Kubvuma kuverenga statistics, kurwadziwa kunorwadza shure kunogona kuva mugumisiro wekukuvara kwakasiyana-siyana uye / kana mamiriro ezvinhu anokonzera lumbar musana uye zvivakwa zvaro zvakapoteredza. Nyaya dzakawanda dzekutambudzika kwepamusoro, zvisinei, dzichagadzirisa pachavo mune imwe nyaya yevhiki. Asi kana zviratidzo zvekurwadziwa kwepashure zvisingadzoki, zvakakosha kune munhu akazvipira kutsvaga kurapwa kubva kune unyanzvi hwezvehutano hwakakwana. Nzira yeMcKenzie yakashandiswa nehuwandu hwehutano hwehutano mukurapa kunorwadza kwepashure uye migumisiro yaro yakanyorwa zvakanyanya mumhando dzakasiyana-siyana dzekutsvakurudza. Nyaya mbiri dzinotevera dziri kuendeswa kuti dziongorore nzira yeMcKenzie mukurapa kweLBP pakuenzanisa kune mamwe marudzi ezvokurapa.

 

Kubudirira kweMecKenzie Method muvarwere vane Chronic Chronic Nonspecific Back Back: A Protocol yeRandomized Placebo-Controlled Trial

 

Presented Abstract

 

• Background: Nzira yeMcKenzie inowanzoshandiswa sechinhu chinopindira kupindira mukurapa kwevarwere vane nonspecific kurwadziwa kunorwadza shure. Kunyange zvazvo nzira yeMcKenzie yakaenzaniswa nezvimwe zvinopindira, hazvizivikanwe kana nzira iyi iri nani kupfuura placebo kune varwere vane chirwere chisingaperi chisingarware shure.
• Chinangwa: Chinangwa chemuedzo uyu ndechokuongorora kushanda kweMacKenzie nenzira yevarwere vane chirwere chisingaperi chisingagoneki.
• Design: Muongorori-akapofumadza, 2-ruoko, muitiro we randboed-controlled control ichaitwa.
• Kuisa: Ichi chidzidzo chichaitwa mumakiriniki ekurapa mumuviri muS o Paulo, Brazil.
• Vadzidzi: Vatori vechikamu vachave varwere ve148 vachitsvaga kutambudzika kusingaperi kwemarwadzo ekudzokera shure.
• Kupindira: Vatori vechikamu vachange vaine zvigaro zvakapiwa 1 yemapoka emishonga e2: (1) nzira yeC McKenzie kana (2) placebo therapy (yakawana ultrasound uye shortwave therapy). Boka roga roga richagamuchira zvikamu zve10 zvemaminitsi e30 imwe neimwe (2 masangano pavhiki pamavhiki e5).
• Miedzo: Izvi zvinowanikwa pakupera kwemishonga (masvondo e5) uye pa 3, 6, uye 12 mwedzi mushure mekunge maitiro. Mhedzisiro inotevera ichava kurwadziwa kwepamusoro (kuenzaniswa neRumen Numerical Rating Scale) nekuremara (kuenzaniswa neRandand-Morris Dhaibhadhi yeMibvunzo) pakapera kurapwa. Zvimwe zvinotevera zvichava kurwadziwa; kuremara uye basa; kinesiophobia uye pasi rose inonzwisisika ku3, 6, uye 12 mwedzi mushure mekunge kuitika; uye kinesiophobia uye nyika yose inoonekwa pakupera kwekurapa. Iyo data ichaunganidzwa nemufuridzi anofufutirwa.
• Nokuremara: Vanachiremba havazoiti bofu.
• Mhedziso: Ichi chichava chiedza chekutanga chekuenzanisa nzira yeMcKenzie ne placebo therapy mune varwere vane chirwere chisingaperi chisingagumi chinorwadza shure. Migumisiro yenyaya ino ichaita kuti hutungamiri huve nani hwehuwandu hwevanhu.
• Subject: Kurapa Kurapa, Kukuvara uye Zvimwe Zvayo: Low Back, Zvirongwa
• Nyaya Chikamu: Protocol

 

Kutambudzika kwekudzokera kumashure chinhu chakakomba chehutano chinosanganisirwa nehupamhi hwehuwandu hwekusaenda kubasa uye kushandiswa kwakawanda kwemabasa ehutano nemabasa ekuzorora. [1] Kutambudzika kwekudzokera kumashure nguva pfupi yadarika kwakaverengerwa neGlobal Burden yeChirwere Kudzidza seimwe yeanomwe mamiriro ehutano ayo anonyanya kukanganisa huwandu hwepasi rose, [7] uye inoonekwa sehunhu husina simba hunokanganisa huwandu hwevanhu kune huwandu hukuru hwemakore pamusoro pe hupenyu. [2] Iko kuwanda kwehuwandu hwehutambudzo hwekudzokera kumashure muhuwandu hwevanhu hunonzi hwave kusvika pa2%, ichiwedzera kusvika pa18% mumazuva makumi matatu apfuura, 31% mumwedzi gumi nembiri yekupedzisira, uye 30% panguva ipi neipi yehupenyu. [38] Kutambudzika kwakadzika kumashure kunosanganisirwa nemutengo mukuru wekurapa. Inofungidzirwa kuti munyika dzeEurope, mitengo yakananga uye isina kunangana inosiyana kubva pa12 kusvika ku39 emabhiriyoni pagore. [3] Kufungidzira kwekutambudzika kwepashure kwakanangana zvakananga nekureba kwezviratidzo. [4] Varwere vane chirwere chisingaperi chisingarwadze musana vane fungidziro isingafarire kana ichienzaniswa nevarwere vane kurwadziwa kwakanyanya kwepashure [2] uye vane mhosva kune vazhinji yemitengo yekutungamira kwekurwadziwa kumashure, zvichikonzera kudiwa kwekutsvaga kwakanangana nekuwana kurapwa kuri nani kwevarwere ava.

 

Kune nzira dzakasiyana siyana dzekurapa kwevarwere vane kurwadziwa kusingaperi, kusanganisira nzira yeMcKenzie yakagadzirwa naRobin McKenzie kuNew Zealand muna 1981. [8] Iyo nzira yeMcKenzie (inozivikanwawo seMechanical Diagnosis and Therapy [MDT]) mushonga unoshanda unosanganisira kufamba kwakadzokororwa kana zvigaro zvinotsigirwa uye une chikamu chedzidzo nechinangwa chekudzora kurwadziwa nekuremara uye kugadzirisa kufamba kwemuzongoza. [8] Iyo nzira yeMcKenzie inosanganisira kuongororwa kwezviratidzo uye zvemagetsi mhinduro kudzokororwa mafambiro uye nzvimbo dzakatsiga. Mhinduro dzevarwere kuongororo iyi dzinoshandiswa kuvapatsanura muzvikamu zvidiki kana ma syndromes anonzi kupenga, kusagadzikana, uye chimiro. [8-10] Kupatsanura zvinoenderana nerimwe remapoka aya kunotungamira maitiro ekurapa.

 

 

Derangement syndrome ndiro boka rakakura uye rinoratidzwa nevarwere vanoratidzira centralization (kuchinja marwadzo kubva ku distal kusvika kune zvakanyanya) kana kuparara kwemarwadzo [11] nekudzokorora kushandiswa kwekufamba mune imwe nzira. Varwere ava vanorapwa nekudzokororazve kana nzvimbo dzinotsigirwa dzinogona kuderedza marwadzo. Varwere vanorondedzerwa sevari kuita dysfunction syndrome vanorwadziwa zvinowanzoitika pamagumo emafambiro ekufamba kwechimwe chete. [8] Hurwa hunochinja kana hukuru hwepakati nekudzoka kwekufamba kwekufamba. Mushonga wekurapa kune varwere vane kusakosha kunowanzofambiswa mumakwara akaita marwadzo. Pakupedzisira, varwere vanorondedzerwa sevanonzi postural syndrome vanonzwa kurwadziwa kwepakati pega paya pavanenge vakagadziriswa pamagumo ekufamba (semuenzaniso, vakachengetwa slumped vagere). [8] Kurapa kwechirwere ichi kune mushure mekugadziriswa. [11]

 

Maitiro aMcKenzie anosanganisirawo chikamu chakasimba chekudzidzisa kubva pamabhuku akanzi The Lumbar Spine: Mechanical Diagnosis & Therapy: Volume Two [11] uye Treat Your Own Back. [12] Iyi nzira, kusiyana nedzimwe nzira dzekurapa, inovavarira kuita kuti varwere vazvimiririre kune vechiremba sezvazvinogona uye nekudaro vachikwanisa kudzora marwadzo avo kuburikidza nekuchengetwa kwepashure uye tsika yemamwe maekisesaizi edambudziko ravo. [11] Inokurudzira varwere kuti vafambise musana munzira isingakuvadze kunetseka kwavo, nekudaro vachidzivirira kufambiswa kwekufamba nekuda kweinesiophobia kana kurwadziwa.

