa maitiro uye kuti maitiro ezvokubatsira angave akakosha kana kushandiswa kunezvino zverapi. Chiesa naSerretti vakaitawo mamwe maitiro ekugadzirisa pamusoro pekuita kwepfungwa dze 10. [11] Zviwanikwa zvikuru ndezvokuti kupindira uku kwakabudisa migumisiro miviri isina kukwana maererano nekuderedza kurwadziwa kusingaperi uye zviratidzo zvekuora mwoyo. Kana ichienzaniswa nemapoka ekutungamirira anoshanda (rubatsiro uye dzidzo) hapana mamwe maitiro makuru akaonekwa.

Mukupfupisa, kune chido chekuwedzera zvidzidzo mune zvakakonzera zvidzidzo zvepfungwa pamusoro pekutambudzika kusingaperi. Nezvekutsvaga kwakaita muongorori ruzivo rwehutano hwekufunga hauna kuongororwa pamhando yehupenyu hwevarwere vasingaperi vanorwara muIran. Vanyori vaine chinangwa chekuongorora kuve kwepfungwa dzinovakirwa kunetseka kuderedza (MBSR) protocol yakagadzirirwa kurwadziwa kwehurombo pamusoro pehupenyu hwehupenyu uye kurwadziwa kwemuenzaniso weiwo wevakadzi vane nonspecific chronic LBP (NSCLBP) mukuenzanisa neboka rinowanzochengetwa rekurapa.

nzira

Sampling

Kunze kwemasampuli echikadzi ekutanga ane makore 30 45 (n = 155) akaonekwa seisingaperi NSLBP navanachiremba muzvipatara zvephyotherapy yeArdebil-Iran mwedzi mitanhatu zvisati zvaitika. 6 chete ndivo vakasangana neyakaiswa nzira uye vakapa mvumo yekutora chikamu muchirongwa chekutsvaga. Varwere vaiwanzopihwa mumapoka madiki kuti vagamuchire MBSR pamwe nekurapwa kwakajairika kurapwa (boka rekuyedza) uye kurapwa kwakajairwa kurapwa (boka rekutonga). Vamwe varwere vakadonha panguva uye mushure mekurapwa. Muenzaniso wekupedzisira wechidzidzo uyu waive nevakadzi makumi mana nevasere.

Inclusion Criteria

Zera makore makumi matatu nemashanu
Kuva pasi pemishonga yezvokurapa sa physiotherapy uye mishonga
Dambudziko rezvoutano-nhoroondo yeNSCLBP uye kurwadziwa kunoramba kuripo kwemwedzi inenge ye6
Mutauro - Persian
Gender - mukadzi
Kudzidza - vakadzidziswa zvishoma kusvika kuchikoro chesekondari
Mvumo uye chido kune dzimwe nzira dzokurapa uye dzinobatanidza dzekutambudzika kwekutambudzika.

Kusagadziriswa Criteria

Nhoroondo yekuvhiyiwa kweperepa
Kusangana nezvimwe zvirwere zvisingaperi
Psychotherapy mumakore ekupedzisira e2 asina kubviswa
Kusabvumirwa mumwedzi inotevera ye3.

Chirongwa chekudzidza chakatenderwa nesainzi komiti ye Panjab University, dhipatimendi rezvepfungwa nevarwere vese vakasaina mvumo yekutora chikamu muchidzidzo chazvino. Chidzidzo chakabvumidzwa muIndia (kuyunivhesiti iyo muongorori akaita PhD yake), asi akaitisa muIran nekuti muongorori anobva kuIran pakutanga uye pakanga paine dambudziko remutauro netsika. Kubvumidzwa kubva kuInstitutional Ethics Committee yephyotherapyotherapy nzvimbo yeArdebil yakawanikwa muIran zvakare kuita tsvagiridzo.

patani

Chidzidzo ichi chakashandisa pre-post quasi nguva dzakateedzana dhizaini yekuyedza kuongorora kushanda kweMBSR muma3 nguva mafuremu (pamberi-mushure-memavhiki mana mushure megurogiramu). Chirongwa cheMBSR chaitisa chikamu chimwe chete pasvondo chekutsanangura matekinoroji, maitiro, uye mhinduro uye kugovana ruzivo rwavo kwemavhiki masere padivi pe4 8 min tsika yekumba mazuva ese [Tafura 30]. Kupindira kwakaitwa mumapoka matatu aisanganisira vatori vechikamu 45 1 muboka rega rega. Maitiro ekugadzirisa chirongwa ichi aive akavakirwa pamitsetse yequid yakapihwa naKabat-Zinn, Morone (7a, 9b na2008) [2008] uye kumwe kugadziridzwa kwakaitirwa varwere vari muchidzidzo ichi. Boka rinodzora harina kupihwa chero rudzi rwekupindira muchirongwa chekutsvaga. Nekudaro, ivo vakawana akajairwa maitiro mune zvehutano zvinosanganisira physiotherapy uye mushonga.

Tafura 1: Zviripo zveZVSR zvidzidzo.

Kupindira

Izvo zvikamu zvakaitiswa mune yakasarudzika physiatrist kiriniki padyo ne physiotherapy nzvimbo. Zvirongwa zvakatora mavhiki masere, uye chikamu chega chega chakatora maminetsi makumi mapfumbamwe. Kufungisisa kwakashandura kuziva kwevarwere kuburikidza nehunyanzvi hwekufema uye kufunga. Kupindira kwakaitwa mumapoka madiki aisanganisira vatambi ve8 muboka rega rega. Tafura 90 yezvinhu zvemukati wechikamu zvakagadzirirwa zvinoenderana nemabhuku uye zvidzidzo zvekare. [7]

Miedzo

Mubvunzo unopedzwa nevarwere vasati vapindira, mushure mokupindira uye mavhiki e4 mushure mokupindira. Mutori we physiotherapy nzvimbo akaitisa kuongorora. Vakatambira vakarovedzwa vasati vaita kuongororwa, uye vakanga vasina bofu nokuda kwechikonzero chekudzidza. Izvi zvinotevera zvinoshandiswa kuongororwa kwevatori vechikamu:

McGill Pain Questionnaire

Chimwe chikamu chikuru chechiyero ichi chinosanganisira zvirevo zve 15 zvinotsanangurwa, zvinonzi 11 zvinosanganisira: Kubvambura, kupfura, kubata, kutsvaira, kuputika, gnawing, kupisa, kutsvaira, kutakura, kutenderera, kutsvaira, uye kuipa kwechina kunosanganisira: Kuneta-kuneta, kuneta , Kutya, Kuranga-utsinye, iyo inorongwa nevarwere maererano nekutsungirira kwavo pamakona mana (0 = hapana, 1 = runyararo, 2 = inonyoresa, 3 = yakanyanya), ichipa zvikamu zvitatu. Izvo zvinonzwa uye zvinokonzera zviyero zvinoratirwa nekuwedzera manzwiro uye mafungiro emhando yezvinhu zvakasiyana zvakasiyana, uye chikamu chakanaka chikamu chezvinhu zviviri zvakataurwa pamusoro apa. Muchidzidzo ichi, takangoshandisa marwadzo ekunyorwa kwekero uye zvikamu zvese. Adelmanesh et al., [15] yakashandura uye yakashandura Iran yevhidhiyo yemubvunzo uyu.

Quality of Life (SF-12)

Unhu hwehupenyu hwakaongororwa neSF-12 Health Survey yakagadziriswa. [16] Yakagadziriswa sechidimbu, chinokurumidza-kuzadzikisa zvimwe zveSF-36v2 Health Survey uye inoyera humwe hutano hunovaka. Izvo zvinogadzirwa ndezvi: Kuita muviri; role physical; kurwadziwa mumuviri; general health; simba; kushandiswa kwehutano; role emotion; uye utano hwepfungwa. Zvinhu zvine zvishanu kusarudzwa (semuenzaniso: Nguva yose, nguva yakawanda, imwe yenguva, nguva shoma, hapana nguva), kunze kwemibvunzo miviri yekuti pane zvitarudzo zvitatu zvinosarudzwa ( physically functioning domain). Zvinhu zvina zvinodhindurwa zvakawanikwa. Yakagadziriswa mavara matsva mumasere masere akachinjwa kuti achinje matanho ekudzikisa anokwanisa kusvika kuZ100. Dzidzo dzakakwirira dzinomiririra utano hwakanaka uye hukama hwakanaka. Chimiro chechimiro cheSF-12 chinoshandisa nguva yemavhiki e4 apfuura. [16]

Iyo Iranian vhezheni yeSF-12 muMontazeri et al. (2011) kudzidza kwakaratidza kugutsikana kwemukati kuenderana kweese matanho epfupikiso, ayo ari ePhysical Component Summary (PCS) uye Mental Component Summary (MCS); Cronbach's? yePCS-12 uye MCS-12 yaive 0.73 uye 0.72, zvichiteerana. Muenzaniso weboka unozivikanwa wakaratidza kuti SF-12 yakasarura zvakanaka pakati pevarume nevakadzi nevaya vakasiyana nezera uye chinzvimbo chedzidzo (P <0.001) 2.5. [17]

Nhamba yekuongorora

The SPSS 20 (Armonk, NY: IBM Corp) yakashandiswa kuongorora data. Nekutsanangurwa kunotsanangurwa zvinoreva, kupotsa kwakakwana (SD) yakashandiswa. Nekuita ANCOVA, zviitiko zvepamberi zvakashandiswa se-covariates.

Results

Zera rinoreva 40.3, SD = 8.2. 45% yevakadzi vakanga vari kushanda uye vamwe vose vakanga vari mudzimai weimba. 38% aiva nevana vaviri, 55% mwana mumwechete uye vamwe vose vakava nevana. Vose vakanga vakaroorana uye kubva kumhuri yakapfuma-miviri. 9.8% yevarwere vakarondedzera hutsika hwakanyanya hwehupenyu hwehupenyu, uye vamwe vose vakanga vari pasi (54.8%) uye vanoenzanisa (36.4%). Ichi chakanga chiri 12.4%, 40% uye 47.6% yakadzika kwazvo, yakadzika uye mizinga yepamusoro yehutano hwepfungwa hwehupenyu muvarwere vakabatanidzwa mukudzidza kwedu (n = 48). Zvinoreva uye SD yevarwere muBMSR uye boka rekutonga rakaratidza kuderera kwekutambudzika uye kuwedzera muhutano hwepfungwa uye hwehupenyu [Tafura 2].

Tafura 2: Zvinoreva uye SD yevarwere mukurwadziwa, hutano nehuviri hwehupenyu huri muhutano, mushure mekupindira uye mavhiki e4 mushure mokupindira.

Kuenzanisa Kuwanikwa

Pain. Mhedzisiro yacho yakaratidza kuti mushure mekugadzirisa zvikwangwani zvekutanga, paive nemhedzisiro yakakosha yepakati penyaya yechinhu (F [1, 45] = 110.4, P <0.001) uye (F [1, 45] = 115.8, P <0.001) . Yakagadziriswa post-bvunzo zviyero zvinoratidza kuti kupindira kwaive nemhedzisiro yekuwedzera marwadzo evarwere veNSCLBP vakagamuchira MBSR kana vachienzaniswa nevaya vaive muboka rekutonga uye vasina kugamuchira chero kurapwa kwepfungwa-muviri [Tafura 3].

Tafura 3 Chigumisiro Chokufananidza Nhamo Nehupenyu Hweupenyu

Tafura 3: Mugumisiro wekufananidza marwadzo uye hupenyu hwehupenyu hweMBSR uye kutungamirira boka mushure mokupindira (nguva 1) uye mavhiki e4 mushure mokupindira (nguva 2).

Unhu hwehupenyu. Mhedzisiro yacho inoratidza kuti mushure mekugadzirisa zvikwangwani zvekutanga, paive nemhedzisiro yakakosha yepakati penyaya yechikwata (F [1, 45] = 16.45, P <0.001) uye (F [1, 45] = 21.51, P <0.001) . Yakagadziriswa post-bvunzo zviyero zvinoratidza kuti kupindira kwaive nemhedzisiro mukuwedzera hunhu hwehupenyu hwevazhinji vevarwere veNSCLBP vakagamuchira MBSR kana zvichienzaniswa neavo vaive muboka rekutonga uye vasina kugamuchira chero kurapwa kwepfungwa-muviri [Tafura 3 ].

Mhedzisiro yacho yakaratidza zvakare kuti mushure mekugadzirisa zvikwangwani zvekutanga, paive nemhedzisiro yakakosha yepakati penyaya yechikwata (F [1, 45] = 13.80, P <0.001) uye (F [1, 45] = 25.07, P <0.001 ). Yakagadziriswa post-bvunzo zviyero zvinoratidza kuti kupindira kwakave nekukonzeresa kuwedzera kwehunhu hwepamoyo hwehuwandu hwevarwere veNSCLBP vakagamuchira MBSR kana zvichienzaniswa neavo vaive muboka rekutonga uye vasina kugamuchira chero kurapwa kwepfungwa [Tafura 3].

Dr Jimenez White Coat

Dr. Alex Jimenez's Insight

Kungwarira inzira yepfungwa inosanganisira kuita kumisikidza nzira yekuzorodza kwehuropi nemaune nekuregeredza "kutaura" kwepfungwa, kuunza kutarisisa kune zviitiko zvinoitika munguva yazvino uye kutarisa kufema kwako. Kungwarira kunogona kuwanikwa kazhinji kuburikidza nekudzidzira kwekufungisisa uye kushushikana manejimendi nzira nemaitiro Zvinoenderana nezvidzidzo zvekutsvaga, kufunga inzira yekurapa inoshanda iyo inogona kubatsira kudzikisira marwadzo ekurwadziwa asingaperi. Vatsvaguriri vakambofananidza kufunga-kwakadzikira kushushikana kwekudzikisira, kana MBSR, nekuziva kwehunhu hwekurapa kuti vaone kana kupindira kwepfungwa uku kunogona kugadzirisa marwadzo ekurwadziwa asingaperi. Chinyorwa chinotevera chakaitiswawo kuti chione kana kufunga kwekufungisisa inzira yekurapa inoshanda yehurombo husingaperi hwekurwadziwa shure. Mhedzisiro yezvose zviri zviviri zvidzidzo zvekutsvagisa zvaivimbisa, zvichiratidza kuti kufunga kunogona kuve kwakanyanya kushanda kune kusingaperi kwekurwadziwa kwepashure pane zvetsika nzira dzekurapa pamwe nekushandiswa kwemishonga uye / kana mushonga.

hurukuro

Mhedzisiro yacho yakaratidza kuti iro boka rekuyedza iro rakaiswa pasi peMBSR rakaratidza shanduko yakakura mukushungurudzika kwavo kwakanyanya, kwemuviri uye wepamoyo hutano hwehuwandu hwehuwandu nekuda kwekudzidziswa kwakagamuchirwa zvichienzaniswa neboka rinodzora rakagamuchira kurapwa kwese kwakajairika. Iyo purogiramu yakadzora kurwadziwa kwekuona uye yakawedzera zvese zvemuviri uye zvepamoyo hupenyu uye zvakakanganisa paboka rekuyedza zvakajeka mukuenzanisa kweyakajairwa kurapwa kurapwa. Baranoff et al., 2013, [18] Nykl cek naKuijpers, 2008, [19] naMorone (2) et al., 2008 [20] vakataura zvakafanana mhedzisiro.

Kabat-Zinn et al. akatenda maitiro ekuderedza marwadzo akaitika ne uncoupling iyo yekunzwa kwemuviri, kubva kune yekufunga uye yekuziva chiitiko chekurwadziwa, murwere anokwanisa kudzikisa marwadzo. [21] Muchidzidzo chazvino, vatori vechikamu vakasunungura zvikamu zvakasiyana zvechiitiko chekurwadziwa. Kufuridzira kurovedza muviri kunokanganisa pfungwa dzavo kubva pakurwadziwa kusvika pakufema uye kurarama kwepfungwa kwakavaita kuti vazive nezve maladaptive ekugadzirisa maitiro.

Muchikamu chekutanga, ruzivo runopiwa pamusoro pezvakakosha zvekufunga, kurondedzera kufunga kwekusimbisa mafungiro kunosanganisira kusava nemafungiro kune mafungiro, manzwiro kana manzwiro sezvavanomuka, kushivirira, kusagadzikana, tsitsi, kugamuchira uye kuda kuziva kwakavapa uchenjeri uye vanotenda kuti vari kutambura kubva pamanzwiro anorwadza kudarika kurwadziwa pachako.

Zvakare, panguva yekuyedza muviri kuongorora ivo vakadzidza kuona kwavo chaiko mamiriro emuviri, sezvazvaive chaizvo, pasina kuyedza kushandura chokwadi. Kugamuchira chirwere chavo chisingaperi kwakavabatsira kuti vaone humwe hunyanzvi hwavanogona kuita munzvimbo yavo yemagariro uye nemanzwiro. Muchokwadi maitiro ekuongorora muviri akavabatsira kuti vachinje hukama nemuviri wavo uye kurwadziwa. Kubudikidza neruzivo rwakananga mukuongorora kwemuviri, munhu anoziva kubatana pakati penyika yepfungwa nemuviri, uye nokudaro kunowedzera kuzvidzora kwevarwere pamusoro pehupenyu hwavo. Matanho ehupenyu ehungwaru akavandudzawo hupenyu hwavo nekuvadzidzisa kuti vatarise zvakanyanya kune zvavanoda zvezuva nezuva, izvo zvakatungamira mukuziva kwekunzwa kwakanaka manzwiro, serunyararo nemufaro, kuzvitemba uye kuvimba. Uyezve, vaitenda zvinhu zvakanaka. Kana vachinge vadzidza kuona marwadzo anoramba aripo zvisina mwero uye nekuona kumwe kunzwika mumuviri wavo, vakashandisa iwo iwo iwo musimboti kuburikidza nehungwaru hwekurarama maitiro muhupenyu hwavo hwezuva nezuva. Nekuda kweizvozvo, ivo vakadzidza maitiro ekugadzirisa hutano hwavo uye vakatanga kuita mumabasa avo zvine hungwaru.

Zvimwe zvidzidzo zvitsvakurudzo zvakadai sePlews-Ogan et al., [22] Grossman et al., [23] uye Sephton et al., (2007) [24] vakaratidza kubudirira kwepfungwa yekufungisisa mupfungwa pamusoro pehupenyu hwevarwere vane chisingarwadza mamiriro ezvinhu.

mhedziso

Zvose pamwe chete mugumisiro wekudzidza uku uye zvidzidzo zvekare zvakaratidza kubudirira kwekugadzirisa uye kushandiswa kwemishonga kune varwere vane LBP isingaperi. Nezvematongerwo emhando yehupenyu hwehupenyu hwehutano uye hwehupenyu huri kuronga hutano hwehutano hunobudirira kunyanya kusimbisa hutano hwehupenyu hwevarwere vane chirwere chisingaperi chine LBP zvakanyatsoratidzwa nevanyori.

Chidzidzo ichi chakabatanidzwa nezvikanganiso zvakawanda zvakadai sekuchengetwa kwemazuva ose kusina kugadziriswa kunowanikwa nevarwere. Zvirongwa zve physiotherapy zvakapiwa kana nzira uye mishonga yakagadzirirwa navanachiremba vakasiyana nenzira yakasiyana. Kunyange zvazvo vamwe varwere vanowanzoita kuti dose isapedze physiotherapy sessions. Muenzaniso wekukura wakanga uri muduku uye waingova wega kune nzvimbo nhatu. Izvi zvinokurudzirwa kuti vaongorori vepamangwana vaite zvidzidzo nekufungisisa zvipimo zve physologic zvakadai seMRI, NMR uye zviratidzo zveeurologic kuedza kubudirira kweMBSR kuderedza marwadzo anorwara.

Mukupedzisa, humwe humwe uchapupu hunotsvaga hukuru hunotsvakurudza nehuwandu hunotevera hunodiwa kuti huwedzere kuwedzerwa kuyerwa kwehutano uye kukosha kweMBSR sechikamu chekugadzirisa kumwe kushandiswa kwemishonga yekudzivirira uye nzira yekuvandudza pakati peVACBP varwere.

Kuonga

Isu tiri kuvonga kubva kune varwere vakange vari pamwe nesu. Dr. Afzalifard nevashandi ve physiotherapy nzvimbo dzeArdebil.

Mashoko Omuzasi

Chitubu chekutsigirwa: Nil.
Kupesana kwechido: Hapana chakaziviswa.

Mukupedzisa,Kufunga- ndiyo kurapwa kwakanyanya nehumwe hwakanakisa hunotsigira kugadzirisa nekugadzirisa marwadzo ekurwadziwa asingaperi. Kupindira kwepfungwa, kwakadai sekufunga-kunetseka kwekudzikisira uye kugona kwehunhu kurapwa, zvakaratidza kuve zvinoshanda kune risingaperi kurwadziwa shure. Uyezve, kufungisisa kwepfungwa kwakaratidzirwawo kuti zvinobatsira kubatsira kugadzirisa pamwe nekugadzirisa maronda ekurwadziwa asingaperi anokonzerwa nekushushikana. Zvisinei, zvimwe zvidzidzo zvekutsvakurudza zvichiri kudiwa kuti zvigadzire yakasimba mhedzisiro chiyero chekupindira kwepfungwa uye kurwadziwa kusingaperi. Ruzivo rwunotsanangurwa kubva kuNational Center yeBiotechnology Ruzivo (NCBI). Chiyero cheruzivo rwedu chinogumira kuchiropractic pamwe nekukuvara kwepamuviri nemamiriro. Kuti ukurukure nyaya yacho, ndapota inzwa wakasununguka kubvunza Dr. Jimenez kana kutibata nesu pa 915-850-0900 .

Yakarongedzwa naDkt Alex Jimenez

Zvimwe Zvinyorwa: Kubva Painini

Maererano nehuwandu, inenge 80% yevanhu ichaona zviratidzo zvekurwadziwa shure shure kamwechete munguva yeupenyu hwavo hwose. Kushungurudza kumashure ndekunyunyuta kunowanzoitika kunogona kuguma nekuda kwekukuvara kwakasiyana siyana uye / kana mamiriro. Kazhinji kacho, kuora kwechimiro chemupaka nezera kunogona kukonzera marwadzo kumashure. Herniated discs inoitika apo ganda rakanyorova, segel-like re intervertebral disc rinodonha nekubvarura mukati maro, rinenge riri kunze kwekatekete, kubvongodza nekugumbura midzi midzi. Dhizinesi dzinozivikanwa dzinowanzoitika kumucheto kumashure, kana kuti nhengo dzomukati, asi dzinogonawo kuitika pamucheto wepervical, kana mutsipa. Kuiswa kwemitsipa inowanikwa mucheka shure nekuda kwekukuvara uye / kana mamiriro akaoma kunogona kutungamirira kune zviratidzo zve sciatica.

blog chinyorwa chekartoon paperboy makuru makuru

NHAURWA INOKOSHA INOKOSHA: Kutarisira Kushungurudzika Kwebasa

ZVIMWE ZVINOKOSHA ZVINOKUDZIDZA: KUDZIDZA KUNYANYA: Kusarudza Chiropractic? | Familia Dominguez | Varwere | El Paso, TX Chiropractor

Hazvina kuchena

References

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12. Morone NE, Greco CM, Weiner DK. Kufungisisa kwekufungisisa kwekurapa kwekusingaperi kurwadziwa kunorwadza kumashure kune vakura vakuru: Ongororo yakasarudzika inodzorwa yekutyairaMarwadzo2008;134: 310-9. [PMC free article][PubMed]

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14. Morone NE, Greco CM. Pfungwa-muviri kupindira kwekurwadziwa kusingaperi muvakuru vakuru: Ongororo yakarongekaMarwadzo Med2007;8: 359-75. [PubMed]

15. Adelmanesh F, Arvantaj A, Rashki H, Ketabchi S, Montazeri A, Raissi G. Mhedzisiro kubva kududziro uye kuchinjika kweIranian Pfupi-Fomu McGill Pain Mubvunzo (I-SF-MPQ): Huchapupu hwepakutanga hwekuvimbika kwayo, kuvaka kuvimbika uye kunzwisisika muhurombo hwevanhu veIranMitambo Med Arthrosc Rehabil Ther Technol. 2011;3: 27. [PMC free article] [PubMed]

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17. Montazeri A, Vahdaninia M, Mousavi SJ, Omidvari S. Iyo Irani vhezheni ye12-chinhu chipfupi fomu fomu ongororo yehutano (SF-12): Yevanhu-based-yakasimbiswa kudzidza kubva kuTehran, Iran. Hutano Hupenyu Mhedzisiro2011;9: 12. [PMC free article] [PubMed]

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19. Nyikl cek I, Kuijpers KF. Mhedzisiro yekufunga-kunetseka kwekudzikisira kupindira kupindira pahutano hwepfungwa uye hupenyu hwehupenyu: Kuwedzera kufunga chaiko iko mashandiro?Ann Behav Med2008;35: 331-40. [PMC free article] [PubMed]

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22. Plews-Ogan M, Owens JE, Goodman M, Wolfe P, Schorling J. Chidzidzo chevatyairi chekuongorora kufunga-kunetseka kwekudzikisira uye kushambadza kwevatungamiriri vekurwadziwa kusingaperi.J Gen Mukati Med. 2005;20: 1136-8. [PMC free article] [PubMed]

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24. Sephton SE, Salmon P, Weissbecker I, Ulmer C, Floyd A, Hoover K, et al. Kufungisisa kwepfungwa kunoderedza kushushikana kwezviratidzo muvakadzi vane fibromyalgia: Mhedzisiro yeakajairwa kiriniki kutongwaArthritis Rheum. 2007;57: 77-85. [PubMed]

Close Accordion

Migumisiro yekudzvinyirirwa kwepfungwa yekurapa kurapwa kweAre Back Pain muEl Paso, TX

by spinedoctors | Chiropractic, Physical Rehabilitation, Randomized Controlled Trial, kushushikana, Mishonga

Chiropractic kuchengetedza inonyanya kuzivikanwa nzira yekurapa inoshandiswa inowanzoshandiswa kune zvakasiyana-siyana zvekukuvara uye / kana mamiriro ezvinhu, kusanganisira kurwadziwa kwepamusoro uye sciatica. Ichokwadi, kwete marwadzo ose ari mumuviri kana kuti haasi nguva dzose ane chikonzero chepanyama. Kushungurudzika, kuzvidya mwoyo uye kuora mwoyo zvinokanganisa mamiriyoni evanhu gore negore. Kunyange zvazvo varwere vazhinji vachida kurapwa kwemishonga inodhaka kuti vapore mararamiro avo ehutano, vamwe vangagona kudzora uye kubata zviratidzo zvavo nenzira yakakwana. Chiropractic kuchengetedza inoshandiswa kugadzirisa kushandiswa kwekutambudzika kunogona kubatsira kuderedza zviratidzo zvinosangana nekudzvinyirira, zvakadai sekurwadziwa kwepamusoro uye sciatica.

Kushungurudzika Kunobatsira Sei Mutumbi?

Kune 3 makanda makuru ekudzvinyirira: mumuviri, kwakatipoteredza uye mupfungwa.

Bodily stress: Inokonzerwa nekushaya kurara, zvirwere, kushungurudzika kana kukuvara, uye kudya kwakashata.
Kushungurudzika kwepanyika Inokonzerwa nenzwi guru (kamwe-kamwe kana rakachengetedzwa), kusvibiswa uye zviitiko zvenyika, zvakadai sehondo uye zvematongerwo enyika.
Kushungurudzika mupfungwa: Zvinokonzerwa nezviitiko zvakasiyana-siyana zvehupenyu, zvakadai sokufamba kwemisha, kutanga basa idzva uye kubatana kwevanhu nguva dzose. Kusiyana nezvimwe zvikamu zviviri zvekutambudzika, zvisinei, vanhu vanogona kuva nekutonga pamusoro pekunetseka kwavo mupfungwa. Izvozvo zvinogona kuvimba nemunhu wacho pachake.

Kushungurudzika kunogona kukanganisa muviri womunhu nenzira dzakasiyana-siyana, zvose zvakanaka uye zvisina kunaka, mumuviri uye mupfungwa. Kunyangwe kushamiswa kwenguva pfupi kunogona kubatsira, nguva yakareba kushungurudzika kunogona kukonzera kuwanda kwehutano hwehutano pane zvose mupfungwa nemuviri. Kushungurudzika kunoita kuti "kurwisana kana kutizaza" kupindurwa, chirongwa chinodzivirira chinokonzerwa nehurumende inonzwira tsitsi inogadzirisa muviri kuti uone njodzi nokuwedzera kukura kwemwoyo nekufema pamwe nemanzwi, nenzira yekuona, maziso anokwanisa kuva akaoma. Kana imwe nguva kushungurudzika kuchienda, inheyo yenheyo inotumira shoko kumutumbi uye mavhiri anodzokera kune zvakasikwa.

Muzviitiko zvakasiyana-siyana, nheyo yepamusoro yenheyo inogona kukundikana kutumira chiratidzo kune muviri kana yava nguva yekudzokera kune yakasununguka. Vanhu vazhinji vanoonawo kuramba vachinyanya kushungurudzika, kunonzi kusagadzikana kusingaperi. Zvose zvinowanzoitika zvinotora mutambo pamuviri womunhu. Izvi zvinowanzokonzera kurwadziwa, kuzvidya mwoyo, kusagadzikana uye kuora mwoyo.

Kutarisira Kushungurudzika Kwako

Kushushikana kwepfungwa kunogona kukonzera zviratidzo zvinorwadza, zvakadai sekurwadziwa kwepamusoro uye sciatica, izvo zvinogona kukonzera kushungurudzika. Nhamo inowanzoita kuti pave nenyaya dzemufaro, dzakadai sekuzvidya mwoyo uye kuora mwoyo, maitiro ekufungidzira akazara, uye kusakwanisa kuisa pfungwa. Vanhu vane kusagadzikana kusingaperi vanoona zviratidzo zvinorwadza vangafunga kuti havagone kuita uye kuita mabasa anowanzoitika.

Kushungurudzika mupfungwa kurapwa kunogona kubatsira vanhu kuvandudza pamwe nekugadzirisa kusagadzikana kwavo kusingaperi uye zviratidzo zvayo. Kuchengetedza chiropractic kunogona kubatsira kuderedza marwadzo uye kushungurudzika kwemisimba, zvichiwedzera kuderedza kushungurudzika. Iyo yakakosha yenheyo inogonawo kubatsirwa nemigumisiro yechiropractic treatment. Iyo inonzi central nerve system, kana CNS, inobatsira kudzora mafungiro, pamwe nehutano hwakakwana hwehutano nehutano hwakanaka, zvinoreva kuti kuenzanisa kwakakwana kwehurongwa hwemitsipa kunogona kubatsira kuwedzera hupenyu hune hutano.

Kubatsirwa kweChiropractic Care

Chiropractic kuchengetedza inzira yakakwana yekurapa, yakagadzirirwa kudzorera muviri kune imwe nyika yepakutanga inofanirwa kuchengetedza mishonga nemisangano inoshanda zvakanaka. Kushushikana kwepfungwa kunogona kukonzera kushungurudza kwemashure kumucheto, izvo zvingaguma zvichitungamirira kumusana wemasana. Kusaruramisa kwemupaka, kana kugunun'una, kunogona kuita kuti zviratidzo zvakasiyana-siyana, kusanganisira kuora mwoyo uye kurutsira, misoro yepamusoro uye migraines, kushungurudzika uye zvinetso zvekudya. A chiropractor anoshandiswa pamusana pemaginha uye maitiro ekunyora kusunungura kusvitsa uye kuderedza kusuruvara kumativi ose emusana kuti kuwedzere nerve basa uye kubvumira muviri kuti uzviporese pachawo. Kuderedza marwadzo kunogona kupedzisira kubatsira kuderedza kushungurudzika uye kuwedzera hutano hwakakwana uye hukama hwakanaka. Chiropractic kuchengetedza inogonawo kusanganisira massage pamwe nekupa mazano kubatsira kubvisa kushushikana, kuzvidya mwoyo uye kuora mwoyo.

A Holistic Care Approach

Vakawanda vanochirapa vachashandisa dzimwe nzira dzokurapa uye maitiro, zvakadai sokurapa kwepanyama, kurovedza muviri, uye kurapa kunovaka muviri, kuti uwedzere kuwedzera kudzvinyirira kwekugadzirisa zvinokonzerwa nechiropractic. Izvi zvinoshandura mararamiro anoshanda pane zvose zvehupenyu hwako. Uyezve, chinangwa chechinyorwa chiri pasi apa ndechekuratidza zvinokonzerwa nekufunga-zvakakonzerwa nekuderedzwa kwepfungwa zvichienzaniswa nekunzwisisa-maitiro ehutano uye kushandiswa kwemazuva ose kunetseka kwezviratidzo zvehupenyu husingaperi hunorwadza shure uye sciatica.

Migumisiro Yechenjeri-Yakaneta Kushungurudzika Kwepfungwa neCognitive-Behavioral Therapy uye Usual Care pamusoro Pokurwadziwa Kwekare uye Kushandiswa Kwekushanda pakati peVakuru neHure Low Low Back Pain: A Randomized Clinical Trial

ngovepo

kukosha

Kufungidzira-based stress stress (MBSR) haina kuongororwa zvakananga kune vechidiki nevepakati pemakore vane chirwere chisingaperi chisingaperi.

vavariro

Kuongorora kubudirira kwehutano husingaperi huri shure hweMBSR zvichienderana nekuchengetedzwa kwekuchengetedza (UC) uye kugona-maitiro-behavioral therapy (CBT).

Kugadzira, Kuisa, uye Vadzidzi

Randomized, mubvunzurudzo-bofu, kutonga kwakadzvanywa mune yakasanganiswa hutano hutano system muWashington State ye342 vakuru vane makore 20-70 makore neCLBP yakanyoresa pakati paGunyana 2012 naApril 2014 uye zvakasarudzika zvakapihwa MBSR (n = 116), CBT (n = 113), kana UC (n = 113).

