Clinical Prediction Rules For Back And Spinal Pain Syndromes

Clinical Prediction Rules:

"Chipatara chisarudzo chinotonga, chirwere chepamuviri chinosarudzwa uye kufanotaura kwemishonga yemagumisiro: Kukurukurirana kwemashoko apfuura mubhuku rekudzorera"

ngovepo

Mitemo yemakiriniki esarudzo iri kuramba ichiwanda kuvapo muzvinyorwa zvebiomedical uye inomiririra imwe nzira yekusimudzira kuita sarudzo yekiriniki yekuvandudza mashandiro uye kushanda kwehutano hwehutano. Muchirevo chekutsvagisa tsvakiridzo, mitemo yesarudzo yekiriniki yakave yakanyanya kuitirwa kurongedza varwere nekufanotaura mhinduro yavo yekurapa kune chaiwo marapirwo. Sechinyakare, kurudziro yekugadzira mitemo yesarudzo yekiriniki inopa maitiro akawanda (kutorwa, kusimbiswa, kuongororwa kwemhedzisiro) uchishandisa nzira yakatsanangurwa. Kuedza kutsvagisa kwakanangana nekugadzira kuongororwa-kwakavakirwa kiriniki sarudzo mutemo kwabva pagungano iri. Zvinyorwa zvichangoburwa mumutsara uyu wekutsvagisa zvakashandisa yakagadziridzwa terminology diagnostic-based clinical decision guide. Shanduko kumatemu uye nzira yakatenderedza mitemo yesarudzo yekiriniki inogona kuita kuti zvinyanye kuomera varapi kuti vaone nhanho yehumbowo hune chekuita nemutemo wesarudzo uye kunzwisisa kuti humbowo uhwu hunofanira kuitwa sei kuzivisa kutarisirwa kwevarwere. Isu tinopa muchidimbu muchidimbu chekiriniki yekutonga kutonga kwekutonga mumamiriro ezvinhu ekugadzirisa mabhuku uye mapepa maviri chaiwo achangobva kubudiswa muChiropractic uye Manual Therapies.

Clinical Prediction Rules

• Hutano hwehutano hwakaita yakakosha paradigm shanduko kune humbowo-hwakavakirwa tsika. Nzira inofungidzirwa yekusimudzira kuita sarudzo yekiriniki nekubatanidza humbowo hwakanakisa huripo nehunyanzvi hwekiriniki uye zvinodiwa nevarwere.
• Pakupedzisira, chinangwa cheuchapupu-chakavakirwa tsika ndechekuvandudza hutano hwehutano. Zvisinei, kushandurwa kwehumbowo hwesainzi kuita basa kwakaratidza kuedza kwakaoma.
• Mitemo yesarudzo yekiriniki (CDRs), inozivikanwawo semitemo yekufanotaura kwekiriniki, iri kuwedzera kuwanda mumabhuku ekuvandudza.
• Aya maturusi akagadzirirwa kuzivisa kukiriniki kuita sarudzo nekuona vanogona kufanofungidzira kwechirwere chekuongorora mhedzisiro, prognosis, kana mhinduro yekurapa.
• Muzvinyorwa zvekudzorera, maCDR anonyanya kushandiswa kufanotaura mhinduro yemurwere pakurapwa. Ivo vakarongedzerwa kuti vaone makiriniki akakodzera mapoka evarwere vanouya nezvimwe zvakasiyana-siyana kusagadzikana senge isina-yakananga mitsipa kana yakaderera. kurwadziwa shure, ndiwo maonero atinoda kutarisa paari.