 

Mhinduro mbiri dzakapfuura dzakarongeka dzakaongorora mhedzisiro yeMcKenzie nzira [9,10] mune varwere vane acute, subacute, uye chirwere chisingaperi chisingarware shure. Kuongorora kwakaitwa naClare et al [9] kwakaratidza kuti iyo nzira yeMcKenzie yakaratidza mhedzisiro zvirinani mukusununguka kwekurwadziwa kwenguva pfupi uye kugadzirisa kwehurema zvichienzaniswa neanopindira anoshanda sekuita muviri. Kuongororwa kwakaitwa naMachado et al [10] kwakaratidza kuti iyo nzira yeMcKenzie yakadzora kurwadziwa nekuremara munguva pfupi kana ichienzaniswa neasipo kurapa kwekurwadziwa kwakanyanya kumashure. Zvekurwadziwa kusingaperi kwekuseri kwekurwadziwa, ongororo mbiri dzakatadza kutora mhedzisiro nezve kugona kweMcKenzie nzira nekuda kwekushayikwa kwemiedzo yakakodzera. Iyo miedzo yakarongedzwa yakasarudzika iyo yakaongorora nzira yeMcKenzie mune varwere vane chirwere chisingaperi chisingarware musana [2-13] ichifananidza nzira nedzimwe nzira dzakadai sekudzidzira kuramba, [17] nzira yaWilliams, [17] kurovedza muviri kusingatarisirwe, [14] trunk kusimbisa, [16] uye kudzikamisa kurovedza. [15] Mhedzisiro zvirinani mukuderedza kurwadziwa kwakanyanya kwakawanikwa neiyo nzira yeMcKenzie kana ichienzaniswa nekurwisa kudzidziswa, [13] iyo Williams nzira, [17] uye rinotarisirwa kurovedza muviri. [14] Nekudaro, iwo maitiro ehunhu hweiyi miedzo [16-13] iri pamusoro.

 

Inonyatsozivikanwa kubva mumabhuku kuti nzira yeMcKenzie inobereka migumisiro inobatsira kana ichienzaniswa nezvimwe zvirongwa zvechipatara kune varwere vane chirwere chisingaperi chisingarwadzo shure; zvisinei, kusvika panguva, hapana zvidzidzo zvakafananidza nzira yeMcKenzie kurwisana nekurapwa kwepa placebo kuitira kuti ione kuti inoshanda sei. Clare et al [9] vakasimbisa kudikanwa kwekuenzanisa nzira yeMcKenzie ne placebo therapy uye kuongorora migumisiro yeyo nzira munguva refu. Mune mamwe mazwi, hazvizivikanwe kana zvibereko zveMcKenzie zvinokonzerwa nekubudirira kwayo chaiyo kana kuti kungoita nzvimbo yebhendi.

 

Chinangwa chechidzidzo ichi chichave chekuongorora kushanda kwe nzira yeMcKenzie kune varwere vane chirwere chisingaperi chisingagoneki mushure mekushandisa kushandiswa kwepamusoro-soro kunongedza kwakaitwa placebo-kutongwa.

 

nzira

 

Chigadziro Chekudzidza

 

Izvi zvichava muchengeti-akapofumadza, 2-ruoko, randomized trialbo-controlled control.

 

Kudzidza Kudzidza

 

Ichi chidzidzo chichaitwa mumakiriniki ekurapa mumuviri muS o Paulo, Brazil.

 

Kukodzera Kururamisa

 

Chidzidzo chacho chichabatanidza varwere vanotsvaka kutarisira marwadzo asingagoneki mushure mekurwadziwa (anorondedzerwa sokurwadziwa kana kusagadzikana pakati pematombo ekudhura uye asina kudzika gluteal folds, kana kana pasina kunze kwezviratidzo muzvikamu zviduku, kweusina mwedzi 3 [18]), ne kunorwadza kwemashoma mapeji e3 sezvakaenzana ne 0- kusvika ku10-Pakati Pein Numerical Rating Scale, ane makore pakati pe18 nemakore 80, uye anokwanisa kuverenga chiPutukezi. Varwere vachabviswa kunze kana vane zvinopesana nekuita muviri [19] kana ultrasound kana shortwave therapy, uchapupu hwehutano hwehutano hunopesana (kureva, imwe kana kupfuura motokari, kufungidzira, kana kutadza kunzwa), zvakakomba zvepamuviri (semuenzaniso, kuputsika, tumarara , zvirwere zvinoputika uye zvinopararira), zvirwere zvakakomba zvepfungwa uye zvirwere zvemagetsi, chirwere chekare chakare, kana pamuviri.

 

nzira

 

Chokutanga, varwere vachabvunzurudzwa nemunhu anoongorora akafufudzira, uyo achaona kugona. Vagari vakakodzera vachaudzwa pamusoro pezvinangwa zvekudzidza ndokukumbira kusaina fomu yemvumo. Zvadaro, dhiyabhorosi yedhemododhe data uye nhoroondo yezvechiremba zvichabviswa. Muongorori achazogadzirisa dhepfenyuro yakabatana nemigumisiro yekudzidza pachirongwa chekutanga, mushure mekupera kwevhiki dze 5 dzokurapa, uye 3, 6, uye 12 mwedzi mushure mekushanda. Kunze kwezviyero zvepamusoro, zvimwe zvose zvidzidzo zvichaunganidzwa pamusoro pefoni. Zvose zvinyorwa zvekutsvaga zvichange zvakanyorwa, zvakapinda muExcel (Microsoft Corporation, Redmond, Washington) pepafurasi, uye kaviri-checked isati yasarudzwa.

 

 

Migumisiro yeMitemo

 

Zvirwere zvemakiriniki zvichave zvichienzaniswa pamusangano wekutanga, mushure mekurapa, uye 3, 6, uye 12 mwedzi mushure mekugoverwa kwenyika. Mhedzisiro yepamusoro ichava kurwadziwa kwakanyanya (kuenzaniswa neRumen Numerical Rating Scale) [20] nekuremara (kuenzaniswa neRandand-Morris Dambudziko reMibvunzo) [21,22] mushure mekupera kwevhiki dze5 dzokurapa. Zvimwe zvikamu zvinotevera zvichava kurwadza nekuremara 3, 6, uye 12 mwedzi mushure mekunge maitiro uye kuremara nekushanda (zvakaenzaniswa neMuviri-Chirwere Chekuita Basa), [20] kinesiophobia (yakaenzaniswa neTampa Scale of Kinesiophobia), [23] uye kuonekwa kwenyika yose (yakaenzaniswa ne Global Perceived Effect Scale) [20] mushure mekurapwa uye 3, 6, uye 12 mwedzi mushure mekunge maitiro. Pazuva rekuongorora kwekutanga, murwere wega wega wekuvandudza uyewo achaongororwa achishandisa Expectancy of Improvement Numerical Scale, [24] yakateverwa nekuongorora achishandisa nzira yeMcKenzie. [8] Varwere vanogona kuwedzera kuwedzera kwezviratidzo mushure mekuongorora kwekutanga nekuda kwekuongorora kweMDC. Zvose zviyero zvakambopfuura-tsika zvakagadziriswa kuva chiPutukezi uye kuchipatara zvakaedzwa uye zvinorondedzerwa pasi apa.

 

Pain Numerical Rating Scale

 

Iyo Pain Numerical Rating Scale chiyero chinoongorora iwo maronda ekurwadziwa kwakanyanya kunoonekwa nemurwere achishandisa 11-poindi chikero (zvichisiyana kubva pa0 kusvika 10), umo 0 inomiririra "hapana kurwadziwa" uye 10 inomiririra kurwadziwa kwakanyanya. 20 [7] Vatori vechikamu vacharairwa kusarudza avhareji yekurwadziwa kwakanyanya kunoenderana nemazuva manomwe apfuura.

 

Roland-Morris Dambudziko Rekuremara

 

Uyu mubvunzo unobatanidza zvinhu zve 24 zvinotsanangura mabasa ezuva nezuva ayo varwere vane zvakaoma kuita nekuda kwekurwadziwa kwepashure. [21,22] Iyo yakakwirira nhamba yemhinduro dzakasimba, inowedzera hutano hwekuremara hunoenderana nekurwadziwa kwakanyanya kumashure. [21,22] Vatori vechikamu ngorayirirwe kupedzisa mubvunzo wemibvunzo kubva pamaawa ekupedzisira e24.

