1、屈曲關(guān)節(jié)松動(dòng)術(shù)患者脊柱運(yùn)動(dòng)范圍和腰痛的即刻效KikaKonstantinou,PhD,MSc,aNadineFoster,DPhil,PGCE,bAlisonRushton,EdD, MSc,c David Baxter, DPhil,dChristine Wright, C. Math,eand Alan Breen, PhD, DCf屈曲關(guān)節(jié)松動(dòng)術(shù)患者脊柱運(yùn)動(dòng)范圍和腰痛的即刻效KikaKonstantinou,PhD,MSc,aNadineFoster,DPhil,PGCE,bAlisonRushton,EdD, MSc,c David Baxter, DPhil,dChristine W

2、right, C. Math,eand Alan Breen, PhD, DCf26名具有腰痛與腰椎屈曲疼痛等MWMs （VAS結(jié)果：MWMs（實(shí)際曲度：MWMs49.2標(biāo)準(zhǔn)差SD16.4 45.3SD 14.1 P =.005；總曲度：MWMs76.7SD22.469.7SD21.5P =.005。疼痛評(píng)結(jié)論：MWMs較之安慰劑對(duì)增加脊椎活動(dòng)性具有較小的統(tǒng)計(jì)學(xué)顯著意義，但對(duì)減少疼痛沒有差別。將臨床判斷引入試驗(yàn)對(duì)象的選擇過程，2619名受 使用安慰劑后出現(xiàn)相同改變。(JManipulativePhysiolTher2007;30:178-（LBP的人都會(huì)尋求醫(yī)療救助 1-3。許多研究建議 10

3、%-50%的腰痛患者應(yīng)該接受理療 4-6。最者的管理中十分普遍8,9。徒手療法是一個(gè)aSpinalPhysiotherapySpe list/Research,Chiropractic, Bournemouth, Submitrequestsforrepr sto:KikaKonstantinou,HaywoodHospital/PrimaryCareKeeleUniversity,ResearchMSc,MCSP,mMACP,PrimaryCarebSeniorherapiesanagement), Centre,KeeleUniversity,Keele,Staffordshire,ST5

4、5BG, :rsubmittedOctober13,2006;inrevisedform November 11, 2006; accepted December 6, 2006.0161-CareResearchCentre,KeeleUniversity,cLecturerinPhysiotherapy,SchoolofHealthScien Universityof Birmingham, UK.dDeanofPhysiotherapy,Centrefor,iversityofOtago,NeweSeniorLecturerinethods, SchoolofCopyright2007b

5、yNationa iversityof,UniversityofBirmingham,fDirector,InstituteforMusculoskeletalResearchand ClinicalImplemen ion,Anglo-EuropeanCollege207位腰痛患者預(yù)96位不適合MWMs，益評(píng)估122 （MWMS207位腰痛患者預(yù)96位不適合MWMs，益評(píng)估122 （MWMS11,p.44,4526 位適合隨15 位先接MWMs治15 位先接受基線圖1.入組患者篩選流程據(jù)方NHS 過的MWMs功效。18設(shè)27.5%MWMs 即刻4納入和排除標(biāo)2 NHS 來果20012002

6、18 周歲，而只有門診醫(yī)生通過臨床 認(rèn)為受試者具有腰痛理療適應(yīng)癥和MWMs 適應(yīng)癥且能從中獲益的患者才會(huì)被納入研究。相當(dāng)多的患者（96 名）在ROM 結(jié)果18，針對(duì)英國(guó)國(guó)家醫(yī)務(wù)體系（）Ms2. 樣本容量計(jì)算公1總結(jié)了所有受試者進(jìn)行篩選、 （VAS）31-33VAS 10cm2 個(gè)描述性詞語，左手 ROM，但不能知2. 樣本容量計(jì)算公1總結(jié)了所有受試者進(jìn)行篩選、 （VAS）31-33VAS 10cm2 個(gè)描述性詞語，左手 ROM，但不能知樣本容 ROM預(yù)期偏差ROM重要臨床誤差的信息，屈曲 ROM 變量預(yù)設(shè)誤差需要至少高于平均測(cè)量誤差 20。在一定程度上，任何這種改變可ROM 6.5。MWMsL

7、BP 26 名受試者（15 ，11 名女性5%顯著性水平將有 90%的效率檢測(cè)實(shí)際腰椎屈曲 ROM 7或更大。功能評(píng)分 34，當(dāng)前腰痛發(fā)作持（月，估方法（DRAM）35，MWMDI 測(cè)量實(shí)際主動(dòng) ROM T12 S2 分別 S2）21。總腰椎屈 T12 21。RMDQ，獲得受試者的背痛歷史。ROM，腰椎被 MWMs 中獲益。理療醫(yī)師認(rèn)為可以從中 ROM 以及MedicalUKROMDRAM。來自于兩個(gè)理療部門的695 在前舉行了MWMs椎階段的中心或者單側(cè)行屈曲MWMs13 3套，46個(gè)重復(fù)。癥狀的反應(yīng)水平指問Maitland36,p.107 和Mulligan11,p.46 ROMDRAM。