Clinical Prediction Rules

• Kukwanisa kurongedza kana kugovera varwere vane zvirwere zvakasiyana-siyana zvakadai sekurwadziwa kwemusana kwakasimbiswa sechinhu chinonyanya kukosha chekutsvakurudza uye, naizvozvo, chinangwa chekuedza kwakawanda kwekutsvakurudza. Kukwezva kwemaitiro emhando dzakadai ndiko kugona kwavo kwekuvandudza kurapa kwakanaka uye kushanda nesimba nekufananidza varwere vane kurapa kwakakwana. Munguva yakapfuura, kusarudzwa kwevarwere kwaivimba nemaitiro akajeka akavakirwa mutsika kana kusarongeka kwekutarisa. Kushandiswa kweCDR kuzivisa kupatsanurwa kumwe kuedza kune imwe nzira inofambiswa nehumbowo, isingatsamiri padzidziso isina hwaro.
• CDRs inogadzirwa mumaitiro akawanda anosanganisira zvidzidzo zvekutorwa, kusimbiswa, uye kuongororwa kwemhedzisiro, neimwe neimwe iine chinangwa chakatsanangurwa uye maitiro emaitiro. Sezvo nemhando dzose dzehumbowo hunoshandiswa kuita sarudzo pamusoro pevarwere, kutarisa kune nzira yekudzidza yakakodzera kwakakosha pakuongorora zvingangobatsira zvekushandisa.

Kubatsira Kwekuchipirikidzwa Kwechipatara Mitemo

• Inogona kugadzirisa zvinhu zvakawanda kupfuura izvo uropi hwemunhu hunogona kufunga nezvazvo
• CDR / CPR muenzaniso uchagara uchipa mhinduro imwechete (mathematical equation)
• Inogona kuva yakarurama kupfuura kutonga kwekliniki.

Clinical Uses Of Clinical Prediction Rules

• Kuongororwa prob Mikana yakanyanya
• Kufungidzira Kufanotaura njodzi yemhedzisiro yezvirwere

 

 

johnsnyderdpt.com/for-clinicians/clinical-prediction-rules/cervical-manipulation-for-neck-pain/

johnsnyderdpt.com/for-clinicians/clinical-prediction-rules/thoracic-manipulation-for-neck-pain/

johnsnyderdpt.com/for-clinicians/clinical-prediction-rules/manipulation-for-low-back-pain

johnsnyderdpt.com/for-clinicians/clinical-prediction-rules/lumbar-spinal-stenosis/

Dhiyabhorosi John Snyder Website

Flynn Clinical Prediction Rule Video

CDR Kuongorora Kwakaitika

Pakupedzisira, kubatsira kweCDR hakusi nekururama kwayo asi nekugona kwayo kuvandudza mhedzisiro yekiriniki uye kuwedzera kugona kwekutarisira.[15] Kunyangwe kana CDR ikaratidza kusimbiswa kwakafara, izvi hazvivimbise kuti ichachinja kuita sarudzo yekiriniki kana kuti shanduko yainoburitsa ichaunza kutarisirwa kuri nani.

Kuchinja kwainoita kuchaguma nekutarisirwa kuri nani. McGinn et al.[2] yakaratidza tsananguro nhatu dzekutadza kweCDR panguva ino. Kutanga, kana kutonga kwechiremba kwakarurama sechisarudzo cheCDR-chinoziviswa, hapana chinobatsira pakushandiswa kwayo. Chechipiri, kushandiswa kweCDR kunogona kusanganisira kuverenga kwakaoma kana nzira dzinoita kuti varapi vasashandise CDR. Chechitatu, kushandisa CDR kunogona kusagoneka munzvimbo dzese kana mamiriro. Mukuwedzera, tichazobatanidza chokwadi chokuti zvidzidzo zvekuedza zvinogona kusanganisira varwere vasingamiriri zvachose avo vanoonekwa mukuchengetwa kwemazuva ose uye kuti izvi zvinogona kuderedza kukosha chaiko kweCDR. Naizvozvo, kuti unzwisise zvizere mashandisiro eCDR uye kugona kwayo kuvandudza hutano hwehutano, zvinodikanwa kuita ongororo yehunyanzvi yekugoneka kwayo uye mabatiro kana ichishandiswa munzvimbo inoratidzira chaiyo-yepasirese maitiro. Izvi zvinogona kuitwa nemagadzirirwo akasiyana ekudzidza akadai seyedzo isina kurongeka, miedzo yakasarudzika, kana dzimwe nzira dzakadai sekuongorora maitiro eCDR isati yaitwa uye mushure mekushandiswa kwayo.