 

Murefu-Anonyatsoshanda Maitiro Anoshanda

 

Mushandi-Anonyanya Kubudirira Anoshanda ndeyepasi rose; saka, inogona kushandiswa kune chero chikamu chemuviri. [25,26] Varwere vachakumbirwa kuti vaone kusvika kune zvinhu zve 3 zvavanofunga kuti hazvigoni kuita kana kuti vane dambudziko rokuita nekuda kwekurwadziwa kwavo kwepashure. [25,26] Kuyera inotorwa uchishandisa Likert-type, 11-chiyero chechikamu chebasa rimwe nerimwe, nepamusoro-kati yezvikoro (kubva ku0 kusvika ku10 points) inomiririra kukwanisa kuri nani kuita mabasa. [25,26] Tichaverenga mavhareji emabasa aya anobva pa ekupedzisira 24 maawa, ane mapepa ekupedzisira kubva ku0 kusvika ku10.

 

Pasi Pose Mugumisiro Unonzwisisika Scale

 

Global Inonzwisisika Mhedzisiro Scale ndeye Likert-mhando, 11-poindi chikero (kubvira? 5 kusvika +5) iyo inofananidza mamiriro emurwere azvino neake mamiriro pakutanga kwezviratidzo. [20] Zvibodzwa zvakanaka zvinoshanda kuvarwere vari nani uye zvisina kunaka zvibodzwa zvinoshanda kuvarwere avo vakaipisisa maererano nekutangira kwezviratidzo. [20]

 

Tampa Scale yeKinesiophobia

 

Ichi chiyero chinoongorora huwandu hweinesiophobia (kutya kufamba) nenzira yemibvunzo gumi neshanu inobata nekurwadziwa uye kusimba kwezviratidzo. [17] Zvibodzwa kubva pachinhu chimwe nechimwe zvinosiyana kubva pa23 kusvika pa1 mapoinzi (semuenzaniso, 4 poindi yekusabvumirana zvakasimba, points 1 mapoinzi eanopokana, matatu mapoinzi eanobvumirana, uye mana mapoinzi ekubvumirana zvakasimba). [2] Pachikamu chakazara, zvakafanira kuti ushandure huwandu hwemibvunzo 3, 4, 23, uye 4. [8] Chikamu chekupedzisira chinogona kusiyana kubva pamatanhatu kusvika pamatanhatu makumi matanhatu neshanu, nezvikamu zvepamusoro zvinomiririra mwero wepamusoro weinesiophobia. [12]

 

Kutarisira Kwekuvandudza Numerical Scale

 

Chiyero ichi chinoyedza tarisiro yemurwere yekuvandudza mushure mekurapwa muhukama nehumwe kurapwa. [24] Inosanganisira 11-poindi chikero chakasiyana kubva pa0 kusvika gumi, umo 10 inomiririra hapana tarisiro yekuvandudza- uye gumi inomiririra tarisiro yekuvandudzika kukuru. [0] Chiyero ichi chichaitwa chete pazuva rekutanga kuongorora (yekutanga) kusati kwaitika. Icho chikonzero chekusanganisa chiyero ichi kuongorora kana iko kutarisira kwekuvandudza kuchakanganisa mhedzisiro.

 

Random Allocation

 

Pamberi pemishonga isati yatanga, varwere vacharamba vachiendeswa kumapoka avo ekupindira. Kugoverwa kwekugoverana kunenge kushandiswa neumwe wevanotsvakurudza vasingabatanidzi pakuunganidza uye kuongorora varwere uye ichagadzirwa pa Microsoft Excel 2010 software. Iyi kugoverwa kusarudzwa kuchaiswa mune sequentially count, opaque, yakavharidzirwa mavhopu (kuve nechokwadi kuti kugoverwa kwakavanzwa kubva kune muongorori). Mavhopufomu achazarurirwa nemutapi wepanyama uyo achabata varwere.

 

Kupofumadza

 

Zvichienderana nemhando yekudzidza, hazvibviri kupofumadza vanachiremba kumamiriro ekurapa; zvisinei, muongorori nevarwere vachabviswa kumapoka ekurapa. Pakupera kwekudzidza, muongorori achabvunzwa kana varwere vakagoverwa kumapoka chaiwo ekurapwa kana kuti boka re placebo kuitira kuongorora kuongorora kupofumadza. Chiratidzo chinomiririra chigadziro chekudzidza chinowanikwa muMufananidzo.

 

 

Zvinyorwa

 

Vatori vechikamu vachagoverwa kumapoka anogamuchira 1 ekugadzirisa kwe2: (1) placebo therapy kana (2) MDT. Vagari veboka rimwe nerimwe vachagamuchira zvikamu zve 10 zvemaminitsi e30 imwe neimwe (2 masangano pavhiki pamavhiki e5). Zvidzidzo zveMcKenzie hazvina huwandu hwemazvikamu zvakapiwa kuti zvimwe zvidzidzo zvinopa kuderedza maitiro ekurapwa, [16,17,27] uye vamwe vanokurudzira madhigiri akakwirira. [13,15]

 

Pamusoro pezvikonzero zvepamutemo, pazuva rokutanga rekurapa, varwere vanobva kumapoka maviri aya vachawana kabhuku kanhau rinonzi The Back Book, [28] yakavakirwa mazano akafanana semitemo iripo. [29,30] Bhuku rino richashandurirwa muchiPutukezi kuitira kuti inogona kunzwisiswa zvakakwana nevatori vechidzidzo, avo vachawana mamwe matsanangudzo pamusoro pezvakanyorwa mubhuku, kana zvichidikanwa. Varwere vachabvunzwa muchidzidzo chega chega kana vakanzwa zviratidzo zvakasiyana. Muchengeti mukuru wekudzidza achawanzoongorora zvekupindira.

 

Placebo Group

 

Varwere vakagoverwa kuboka re placebo vacharapwa ne detunun pulsed ultrasound kwemaminitsi mashanu uye vadzora shortwave diathermy mu pulsed mode kwemaminitsi makumi maviri neshanu. Iyo michina inozoshandiswa netambo dzemukati dzakatemwa kuti dziwane iyo placebo mhedzisiro; zvisinei, zvinokwanisika kuzvibata nekugadzirisa dosi nemaalarm sekunge zvakabatana kuti zvienzanise pragmatism yekiriniki yekuita pamwe nekuwedzera kutendeka kwekushandiswa kweizvi zvishandiso pane varwere. Iyi nzira yakashandiswa zvakabudirira mumiedzo yapfuura nevarwere vane kurwadziwa kwepashure. [5-25]

 

McKenzie Group

 

Vagari veboka reMcKenzie vachabatwa maererano nemitemo yeMcKenzie, [8] uye kusarudzwa kwekurapa kwokurapa kuchave kutungamirirwa nehuongorori hwekuongorora nekuongorora. Varwere vanozogamuchirawo mazano akanyorwa kubva mubhuku reTe Your Own Back [12] bhuku uye vachakumbirwa kuti vashandise maitiro ekudzidzira zvichienderana nemitemo yeMcKenzie. [11] Tsanangudzo yezvidzidzo zvichatsanangurwa munyaya ino inobudiswa kune imwe nzvimbo . [27] Kuenderana nemitambo yemusha kuchaongororwa nenzira dzezvigwaro zvezuva nezuva izvo murwere achazadza mumba uye kuunza kumurapi pachikamu chega chega chinotevera.

 

 

Statistical Methods

 

Sample Size Calculation

 

Chidzidzo chacho chakanga chagadzirirwa kuti chione kusiyana kwe1 nepfungwa inorwadza yakaenzana neInhamo Numerical Rating Scale [20] (inofungidzira kukanganisa kwakakwana = 1.84 points) [31] uye musiyano wehutano hwe4 mukuremara hunobatanidza nehutano hwakacheka huri shure pamwe neRandand-Morris Disability Questionnaire [21,22] (inofungidzira kukanganisa kwakakwana = 4.9 points). [31] Zvinyorwa zvinotevera zvaiongororwa: nhamba yehuwandu ye80%, alpha yezinga re 5%, uye kurasikirwa-kupera kwe15%. Nokudaro, chidzidzo chinodikanwa muenzaniso wevarwere ve74 neboka rimwechete (148 muhuwandu).

 

Kuongorora kweMigumisiro yeMutano

 

Nhamba yekuongororwa kwekudzidza kwedu kuchaita zvinangwa-ku-kubata-maitiro. [36] Chimiro chezvinyorwa chichaongororwa nekuonekwa kuonekwa kwehetogram, uye kuratidzirwa kwevatori vechikamu kuchaverengerwa kushandura tsananguro yekuongorora. Iko pakati--kusiyana kweboka (zvinokonzerwa nehutano) uye zvigaro zvadzo zve 95% zvinotarisirwa zvichaverengwa kuburikidza nekugadzira mhando dzakasiyana dzakasiyana-siyana [37] vachishandisa mazwi ekubatanidza emapoka ekurapa kusvika panguva. Tichaitisa chikamu chechipiri kutsvakurudza kuongorora kana varwere vanorondedzerwa seve derangement syndrome vane mhinduro yakanakisisa nenzira yeMcKenzie (vachienzaniswa ne placebo) kune avo vane mamwe maitiro. Nokuda kwekuongorora uku, tichashandisa nzira ye 3-yeboka, nguva, uye maitiro. Nokuda kwezvose izvi kuongorora, tichashandisa IBM SPSS software package, version 19 (IBM Corp, Armonk, New York).