8、來自于兩個(gè)理療部門的695 在前舉行了MWMs椎階段的中心或者單側(cè)行屈曲MWMs13 3套，46個(gè)重復(fù)。癥狀的反應(yīng)水平指問Maitland36,p.107 和Mulligan11,p.46 描述。 越嚴(yán)重a分?jǐn)?shù)0-24包括側(cè)臥39,40Everitt39 。包Ill 痛和總腰椎伸展）Everitt2階方法計(jì)算。1階測(cè)試使用在基線用獨(dú)立樣本t性延滯效應(yīng)，P=.202樣本t檢驗(yàn)處理MWM的數(shù)據(jù)以測(cè)試MWM5%41,42，次要結(jié)果（腰椎伸展，疼痛）1%41,42。數(shù)據(jù)的總95%99%）39變特均（VAS,0-10級(jí)）（VAS,0-10級(jí)DRAM（2 錯(cuò)失數(shù)1.7-女性3正常8， 11，痛苦/軀體 4

9、，痛苦/抑郁12 劑后和MWMs 后MWMs和安慰3 根據(jù)初始數(shù)據(jù)和中止分?jǐn)?shù)，ROM和疼痛上2的2 劑后和MWMs 后MWMs和安慰3 根據(jù)初始數(shù)據(jù)和中止分?jǐn)?shù)，ROM和疼痛上2的均值差3.9總腰椎屈曲7，0.1cm。第二階段分析顯示實(shí)際腰椎屈曲（= ）P=.005（P 045）（P.800）MM9 （受試者表示屈伸RM （S 上2 點(diǎn)）得到了改善。安慰劑治療之后，9名（35%）ROM 和或疼痛得到 均值差異MWM abROM 改變（除去測(cè)ROM 改變7即認(rèn)為是一個(gè)真正的改變。Farrar43的建議疼痛程度顯著性改變的中止分?jǐn)?shù)為VAS2點(diǎn)（cm）的結(jié)26位參與研究的受試者都接受了治療。1。所有的

10、數(shù)據(jù)都是正（P.20MWMs 和安慰劑7 名受試者在接受MWMs 后沒有治疼屈伸結(jié)果測(cè)總基線測(cè)均值(SD) 44.4(14.7) 69.5(19.0) 21.9(10.2) 38.5-14.7 61.8-77.1 16.3-27.5 4.2-安慰劑均值(SD) 45.314.169.721.5) 39.6-51.0 61.0-78.4 15.1-27.3 3.1-MWM 均值(SD) 49.216.476.722.4) 24.011.04.242.6-55.8 67.7-85.8 18.0-30.0 2.8-均值(SD) 3.97.0(9.3) 2.8(6.8) -0.1 3.3-10.8 -

11、0.9-P （2 尾分6,8,44,45ROM 評(píng)分大于平均測(cè)量誤差（DI4 治療應(yīng)答和治療無應(yīng)答的特征總ROM測(cè)量值與基線和MWMs治療后數(shù)據(jù)都46。與安慰劑相比，MWMs6,8,44,45ROM 評(píng)分大于平均測(cè)量誤差（DI4 治療應(yīng)答和治療無應(yīng)答的特征總ROM測(cè)量值與基線和MWMs治療后數(shù)據(jù)都46。與安慰劑相比，MWMsMWMsROM MWMs 中重復(fù)47,48。本ROM。然而，并不是ROM 都增加，盡管他們都在ROM 增加的原因。其他可能的解釋有對(duì)治 37ROMROM 包括了盆骨ROM議看起來有一定幫助 49估a分?jǐn)?shù)0-24ROM的影響的文獻(xiàn)，其實(shí)驗(yàn)ROM有顯著性增長(zhǎng)，但是疼ROM會(huì)有全

12、面的、立刻的、積極的改 本研究試驗(yàn)了屈曲MWMs 的效應(yīng)，臨屈曲MWMs 后ROM 立即改善具有顯著統(tǒng)計(jì)ROM改 變無應(yīng)答癥狀持續(xù)時(shí)間29.9(2-(0.13d-10.6 (4-13.6 (8-最近情7.0,SD7.0,SD (3-(6-5.1,SD5.3,SD女性女性腰痛歷史有10，無有2，無屈曲屈曲伸展屈曲和伸展屈曲和伸展其他其他腰痛腰痛表腿痛腿痛臨關(guān)節(jié)病變關(guān)節(jié)病變椎間盤病變1， 椎間盤病變2，癥狀描述11，癥狀描述1其他其他正常9， 正常（2 錯(cuò)失數(shù)值） 痛苦/軀體痛苦/軀體痛苦/抑郁VAS 上兩點(diǎn)的差（信度90%顯著性46 人的樣本。MWMs 中獲益的受試者M(jìn)WMs 治療，如何6 5位

13、參加過MWM數(shù)據(jù)之前，所有理療師接受了關(guān)于MWMs結(jié)MWM ROM 和疼痛評(píng)分的影響。ROM具有統(tǒng)計(jì)學(xué)顯著性差ROMVAS 上兩點(diǎn)的差（信度90%顯著性46 人的樣本。MWMs 中獲益的受試者M(jìn)WMs 治療，如何6 5位參加過MWM數(shù)據(jù)之前，所有理療師接受了關(guān)于MWMs結(jié)MWM ROM 和疼痛評(píng)分的影響。ROM具有統(tǒng)計(jì)學(xué)顯著性差ROM的差MWM 技術(shù)可能會(huì)給某些患者的脊支MWM51,52。致PhD 項(xiàng)目的改進(jìn)。在此十分感謝物理療法的NHS 。參考文1.AnderssondemiologyoflowbackActaOrthopScand1998;S281:28-2.WaxmanR,Tennant

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