Kuwandisa kwekugadzirisa nzira dzevarwere vane utachiona husina kumira shandisa uchishandisa McKenzie syndromes, maitiro ekurwadza, kushandiswa, uye kugadziriswa kwekliniki yekufanotaura mitemo.

www.ncbi.nlm.nih.gov/pmc/articles/PMC3113271/

zvinangwa

Zvimwe zvaive (1) kuongorora huwandu hwevarwere vane utachiona husina kunaka hunogona kuenzaniswa nokudya naMcKenzie syndromes (McK) uye marwadzo akaronga maitiro (PPCs) achishandisa nzira dzekuongorora Mechanical Diagnosis uye Therapy (MDT), kushandiswa, uye kugadziriswa kwekliniki inofanotaura inotonga (CPRs) uye (2) kumunhu mumwechete CPR kana Stra CPR, sarudza maitiro ekuwandisa kwevanhu achishandisa McK uye PPC.

CPRs inonyanya kufungidzirwa uye inofanirwa kutaridzirwa apo boka revarwere rakataridzirwa nehutachiona zviratidzo nezviratidzo zvinowanzobatanidzwa nehuwandu hunofanirwa hwekutaura kwezviitiko zvinorwara.

MaCPR maviri akasiyana akagadzirwa nevatsvakurudzi kuti vaone varwere vaizopindura zvakanaka pakugadzirisa.33,34 Flynn et al. yakagadzira CPR yepakutanga inoshandiswa uchishandisa maitiro mashanu, kureva, hapana zviratidzo pasi pebvi, kutanga kwezviratidzo (<16 mazuva), kuderera kwekutya-kudzivisa kutenda mubvunzo mubvunzo36 chikamu chebasa (<19), hypomobility ye lumbar spine, uye hip mukati. kutenderera ROM (> 35 kweinenge hudyu imwe).33

Flynn's CPR yakazogadziridzwa naFritz et al. kune nzira mbiri, iyo yaisanganisira pasina zviratidzo pasi pemabvi uye kutanga kwezviratidzo zvemazuva ano (<16 mazuva), seimwe nzira yepragmatic yekuderedza mutoro wekiriniki wekuziva varwere mukutarisira kwekutanga vangangopindura pakusundira kushandiswa.34 zvakanaka

"Potentia.l Pitfalls Of Clinical Prediction Rules"

Chii Chinonzi Clinical Prediction Rules?

A Clinical prediction rule (CPR) isanganiswa yezviwanikwa zvekiriniki izvo zvakaratidza nenhamba yakaratidza fungidziro ine musoro pakusarudza mamiriro akasarudzwa kana kufungidzira kwemurwere akapihwa kurapwa chaiko 1,2. MaCPR anogadzirwa achishandisa nzira dzakasiyana-siyana dzehuwandu, dzakagadzirirwa kuongorora kukwanisa kwekufungidzira kwezvikwata zvakasarudzwa zvemakiriniki akasiyana-siyana3,4, uye zvinotarisirwa kubatsira varapi kuita zvisarudzo zvinokurumidza izvo zvingawanzove zvichienderana nekusarura kunowanikwa5. Mitemo ndeye algorithmic muchimiro uye inosanganisira ruzivo rwakapfupikiswa runozivisa nhamba diki yezviratidziro zvekuongorora kune iyo yakanangwa mamiriro6.

Mitemo yekufanotaura kwekiriniki inowanzogadzirwa uchishandisa nzira ye3-nhanho14. Kutanga, maCPR akatitorera isu tarisiro-
ing multivariate nhamba nzira dzekuongorora kukwanisa kufanotaura kwezvikwata zvakasarudzwa zvemakiriniki akasiyana-siyana3. Danho rechipiri rinosanganisira kusimbisa CPR muyedzo yakarongeka yakarongeka kuderedza dambudziko rekuti zvinhu zvinofanotaura zvakagadziridzwa panguva yechikamu chekutora zvakasarudzwa nemukana14. Danho rechitatu rinosanganisira kuitisa ongororo yekuona kuti CPR inovandudza sei kutarisirwa, inoderedza mari, uye inotsanangura nemazvo chinangwa chakanangwa14.