 

Ethics

 

Ichi chidzidzo chakagamuchirwa neKutsvagisa Ethics Committee yeUniversidade Cidade de S o Paulo (# 480.754) uye vanotarisirwa kunyoreswa ku ClinicalTrials.gov (NCT02123394). Chero chero shanduro yekushandurwa kweprotocol ichazoendeswa kuChitatimendi Chekuongorora (Research Ethics Committee) pamwe nekuregererwa kwekuedzwa.

 

Dr. Alex Jimenez's Insight

Kutambudzika kwekudzokera shure ndeimwe yezvikonzero zvinowanzovhiringidza vanhu kutsvaga kurapwa kwenguva pfupi gore negore. Kunyange zvazvo vakawanda vashandi vezvehutano vakagadzikana uye vane ruzivo mukuongororwa kwechikonzero chekurwadziwa kwemuchembera kwemurwere, kutsvaga mukana wehutano hwehutano hwakanaka uyo anokwanisa kupa kurapa kwakakodzera kune mumwe munhu weLBP anogona kuva dambudziko rechokwadi. Mishonga yakasiyana-siyana inogona kushandiswa kugadzirisa marwadzo ekurwadziwa, asi, ruzhinji rwevashandi vehutano hwakatanga kutora nzira yeMcKenzie mukurapa varwere vane nonspecific marwadzo ekudzokera shure. Chinangwa chenyaya inotevera ndechokuongorora kubudirira kweMacKenzie nzira yekurwadziwa kwepamusoro, kunyatsoongorora tsanangudzo yekutsvakurudza.

 

hurukuro

 

Zvinogona Kuitika uye Kukosha kweChidzidzo

 

Iwo aripo akaedzwa akasarudzika miedzo inotsvaga nzira yeMcKenzie muvarwere vane chirwere chisingaperi chisingarware shure vese vakashandisa imwe nzira yekupindira seboka rekuenzanisa. [14-17] Kusvika pari zvino, hapana chidzidzo chakafananidza nzira yeMcKenzie nemushonga we placebo mune varwere vane yakaderera musana musana kuitira kuti uone kushanda kwayo chaiko, rinova iro rakakosha mukaha mumabhuku. [9] Dudziro yezvakaitika zvidzidzo zvekufananidza zvakapfuura nekushomeka kweruzivo rwekubudirira kweiyo nzira yeMcKenzie kune vanhu vane marwadzo ekurwadziwa asingaperi. Ichi chidzidzo chichava chekutanga kuenzanisa nzira yeMcKenzie ne placebo therapy mune varwere vane chirwere chisingaperi chisingarwadzire zvekurwadziwa shure. Kufananidza kwakaringana neboka re placebo kuchapa huwandu hwesimba hwekupindira uku. Rudzi urwu rwekuenzanisa rwakatove kuitwa mumiedzo yakanangana nekuongorora kushanda kwemagetsi ekudzora maekisesaizi evarwere vane kurwadziwa kusingaperi kwemusana, [31] musana wekurapa musana uye diclofenac yevarwere vane kurwadziwa kwakanyanya kwepashure, [38] uye kurovedza muviri uye mazano yevarwere vane subacute low back pain. [39]

 

Mupiro wePhysical Therapy Professional uye Vatano

 

Nzira yeMcKenzie ndeimwe yenzira shomanana dzinoshandiswa mukurapa kwepanyama inotsigira kuzvimiririra kwevarwere. [8,12] Iyi nzira inopawo varwere vane zvigadziro zvekusimudzira kusununguka kwavo mukugadzirisa marwadzo anowanzo uye kunyange nekudzokazve kwemuviri. [12] Tinotarisira kuti varwere vanobata neMcKenzie nzira inobatsira zvikuru kupfuura varwere vanobatwa nehutano hwe placebo. Kana iyi pfungwa yakasimbiswa mune zvidzidzo zvedu, zvigumisiro zvichaita kuti zvirongwa zvekuchirapa zviri nani zvive zvechiremba. Uyezve, nzira iyi ine mikana yekuderedza mutoro unobatanidza nehuwandu hwehutano hushoma huri shure kana varwere vanogona zviri nani kuzvitonga zvikamu zvenguva yemberi.

 

Simba uye Utera hweChidzidzo

 

Uyu muedzo unofungisisa huwandu hwakawanda hwevarwere kuti vadzikise rusarura, uye zvakatariswa zvakanyoreswa. Isu tinoshandisa yechokwadi randomization, yakavanzika kugoverwa, kupofumadzwa kuongororwa, uye chinangwa-chekurapa kuongorora. Marapirwo acho achaitwa nevarapi vaviri avo vakadzidziswa zvakanyanya kuita kupindira. Tichaongorora chirongwa chekudzidzira pamba. Nehurombo, nekuda kweanopindira, isu hatizokwanise kupofumadza varapi kune kugoverwa kwekurapa. Zvinozivikanwa kubva mumabhuku kuti nzira yaMcKenzie inoburitsa mibairo inobatsira kana ichienzaniswa nedzimwe nzira dzekurapwa muvarwere vane marwadzo ekurwadziwa asingaperi. [2-14] Kusvika parizvino, zvisinei, hapana zvidzidzo zvakafananidza nzira yeMcKenzie nemushonga we placebo kuona kushanda kwayo chaiko.

 

Future Research

 

Chinangwa cheboka iri rekudzidza ndechokuisa mhinduro dzekudzidza uku kune imwe nhamba yepamusoro-soro, yepamusoro-soro yepamusoro-pepanhau rekuongorora. Izvi zvinogadziriswa zvinogona kupa chikonzero chemiedzo yemberi yeramangwana inotsvaga kubudirira kwe nzira yeMcKenzie kana ichiendeswa pamitambo yakasiyana (nhamba dzakasiyana dzemasere, kudzokorora, uye zvidzidzo), izvo zvisati zvanyatsojeka mumabhuku. Ongororo yedu yechipiri inotsvaga kuongorora kana varwere vanorondedzerwa seve derangement syndrome vane mhinduro yakanakisisa nenzira yeMcKenzie (kana ichienzaniswa nerutendo rwe placebo) kune avo vane mamwe maitiro. Ichi chiongorudzo chichaita kuti pave nokunzwisisa zviri nani zvikamu zvingangodaro zvevarwere vane chirwere chisingaperi chisingarware shure vanopindura zvakanakisisa kune zvinyorwa zvakananga. Iyi inyaya inokosha, sezvo kuongorora mazana mashoma ikozvino inonzi inonyanya kukosha pakutsvakurudza mundima yekurwadziwa kwepamusoro. [40]

 

Ichi chidzidzo chakatsigirwa zvizere neS o Paulo Research Foundation (FAPESP) (Grant nhamba 2013 / 20075-5). Ms Garcia anobhadharwa nehunyanzvi kubva kuConordination yeKusimudzira kweVadzidzi Vepamusoro / Hurumende yeBrazil (CAPES / Brazil).

 

Chidzidzo chacho chakanyatsotaridzirwa kuClinikiTrials.gov (kuverengwa kwekutsvaga: NCT02123394).