Zvinyorwa

CBT (kurovedza kushandura mafungiro anokonzera marwadzo nemafambiro) uye MBSR (kurovedzwa mukufungisisa kwepfungwa uye yoga) yakapiwa mu 8 vhiki nevhiki 2-awa maawa. UC yakabatanidza chero basa rekutarisira rakagamuchira.

Migumisiro mikuru nezviito

Co-primary mhedzisiro yaive zvikamu zvevatori vechikamu vane kiriniki ine chinangwa (? 30%) kuvandudzwa kubva kune yekutanga mukutadza kushanda (yakagadziridzwa Roland Disability Questionnaire [RDQ]; renji 0 kusvika 23) uye mukuzvitaurira wega kurwadziwa kunorwadza (0 kusvika 10 chikamu ) pamasvondo makumi maviri nematanhatu. Mhedzisiro yakaongororwawo pa26, 4, uye 8 mavhiki.

Results

Pakati pevane makumi matatu nevatatu vatori vechikamu (zvinoreva zera, 342 (renji, 49-20); 70 (225%) vakadzi; zvinoreva nguva yekurwadziwa kumashure, makore 66 (marange mwedzi mitatu kusvika pamakore makumi mashanu), <7.3% vakapinda 3 kana kupfuura Zvikamu zvisere, 50 (60%) vakapedza chidzidzo pamasvondo makumi maviri nematanhatu uye 6 (8%) vakapedza kudzidza masvondo makumi mashanu nemaviri. yeMBSR (294%) uye CBT (86.0%) kupfuura yeUC (26%) (yakazara P = 290; MBSR inopesana neUC: RR [84.8% CI] = 52 [26 kusvika 61]; MBSR inopesana neCBT: 58 [44 kusvika 0.04]; CBT inopesana neUC: 95 [1.37 kusvika 1.06]. Iyo chikamu chevatori vechikamu vane kiriniki inovandudzika mukushungurudzika kunetseka kwaive 1.77% muMBSR uye 0.95% muCBT, maringe ne0.77% muUC (yakazara P = 1.18; MBSR maringe UC: 1.31 [1.01 kusvika 1.69]; MBSR inopesana neCBT: 44 [45 kusvika 27]; CBT inopesana neUC: 0.01 [1.64 kusvika 1.15]) .Zviwanikwa zveMBSR zvakaramba zvichishanduka kushoma pamasvondo makumi mashanu nemaviri ezviwanikwa zvese zvekutanga.

Kugumisa uye Kukwana

Pakati pevanhu vakuru vane chirwere chisingaperi chisingarwadziri, kurapwa ne MBSR uye CBT, kufananidzwa neUC, kwakaguma nekuvandudza kukuru mumarwadzo ekurwa uye kushanda kwemasvondo pamasvondo e26, pasina misiyano yakakura mumigumisiro pakati peMBSR neBBCT. Izvi zvitsva zvinoratidza kuti MBSR inogona kuva yakagadziriswa kurapa kwavanorwara vane chirwere chisingaperi chisingarware shure.

ziviso

Kutambudzika kwakadzoka kwakakonzera chinokonzera chikonzero chekuremara muUnited States [1]. Pasinei nekusarudzwa kwakasiyana-siyana kwekurapwa uye zvakanyanya kuwedzerwa kurapwa kwezvokurapa zvakagadzirirwa dambudziko iri, kushanda kwevanhu vane kurwadziwa kwepamuviri muU.S. kwakaderera [2, 3]. Pane chido chekurapa nehutano hwakaratidzwa huri huwandu hwehutano uye hune simba hwekuwanika kwose kwose.

Mafungiro ezvepfungwa anotamba akakosha pakurwadziwa uye nehukama hwepanyama uye hwepfungwa [4]. Ichokwadi, 4 ye8 isiri-pharmacologic kurapa yakakurudzirwa yekuramba uchirwadziwa shure kunosanganisira mind-body components [4]. Imwe yeiyi, yekuziva-maitiro ekurapa (CBT), yakaratidza kushanda kweakasiyana maronda maronda [5 8] uye inokurudzirwa zvakanyanya kune varwere vane maronda asingarware musana (CLBP). Nekudaro, mukana wevarwere weCBT ishoma. Kufungisisa-Kunobva Kuderedza Kushushikana (MBSR) [9], imwe mind-body nzira, inotarisana nekuwedzera kuziva nekugamuchirwa kwezviitiko zvenguva-kusvika-nguva, kusanganisira kusagadzikana kwepanyama uye nemanzwiro akaoma. MBSR iri kuramba ichizivikanwa uye ichiwanika muUS Saka, kana ikaratidzirwa kubatsira kuCBBP, MBSR inogona kupa imwezve nzira yekurapwa kwepfungwa nenhamba huru yevaAmerican vane mamiriro aya. MBSR uye mamwe maitiro ekufunga-akawanikwa akawanikwa anobatsira kune akasiyana mamiriro, kusanganisira kurwadziwa kusingaperi [10-12]. Zvisinei, imwe chete yakakura yakarongeka yekliniki yekuedza (RCT) yakaongorora MBSR yeCLBP [13], uye kuyedzwa kwacho kwaingogumira kune vakuru vakuru.

Iyi RCT yakaenzanisa MBSR ne CBT uye kutarisirwa kwekare (UC). Takafungidzira kuti vanhu vakuru neCCLBP dzakarongerwa kuMBSR zvingaratidza kukura kwenguva refu nekureba kwenguva refu mumarwadzo ekurwadziwa anorwadza shure, marwadzo ekudzokera kunetseka, nezvimwe zvinoguma, zvichienzanisa neavo vakagadzirirwa kuUC. Isuwo takafungidzira kuti MBSR yaizova yakakwirira kupfuura CBT nokuti inosanganisira yoga, iyo yakawanikwa yakabudirira yeCCLBP [14].

nzira

Chigadziro Chekudzidza, Kugadzirisa, uye Vadzidzi

Isu takamboburitsa iyo Pfungwa-Muviri Nzira dzePain (MAP) yekuyedza protocol [15]. Iyo yekutanga sosi yevatori vechikamu yaive Boka Hutano (GH), hombe yakabatanidzwa yehutano system muWashington State. Tsamba dzinotsanangura kutongwa uye kukoka kutora chikamu dzakatumirwa kunhengo dzeGH dzakasangana neyemagetsi rekodhi rekodhi (EMR) yekuisa / yekuregedza maitiro, uye kune asina kujairika masampula evagari munharaunda dzakashanda neGH. Vanhu vakapindura kukoka vakaongororwa uye vakanyoreswa nefoni (Mufananidzo 1). Vangangodaro vatori vechikamu vakaudzwa kuti vaizoitwa zvakasarudzika kune maviri eakasiyana-siyana anoshandiswa marwadzo ekuzvidzivirira-zvirongwa zvakawanikwa zvichibatsira mukuderedza marwadzo uye kuita kuti zvive nyore kuita zviitiko zvezuva nezuva kana kuenderera mberi nekuchengetwa kwakajairwa pamwe ne $ 50. Vaya vakapihwa MBSR kana CBT havana kuziviswa nezve kwavo kupihwa kurapwa kusvikira vapinda musangano wekutanga. Takatsvaga vatori vechikamu kubva kumaguta matanhatu mumafungu gumi akasiyana.

Mufananidzo 1 Kuyerera kweVatori vechikamu kuburikidza nekuedzwa

Mufananidzo 1: Kuyerera kwevatori vechikamu kuburikidza nekuenzanisa kufungidzira-kunokonzera kuderedzwa kwepfungwa nekuziva-kugadzirisa utachiona uye kugara uchichengetedza chirwere chisingaperi chinorwadza.

Isu takatora vanhu makumi maviri kusvika makumi manomwe ezera nemarwadzo asiri ekurwadziwa kumashure achiramba achingoita mwedzi mitatu. Vanhu vane kurwadziwa musana kwakabatana nehumwe hutachiona (semuenzaniso, spinal stenosis), nemubhadharo kana nyaya dzematareji, ndiani anganetse kutora chikamu (semuenzaniso, asingakwanise kutaura Chirungu, asingakwanise kuenda kumakirasi panguva yakatarwa nenzvimbo), kana ndiani akayera kutambudzika kunetseka <20 uye / kana kupindira kwekurwadziwa nemabasa <70 pane 3-4 zviyero zvakabviswa. Kuisirwa uye yekuregedza maitiro akaongororwa achishandisa EMR dhata yegore rapfuura (yeGH vakanyoresa) uye kuongorora kuongororwa. Vatori vechikamu vakanyoreswa pakati paGunyana 3 naApril 0. Nekuda kwekunonoka kunyoreswa, mushure mekunge 10 vatori vechikamu vanyoreswa, isu takamira kusasiya vanhu vane makore makumi matanhatu neshanu ekuberekwa, nhengo dzeGH pasina kushanya kwazvino kwekurwadziwa kumashure, uye varwere vane sciatica. Iyo yekuyedza protocol yakatenderwa neGH Human Subjects Yekuongorora Komiti. Vese vatori vechikamu vakapa kubvumidzwa kune ruzivo.

Randomization

Pakarepo mushure mekupa mvumo uye kupedzisa ongororo yekutanga, vatori vechikamu vakasarudzika zvakaenzana kuMBSR, CBT, kana UC. Randomization yaive yakamisikidzwa neyekutanga mamakisi (? 12 maringe? 13, 0 23 chikero) yeimwe yemhedzisiro mhedzisiro matanho, akagadziridzwa Roland Disability Mubvunzo (RDQ) [16]. Vatori vechikamu vakasarudzika mukati meizvi zvidimbu mumabhuroko e3, 6, kana 9. Iyo yakarongedzwa randomization kuteedzana kwakagadzirwa neyekudzidza biostatistician uchishandisa R Statistical software [17], uye kuteedzana kwacho kwakachengetwa mudhatabhesi yekutsvagisa yekudzidza uye yakavanzwa kubva kune vanodzidza kusvika randomization.

Zvinyorwa

Vose vatori vechikamu vakagamuchira kurapwa kupi zvayo kwaiwanzogamuchira. Izvo zvakasarudzwa kuUC zvakagamuchira $ 50 asi hakuna MBSR kudzidziswa kana CBT sechikamu chekudzidza uye vakange vakasununguka kutsvaga kurapa chero kupi zvako, kana pane, vaida.

Kupindira kwacho kwaifananidzwa nemhando (boka), nguva (2 maawa / vhiki kwemavhiki masere, kunyange chirongwa cheMBSR chaisanganisirawo yekusarudzika kwemaawa matanhatu), kuwanda (vhiki nevhiki), uye nhamba yevatori vechikamu neboka rimwe [Ona chirevo 8 che kupindira ruzivo]. Kupindira kwega kwega kwakaunzwa zvinoenderana nechirongwa chemanyorerwo umo varairidzi vese vakadzidziswa. Vatori vechikamu mukupindira kwese vari vaviri vakapihwa mabhuku ebasa, maCD odhiyo, uye mirairo yekudzidzira kumba (semuenzaniso, kufungisisa, kuongorora muviri, uye yoga muMBSR; zororo uye mifananidzo muCBT). MBSR yakapihwa nevarairidzi vasere vane makore mashanu kusvika makumi maviri nemapfumbamwe echiitiko cheMBSR. Vatanhatu vevarairidzi vaive vagamuchira kudzidziswa kubva kuCentre for Mindfulness paYunivhesiti yeMassachusetts Medical School. CBT yakaunzwa neana6 vane marezinesi Ph.D.-level masayendisiti epfungwa ane ruzivo muboka uye wega CBT yekurwadziwa kusingaperi. Checklists ezvokurapa protocol zvikamu zvakapedzwa nemubatsiri wekutsvaga pane yega yega chikamu uye kuongororwa vhiki nevhiki nemuongorori wekudzidza kuti ave nechokwadi chekuti zvese zvekurapa zvakaunzwa. Uye zvakare, zvikamu zvaive zvakarekodhwa-zvakanyorwa uye muongorori wekuongorora akacherekedza varairidzi kutevedzera mutemo mumunhu kana kuburikidza odhiyo-kurekodha kweinenge chikamu chimwe chete paboka.

MBSR yakaenzanisirwa padyo nepakutanga chirongwa cheMBSR [9], pamwe nekuchinjisa kwebhuku ra2009 MBSR murayiridzi [18] nemudzidzisi weMBSR mukuru. Chirongwa cheMBSR hachi tarise zvakanyanya pane chakadai mamiriro sekurwadziwa. Makirasi ese aisanganisira zvemukati zvekuita uye kufunga kwepfungwa (muviri kuongorora, yoga, kufungisisa [kutarisisa pfungwa, manzwiro, uye kunzwa mune ino nguva pasina kuyedza kuzvichinja, kugara pasi kufungisisa nekuziva kufema, kufamba kufungisisa]). Iyo CBT protocol yaisanganisira matekinoroji eCBT anowanzo shandiswa uye anodzidziswa CLBP [8, 19-22]. Kupindira kwacho kwaisanganisira (1) dzidzo nezvekurwadziwa kusingaperi, hukama pakati pemafungiro uye kugadzirisa kwepamoyo uye kwemuviri, hutsanana hwekurara, kudzivirira kudzokazve, uye kuchengetedza zviwanikwa; uye (2) kurairirwa uye kujairira mukuchinja pfungwa dzisina basa, kumisikidza uye kushanda kune zvinangwa zvehunhu, hunyanzvi hwekuzorora (kufema kwepamuviri, kufambira mberi kwemhasuru kuzorora, mifananidzo inotungamirwa), chiitiko chekufamba, uye maratidziro ekurwadziwa ekurwadziwa. Pakati pe-chikamu zviitiko zvaisanganisira kuverenga zvitsauko zve Iyo Pain Survival Nhungamiro [21]. Kufungisisa, kufungisisa, uye maitiro eyoga zvakanyorwa muBBT; nzira dzekupokana nepfungwa dzisina kushanda dzakarambidzwa muMBSR.

Tevera

Vadzidzi vakarovedzwa vakavhara kuboka rekurapa vakaunganidza dhidhiyo pafoni pazvinyorwa (vasati vasvika) uye 4 (pakati pekurapa), 8 (mushure mekurapa), 26 (pokupedzisira pakupedzisira), uye masvondo e52 mushure mekushandura. Vabatanidzwa vakabhadharwa $ 20 pamubvunzo mumwe nomumwe.

Nzira

Inhoroondo yehupfumi uye yehutano yakagadziriswa pamusana wekutanga (Table 1). Zvose zvinonyanya kuguma matanho zvaiitwa panguva imwe neimwe-nheyo; zvikamu zvechipiri zvakaongororwa panguva dzose-mapeji kunze kwevhiki dze4.

Tafura 1 Baseline Zviratidzo zveVatori vechikamu

Tafura 1: Baseline unhu hwevatori vechikamu neboka remishonga.

Co primary Mhedzisiro

Kudzoka kwakanangana nemarwadzo-ane chekuita nehuremu akaongororwa neiyo RDQ [16], yakashandurwa kuita 23 (maringe neyekutanga 24) zvinhu uye kubvunza nezve yapfuura vhiki kwete nhasi chete. Zvikoro zvepamusoro (renji 0 23) zvinoratidza kukura kukuru kwekuita. Iyo yekutanga RDQ yakaratidza kuvimbika, kuvimbika, uye kunzwisisika kuchipatara shanduko [23]. Kutambudzika kwekushungurudza kunetseka muvhiki yapfuura kwakayerwa ne 0 10 chikero (0 = kwete zvachose zvinoshungurudza, 10 = zvinonyanya kunetsa ). Yedu yekutanga ongororo yakaongorora zvikamu zvevatori vechikamu zvine kiriniki inovandudzwa inovandudza (? 30% kuvandudza kubva kune yekutanga) [24] pane imwe nhanho. Sekondari kuongororwa kwakafananidza iyo yakagadziriswa zvinoreva shanduko kubva kune yekutanga pakati pemapoka.

Secondary Outcomes

Zviratidzo zvekushushikana zvakaongororwa neMubvunzo Wehutano Hwepfungwa-8 (PHQ-8; renji, 0 24; zvikwiriso zvakakwirira zvinoratidza kukura kukuru) [25]. Kuzvidya mwoyo kwakayerwa uchishandisa iyo 2-chinhu Generalized Anxiety Disorder scale (GAD-2; renji, 0 6; zvikoro zvepamusoro zvinoratidza kukura kukuru) [26]. Hunhu hwekurwadziwa kwakanyanya kwakaongororwa seyakakosha yeatatu 0 ratings (ikozvino kurwadziwa kwekuseri uye kwakaipisisa uye kwepakati kurwadziwa kurwadziwa mumwedzi wapfuura; renji, 10-0; zvikwiriso zvepamusoro zvinoratidza kukura kukuru) kubva kuGraded Chronic Pain Scale [10] . Patient Global Impression of Change sikero [27] yakabvunza vatori vechikamu kuti vaone kuvandudza kwavo mukurwadziwa pachiyero che28-poindi ( zvose zvakapera, zvirinani, zvirinani, zvirinani zvishoma, zvakafanana, zvakatonyanya, uye zvakatonyanya ). Hutano hwepanyama uye hwepfungwa huzhinji hwakaongororwa neiyo 7-chinhu Ipfupi-Fomu Hutano Ongororo (SF-12) (12 chikero; zviyero zvakaderera zvinoratidza mamiriro ehurombo ehutano) [0]. Vatori vechikamu vakabvunzwawo nezve kwavo mashandisiro emishonga uye kurovedza muviri kwekushungurudza musana muvhiki yapfuura.

Zvakaipa Zvakaitika

Zvakaipa zvakasangana zvakaonekwa munguva dzekupindira uye nekutevera-mibvunzo yekubvunzurudza pamusoro pekunetseka kukuru, kurwadziwa, kana kukuvara kunokonzerwa nekupindira.

Sample Size

Muenzaniso wekukura wevatori vechikamu 264 (88 muboka rega rega) yakasarudzwa kuti ipe simba rakaringana kuona mutsauko unonzwisisika pakati peMBSR neCBT neUC pamasvondo makumi maviri nematanhatu. Muenzaniso masvomhu ekuverenga akavakirwa pamhedzisiro yekuvandudzika kwechipatara (? 26% kubva pane yekutanga) paRDQ [30]. Kufungidzira kwekuvandudzika kwechipatara mune zvekupindira uye mapoka eUK aive akavakirwa pane zvisina kunyorwa kuongororwa kwedata kubva muyedzo yedu yapfuura yekumesa massage kweCBBP mune yakafanana vanhu [24]. Iyi saizi saizi yakapa simba rakaringana kune ese maviri-epamberi mhedzisiro. Saizi yakarongwa saizi yakapa 30% simba rekuona musiyano we90% pakati peMBSR neUC muchiyero nekuvandudzwa kunonzwisisika paRDQ, uye? 25% simba rekuona mutsauko we80% pakati peMBSR neCBB, ichifungidzira 20% yevatambi veUC uye 30% yevatori vechikamu veCBT vakaratidza kunatsiridza zvine musoro. Nekugadzirisa kunzwisisika mukurwadziwa kunetseka, iyo yakarongwa saizi saizi yakapihwa? 55% simba rekuona 80% mutsauko pakati peMBSR neUC, uye 21.8% musiyano pakati peMBSR neCBT, ichifunga kuti 16.7% muUC uye 47.5% muCBT yakaratidza kunatsiridza zvine musoro. .

Kubvumira kuti 11% kurasikirwa kwatevedzere, takaronga kuunganidza vatori vechikamu 297 (99 neboka). Nekuda kwekutevera kutevera-up mairi kwaive pasi kudarika kutarisirwa, imwe yero yakatorwa. Chikamu chevatori vechikamu che342 chakanga chisinganzwisisiki kuti zvive nechinangwa chekuenzanisa kukura kwe264 nemigumisiro yakakwana yedhenda kumasvondo e26.

Nhamba yekuongorora

Kutevera pre-yakatsanangurwa chirongwa chekuongorora [15], misiyano pakati pemapoka matatu pane yega yega mhedzisiro yakaongororwa nekukomberedza regression modhi iyo yaisanganisira mhedzisiro matanho kubva kune ese mana nguva-mapoinzi mushure mekutanga (4, 8, 26, uye 52 mavhiki) . Mumwe muenzaniso wakaringana waikodzera yega yega co-yekutanga mhedzisiro (RDQ uye kunetseka). Zviratidzo zvenguva-poindi, kurongedza boka, uye kusangana pakati pezvakasiyana izvi kwakabatanidzwa mune yega modhi yekufungidzira kupindira mhedzisiro panguva yega yega-poindi. Mienzaniso yaive yakakodzera kushandisa yakajairwa kufungidzira equations (GEE) [31], iyo yaitora mukana wekubatana mukati mevanhu. Pamabhinari ekutanga mhedzisiro, isu taishandisa yakashandurwa Poisson regression modhi neiyo log link uye yakasimba sandwich variance estimator [32] kufungidzira zvine njodzi. Nezve zviyero zvinoenderera, isu taishandisa mitsara yekudzora mamodheru kufungidzira zvinoreva shanduko kubva kune yekutanga. Mienzaniso yakagadziridzwa zera, bonde, dzidzo, kurwadziwa kwenguva Kuongororwa kwemigumisiro yechipiri kwakatevera nzira yakafanana yekuongorora, kunyange mamodheru asina kusanganisira 1-vhiki zvikoro nekuti zvabuda zvechipiri hazvina kuongororwa pamasvondo mana.

Isu takarongedza kuverengwa kwezvinorehwa zvekupindira kwemagariro panguva imwe neimwe-nzvimbo imwechete. Takasarudza a priori kuti tibvunze MBSR kubudirira chete kana makakatano eboka akange akakosha pa26-vhiki yekupedzisira yekupedzisira. Kuti tidzivirire pakurwisana kwakawanda, takashandisa Fisher kuchengetedza zvishoma-kusiyanisa kusiyana kusvika [33], iyo inoda kuti kuenzanisa kushandiswa kwemishonga kuenzaniswa chete kana huwandu hwese hwekuedzwa hunoverengwa.

Nekuti yedu yakacherechedzwa yekutevera-mitero yaisiyana pamapoka ekupindira uye yaive yakaderera pane yaifungidzirwa (Mufananidzo 1), isu takashandisa nzira yekumisikidza yekusakanganwa kusapindura sekutanga kwedu ongororo yekuzvidavirira kune zvingangoita zvisina-mhinduro. Iyo imputation nzira yakashandisa pateni musanganiswa modhi dhizaini uchishandisa 2-nhanho GEE nzira [34]. Nhanho yekutanga inofungidzira iyo GEE modhi yakambotsanangurwa pamwe nekucherechedzwa kwemhedzisiro dhijitari yekugadzirisa macovariates, asi kuwedzera kugadzirisa mapatani ekusa-kupindura. Isu takasanganisira anotevera akashaikwa echiratidzo chechiratidzo misiyano: kushaya imwe mhedzisiro, kushaya imwe mhedzisiro uye kupihwa CBT, kushaikwa imwe mhedzisiro uye kupihwa MBSR, uye kushaikwa? 2 mhedzisiro (hapana kumwe kudyidzana neboka kwakabatanidzwa nekuti vashoma kwazvo vatori vechikamu veUC vakapotsa? kumusoro nguva-mapoinzi). Nhanho yechipiri inofungidzira iyo GEE modhi yakambotsanangurwa, asi yaisanganisira mhedzisiro mhedzisiro kubva padanho rekutanga kuneavo vasina nguva dzekuteedzera. Isu takagadzirisa misiyano yekufungidzira kune account yekushandisa yakatemwa mhedzisiro matanho ezviwanikwa zvisingaonekwe.

Ongororo dzese dzakatevera nzira-yekurapa nzira. Vatori vechikamu vakaverengerwa mukuwongorora ne randomization kupihwa, zvisinei nedanho rekupindira kutora chikamu. Yese bvunzo uye nguva dzekuvimba dzaive 2-mativi uye kukosha kwehuwandu kwakatsanangurwa seP-kukosha? 0.05. Ongororo dzese dzakaitwa pachishandiswa nhamba yepakeji R vhezheni 3.0.2 [17].

Results

Mufananidzo 1 inoratidzira anotora chikamu kupinda muchidzidzo. Pakati pevanhu 1,767 vanoratidza kufarira kutora chikamu chekudzidza uye kuongororwa kuongororwa, 342 vakanyoreswa uye vakasarudzika. Izvo zvikonzero zvikuru zvekuregererwa kwaive kusakwanisa kuenda kumisangano yekurapa, kurwadziwa kunogara <mwedzi mitatu, uye kurwadziwa kushoma kunetsekana kana kupindira nezviitiko. Vese kunze kwevatori vechikamu 3 vakanyoreswa kubva kuGH. Vanenge makumi mapfumbamwe muzana muzana vevatori vechikamu vakasarudzika kuenda kuMBSR uye CBT vakapinda kanenge chikamu chimwe chete, asi chete 7% muMBSR uye 90% muCBT vakapinda angangoita matanhatu zvikamu. Chete 1% yeavo vakasarudzika MBSR vakapinda 51-awa kudzoka. Yakazara yekutevera-mhinduro mhinduro dzakatangira kubva ku57% pamasvondo mana kusvika 6% pamasvondo makumi mashanu nemaviri, uye vaive vakakwira muboka reUC.

Pakutanga, mapoka ekurapa aive akafanana mumasocodemographic uye marwadzo maitiro kunze kwevakadzi vazhinji muUC uye vashoma koreji vakapedza kudzidza muMBSR (Tafura 1). Kupfuura 75% yakashuma rinenge gore rimwe chete kubva pasvondo risina kurwadziwa musana uye marwadzo mazhinji akataurwa pane angangoita 160 emazuva 180 apfuura. Iyo inoreva RDQ mamaki (11.4) uye kurwadziwa kunetseka kunetseka (6.0) kwakaratidza mwero mwero wekuomarara. Gumi neimwe muzana vakataura vachishandisa maopioid ekurwadziwa kwavo muvhiki yapfuura. Makumi gumi nemanomwe muzana aive nemwero wepakati wekushushikana (PHQ-8 mamakisi? 10) uye 18% vaive nemwero wepakati wekushushikana (GAD-2 zvikoro? 3).

Co-Primary Outcomes

Panguva yekupedzisira-masvondo makumi maviri nematanhatu, mapoka akapesana zvakanyanya (P = 26) muzana nekuvandudzika kwechipatara pane RDQ (MBSR 0.04%, UC 61%, CBT 44%; Tafura 58a). Vatori vechikamu vakasarudzika kuenda kuMBSR vaive nemikana yakawanda kupfuura iya yakasarudzika kuenda kuUK kuratidza kunatsiridzwa paRDQ (RR = 2; 1.37% CI, 95 1.06), asi haina kusiyana zvakanyanya kubva kune yakasarudzika kuenda kuCBT. Musiyano wakazara pakati pemapoka mune yekiriniki kuvandudzwa kunzwisisika kwekutambudzika kunetseka pamasvondo makumi maviri nematanhatu yaive zvakare yakakosha (MBSR 1.77%, UC 26%, CBT 44%; P = 27). Vatori vechikamu vakasarudzika MBSR vaiwanzo kuratidza kunatsiridza zvine mutsindo kana vachienzaniswa neUC (RR = 45; 0.01% CI, 1.64 95), asi kwete kana ichienzaniswa ne CBT (RR = 1.15; 2.34% CI, 1.03 95). Misiyano yakakosha pakati peMBSR neUC, uye misiyano isiri-yakakosha pakati peMBSR neCBT, muzana nekuita zvine basa uye nekuvandudzwa kwekurwadziwa kwakapfuurira pamasvondo makumi mashanu nemaviri, zvine njodzi dzakangofanana neidzo dziri mumavhiki e0.78 (Tafura 1.36a). CBT yakanga iri pamusoro peUC kune ese maviri ekutanga mhedzisiro pa52, asi kwete makumi mashanu nemaviri, mavhiki. Kurapa mhedzisiro kwanga kusingaonekwe kupera kwekurapa (mavhiki masere). Kazhinji mhedzisiro yakafanana yakawanikwa apo mhedzisiro yekutanga yakaongororwa sezvimwe zvinowirirana, kunyangwe misiyano yakawanda yaive yakakosha pamasvondo masere uye boka reCBT rakagadziriswa kupfuura iro boka reUC mumasvondo makumi mashanu nemaviri (Tafura 26b).

Tafura 2A: Co-primary results: Percentage yevatori vechikamu vane hutano hwakanaka hunogadzirisa muhutano husingaperi hwekurwadziwa shure kweboka rekurapa uye nengozi dzakasiyana dzienzanisa mapoka ehutano (Adjusted Imputed Analyzes).

Tafura 2B: Nhengo dzepamusoro-pfupi: Inoreva (95% CI) inoshanduka muhutano husingaperi huri shure neboka rehutano uye zvinoreva (95% CI) kusiyana pakati pemapoka ekurapa (Adjusted Imputed Analyzes).

Secondary Outcomes

Mamiriro ehutano hwepfungwa (kuora mwoyo, kuzvidya mwoyo, SF-12 Mental Component) yakasiyana zvikuru pamapoka e8 uye 26, asi kwete 52, mavhiki (Table Table 3). Pakati pezviyero izvi uye nguva-nharo, vatori vechikamu vakashandurwa kune MBSR zvakagadziriswa kudarika izvo zvakasarudzwa kuUC chete pane kuora mwoyo uye SF-12 Mental Component pamakhiki e8. Vatori vechikamu vakashandurwa kuBBCT vakagadziriswa kupfuura izvo zvakasarudzwa kuMBSR pamusoro pekuora mwoyo pavhiki dze8 nekuzvidya mwoyo pamasvondo e26, uye kupfuura boka reUC pa8 nevhiki ye26 pamatatu ose.

Tafura 3: Zvikamu zvitsva zvinowanikwa neboka remishonga uye pakati pe-boka kuenzanisa (Adjusted Imputed Analyzes).

Mapoka acho akasiyana zvikuru mukuvandudzika kwehutano hwehutano hwakasimba panguva dzose nhatu-nguva, nekuvandudza kukuru muBMBS uye CBT kupfuura muUC uye pasina kusiyana kukuru pakati peMBSR neBBCT. Hazvisi zvachose kusiyana kwezvipatara zvakagadziriswa kweSF-12 Physical Component chikwata kana kuzviratidza kushandiswa kwemishonga yekurwadziwa kwemuviri. Mapoka akasiyana paC26 uye mavhiki e52 mukuzvidzivirira kwehuwandu hwehuwandu hwepasi rose, pamwe neboka reMBSR neC CBT rinotaura kuwedzera kukuru kune boka reUC, asi harisi zvakasiyana zvikuru kubva kune mumwe.

Zvakaipa Zvakaitika

Vane makumi matatu ve103 (29%) vatori vechikamu vanoenda kushanyira 1 MBSR svondo vakaratidza ruzivo rwakashata (kazhinji kacho kuwedzera kurwadziwa ne yoga). Vane gumi ve100 (10%) vatori vechikamu vaipinda chikamu chimwechete chechikwata cheC CBT vakarondedzera ruzivo rwakashata (kazhinji kacho kuwedzera marwadzo nekufambira mberi kwemaviri musimba). Hapana zviitiko zvakakomba zvakashata zvakaitika.

Dr Jimenez White Coat

Dr. Alex Jimenez's Insight

Kushungurudzika kwekutarisira kurapwa kunosanganisira kusanganiswa kwekunyanya kunetseka nzira nemaitiro uye mararamiro ekuchinja mararamiro kubatsira kubatsira nekugadzirisa kushushikana uye zviratidzo zvayo. Nemhaka yokuti munhu wose anopindura kunetseka nenzira dzakasiyana-siyana, kurapwa kwekunetseka kunowanzosiyana zvikuru zvichienderana nezviratidzo izvo munhu ari kutarisana uye maererano nehuwandu hwavo hwekuoma. Chiropractic kuchengetedza inoshandiswa kugadzirisa kurapwa kwekushungurudza kunobatsira kuderedza kusagadzikana kusingaperi uye zviratidzo zvayo zvinobatanidza nekudzikisa kurwadziwa uye kushungurudzika kwemisungo pane zvivako zvakapoteredza musana. Kuvhiringidza kwepelinha, kana kugunun'una, kunogona kukonzera kushungurudzika uye zvimwe zviratidzo, zvakadai sekurwadziwa kwepamusoro uye sciatica. Uyezve, migumisiro yenyaya iri pamusoro apa yakaratidza kuti pfungwa-based based stress reduction, kana MBSR, inobatsira kushandiswa kwekutambudzika kwevanhu vakuru vane marwadzo asingagoneki shure.

hurukuro

Pakati pevakuru vane CLBP, ese MBSR uye CBT zvakakonzera kuvandudzika kukuru mukurwadziwa kwemusana uye kushomeka kwekushanda pamasvondo makumi maviri nemaviri nemakumi mashanu nemaviri, zvichienzaniswa neUC. Pakanga pasina misiyano ine revo mumhedzisiro pakati peMBSR uye CBT. Mhedzisiro yacho yaive ine mwero muhukuru, izvo zvave zvakajairwa nehuchapupu-hwakavakirwa marapirwo anokurudzirwa CLBP [26]. Aya mabhenefiti anoshamisa akapihwa kuti chete 52% yeavo vakasarudzika MBSR uye 4% yeavo vakasarudzika kuenda kuCBT vakapinda? 51 yezvikamu zvisere.

