金乌骨通胶囊联合骨肽片治疗颈椎骨质增生的疗效观察

目的探讨金乌骨通胶囊联合骨肽片治疗颈椎骨质增生的临床疗效。方法选取2019年5月—2020年5月在中国平煤神马医疗集团总医院进行治疗的226例颈椎骨质增生患者为研究对象,根据就诊顺序分为对照组(113例)和治疗组(113例)。对照组口服骨肽片,0.6 g/次,3次/d;治疗组在对照组基础上口服金乌骨通胶囊,1.5 g/次,3次/d。两组均经15 d治疗。比较两组的临床疗效,观察两组治疗前后中医症候积分、相关评分和椎动脉血流速度参数的变化情况。结果治疗后,治疗组总有效率是97.35%显著高于对照组的82.30%(P0.05)。治疗后,两组颈项酸痛积分、肩背酸痛积分、活动受限积分、肢体麻木积分、头晕目眩积分等中医症候积分均较治疗前显著降低(P0.05);治疗后,治疗组这些中医症候积分显著低于对照组(P0.05)。治疗后,两组CASCS评分、ESCV评分、QLQC30评分均显著升高,但NDI评分显著降低(P0.05);治疗后,治疗组CASCS评分、ESCV评分、QLQC30评分显著高于对照组,而NDI评分显著低于对照组(P0.05)。经治疗,两组平均血流速度(VM)、舒张末期血流速度(VD)、收缩期血流速度(VP)均较治疗前显著升高(P0.05);治疗后治疗组这些椎动脉血流速度参数显著高于对照组(P0.05)。结论金乌骨通胶囊联合骨肽片治疗颈椎骨质具有较好的临床疗效,可有效改善患者临床症状,提高颈部活动能力,改善眩晕程度及椎动脉血流速度,有利于提高患者生活质量,具有一定的临床推广应用价值。     

颈复康颗粒联合神经妥乐平治疗神经根型颈椎病的临床研究

目的 探讨颈复康颗粒联合神经妥乐平治疗神经根型颈椎病的临床疗效。方法 选择2020年6月—2022年6月河南中医药大学第三附属医院收治的60例神经根型颈椎病患者,随机分为对照组（30例）和治疗组（30例）。对照组口服神经妥乐平片,4片/次,2次/d。在对照组的基础上,治疗组口服颈复康颗粒,1袋/次,2次/d。两组服用药物14 d。观察两组患者临床疗效,比较治疗前后两组患者症状改善时间,颈椎功能障碍指数评分（NDI）和视觉模拟疼痛评分（VAS）,及血清炎性因子白细胞介素-1β（IL-1β）、丙二醛（MDA）、肿瘤坏死因子-α（TNF-α）和皮质醇（Cor）水平。结果 治疗后,治疗组总有效率为96.67%,显著高于对照组（73.33%,P＜0.05）。治疗后,治疗组症状改善时间均明显早于对照组（P＜0.05）。治疗后,两组患者NDI评分和VAS评分均明显降低（P＜0.05）,且治疗组明显低于对照组（P＜0.05）。治疗后,两组血清炎性因子IL-1β、MDA和TNF-α水平明显降低,而Cor水平明显升高（P＜0.05）,且治疗组IL-1β、MDA、TNF-α和Cor水平明显好于对照组（P＜0.05）。结论 神经妥乐平联合颈复康颗粒治疗神经根型颈椎病效果确切,可减轻患者疼痛,有效改善患者炎性因子水平,颈椎功能恢复良好。     

Psychometric properties of the neck disability index amongst patients with chronic neck pain using item response theory

Objective: The Neck Disability Index (NDI) is commonly used for clinical and research assessment for chronic neck pain, yet the original version of this tool has not undergone significant validity testing, and in particular, there has been minimal assessment using Item Response Theory. The goal of the present study was to investigate the psychometric properties of the original version of the NDI in a large sample of individuals with chronic neck pain by defining its internal consistency, construct structure and validity, and its ability to discriminate between different degrees of functional limitation.

Methods: This is a cross-sectional cohort study of 585 consecutive patients with chronic neck pain seen in a university hospital rehabilitation clinic. Internal consistency was evaluated using Cronbach’s alpha, construct structure was evaluated by exploratory factor analysis, and discrimination ability was determined by Item Response Theory.

Results: The NDI demonstrated good internal consistency assessed by Cronbach’s alpha (0.87). The exploratory factor analysis identified only one factor with eigenvalue considered significant (cutoff 1.0). When analyzed by Item Response Theory, eight out of 10 items demonstrated almost ideal difficulty parameter estimates. In addition, eight out of 10 items showed high to perfect estimates of discrimination ability (overall range 0.8 to 2.9).

Conclusions: Amongst patients with chronic neck pain, the NDI was found to have good internal consistency, have unidimensional properties, and an excellent ability to distinguish patients with different levels of perceived disability.

• Implications for Rehabilitation

• The Neck Disability Index has good internal consistency, unidimensional properties, and an excellent ability to distinguish patients with different levels of perceived disability.

• The Neck Disability Index is recommended for use when selecting patients for rehabilitation, setting rehabilitation goals, and measuring the outcome of intervention.

     

Is there preliminary value to a within- and/or between-session change for determining short-term outcomes of manual therapy on mechanical neck pain?

Objectives:

The primary purpose of this study was to determine whether occurrences of within- and between-session changes were significantly associated with functional outcomes, pain, and self-report of recovery in patients at discharge who were treated with manual therapy for mechanical neck pain. A secondary purpose was to determine the extent of change needed for the within- and between-session change in association to function.

Methods:

This secondary data analysis examined 56 patients who demonstrated a positive response to manual therapy during the initial assessment within a randomized controlled trial (RCT) that examined manual therapy techniques and a home exercise program (HEP). Within- and between-session findings were defined as ‘changes in pain report during the initial session (within)’ and ‘changes in pain from baseline to 48-hours post initial assessment (between)’. Outcomes were analyzed for associations with the global rating of change (GRoC), self-report activity scale (SRAS), and a 50% reduction of the neck disability index (NDI) by discharge at 96 hours.

Results:

Findings indicate that within-session pain changes of 36·7% are strongly associated with a 50% change in NDI at 96 hours. Between-session changes in pain were associated with 50% change in NDI and a ≧3-point change in GRoC at 96 hours.

Conclusion:

Both within- and between-session measures may be useful to predict success levels at 96 hours for NDI; however, between-session changes are more useful to predict success in GRoC. Measures used during clinical examination may help guide clinicians in identification of candidates best suited for the treatment.