 

Kufanotaurira Chiitiko Chinokosha Muzvipatara Nevarwere Vasingadzokeri Kurapa Kuchitevera McKenzie Therapy kana Kurapa Kwepasina: Kuongororwa Kwakasimba muRandomized Controled Trial

 

Presented Abstract

 

• Background: Mishumo inowirirana zvakasiyana pamusoro pemamiriro ezvinhu evarwere vanozopindura pakuita zvekudzidzira maitiro kana kushandiswa. Chinangwa chekutsvaga kwekutsvaga kwekutsvaga kwekutora ndechekuziva zviratidzo zvevarwere vane mamiriro ezvinhu akachinja, kureva kupa pachena ne centralization kana peripheralization, izvo zvingangobatsira zvikuru kubva kune imwe nzira yeMcKenzie kana kushandiswa kwepamuviri.
• Nzira: Vashandi ve350 vane chirwere chisingaperi chisingadzokeri shure vakashandurwa kune imwe nzira yeMcKenzie kana kushandiswa. Izvo zvinogadzirisa zvinogadzirisa maitiro aive makore, kusuruvara kwemarwadzo emakumbo, kuparadzirwa-kurwadziwa, kusvibiswa kwemutsipa mukati, nguva yezviratidzo, uye centralization yezviratidzo. Mhedzisiro yepamusoro ndiyo nhamba yevarwere vanotaura kubudirira pamwedzi miviri kutevera. Maitiro ezvokufungidzira dichotomized akaedzwa maererano nehuwandu hwekuongorora hurongwa.
• Results: Hapana vafanotaura vakawanikwa vachigadzira huwandu hwakakosha hwekudyidzana. Maitiro aMcKenzie aive akakurisa kupfuura ekunyengedza mukati memapoka ese, nekudaro mukana wekubudirira waigara uchifarira kurapwa uku kwakazvimirira kwekufungidzira kunoonekwa. Kana vafungidziri vaviri vane simba, kubatanidzwa kwemidzi yemutsinga uye peripheralization, zvakabatanidzwa, mukana wekubudirira yaive njodzi 10.5 (95% CI 0.71-155.43) yemaitiro eMcKenzie uye 1.23 (95% CI 1.03-1.46) yekumanikidza (P? =? 0.11 yekudyidzana mhedzisiro).
• Mhedziso: Hatina kuwana chero zvikamu zvekutanga zvekutanga zvinotaridzika zvakagadzirisa zvinogadzirisa muhutano mukufananidza kupindura kwakasiyana kune kurapwa kwaMcKenzie kana kushandiswa kwepamuviri kana zvichienzaniswa kune mumwe nemumwe. Zvisinei, isu takatora mishonga inopindirana uye inoparadzanisa kuti kuve nekusiyana kwekuteerera kuchipatara cheMcKenzie kana zvichienzaniswa nekugadzirisa kunoonekwa kuchiremba. Zviwanikwa izvi zvinoda kuongororwa mune zvidzidzo zvakakura.
• Trial registration: Clinicaltrials.gov: NCT00939107
• Electronic supplementary material: Iyo inowanikwa muIndaneti yenyaya ino (doi: 10.1186 / s12891-015-0526-1) ine zvinyorwa zvinowedzera, izvo zvinowanikwa kuvashandi vane kodzero.
• Keywords: Kutambudzika kwakadzoka shure, McKenzie, Spinal manipulation, Predictive value, Kuchinja kuchinja

 

kumashure

 

Nzira dzakabudiswa munguva pfupi yapfuura yekurapa kwevarwere vane hurumende dzisingazivikanwi dzakasuruvara (NSLBP) dzinoronga chirongwa chinotarisa kuzvimiririra mavo mushure mekutanga mazano uye ruzivo. Vachirwere vanofanirwawo kupiwa maitiro akarongeka akafanirwa kune mumwe murwere uye mamwe maitiro akadai semusana wechirwere [1,2].

 

Ongororo yapfuura yakafananidza nemigumisiro yeMcKenzie-nzira, inozivikanwawo seMechanical Diagnosis uye Therapy (MDT), neyoyemagunha (SM) muhutano husingaenzaniswi nevarwere vane NSLBP inobata uye yakashata uye havana kuwana mutsauko pakuguma [3,4] .

 

 

Munguva pfupi yapfuura, kudiwa kweongororo kuyedza mhedzisiro yemazano ekurapa ezvikamu zvevarwere vane NSLBP mukutarisira kwekutanga kwakasimbiswa mukubvumirana-mapepa [5,6] pamwe nemazuvano eEuropean nhungamiro [7], zvichibva pane fungidziro iyo inobatanidza. inoongorora, zvichiteerana nemazano e'Prognostic Factor Research '[8], ichavandudza kuita sarudzo kune akanyanya marongero ehurongwa. Kunyangwe dhata yekutanga ichiratidza mhedzisiro inovimbisa, parizvino pane humbowo husina kukwana hwekukurudzira nzira dzakasarudzika dzekubatisa kwekutanga [1,9].

 

Zvidzidzo zvitatu zvakarongeka, zvinosanganisira varwere vane maitiro akaoma zvikuru kana kuti vanorwara kurwadziwa kwakanyanya (LBP), vakaedza migumisiro ye MDT neye SM mune rimwe boka revarwere iro rinouya ne centralization yezviratidzo kana kutungamirirwa kunofanirwa kuongorora [10-12]. Mhedziso yakabva kune zvidzidzo izvi yakanga isiri muchibvumirano uye kubatsira kwakagadziriswa nehutsika hwehutsika hwehutano.

 

Kudzidza kwedu kwemazuva mashoma, kuve nevarwere vane LBP isingaperi (CLBP), vakawana mararamiro akanaka eDMT kusvika kune SM mune rimwe boka rakafanana [13]. Kuti titevere pfungwa yekugadzirisa mberi, yakange iri chikamu cherongwa hwekudzidza kutsvaga kufungidzira kunobva pane zvirwere zvinokwanisa kubatsira chiremba mukutsvaga kurapa kwakanakisisa kune mumwe murwere.

 

Chinangwa chechidzidzo ichi chaiva chekuona zvikamu zvevarwere vane CLBP yakawanda, vachitaura ne centralization kana peripheralization, iyo inogona kubatsirwa kubva kune MDT kana SM mwedzi miviri mushure mokupera kwekurapa.

 

nzira

 

Data Collection

 

Chidzidzo chezvino chiri chekuongorora kwechipiri chepakutanga kwakabudiswa kuongororwa kwakaitwa randomized [13]. Takatora varwere ve350 kubva munaSeptember 2003 kusvika May 2007 kune imwe nzvimbo yekuchengetedzeka kunze kwekuchengetedzwa kwekare muCopenhagen, Denmark.

 

Varwere

 

Varwere vaitumirwa kubva kuchikoro chekuchengetedza vanachiremba kurapwa kweRBB inopfuurira. Varwere vakakodzera vaiva pakati pe18 uye 60 yemakore emakore, vachitambura neLBP kana kuti vasina kurwadziwa kwegumbo kwenguva yakareba kwemavhiki e6, vakakwanisa kutaura uye kunzwisisa mutauro wechiDanish, uye akazadzisa chirongwa chekliniki yekutangira kana kuparadzanisa zviratidzo pakutanga kuongorora. Centralization yakarondedzerwa sekuti kubviswa kwezviratidzo munzvimbo yakasiyana-siyana yemuviri (yakadai sedutsoka, gumbo rezasi, gumbo repamusoro, zvigaro, kana kuti shure zvakasara kumashure) uye peripheralization yakarondedzerwa sekugadzirwa kwezviratidzo mune imwe nzvimbo yomuviri wakasiyana. Izvi zvakawanikwa kare zvakawanikwa kuti zvine dhigirii inogamuchirika ye-inter-tester kutendeseka (Kappa kukosha 0.64) [14]. Kuongororwa kwekutanga kwakagadzirwa kusati kwamboitwa noutano hwepanyama ane diploma mumutambo we MDT wokuongorora. Varwere vakanga vasina kubhadhara kana vakanga vasina zviratidzo panguva yekubatanidzwa, vakaratidza maitiro akanaka kwete-organic (15], kana kuti kana chirwere chakakomba, kureva kusuruvara kwemutsipa kubatanidzwa (kuremedza shure kana kurwadziwa kwemakumbo pamwe chete nekuvhunduka kunofambira mberi mumusana, musimba simba, kana mafungiro), osteoporosis, spondylolisthesis yakaipisisa, kuputsika, kuputika arthritis, kenza, kana kurwadziwa kwakabva kune veccera, yaifungidzirwa zvichienderana nekuongorora mumuviri uye / kana magintic resonance imaging. Zvimwe zvikonzero zvekuregererwa zvaive kushanda kwekuremara kwepenjeni, kumirira kutongwa, kuberekwa, kurwisana, kushandiswa kwekare munguva ichangopfuura, matambudziko emitauro, kana matambudziko ekukurukurirana kusanganisira kushandiswa kwezvinodhaka kana doro.

 

Nhamba yekutongwa yaiva neCCLBP yakaramba iri pamusana pevhiki ye95 (SD 207), kureva kuti makore akange ari 37 makore (SD10), zvinorehwa nehutano hwemakumbo nemakumbo aive 30 (SD 11.9) pane Numeric Rating Scale kubva ku0 kusvika ku60, uye zvinoreva kuti hutachiona hwakanga huri 13 (SD 4.8) paRandand Morris Dambudziko reHubhaibheri (0-23). Nzira yedu yekurwadza inoratidza inoratidza kuti marwadzo ekudzoka kazhinji anowanzochinja-chinja apo kunorwa kunzvimbo uye kuoma kunogona kusiyana zuva nezuva. Saka, chirongwa chakanyatsogadziriswa chepfungwa chinonzi [16] chakashandiswa kuitira kuti zvive nechokwadi chokuti zvinhu zvose zvekurwadziwa kwegumbo nemagumbo zvakanyorwa. Zviyero zvinotsanangurwa munhoroondo yeTable 1.