Zvatinowana zvinowirirana nemhedzisiro ye2011 yakarongeka yekuongorora [35] iyo "kugamuchirwa-kwakavakirwa" kupindira senge MBSR ine mhedzisiro inobatsira pahutano hwepanyama uye hwepfungwa hwevarwere vane kurwadziwa kusingaperi, kwakaenzana neiyo yeCBT. Ivo vanongoenderana zvishoma neiyo chete imwe hombe RCT yeMBSR yeCLBP [13], iyo yakawana kuti MBSR, kana ichienzaniswa neyenguva- uye kutarisisa-inowirirana-inodzidzisa yehutano kudzora boka, yakapa mabhenefiti ekushanda mushure mekurapa (asi kwete pamwedzi mitanhatu yekutevera) uye yeavhareji marwadzo pamwedzi mitanhatu yekutevera (asi kwete post-kurapwa). Misiyano yakati wandei pakati pekuyedzwa kwedu neyayo (yaive yakaganhurirwa kune vakuru? Makore makumi matanhatu nemashanu uye yaive nemamiriro ekuenzanisa) inogona kuve nemhosva yekusiyana kwezviwanikwa.

Kunyange zvazvo kutongwa kwedu kusina mamiriro ekudzivirira kwekusagadzikana kwekudzidziswa kwevarayiridzi uye kubatana kweboka, CBT uye MBSR dzakaratidzwa kuva dzakakosha kudarika kutonga uye kushandiswa kwekuita kwekutambudzika kwemamiriro ezvinhu. Mukuwedzera kune kuedzwa kwevakuru vakwegura neCCLBP [14] vakawana MBSR kuti ibudirire kupfuura hutano hwehutano hwehutano hwehutano, kuongororwa kwakagadziriswa kweBBCT kwekunze kwekunetseka kwakanyanya kwekare kunowanikwa CBT kuti ibudirire pane kutungamirirwa-based based treatment mukuvandudza marwadzo nekuremara kwenguva pfupi-uye kwenguva refu yekutevera [7]. Kuwedzera kutsvakurudza kunodiwa kuti muone vaongorori uye vamiririri vemigumisiro yeBMSR pamusoro pebasa uye kurwadziwa, kuongororwa zvinobatsira zveMBSR kupfuura gore rimwe chete, uye kutsvaga mari inobatsira-kubudirira. Kutsvakurudza kunobatsirawo kuziva zvikonzero zvekugadzirira kusati kwavapo uye nzira dzekuwedzera vanhu varipo, uye kuongorora huwandu hwemajairo anodiwa.

Kuwana kwedu kwekuwedzera kushanda kweMBSR pamasvondo makumi maviri nemaviri nemakumi mashanu nemaviri maererano neashure-kurapwa kweese maviri ekutanga misiyano inopesana nezvakawanikwa muzvidzidzo zvedu zvekare zvekugwinya, kukwiza muviri, uye iyoga inoitiswa muhuwandu hwevanhu sekutongwa kwazvino [26, 52, 30 ]. Mune izvo zvidzidzo, mhedzisiro yekurapa yakaderera pakati pekupera kwekurapwa (masvondo masere kusvika gumi nemaviri) uye yekutevera kwenguva refu (36 kusvika kumavhiki e37). Yakareba mhedzisiro mhedzisiro yeCBT yeCLBP yakataurwa [8, 12, 26]. Izvi zvinoratidza kuti kurapwa kwepfungwa-semuviri seMBSR uye CBT kunogona kupa varwere hunyanzvi hurefu hunoshanda mukugadzirisa marwadzo.

Paiva nezvimwe kusiyana pakati peBBCT neUC kupfuura pakati peMBSR neUC pane zviyero zvepfungwa dzepfungwa. CBT yakanga yakakwirira kune MBSR pane kuora mwoyo kwemavhiki e8, asi mutsauko wepakati pakati pemapoka akanga ari maduku. Nemhaka yekuti muenzaniso wedu wakanga usishushikana zvikuru pamusana pekutanga, kutsvakurudza kwakawedzerwa kunofanirwa kuenzanisa MBSR ne CBT mune imwe nhamo yakaora mwoyo yevarwere.

Kukanganisa kwekudzidza uku kunofanira kubvumidzwa. Vadzidzi vadzidza vakanyoreswa mune imwe nzira yehutano yehutano uye kazhinji vakadzidza zvikuru. The generalizability of findings to other settings and populations is unknown. Panenge ne20% yevatori vechikamu vakashandurwa kune MBSR uye CBT vakarasikirwa kutevera. Takaedza kugadzirisa kusava nehanya kubva kune dhaka iripo mune zvatinoongorora kuburikidza nekushandisa nzira dzekushandisa. Pakupedzisira, generalizability yezviwanikwa zvedu kune CBT yakapiwa kune mumwe munhu panzvimbo yeboka maitiro haazivi; CBT inogona kuva yakakosha kana ichiendeswa mumwe nomumwe [40]. Kudzidza masimba kunosanganisira shanho huru ine simba rakawandisa rekuona kuti zvinogadziriswa zvinokonzerwa nekliniki, kufanana kufanana kwezvibvumirano zveBMBSR uye CBT mumasikirwo, uye kwenguva refu yekutevera.

mhedziso

Kutenda

Mari / Kutsigira: Tsvagurudzo yakataurwa mubhuku rino yakatsigirwa neNational Center yeComplementary & Integrative Hutano yeNational Institutes of Health pasi peAward Number R01AT006226. Izvo zvirimo ndezve chete iro basa revanyori uye hazvireve kuti zvinomiririra zviri pamutemo maonero emaNational Institutes of Health.

Basa rekutsigira: Chidzidzo chekubhadhara chakanga chisina basa mubumbiro uye mufambiro wekudzidza; kuunganidzwa, kutungamira, kuongorora, uye kududzirwa kwe data; Kugadzirira, kuongorora, kana kubvumirwa kwezvinyorwa; kana chisarudzo chekuisa gwaro racho kuti ribudiswe.

Mashoko Omuzasi

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

Information Contributor

Daniel C. Cherkin, Group Health Research Institute; Dhipatimendi reZvipatano Zvehutano uye Family Medicine, University of Washington.
Karen J. Sherman, Group Health Research Institute; Dhipatimendi reEpidemiology, University of Washington.
Benjamin H. Balderson, Group Health Research Institute, University of Washington.
Andrea J. Cook, Group Health Research Institute; Dhipatimendi reBoostatistics, University of Washington.
Melissa L. Anderson, Group Health Research Institute, University of Washington.
Rene J. Hawkes, Group Health Research Institute, University of Washington.
Kelly E. Hansen, Group Health Research Institute, University of Washington.
Judith A. Turner, Dhipatimendi re Psychiatry uye Behavioral Sciences uye Rehabilitation Medicine, University of Washington.

Mukupedzisa,Irchiropractic kuchengetedza inozivikanwa seyakanaka inoshanda yekugadzirisa kurapa kwekurwadziwa kwepashure uye sciatica. Nekuti kusingaperi kushushikana kunogona kukonzeresa nyaya dzakasiyana dzehutano nekufamba kwenguva, kugadzirisa pamwe nekugadzirisa kushushikana zvinoenderana nekukosha mukuzadzisa hutano nehutano. Pamusoro pezvo, sezvakaratidzirwa muchinyorwa chiri pamusoro tichienzanisa mhedzisiro yekufunga-kunetseka kuderedzwa pamwe nekuziva-kwehunhu kurapwa uye kujairika kutarisirwa kwekushushikana nehukama hwusingaperi husingaperi musana marwadzo, kufunga-kwakavakirwa kushushikana kwekudzikisira, kana MBSR, inoshanda sekushushikana manejimendi kurapwa . Ruzivo rwunotsanangurwa kubva kuNational Center yeBiotechnology Ruzivo (NCBI). Chiyero cheruzivo rwedu chinogumira kuchiropractic pamwe nekukuvara kwepamuviri nemamiriro. Kuti ukurukure nyaya yacho, ndapota inzwa wakasununguka kubvunza Dr. Jimenez kana kutibata nesu pa 915-850-0900 .

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ZVIMWE ZVINOKOSHA ZVINOKUDZIDZA: KUDZIDZA KUNYANYA: Kusarudza Chiropractic? | Familia Dominguez | Varwere | El Paso, TX Chiropractor

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Kushungurudzika Kwekugadzirisa Matanho eHumambo Husingaperi muEl Paso, TX

by spinedoctors | chisingaperi Pain, Mamiriro Ekutongwa, Randomized Controlled Trial, Mishonga

Munyika yanhasi, zviri nyore kuwana mamiriro ekumanikidzira pamusoro. Pasinei nokuti zvinosanganisira basa, mari, hurongwa hwehutano hwakanaka, hukama hwehukama, huwandu hwemashoko uye / kana zvimwe zvikonzero, kushushikana kunogona kutanga kutarisa kuburikidza nehutano hwedu uye hutano kana husina kutarisirwa zvakanaka. Uyewo, tinowanzoita kuti tisazvidye mwoyo kuburikidza nehutachiwana husina kunaka nekushaya kurara.

Muchokwadi, vanopfuura vatatu-vana vevanhu muUnited States vanosangana nekushushikana nguva dzose, apo chikamu chimwe muzvitatu cheavo vanhu vanoratidza kushushikana kwavo se "kwakanyanyisa". Kunyangwe kushushikana kwenguva pfupi kunogona kubatsira, kushushikana kwenguva refu kunogona kutungamira kune akasiyana ehutano nyaya. Kushungurudzika kwave kuchinzi ndiko kunokonzera hosha dzakawanda, vezvehutano vanofungidzira kuti inoverengerwa hafu yemari inoshandiswa munyika nezvehutano, sekureva kweUS News & World Report.

Kushungurudzika Kunobata Sei Mutumbi

Kushushikana mupfungwa kunoratidza kushungurudzika kwehurongwa hwekutya kunokonzera kupindura "kurwisana kana kutiza," chirongwa chinodzivirira chinogadzirisa muviri nokuda kwekuona njodzi nekuita kuti mwoyo uwedzere, ropa reropa neropa rekuwedzera. Izvi zvinodzinga ropa kure negadziriro yezvokudya uye zvikamu. Izvo zvinonzi adrenal glands zvinodzidzisawo kusanganiswa kwemahomoni nemakemikari, kusanganisira adrenaline, epinephrine uye norepinephrine, izvo zvingakanganisa hukama hwevanhu kana vachigara vachivanzwa mumuviri.

Uyezve, kusagadzikana kusingaperi kunogona kukonzera musikana kutseuka. Kunyanya kukanganiswa kwemisasa pamutsipa uye kumashure kunogona kuita kuti kusagadzikana kwemupaka, kunozivikanwa sekugunun'una, pakupedzisira kunopesana nebasa rakanaka remamiriro emagetsi uye zvinokonzera zviratidzo zve kurwadziwa shure uye sciatica. Nenzira, maitiro akasiyana-siyana ekugadzirisa zvinetso, kusanganisira chiropractic kuchengeta uye kufunga kwepfungwa, zvinogona kubatsira kuderedza Chronic pain, inowanzobatanidzwa nekusingaperi mupfungwa.

Chiropractic Kuchengeta Kushungurudzika

Chiropractic kuchengetedza inonyatsozivikanwa, imwe nzira yekurapa inoshandiswa kurapa zvakasiyana-siyana zvekukuvadzwa uye mamiriro ezvinhu akabatanidzwa ne musculoskeletal uye nervous system. Kana paine subluxation mumuzongoza, hurongwa hwetsinga hunogona kazhinji kusakwanisa kutumira masaini mukati memuviri wese. Nekushandisa kugadziriswa kwemusana uye kugadziriswa kwebhuku, chiremba wechiropractic anogona kunyatsogadzirisa musana, kusunungura kushushikana kwemhasuru, kunyorovesa tsinga dzemusana uye kuvandudza kuyerera kweropa, shanduko dzinogona kunyevera uropi kuti udzime "kurwa kana kutiza" mhinduro saka kuti muviri unogona kudzokera kune imwe nzvimbo yakasununguka.

Uyezve, chiropractor inogonawo kukurudzira kugadzirisa mararamiro, pamwe nekugadzirisa kwepelinha uye kugadzirisa maitiro, kubatsira kubvisa kudzvinyirira. Kuwedzerwa kwezvokudya, kugadzirisa maitiro, kudzika-mavara, kuchinja kwemaitiro uye kugadzirisa kushandurwa kunorudzirwa nechiropractor kune nzira dzakasiyana siyana dzekutarisira kushungurudza izvo zvinogona kubatsira kuwedzera zviratidzo zvekusarwa kusingaperi kunosangana nekunetseka. Nyaya inotevera inongororwa nenzira yakarongeka uye meta-analysis inoratidza kushandiswa kwemishonga yekufunga kwekutambudzika kusingaperi, kusanganisira kurwadziwa shure uye sciatica.

Kufungisisa Kufungisisa Kwemhirizhonga Isingaperi: Ongororo Yakarongeka uye Kuongorora Meta

ngovepo

Background: Vanorwadziwa kwenguva refu varwere vanowedzera kutsvaga kurapwa kuburikidza nepfungwa yekufungisisa.
Chinangwa: Ichi chidzidzo chinangwa chekugadzira humwe uchapupu pamusoro pekushanda nekuchengeteka kwepfungwa yekufungisisa zvinyorwa zvekurapa marwadzo asingagumi kune vanhu vakuru.
nzira: Takaita sarudzo yakarongeka pane miedzo yakarongeka yakasarudzwa (RCTs) ine meta-kuongorora kushandisa Hartung-Knapp-Sidik-Jonkman nzira yemagadzirirwo emagetsi. Uhu hwehupatidzo hwakaongororwa uchishandisa nzira ye GRADE. Migumisiro yaisanganisira kurwadziwa, kuora mwoyo, hupenyu hwehupenyu, uye kushandiswa kwakafanana.
Results: Makumi makumi masere nemasere RCTs akabatanidza zvidzidzo; zvinomwe zvakataurwa pamusoro pekuchengeteka. Takawana uchapupu hwehutsika hwakakosha hwokuti kufungisisa kwepfungwa kunobatanidza nekuderera kuduku mukurwadziwa kana kuchienzaniswa nemhando dzose dzekutonga mu 30 RCTs. Zvinyorwa zvinokonzerwa nemigumisiro yakawanikwa zvakare nokuda kwezvirwere zvekuora mwoyo uye hupenyu hwehupenyu.
Mhedziso: Kunyange kufungisisa kwepfungwa kunovandudza marwadzo uye kuora mwoyo zviratidzo uye hupenyu hwehupenyu, zvimwe zvakagadzirirwa zvakanaka, zvakasimba, uye zvakakura-zhinji RCTs zvinodiwa kuti zvigadzirise kuongororwa kwehutano hwekufunga kufungisisa kwekutambudzika kusingaperi.
Electronic supplementary material: Iyo inowanikwa muIndaneti yenyaya ino (doi: 10.1007 / s12160-016-9844-2) ine zvinyorwa zvinowedzera, izvo zvinowanikwa kuvashandi vane kodzero.
Keywords: Kurwara kusingaperi, Kufunga, Kufungisisa, Kurongeka kweChirongwa

ziviso

Kurwadziwa kusingagumi, kunowanzotsanangurwa sekurwadziwa kunogara kwenguva refu kupfuura mwedzi ye3 kana kupfuura nguva yakajairika yekuporesa kwenyama [1], inogona kutungamirira kumigumisiro inokosha yezvokurapa, zvemagariro evanhu, uye zvehupfumi, nyaya dzehukama, kurasikirwa kwezvibereko, uye mari yakawanda yekuchengetedza utano. Sangano reMishonga rinoona marwadzo sedambudziko rakakura rehutano hweveruzhinji rinodyira nyika yedu mari inosvika madhora mazana mashanu nemakumi matanhatu nenhanhatu pagore pagore, kusanganisira mutengo wehutano uye kurasikirwa nekubudirira [560]. Kupfuurirazve, kurwadziwa kusingaperi kunowanzoperekedzwa nezvinetso zvepfungwa zvakadai sekurwadziwa kwemishonga kupindwa muropa uye kuora mwoyo kunoita kuti kurapwa kuve kwakaoma [635]. Kuwanda kwepamusoro uye kusagadzikana kwehutano husingaperi, pamwe chete nemigumisiro yakaipa yekuvimba nemishonga inorwadza, zvakakonzera kuwedzera kufarira muzvirongwa zvekurapa zvinosanganisira adjunctive therapy kana dzimwe nzira dzemishonga [2]. Imwe nzira yakadaro iyo varwere vanorwadziwa vari kushandisa ndeyekurangarira kufungisisa. Zvichienderana nemaitiro ekare ekuMabvazuva ekufungisisa, kungwarira kunofambisa chimiro chekutarisa chakavharika chekutarisa. Iyo inoratidzirwa nekuteerera kune yazvino nguva nekuvhurika, kuda kuziva, uye kugamuchirwa [3, 4]. Kufungisisa kwekufungisisa kunofungidzirwa kushanda nekuisa pfungwa patsva pane zvazvino uye kuwedzera kuziva kwekunze kwakapoteredza uye manzwiro emukati, zvichibvumira munhu kuti adzoke shure uye atangezve zviitiko. Tsvagiridzo yemazuva ano ichishandisa neuroimaging kujekesa nzira dzetsinga dziri pasi pemhedzisiro yekufunga kwakanangana nezvimiro zvehuropi senge posterior cingulate cortex, iyo inoita kunge inobatanidzwa mukuzvimiririra [5, 6]. Kushandiswa kwekliniki yekufunga kunosanganisira kushandiswa kwekushandisa zvinodhaka [7], kupera kwefodya [8], kuderedza kushungurudzika [9], uye kurapwa kwemarwadzo asingagumi [10�11].

Ongororo dzepfungwa dzepakutanga muvarwere vanorwadziwa dzakaratidza migumisiro yakavimbiswa pazvirwere zvinorwadza, kushungurudzika kwepfungwa, kushungurudzika, uye kuora mwoyo, pamwe nekurwadziwa-kunoshandiswa kwezvinodhaka zvinoshandiswa [5]. Kuongororwa kwakawanda kwehutano pamusoro pemigumisiro yekufungisisa kwepfungwa kwakabudiswa mumakore achangopfuura. Pane avo vanorondedzera migumisiro inorwadza, mamiriyoni akaisa pfungwa pamhando dzakasiyana dzemarwadzo zvakadai sokurwadziwa kunorwadza kwepamusoro [13], fibromyalgia [15], kana chirwere chekusangana [16]. Zvimwe zvakanga zvisingagumi kuRCTs [14, 17]. Iko kwakave nekuverengeka kwakanyatsorondedzerwa kunongororwa pamusoro pematambudziko akachengetedzwa ekupindira kwepfungwa kwekurwadziwa kusingaperi kusanganisira kubvunzurudza [4] iyo yakaratidza kuvandudzwa kwezvinoshungurudza zviratidzo uye kukunda, imwezve kudzokorora [18] mukurangarira kwekusingaperi kurwadziwa, kurwadza kwe fibromyalgia, uye musumuloskeletal akaratidza zvishoma zvigaro zvinokonzera kurwadziwa, uye kunyanya kuongorororwa [19] kune marwadzo akasiyana-siyana akawana kuvandudzwa mukurwadziwa, kugamuchirwa marwadzo, hupenyu hwehupenyu, nemamiriro ekushanda. Vanyori vezviongorori izvi vakaratidza kunetseka kuti kune uchapupu hushoma hwekubudirira kwepfungwa-yakabatanidzwa pamagariro kune varwere vane marwadzo asingagumi nekuda kwematongerwe enyika. Vakagumisa kuti kumwe kutsvakurudza kwepamusoro kwakada kudiwa musati mazano okushandisa kwekufungisisa kwepfungwa kune zvirwere zvinorwadza zvisingaperi zvinogona kuitwa.

Chinangwa chekudzidza ichi ndechekuita sarudzo dzakarongeka uye kuongorora maitiro nekuchengeteka kwefungwa mupfungwa, sekugadzirisa kana kuti monotherapy kuporesa vanhu vane marwadzo asingagumi nekuda kwemasimba, misoro, kurwadziwa shure, osteoarthritis, kana kurwa neuralgic kuenzaniswa pamwe nekurapa sezvisizvo, kushandura, kusarapwa, kana zvimwe zvirwere zvinoshanda. Marwadzo aive maitiro ekutanga, uye zvikamu zvechipiri zvaisanganisira kuora mwoyo, hupenyu hwehupenyu, uye kushandiswa kwakafanana. Iyo yakarongeka yokuongorora protocol inyoresa mubhuku renyika dzepasi kune maitiro ekugadzirisa (PROSPERO 2015: CRD42015025052).

nzira

Tsvaga Chirongwa

Takatsvaga zvinyorwa zvemagetsi zvePubMed, Cumulative Index kuNursing uye Allied Health Literature (CINAHL), PsycINFO, uye Cochrane Central Register of Controlled Trials (CENTRAL) yeChirungu-mutauro-randomized controlled controlled trials kubva pakatanga kusvika munaJune 2016. Takabatanidza marwadzo uye mamiriro ezvinhu uye takabatanidza marwadzo uye mamiriro ekurwadziwa. gadzira mazwi ane anotevera manzwi ekutsvaga: �Kungwarira� [Mesh]) kana �Kufungisisa� [Mesh] kana kufunga* kana kufunga-kwakavakirwa kana MBSR kana MBCT kana M-BCT kana kufungisisa kana kufungisisa* kana Vipassana kana satipa??h ?na kana anapanasati kana Zen kana Pranayama kana Sudarshan kana Kriya kana zazen kana shambhala kana mabhudhi*.� Pamusoro pekutsvaga uku uye migodhi yezvidzidzo zvese zvakasanganisirwa zvakaonekwa kuburikidza nazvo, tinonongedza ongororo dzakarongwa kare uye takatora zvidzidzo zvese zvakabatanidzwa imomo. .

Kukodzera Kururamisa

Boka rakafanana, munhu mumwechete kana maCD RCTs evanhu vakuru vanorondedzera kurwadziwa kusingaperi kwakabatanidzwa. Zvidzidzo apo munyori akarondedzera kurwadziwa kusingaperi uye kuongororwa nevarwere vanotaura kurwadziwa kwemadiki emwedzi 3 vakaiswa. Zvidzidzo zvaidiwa kusanganisira kufungisisa kwepfungwa, sekunge shanduro kana monotherapy; zvidzidzo kuedza dzimwe nzira dzekufungisisa dzakadai se yoga, tai chi, qigong, uye maitiro ekudengisa kweCheccendental pasina kureva kufungwa kwakabviswa. Kufungisisa kwepfungwa kwakange kusingadi kufungisisa, sekugamuchirwa uye kuzvipira kurapa (ACT) kwakabviswawo. Dzidzo chete inotaura nezvekurwadziwa kwezviyero kana kushandiswa kwekushandiswa kwekare kunosanganiswa. Kunyunyuta uye musangano zvinyorwa zvakabviswa.

Dzokuvhiyiwa

Vaviri vakazvimiririra vanoongorora vakaongorora mazita uye zvipfupi zvezvakadzokororwa zvinyorwa-zvichitevera chikamu chekutyaira kuti ive nechokwadi chekududzira kwakafanana kwekubatanidzwa uye kusabvisa maitiro. Zvinyorwa zvinoonekwa sezvingangove zvinokodzera nemumwe kana vese vaongorori vakawanikwa sechinyorwa chakazara. Izvo zvinyorwa zvizere zvakaburitswa zvakabva zvaongororwa zvakapetwa zvichipesana neakatsanangurwa maitiro ekusanganisa. Kuyerera kwezvinyorwa mukati meiyi nzira yakanyorwa mudura remagetsi, uye zvikonzero zvekusabatanidzwa kwezvinyorwa zvizere zvinyorwa zvakanyorwa. Kubviswa kwedata kwakaitwa zvakare mumaviri. Ngozi yekusarura yakaongororwa uchishandisa Cochrane Risk yeBias chishandiso [20]. Zvimwe zvisizvo zvine chekuita neUS Preventive Services Task Force's (USPSTF) maitiro echokwadi chemukati chezvidzidzo zvakasanganisirwa zvakaongororwa [21, 22]. Aya maitiro akashandiswa kuyera kunaka kwehumbowo sechakanaka, chakanaka, kana kuti chakashata pane yega yega inosanganisirwa kudzidza.

Meta-Analytic Techniques

Apo ruzivo rwakakwana rwakanga rwuripo uye nhamba yehterogeneity yakanga iri pasi pezvikumbaridzo zvakabvumiranwa [20], takaita meta-analysis kuti tiwane mhinduro dzekushanda kune dzakabatanidzwa zvidzidzo zvemigumisiro yekufarira uye kupa sango rekutsvaga meta-analysis. Isu takashandisa nzira yeHartung-Knapp-Sidik-Jonkman yemaitiro asina kujairika meta-analysis tichishandisa nzira dzisina kurongeka uye zviyero zvekupararira [23�25]. Kune zvidzidzo zvinorondedzera marwadzo akawanda, takashandisa matanho chaiwo ekurwadziwa, akadai seMcGill Pain Questionnaire (MPQ) nokuda kwemeta-analysis panzvimbo yekurwadziwa kweSF-36, uye chiyero chepakati kana marwadzo ekurwadziwa panzvimbo pemamiriro ezvinhu akadaro. sekurwadziwa panguva yekuongorora. Nokuda kwenhamba shoma yezviitiko zvakashata zvakashumwa, kuongororwa kwehuwandu hakuna kuitwa. Takaita subgroup ongororo uye meta-regressions kugadzirisa kana paine misiyano muhukuru hwekuita pakati pemhando dzakasiyana dzekupindira, huwandu hwevanhu, kana painoshandiswa se monotherapy versus an adjunctive therapy. Unhu hwehumwe humbowo hwehupupu hwakaongororwa uchishandisa GRADE nzira [22, 26] iyo yakagadziriswa yepamusoro, yakadzikama, yakaderera, kana yakaderera kwazvo yakaitwa kune yega yega mhedzisiro [27].

Results

Tsanangudzo yeKubatanidzwa Zvidzidzo

Isu takaratidza 744 zvinyorwa kuburikidza nekutsvaga kwemagetsi dhatabhesi uye gumi nemana marekodhi akawanikwa kuburikidza nezvimwe zvinyorwa (ona Mufananidzo 11). Zvinyorwa zvizere zvakawanikwa zvegumi nemakumi mashanu neshanu zvakatorwa sezvingave zvinokodzera nevaongorori vaviri vakazvimirira; 1 RCTs yakasangana nemitemo yekubatanidzwa. Rondedzero yehunhu hwekudzidza hunoratidzwa muTafura? 125 uye mhedzisiro yezvidzidzo zvega zvinoratidzwa muTafura? 38.

Tafura 1 Zvimwe zveKubatanidzwa Zvidzidzo

Tafura 1: Zviratidzo zvekubatanidza zvidzidzo.

Tafura 2: Migumisiro yezvidzidzo zvega.

Pakazara, zvidzidzo zvakapiwa vatori vechikamu 3536; sampuli mazamu akasiyana kubva ku19 kusvika ku342. Zvidzidzo gumi nemashanu zvakarondedzera a priori simba kuverenga nechinangwa chakakosha sarudzo yakagadziriswa, zvidzidzo gumi hazvina kupa ruzivo pamusoro pesimba rekuverenga, uye zvidzidzo zvitatu hazvina kunyatsojeka mukuzivisa kwekuverenga simba. Zvidzidzo gumi zvakaonekwa ipapo zvakanga zvisina simba; vanyori vakafunga izvi zvidzidzo zvepayenzi. Ruzhinji rwezvidzidzo zvakaitwa muNorth America kana kuEurope. Nguva yevatori vechikamu yakatangira kubva ku30 (SD, 9.08) kusvika kumakore 78 (SD, 7.1.

Zvirwere zvinonzi zvinosanganisira fibromyalgia mune zvidzidzo zvisere uye kurwadziwa shure shure mune zvidzidzo zvisere. (Zvikamu hazvisi pamwe chete zvakasiyana; zvimwe zvidzidzo zvaisanganisira varwere vane mamiriro akasiyana-siyana.) Osteoarthritis yakarondedzerwa mune zvidzidzo zviviri uye rheumatoid arthritis mune zvitatu. Migraine headache yakashumwa mune zvidzidzo zvitatu uye rumwe rudzi rwemusoro muzvidzidzo zvishanu. Zvidzidzo zvitatu zvakarondedzerwa zvinokanganisa bowel syndrome (IBS). Zvidzidzo zvisere zvakarondedzera zvimwe zvinokonzera marwadzo uye zvidzidzo zvitatu hazvina kureva chirwere chezvechiremba kana kuti chinokonzera kurwadziwa kusingaperi.

Iyo yakareba yakareba yezvipindiro yakabva kune 3 kusvika kumavhiki e12; ruzhinji rwekupindira (29 zvidzidzo) mavhiki e8 akareba. Zvidzidzo makumi maviri nechimwe zvakaitwa pamusoro-pfungwa-based based stress reduction (MBSR) uye nhanhatu pamagariro-based based cognitive therapy (MBCT). Zvikwata gumi nezvimwe zvezviongorori zvakashuma migumisiro pane mamwe maitiro ekudzidzira pfungwa. RCT gumi nemitatu yakapa kupindira kwepfungwa se monotherapy, uye gumi nemasere anoshandiswa pakupindira kwepfungwa sekugadzirisa chirwere, achitsanangura kuti vose vatori vechikamu vakagamuchira izvi kuwedzera kune dzimwe kurapwa semishonga. Zvidzidzo zvinomwe zvakanga zvisinganzwisisi kuti kana kupindira kwepfungwa kwaiva monotherapy kana kuti chirongwa chechirongwa. RCT gumi nemasere yakashandisa kurapwa sezvinowanzoitwa sevheenzanisi, gumi nemitatu yakashandiswa kuenzanisa nekuenzanisa, uye mapoka gumi ezvidzidzo / mapoka ekutsigira sevheenzanisi. Kunze kwezvienzanidzo zvakajairika, chimwe chidzidzo chinoshandisa kushandiswa kwekunetseka, kushambadza, hutano hwakasiyana-siyana hunopindira, kuporesa / kutaridzika, uye ruzivo rwezvokudya / zvokudya zvekudya sekuenzanisa; zvidzidzo zviviri zvakashandisa kugadzirisa-maitiro ekurapa. Dzidzo dzakawanda dzaiva nemaoko maviri ekuenzanisa.

Kudzidza Unhu uye Njodzi yeBaas

Hunhu hwechidzidzo hwechidzidzo chega chega chinosanganisirwa hunoratidzwa muTable ?1. Zvidzidzo gumi nechimwe zvakawana �zvakanaka� chiyero chemhando [28�38]. Zvidzidzo gumi nezvina zvakatongwa kuve zvemhando yakanaka, zvakanyanya nekuda kwekusajeka mune zvimwe zvikamu zvenzira [39�52]. Zvidzidzo gumi nenhatu zvakatongwa kuva murombo; gumi zvakanyanya nekuda kwenyaya nekuzara kwekushuma mhedzisiro data senge isina kukwana kana kushayikwa chinangwa chekurapa (ITT) kuongororwa uye / kana pasi pe80% yekutevera [53�62] uye zvitatu nekuda kwenzira dzisina kujeka [63�65]. Tsanangudzo yezviyero zvemhando uye njodzi yekurerekera kune yega yega inosanganisirwa chidzidzo inoratidzwa muElectronics Supplementary Material 1.

Nzira

Zvidzidzo zvakarondedzera marwadzo ekurwara kwenguva yakaita seA Visual Analog Scale, SF-36 kurwadziwa kwekubva, uye McGill Pain Questionnaire. Chikamu chemigumisiro yezviyero zvinosanganisira kuora mwoyo zviratidzo (eg, Beck Depression Inventory, Patient Health Questionnaire), hutano hwehutano hwepanyama uye hwepfungwa (semuenzaniso, SF-36 mupfungwa uye nhengo dzemuviri), uye kukanganisa kushanda / kuremara (semuenzaniso, Roland-Morris Disability Questionnaire, Sheehan Disability Scale).

Chisingarapiki Manzwiro Okurapa Mhinduro

Makumi matatu eRCTs akashuma mhedzisiro inoenderera data pazviyero zvinoongorora kurwadziwa kusingaperi [29, 31�33, 36, 39�49, 51�60, 62�64, 66].

Zvidzidzo zvisere zvakasangana nekuongororwa kwekuisirwa maitiro asi hazvina kubatsira pakuita meta-ongororo nekuti havana kuzivisa data rinosanganisika [28, 30, 34, 35, 38, 50, 61, 65]. Hunhu hwavo hwekudzidza hunoratidzwa muTafura? 1, uye yekudzidza mwero mhedzisiro pamwe nezvikonzero zvaive zvisiri mune zvakabatanidzwa ongororo zvinoratidzwa muTafura? 2.

Zviyero zvemarwadzo uye zvienzanisi zvakasiyana kubva pakudzidza kusvika pakudzidza. Nguva yekutevera yepakati yaive mavhiki e12, ine huwandu hwe4 kusvika kumavhiki e60. Mufananidzo ?2 unoratidza mibairo yemeta-analysis uchishandisa data panguva yakareba yekutevera pachidzidzo chega chega. Ongororo yakabatanidzwa inoratidza mhedzisiro yakakosha yekufungisisa kwekufungisisa kana ichienzaniswa nekurapa semazuva ese, kudzora, uye mapoka edzidzo / ekutsigira (SMD, 0.32; 95 % CI, 0.09, 0.54; 30 RCTs). Huru heterogeneity yakaonekwa (I 2 = 77.6%). Pakanga pasina humbowo hwekudhirowa kwakarerekera (Begg�sp = 0.26; Egger's bvunzo p = 0.09). Kuti tiongorore kana fungidziro yekurapa yakasimba kana tisingasanganisire zvidzidzo zvemhando yakashata uye kuongorora zvingangobva zvehuterogeneity yakakura, takaita ongororo yekunzwa kunosanganisira zvidzidzo zvemhando yepamusoro chete. Iko kuvandudzwa kwakaramba kwakakosha, hukuru hwekuita hwakanga huri diki (SMD, 0.19; 95% CI, 0.03, 0.34; 19 RCTs), uye pakanga pasina heterogeneity shoma (I 2 = 50.5%). Meta-regressions yakaratidza kuti kuchinja mumigumisiro yemarwadzo mune zvakanaka- (p = 0.42) uye kururamisira-mhando (p = 0.13) zvidzidzo zvakanga zvisina kunyanya kusiyana nekuchinja kwezvidzidzo zvisina kunaka.