Kunyange zvazvo pane nharo huru iyo yakanyatsogadziriswa CPRs inogona kuvandudza chiito chekuchirapa, kune ruzivo rwangu, hapana mitsara inotsanangura nzira dzekushandisa dzeCPRs dzekudzivirira mukati memaitiro ose emakiriniki. Mirayiridzo yakasikwa kuti ivandudze kusagadzikana kwekudzidza nekugadzira nekubika. Izvo zvinotevera zvinyorwa zvemasangano zvinogona kuvhiringidza maitiro edzidziso muCPRs izvo zvingaita kuti zvishoma nezvishoma kuwedzerwa kwechirongwa chegoridhi. Mumunda wekuvandudza, maCPR akawanda ave achinyorwa; saka, zvandinotaura apa zviri kuratidza CPRs inorondedzerwa.

Nzira dzeMitemo

MaCPR akagadzirwa kuti atsanangure homogenous seti yehunhu kubva kune yakasarudzika huwandu hwevanotarisirwa kusarudzwa vakatevedzana varwere5,15. Kazhinji, mhedzisiro yehuwandu hunoshanda idiki diki remuenzaniso muhombe uye inogona kungomiririra chikamu chidiki muzana chemazuva ese emuchipatara. Mamiriro uye nzvimbo yemuenzaniso mukuru inofanira kuva generalizable15,16, uye zvidzidzo zvinotevera zvehutano zvinoda kuongororwa kweCPR mumapoka akasiyana-siyana evarwere, munzvimbo dzakasiyana-siyana, uye neboka revarwere rinowanzoonekwa nevakawanda varapi16. Nemhaka yokuti maCPR akawanda anogadzirwa zvichienderana neboka rakasiyana-siyana rinogona kuratidza kana kusaratidza huwandu hwevarwere, iyo spectrum transportability17 yezvino yakawanda CPR algorithms inogona kuderedzwa.

Mitemo yekufembera kwekiriniki inoshandisa matanho emhedzisiro kuti ione kushanda kwekupindira. Matanho emugumisiro anofanirwa kuve netsanangudzo imwechete yekushanda5 uye inoda kuterera kwakakwana kutora shanduko yakakodzera mumamiriro14 zvechokwadi; uyezve, zviyero izvi zvinofanirwa kuve neyakavakwa-yakachekwa-yekubvisa zvibodzwa16,18 uye inounganidzwa neakapofumadzwa maneja15. Kusarudzwa kweiyo anchor mamakisi akakodzera ekuyera shanduko chaiyo iko zvino kune nharo19-20. Zvizhinji zvinoguma zviyero zvinoshandisa murwere anoyeuka-based questionnaire yakadai seyero yepasi rose yekuchinja chiyero (GRoC), iyo yakakodzera kana yakashandiswa munguva pfupi asi inotambura nekuyeuka kurangarira kana ichishandiswa mukuongorora kwenguva refu19-21.

Iyo inogona kudzoserwa kumashure kweCPRs ndiko kutadza kuchengetedza kunaka kweyedzo uye zviyero zvinoshandiswa sekufanotaura mune algorithm. Naizvozvo, bvunzo yemaonero uye zviyero zvinofanirwa kuve zvakasununguka kubva kune mumwe panguva yekuenzanisira16; chimwe nechimwe chinofanira kuitwa nenzira ine revo, inogamuchirika4; varapi kana vatariri vedata vanofanirwa kupofumadzwa kune zviyero zvemurwere uye mamiriro22.

Sources

Zvinogona Kukanganisa zveKiriniki Kufembera Mitemo; Iyo Nhoroondo yeManyorero & Manipulative Therapy Vhoriyamu 16 Nhamba Yechipiri [69]

Jeffrey J Hebert naJulie M Fritz; Chipatara chisarudzo, mitemo yepemumunyo kusarudzwa uye kufanotaura kwehutano zvinoguma: Kukurukurirana kwezvakaitika munguva pfupi mumabhuku ekudzorerazve