 

 

Mushure mokunge matanho ekutanga akawanikwa, randomisation yakagadzirwa nekombiyuta-yakanyorwa mazita emapurogiramu akasiyana-siyana mumatombo gumi anoshandisa mavhopu epaque yakavharwa.

 

Ethics

 

Chibvumirano chetsika chekudzidza chakapiwa neCopenhagen Research Ethics Committee, faira kwete 01-057 / 03. Vose varwere vakagamuchira zvinyorwa zvakanyorwa pamusoro pekudzidza uye vakapa kubvumwa kwavo kwakanyorwa vasati vapinda.

 

Mishonga

 

Vashandi vanoita kurapwa vakanga vasina zivo yemigumisiro yekuongorora kwekutanga. Zvirongwa zvekurapa zvakagadzirirwa kuratidza chiito chezuva nezuva sezvinogona. Tsanangudzo yakajeka pamusoro pezvirongwa izvi zvakabudiswa mberi [13].

 

Mushonga we MDT wakarongwa wega zvichitevera mushonga wepamberi kurapwa. Hakananga echinyorwa vertebral yekumisikidza matekiniki anosanganisira yakakwira velocity kukanda haina kubvumidzwa. Bhukwana redzidzo rinotsanangura kuzvitarisira [17] kana lumbar roll yekugadzirisa nzvimbo yakagara dzimwe nguva yaipiwa kumurwere nekufunga kwemurapi. Mukurapa kweSM, kukwirisa velocity kwakashandiswa mukubatana nemamwe marudzi emaoko enzira. Sarudzo yekubatanidzwa kwehunyanzvi yaive mukufunga kwechiropractor. Kazhinji kuunganidza kurovedza muviri, kureva kuzvidzora, kuchinjanisa kufamba kwemaoko / kuwedzera kwekutambanudza, uye kutambanudza, zvakabvumidzwa asi kwete zviito zvekuita munzira yekuda. Mutsamiro wakakomberedzwa wedged yekugadzirisa nzvimbo yakagara waiwanika kuvarwere kana chiropractor achitenda kuti izvi zvinoratidzwa.

 

Mumapoka maviri ekurapa, varwere vakaudzwa zvakakwana nezve mhedzisiro yekuongororwa kwemuviri, iyo nzira isina kunaka yekurwadziwa kumashure, uye kukosha kwekugara wakasimba panyama. Nhungamiro pakuchengetwa musana kwakakodzera yakapihwawo. Uye zvakare, vese varwere vakapihwa iyo Danish vhezheni ye'The Back Book 'iyo yaimbove yakaratidzirwa kuve inobatsira pamagariro evatendi nezvekutambudzika kwekuseri [18]. Kuwanda kwemishonga gumi neshanu kwenguva yemasvondo gumi nemaviri yakapihwa. Kana zvikaonekwa zvichidikanwa nachiremba anorapa, varwere vakadzidziswa muchirongwa chega chekuzvimiririra-kusimudzira, kutambanudza, kudzikamisa, uye / kana kusimbisa zviitwa pakupera kwenguva yekurapa. Kurapa kwakaitwa navanachiremba vane makore akati wandei echiitiko. Varwere vakarairwa kuti vaenderere mberi nekurovedza muviri kwavo pamba kana kunzvimbo yekurovedza muviri kwenguva isingasviki mwedzi miviri mushure mekupedzwa kwekurapwa kunzvimbo yekumashure. Nekuti varwere vakatambura zvakanyanya kubva kuCLBP isu taitarisira kuti iyi nguva yekuzvimiririra yekurovedza muviri kuti ive yakakosha kuti varwere vaone kuzara kwekupindira. Varwere vakakurudzirwa kuti vasatsvage chero imwe mhando yekurapwa mukati memwedzi miviri iyi yekuzvibata-wega maitiro.

 

 

Migumisiro yeMitemo

 

Icho chinonyanya kuguma chaive chiyero chevarwere vanotaura kubudirira pavanotevera-mwedzi miviri mushure mokupera kwekurapa. Kurapa kubudirira kwakarondedzerwa sekuderedza kwemashoko anonzi 5 kana mapepa ekupedzisira pasi pe 5 points pa 23-chimwe chinhu chakagadziriswa Roland Morris Inodhindwa Inodhidhiyo (RMDQ) [19]. Danish yakagadziriswa version ye RMDQ yakashandiswa [20]. Tsanangudzo yekubudirira kwemishonga yakabva pane zvinokurudzirwa nevamwe [21,22]. Kuongorora kwekunzwisisika kunoshandisa 30% kuwirirana kwepamusoro paRMDQ senzira yekubudirira yakaitwawo. Maererano neprotocol [13], taifunga kuti hama iri pakati-yeboka yakasiyana-siyana ye15% muchiverengo chevarwere vane kubudirira kwekugadzirisa kusava nekliniki inokosha mukuongorora kwedu kwekubatana.

 

Prepecified Predictor Variables

 

Kuitira kudzikisira mukana wekuwana zvisirizvo [23], isu takadzora huwandu hwevashandisi vanogadzirisa dhatabheti kusvika pamatanhatu. Kuti tiwedzere huchokwadi hwezviwanikwa zvedu, inotungamirwa fungidziro yakagadzwa pamusiyano wega wega zvinoenderana nezvakakurudzirwa naSun et al. [24] Mhando ina dzepakutanga dzakambofungidzirwa muzvidzidzo zvisina kujairika kuti zvive fungidziro yemhedzisiro yakareba kune varwere vane LBP inoramba ichitevera MDT mukuenzanisa nekusimbisa kudzidzisa: centralization [25,26], kana kutevera SM mukuenzanisa ne physiotherapy kana kurapwa yakasarudzwa nachiremba mukuru: zera riri pasi pemakore makumi mana [40], nguva yezviratidzo zvinopfuura gore rimwe [27,28], uye kurwadziwa pasi pebvi [1]. Sezvakakurudzirwa nevamwe [27], mimwe mienzaniso miviri yakawedzerwa zvichibva pamatare ekutora mukana evanachiremba ane hunhu hwavanotarisira kufanotaura mhedzisiro kubva pakurapwa kwavo zvichienzaniswa neimwe. Mimwe misiyano yakaiswa pamberi nevephyotherotherapists muboka reMDT yaive zviratidzo zvetsinga midzi yekubatanidzwa uye kurwadziwa kwakanyanya kwemakumbo. Iyo yekuwedzera misiyano yakakosheswa neyechiropractors muboka reSM yakanga isina zviratidzo zvetsinga midzi yekubatanidzwa uye kwete yakanyanya kurwadziwa kwemakumbo.

 

Mukuwedzera kwekuongorora, takatora mukana wokutsvaga kana kuiswa kwezvimwe zvikamu zvitanhatu zvekutanga, kufungidzirwa kuva nechirevo chekufananidzira kwezvakanaka mune imwe yemapoka ekurapa, zvingaita seine simba rinoshandiswa zvakare. Kuziva kwedu, hapana zvimwe zvakasiyana-siyana zvepfuura zvidzidzo zvemaoko zvakapfuura zvakataurwa kuti zvine chirevo chekufananidzira kwenguva yakareba mhinduro kune varwere vanoramba vari LBP iri kutevera MDT, asi mitemo mitatu yakataurwa iine chirevo chekufananidzira kunotevera SM: varumekadzi [28] , urema huri [28], uye urombo huri shure [28]. Zvimwe zvitatu zvakasiyana zvakagamuchirwa nevanakiriniki kuti vabatanidzwe mukuwedzera kuongororwa sezvo vaifungidzirwa nechiitiko kubva kuchipatara chekuita kuti vave nechirevo chekufananidzira kwechibereko chakanaka pasinei nekurapwa ne MDT kana SM: kuderera kwemazuva pazorwere rinopera gore rapfuura, akakurudzire zvakatarisira kugadzirisa, uye zvakanyanya zvinotarisirwa nemurwere nezvekubata nemabasa mabasa masvondo masere mushure mekurohwa mushonga.

 

Dichotomization yezvigadziriswa zvinogona kuchinja zvakagadzirwa kuti zvibvumire kuenzanisa kuitwa neavo zvidzidzo zvekare. Mumamiriro ezvinhu apo hapana kuregererwa kwemaitiro kunowanikwa mumabhuku, dichotomization yakaitwa pamusoro / pasi pemuviri wakawanikwa mune muenzaniso. Tsanangudzo dzemhando dzakasiyana-siyana dzinowanikwa munyaya yeTable 1.