Mufananidzo 2 Kufunga Kwekufungisisa Kuzoitika Pamarwadzo Asingaperi

Mufananidzo 2: Kunyatsofungisisa kufungisisa kunokonzerwa nekusingaperi kurwadziwa.

Muchikamu chekuongorora, mhedzisiro yacho yakanga isingaverengeki yakakosha pamasvondo e12 kana pasi (SMD, 0.25; 95% CI, ?0.13, 0.63; 15 RCTs; I 2 = 82.6%) asi yakanga yakakosha kune nguva dzekutevera kupfuura mavhiki e12 ( SMD, 0.31; 95% CI, 0.04, 0.59; 14 RCTs, I 2 = 69.0%). Muedzo weBegg wanga usina kukosha (p = 0.16) asi bvunzo yeEgger yakaratidza humbowo hwekusarudzika kwekushambadzira (p = 0.04). Unhu hwehuchapupu hwokuti kufungisisa kwekufungisisa kunobatanidza nekuderera kwekurwadziwa kusingaperi kuenzaniswa nekutonga kwakaderera zvachose uye kune zvose zvenguva pfupi uye kwenguva refu kutevera nekuda kwekusagadzikana, heterogeneity, uye zvingave zvichikonzerwa nekudhinda. Tafura yakadzama inoratidza kunaka kwehumbowo hwezviwanikwa kune yega yega mhinduro huru muElectronics Supplementary Material 2.

Kuti tiratidze mhedzisiro inechipatara, takaverenga muzana shanduko muzviratidzo zvekurwadziwa kubva kune yekutanga kusvika yekutevera yekufunga nekufungisisa uye kuenzanisa mapoka echidzidzo chimwe nechimwe uye kuratidza zvakawanikwa muTebhu? 2. Isu takazoverenga huwandu hwese huremu kureva muzana shanduko yemafungiro ekufungisisa emapoka maringe nekuenzanisa mapoka mhedzisiro yekufungisisa kwekutambudzika pakureba kwekutevera. Zvinoreva muzana muzana zvinoshanduka mukurwadziwa kwemapoka ekufungisisa aive? 0.19% (SD, 0.91; min,? 0.48; max, 0.10) nepo zvirevo muzana zvichichinja mukurwadziwa kwemapoka ekudzora aive? 0.08% (SD, 0.74; min,? 0.35 ; max, 0.11). Iko p kukosha kwemusiyano pakati pemapoka kwaive kwakakosha (p = 0.0031).

kusuruvara

Mhedzisiro yekuora mwoyo yakataurwa mu12 RCTs [29, 31, 33, 34, 45, 46, 48, 49, 51�53, 56]. Pakazara, kufungisisa kwakaderedza zvakanyanya kuderera kwezvibodzwa kana zvichienzaniswa nekurapa senguva dzose, rutsigiro, dzidzo, manejimendi ekudzora, uye mapoka ekudzora ekumirira (SMD, 0.15; 95% CI, 0.03, 0.26; 12 RCTs; I 2 = 0%). Hapana heterogeneity yakaonekwa. Hunhu hwehuchapupu hwakanzi hwakakwirira nekuda kwekushaikwa kwehuterogeneity, mhedzisiro yekudzidza inowirirana, uye kurongeka kwemhedzisiro (nguva diki dzekuvimba).

Unhu hweHupenyu

Zvidzidzo gumi nezvitanhatu zvakashuma hutano hwepfungwa-hune hutano hwehupenyu; Mhedzisiro yekufungisisa kwekufungisisa yakanga yakakosha mukuongorora kwakasanganiswa kana ichienzaniswa nekurapa semazuva ese, mapoka ekutsigira, dzidzo, kudzora kushushikana, uye waitlist controls (SMD, 0.49; 95 % CI, 0.22, 0.76; I 2, 74.9%). [32�34, 45�49, 52, 54, 56, 59, 60, 62�64]. Zvidzidzo gumi nenhanhatu zvakayera hutano hunoenderana nehutano hwehupenyu [32�34, 36, 45�49, 52, 54, 56, 60, 62�64]. Ongororo dzakabatanidzwa dzakaratidza mhedzisiro yakakosha yekufunga kwekufungisisa kana ichienzaniswa nekurapa semazuva ese, mapoka ekutsigira, dzidzo, kudzora kushushikana, uye waitlist controls (SMD, 0.34; 95 % CI, 0.03, 0.65; I 2, 79.2%). Ose ari maviri emhando-ye-hupenyu ongororo yakaona yakakura heterogeneity, uye mhando yehumbowo hwakanzi hune mwero kune hutano hwepfungwa (nguva diki dzekuvimba, mhedzisiro inoenderana) uye yakaderera kune hutano hwepanyama hune hukama hwehupenyu.

Kushanda Kunetseka (Maitiro Akaremara)

Zvidzidzo zvina zvakazivisa huwandu hwehurema hunokosheswa kubva kuRoland-Morris Disability Questionnaire uye Sheehan Disability Scale [33, 36, 47, 55]. Musiyano uripo pakati pekufunga uye mapoka ekuenzanisa mukutevera kwanga kusingaverengeke kwakakosha (SMD, 0.30; 95% CI,? 0.02, 0.62; I 2 = 1.7%), kunyangwe mhedzisiro yacho yasvika pakukosha. Hapana huterogeneity yakawanikwa. Hunhu hweuchapupu hwaiverengerwa pasi nekuda kwekukanganisa uye diki yakazara saizi saizi.

Analgesic Use

Zvidzidzo zvina chete zvakaratidza kushandiswa kwemaanalgesics semhedzisiro. Mune ongororo yeMBSR yekurapa kurwadziwa kusingaperi nekuda kwekutadza kumashure chirwere chekuvhiya [55], pa12-vhiki yekutevera, iyo analgesic mishonga matanda eboka rekupindira rakaratidza kuderera kwekushandisa analgesic zvichienzaniswa neavo vari muboka rinodzora ( 1.5 (SD = 1.8) vs. 0.4 (SD = 1.1), p = <0.001). Chidzidzo chekufungisisa kwepfungwa uye kugona kuziva-maitiro ehutachiona maringe neyakajairwa kutarisirwa kwekutambudzika kwepashure [35] yakashuma kuti iyo inorehwa morphine yakaenzana dosi (mg / zuva) yeopioid yakanga isina kunyanya kusiyana pakati pemapoka mavhiki e8 ne26 Saizvozvowo, kuyedzwa kweMBSR yemarwadzo ekumusana [38] hakuna kuwana musiyano wakakura pakati pemapoka mukuzvishambadza-kushandiswa kwemishonga yekurwadziwa. Chekupedzisira, kuyedzwa kwepfungwa-kwakanangana nekuvandudza kusimudzira (ZVIMWE) zvekurwadziwa kusingaperi kwemhando dzakasiyana dzeetiologies [44] yakawana vatori vechikamu vanopindira zvakanyanya mukana wekusagona kuzadzisa nzira dzeopioid yekushandisa kusagadzikana nekukurumidza mushure mekurapwa (p = 0.05); zvisinei, izvi mhedzisiro haina kutsigirwa pamwedzi mitatu yekutevera.

Zvakaipa Zviitiko

Iko 7 chete ye38 yakaisa RCTs yakashuma pamusoro pezviitiko zvakashata. Zvine zvakati hapana zviitiko zvakashata zvakaitika [36, 47, 50, 57]; imwe yakatsanangura kuti vatori vechikamu vaviri vakave nekushushikana kwekanguva kwekutsamwa kwekutambudzika kwavo uye vaviri vevatori vechikamu vakaona kushungurudzika kukuru [46]; zvidzidzo zviviri zvakanyorwa zvakanyanyisa migumisiro kubva ku yoga uye kufambira mberi kwemaviri kusununguka [35, 38].

Chidzidzo Chekudzidza Moderators

Meta-mitambo yakamhanyirira kuti ione kana kuchinja mumarwadzo ekurwadziwa kwakarongeka zvakasiyana nemajeri mashoma. Kwakanga kusina kusiyana pakati pemarwadzo pakati peMBSR (16 zvidzidzo) uye MBCT (4 zvidzidzo; p = 0.68) kana mamwe maitiro ekupindira kwepfungwa (10 zvidzidzo; p = 0.68). Pakufananidza MBSR (16 zvidzidzo) kune dzimwe nzira dzakabatanidzwa (14 zvidzidzo), pakange pasinawo kusiyana pakati penyaya (p = 0.45). Sezvakataurwa mune mamwe mashoko pamusoro apa, zvirwere zvehutano zvakataurwa zvinosanganisira fibromyalgia, kurwadziwa shure, arthritis, kuora musoro, uye kushungurudzwa kwemawere (IBS). Meta-regressions haina kuratidza kupesana pakati pemusoro wepamusoro (zvidzidzo zvitanhatu) nemamwe mamiriro (p = 0.93), kurwadziwa shure (masere masere) uye mamwe mamiriro (p = 0.15), uye fibromyalgia (zvidzidzo zvisere) uye mamwe mamiriro (p = 0.29 ). Gender chimiro (% yevarume) chakanga chisina kushamwaridzana nechisimba pamarwadzo (p = 0.26). Zvose zvakakwana zvepurogiramu yekupindira yakabva kune 3 kusvika kumavhiki e12 (kureva mavhiki e8). Meta-regression haina kuratidza kupesana pakati pekugadziriswa kwepamusoro-purogiramu uye pakati-(p = 0.16) kana kuti zvishoma-pfupi (p = 0.44). Hapana misiyano yakagadziriswa pamigumisiro yekurwadziwa pakati pekugadzirisa therapy uye monotherapy (p = 0.62) kana pakati pekugadzirisa chirwere uye kupindira apo izvi zvakanga zvisina kujeka (p = 0.10) yakawanikwa. Pakupedzisira, kwakanga kusina kusiyana kwakagadziriswa mubasa kana muenzanisi aive kurapwa saizvozvowo, waitlist, kana imwe kupindira (p = 0.21).

Dr Jimenez White Coat

Dr. Alex Jimenez's Insight

Kunyanya kushushikana mupfungwa inhau huru muUnited States uye yakakanganisa hutano hwakakwana uye hukama hwevanhu veAmerica. Kunetseka kunogona kuchinja nzvimbo dzakasiyana dzomuviri. Kushungurudzika kunogona kuwedzera kukurumidza kwemwoyo uye kunokonzera kufema nokukurumidza, kana kuti hyperventilation, pamwe nekushungurudzika kwemisimba. Uyezve, kushungurudzika kunokonzera kupindura "kurwisana kana kutiza", izvo zvinokonzera hurongwa hwekutambudzika hunobudisa musanganiswa wehomoni nemakemikari mumuviri. Nenzira yakanaka, chiropractic inogona kubatsira kuburikidza nekunyanya kushungurudza. Chiropractic kurapa inoita kuti purosiyasi inokanganisa iyo inogadzirisa mhinduro "kurwisana kana kutiza". Uyezve, chiropractic kuchengetedza inogona kubatsira kuderedza kushungurudzika kwemasumbu, kuvandudza zvirwere zvinorwadza zvisingaperi.

hurukuro

Muchidimbu, kufungisisa kwepfungwa kwakabatanidzwa nechinguva chiduku chezviratidzo zvekurwadziwa zvakagadziriswa zvichifananidzwa nekurapa sezvinowanzoitwa, maitiro asingatauri, uye mapoka / dzidzo / mapoka ekutsigira meta-kuongororwa kwe 30 randomised trial trials. Zvisinei, pane humwe humwe humwe humwe hutano hwehutano hwakanaka pakati pekutsvaga uye kushandiswa kwezvinyorwa zvinyorwa zvinokonzera hutsika hwehupupuri hwehutsika. Kubudirira kwepfungwa kufungisisa pamusoro pekutambudzika kwakanga kusiyana nenzira yakarongeka nerudzi rwekupindira, chirwere chehutano, kana nehurefu kana huwandu hwekupindira. Kunyatsofungisisa kufungidzirwa kwaibatanidza nehuwandu hwekuwedzera huri mukuderera, hutano hwehutano hwehupenyu, uye hutano hwehutano hwehutano. Uhu hwehupupuri hwakakosha nokuda kwekuora mwoyo, kuenzanisa kwehutano hwehutano hwehutano hwehutano, uye hwehutano hwehutano hwehutano hwehutano. Zvidzidzo zvina chete zvinorondedzerwa pamusoro pekushandura kwekushandiswa kwemaalgoni; migumisiro yakavhenganiswa. Zviitiko zvakashata mumatare eRCT zvaive zvisingawanzoitiki uye hazvisi zvakakomba, asi huwandu hwekutsvakurudza hauna kuunganidza dambudziko rezviitiko zvezviitiko.

Iyi nyanzvi ine simba rakasiyana-siyana rekushandisa: an priori tsvakurudzo yekugadzira, kudzokorora kusarudzwa kwekutsvaga uye kudhindwa kwemashoko ekudzidzira ruzivo, tsvakurudzo yakazara yehuwandu hwemashoko ehuwandu, dambudziko rekuongororwa kwezvinyorwa, uye huwandu hunhu hwehuchapupu hunoshandiswa pakugadzirisa kuongorora kwekupedzisira. Chimwe chekuregererwa ndechekuti hatina kutaurirana vanyori vezvidzidzo zvega; Migumisiro inonzi yakabvunzwa ichi yakabva pane zvakabudiswa. Isu hatina kuburitsa musangano zvinyorwa zvisina dha rakakwana kuti uongorore hutano hwekudzidza. Mukuwedzera, taisanganisira zvidzidzo zvakabudiswa muChirungu.

Zvidzidzo zvakabatanidzwa zvaive nezvipingamupinyi zvakawanda. Zvidzidzo zvitatu zvemashure makumi matatu nemasere zvakarongwa sehurombo husina kunaka, kunyanya nekuda kwekushayikwa kweTT, kusarudzwa kwakashata, kana kushaya ruzivo rwokutsvaga nzira dzekudzidzira nekudzivirirwa kwekugoverwa. Vanyori vezvidzidzo gumi vakarondedzera kusakwana kwechirwere simba kuti vaone kusiyana kwezvinhu zvinorwadza pakati pekufunga nekufungisisa uye muenzanisi; vanyori vakafunga izvi zvidzidzo zvepayenzi. Zvimwe zvidzidzo gumi hazvina kuudza simba kuverenga. Sample masikisi aiva maduku; 15 zvidzidzo zvakasarudzwa zvishoma kudarika vatambi ve 50.

Zvimwe zvakanyatsogadziriswa, zvakasimba, uye zvikuru zveRCT zvinodiwa kuti zvive nehuchapupu huripo hunogona kupa zvakanyanya kuongororwa kwekubudirira kwayo. Zvidzidzo zvinofanira kunyoresa zviyero zvakakura zvakakwana kuti zvione kuenzana kwezviitiko mumigumisiro uye inofanira kuteverwa nevatori vechikamu kwe6 kusvika ku12 mwedzi kuti vaongorore nguva yakareba yekukanganisa kwekufungisisa. Kuteerera kune pfungwa kungoita uye kushandiswa panguva imwechete kweimwe mishonga kunofanira kuongororwa nguva nenguva. Kupindira maitiro, kusanganisira chirongwa chakanaka, hachina kumbogadziriswa. Kuti uone kuti kupindira kwakagadzirisa zvakadini, zvidzidzo zvinoda kuva nehanya-zvakaenzana nekudzivirira. Miedzo shomanana inogona kuitwa kuitira kupindura mibvunzo iyi. Zvimwe zviitiko zvakanga zvisina kunze kwehuwandu hwekuongorora uku zvingave zvakakosha kuongorora. Sezvo kukanganisa kwepfungwa kungave kwakabatana nekuongororwa kwemarwadzo, zvingave zvakakosha kumayera emangwana kutarisa zvinowanzoitika zviratidzo zvinosangana nemarwadzo akadai sehupenyu hwehupenyu, kupindira kwakabatanidzwa, kushungurudzika kwekunetseka, mhirizhonga, uye nyaya dzakabatana dzakadai seapioid chido. Zvinyorwa zvenguva yakazara paRCTs yekufunga kufungisisa zvinofanira kufanana neConsolidated Standards of Reporting Trials (CONSORT) mitemo.

Nhatu chete dzeRCTs dzinoti zviitiko zviduku zvakashata pakufungisisa mupfungwa. Zvisinei, 7 chete yeC38 yakaisa RCTs yakataura kana zviitiko zvakashata zvakaongororwa uye zvakabatanidzwa. Nokudaro unhu hwehuchapupu hwezviitiko zvakashata zvakataurwa muRCTs hazvina kukodzera kuongorora kwakakwana. Inopa mharidzo yakabudiswa yezviitiko zvakashata panguva yekufungisisa, kusanganisira psychosis [67], miedzo yeramangwana inofanira kuunganidza zvakashata zviitiko zvezviitiko. Mukuwedzera, kuongorora kwakarongeka kwezvidzidzo zvekucherechedza uye nhoroondo dzemhosva zvinogona kuwedzera kujekesa zviitiko zvakashata panguva yekufungisisa mupfungwa.

Kupfuurira mberi kutsvakurudza kuongorora kushanda kwekufungisisa kwepfungwa pamusoro pemarwadzo asingagumi kunofanirawo kutarisa pakunzwisisa zviri nani kana pane nguva shoma kana nguva yekufungisisa kuitira kuti ibudirire. Kunyange zvazvo zvidzidzo zvemazuva ano zvakabereka migumisiro yakafanana yekufunga kwekutambudzika, izvi zvinowanzova zviduku kusvika pakati uye zvichibva mumuviri wehumwe uchapupu hunofanirwa, hwakanakisisa, hwehuwandu hwehutano. Imwe nzira inogona kuendesa mberi kutsvakurudza pamusoro pemarwadzo asingagumi kungave yekuvandudza kupindira nekutarisa boka tsanangudzo, tsanangudzo dzakasiyana-siyana dzezvikamu zvakasiyana-siyana zvekugadzirisa kwakakomba, uye kushanda kune imwe nzira yakatarwa yekuongororwa kuwana kurapa [68]. Musoro-ku-misoro miedzo inofanidza kupindira kwepfungwa dzechikamu chakafanana asi nekusiyana kwezvikamu kana chirwere zvingave zvichibatsira kuvhiringidza zvinhu zvinobudirira zvezvinhu izvi [69].

Kufanana nemhinduro dzakapfuura munharaunda ino, tinogumisa kuti nepo kufunga kwepfungwa nekufungisisa kwakaratidza kuchinja kukuru kwehupenyu husingaperi, kuora mwoyo, uye hutano hwehupenyu, utera hwuri mumuviri hwehupupuriro hunodzivisa zvakasimba mhedziso. Ihwo humwe uchapupu huripo hahuna kupa zvibereko zvinogadziriswa pamigumisiro inorwadza, uye zvidzidzo zvishomanana zvaivepo kune maitiro ekufungisisa kwepfungwa kunze kweMBSR. Unhu hwehupupuriro hwekubudirira kwepfungwa dzakagadziriswa mukuderedza kushungurudzika kusingaperi kwakaderera. Ikoko kwakanga kune uchapupu hwehupamhi hwehutano hwekufunga kwekufunga kufungisisa nezvekuora mwoyo uye hutano hwehutano-hunoenderana nehupenyu hwehupenyu. Ichi chiongorori chinopindirana neongororo dzasati dzapera kugumisa kuti zvakanyatsogadzirwa zvakanaka, zvakasimba, uye zvikuru zveRCT zvinodiwa kuitira kukudziridza uchapupu hunogona hunozopa zvakanyanya kuongororwa kwehutano hwekufunga kufungisisa kwekutambudzika kusingaperi. Munguva iyi, kurwadziwa kusingaperi kunoramba kuchiita mutoro unorema pavanhu uye nevanhu. A inoverengeka nzira yekurapa kwekusingaperi kushungurudzika kwakadai sekufunga kufungisisa kungave kwakagamuchirwa nevarwere vane marwadzo.

Electronic Supplementary Material

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

Kuteerera neMitemo Maitiro

Kubhadhara uye Kuzvidzivirira

Kuongororwa kwakarongeka kwaibhadharwa neDhipatimendi reVenjini dzeZvibvumirano zveHurumende yePychoticlogical Health uye Traumatic Brain Injury (chibvumirano chenhamba 14-539.2). Zvakawanikwa uye mhedziso munyaya ino ndeyevanyori uye hazvirevi kuti zvinomiririra maonero eDhipatimendi Rezvidziviriro zveZviviri zvePeople for Psychological Health and Traumatic Brain Injury.

Vanyori Nhoroondo yeKakawirirana Kwekufarira uye Kubvuma Maitiro Akanaka Mavhinga

Vanyori Hilton, Hempel, Ewing, Apaydin, Xenakis, Newberry, Colaiaco, Maher, Shanman, Sorbero, naMaglione vanoti havagoni kupesana. Zvose zvinongororwa, kusanganisira nzira yekubvumirwa kwebvumirano, zvakaitwa maererano nemitemo yekodzero yekambani inotarisira kuedza kwevanhu (masangano uye enyika) uye neHelsinki Declaration ye 1975, sezvakadzokororwa mu2000.

Mukupedzisa,�kushungurudzika kunogona kukanganisa utano hwedu hwehutano uye hutano kana husina kutarisirwa zvakanaka. Nenzira, maitiro akawanda ekugadzirisa matambudziko, kusanganisira chiropractic kutarisira uye kufunga kwefungwa, zvinogona kubatsira kuderedza kushungurudzika pamwe nekuvandudza marwadzo asingagumi anosangana nekuzvidya mwoyo. Chiropractic kurapwa chirongwa chakakosha chekugadzirisa mupfungwa nekuti chinogona kudzivisa "kurwisana kana kutiza ndege" inobatanidza nekusingaperi mupfungwa. Nyaya iri pamusoro apa yakaratidzawo kuti kufungisisa kwepfungwa kunogona kuva nzira yekugadzirisa yekusimudzira pfungwa yekuvandudza hutano hwakakwana uye hukama. Mashoko anotsanangurwa kubva kuNational Center for Biotechnology Information (NCBI). Kuwanda kweruzivo rwedu kunogumira kune chiropractic pamwe nekukuvara kwepamuviri nemamiriro. Kuti ukurukure nyaya yacho, ndapota ivai vakasununguka kubvunza Dr. Jimenez kana kuti tibvunzei kwatiri 915-850-0900 .

Yakarongedzwa naDkt Alex Jimenez

Zvimwe Zvinyorwa: Kubva Painini

blog chinyorwa chekartoon paperboy makuru makuru

NHAURWA INOKOSHA INOKOSHA: Kutarisira Kushungurudzika Kwebasa

ZVIMWE ZVINOKOSHA ZVINOKUDZIDZA: KUDZIDZA KUNYANYA: Kusarudza Chiropractic? | Familia Dominguez | Varwere | El Paso, TX Chiropractor

Hazvina kuchena

References

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Chiropractic & Stress Management for Back Pain in El Paso, TX

by spinedoctors | Kudzorera Pain, Chiropractic, Randomized Controlled Trial, Mishonga

Kushungurudzika ndezvechokwadi hwehupenyu hwemazuva ano. Munharaunda umo maawa ekushanda ari kuwedzera uye vhidhiyo iri kuramba ichiwedzeredza pfungwa dzedu nematambudziko akawanda ehurumende, hazvishamisi nei vanhu vakawanda vachiwana huwandu hwakanyanya hwekutambudzika nguva dzose. Nenzira yakanaka, vashandi vakawanda vezvehutano vari kuunza kushandiswa kwepfungwa uye maitiro sechikamu chekurapa kwevarwere. Apo kushungurudzika kwekuita kwepanyama kunobatsira kugadzirira muviri kune ngozi, kugara uchinetseka kunogona kuva nemigumisiro yakaipa pamuviri, zvichikonzera zviratidzo zvehutambudzo shure uye sciatica. Asi, nei kunyanya kunetseka kuchikanganisa muviri wemunhu?

Kutanga, zvakakosha kunzwisisa kuti muviri unoona sei kudzvinyirira. Kune zvitatu "zviteshi" zvatinotarisana nayo nekushungurudzika: nzvimbo, muviri, uye manzwiro. Kushungurudzika kwepanyika ndiko kunoreva kuzvitsanangurira; kana uri kufamba mumugwagwa wakanyarara uye iwe unonzwa rwiyo rukuru pedyo, muviri wako uchanzwisisa kuti senjodzi pakarepo. Izvozvo zvinodzvinyirira zvakatipoteredza. Kusvibiswa kunogona kuva mumwe muenzaniso wekudengenyeka kwezvakatipoteredza nekuti unowedzera kunze kwemuviri iyo yakawanda inowanikwa nayo.

Kushungurudzika kuburikidza nomuviri kunosanganisira zvirwere, kusakwanisa kurara uye / kana kudya zvisina kunaka. Kushungurudzika mupfungwa kunopesana zvakanyanya, sezvo kunosanganisira nzira iyo ubongo hwedu hunoshandura zvimwe zvinhu. Nemuenzaniso, kana mumwe munhu waunoshanda naye ari kunyengera-utsinye, iwe ungasimbiswa. Pfungwa dzakadai sokuti, "anonditsamwira nokuda kwechimwe chikonzero" kana kuti "vanofanira kunge vaine dambudziko rakaoma", rinogona kuonekwa sekunetseka mupfungwa. Chii chakasiyana nekunetseka mupfungwa, zvisinei, ndechokuti tine simba pamusoro pekuwanda kwatinoona, zvakanyanya kudarika zvinokonzera mamiriro ezvemhuka kana kuti kushungurudza muviri.

Iye zvino zvatinoziva kuti muviri unogona kuona sei kushungurudzika nenzira dzakasiyana-siyana, tinogona kukurukura kuti zvii zvinogadzirisa nguva dzose zvinogona kuve nehutano hwakanaka uye hukama hwakanaka. Kana muviri ukaiswa pasi pekunetseka, kuburikidza nemimwe nzira yakataurwa pamusoro apa, kurwiswa kwemuviri kana kupindura kwechikwata kunokonzerwa. Tsitsi dzinotyisa, kana SNS, dzinokurudzirwa, izvo zvinoita kuti mwoyo unorove nekukurumidza uye yese yeshungu dzomuviri dzinowedzera. Iyi ndiyo nzira yekudzivirira yakasara kubva panguva yekufananidzira; iyo ndiyo chikonzero chatakaponesa kusvikira nhasi, panzvimbo yekudya kwemasikati kune avo vanofa nenzara kunze kwemusango.

Zvinosuruvarisa, nyaya chaiye ndeyekuti mune zvevanhu vemazuva ano, vanhu vanowanzodzvinyirirwa uye muviri wemunhu haugone kusiyanisa pakati pekutyisidzira kwakangoerekana kwaitika uye kushamwaridzana kwevanhu vari nyore. Kwemakore akawanda tsvakurudzo dzakawanda dzakaitwa kuenzanisa kuitika kwekusingaperi kushungurudzika pamuviri wemunhu, nemigumisiro yakafanana nehuwandu hwehutachiona, huwandu hwehutano hwemwoyo uye kukanganisa mishonga yemisvo pamwe chete nezviratidzo zvehutambudzo shure uye sciatica.

Maererano nezvimwe zvidzidzo zvekutsvakurudza, kubatanidza kushandiswa kwekushungurudza maitiro uye maitiro nemaitiro akasiyana-siyana ekurapwa kunogona kubatsira kunyatsobudirira zviratidzo uye zvinogona kukurudzira kukurumidza kuwana. Chiropractic kuchengetedza inonyanya kuzivikanwa mamwe mushonga mushonga unoshandiswa mukurapa zvakasiyana-siyana zvekukuvadzwa uye / kana mamiriro ehutachiona hwehutachiona uye hwekutya. Nokuti chiropractic mishonga inotarisa pamusana, iyo midzi yenheyo yenyoka, chiropractic inogonawo kubatsira nekunetseka. Pakati pemigumisiro yekushungurudzika kunetsa, izvo zvingadaro zvinotungamirira kumagumisiro kana kusanzwisiswa kwepamusoro. Kugadziriswa kwepamuviri uye nzira dzekushandisa zvinogona kubatsira kuderedza kushungurudzika kwemaviri, izvo zvinoita kuti kuderedza kunetseka kune dzimwe nzvimbo dzomumumhanya uye kunobatsira kugadzirisa kusagadzikana. Kuenzanisa kwakakosha chinhu chinonyanya kukosha chekutarisana nemanzwiro emunhu. Sezvambotaurwa, chirongwa chakakodzera nekurara zvakakwana chikamu chinokosha chekutarisira kushungurudzika, icho chiropractic kuchengetedza inopa maitiro ekuchinja mararamiro ekuvandudza mararamiro emurwere pamwe nekuderedza zviratidzo zvavo.

Chinangwa chechinyorwa chiri pasi apa ndechekuratidzira tsvakurudzo yekuongorora yakagadzirwa kuenzanisa mishonga inobatanidza uye inoshandiswa nemishonga inowanikwa mupfungwa-muviri kurapwa nokuda kwokurwadziwa kusingaperi. Muedzo wakatarwa unongororwa wakanyatsotarisirwa uye zvakasara kubva pakutsvakurudza kwakaitwa zvakanyorwa pasi apa. Sezvimwe nezvimwe zvidzidzo zvekutsvakurudza, humwe humwe uchapupu hunobva kune humwe hunogona kudiwa kuti huongorore zvakajeka kuitika kwekushungurudzika kwepfungwa nekurapa kwekunzwa kurwadziwa.

Kufananidza kweKubatanidza uye Kwakasiyana Mushonga neyakajairika Pfungwa Body Therapies yeChisingararame Kudzoka Pain: Protocol yeMafungiro Muviri Anosvika Kurwadziwa (MAP) Randomized Inodzorwa Trial

ngovepo

kumashure

Kuzvimiririra kwehutano uye hutano hwehupenyu hwevanhu vane marwadzo ekurwa muUnited States zvakaramba mumakore achangopfuura, pasinei nekuwedzerwa kwemari yemari yekuwedzera nekuda kwedambudziko iri. Kunyange zvazvo vane moyo murefu mupfungwa dzakadai sekutenda-kwakabatana, maitiro uye maitiro ekutevedzera zvakaratidzwa kuti zvive nehutano hwekuti varwere vanoita sei mukurapwa kwehutambudzo shure, vashoma varwere vanowana kurapwa kunogadzirisa zvinhu izvi. Kuchengetedza-behavioral therapy (CBT), iyo inotarisana nehutano hwezvepfungwa, yakawanikwa iine hutano hwehutano hwemarwadzo, asi kuwanika kune vakagadzirirwa vakagadzikana hazvina kukwana. Imwe nzira yekurapa ine mikana yekugadzirisa nyaya dzepfungwa, pfungwa-based based stress (MBSR), iri kuwedzera kuwanikwa. MBSR yakawanikwa ichibatsira pamamiriro ezvinhu akasiyana-siyana epfungwa uye mumuviri, asi haina kuongororwa zvakanyatsoenderana nekushandiswa nevarwere vasingaperi vanorwadziwa. Muchiitiko ichi, tichaedza kutsvaga kana MBSR inoshanda uye ine mari inoshandiswa kurapa kwevanhu vane marwadzo asingagumi, kuenzanisa nekubudirira kwayo uye mari inobudirira kana ichienzaniswa neC CBT uye kuongorora mamiriro ezvinhu ehupfungwa anokwanisa kutarisana nemigumisiro yeBSSR uye CBT pamigumisiro yevarwere.

Nzira / Kubwinya

Muchiitiko ichi, tichaita kuti vanhu vakuru ve397 vasina nhamo yekushungurudzika kusingagumi kune CBT, MBSR kana kuti maoko ekuchengetedza (99 neboka). Zvose zvinopindira zvichaita masere evhiki nevhiki 2-maawa masangano masangano anobhadharwa nemitambo yeimba. Iyo MBSR protocol inosanganisirawo kusarudzwa kwemaawa 6-awa. Vabvunzi vakavhara kumabasa ekurapa vachaongorora zviitiko 5, 10, 26 uye mavhiki e52 mushure mekuita. Mhedzisiro yepamusoro ichava nekurwadziwa-kwakabatana nemiganhu yekushanda (yakabva paRandand Disability Questionnaire) uye chiratidzo chinotyisa (yakarongwa pamusoro pe0 kusvika ku10 kuverenga nhamba yechiyero) pamasvondo e26.

hurukuro

Kana MBSR inowanikwa kuva inoshanda uye ine mari inoshandiswa kurapa chirwere kune varwere vane kurwadziwa kusingaperi, ichava kuwedzerwa kwepamusoro kune zvishoma zvinoshandiswa pakushandiswa zvinowanika kuvarwere vane huwandu hwehupfungwa hwehupfungwa hunokonzera kurwadziwa kwavo.

Trial Registration

Clinicaltrials.gov Chizivo: NCT01467843.

Keywords: Kushungurudza kumashure, Kuziva-mufambiro wehutachiona, Kufungisisa pfungwa

kumashure

Kuziva zvirwere zvinoshandiswa zvinodhura zvehutano husingaperi huri shure (CLBP) rinoramba riri dambudziko kune vanachiremba, vatsvakurudzi, vateresi uye varwere. Inenge $ $ 26 inoshandiswa gore rega rega muUnited States muhutano hwehutano hwehutano hwehutano hwemarwadzo [1]. Muna 2002, inofungidzirwa mari yekurasikirwa nevashandi kuburitswa nekuda kwekunzwa kurwadziwa kwaiva $ 19.8 bhiriyoni [2]. Pasinei nezvisarudzo zvakawanda zvekuongorora nekurapa kurwadziwa shure, pamwe nekuwedzerwa kwekurapa kwezvokurapa zvakagadzirirwa dambudziko iri, hutano uye hutano hwevanhu vane marwadzo ekurwa muUnited States zvakaderera [3]. Uyezve, vose vanotarisira nevarwere havagutsikani nehuwandu hweiyo [4-6] uye vanoramba vachitsvaka nzira dzakanakisisa dzokurapa.