 

Statistics

 

Zvose-chinangwa-chekubata (ITT) chikwata chakashandiswa mune zvose zvakaongororwa. Nhamba yekupedzisira yakaendeswa mberi kune zvidzidzo zvisipo pamwedzi miviri RMDQ scores (7 varwere muboka re MDT uye varindi ve14 muboka SM). Mukuwedzera, imwe nhepfenyuro yekuongorora ye protocol yakaitwa iyo inongowanikwa chete nevarwere ve259 vakazadza zvakakwana kurapwa. Iro urongwa hwekuongorora hwakabvumiranwa mberi neboka rekutonga kwekutongwa.

 

Izvo zvinogona kuitika kare zvaive zvakasarudzwa uye mukana wekubudirira wakatsvakurudzwa nekufungidzira njodzi yakakwana (RR) yekubudirira mune imwe neimwe yezvidimbu zviviri. Izvo zvinokonzerwa nekufungidzirwa kwekufungidzirwa kwakafungidzirwa nekuenzanisa mukana wekubudirira pakati pemapoka ekurapa paakakamurwa muzvidimbu zviviri. Kuongororwa kwehutano hwekugadzirisa kushandiswa kwezvakafanirwa isu takaita chi-squared kuedza kwekubatana pakati pekupindira uye tambo mbiri dzakasiyana kune imwe neimwe yekufungidzira. Izvi zvinonyanya kufanana nekubatanidza kubva pamagadzirirwo emhando. Nguva dzekuvimba dzaiongororwawo kuitira kuti zviitiko zvingave zvakakosha mumigumisiro.

 

Kutevera kuongorora kusina kufanana, kuongorora kwakawanda kwakarongeka kusanganisira kushandiswa kwegadziriro ne p-value pasi pe0.1.

 

Dr. Alex Jimenez's Insight

Kutambudzika kwekudzokera shure kunogona kuitika nekuda kwemhando dzakasiyana dzekukuvara uye / kana mamiriro uye zviratidzo zvayo zvinogona kuva zvakanyanya uye / kana kusingaperi. Varwere vane kurwadziwa kunorwadza shure vanogona kubatsirwa nemishonga yakasiyana-siyana, kusanganisira chiropractic kuchengetedza. Chiropractic mishonga ndeimwe yenzira dzakasiyana-siyana dzokurapa dzinoshandiswa pakurapa kurwadziwa kwakanyanya. Maererano nenyaya yacho, migumisiro yekuvandudzwa kweLBP nemararamiro emusana uye kushandiswa kwemashoko, pamwe nekushandiswa kwekurovedza muviri, zvinowanzosiyana pakati pevatori vechikamu. Chinangwa chekutsvakurudza kwekutsvakurudza ndekutsvaga kuti varwere vangani vanogona kubatsirwa nenzira yeMcKenzie kana vachienzaniswa nekugadzirisa kwemapapu uye maitiro ekushandisa.

 

Results

 

Vatori vechikamu vakanga vakafanana nechekuremekedza huwandu hwevanhu nehuwandu hwemakiriniki pamamiriro ekutanga mumapoka ekurapa. Chidimbu chekupararira kwezvinyorwa zvakasanganiswa zvakasiyana-siyana pazvinyorwa zvekutanga zvinopiwa muTebhenekeri 1. Hapana kupesana kwakawanikwa pakati pemapoka ekurapa.

 

Pasi rose, nzvimbo yekutsvaga kwekutsvakurudza kweprototi haina kuunza migumisiro yemigumisiro yakanga yakasiyana nemigumisiro yeruzivo rweItT uye naizvozvo mhinduro chete yeItT analysis ichaziviswa.

 

Mufananidzo 1 unopa kugoverwa kweanofanotaura nezve kuita shanduko muboka reMDCT maringe neSM. Muzvikamu zvese zvidiki, mukana wekubudirira neMDT waive wakakwirira pane iwo weSM. Nekuda kweiyo yakaderera sampuro saizi, nguva dzekutenda dzaive dzakafara uye hapana chimwe chekufungidzira chaive neyakaverengeka yakakosha kurapwa kugadzirisa maitiro. Vafungidziri vane kiriniki yakakosha inogona kuitika mukufarira MDT ichienzaniswa neSM yaive neropa midzi kubatanidzwa (28% yakakwira chikamu chevarwere vakabudirira apo nerve midzi kubatanidzwa kwaivepo pane kusipo) uye peripheralization yezviratidzo (17% yakakwira chikamu chevarwere vane kubudirira kana paine peripheralization pane kana paine centralization). Kana zviripo, nerve midzi kubatanidzwa kwakawedzera mukana wekubudirira zvichitevera MDT 2.31 nguva zvichienzaniswa neiyo yeSM uye 1.22 nguva kana isipo. Izvi zvinoreva kuti kune chikamu chevarwere vane nerve midzi kubatanidzwa kugamuchira MDT, zvichienzaniswa neavo vanogamuchira SM, zvinoenderana zvinoita kunge 1.89 nguva (2.31 / 1.22, P? = 0.118) yakakwira kupfuura yeboka risina mutsinga unobatanidzwa.

 

 

Mufananidzo 2 unopa iyo yekugadzirisa mhedzisiro yemubatanidzwa wevaviri vanofungidzira neakiriniki yakakosha mhedzisiro mhedzisiro. Kana zviratidzo zvetsinga midzi yekubatanidzwa uye peripheralization zvaivepo pakutanga, mukana wekubudirira neMDT uchienzaniswa neSM yakaonekwa ka8.5 zvakapetwa kupfuura zveboka risina kana centralization uye nerve midzi kubatanidzwa. Huwandu hwevarwere hwaive hushoma uye misiyano yakanga isiri yehuwandu (P? =? 0.11).

 

 

Hapana mumwe wevashanduri vakatsanangurwa vakatsvakurudza mukuwedzera kuongorora kwakaratidzwa kune chero ipi zvayo yakagadziriswa inoshandiswa kugadzirisa (Yakawedzerwa file 1: Table S1).

 

Zvinokonzerwa nekuongororwa kwekunzwisisa kuburikidza ne30% kuenzanirana kwekuwedzera paRMDQ senzira yekubudirira yakanga isiri yakasiyana neiyo yakataurwa pamusoro (Kuwedzera faira 2: Tafura S2).

 

hurukuro

 

Kuziva kwedu, ichi ndicho chidzidzo chekutanga chekuedza kuziva mafungiro ekugadzirisa apo masangano maviri ekuunganidza, kureva MDT uye SM, anofananidzwa mumuenzaniso wevarwere vane shanduko inoshandiswa kuburikidza nekugadzirisa kana kuparadzanisa.

 

Chidzidzo chedu chakawana kuti hapana chekugadzirisa zvinogona kugadzirisa zvakakwanisa kuwedzera zvakanyanya kuitika kwehuwandu hweMDC zvichifananidzwa neye SM. Kunyange zvakadaro, kusiyana kweboka pakati pezvikamu zviviri zvezvipembenene zvakapfuura kubudirira kwedu kwekliniki-kubudirira kwehuwandu hwe15% muwandu hwevarwere vane mabudiro akabudirira, saka kudzidza kwedu kunogona kunge kwakashaya chokwadi chechokwadi uye, nenzira iyoyo, chikamu chikuru chakakosha chemuenzaniso.

 

Izvo zvakanyanya kuwanikwa ndeyekuti mudiki chechidiki chevarwere vane zviratidzo zvehutano hwekushungurudzika kwehutano, mukana wekubudirira wakaonekwa 1.89 nguva (2.31 / 1.22) yakakwirira kudarika nevarwere vasina mishonga yekubatwa kwemutsipa pavanorapwa ne MDT, vachienzaniswa nevaya vanobatwa na SM. Misiyano yacho yaiva mumutungamiri wakatarisirwa.

 

 

Kunyange zvazvo zvisingaverengeki zvakakosha mune samuenzaniso yedu shoma, purogirherati yakasiyana-siyana yakadarika kubudirira kwedu kwekliniki yakakosha-muzana we15%, asi yakawanikwa isingave iri mutungamiri anotarisirwa. Hapana zvidzidzo zvekare zvakaratidza kugadziriswa kwegadziriro ye centralization kana peripheralization kune varwere vane CLBP. RCT na Long et al. [25,26] akagumisa kuti varwere vane chinangwa chekutungamira, kusanganisira centralization, vakafambira mberi kwemavhiki e2 mushure mekutanga kune vashandi vasingatungamiri mutungamiri kana vachibatwa neMDC mukuenzanisa nekusimbisa kudzidziswa. Kunyange zvakadaro, zvakaguma pakati pezvinokonzerwa nehutachiona hazvina kuzivikanwa, saka mararamiro aripo anotaurwa kune varwere vasina hutungamiri hunoenderana nehuwandu hwevarwere avo vakapindura pasina kuchinja kwezviratidzo panguva yekuongorora kwekutanga uye kwete kune avo vakagamuchira nekunzwisisa. Imwe tsananguro inogona kunge iine kuti kugadzirisa kushandiswa kwehutano hwekugadzirisa hutsika kana kuti peripheralization kune MDT kunobva pane kurapa kurapwa. Zvatinowana zvinoratidza kuti zvidzidzo zvenguva yemberi munharaunda ino dzinoda kusanganisira kuverenga kwekukosha kwe peripheralization pamwe nekutangira.