Pane humbowo hwakasimba hwekuti varwere vane hutano hwepfungwa, sekutenda kwakanangana nekurwadziwa, mafungiro uye maitiro ekutsungirira, zvinogona kukanganisa zvakanyanya ruzivo rwekurwadziwa nemhedzisiro yaro mukushanda [7]. Huno humbowo hunoratidza kukosha kwekukosha kwekurapa kwekushungurudza kumashure uko kunogadzirisa zvese pfungwa nemuviri. Kutaura zvazviri, ina yechisere yeaspharmacologic kurapwa inokurudzirwa neAmerican College yeVanachiremba uye neAmerican Pain Society nhungamiro yekuramba uchirwadziwa shure inosanganisira mind body components [8]. Imwe yemishonga iyi, kugona kwekuziva-maitiro ekurapa (CBT), inosanganisira zvinhu zvepfungwa - zvakaita sekuzorora uye zvakawanikwa zvichibatsira pamatambudziko akasiyana siyana ekurwadziwa, kusanganisira kurwadziwa musana [9-13]. CBT ndiyo yakanyanya kushandiswa kurapwa kwepfungwa nevarwere vane kurwadziwa kusingaperi. Imwe yekurapa-pfungwa kurapa, kufunga-kwakavakirwa kuderedzwa kunetseka (MBSR) [14,15], inotarisana nehunyanzvi hwekudzidzisa kuwedzera pfungwa. MBSR pamwe nehukama hwakanangana nehungwaru hwakawanikwa huchibatsira kune hwakawanda hutano hwepfungwa nemuviri, kusanganisira kurwadziwa kusingaperi [14-19], asi hazvina kunyatso dzidziswa nezvekurwadziwa kusingaperi musana [20-24] . Iwo mashoma mashoma madiki ekuyedza miedzo akaongorora kushanda kweMBSR yemarwadzo ekumusana [25,26] uye zvese zvakataurwa kuvandudzwa kwekutambudzika kwekurwadziwa [27] kana kugamuchirwa kwevarwere kwekurwadziwa [28,29].

Kuenderera mberi nekutsvagisa nezve kuenzanisa kwekuita uye mutengo-kugona kwepfungwa - munhu kurapwa kunofanirwa kuve kwekutanga mukutsva kwekurwadziwa kumashure nekuda kwezvikonzero zvinotevera: (1) hukuru hwehukama uye hwemagariro hwehurombo husingaperi hwekurwadziwa, (2) kugona kune mwero kwezvazvino. kurapwa, (3) mhedzisiro yakanaka yemiyedzo mishoma umo vatsvaguriri vakaongorora kurapa kwepfungwa - munhu wese wemarwadzo ekudzokera shure uye (4) kukura kuri kuwedzera nekuchengeteka, pamwe nemutengo wakaderera, wepfungwa dzemunhu. Kubatsira kuzadza iri gakava reruzivo, tiri kuita muyedzo wakasarudzika kuti tiongorore kushanda, kuenzanisa kushanda uye mutengo-unoshanda weMBSR neboka CBT, zvichienzaniswa neyakajairwa kurapwa chete, kune varwere vane kurwadziwa kusingaperi kwemarwadzo.

Mazano chaiwo

Zvinangwa zvedu zvakananga nemafungiro avo anoenderana zvakataurwa pasi apa.

1. Kuti uone kana MBSR inogadzirisa zvakajeka kutarisirwa kwechiremba kwevanhu vane CLBP
Hypothesis 1: Vanhu vanongoratidzirwa kuMBSR dzicharatidza hukuru kwenguva refu (8 uye vhiki dze26) uye kwenguva refu (mavhiki e52) kubudirira muhutano hwehutano hwemabasa, marwadzo anorwadza nezvimwe zvinogumuchirwa nehutano kupfuura izvo zvakasarudzwa kuti zvirambe zvichiramba zvichengetwa chete .
2. Kuenzanisa kushanda kweMBSR uye boka reBBT mukuderedza marwadzo ekudzokera shure- zvinoenderana nezviitwa uye kurwadziwa kunonetsa
Hypothesis 2: MBSR ichave inoshanda zvakanyanya kupfuura yeboka CBT mukuderedza maronda-ane hukama zviitiko zvekutadza uye kurwadziwa kunetsekana mune zvese zvenguva pfupi uye kwenguva refu. Pfungwa yeiyi hypothesis yakavakirwa pa (1) kugona kune mwero kweCBT yekurwadziwa kusingaperi kunowanikwa muzvidzidzo zvakapfuura, (2) mhedzisiro yakanaka yekushomeka kwekutanga kutsvagurudza kuongorora MBSR yekurwadziwa kusingaperi uye (3) humbowo huri kukura hwekuti chikamu chakakosha chekudzidziswa kweMBSR (asi kwete kudzidziswa kweCBT) yoga inoshanda pakurwadziwa kusingaperi kwemusana.
3. Kuziva vamiririri vezvimwe zviitiko zvakaratidzwa zveMBSR neboka re CBT pamarwadzo ane chokuita nekurwadziwa uye kusuruvara kunetseka
Hypothesis 3a: Migumisiro yeBMBS pamiganhu yezviitiko uye kurwadziwa kunotambudza kuchapindirana nekuwedzera mukufunga uye kubvuma kurwadziwa.
Hypothesis 3b: Migumisiro yeBBCT pamiganhu yezviitiko uye kurwadziwa kunorwadza kuchapindirana nekushandurwa mukurwadziwa-kunokonzera kugadziriswa (kunopera mukushungurudza, zvitendero kuti munhu akaremara nemarwadzo uye zvinotenda kuti kurwadziwa kunoratidza kukuvadza, uyewo kuwedzerwa mukutonga kunzwisiswa pamusoro pekutambudzika uye kuzvidzora -kugadzirisa kugadzirisa marwadzo) uye kuchinja mukudzivirira mafungiro (kushandiswa kwakawedzerwa kwekuzorora, kushivirira kwebasa uye kugadzirisa kuzvitaura-zvinyorwa uye kushandiswa kuderera kwezororo).
4. Kufananidza kubhadhara mari-yehutano hweBMBS neboka re CBT sechigadziriswa kune zvekuchengetwa kwevanhu vese vane kurwadziwa kusingaperi
Hypothesis 4: Vose MBSR uye boka re CBT richava shanduro dzinoshandiswa mari dzinoshandiswa pakuchengetwa kwemazuva ose.

Tichaongorora zvakare kana zvimwe zvirwere zvemuviri zvinofanotaura kana kuenzanisa mishonga yekurapa. Semuenzaniso, tichaongorora kana varwere vane huwandu hwakanyanya hwekuora mwoyo hazvikwanisi kuvandudza pamwe ne CBT ne MBSR kana kuti varwere vakadaro vanogona kubatsirwa neBBCT kudarika kubva ku MBSR (kureva kuti, kana chirwere chekuora mwoyo chiri muongorori wemishonga ).

Nzira / Kubwinya

tsananguro

Tiri kuitisa kiriniki yakasarudzika muyedzo umo vanhu vane CLBP vanogoverwa zvisina kurongwa kuboka CBT, boka reboka reMBSR kana kutarisirwa kwese kwoga (Mufananidzo 1). Vatori vechikamu vachateverwa kwemavhiki makumi mashanu nemaviri mushure mekuita zvisina kujairika. Vabvunzi venhare vakavharidzirwa kune avo vanotora chikamu - mabasa ekurapa anoongorora mhedzisiro 52, 4, 8 uye 26 mavhiki postrandomization. Mhedzisiro mhedzisiro yatinozoongorora ndeyekurwadziwa-zvine chekuita nezviitiko kutadza uye kurwadziwa kunetseka. Vatori vechikamu vanozoziviswa kuti vaongorori vezvidzidzo vari kuenzanisa maviri akasiyana-siyana anoshandiswa marwadzo ekuzvidzora-zvirongwa zvakawanikwa zvichibatsira mukuderedza marwadzo uye kuita kuti zvive nyore kuita zviitiko zvezuva nezuva .

Mufananidzo 1 Flowchart weChirongwa cheChirongwa

Mufananidzo 1: Flowchart yemutambo protocol. CBT, Cognitive-behavioral therapy; MBSR, Mindfulness-based stress stress.

Purogiramu yekuedzwa iyi yakagamuchirwa neHuman Subjects Review Committee yeBlue Health Cooperative (250681-22). Vose vatori vechikamu vanozodikanwa kupa chibvumirano chavo chinyorwa vasati vanyora muchidzidzo ichi.

Dzidza Sample nekuisa

Icho chinonyanya kutora vatori vechikamu chekuedza uku chichave che Group Group Cooperative (GHC), sangano-rekufananidzira, risingaiti-re-profit-care organization iro rinoshumira pamusoro pe600,000 rinyoresa kuburikidza nedzimba dzayo dzokutanga dzokutarisira mu Washington. Sezvo zvichidikanwa kuti uwane zvinangwa zvekugadzirira, tsamba dzekunyorera dzichaendeswa kune vanhu 20 kusvika kumakore emakore e70 vanogara munzvimbo dzinoshandiswa neGHC.

Kubatanidzwa neChirangaridzo Criteria

Tiri kutora vanhu kubva pamakore makumi maviri kusvika makumi manomwe ekuberekwa avo marwadzo ekumusana akaenderera kwemwedzi mitatu. Maitiro ekubatanidza uye ekuregedza akagadziridzwa kuti awedzere kunyoreswa kwevarwere vakakodzera vachiongorora varwere vane marwadzo ekudzokera kumashure ehumwe hunhu (semuenzaniso, spinal stenosis) kana hunhu hwakaomarara kana ndiani anganetse kupedzisa matanho ekudzidza kana kupindira ( semuenzaniso, psychosis). Zvikonzero zvekuregererwa kwenhengo dzeGHC zvakaonekwa pahwaro hwe (20) otomatiki dhata yakanyorwa (vachishandisa iyo International Classification yezvirwere, yechipfumbamwe Revision coding system), panguva dzese dzekushanya pamusoro pegore rapfuura uye (70) kubvunzurudzwa kwekukodzera kunoitwa runhare. Kune vasiri-nhengo dzeGHC, zvikonzero zvekuregererwa zvakaonekwa pahwaro hwekubvunzurudzwa parunhare. Matafura 3 uye? 1 nyora maitiro ekubatanidza uye ekuregedzera, zvichiteerana, pamwe nepfungwa dzechimwe nechimwe chirevo uye nekwavo ruzivo.

Mukuwedzera, tinoda kuti vatori vechikamu vave vanoda uye vanokwanisa kuenda kumakirasi eBBCT kana MBSR panguva yeC8-vhiki yekupindira iyo iyo inopiwa kune rimwe remishonga iyoyo, uye kupindura kumibvunzo mina yekutevera kuitira kuti tigone kuongorora mhinduro.

Nzira dzeKutsvaga

Nekuti kupindira kwekudzidza kunosanganisira makirasi, tiri kutora vatori vechikamu mumapoka gumi ane vanhu vanosvika makumi mana nevashanu mumwe nemumwe. Tiri kutora vatori vechikamu kubva kumatatu makuru: (1) Nhengo dzeGHC dzakashanyira avo vanovapa pekutanga kurwadziwa kwekurwadziwa kwepashure uye kurwadziwa kwavo kwakaramba kuripo kwemwedzi mitatu, (3) nhengo dzeGHC dzisina kushanya wavo wekutanga wekutarisira kurwadziwa musana asi vari pakati pemakore makumi maviri nemakumi manomwe emakore uye vanopindura kune yedu isingarongedzerwa kutumira tsamba kweGHC kana kushambadza kwedu muGHC s kaviri-gore magazini uye (2) vagari vemunharaunda vari pakati pemakore makumi maviri nemakumi manomwe. makore anopindura akananga tsamba yekunyorera tsamba.

Kune yakatarwa GHC huwandu, mugadziri anoshandisa GHC s manejimendi uye kiriniki emagetsi dhatabhesi kuti aone vanogona kuve vanokodzera mitezo nekushanya mune yapfuura 3 kusvika 15 mwedzi kune mupi uyo akagumisa kuongororwa kunowirirana neasinga tsanangurike kurwadziwa kwekuseri. Nhengo idzi dzeGHC dzinotumirwa tsamba uye yekutarisa yekutarisa iyo inotsanangura izvo kudzidza uye kukodzera zvinodiwa. Nhengo dzinofarira kusaina kutora chikamu uye vanodzosa chirevo chinoratidza kuda kwavo kusangana navo. Nyanzvi yekutsvagisa inobva yadaidza anogona kutora chikamu kuti abvunze mibvunzo; sarudza kukodzera; kujekesa njodzi, zvakanakira uye kuzvipira kunotarisirwa kuchidzidzo; uye kumbira kubvumirwa kune ruzivo. Mushure mekubvumidzwa kwakaziviswa kubva kune iye munhu, kuongororwa kwekutanga kwenhare kunoitwa.

Kune vasiri nhengo yeGHC (iyo inoreva, nhengo dzeGHC dzisingashanyi nemarwadzo ekudzokera shure mushure mokunge dzakatarirwa mukati me3 kusvika kumwedzi we15 asi avo vanogona kunge vane kurwadziwa kwakanyanya kwepamusoro), mupurogiramu anoshandisa hutungamiri nemakiriniki emagetsi ehurumende kuti aone avo vanogona kukodzera nhengo dzaive kwete muzvikamu zvakarongwa zvakatsanangurwa mundima yapfuura. Iyi vagari inosanganisirawo nhengo dzeGHC dzinopindura kune chikwata mumagazini yeGHC. Nzira imwechete dzinoshandiswa kune vanhu vakatarwa dzinoshandiswa kuonana uye kuongorora avo vanogona kuita, kuwana chibvumirano chavo chekuziva uye kutora dheedheni yekutanga.

Nezvemunharaunda vagari venyika, takatenga mazita emazita neateri yesarudzo yakasarudzwa yevanhu vanogara munzvimbo yedu yekushandira iyo iri pakati pe20 uye 70 yemakore. Vanhu vari pane zvakatumirwa vanotumirwa zvakananga ema mail mapepadhi anotsanangura kuongorora kusanganisira mashoko pamusoro pekutaurirana nevashandi vekudzidza kana vachifarira kupinda. Pane imwe nguva munhu anofarira akaonana neboka rekutsvakurudza nzira imwe chete yakataurwa pamusoro apa inoteverwa.

Kuchengetedza kuti vose vakatanga kuongororwa vachipinda kudzidza vanogona kukodzera panguva iyo makirasi anotanga, avo vanobvuma kupfuura mazuva e14 vasati vatanga masangano ekupindira vachadzokorora anenge 0 kune mazuva 14 vasati vatanga kirasi kuti vadzokezve kuti vanofanirwa. Chinonyanya kukosha ndechokubvisa vanhu vasingasviki zvishoma nezvishoma zvinyorwa zvitsanangudzo zvekurwadziwa kushungurudzika uye kushungurudzwa kunorwadza nemabasa. Vanhu ivavo vanogara vakakodzera uye kupa chibvumirano chavo chekupedzisira chichagoverwa mubvunzo wekutanga.

Randomization

Mushure mekupedza ongororo yekutanga, vatori vechikamu vanozoitwa zvakasarudzika zvakaenzana kune iyo MBSR, CBT kana yakajairwa boka rekutarisira. Ivo vakasarudzika kune MBSR kana CBT boka havazoziviswa nezverudzi rwavo kurapwa kusvikira vasvika kumakirasi ekutanga, anozoitika panguva imwe chete muchivako chimwe chete. Boka rekupindira rinozopihwa pachishandiswa makomputa-akagadzirwa akateedzana manhamba akasarudzika achishandisa chirongwa chinoona kuti kugoverwa hakugone kuchinjwa mushure mekusarongeka. Kuti uve nechokwadi chekuyera pane yakakosha yekutanga fungidziro yechinhu, kusarongeka kuchasimbiswa zvichienderana neyedu yekutanga mhedzisiro yekuyera mudziyo: iyo yakashandurwa vhezheni yeRoland Disability Questionnaire (RDQ) [30,31]. Ticharongedza vatori vechikamu muzvikamu zviviri zvekukanganisa zviitiko: zvine mwero (RDQ mamaki? 12 pachiyero che 0 kusvika 23) uye yakakwira (zvikoro zveRDQ? 13). Vatori vechikamu vanozoitwa zvakasarudzika mukati meaya mabara mumatombo ehukuru hwakasiyana (vatatu, vatanhatu kana vapfumbamwe) kuve nechokwadi cheyakaenzana asi isingafungidzirwe kupihwa kwevatori vechikamu. Munguva yekutora, iyo biostatistician yekudzidza ichagamuchira huwandu hwakaenzana hwevatori vechikamu vakasarudzika kuboka rega rega kuti vimbise kuti preprogrammed randomization algorithm iri kushanda nemazvo.

Kudzidzira Kurapa

Zvose mbiri dzeboka re CBT neBhuku reMatS rine mavhiki masere ega yevhiki 2-maawa masangano anotsiviwa nemabasa epamba.

Kufungisisa-Kwakadzika Kunetseka Kwepfungwa

Kufungisisa-kwakavakirwa kuderedzwa kwekushushikana, chirongwa chemakore makumi matatu chekurapa chakagadzirwa naJon Kabat-Zinn, inotsanangurwa mushe mumabhuku [30-32]. Vanyori vekuchangobva kuitika meta-ongororo vakawana kuti MBSR yaive nehuremu hwekuita masimba ekuvandudza hutano hwepanyama uye hwepfungwa hwevarwere vane hutano hwakasiyana siyana [34]. Yedu MBSR chirongwa chakanyatsoteedzerwa pane yekutanga uye inosanganisira sere vhiki nevhiki 16-awa makirasi (akapfupikiswa muTafura 2), 3-awa kudzoka pakati pevhiki 6 ne6 uye kusvika pamaminetsi makumi mana nemashanu pazuva rekudzidzira kumba. Yedu MBSR protocol yakashandurwa nemudzidzisi mukuru weMBSR kubva mubhuku ra7 MBSR rekudzidzisa rinoshandiswa paUniversity yeMassachusetts [45]. Iri bhuku rinobvumidza rusununguko mune kuti varairidzi vanounza sei kufunga uye maitiro ayo kune vatori vechikamu. Iwo ekupa uye zvekudzidzira zvekumba zvigadzirwa zvakaenzana pachidzidzo ichi.

Tafura 3 Content ye CBT uye MBSR Class Sessions

Tafura 3: Nyaya yemagariro-maitiro therapy uye pfungwa-based based stress reduction sessions sessions.

Vatori vechikamu vachazopihwa pasuru yeruzivo mukirasi yekutanga inosanganisira kosi yekutaura uye murayiridzi wekufambidzana ruzivo. ruzivo nezve kufunga, kufungisisa, hunyanzvi hwekutaurirana uye mhedzisiro yekushushikana pamuviri, manzwiro uye maitiro; mabasa epamba; nhetembo; uye bhuku rebhaibheri. Masangano ese anosanganisira kurovedza muviri, uye zvese asi zvekutanga zvinosanganisira iyo yoga kana mamwe mafambiro ekufambisa. Vatori vechikamu vachazopihwa odhiyo marekisheni enjere uye maitiro eyoga, ayo anozove akanyorwa nevadzidzisi vavo. Vatori vechikamu vanokumbirwa kudzidzira iwo matekiniki anokurukurwa mukirasi yega yega zuva nezuva kusvika pamaminetsi makumi mashanu nemashanu mukati menguva yekupindira uye mushure memakirasi apera. Ivo zvakare vanozopihwa kuverenga kuti vapedze pamberi pekirasi yega yega. Nguva ichave yakapihwa mukirasi yega yega kuongorora zvematambudziko izvo vatori vechikamu vakave nazvo mukuita zvavakadzidza mumakirasi apfuura uye nebasa ravo rechikoro. Zuva rekuzvipira rekudzidzira paMugovera pakati pemakirasi echitanhatu neechinomwe achapihwa. Iyi -retreat yemaawa matanhatu ichaitwa nevatori vechikamu chinyararire uye chete murairidzi achitaura. Izvi zvinopa vatori vechikamu mukana wekudzamisa izvo zvavakadzidza mukirasi.

Kuchengetedza-Maitiro Anorwara

CBT yekutambudzika kusingaperi inotsanangurwa zvakanaka mumabhuku uye yakawanikwa iine mwero kunyatsoshanda pakuvandudza matambudziko anorwadza asingagumi [9-13]. Hapana humwe humwe hunoenderana, hunoenderana nehutano hwe CBT hwehutano husingaperi, kunyange zvazvo maitiro ese eC CBT anobva pakufungidzira kuti zvose kugadzirisa uye kugadzirisa mafambiro kunokonzerwa nekurwadziwa kusingaperi uye kuti maladaptive cognition uye mufambiro zvinogona kuonekwa uye kuchinjwa kuti kuwedzere chirwere chekushanda [36]. CBT inotsigira nzira dzakashanda, dzakarongeka kudzidzisa varwere nzira yekuziva, kuongorora uye kuchinja mafungiro emadadaptive, manzwiro nemafambiro, nekuisa pfungwa pakubatsira varwere kuwana unyanzvi hwavanogona kushandisa kune zvinetso zvakasiyana-siyana uye kubatana pakati pemurwere nemushonga. Nzira dzakasiyana-siyana dzinodzidziswa, kusanganisira kudzidziswa muhutano hwekudzidzira kurwadziwa (somuenzaniso, kushandiswa kwakanaka kwekuzvidzivirira-zvinyorwa, kushungurudzika, kunonoka uye kugadzirisa matambudziko). CBT inokurudzirawo kugadzirisa uye kushanda kune zvinangwa zvekuita.

Zvose mafambiro evanhu neboka zvakashandiswa muBBCT. Boka reC CBT rinowanzotora chikamu chakakosha chezvirongwa zvekurapa zvinorwadza marudzi akawanda. Tichashandisa mapepa eboka reC CBT nokuti rawanikwa richibudirira [37-40], rinowedzera mashizha kune hutachiona hwega uye rinopa varwere vane zvingabatsira zvinobva pakusangana nazvo, uye kutsigirwa nekukurudzirwa kubva kune vamwe vane zviitiko nezvinetso. Mukuwedzera, kushandisa maitiro eboka kweMBSR uye CBT ichagumisa maitiro ekupindira sechinhu chinogona kutsanangurwa chekusiyana kupi kunoonekwa pakati pemishonga mbiri.

Pachidzidzo ichi, takagadzira bhuku rakadzama rerapi nezvakanangana nechikamu chega chega, pamwe nebhuku rebasa revatora chikamu rine zvinhu zvekushandisa muchikamu chega chega. Isu takagadzira bhuku remurapi uye mabhuku evatori vechikamu anotorwa kubva pane zviripo zvakaburitswa zviwanikwa pamwe nezvezvinhu zvatakashandisa muzvidzidzo zvisati zvaitika [39-47].

Kupindira kweBBT (Tafura 3) ichave nemasere masere evhiki maviri-awa masystem ayo anozopa (2) dzidzo nezve iro basa remaladaptive otomatiki pfungwa (semuenzaniso, kukanganisa) nekutenda (semuenzaniso, kugona kwemunhu kudzora kurwadziwa, zvinokuvadza zvakaenzana zvinokuvadza) zvakajairika muvanhu vane kushushikana, kushushikana uye / kana kurwadziwa kusingaperi uye (1) kuraira uye kuita mukuziva uye kupokana nepfungwa dzisina kunaka, kushandiswa kwehunyanzvi hwekumisa kufunga, kushandiswa kweakanaka kukurira kuzvitaurira -kuzvimirira uye kugadzirisa-chinangwa , maitirwo ekuzorora uye kurarama nemarwadzo kuputika. Kupindira kunosanganisirawo dzidzo nezve chiitiko chekufamba uye kuronga uye nezve kudzokazve kudzivirira uye kugadzirisa zviwanikwa. Vatori vechikamu vachapihwa odhiyo marekodhi ezororo uye emifananidzo maitiro uye vanokumbirwa kumisikidza zvinangwa maererano nezororo ravo tsika. Pakati pechirongwa chega chega, vatori vechikamu vanozopedzisa chirongwa chega chega chezviito kuti zviitwe pakati pezvikamu. Aya marongero anozoshandiswa se matanda ekumisikidza chaiwo maitiro epamba uye kutarisa zviitiko zvakaitwa mukati mevhiki kuti zviongororwe musangano unotevera wevhiki.

Usual Care

Iboka rinowanzo chengetwa rinogashira chero kurapwa kwavanowanzo gashira panguva yekudzidza. Kuti kuderedze kuora mwoyo kunogona kuitika nekusagadziriswa kurapwa kwepfungwa, vatori vechikamu muboka iri vanowana muripo we $ 50.

Chikoro Sites

Makirasi eCBCT neBSSR achaitwa munzvimbo dzakasvikidzwa nevanhengo dzeGHC muWestern State (Bellevue, Bellingham, Olympia, Seattle, Spokane uye Tacoma).

Vadzidzisi

Vose vadzidzisi veMBS vachave vakagamuchira dzidzo yakadzidziswa mukudzidzisa MBSR kubva kuCent for Mindfulness kuYunivhesiti yeMassachusetts kana kudzidziswa kwakaenzana. Ivo pachavo vachave vashandi vekufunga kwemaviri uye chirango chinotungamirirwa nemuviri (somuenzaniso, yoga), vachave vakadzidzisa MBSR kare uye vachave vakagadzirira kufunga kwechinhu chikuru cheupenyu hwavo. Kubatsira kweBCT kuchaitwa nevechiremba-level clinical psychologists nevekare mune ruzivo kupa CBT kuvarwere vane kurwadziwa kusingaperi.

Kudzidzira nekuongorora Vadzidzisi

Varairidzi vese veCBT vachadzidziswa muprotocol yekudzidza yeCBT yekupindira nevekuongorora vanoongorora nezvepfungwa (BHB neJAT), avo vane ruzivo rwekupa CBT kuvarwere vane kurwadziwa kusingaperi. BHB ichatarisira varairidzi veCBT. Mumwe wevatsvagiri (KJS) anodzidzisa varairidzi veMBSR mune yakatemwa MBSR protocol uye nekuvatarisa. Mudzidzisi wega wega anozoenda kumisangano yekutarisa vhiki nevhiki, iyo inosanganisira kukurukura zviitiko zvakanaka, zviitiko zvakashata, kunetsekana kwakasimudzwa nemurairidzi kana vatori vechikamu uye kutendeka kweprotocol. Kurapa kutendeseka zvinyorwa zvekutarisa zvinoratidza zvakakosha zvikamu zvechikamu chega chega zvakagadzirirwa iwo ese maCBT nemaMBSR maoko. Nyanzvi yakadzidziswa yekutsvagisa inoshandisa iyo yekutendeseka yekutarisa panguva yekutarisa kwega kwega chikamu. Nyanzvi yekutsvagisa ichapa mhinduro kumutariri kuti afambise kutarisa kwevhiki nevhiki kwevadzidzisi. Uye zvakare, ese zvikamu zvichave odhiyo-yakanyorwa. Iwo manejimendi anoteerera kune yakasarudzika sampuro uye vakakumbira zvikamu zvemasangano uye vanozovatarisa ivo vachishandisa kutendeka yekutarisa. Mhinduro dzinozopihwa kune varairidzi panguva yavo yekutarisa vhiki nevhiki. Kutendeseka kwekurapa kunozoongororwa mumapoka ese ekupindira neKJS neBHB nerubatsiro kubva kune nyanzvi dzekutsvaga. Uye zvakare, ivo vanozoongorora uye nekuyera pane yekutendeka yekutarisa muyedzo wakasarudzika wezvikamu zvakanyorwa.

Kubata Mumiririri Mutevedzeri uye Kuenderana Nekuita Kumba

Vagari vemunharaunda vachagamuchira chiyeuchidzo foni pamberi pekirasi yokutanga uye chero pavanosuwa kirasi. Vachakumbirwa kunyoresa maitiro avo emisha zuva nezuva pamatombo evhiki nevhiki. Mibvunzo pamusoro pemishandiro avo emusha munguva yevhiki yapfuura ichabatanidzwawo mumibvunzo yose yekutevera. Kuti urambe uchibvunzurudza nekupofumadza, mibvunzo yekuteerera ichabvunzwa mushure mokunge zvose zvabuda zvakagadziriswa.

Nzira

Isu tichaongorora dzakasiyana siyana dzevatori vechikamu maitiro, anosanganisira sociodemographic hunhu, kumashure kurwadziwa nhoroondo uye tarisiro yekubatsira kwepfungwa- munhu kurapwa kwekurwadziwa kumashure (Tafura 4).

Tichaongorora nheyo yemigumisiro yevarwere vane chirwere chepamuviri (basa rekudzokera shure, marwadzo, hutano hwehutano, basa hwekuremara kwebasa uye kugutsikana kwechigarire) [48] iyo inopindirana neChitatu cheMatenhe, Chiyero, uye Kuongorora Kwemarwadzo muKliniki Miedzo inokurudzirwa kwekliniki miedzo yekusingaperi kurwadziwa kushanda kubudirira uye kubudirira [49]. Tichayera zviitiko zvenguva pfupi (masikati 8 uye 26) nemigumisiro yenguva refu (vhiki dze52). Tichazobatanidzawo pfupi, 4-vhiki, kuongorora kwepakati pekutendera kubvumira kuongororwa kwevanopindirana vanofunga nezvemigumisiro ye MBSR uye CBT pane zvinotanga kuitika. Pfungwa yekupedzisira yekudzidza ndiyo mavhiki e26. Vadzidzi vanozobhadharwa $ 20 pane imwe nhaurirano yekutevera yakazadzikiswa kuti kuwedzere mitemo yekupindura.

Co Primary Mhedzisiro Matanho

Iwo epamberi mhedzisiro matanho anozove kumashure-zvine chekuita nezviitiko kutadza uye musana kurwadziwa kunetseka.

Kudzoka-zvine chekuita nezviyero zvezviitiko zvinoyerwa pamwe neakagadziridzwa RDQ, iyo inobvunza kana 23 chaiyo zviitiko zvave zvakaganhurirwa nekuda kwekurwadziwa kumashure (hongu kana kwete) [30]. Isu takagadzirisazve RDQ kuti tibvunze mubvunzo nezve svondo rapfuura pane kungoti nhasi . Iyo yekutanga RDQ yakawanikwa yakavimbika, inoshanda uye inonzwisisika kuchipatara shanduko [31,48,50-53], uye inokodzera manejimendi manejimendi uye kushandisa nevarwere vane zvine mwero zviito zvekuita [50].

Kutambudzika kwekudzokera shure kunoyerwa nekukumbira vatori vechikamu kuti vaone kuti kushungurudza kwavo musana kwave kunetsa sei mukati mevhiki yapfuura pachiyero che 0 kusvika 10 (0? =? kwete kunetsa uye 10? =? Botherzvinonyanya kunetsa ). Pamusoro pe data rakanyorwa kubva kuboka rakafanana renhengo dzeGHC dzine marwadzo ekumashure, takawana ichi chiyero chekushushikana kuti chiwirirane kwazvo ne0 kusvika 10 chiyero chekurwadziwa zvakanyanya (r? =? 0.8 kusvika 0.9; isina kunyorwa data (DCC neKJS ) uye nezviyero zvekushanda uye zvimwe zvabuda zviyero [54]. Kuvimbika kwenhamba yekuyera zviyero zvekurwadziwa zvakanyatsonyorwa, uye zviyero zvakadaro zvakaratidza kunzwisisika pakuona shanduko mukurwadziwa mushure mekurapwa [55].

Tichaongorora nekumhan'ara zvibodzwa zvekutanga nenzira mbiri. Chekutanga, kune edu ekupedzisira magumo ekuongorora, isu tichafananidza zvikamu zvevatori vechikamu mumapoka matatu ekurapa vanozadzisa kiriniki kuvandudza kunobatsira (? 30% kuvandudzwa kubva pakutanga) [56,57] panguva yega yega poindi (ine 26-vhiki yekutevera-kumusoro kuva pekupedzisira pekupedzisira). Tichazoongorora, mune yechipiri mhedzisiro yekuongorora, izvo zvakagadziriswa zvinoreva kusiyana pakati pemapoka pane izvi matanho panguva yekutevera.

Secondary Outcome Measures

Mhedzisiro yechipiri yatinozoyera nayo inodzvinyirira zviratidzo, kushungurudzika, kushungurudzwa kwebasa rinoshungurudza, kushandiswa kwenyika nekurapa, kushandiswa kwemishonga yekurwadziwa shure, huwandu hutano hwehutano nemigumisiro yepamusoro.

Zviratidzo zvinoshungurudza zvichaongororwa nePatient Health Questionnaire-8 (PHQ-8) [58]. Kunze kwekubviswa kwemubvunzo pamusoro pekuzviuraya, PHQ-8 yakafanana neyo PHQ-9, iyo yakawanikwa yakavimbika, inobvumirana uye inobvuma kuchinja [59,60].

Kuzvidya mwoyo kuchaenzaniswa neC2-item Generalized Anxiety Disorder scale (GAD-2), iyo yakaratidza hukuru hwekunzwisisa uye humwe hunoonekwa mukuona kusagadzikana kwepfungwa kunowanikwa munharaunda yekuchengetedza vanhu [61,62].

Kurwadziwa-kwakabatana zviitiko zvekupokana nezviitwa zvezuva nezuva zvichaongororwa uchishandisa zvinhu zvitatu kubva kuGraded Chronic Pain Scale (GCPS). Iyo GCPS yakave yakasimbiswa uye yakaratidzirwa kuve neakanaka psychometric zvivakwa mune yakakura huwandu hwevanhu uye mune makuru masampula evakuru ekuchengetedza varwere vane kurwadziwa [63,64]. Vatori vechikamu vanozobvunzwa kuyera zvinhu zvitatu zvinotevera pachiyero che0 kusvika gumi: kwavo kwazvino kurwadziwa musana (kurwadziwa musana ight now), kurwadziwa kwavo kwekushure mumwedzi wapfuura uye neavhareji yavo yemarwadzo pamusoro pemwedzi wapfuura.

Kugadziridzwa kwepasirese nemushonga kuchayerwa neMurwere Global Impression of Change sikero [65]. Uyu mubvunzo mumwechete unobvunza vatori vechikamu kuti vaone kuvandudza kwavo nemushonga pachiyero chemapoinzi manomwe kubva pane "zvakanyanya kuvandudzwa" kusvika pa "zvakanyanya kuipa," pasina "shanduko" inoshandiswa senge midpoint. Kuyera kwepasirese kwekuvandudzwa nemushonga kunopa chiyero chekiriniki kubatsirwa kubva pakurapwa uye kunoonekwa seimwe yemhedzisiro mhedzisiro domains mumarwadzo emakiriniki ekuedzwa [7].

Kushandisa mishonga uye kurovedza muviri kunorwadza shure munguva yevhiki yapfuura kuchaongororwa nemibvunzo ye 8-, 26- uye 52-week.

Nenzira yehutano yehutano ichaongororwa neC12-item Short Form Form Survey (SF-12) [66], chiridzwa chakashandiswa zvikuru chinopa zvinyorwa zvishoma zvehutano hwepanyama uye hwepfungwa. SF-12 inoshandiswawo kuverenga hupenyu-hwakashandurwa-makore-QALYs achishandisa Shanduro Yemafuro Ehutano Hwehutano mumakiromita e6 mukudhura-kubudirira kwekuongorora [67].

Mhedzisiro mhedzisiro inozoyerwa nemibvunzo yakavhurika. Isu takasanganisira mibvunzo yakavhurika mumiedzo yedu yapfuura uye takaona kuti vanopa ruzivo rwakakosha mumanzwiro evatori vechikamu nezvekukosha kwezvimwe zvinhu zvekupindira pamwe nekukanganisa kwekupindira pahupenyu hwavo. Saka isu tichasanganisira mibvunzo yakavhurika pamusoro penyaya idzi pakupera kwema 8-, 26- uye makumi mashanu nemaviri evhiki yekutevera hurukuro.

Miitiro Inoshandiswa Murevereri Anotsvaga

Muchikwata cheMBSR, tichaongorora kuwirirana kwekuwedzera kwefungwa (kuyerwa neArereactivity, Kucherechedza, Kuita nekuziva, uye kusatonga kwechimwe chikamu cheS Five Facet Mindfulness Questionnaire pfupi fomu [68-70]) uye kuwedzerwa kurwadziwa kwepamusoro (kuenzaniswa ne The Chronic Pain Acceptance Questionnaire [71,72]) pamitambo yekutanga. Muchikwata cheBBCT, tichaongorora kugadziriswa kwekuvandudzwa kwekutenda kwekutambudzika uye / kana kuongororwa (yakaenzaniswa neMibvunzo Yezvokurapa Kuzvigadzirisa [73]; Kuongorora Kwepfungwa Maonero 2-Chigadziro Chezvinhu, Chiremara, uye Makuvadza [74 -76]; uye Maitiro Okurwadziwa Kwepfungwa [77-80]) uye kuchinja mukushandiswa kwezvirwere zvekurwadziwa (zvinotaridzwa neHigh Chronic Pain Coping Inventory 2-item Relaxation scale uye yakakwana yeAction Pacing scale [81,82] pane migumisiro. Kunyange zvazvo tichifunga kuti migumisiro yeBMBS neC CBT pamusoro pemigumisiro yekubatanidza nemhando dzakasiyana-siyana, tichaongorora migumisiro yevashanduri vose vanogona kubuda mumapoka maviri ekurapa.

Miitiro Inoshandiswa Mukudhura-Kubudirira Kuongorora

Kutungamira mari ichafungidzirwa kushandisa mari inodonhedzwa kubva kumagetsi ezvigadzirwa zvemagetsi ehutano hwakabhadharwa hupiro hwakapiwa huripo kana huripo neGHC uye kubva kumigumo yevarwere yekutarisirwa isina kuvharwa neGHC. Nzira dzisinganzwisisiki dzichafungidzirwa kushandiswa kweBasa Rokuita uye Bhuku Rekunyora Kwemabasa [83]. Kubudirira kwekupindira kuchabva kune SF-12 huwandu hwehutano hwehutano hwepamusoro [84].

Data Collection, Quality Control uye Confidentiality

Dhiyabhorosi ichaunganidzwa kubva kune vatori vechikamu nevanodzidziswa nefoni vachidzidzira vachishandisa kombiyuta inobatsirwa nhare yekombiyuta (CATI) yemibvunzo yejeti kuti kuderedza zvikanganiso nekushayikwa kwedata. Mibvunzo pamusoro pezvakaitika nezvimwe zviitiko zvekugadziriswa (somuenzaniso, yoga, kufungisisa, kurairirwa mumagadzirirwo ekugadzirisa) izvo zvingadanha vvunzurudzo kumapoka emishonga zvichabvunzwa panguva imwe neimwe pfungwa pashure pezvimwe zviitiko zvakati zvarongororwa. Tichaedza kuwana zvakagadziriswa kubva kune vose vatori vechikamu mukutongwa, kusanganisira avo vasingambopindi kana kubuda mumakirasi, avo vanorega kunyoresa muurongwa hwehutano nevaya vanoenda. Vaparidzi vasingatauri pakuedzazve kuwana data yekutevera nefoni vanotumirwa mubhuku remibvunzo iyo inongowanikwa chete miviri yekugadzirisa matanho uye yakapa $ 10 yekupindura.

Isu tichaunganidza ruzivo pane imwe nhanho yekugadzirira, kurasika uye kurapa kuitira kuti tikwanise kuudza murwere kupera maererano neCONSORT (Consolidated Standards of Reporting Trials) mirayiridzo [85]. Kuti urambe uine hutano hwehutano hunoenderana-nehutano mu database, nhamba dzakasiyana-siyana dzekudzidza dzichashandiswa kuzivisa zvinogadziriswa nemigumisiro yehutano. Nzira dzekudzidza dziri munzvimbo yekuvimbisa kuti vashandi vose vakagadzikana vacharamba vakavharwa kuboka rekurapa.

Kudzivirirwa kweVatori vechikamu zvevanhu uye Kuongorora kweKachengeteka

Kudzivirirwa kweVadzidzi vevanhu

GHC Institutional Review Board (IRB) yakagamuchira chidzidzo ichi.

Kuchengetedzwa kwekuchengetedza

Uyu muedzo uchaongororwa nekuda kwekuchengetedzwa neDean and Safety Monitoring Board (DSMB) yakazvimirira yakagadzirwa nechiremba wekutanga wekuchirumbira anoyeuka mupfungwa, biostatistician uye kliniki yepfungwa uye ruzivo mukurapa varwere vane kurwadziwa kusingaperi.

Zvakaipa Zvakaitika

Tichaunganidza data pane zvakasangana nezviitiko (AEs) kubva kune akati wandei masosi: (1) mishumo kubva kune veCBT uye veMBSR varairidzi veavo vese vatori vechikamu zviitiko zvekuvashungurudza; (2) iyo 8-, 26- uye 52-vhiki CATI yekuteedzera kubvunzurudzwa umo vatori vechikamu vanobvunzwa nezve chero kukuvara kwavakanzwa panguva yekurapwa kweCBT kana MBSR uye chero matambudziko ehutano akakomba avakave nawo mukati menguva dzakatarisana; uye (3) mishumo yepamoyo kubva kuvatori vechikamu. Vanoongorora mari yeprojekti uye weGHC wekutanga anotarisira internist anoongorora mishumo yeAE kubva kunzvimbo dzese vhiki nevhiki. Chero maAE akakomba anozotaurwa nekukurumidza kuGHC IRB uye neDSMB. MaEE ayo asiri akakomba anozonyorwa uye anowanikwa mumishumo yenguva dzose yeDSMB. Chero chero kufa kwakazivikanwa kwevatori vechikamu kunozoziviswa kune DSMB sachigaro mukati memazuva manomwe ekuwanikwa, zvisinei nekupihwa.

Kuisa Mitemo

Dare racho richavharwa chete kana DSMB inofunga kuti kune ngozi inogamuchirwa yeAEs yakaoma mune imwe kana kupfuura mamwe emishonga. Muchiitiko ichi, DSMB inogona kusarudza kubvisa chimwe chemaoko ekutongwa kana yese yekuedzwa.

Matanho Matanho

Sample Size uye Kuonekwa Kusiyana

Saizi yedu yekuenzanisira yakasarudzwa kuti ive nesimba rakaringana rekuona musiyano wakakosha pakati peumwe neumwe wemapoka maviri ekurapa pfungwa neboka rekuchengetedza, pamwe nesimba rekuona musiyano wakakura pakati pemapoka maviri ekurapa pfungwa. Nekuti takafunga kushivirira kwekuita kwevarwere kuve kwakanyanya kukoshesa maviri edu epamberi mhedzisiro matanho, isu takavakira yedu yekuyera saizi kuverenga pane yakashandurwa RDQ [30]. Isu takadudza saizi yedu yekuenzanisira pahwaro hweperesenti inotarisirwa yevarwere vane kiriniki inovandudzika inoyerwa neiyo RDQ pakuongorora kwemasvondo makumi maviri nematanhatu (ndiko kuti, ingangoita 26% inoenderana neyekutanga) [30].

Nekuda kwekuenzanisa kwakawanda, isu tinoshandisa Fisher's kuchengetedzwa kushoma musiyano bvunzo [86], kutanga ongorora kana paine chero musiyano wakakosha pakati pemapoka ese matatu (uchishandisa omnibus? 2 mukana weyero bvunzo) kune wega mhedzisiro uye yega nguva poindi. Kana isu tikawana mutsauko, isu tobva tayedza yematanho akapesana pakati pemapoka. Tichada 264 vatori vechikamu (88 muboka rega rega) kuwana 90% simba rekutsvaga kurapwa kwepfungwa kwakasiyana neyakajairwa kutarisirwa paRDQ. Izvi zvinotora kuti makumi matatu kubva muzana eboka rinowanzo chengetwa uye 30% yeboka rega rega rekurapa pfungwa richava nekuvandudzika kwechipatara paRDQ pamasvondo makumi maviri nematanhatu, zviyero zvekuvandudza izvo zvakafanana neizvo zvatakaona muhurombo hwevanhu kumashure. kuongororwa kwekuwedzera uye kumwe kurapa kwekurwadziwa kumashure [55]. Tichava neinenge 26% simba rekuona musiyano wakakura pakati peMBSR ne CBT paRDQ kana MBSR ingangoita makumi maviri muzana poindi inoshanda kupfuura CBT (ndokuti, 87% yeboka reMBSR maringe ne80% yeboka reCBT) .

Yedu imwe co primary mhedzisiro marwadzo ekunetseka chiyero. Tiine huwandu hwesampula hwevatori vechikamu mazana maviri nemakumi mana nevatanhatu, tichava ne264% simba rekuona musiyano uripakati peboka rekurapa pfungwa nekuchengetwa kwakajairwa pachiyero chekunetseka, tichifungidzira kuti 80% yekuchengetwa kwakajairwa uye 47.5% yeavo munhu wepfungwa. boka rekurapa rine makumi matatu kubva muzana kana kuwedzerazve kuvandudzwa kubva pane yekutanga pane marwadzo ekunetseka chiyero. Tichava nesimba rinosvika makumi masere muzana kuti tione musiyano wakakura pakati peMBSR neCBT pachiyero chekunetsa kana MBSR ingangoita 69.3 muzana poindi inoshanda zvakanyanya kupfuura CBT (kureva, 30% yeboka reMBSR maringe ne80% yeCBT. boka).

Kana tichiongorora mhedzisiro yekutanga senge matanho anoteedzana, tichava ne90% simba rekuona musiyano we2.4-poindi pakati pekuchengetwa kwese uye chero kurapwa kweyemunhu pane yakagadziriswa RDQ zviyero uye 1.1-poindi musiyano pakati peyakajairwa hanya uye chero pfungwa kurapwa kwemuviri pakurwadziwa kunetseka chiyero cheyero (inofungidzira zvakajairika kuenzanisa nzira mbiri dzekuzvimiririra nemisiyano yakaenzana uye maviri-mativi P? =? 0.05 kukosha kwakaringana nekutsauka kwakajairwa kwe5.2 uye 2.4 yeRDQ nematanho ekutambudza matanho, zvichiteerana [88] Tichifunga kuti kurasikirwa kwe11% kunotevera (zvishoma zvishoma pane izvo zvakawanikwa mumiedzo yedu yepamberi yekurwadziwa), isu tinoronga kutora muenzaniso wevatori vechikamu 297 (99 paboka).

Ose ari maviri epamberi mhedzisiro anozoedzwa paP?

Statistical Analyzes

Primary Analyzes

Mukuenzanisa kwedu nemishonga inobva pamigumisiro yemigumisiro, tichazoongorora zviongororwo zvinongororwa panguva dzose dzekutevera-nguva mumuenzaniso mumwe chete, kugadzirisa kuti zvigone kuwirirana mukati mevanhu uye mapoka emakambani ekurapa achishandisa kuenzanisa kuenzanisa kuenzanisa [89]. Nokuti hatigoni kuita zvinonzwisisika pamusoro pekupesana kweboka nguva dzose kana kwemazuva, tinozobatanidza izwi rekubatana pakati pemapoka ekurapa uye nguva dzenguva. Tinoronga kugadzirisa hutsika hunotangira hutsika, zvepabonde nezera, pamwe chete nedzimwe nheyo dzepakutanga dzakagadzikana kuti dzisiyane zvikuru neboka rekurapa kana zviitiko zvekutevera, kuvandudza kunyatsogwinya uye simba rekuyera kwedu kuongororwa. Tichaita sarudzo inotevera yekutsvakurudza kune zvose zvinopfuurira mugumisiro uye mugumisiro webhanary (kuchipatara chinoshanduka kubva kubva pakutanga), kusanganisira nguva dzose dzekutevera (4, 8, 26 nevhiki dze52). Mushonga weBSSR uchaonekwa uchibudirira chete kana 26-vhiki nguva yekuenzanisira inokosha. Dzimwe nguva pfungwa dzinofanirwa kuongororwa sechipiri chekuongorora.

Tichashandisa chinangwa chekuita-kutarisa mune zvese kuongorora; ndiko kuti, kuongorora kwevanhu pachavo kuchaongororwa neboka rakarongeka, pasinei nekubatanidzwa mune zvidzidzo. Kuongorora uku kuderedza kusagadzikana kunowanzoitika apo vatori vechikamu vasingagamuchiri kurapwa vakapiwa havakwanisi kuongororwa. Iyo yekudzorera muenzaniso ichava mune fomu inotevera inotevera:

Kuzvidzora Mutevedzeri Mukuru Fomu

uko yt iri mhinduro panguva yekutevera-nguva t, hwaro hwekutanga ndeyekufungidzira kukosha kwechiyero chemhedzisiro, kurapwa kunosanganisira dummy misiyano yeboka reMBSR uye CBT, nguva inoteedzana yemhando dzakasiyana dzinoratidza nguva dzekutevera uye z is a vector yecovariates inomiririra zvimwe zvinoshandurwa. (Cherekedza kuti? 1,? 2,? 3 uye? 4 mavecitor.) Boka rakasarudzika mumuenzaniso uyu iboka rinowanzo chengetwa. Nezvemabhinari uye zvinoramba zvichiitika, isu tinoshandisa yakakodzera link mabasa (semuenzaniso, logit yebhanari). Kune yega yega yekutevera-nguva nguva iyo iyo omnibus? 2 bvunzo ine huwandu hwakakosha, isu tichaenderera mberi kuti tione kana paine musiyano pakati peMBSR nekuchengetwa kwese kugadzirisa chinangwa 1 uye mutsauko pakati peMBSR neCBT kugadzirisa chinangwa 2. Tichataura zvakare kuenzaniswa kweCBT kune akajairwa kutarisirwa. Kana uchiona kana MBSR iri yekurapa kunoshanda kwekurwadziwa kumashure, isu tinoda icho chinangwa 1, kuenzaniswa kweMBSR nekuchengetwa kwese, kunofanirwa kucherechedzwa.

Pachikonzero chemuedzo wedu wekare wemarwadzo ekudzokera shure, tinotarisira zvishoma kana 89% kutevera uye, kana izvozvo zvichinyatsoitika, kuongorora kwedu kwekutanga kuchave kuongororwa kwakakwana, kusanganisira zvose zvakachengetwa zvinotevera. Kunyange zvakadaro, tichagadzirisa maitiro ose ekutanga emakambani ayo ari ekufananidzira kwekupedzisira, mikana yavo yekushayikwa uye kusiyana pakati pemapoka ekurapa. Nokugadzirisa mavhesi ekutanga aya, tinofunga kuti izvo zvisiri izvo zvakagadziriswa dambudziko remuenzaniso wedu zvinoshayikwa pasina (zvakapiwa kuti nheyo yekutanga yekare inofanirwa kushandiswa kwematongerwo emitemo) panzvimbo yekushayikwa zvachose pasina. Tichaitawo kuongorora tsanangudzo kuburikidza nekugadzirisa nzira yezvisizvo zvisingaverengeki kuti tione kana zvigumisiro zvedu zvakasimba zvakakwana kuti tibhadhara zvakasiyana-siyana zvisingambofungi zvido zvekare [90].

Murevereri Anotsvaga Kana MBSR kana CBT inowanikwa ichishanda (maererano nekuchengetwa kwemazuva ose uye / kana kune mumwe kune mumwe) mukuvandudza zvimwe zvikamu zvekutanga pa26 kana mavhiki e52, tichaenda kune chinangwa che 3 kuti tione vamiririri vemigumisiro yeBMBS neboka re CBT pane RDQ uye kurwadziwa kunorwadza. Tichaita rutsva rwekugoverana kunotsanangurira zvakasiyana nezvezvikamu zviviri zvinokosha (RDQ nemarwadzo zvinotambudza zvakawandisa zvikwata) uye kune imwe neimwe yakasiyana yekurapa muenzanisi wezvakada (kunyanya kutarisirwa neBBCT, kutarisirwa kwechirongwa pamwe ne MBSR uye CBT kune MBSR). Tichaitisa muongorori akaenzana wekwenyanzvi weZ26- uye 52-vhiki dzekupedzisira (kana MBSR kana CBT inowanika kuti inoshanda panguva iyoyo maonero).

Tevere, isu tinotsanangura zvakadzama muyananisi kuongorora kweye-26-vhiki nguva poindi. Kuongorora kwakafanana kuchaitwa kweiyo 52-vhiki nguva poindi. Isu tichaisa hwaro hweyakanyanya kushandiswa nzira yaBaron naKenny [91]. Kana tangoratidza kushamwaridzana pakati pekurapwa uye mhedzisiro inoshanduka (iyo total mhedzisiro yekurapa pane mhedzisiro), danho rechipiri rinenge riri rekuratidzira kusangana pakati pekurapwa uye neumwe neumwe anoisa muyananisi. Tichavaka regression modhi yemumwe murevereri neiyo 4- kana 8-vhiki mamaki emurevereri seyakatsamira kusiana uye chikamu chekutanga chemuyananisi uye chiratidzo chekurapa sezvakasiyana kuzvimiririra. Tichaita ongororo iyi kune mumwe nemumwe anogona kunge ari muyananisi uye tichasanganisira sevangangodaro muyananisi mune inotevera nhanho chete avo vane P-kukosha? 0.10 yehukama nemushonga. Nhanho yechitatu ichave yekuratidza kudzikiswa kwemhedzisiro yekurapa pane mhedzisiro mushure mekubvisa mhedzisiro yevarevereri. Tichavaka multimediator inverse mukana wehuremu (IPW) regression modhi [92]. Maitiro aya anozotibvumidza isu kufungidzira zvakanangana nemhedzisiro yekurapa mushure mekuenzanisazve mapoka ekurapa maererano nevamiririri. Kunyanya, isu tichatanga kuenzanisira mukana wemhedzisiro yekurapa, zvichipiwa varevereri (ndokuti, vese varevereri vakawanikwa vachibatana nekurapwa mudanho rechipiri), vachishandisa kudzikisira zvinhu uye kugadzirisa kwevanogona kuvhiringidzika vekutanga. Tichishandisa iyi modhi, isu tinowana mukana unofungidzirwa wekuti munhu wega wega akagamuchira kurapwa kunoonekwa, zvichipiwa kukosha kwemurevereri. Isu tinobva tashandisa IPW kudzokorodza ongororo kuenzanisira mhedzisiro mhedzisiro pane chinzvimbo chekurapa uku tichigadzirisa kumatunhu ekutanga emhedzisiro uye murevereri. Kufananidza iyo yakaremerwa modhi neisina kuremerwa modhi kunotibvumidza isu kufungidzira kuti yakawanda sei chaiyo mhedzisiro mhedzisiro yekurapa pane inoenderana mhedzisiro inogona kutsanangurwa neese anogona mutongi. Iko kuiswa mune nhanho 2 yevarevereri vese vanoonekwa kuve kwakakosha padanho rechipiri kuchatigonesa kuongorora kana misiyano yakatarwa yataifungidzira yaizopatsanura mhedzisiro yeMBSR inopesana neCBT ichitopindirana mhedzisiro yekurapa kwega pasina zvinokanganiswa zvimwe kugadzirisa kusiana .

Kudhura-Kubudirira Kunotsvakurudza

Maonero ehurongwa hwemagariro emunhu mutengo weuongorori (CUA) huchaitwa kuti kuenzanise mari inowanda yemagariro yakaratidzwa kune imwe neimwe ruoko rwekurapa (mari dzakananga dzekurapa dzakabhadharwa neGHC uye mutori wechikamu pamwe nemari yekugadzira) kuita basa rakakura maererano neshanduko yevatori vechikamu QALYs [ 93]. Kuongorora uku kunogoneka chete kune vatori vechikamu vakatorwa kubva kuGHC. Iyi CUA inogona kushandiswa nevagadziri vezvematongerwo enyika vane chekuita nekugoverwa kukuru kwe zviwanikwa zvine chekuita nehutano [94,95]. Nezve iwo muripo maonero, akananga ekurapa mitengo (kusanganisira yekupindira mutengo) ichaenzaniswa neshanduko muQALYs. Iyi CUA ichatibatsira kuona kuti zvinoita here kuti hupfumi hweMBSR huve basa rakadzoserwa pakati pevanhu ava. Nzira yebhootstrap ichashandiswa kuyera nguva dzekuvimba [96]. Mune ongororo yechipiri yakaitiswa kuongorora kunzwisisika kwemhedzisiro kune akasiyana madudziro emitengo, senge fungidziro dzakasiyana dzemitero yemubairo inoshandiswa kukoshesa kugadzirwa uye kuiswa kweasina-back-zvine chekuita nezvehutano - zviwanikwa , ichatarisirwawo. Mukuongorora kunodhura-kunoshanda, isu tinoshandisa chinangwa chekurapa uye kugadzirisa ekushandisa-ekuchengetedza mashandisirwo emashandisirwo mune rimwe gore rekarenda usati wanyoresa uye nematanho ekutanga angangobatanidzwa neboka rekurapa kana mhedzisiro, senge kushandiswa kwemushonga, kudzora vanogona kuvhiringidza. Isu tinotarisira kuti kuchave neinoshomeka dhata, asi kunzvera kuongororwa (sezvakatsanangurwa pamusoro pemhedzisiro mhedzisiro) ichaitwawo kuongorora matanho emitengo.

Dr Jimenez White Coat

Dr. Alex Jimenez's Insight

Kushungurudzika ndechokuti muviri unopindura sei mumuviri kana mupfungwa. Zvimwe zvinhu zvinogona kukonzera kushungurudzika, izvo zvinozoita kuti "kurwisana kana kutizaza" kupindurwa, chirongwa chekudzivirira chinogadzirisa muviri nekuda kwekuona njodzi. Paunomanikidzirwa, hurongwa hwekutambudzika hunosimudzirwa uye hunovanza kusanganiswa kwemahomoni nemakemikari. Kushungurudzwa kwenguva pfupi kunogona kubatsira, kunyange kwenguva refu kushungurudzika kwakabatanidzwa kune zvakasiyana-siyana zvehutano, kusanganisira kurwadziwa shure uye sciatica zviratidzo. Maererano nekuongorora kwekutsvakurudza, kushandiswa kwepfungwa kunowedzera kukosha kune nzira dzakawanda dzekurapa nokuti kuderedza kuderedza kunogona kubatsira kuvandudza kurapwa kwemigumisiro. Chiropractic kuchengetedza inoshandisa kugadzirisa kwepelinha nekugadzirisa manzwiro pamwe chete nemararamiro ehupenyu hwekuita kuti mushonga wechipfuva, mudzi wehutachiona hwepamusoro, pamwe nekukurudzira kuderedzwa kwepfungwa kuburikidza nekudya kwakakwana, kufanana uye kurara.

hurukuro

Mune ino muyedzo, isu ticha tsvaga kuona kana iri kuwedzera inokurumbira nzira yekubata nekushushikana -kufunga-kwakavakirwa kushushikana kwekutemesa i inoshanda uye inodhura kurapa sarudzo kune vanhu vane chirwere chisingaperi chisingarware shure. Nekuda kwekutarisa kwayo pfungwa pamwe nemuviri, MBSR ine mukana wekugadzirisa zvimwe zvezvepfungwa nezvehukoshi izvo zvakakosha kufungidzira kwemhedzisiro yakaipa. Mune muyedzo iyi, isu tichafananidza kushanda uye mutengo-unoshanda weMBSR neiyo yeCBT, iyo yakawanikwa ichishanda pakurwadziwa kumashure asi isingawanikwe zvakanyanya. Chidzidzo ichi chichaongororawo misiyano yepfungwa nehunhu iyo inogona kupindirana nemhedzisiro yeMBSR uye CBT pamhedzisiro yevarwere. Kana MBSR ikaonekwa iri inoshanda uye inodhura kurapa sarudzo kune vanhu vane kurwadziwa kusingaperi kwemusana, chichava chiwedzerwa chakakosha kune nzira dzekurapa dzinowanikwa kune varwere vane zvakakosha zvepfungwa vanopa kune dambudziko iri.

Chimiro Chimiro

Kubhadhara kwakatanga muna August 2012 uye yakapedzwa muna April 2014.

Abbreviations

AE: Chiitiko chakaipa; CAM: Mishonga inobatanidza uye inoshandiswa; CATI: Kubvunzana nefoni kubatsirwa nefoni; CBT: Kuchenjera-kwetsika kurapwa; CLBP: Kusingaperi kurwadziwa kunorwadza shure; CUA: Kuongorora kweutengo; DSMB: Dhata uye Yekuchengetedza Monitoring Board; GHC: Boka Hutano Kubatana; ICD-9: Kuratidzwa Kwepasi Pose Kwezvirwere Rechipfumbamwe Revision; IPW: Inverse mukana wehuremu; IRB: Institutional Ongorora Bhodhi; MBSR: Kufungisisa-kwakavakirwa kuderedzwa kunetseka; NCCAM: National Center yeComplementary uye Imwe Mishonga; QALY: Hupenyu-hwakagadziriswa hupenyu-gore.

Kukwikwidzana Kufarira

Vanyori vanotaura kuti havana kukwikwidzana.

Vanyori Mipiro

DC uye KS yakagadzirirwa kuedza. DC, KS, BB, JT, AC, BS, PH, RD uye RH vakabatanidzwa pakugadzira zvidzidzo nekugadzirisa nekugadzirisa zvinhu uye pakusarudzwa kwemigumisiro yemiganho. AC yakagadzira zvirongwa zvekuverenga inotsanangura. JT neAAC vakagadzirira zvirongwa zvemuongororori. BS, BB uye JT vakagadzira zvigadzirwa zvebato re CBT. PH yakagadzirirwa zvirongwa zvekubhadhara mari-kubudirira. DC yakanyora bhuku racho. Vose vanyori vakabatanidzwa mukunyora kwebhuku racho uye vakaverenga uye vakabvuma magwaro ekupedzisira.

KUTENDA

Sangano reNational Center for Complementary and Alternative Medicine (NCCAM) rakapa mari yekuyedza uku (kupihwa R01 AT006226). Dhizaini yekutongwa uku yakaongororwa uye yakatenderwa neNCCAM's Hofisi yeKiriniki uye Yezvekutonga Zvinhu.

Mukupedzisa, zvakatipoteredza, mumuviri uye kushungurudzika mupfungwa zvinogona kukonzera "kurwa kana kupindura kwendiza" mukutarisira kugadzirira muviri wemunhu nenjodzi. Kunyangwe kushushikana kuchikosha kuti tiwedzere mashandiro edu, kushushikana kusingaperi kunogona kuve nemhedzisiro yakaipa mukufamba kwenguva, kuratidza zviratidzo zvine chekuita nemarwadzo kumashure uye sciatica. Chiropractic kuchengetedza inoshandisa nzira dzakasiyana dzekurapa, pamwe nemaitiro ekudzvinyirira uye matekinoroji, kubatsira kudzikisira kushushikana pamwe nekuvandudza uye kugadzirisa zviratidzo zvine chekuita nekukuvara uye / kana mamiriro e musculoskeletal uye nervous system. Nervous Ruzivo rwunotsanangurwa kubva kuNational Center for Biotechnology Ruzivo (NCBI). Chiyero cheruzivo rwedu chinogumira kuchiropractic pamwe nekukuvara kwepamuviri nemamiriro. Kuti ukurukure nyaya yacho, ndapota inzwa wakasununguka kubvunza Dr. Jimenez kana kutibata nesu pa 915-850-0900 .

Yakarongedzwa naDkt Alex Jimenez

Zvimwe Zvinyorwa: Kubva Painini

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CHINOKOSHA CHINOKOSHA: KUDZIDZA KUNYANYA: Anokufadza Iwe!

ZVIMWE ZVINOKOSHA ZVINOKOSHA: KUTAURA: Kukuvara Kwemitambo? | Vincent Garcia | Mwoyo murefu | El Paso, TX Chiropractor

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Kushungurudzika Management & Kuderera Kudzoka Kwemarwadzo muEl Paso, TX

by spinedoctors | Kudzorera Pain, Physical Rehabilitation, Randomized Controlled Trial, Research Studies, Mishonga

Vanhu vanowanzozvidya mwoyo nguva dzose. Kubva kunetseka nezvemari kana basa kune zvinetso nevana vako kana zvimwe zvakakosha, kunyanya kunetseka pamusoro pemamiriro enyika, zvinogona kunyoresa sezvinetso zvevanhu vakawanda. Kushungurudzika kunokonzera zvose zvakanyanya (pakarepo) uye zvisingaperi (kwenguva refu) nhau dzehutano, kusanganisira kurwadziwa kwepamusoro, chiratidzo chinowanzoburwa kazhinji nevarwere vazhinji vanotambura nekugara vachizvidya mwoyo. Nenzira inofadza, hutano hwakasiyana-siyana hunoswedera pedyo, kusanganisira chiropractic kuchengetedza, hunogona kubatsira kuderedza zvose manzwiro nemigumisiro yekudzvinyirira, pakupedzisira nekutungamirira vanhu kuburikidza nehutano hwakanaka hwekugadzirisa matambudziko.

Zviratidzo zvepfungwa

Kushungurudzika kunokonzera kurwa kwemuviri kana kupindura kwemhepo. Iyo adrenaline inopera iwe unonzwa pashure pokunge uchinzwa inzwi guru ndeimwe yezvisizvo zvakasara zvemadzitateguru edu, achitya kuti ruzha rukuru urwu rwakabva pane chimwe chinhu chaida kuidya.

Kushungurudzika kunokonzera kuchinja kwemuviri mumuviri, kutanga neuropi. Iko mwoyo inowedzera uye inotanga kutungamirira ropa kune imwe migumo. Kunzwa uye maziso zvinowedzera. Uye zvipembenene zvinotanga kuvhara adrenaline senzira yekugadzirira muviri kuti uve nesimba. Izvi ndizvo chaizvo izvo "kumhanya kana kurwisa mhinduro" zvinoreva chaizvo.

Kana iwe uri kufamba uri woga usiku uye unonzwa tsoka dzako shure kwako, kurwisana kwekupindura kwemhepo kunogona kunge kunoshamisa kwazvo kubudirira kwako kune ngozi yako. Zvisinei, kana iwe uchinetseka kwenguva yakareba, izvi zvakadai zvinoita kuti uve nehutano hwakasiyana-siyana, hwakadai sehuwandu hwehutachiona hwehutachiona, chirwere cheshuga, hutachiona hwemajoni uye hutachiona hunokanganisa. Izvozvo ndezvokuti muviri wako hauzive kuti kune marudzi akasiyana ekutambudzika; inongoziva chete kuti kunetseka kunomiririra njodzi uye inopindirana maererano.

Kushungurudzika Kwepfungwa neChiropractic Care

Chiropractic kuchengetedza inogona kubatsira kuvandudza pamwe nekugadzirisa zviratidzo zvakawanda zvekunetseka. Ichi ndechokuti musana wechipfuva ndiwo midzi yenheyo yenheyo. Kugadziriswa kwepamuviri uye nzira dzekushandisa dzinodzivisa kurwisana kana kupindura kwechikepe kuburikidza nekugadzirisa chirongwa chepasyympathetic. Uyezve, chiropractic inogona kubvisa marwadzo uye kushungurudzika kwemumusimba, kuwedzera kupararira, uye kururamisa kwepasina kushandiswa. Izvo zvikomborero zvose zvinobatanidza nekudzikisa zviratidzo zvekunetseka, izvo zvinoita kuti kuderedza kusimbisa kwomurwere anonzwa.