 

Apo chikamu chezvirevo zviviri zvakavimbiswa kwazvo, peripheralization uye zviratidzo zvehutano hwemutsipa, zvaivepo pazvinyorwa zvekutanga, mukana wakakwana wekubudirira ne MDT yakaenzaniswa naSIM yakaonekwa nguva ye8.5 yakakwirira pane yeboka risina chekugadzirisa uye kusvibiswa kwemutsipa. Nhamba yevarwere yakanga iri duku uye nguva yekuvimba yakanga yakakura. Nokudaro kungotanga kuguma kwekubatana kunogona kukweverwa uye kunoda kubvumirwa mune zvidzidzo zvenguva yemberi.

 

Muchidzidzo chedu, zvakaonekwa kuti hazvina unhu hupi iyo SM yakave nemigumisiro inofananidzwa nekuenzaniswa neMDC. Nokudaro, isu hatina kukwanisa kubatsirana nemigumisiro yezvidzidzo zviviri pamwe nekugadzirwa kwakafanana seyedu (maoko maviri, muenzaniso wevarwere vane chirwere ichi chinoramba chiripo, uye mugumisiro wakataurwa maererano nekutapudzwa kwekuremara kwenguva refu inotevera) [27,29]. Mune zvidzidzo izvi, Nyiendo et al. [29] akawana kuchinja kwehutano hwemakumbo pasi pamabhedha pakurapwa neS SM yakaenzaniswa neyomutungamiriri mukuru mwedzi mitanhatu mushure mekutanga, uye Koes et al. [27] akawana kuchinja kwezera iri pasi pemakore 40 uye nguva yezviratidzo zvinopfuura gore pamusoro pekurapa kwaS SM yakaenzaniswa neyedzipiotherapy 12 mwedzi mushure mekutanga. Zvisinei, zvakaguma kune avo, pamwe chete nezvimwe zvekare zveRCTs zvinosanganisira varwere vanoramba vachishanda, vakatsigira zvatinowana pamusoro pokusava nesimba kwekuchinja kwezera [27,29,31], zvepabonde [29,31], kuremara kwepabonde [27,29,31], uye nguva yezviratidzo [ 31], pane SM kana yakaenzaniswa pakuderedzwa kweukuremara 6-12 mwedzi mushure mokunge uchangobva kuitika. Saka, kunyange zvazvo uchapupu huri kubuda kune varwere vane LBP yakaoma pamusoro pekugadzirisa maitiro ekufananidzira kwezvibereko zviri nani kubva kuna SM zvichienzaniswa nemamwe marudzi ekurapa [32], isu tichiri murima nekuremekedza varwere vanoramba vari LBP.

 

Kubatsira kwokusarudza muongorori wekubudirira kuburikidza nekuvandudzika kwemashoko mapfumbamwe e5 kana mutsara wakakwana pasi peZ5 nhepfenyuro pamusoro peRDDQ inogona kushandiswa. Zvose zvevarwere veC22 vaifungidzirwa kubudirira zvichienderana nezvikamu pasi apa 5 pakutevera pasina kuve nekuvandudzika kwemashoko anopfuura 5. Saka takagadzirisa tsananguro yekushandura tichishandisa kuvandudzwa kwevamwe ne30% semuenzaniso wekubudirira sezvinokurudzirwa nevamwe [22] (ona Zvimwe faira 2: Tafura S2). Somugumisiro, chiyero chevarwere vane kubudirira kwemugumo muboka re MDT rakaramba rakafanana asi 4 vamwe varwere vakatsanangurwa sekuti kubudirira muboka SM. Kakawanda kuongorora kunzwisisika hakuna kuunza migumisiro yezvakaitika zvakasiyana zvakasiyana neyekuongorora kwekutanga uye naizvozvo chete avo vakambotaurwa pamusoro apa.

 

Simba uye Kukwana

 

Ichi chidzidzo chakashandisa data kubva kuRCT, asi vamwe vakawanda vakashandisa ruoko rumwe chete maitiro asingakodzeri chinangwa chekuongorora kurapwa kwekugadzirisa kushandiswa [33]. Maererano nekurudzirwa neboka re PROGRESS [8] takanyatsojekesa maitiro ekugadzirira uyewo kutungamirirwa kwechiitiko chacho. Uyezve, isu takaderedza nhamba yezvakafanirwa kusanganisa zvakatorwa kuitira kuti kuderedze mukana wekutsvaga zvinyorwa.

 

Chimwe chikamu chikuru chezvidzidzo zvechipiri kune RCT dzakambotarisirwa ndezvekuti dzinoshandiswa kuongorora huwandu hwehutano huri nani pane kugadzirisa kuchinja. Mukucherechedza kwemaitiro ekunyora kwekuongorora kwedu, kuratidzirwa mune zvakaperera nguva dzakasiyana, tinofanirwa kusimbisa kuti zvatinowana zviri kuongorora uye zvinoda kuongororwa kwepamutemo mune imwe shanduko yakakura shamba.

 

 

mhedziso

 

Muzvikamu zvese, mikana yekubudirira ne MDT yakanga yakakwirira kune ye SM. Kunyange zvazvo zvisingaverengeki zvakakosha, kuvapo kwehutano hwemutsipa kubatanidzwa uye kuparidzika kunoita sevimbiso inogadzirisa kuchinja mukuda kweMDC. Zviwanikwa izvi zvinoda kuongororwa mune zvidzidzo zvakakura.

 

KUTENDA

 

Vanyori vanotenda Jan Nordsteen naSteen Olsen vezvenzvikokota mazano, uye Mark Laslett nokuda kwemashoko uye kururamisa mutauro.

 

Ichi chidzidzo chaive chikamu chinotsigirwa nezvipo kubva kuDanish Rheumatism Association, Danish Physiotherapy Organization, Danish Foundation yeChiropractic Research uye Continuous Education, uye The Danish Institute for Mechanical Diagnosis and Therapy. RC / The Parker Institute inobvuma kutsigirwa mari kubva ku Oak Oak. Mari yacho yakanga isiri yehutungamiri, kuongorora, uye kududzirwa kwechidzidzo.

 

Mashoko Omuzasi

 

Kukwikwidzana: Vanyori vanotaura kuti havana kukwikwidzana.

 

Mipiro yevanyori: Vose vanyori vakabatanidzwa mukutsvakurudza kwezvinhu nekunyorwa kwekunyora, uye zvido zvekunyora zvakasangana. Kuongorora kwose kwakaitwa neT TP, RC, uye CJ. TP yakagadzirira uye yakatungamirira chidzidzo uye yakanga yakatarisa kunyora rugwaro rwekutanga rwepapepa, asi vamwe vanyori vakapinda mubasa rose pakunyora uye vakaverenga uye vakabvumirana shanduro yekupedzisira.

 

Mukupedzisa, zvinyorwa zviviri zviri pamusoro zvakaunzwa kuitira kuti vaongorore nzira yeMcKenzie mukurapa kweLBP mukuenzanisa nedzimwe mhando dzesarudzo dzekurapa. Chidzidzo chekutanga chekutsvaga chakafananidza nzira yeMcKenzie ne placebo therapy mune varwere vane kurwadziwa kwepashure, zvisinei, mhedzisiro yechidzidzo ichi ichiri kuda kuwedzerwa kuongororwa. Muchidzidzo chechipiri chekutsvaga, hapana mibairo yakakosha yaigona kufanotaura mhinduro dzakasiyana mukushandisa kweMcKenzie nzira. 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

 

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[/ zvikamu]

 

 

Mimwe Misoro: Sciatica

 

Sciatica inotumidzwa sekusanganiswa kwezviratidzo kwete pane imwe rudzi rwekukuvara kana mamiriro. Zviratidzo izvi zvinoratidzika sehupenzi huri kurwadza, kupera uye kurira kwekunzwa kubva mumusana wakagadzika mumucheto wakadzika, pasi pamakumbo nemahudyu uye kuburikidza nemumwe kana makumbo maviri nemakumbo. Sciatica inowanzokonzera kutsamwa, kuvhiringidzika kana kuwedzerwa kwechiremera chikuru mumutumbi wemunhu, kazhinji zvichienderana nekodhi kana kuti bone spur.

 

 

NHAURWA INOKOSHA: KUDZIDZISA KWENYAYA: Kurapa Sciatica Pain