A Well-Rounded Strategy

Chiropractors inotungamirira varwere vavo kuburikidza nekugadzirisa kwekutarisira kushungurudzika, zvinosanganisira kuchinja kwekudya, kurovedza muviri, kufungisisa, nekuzorora. Kudya kunovaka muviri kunogona kubatsira muviri kubata zvinhu zvakasiyana-siyana, kusanganisira kushungurudzika. Kutevera kudya kunowanikwa muzvibereko nemiriwo, maonda maprotestine, uye makurubahijidhi akaoma, ane zvishoma kudyiwa uye zvakagadzirirwa kudya, zvinogona kuchinja zvikuru hutano hwakanaka uye hukama. Kudzidzira muviri kunobatsira kugadzirisa kunetseka. Simba raunoshandisa kuburikidza nekurovedza muviri rinoderedza kukanganisa pamwe nesimba rekunetseka. Iyo inoburitsa endorphins, iyo inobatsira kusimudzira mafungiro. Yoga ndiyo inonyanya kukoshesa basa rekuita zvekubvisa kudzvinyirira.

Kufungisisa kunogona kuitwa nenzira dzakasiyana-siyana uye kunogona kuitwa nevanodzidza nezvehutano hwakasiyana-siyana. Kune vamwe, kunyora mubhuku nderudzi rwekufungisisa, nepo dzimwe dzakawanda zvekare mumagariro avo. Nzira dzakawanda dzekuzorora dzinobatana zvikuru nekufungisisa, zvakadai sekufema maitiro, kusunungura kushungurudzika kwemisungo, nekuteerera mimhanzi inonyaradza kana chimiro chemazwi.

Kudzidzira kupfurikidza kwakadzika uye kunopa kukurumidza kushungurudzika. Tanga nekugadzirisa zvishoma nezvishoma kuburikidza nemhino dzako, uchiverenga kusvika kumatanhatu uye kuderedza dumbu rako. Tora mweya wako kuti uwane nhamba yechina, uye usunungure mweya mukati memuromo wako, kuverenga kusvika kune matanhatu zvakare. Dzokorora ruzivo rwechitatu kusvika kune zvishanu.
Kusunungura mhirizhonga yemisvo kuburikidza nenzira inozivikanwa se "kufambira mberi kwemisimba yekuzorora". Tsvaga nzvimbo yakasununguka, kana ugare nemakumbo ako pasi, kana kurara pamusana wako. Shandisa nzira yako kuburikidza neboka rimwe nerimwe remasumbu, kutanga pamakona ako kana kuti musoro wako, kuvhara musumbu kwechiverengero chechishanu, uye ozosunungura. Chimirira 30 maminitsi uye ozoenda kune rimwe rinotevera musumbu boka. Kufunganya kuti unganyengedza sei misungo yechiso chako? Nokuda kwechiso, simudza maziso ako zvakakura sezvaunogona uye unzwe kushungurudza muhuma yako uye chibwe. Nokuda kwechikamu chepamusoro chechiso chenyu, svinura meso ako uye kumira kumhino yako nemuromo. Pakupedzisira, nokuda kwechiso chepamusoro, sunga mazino ako uye udzokere kumakona omuromo wako.
Kutinhira kunonzwika sezvinoitwa nenziyo yemimhanzi kana zvisikwa zvinonzwika kunobatsira kuponesa muviri uye uropi.

Kuchengetedza mararamiro akasiyana-siyana uyewo kusanganisira chiropractic kuchengetedza sekunetseka kwepfungwa mano inzira inobatsira yekuvandudza nekugadzirisa zviratidzo zvekunetseka. Kuderedza kudzvinyirira kunogona kupedzisira kubatsira kuchengetedza hupenyu hwako hwose.

Kufungisisa-Kwakagadzikana Kushungurudzika Kwepfungwa uye Kuchengetedza-Maitiro Anokonzerwa neHas Low Low Back Pain: Zvakafanana Nezvakanaka Pamusoro Pemafungiro, Kushungurudza, Kuzvigadzirisa uye Kugamuchirwa muRandomized Controled Trial

ngovepo

Kufungisisa-maitiro ekurapa (CBT) inofungidzirwa kuti inovandudza matambudziko esingaperi ekurwadziwa nekudzora murwere kukuvadza uye nekuwedzera kuzvishingisa kwevarwere kugadzirisa marwadzo. Kungwarira-kwakavakirwa kushushikana kwekudzikisira (MBSR) inofungidzirwa kuti inobatsira varwere vasingaperi vanorwadziwa nekuwedzera kufunga uye kurwadziwa kunogamuchirwa. Nekudaro, zvishoma zvinozivikanwa nezvekuti aya marapirwo ekushanduka masisitimu anoenderana sei kune mumwe nemumwe kana kuti akave nekusiyana kwakakanganiswa neMBSR inopesana neCBT. Mune muyedzo yakasarudzika inodzorwa kuenzanisa MBSR, CBT, uye kungochengetwa kwevakuru (UC) yevakuru vane makore 20-70 makore ane chirwere chisingaperi chisingarware shure (CLBP) (N = 342), takaongorora (1) hukama hwepakutanga pakati pezviyero zvekuparadza, kuzvifunga -kushanda, kugamuchirwa, uye kufunga; uye (2) shanduko pane aya matanho mumapoka matatu ekurapa. Pakutanga, kuparadza kwakabatanidzwa zvisina kunaka nekuzvigonesa, kugamuchirwa, uye 3 zvinhu zvekufunga (kusiri-kuita zvekare, kusatonga, uye kuita nekuziva; ese maP-maitiro <3). Kugamuchirwa kwaive kwakabatana zvakanaka pamwe nekuzvishingisa (P <0.01) uye kufunga (P-values <0.01) matanho. Kushungurudza kwakaderera zvishoma-mushure mekurapwa neMBSR pane ne CBT kana UC (omnibus P = 0.05). Marapirwo ese ari maviri aishanda achienzaniswa neUC mukuderedza kutapudza mumavhiki e0.002 (omnibus P = 52). Muzvose zviri zviviri sampuro yakasarudzika uye sub-sampuro yevatori vechikamu vakapinda? 0.001 ye6 MBSR kana zvikamu zveCBB, misiyano pakati peMBSR neCBB kusvika kumavhiki makumi mashanu nemaviri yaive mashoma, mashoma muhukuru, uye neanopokana kiriniki inoreva. Mhedzisiro yacho inoratidza kupindirana pamatanho ekuparadza, kuzvishingisa, kugashira, uye kufunga, uye mhedzisiro yakafanana yeMBSR uye CBT pane izvi matanho pakati pevanhu vane CLBP.

Keywords: kusingaperi kurwadziwa, kurwadziwa, kubvuma, kugamuchirwa, kuparadza, CBT, MBSR

ziviso

Kugadziriswa-behavioral therapy (CBT) yakaratidzwa kubudirira, uye inokurudzirwa zvikuru, nokuda kwezvinetso zvinorwadza zvinogara kwenguva refu. [20] Mishonga inokonzerwa nemafungiro (MBIs) inoratidzawo chivimbiso kune varwere vane kurwadziwa kusingaperi [12,14,25,44,65] uye kushandiswa kwavo nehuwandu hwevanhu kuwedzera. Kunzwisisa nzira dzekuita kwehutano hwepfungwa uye hutano husingaperi uye hunowanikwa mune izvi nenzira dzakasiyana-siyana dzakasiyana-siyana hunokosha pakuvandudza kushanda nekubudirira kwezvirapa izvi. [27,52] Nzira dzinokosha dzekuita kweBBCT nokuda kwekutambudzika kusingaperi dzinosara kuderera kunoparadza uye kuwedzera kuzvidzora kwega- [6-8,56] Kufunga kwakanyanya kunowanzoonekwa sechinhu chinonyanya kushandiswa kweMBIs, [14,26,30] iyo inowedzerawo kugamuchira kurwadziwa. [16,21,27,38,59] Zvisinei, zvishoma zvinonyatsozivikanwa nezvekambani pakati pemarwadzo ekurwadziwa, kuzvigadzirisa, kugamuchirwa, uye pfungwa pamberi pekushaya kurapwa kwepfungwa kana nezvekusiyana kwezviitiko zveBBCT zvichienderana nemaMI pane izvi zvinoshandiswa.

Kune humwe uchapupu hunoti hukama hunokosha pakati pehutano huripo hunosiyana. Uchapupu hwehukama huri pakati pekukanganisa nekufunga hunovhenganiswa. Zvimwe zvidzidzo [10,18,46] zvakawana kushamwaridzana kusina kunaka pakati pezviyero zvekutambudzika zvinoparadza uye pfungwa. Zvisinei, vamwe havana kuwana hukama hunokosha [19] kana masangano (inverse) pakati pekuvhiringidza uye zvimwe zvekufunga (kwete kutonga, kwete reactivity, nekuita nekuziva) asi kwete vamwe (semuenzaniso, kucherechedza). [18] Kutambura kwakaitika Izvozvakaziviswawo kuti zvinosanganiswa zvisina kunaka nekugamuchirwa kwemarwadzo. [15,22,60] Mukumera kwekurwadziwa kwekliniki, kugamuchirwa kwemazhinji kwezviitiko zvepfungwa kwakabatanidzwa zvakashata nekunetsa uye kunakidza nekufunga. [19] kurwadziwa kwekuita kwakaratidzwa kuti kwakabatana zvakanaka ne kugamuchirwa uye kusagadzikana nekuparadza. [22]

Zvakare zvinoratidzira kufambidzana nenzira dzakasiyana-siyana dzemishonga dzakasiyana-siyana dzepfungwa nezvekurwadziwa kusingaperi, kuwedzerwa mupfungwa [10] uye kugamuchirwa [1,64] zvakawanikwa mushure mekufungisisa-maitiro ekurwadziwa kwekutambudzika, uye kuderedzwa kwekukuvara kunowanikwa mushure mekufunga kwehutano-hutano hwehutano hwezvirongwa. [ 17,24,37] Tsvakurudzo shomanana yatsvaga migumisiro yeAIDS nokuda kwekutambudzika kusingaperi mukuzvipira, kunyange zvazvo chirwere chechidiki chekudzidza nezvemigraine varwere vakawana kuwedzerwa kukuru kwekuzvigadzirisa ne Mindfulness-Based Stress Reduction (MBSR) kudzidziswa kupfuura nekuchengetwa kwemazuva ose. [63] Hatina kukwanisa kuziva zvipi zvidzidzo zvehukama pakati pezvinhu izvi zvose zvinorapa zvinoshandiswa kana kuti zvekuchinja mune zvose izvi zvinoshandiswa ne CBT zvichienderana ne MBI yekurwadziwa kusingaperi.

Chinangwa chechidzidzo ichi chaiva chokudzorera uye kuwedzera tsvakurudzo yakashandiswa kuburikidza kushandisa data kubva muedzo unotarirwa nemaitiro (RCT) achienzanisa MBSR, CBT, uye kutarisirwa kwemazuva ose (UC) ye chronic low back back pain (CLBP) [12] kuongorora: (1) hukama hwepakutanga pakati pezviyero zvekutarisa uye kurwadziwa kunoparadza, kuzvigadzirisa, uye kugamuchirwa; uye (2) pfupi uye kwenguva refu kuchinja pane zviyero izvi mumapoka ekurapwa kwe3. Kubva pane zvidzidzo uye tsvakurudzo yapfuura, takafunga kuti: (1) pamusana pekutanga, kukanganisa kungave kwakapesana nekugamuchirwa, kuzviita, uye huwandu hwa 3 hwekufunga (kwete reactivity, kwete kutonga, kuita nekuziva), asi kwete kunobatanidza nekutarisa kwemaonero ekufunga; (2) pamusana pekutanga, kugamuchirwa kwaizobatanidzwa zvakanaka nekuzviriritira; uye (3) kubva kune imwe yekutanga kusvika ku26 nevhiki ye52, kugamuchirwa nekufunga kunowedzera zvakawanda ne MBSR kupfuura ne CBT neUC, uye kukanganisa kunoderedza kuwedzera uye kuzviita kwakanyanya kuwedzera ne CBT pane neBSSR neUC.

nzira

Kugadzirisa, Vadzidzi uye Nzira

Vadzidzi vekudzidza vakanyoreswa muRCT vachienzanisa boka reMBSR, boka CBT, uye UC nokuda kwekusagadzikana kwemarwadzo asingagumi shure pakati paSeptember 2012 naApril 2014. Takambotaura nezvemashoko ezvidzidzo zvekudzidza, [13] Consolidated Standards of Reporting Trials (CONSORT) dhiyagiramu inoyerera, [12] nemigumisiro.[12] Muchidimbu, vatori vechikamu vakatorwa kubva kuGroup Health, chirongwa chakabatanidzwa chehutano muWashington State, uye kubva pakutumira tsamba kuenda kuvagari venharaunda dzinoshandirwa neGroup Health. Mitemo yekukodzera yaisanganisira makore 20 - 70 makore, kurwadziwa shure kweinenge mwedzi ye3, murwere-yakatemerwa kushungurudza kurwadziwa mukati mevhiki yapfuura? (4 - 0 chiyero). Takashandisa International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-10-CM) 3 diagnostic codes kubva kune electronic medical records (EMR) yekushanya mugore rapfuura uye kuongororwa kwefoni kusabvisa varwere vane zvikonzero zvakananga zvekurwadziwa kwepashure. Maitiro ekubvisa aisanganisirawo kubata pamuviri, kuvhiyiwa kwemusana mumakore ekupedzisira e0, kubhadharwa kwekuremara kana kutongerwa mhosva, fibromyalgia kana chirwere chegomarara, mamwe mamiriro makuru ehutano, anoronga kuona chiremba wehutano hwemarwadzo ekudzokera shure, kusakwanisa kuverenga kana kutaura Chirungu, uye kutora chikamu mune �pfungwa-muviri� kurapwa kwemarwadzo ekumusana mugore rapfuura. Vangangove vatori vechikamu vakaudzwa kuti vaizove vakasarudzika kune imwe ye "zvirongwa zviviri zvakasiyana-zvakasiyana-zvinoshandiswa-kuzvigadzirisa marwadzo zvakawanikwa zvichibatsira mukuderedza marwadzo uye kuita kuti zvive nyore kuita mabasa ezuva nezuva" kana kuenderera mberi nekutarisira kwakajairika. Vaya vakagoverwa kuMBSR kana CBT vakanga vasingazivi nezvehutano chaihwo hwavaizogamuchira kusvikira musangano wekutanga wekupindira. Chidzidzo ichi chakatenderwa neBoka Health institutional review board uye vese vatori vechikamu vakapa mvumo vachiziva.

Vatori vechikamu vakasarudzika kune iyo MBSR, CBT, kana UC mamiriro. Randomization yakave yakarongedzwa zvichibva pane yekutanga kukosha kwemhedzisiro mhedzisiro, yakashandurwa vhezheni yeRoland Disability Questionnaire (RDQ), [42] kuita maviri ekurwadziwa-kumashure ane chekuita nemagadzirirwo emagetsi ekumisikidza mapoka: zvine mwero (chikamu cheRDQ? 2 pane 12 - 0 scale) uye yakakwirira (RDQ zvikoro? 23). Kuti kuderedze kuora mwoyo kunogoneka nekusagadziriswa kuCBT kana MBSR, vatori vechikamu vakasarudzika kuUC vakagamuchira $ 13 muripo. Dhata yakaunganidzwa kubva kune vatori vechikamu mumakomputa-akabatsirwa mafoni kubvunzurudzwa nevadzidzi vekuongorora. Vese vatori vechikamu vakabhadharwa madhora makumi maviri kubvunzurudzo imwe neimwe yapera

Nzira

Vatori vechikamu vakapa ruzivo rwakatsanangurwa pakunongororwa uye kuongororwa kwepakutanga, uye vakapedzisa zvidzidzo zvepamusoro pamusana pekutanga (pasina randomization) uye 8 (mushure mekurapa), 26 (iyo yekupedzisira yekupedzisira yekudzidza), uye masvondo e52 mushure mekuita kwenguva. Vatori vechikamu vakapedzawo ssetsi yezviyero pamasvondo e4, asi idzi data hazvina kuongororwa nekuda kwehupoti yemazuva ano.

Nzira dzinotsanangurwa uye Covariates

Kuongororwa uye kubvunzurudzwa kwekutanga kwakaongororwa, pakati pezvimwe zvakasiyana-siyana zvisina kuongororwa zvechidzidzo chazvino, hunhu hwemagariro evanhu (zera, murume kana mukadzi, dzinza, dzinza, dzidzo, chimiro chebasa); nguva yekurwadziwa (inotsanangurwa sehurefu hwenguva kubva panguva ye1 kana mavhiki akawanda pasina kurwadziwa kwepashure); uye nhamba yemazuva ane kurwadziwa shure mumwedzi yapfuura ye6. Mumushumo uyu, tinotsanangura muenzaniso pachiyero chezviyero izvi uye pamatanho ekutanga emigumisiro muRCT: yakashandurwa Roland-Morris Disability Questionnaire (RDQ) [42] uye nhamba yenhamba yemarwadzo ekudzokera shure. The RDQ, chiyero chinoshandiswa zvakanyanya chemarwadzo ekudzokera shure-ane chokuita nekushaya simba kwekushanda, inobvunza kana 24 mabasa chaiwo ari mashoma nhasi nemarwadzo ekudzokera shure (hongu kana kwete).[45] Takashandisa shanduro yakagadziridzwa yaisanganisira zvinhu makumi maviri nenhatu[23] uye takabvunza nezve svondo rapfuura kwete nhasi chete. Kurwadza kwemarwadzo ekudzokera shure kwakayerwa nevatori vechikamu-zviyero zvekushungurudza kwavo kurwadziwa shure kwaive mukati mevhiki yapfuura pane 42 kusvika ku0 nhamba yenhamba yekuyera chiyero (10 = �haisi kunetsa zvachose) uye 0 = �inoshungurudza zvakanyanya�). Iwo covariates emushumo wezvino aive akafanana neaya mukuongorora kwedu kwekutanga kwekupindira - mhedzisiro pamhedzisiro: [10] zera, murume kana mukadzi, dzidzo, uye nguva yekurwadziwa (pasi pegore rimwechete zvichienderana negore rimwechete kubva pakuwana vhiki ye12. pasina marwadzo emusana). Takasarudza priori yekutonga kune izvi zvakasiyana-siyana nekuda kwekugona kwavo kukanganisa maitiro ekurapa maitiro, mhinduro yevatori vechikamu pakurapwa, uye / kana mukana wekuwana ruzivo rwekutevera.

Nzira dzeZvingangodaro Maitiro ekurapa

Kufungisisa. Kungwarira kwakatsanangurwa sekuziva kunobuda kuburikidza nechinangwa, kusingafungiri kutarisa panguva ino.[29] Takapa 4 subscales yeChishanu Facet Mindfulness Questionnaire-Short Form (FFMQ-SF): [5] Kucherechedza (kucherechedza mukati uye kunze kwezviitiko; 4 zvinhu); Kuita neKuziva (kuenda kuzviitiko zvenguva pfupi, zvichienzaniswa nekuzvibata wega uku kutarisa kunonangana kumwe kunhu; 5 zvinhu); Non-reactivity (kwete-reactivity kune zvakaitika mukati: kubvumira pfungwa uye manzwiro kuti amuke uye apfuure pasina kubatanidzwa kana kuvenga; 5 zvinhu); uye Kusatonga (kusatonga kwezvakaitika mukati: kuita chimiro chisiri chekuongorora kune pfungwa, manzwiro, uye manzwiro; 5-chimwe chinhu chiyero; zvisinei, mubvunzo mumwe [�Ndinoita mitongo pamusoro pekuti pfungwa dzangu dzakanaka here kana kuti dzakaipa. ] nekusaziva haana kubvunzwa.). Iyo FFMQ-SF yakaratidzwa kuva yakavimbika, inoshanda, uye ine hanya neshanduko.[5] Vatori vechikamu vakatara maonero avo ezvinowanzova zvechokwadi kwavari maererano nemaitiro avo ekuva nehanya muhupenyu hwavo hwezuva nezuva (chiyero kubva pa1 = �hazvina kana kashoma kuva chokwadi) kusvika 5 = �kazhinji kana nguva dzose ichokwadi�). Pachiyero chega chega, chiyero chakaverengerwa sechinoreva zvinhu zvakapindurwa uye nekudaro huwandu hunogoneka hwaive 1-5, ine zvibodzwa zvakakwirira zvichiratidza mazinga akakwirira emufungo wekurangarira. Zvidzidzo zvekutanga zvakashandisa zvibodzwa kwete nzira, asi isu takasarudza kushandisa zvibodzwa zvakapihwa kureruka kukuru kwekududzira.

Pain catastrophizing. The Pain Catastrophizing Scale (PCS) chiyero che 13-chinhu chinoongorora njodzi ine chekuita nekurwadziwa, kusanganisira rumination, magnification, uye kusabatsira.[50] Vatori vechikamu vakayera dhigirii ravaive vaine dzimwe pfungwa nemanzwiro pavanenge vachirwadziwa (chiyero kubva ku0 = �kwete zvachose� kusvika 4 = �nguva dzese�). Mhinduro dzechinhu dzakapfupikiswa kuti dzipe huwandu hwese (inogoneka huwandu = 0-52). Zvibodzwa zvepamusoro zvinoratidza kutsigirwa kukuru kwekufunga kwakashata mukupindura marwadzo.

Pain acceptance. The Chronic Pain Acceptance Questionnaire-8 (CPAQ-8), 8-chinhu shanduro ye20-chinhu Chronic Pain Acceptance Questionnaire (CPAQ), yakaratidzwa kuva yakavimbika uye inoshanda. [22,23] Iine 2 zviyero: Chiitiko Engagement (AE; kubatanidzwa mumabasa ehupenyu nenzira yakajairika kunyange apo kurwadziwa kuri kuitika) uye Pain Willingness (PW; kurega kuedza kudzora kana kudzivisa kurwadziwa). Vatori vechikamu vakatara zvinhu pachiyero kubva pa0 (�hazvina chokwadi) kusvika pa6 (�icho chiri chokwadi nguva dzose�). Mhinduro dzechinhu dzakapfupikiswa kugadzira zvibodzwa zvechikamu chega chega (chinokwanisika renji 0-24) uye yemibvunzo yese (inogoneka huwandu 0-48). Zvibodzwa zvepamusoro zvinoratidza hukuru hwekuita / marwadzo kuda / kubvuma kurwadziwa. Kutsvakurudza kusati kwaitika kunoratidza kuti 2 subscales inopindirana zvine mwero uye kuti imwe neimwe inoita mupiro wakazvimiririra kune kufanotaura kwekugadzirisa kune vanhu vane kurwadziwa kusingaperi.[22]

Pain self-efficacy. The Pain Self-efficacy Questionnaire (PSEQ) ine zvinhu zve 10 zvinoongorora vanhu � chivimbo mukukwanisa kwavo kurarama nemarwadzo avo uye kuita mabasa pasinei nekurwadziwa kwavo, imwe neimwe yakarongwa pachiyero kubva ku0 = �kwete zvachose chivimbo� kusvika ku6 = �ndinovimba zvakazara.�[39] Gwaro remibvunzo raratidzwa kuva rechokwadi, rakavimbika, uye rinonzwisisa shanduko.[39] Zvinhu zvibodzwa zvinopfupikiswa kuti zvibudise zvibodzwa (zvinogoneka mutsara 0-60); zvibodzwa zvepamusoro zvinoratidza kuzviitira zvakanyanya.

Zvinyorwa

Mishandisirwo ye2 yaienzaniswa nemafambiro (boka), nguva, nguva, uye nhamba yevatori vechikamu neboka reboka. Zvose zviviri zvinotsigira MBSR uye CBT zvinyorwa zve 8 vhiki nevhiki 2-maawa masangano anowanikwa nemabasa epamba. Pamusoro pekupindira kwega rega, takagadzira bhuku rebhuku rekurapa / murayiridzi uye mubhuku wevadzidzi, zvose zvakagadzirirwa uye zvakanyatsorongedzerwa pane zvese zvechidzidzo. Mukupindira kwega kwega, vatori vechikamu vakagoverwa mabasa epamba uye pane kusimbiswa kwekubatanidza zvinyorwa zvepindira muupenyu hwavo hwezuva nezuva. Vadzidzi vakapiwa zvidzidzo zvekuverenga kumba uye maCD ane zvakakosha zvekuita kumusha (semuenzaniso, kufungisisa, kuongorora muviri, uye yoga muBMSR; kupembera uye kugadzirwa kwemifananidzo muBBCT). Takave takabudisa tsanangudzo yakajeka yezvipindiro zviviri, [12,13] asi tsanangurai muchidimbu pano.

MBSR

Kubatsira kweMBSR kwakanyatsotarisa purogiramu yepakutanga yakagadzirwa naKabat-Zinn [28] uye yakabva mubhuku ravarayiri ve 2009 MBSR. [4] Yakanga ine maS8 masangano evhiki nevhiki uye imwe nguva yeA6 yekudzokera pakati pezvikamu zve 6th uye 7th. Iyo protocol yaibatanidza kurovedzwa kweruzivo mupfungwa mupfungwa nekufungisisa yoga. Zvirongwa zvose zvaisanganisira kushandisa mafungiro ekufungidzira (semuenzaniso, kuongorora muviri, kugara nekufungisisa) nekufambisa pfungwa (kazhinji, yoga).

CBT

Bhuku re CBT protocol rinosanganisira nzira dzinowanzoshandiswa muBBCT yeCCLBP [20,58] uye inoshandiswa mune zvidzidzo zvepakutanga. [11,33,41,51,53-55,57,61] Kupindira kwaisanganisira: (1) dzidzo pamusoro (a) kurwadziwa kusingaperi, (b) pfungwa dzisina kunaka (kusanganisira kukanganisa) uye zvitendero (semuenzaniso, kusakwanisa kudzora marwadzo, kukuvadza zvakaenzana nekukuvadza) zvinowanikwa pakati pevanhu vane marwadzo asingagumi, (c) ukama huripo pakati pemafungiro nemafungiro emagariro nemuviri, (d) kurara hutsanana, uye (e) kudzokerazve kudzivirira nekuchengetedza zvekuwana; uye (2) mirayiridzo uye maitiro pakuziva uye kupikisa pfungwa dzisingabatsiri, kuunza dzimwe nzira dzepamusoro dzakarurama uye dzinobatsira, kugadzirisa uye kushanda kune zvinangwa zvemuitiro, kubwinya kwepamuviri uye kufambira mberi kwemaitiro ekuzorodza, maitiro ekufambisa, kumira-kufunga uye kuvhiringidza maitiro, zvakanaka kutsungirira kuzvitaura-zvinyorwa, uye kurarama nemarwadzo anorwa-ups. Hapana chimwe chekugadzirisa uku kwakabatanidzwa mukupindira kweMBSR, uye kufunga, kufungisisa, uye maitiro e yoga zvakanga zvisina kubatanidzwa muBBCT. Vadzidzi ve CBT vakapiwawo bhuku (The Pain Survival Guide [53]) uye vakakumbira kuverenga zvikamu zvakanangana pakati pezvikamu. Pakati pechikamu chega chega, vatori vechikamu vakapedza chirongwa chebasa rega rega chekuita pakati pezvirongwa.

Usual Care

Varwere vakagoverwa kuUC vakagamuchira hakuna MBSR kudzidziswa kana CBT sechikamu chekudzidza uye vakagamuchira chero rubatsiro rweutano rwavaimbowanzogamuchira panguva yekudzidza.

Vadzidzisi / Therapists uye Kurapa Kuvimbika Kutarisa

Sezvakambotaurwa, [12] vadzidzisi vose ve8 MBSR vakagamuchira kudzidziswa kwakadzidziswa mukudzidzisa MBSR kubva kuCent for Mindfulness kuYunivhesiti yeMassachusetts kana kudzidziswa kwakaenzana uye vaiva nehuwandu hwekare hwekudzidzisa MBSR. Kuvhiringidza kweBCT kwakatungamirirwa nevanonzi 4 Ph.D.-level avo vanobvumirana nehutano nehutano hwakapfuura kupa vanhu neboka re CBT kune varwere vane kurwadziwa kusingaperi. Tsanangudzo yekudzidzisa kudzidzisa uye kutarisa uye kurapa kutendeseka kutarisa kwakapiwa kare. [12]

Statistical Analyzes

Takashandisa zvinyorwa zvinotsanangurwa kuti tidimbure zvakaratidzwa zvinyorwa zvitsvene nemapoka ehurumende, zvakasiyana nemuenzaniso we randomzedzesheni pamwe chete nevaya vaitora chikamu avo vakapinda 6 kana zvimwe zveC8 masangano ekupindira (MBSR neboka re CBT chete). Kuongorora ushamwari huri pakati pehutano hwekurapa huripo pahutano hwekutanga, takaverenga Spearman rho correlations pazvikamu zviviri zvezviyero.

Kuenzanisa kushandurwa kwekufamba kwenguva munguva yekurapa maitiro anoshandiswa, takagadzira mhando dzakasiyana-siyana dzekutarisa pamwe nekushanduka kubva kubva pakutanga kusvika shanduko yakatarwa, uye yakaisanganisira zvose nguva dzekurapa nguva (8, 26, uye vhiki dze52) mumuenzaniso iwoyo. Chimwe chimiro chakasiyana chakafungidzirwa kune imwe nzira yekurapa maitiro. Zvinopindirana nematauriro edu ekuongorora zviitiko muRCT, [12] isu takashandurwa kwezera, hutano, dzidzo, uye nheyo dzepakutanga dzekutambudzika kwenguva, marwadzo anoshungurudzika, RDQ yakashandurwa, uye nzira yekurapa chiyero chechido mumutambo iwoyo. Kuenzanisa kupindira kwehutano (musiyano pakati pemapoka mukushandura pamapiranga ekurapa maitiro) panguva imwe neimwe purogiramu, iyo mienzaniso yakabatanidza migumisiro mikuru yekurapa boka (CBT, MBSR, uye UC) uye nguva (8, 26, uye mavhiki e52) , uye mazwi ekubatana pakati pezvipembenene izvi. Takashandisa huwandu huwandu hwekuenzanisa (GEE) [67] kuti uwane maitiro ekugadzirisa, kuverenga kwekukwanisa kuwirirana pakati pezviito zvakadzokororwa kubva kune vamwe vanobatanidzwa. Kuzvidavirira kune zvingave zvakashata zvinokonzerwa nekusiyana kwemaitiro pamapoka ekurapwa, sarudzo yedu yekutanga yakashandisa nzira ye 2-step GEE yekuenzanisira kwekusava nehanya nenyaya yekurapa maitiro. Iyi nzira inoshandisa muenzaniso wekusanganiswa kwemuenzaniso weusingazivikanwi usina-mhinduro uye inogadzirisa kuenzanisa kwekuenzanisira mumagumisiro ekupedzisira ekuenzanisa mamiriro ekugadzirisa kushandiswa kwemashandisirwo ezvakanyorwa. [62] Isuwo, sekunzwisisika kwekunzwisisika, zvakagadzirisa kuongorora zvakare akacherechedza panzvimbo pekutsvaga deta kuti aongorore kana kushandiswa kwemashoko akafanirwa kune zvakakosha pamigumisiro uye kubvumira kufanana kwakananga kune zvimwe zvidzidzo zvakabudiswa.

Ongororo yekutanga yaisanganisira vese vatori vechikamu, vachishandisa chinangwa chekurapa (ITT). Takadzokorora kudzokororwa kwekuongorora tichishandisa subsample yevatori vechikamu avo vakave vasina kurongeka kuMBSR kana CBT uye vakapinda zvishoma 6 yezvikamu zve8 zvekurapwa kwavo (sekurapwa) kana �per protocol� analysis). Nezvinangwa zvinotsanangurwa, tichishandisa mamodheru ekudzoreredza eiyo ITT sampu ine data yakaverengerwa, isu tinofungidzira zvinoreva zvibodzwa (uye yavo 95% nguva yekuvimba [CI]) pamichina yekurapa inosiyana panguva yega yega inogadziriswa zera, murume kana mukadzi, dzidzo, uye yekutanga kukosha. yenguva yekurwadziwa, kurwadziwa kunetsa, uye iyo yakagadziridzwa RDQ.

Kupa mamiriro ezvinhu ekududzira mhinduro, takashandisa t-miedzo uye chi-square-test kuti tienzanise nheyo dzepakutanga dzevatori vechikamu avo vakashandura havana kupedza zvishoma 6 yezvikamu zvekupindira zve 8 (MBSR neBBCT pamwe chete). Isu takafananidza kupindira kunobatana neboka, kushandisa chi-square test kuti ienzanise nekuwanda kwevatori vechikamu vakashandurwa kuBMBS neBBCT avo vakapedza zvishoma 6 yezvikamu zve 8.

Dr. Alex Jimenez's Insight

Kushushikana mupfungwa kunonyanya chikamu chemhinduro ye "kurwa kana kutiza" iyo inobatsira muviri kugadzirira njodzi. Kana muviri wapinda muchimiro chekunetsekana kwepfungwa kana manzwiro kana kukakavara nekuda kwemamiriro ezvinhu akaipa kana kuti anoda zvakanyanya, musanganiswa wakaoma wemahomoni nemakemikari, senge adrenaline, cortisol uye norepinephrine, inovanzwa kuitira kuti muviri ugadzirire muviri uye. chiito chepfungwa.�Kunyange zvazvo kushungurudzika kwenguva pfupi kunotipa huwandu hunodiwa hwemucheto hunodiwa kuti tivandudze kushanda kwedu kwese, kushungurudzika kwenguva refu kwakabatanidzwa kune zvakasiyana-siyana zvehutano, kusanganisira kurwadziwa kwepashure uye sciatica. Kushungurudzika nzira dzekugadzirisa uye maitiro, kusanganisira kufungisisa uye chiropractic kuchengetedza, zvakaratidzwa kubatsira kuvandudza migumisiro yekurapa kwemarwadzo ekudzokera shure uye sciatica. Chinyorwa chinotevera chinokurukura marudzi akati wandei ekurapa kushushikana uye anotsanangura maitiro avo pahutano hwese uye kugara zvakanaka.

Results

Mamiriro eChidzidzo Chekudzidza

Sezvakambotaurwa, [12] pakati pe1,767 vanhu vakaratidza kufarira mukudzidza uye vakaongororwa kuti vakwane, 1,425 yakabviswa (inonyanya kuitika nekuda kwekutambura kusingapi kwemwedzi inopfuura 3 uye kusakwanisa kupinda purogiramu yekupindira). Vakasara ve342 vanhu vakanyoresa uye vakanga vasina kukwana. Pakati pevanhu vane 342 randomised, 298 (87.1%), 294 (86.0%), uye 290 (84.8%) vakapedza 8-, 26-, uye 52-vhiki dzekuongorora, maererano.

Tafura 1 inoratidza humiro hwemuenzaniso pachiyero chekutanga. Pakati pevadzidzi vose, makore anorevei aiva 49 makore, 66% vaiva vakadzi, uye 79% vakaratidza kuva nemarwadzo emarwadzo kwegore rimwe chete pasina vhiki isina kurwadza. Nhamba yepamusoro, zvikamu zveFQ-8 zvaiva pachikumbaridzo chepfungwa dzinoodza mwoyo zviratidzo zvakanyanya. [32] Zvimwe zvikamu paMarwadzo ekurwadziwa (16-18) akanga ari pasi pezvikamu zvakasiyana-siyana zvakagadzirirwa zvakakonzera kuti zvive zvakakanganisika mumakiriniki (semuenzaniso, 24,47 3049) . Pain Self-Efficacy Zvikamu zvepamusoro zvaive zvakakwirira zvakakura pamusana (maererano ne5 points pazera re 0-60) mumuenzaniso wedu kana tichifananidza nevanotarisirwa nevarwere vane kurwadziwa kwakanyanya kwepashure vakanyoreswa muboka rekuongorora RCT CBT muEngland, [33] uye pamusoro peC15 inopfuvura kupfuura yevamwe vane marwadzo asingagumi vachipinda mupfungwa-based program pain management program muEngland. [17]

Vanenge hafu yevatori vechikamu vakasarudzika kuenda kuMBSR (50.9%) kana CBT (56.3%) vakapinda kanokwana zvikamu zvitanhatu zvekurapwa kwavo; mutsauko uripakati pekurapa waisanyanya kukosha (chi-square test, P = 6). Pakutanga, avo vakasarudzika MBSR uye CBT avo vakapedza angangoita matanhatu masosi, zvichienzaniswa nevaya vasina, vaive vakuru zvakanyanya (kureva [SD] = 0.42 [6] maringe nemakore 52.2 [10.9] makore) uye vakataura zvakaderera zvakanyanya kurwadziwa kunonetsa (kureva [SD] = 46.5 [13.0] maringe 5.7 [1.3]), kuremara (kureva [SD] RDQ = 6.4 [1.7] maringe ne10.8 [4.5]), kushushikana (kureva [SD] PHQ-12.7 = 5.0 [ 8] maringe 5.2 [4.1]), nekuparadza (kureva [SD] PCS = 6.3 [4.3] maringe ne15.9 [10.3]), uye nekurwadziwa kukuru kuzviita (kureva [SD] PSEQ = 18.9 [9.8] maringe ne 47.8 [ 8.3]) uye kugamuchirwa kwekutambudzika (CPAQ-43.2 yakazara mamaki anoreva [SD] = 10.3 [8] maringe ne31.3 [6.2]; CPAQ-29.0 Pain Kuda kunoreva [SD] = 6.7 [8] maringe 12.3 [4.1]) (ese P -kukosha <10.9). Izvo hazvina kusiyana zvakanyanya pane chero imwe shanduko inoratidzwa muTafura 4.8.

Baseline Associations Pakati Pekurapa Maitiro Mitezo

Tafura 2 inoratidza iyo Spearman kuwirirana pakati pekurapa mashandiro matanho padanho rekutanga. Pfungwa dzedu pamusoro pehukama hwepakutanga pakati pezviyero izvi zvakasimbiswa. Kushungurudza kwakabatanidzwa zvisina kunaka ne3 kukura kwekufunga (non-reactivity rho =? 0.23, asiri kutonga rho =? 0.30, uye kuita nekuziva rho =? 0.21; ese maP-values <0.01), asi isina kubatana necherechedzo yekufunga (rho =? 0.01). Kushungurudza kwaive kwakabatana zvakashata nekugamuchirwa (yakazara CPAQ-8 mamaki rho =? 0.55, Kurwadziwa Kuda subscale rho =? 0.47, Chiitiko Engagement subscale rho =? 0.40) uye kurwadziwa kuzviita nesimba (rho =? 0.57) (ese P-maitiro <0.01). Pakupedzisira, kurwadziwa kwekuzvibata kwakabatana zvakanaka pamwe nekugamuchirwa kwekutambudzika (yakazara CPAQ-8 mamakisi rho = 0.65, Marwadzo Kuda subscale rho = 0.46, Chiitiko Engagement subscale rho = 0.58; ese P-values <0.01).

Treatment Group Kusiyaniswa muKushandura kweTrapeutic Mechanism Mitezo Pakati peRandomized Participants

Tafura 3 inoratidza yakagadziriswa zvinoreva shanduko kubva kune yekutanga muboka rega rega rekudzidza uye zvakagadziriswa zvinoreva mutsauko pakati pemapoka ekurapa pane ekurapa maitiro matanho pane yega yekutevera mune yese yakasarudzika sampuro. Mufananidzo 1 inoratidza yakagadziriswa anoreva PCS zvikoro zveboka rega rega panguva yega yega poindi. Kupesana nepfungwa yedu yekuti kuparadza kunodzikira zvakanyanya neCBT pane MBSR, kukanganisa (zvibodzwa zvePCS) kwakadzikira zvakanyanya kubva pamberi-pekurapwa muboka reMBSR kupfuura muboka reBBT (MBSR maringe neCBT yakagadziriswa zvinoreva [95% CI] mutsauko pakushanduka =? 1.81 [? 3.60,? 0.01]). Kushungurudza kwakaderera zvakare zvakanyanya muMBSR kupfuura muUC (MBSR maringe neUC yakagadziriswa zvinoreva [95% CI] musiyano mushanduko =? 3.30 [? 5.11,? 1.50]), nepo mutsauko uripo pakati peCBT neUC wanga usina kukosha. Pamasvondo makumi maviri nematanhatu, mapoka ekurapa haana kusiyana zvakanyanya mukuchinja mukuparadza kubva pakutanga. Zvisinei, pamasvondo makumi mashanu nemaviri, ese maMBSR nemapoka eCBT akaratidza kuderera kukuru zvakanyanya kupfuura kwakaita boka reUC, uye pakange pasina musiyano wakakura pakati peMBSR neCBT.

Mufananidzo 1 Chigadziriswa Pakati PCS Scores

Mufananidzo 1: Kugadziriswa kunoreva Pain Catastrophizing Scale (PCS) zvikamu (uye 95% zvishoma zvekuvimba) panguva yekutanga (pre-randomization), mavhiki e8 (pashure pekurapa), mavhiki e26, uye mavhiki e52 kuti vatori vechikamu vatange kuenda kuBBCT, MBSR, uye UC. Nzira dzinofungidzirwa dzakagadziriswa nekuda kwechikamu chemakore, chikadzi, dzidzo, kana kuti kwete 1 gore kubva kwevhiki pasina kurwadziwa, uye nheyo ye RDQ uye kurwadziwa kunetseka.

Mufananidzo 2 inoratidza yakagadziriswa anoreva PSEQ zvikoro zveboka rega rega panguva yega yega poindi. Pfungwa yedu yekuti kuzvishingisa kwaizowedzera ne CBT kupfuura neMBSR uye neUC yakangosimbiswa zvishoma. Kuzvigonesa (PSEQ zvikoro) zvakawedzera zvakanyanya kubva pre- kuenda post-kurapwa neCBT kupfuura neUC, asi kwete neCBT maererano neboka reMBSR, iro rakawedzerawo zvakanyanya kupfuura iro boka reUC (rakagadziriswa kureva [95% CI] musiyano mukuchinja paPSEQ kubva pakutanga kweBBT maringe neUC = 2.69 [0.96, 4.42]; CBT inopesana neMBSR = 0.34 [? 1.43, 2.10]; MBSR inopesana neUC = 3.03 [1.23, 4.82]) (Tafura 3). Iyo omnibus bvunzo yekusiyana kwemapoka mukuzvishandisira-kugona shanduko yanga isina kukosha pamasvondo makumi maviri nemaviri kana makumi mashanu nemaviri.

Mufananidzo 2 Chigadziriswa Chirevo PSEQ Zvikoro

Mufananidzo 2: Chigadziriswa chinoreva Pain Self-Efficacy Questionnaire (PSEQ) zvikamu (uye 95% zvishoma zvekuvimba) panguva yekutanga (pre-randomization), mavhiki e8 (pashure pekurapa), mavhiki 26, uye vhiki dze52 dzevatori vechikamu vakashandurwa kuBBCT, MBSR, uye UC . Nzira dzinofungidzirwa dzakagadziriswa nekuda kwechikamu chemakore, chikadzi, dzidzo, kana kuti kwete 1 gore kubva kwevhiki pasina kurwadziwa, uye nheyo ye RDQ uye kurwadziwa kunetseka.

Tariro yedu yokuti kugamuchirwa kwaizowedzera kuwedzera ne MBSR kupfuura ne CBT uye neUC kwaisawanzosimbiswa. Iko kusvibiswa kwekusiyana kwemapoka emapoka kwakanga kusina kukosha kweCALEQ-8 yakazara kana basa rekuita basa rinoshandiswa panguva ipi zvayo (Table 3). Chiyero cheKuda Kwekuda Kugoverwa kwaive kwakakosha pamasvondo e52 chete, apo mapoka maviri eMBSR ne CBT akaratidza kukura kukuru kana achienzaniswa neUC, asi kwete kana ichienzaniswa nemumwe (mutauro wakashandurwa [95% CI] mukushandurwa kweMBSR kupikisa UC = 1.15 [0.05, 2.24]; CBT inopesana neUC = 1.23 [0.16, 2.30]).

Nechepfungwa yedu yekufunga kuti yaizowedzera yakawanda ne MBSR kupfuura neC CBT yakasimbiswa zvishoma. Vose maBhuku eMBSR nee CBT akaratidza kukura kukuru kana achienzaniswa neUC paFFMQ-SF Isinga-reactivity scale pamasvondo e8 (MBSR nekushamba kweUC = 0.18 [0.01, 0.36]; CBT kupokana naUC = 0.28 [0.10, 0.46]), asi Kusiyana kwekuzotevera kutevedza kwakanga kusingaverengwi (Table 3, Mufananidzo 3). Pakave nekuwedzera kwakakura zvikuru kweZviso risina kutonga ne MBSR neBBCT (mutauro wakashandurwa [95% CI] mukuchinja = 0.29 [0.12, 0.46]) uye pakati peMBSR neUC (0.32 [0.13, 0.50]) pamasvondo e8, asi hapana musiyano mukuru pakati pemapoka panguva dzekupedzisira nguva (Mufananidzo 4). Zvose zvisiri izvo zvekusiyana pakati pemapoka zvakanga zvisina kukosha nokuda kwekuita nekuziva kana kuchengeta zviyero panguva ipi zvayo.

Mufananidzo 3 Chigadziriswa Zvichireva FFMQ-SF Isingaoneki Zvikamu

Mufananidzo 3: Kugadziriswa kunoreva 5 Kutarisana Nemaonero Mubvunzo Mubvunzo-Pfupi Fomu (FFMQ-SF) Zvisiri-reactivity zvikwereti (uye 95% nguva dzekutenda) panguva yekutanga (pre-randomization), mavhiki e8 (pashure pekurapa), masvondo e26, uye vhiki dze52 dzevatori vechikamu zvisiri izvo kune CBT, MBSR, uye UC. Nzira dzinofungidzirwa dzakagadziriswa nekuda kwechikamu chemakore, chikadzi, dzidzo, kana kuti kwete 1 gore kubva kwevhiki pasina kurwadziwa, uye nheyo ye RDQ uye kurwadziwa kunetseka.

Mufananidzo 4 Chigadziriswa Chaizvo FFMQ-SF Kwete Kutonga Zvikoro

Mufananidzo 4: Manzwisisiro zvinoreva Five zvinogonekwa Mindfulness Questionnaire-Short Form (FFMQ-SF) Non-kutonga dzakawanda (uye 95% chivimbo zvikamu) panguva yekutanga (pre-randomization), 8 mavhiki (post-kurapwa), 26 mavhiki, uye 52 mavhiki kuvatori vechikamu randomized kune CBT, MBSR, uye UC. Nzira dzinofungidzirwa dzakagadziriswa nekuda kwechikamu chemakore, chikadzi, dzidzo, kana kuti kwete 1 gore kubva kwevhiki pasina kurwadziwa, uye nheyo ye RDQ uye kurwadziwa kunetsa.

Kunzwisisika kunotsvaga kushandiswa kuburikidza nekucherechedza panzvimbo pekutsvaga dhiyabhorosi kwakabereka zvinenge zvakafanana, pamwe ne2 maduku mashoma. Kusiyana pakati peMBSR neBBCT mukuchinja kwekuparara kwemasvondo e8, kunyange zvazvo yakafanana nehukuru, yakanga isisati yakabatanidzwa inokonzerwa nekanguva kaduku kwekutenderera kushanduka. Chechipiri, kuedza kwemukati kweCPAQ-8 Pain Willingness kuchikwira pamasvondo e52 kwakanga kusisati zvanyanya kuwandisa (P = 0.07).

Chirongwa Cheboka Kusiyaniswa muKushandura kweMishonga yeTrapeutic Mechanism Mitezo Pakati Pevadzidzi Vakagadziriswa kuBBCT kana MBSR Vakagadzirirwa paSastast 6 Sessions

Tafura 4 inoratidza yakagadziriswa inoreva shanduko kubva kune yekutanga uye yakagadziriswa inoreva pakati-yeboka misiyano pane yekurapa mashandiro matanho pa8, 26, uye 52 mavhiki evatori vechikamu avo vakasarudzika MBSR kana CBT uye vakapedzisa 6 kana zvimwe zvikamu zveyavakapihwa kurapwa. Misiyano iri pakati peMBSR neCBT yakanga yakafanana nehukuru kune avo vari muyenzaniso yeITT. Pakanga paine chete misiyano mishoma muhuwandu hwehuwandu hwekuenzanisa. Kusiyana nemhedzisiro ichishandisa iyo ITT sampuro, mutsauko uripo pakati peMBSR neCBT mukuparadza (PCS) mumavhiki masere yanga isisina kukosha uye pamasvondo makumi mashanu nemaviri, boka reCBT rakawedzera zvakanyanya kupfuura zvakaita boka reMBSR paFFMQ-SF Kucherekedza chiyero (chinogadziriswa chinoreva musiyano mukuchinja kubva pakutanga kweMBSR maringe neCBT =? 8 [? 52,? 0.30]). Iko kusanzwisisika kunoongorora kushandisa kunoonekwa pane kungofungidzirwa dhata hakuna kuburitsa mutsauko une revo mumhedzisiro.

hurukuro

Mukuongorora uku kwedata kubva kuRCT kuenzanisa MBSR, CBT, uye UC yeCCLBP, maonero edu kuti MBSR neBBCT zvingasarudzira zvigadziriswa zvekugadzirirwa kuti nzira dzekurapa dzakawanda hadzina kusimbiswa. Semuenzaniso, pfungwa yedu yekufunga ichanyanya kuwedzera ne MBSR kupfuura ne CBT yakasimbiswa kwe 1 chete ye 4 maitiro ekufunga (kwete kutonga). Chimwe chimiro, kushanda nekuziva, chakawedzera zvikuru neC CBT kupfuura neBMBS pavhiki dze26. Zvose zvakasiyana-siyana zvakanga zviduku. Kuwedzera kwepfungwa pashure pechirongwa cheBBCT-based multidisciplinary pain [10] chakataurwa kare; zvatinowana zvinowedzera kutsigira pfungwa yokuti zvose MBSR neBBC zvinowedzera kuve nekufungisisa munguva pfupi. Hatina kuwana nguva yakareba yemigumisiro yehutano huri pakati peUC pakufunga.

Zvakare zvinopesana nemafungiro, kuparadza kwakaderera mberi kwehutano ne MBSR kupfuura ne CBT. Zvisinei, musiyano pakati pezvokurapa wakanga uri muduku uye hauna kuwandisa zvakakosha pazotevera kutevedza. Zvirwere zvose zvakave zvakaenzana nekuenzaniswa neUC mukuderedza kudengenyeka kwevhiki dze52. Kunyange zvazvo zvidzidzo zvekare zvakaratidza kuderedzwa kwekukuvadza pashure pese CBT [35,48,56,57] nemafungiro ekufunga marwadzo ekutambura, [17,24,37] yedu ndeyokutanga kuratidzira kuderera kwakafanana kune mishonga yose, nemigumisiro kusvika kuC1 gore.

Kuwedzera kuzviita kwakaratidzwa kunobatanidza nekuvandudzika mukurwadziwa kwehutano nekushanda, [6] uye mubatsiri akakosha weBBCT. [56] Zvisinei, zvinopesana nemafungiro edu, kurwadziwa kuzviita hakuna kuwedzera zvakawanda ne CBT kupfuura ne MBSR chero nguva nguva. Kuenzaniswa neUC, pakanga pane kuwedzerwa kukuru kwekuzvibata nehuwandu hweMBSR uye CBT mushure mekurapa. Izvi zvinogadzirisa zvakawanikwa kare zvakaguma zvakanaka zveBBCT, kusanganisira boka re CBT remarwadzo ekudzokera shure, [33] pamusoro pekubudirira. [3,56,57] Tsvakurudzo shomanana yakaongorora kuchinja kwekuzvipira kwekuita kwema MBIs kune marwadzo asingagumi, kunyange zvazvo kuzvipira kwakanyanya kuwedzera MBSR pane kugara nekuchengetedza varwere vane migraines mune chidzidzo chekuongorora (63) uye zvizhinji neBMBS kupfuura yehutano hwemitambo yeCCLBP mune RCT. [37] Zvatinoona zvinowedzera kune zivo munharaunda iyi nekuratidza kuti MBSR ine zvishoma zvishoma nekuda kwekunetseka kuzviita kwakangofanana kune avo ve CBT.

Zvidzidzo zvisati zvadzora zvinowanikwa zvakaenzana zvinowedzera mukurwadziwa kugamuchirwa mushure meboka re CBT uye Acceptance uye Kuzvipira Therapy64 (iyo, kusiyana nechekare yeCBC, inonyanya kukurudzira kugumbuka kunorwadza), uye kuwedzerwa kugamuchira mushure mekuita kurapwa kwemarwadzo akawanda e CBT-based. [1,2] MuRCT yedu, kugamuchirwa kwakawedzera mumapoka ose nekufamba kwenguva, ne 1 chete inoratidza kusiyana kwemazana pakati pemapoka e3 kumativi ekugamuchirwa kwe 3 uye nguva dzekutevera 3 (kukura kukuru kune zvose MBSR ne CBT kupfuura neUC paAkuda Paunoda kuenderera kumavhiki e52). Izvi zvinoratidza kuti kugamuchirwa kunogona kuwedzerwa kupfuura nguva zvisinei nekurapwa, kunyange izvi zvinoda kuiswa mune tsvakurudzo yakawedzerwa.

Mikana miviri inogona kutsanangura zvatakawana kare-zvakambotaurwa zvakawanikwa zvakafanana zvinobudirira zveMBSR uye CBT yeCLBP: [12] (1) mhedzisiro yekurapa pamhedzisiro yakakonzerwa nekusiyana, asi yakaenzana inoshanda, nzira dzekurapa, kana (2) marapirwo aive nawo. mhedzisiro yakafanana pane imwechete nzira dzekurapa. Zvatinowana iye zvino zvinotsigira maonero ekupedzisira. Mishonga miviri inogona kunatsiridza marwadzo, kushanda, uye zvimwe mhedzisiro kuburikidza nemaitiro akasiyana anoderedza vanhu maonero ekurwadziwa kwavo sekutyisidzira uye kukanganisa uye kukurudzira kutora chikamu kunyangwe kurwadziwa. MBSR neCBT zvakasiyana mune zviri mukati, asi zvose zvinosanganisira nzira dzekuzorora (semuenzaniso, kufambira mberi kwemhasuru kuzorora muCBT, kufungisisa muMBSR, maitiro ekufema mune zvose) uye mazano ekuderedza kutyisidzira kwekutambudzika (dzidzo uye kugadzirisa pfungwa mu CBT, kugamuchira zviitiko pasina. reactivity kana kutonga muMBSR). Nokudaro, kunyange zvazvo CBT inosimbisa unyanzvi hwekudzidza hwekugadzirisa marwadzo uye kuderedza mhinduro dzisina kunaka dzepfungwa, uye MBSR inosimbisa kufunga uye kufungisisa, zvose zvinorapwa zvinogona kubatsira varwere kuti vazorore, vanoita zvishoma zvakashata kune marwadzo, uye vanoona pfungwa semaitiro epfungwa panzvimbo yezviratidziro zvakarurama zvechokwadi, uye manzwiro ekugadzirisa marwadzo uye kuderera kwehutano hwepfungwa. nokudaro zvichikonzera kuderera kwekushushikana mupfungwa, kudzivisa kuita, uye kurwadziwa kunonetsa.

Kuongorora kwedu kwakaratidzawo kuwirirana pakati pezviyero zvakasiyana zvezvivakwa zvinotendwa kuti zvipindire migumisiro ye MBSR ne CBT pamusoro pemigumisiro isingaperi. Sokufungidzirwa, kusati kwatanga kurapwa, kurwadziwa kunorwadza kwakabatanidzwa zvakashata nekurwadziwa kuzviita, kurwadziwa kunogamuchirwa, uye ukuru hwe 3 yekufunga (kwete reactivity, kusatonga, nekuita nekuziva), uye kugamuchira kurwadziwa kwaibatanidza zvakanaka nekurwadziwa iwe pachako -hutano. Kubvuma kugumbuka uye kuzvipira kwakabatanidzwawo zvakanaka nezviyero zvekufunga. Zviwanikwa zvedu zvinowirirana nekutarisa kwekutanga kwekushamwaridzana kusina kunaka pakati pezviyero zvekukuvadza uye kugamuchirwa, [15,19,60] kusawirirana kwakashata pakati pezviyero zvekuvhiringidza nekufunga, [10,46,18] uye kushamwaridzana kwakanaka pakati pematambudziko ekugamuchirwa nekufunga. [19]

Seboka, kusvika pakuyera kwezviyero izvi zvichiratidza maitiro avakavakirwa, izvi zvakawanikwa zvinotsigira maonero ekuparadzisa sezvinopindirana nehuviri humwe hunoenderana hunoita kuti tibatanidzwe mumabasa emitambo pasinei nekurwadziwa asi kusiyana mukusimbisa kubviswa kwekuedza kubva kuedza kuedza kurwadziwa: kurwadziwa kubvuma (kurega kubvisa kubva kuedza kuronga kurwadziwa uye kubatanidzwa mumabasa pasinei nekurwadziwa) uye kuzvipira (kuvimba mukwanisi yekugadzirisa kurwadziwa uye kubatanidzwa mumabasa emitambo). Kufanana kweimwe mimwe mibvunzo yemibvunzo inowedzera inotsigira maonero aya uye zvichida inobatsira kune masangano anocherechedza. Somuenzaniso, zvose CPAQ-8 nePSEQ zvine zvinhu pamusoro pekuita mabasa akadai pasinei nekurwadziwa. Uyezve, kune chirevo uye chinangwa chekuona kukanganisa (kurangarira marwadzo ane pfungwa dzakaipa dzisinganzwisisiki uye dzinogadzirisa mhinduro) sezvinopesana nekubatisa pfungwa (kureva, kuziva kusaruramisira pasina kutonga kana kusagadzikana), nekuona kutarisa sezvinoenderana uye, asi zvakasiyana kubva, kugamuchirwa uye kuzviita. Chimwe chiitiko chinodiwa kuti tsananguro hukama huripo pakati pezvinyorwa izvi uye zviyero izvo zviyero zvavo zvinoongorora (a) inovaka izvo zvakabatana asi zvinyorwa uye zvechipatara zvakasiyana zvichienderana (b) zvakasiyana-siyana zvehutano hwepamusoro hwakavakwa.

Zvinoramba zvichigoneka kuti MBSR uye CBT inoparadzanisa zvakakosha vaparidzi vasina kuongororwa muchidzidzo chino. zvawanikwa edu anoratidza kudikanwa kumwe kutsvakurudza mamwe zvakajeka kuziva nevamiririri migumisiro MBSR uye CBT pamusoro zvakasiyana marwadzo zvaitika, kuva nezviyero kuti iongorore nevamiririri izvi zvikuru comprehensively uye zvakanaka, nani kunzwisisa ukama pakati kuchirapa mashandiro variables mu bata zvaitika (eg , kuderera kunokanganisa kunogona kupindirana nemigumisiro yefungwa pamusoro pekuremara [10]), uye kunatsiridza kurapa kwepfungwa kuti zvibudirire uye zvinobudirira zvinokonzera vatauriri ava. Kutsvakurudza kunobatsirawo kuziva zvirwere zvinoratidzirwa zvinosanganiswa nekupindura kune zvakasiyana-siyana zvepfungwa nezvehutano husingaperi.

Kuverengeka kuverengera zvidzidzo kugadziriswa kwekubvumirana. Vatori vechikamu vaiva nehutano hwepamusoro hwehutano hwepfungwa (kusanganisa, kuora mwoyo, kuora mwoyo) uye takadzidza boka re CBT, rakaratidza kubudirira, [33,40,55] -kugadziriswa kwezvigadziro, uye zvinogona kubatsira vanhu, asi izvo zvingave zvisingasviki kune munhu wese we CBT. [36,66 ] Migumisiro inogona kunge isingagoneki kune vakawanda vanodzvinyirirwa vanhu (semuenzaniso, varwere vemakirini ekurwadziwa), iyo inenge iine nzvimbo yakawanda yekuvandudza pane zviyero zvehutachiona hunoita uye mikana yakawanda yekurapa kuyananisa zvigadziro izvi, kana kuenzanisa MBSR nemunhu mumwe nomumwe CBT.

Chete chikamu chinopfuura hafu yevatori vechikamu vakarongedzerwa kuMBSR kana CBT vakapinda zvishoma ne6 yezvikamu zve8. Migumisiro inogona kusiyana mune zvidzidzo nemazinga akakwirira ekuteerera kurapwa; zvisineyi, mhedzisiro yedu muongororo ye "as-kurapwa" inowanzofananidzira iyo yekuongorora kweIT. Kurapa kuomerera kwakaratidzwa kuva kwakabatana nezvakanaka kubva kune zvose CBT yemarwadzo asingagumi ekudzokera shure [31] uye MBSR.[9] Tsvagiridzo inodiwa kuti uone nzira dzekuwedzera MBSR uye CBT musangano wekupinda, uye kuona kana mhedzisiro yekurapa pamaitiro ekurapa uye mhedzisiro yemhedzisiro inosimbiswa nekunyanya kuomerera uye kuita.

Pakupedzisira, zviyero zvedu zvingasave zvakanyatsotora zvakagadziriswa. Semuenzaniso, kutarisa kwepfungwa nekurwadziwa kwekugadziriswa kwaiva maitiro mafupi emiganhu yepakutanga; kunyange zvazvo maitiro mafupi aya akaratidza kuvimbika uye kuvimbika, zviyero zvepakutanga kana zvimwe zviyero zvezvivakwa izvi zvinogona kuita zvakasiyana. Lauwerier et al. [34] vanocherechedza matambudziko akawanda neCPAQ-8 Pain Kuda kukura, kusanganisira pasi pekumiririrwa kwezvinhu zvinoda kuora. Uyezve, kugamuchira marwadzo kunoenzaniswa zvakasiyana siyana kuburikidza nemarwadzo akasiyana ekugamuchirwa, zvichida kuratidza kusiyana kwezvitsanangudzo. [34]

Muchidimbu, ichi ndicho chidzidzo chekutanga chekuongorora hukama pakati pezviyero zvehutano hukuru hunofungidzirwa hweMBSR neCBC nokuda kwekutambudzika kusingaperi - kufunga uye kurwadziwa kunoparadza, kuzviita, uye kugamuchirwa - uye kuongorora kuchinja kwezviyero izvi pakati pevatori vechikamu mukuenzanisa kweRCT MBSR uye CBT yekutambudzika kusingaperi. Chiyero chinoparadza chakange chichibatanidza nekugadzirisa zviyero zvakabatana zvakabatana zvekubvuma, kuzvigadzirisa, nekufunga. Muchienzaniso ichi chevanhu vane huwandu hwakaderera hwekutambudzika kwepfungwa mupfungwa pachiyero chekutanga, MBSR uye CBT dzaive nemigumisiro shomanana uye yenguva yakareba pazviyero izvi. Nzira dzekukuvadza, kugamuchirwa, kuzvigadzirisa, uye kufunga kunogona kuisa zvakasiyana siyana zvekuenderera mberi kwekunzwisisa, kugadzirisa, uye maitiro ekuita marwadzo, nekunetsa nekupedza kushanda pane imwe mugumo wekuenderera mberi nekuenderera mberi kupinda muzviitiko zvinowanzoitika nekushayikwa kwe kusanzwisisana kwakashata uye kugadzirisa kugadzirisa kurwadziwa kune imwe. Vose MBSR uye CBT vangave vane rubatsiro rwekurapa kuburikidza nekubatsira vanhu vane marwadzo asingagumi kubva kune akamboenda kune vekupedzisira. Zvigumisiro zvedu zvinoratidza kuti zvingave zvakakosha zvekunatsiridza zvose zviyero uye mienzaniso yehutano hwehupfungwa hwepfungwa dzepfungwa dzehupfungwa kusvika kune zvakanyatsonzwisisika uye zvakajeka kutora zvigadzirwa zvinokosha zvinoenderana nekurwadziwa kusingaperi.

pfupiso

MBSR uye CBT dzaive nemigumisiro yakafanana uye yenguva refu pamaitiro ekufungisisa uye kurwadziwa kunoparadza, kuzviita, uye kugamuchirwa.

KUTENDA

Tsvagiridzo yakataurwa mubhuku iri yakatsigirwa neNational Center yeComplementary & Integrative Hutano yeNational Institutes of Health pasi peAward Number R01AT006226. Mhedzisiro mhedzisiro ine chekuita neichi chidzidzo yakapihwa mune poster pamusangano wegumi nematanhatu weAmerican Pain Society, Palm Springs, Chivabvu 34 (Turner, J., Sherman, K., Anderson, M., Balderson, B., Cook, A., naCherkin, D.: Kushungurudza, kurwadziwa kwekuzvibata, kufunga, uye kugamuchirwa: Hukama uye shanduko pakati pevanhu vanogamuchira CBT, MBSR, kana kutarisirwa kwemazuva ese kwekurwadziwa kusingaperi kwemusana).

Mashoko Omuzasi

Kupesana kwechitema chirevo: Judith Turner anogamuchira zvinyorwa zvePAR, Inc. pakutengesa kweHigh Pain Coping Inventory (CPCI) uye CPCI / Survey yePauin Attitudes (sopa) software report report. Vamwe vanyori vanorondedzera kusawirirana kwechido.

Mukupedzisa, kushungurudzika chikamu chemhinduro inokosha inodiwa kuchengetedza muviri wedu uri pamucheto munyaya yengozi, zvisinei, kushungurudzika nguva dzose kana pasina ngozi chaiyo inogona kuva nyaya chaiye kune vanhu vazhinji, kunyanya kana zviratidzo zvekurwadziwa kwepamusoro, pakati pezvimwe zvinotanga kuitika inoratidza. Chinangwa chechinyorwa chiri pamusoro apa ndechekuona kubudirira kwekutambudzika kwekushungurudzika mukurapa kunorwadza kwepashure. Pakupedzisira, kushungurudzika kwepfungwa kwakagumirwa kubatsira nemishonga. Mashoko anotsanangurwa kubva kuNational Center for Biotechnology Information (NCBI). Kuwanda kweruzivo rwedu kunogumira kune chiropractic pamwe nekukuvara kwepamuviri nemamiriro. Kuti ukurukure nyaya yacho, ndapota ivai vakasununguka kubvunza Dr. Jimenez kana kuti tibvunzei kwatiri 915-850-0900 .

Yakarongedzwa naDkt Alex Jimenez

Zvimwe Zvinyorwa: Kubva Painini

Maererano nehuwandu, inenge 80% yevanhu ichaona zviratidzo zvekurwadziwa shure shure kamwechete munguva yeupenyu hwavo hwose. Kushungurudza kumashure ndekunyunyuta kunowanzoitika kunogona kuguma nekuda kwekukuvara kwakasiyana siyana uye / kana mamiriro. Kazhinji kacho, kuora kwechimiro chemupaka nezera kunogona kukonzera marwadzo kumashure. Hedhiated discs inowanikwa apo gorofu, gel-like centre ye intervertebral disc inodonha nemisodzi mukati mayo, mukati mekunze katekete, kukonzera uye kushungurudza midzi midzi. Dhizinesi dzinozivikanwa dzinowanzoitika kumucheto kumashure, kana kuti nhengo dzomukati, asi dzinogonawo kuitika pamucheto wepervical, kana mutsipa. Kuiswa kwemitsipa inowanikwa mucheka shure nekuda kwekukuvara uye / kana mamiriro akaoma kunogona kutungamirira kune zviratidzo zve sciatica.

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