Professional Association Response to the Manga Report

Abstract

The report entitled “The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low Back Pain” was funded by the Ontario Ministry of Health and undertaken by Pran Manga and Associates. Known as the Manga report, for its lead author, economist Pran Manga, the report raises important issues related to the treatment of low back pain (LBP), a condition with major economic and quality of life implications. In this briefing note to the Ontario Ministry of Health regarding the Manga Report (MR), the Ontario Physiotherapy Association (OPA) questions the interpretation of the data and conclusions made by the authors of the report and expresses the belief that further analysis and discussion are required if appropriate health services policy decisions are to be made.     

保守治疗掌侧Barton骨折的临床探讨

目的：探讨保守治疗掌侧Barton骨折的指征和预后。方法：保守治疗23例掌侧Barton骨折患者,其中男8例,女15例;年龄16～84岁,平均52.2岁;骨折不伴桡腕关节掌侧半脱位7例,伴桡腕关节掌侧半脱位16例（Mehara Ⅰ型15例,Mehara Ⅲ型1例）。并对32具新鲜尸体标本进行实验,推断在掌侧Barton骨折的损伤机制中,桡腕关节背侧韧带损伤是产生桡腕关节向掌侧半脱位的重要原因。应用Pattee和Thompson的评价标准对治疗效果进行评价。结果：进行7～70个月随访,11例疗效满意（优1例、良10例）,12例不满意（中5例、差7例）。7例骨折不伴桡腕关节掌侧半脱位病例中,5例治疗结果满意;16例伴桡腕关节掌侧半脱位病例中,6例治疗结果满意。结论∶①复位结果影响掌侧Barton骨折的预后,复位后桡腕关节面移位应小于2mm。②不伴桡腕关节向掌侧半脱位,建议保守治疗。③伴有桡腕关节向掌侧半脱位,保守治疗预后欠佳,可试行手法整复、石膏外固定,如不能达到桡腕关节面移位小于2mm的标准,就应采取手术方法治疗。     

三步正骨手法整复尺桡骨中下段双骨折的多中心临床研究

目的：比较观察三步正骨手法整复及髓内针内固定治疗尺桡骨中下段双骨折的疗效。方法：随机分实验组105例和对照组105例，实验组接受拔伸旋转、夹挤分离和折顶回旋三步正骨手法复位加小夹板外固定，对照组接受手术开放复位，髓内针内固定治疗。结果：随访6个月，骨折解剖对位及近解剖对位情况，对照组优于实验组；骨折愈合及功能恢复情况，实验组均优于对照组。结论：应用三步正骨手法整复尺桡骨中下段双骨折，有利于伤肢功能恢复并能减少骨折延迟愈合、不愈合的发生。     

Chronic Mechanical Neck Pain in Adults Treated by Manual Therapy: A Systematic Review of Change Scores in Randomized Controlled Trials of a Single Session

We report a systematic analysis of group change scores of subjects with chronic neck pain not due to whiplash and without headache or arm pain, in randomized clinical trials of a single session of manual therapy. A comprehensive literature search of clinical trials of chronic neck pain treated with manual therapies up to December 2006 was conducted. Trials that scored above 60% on the PEDro Scale were included. Change scores were analyzed for absolute, percentage change and effect size (ES) whenever possible. Nine trials were identified: 6 for spinal manipulation, 4 for spinal mobilization or non-manipulative manual therapy (2 overlapping trials), and 1 trial using ischemic compression. No trials were identified for massage therapy or manual traction. Four manipulation trials (five groups) reported mean immediate changes in 100-mm VAS of −18.94 (9.28) mm. ES for these changes ranged from .33 to 2.3. Two mobilization trials reported immediate VAS changes of −11.5 and −4 mm (ES of .36 and .22, respectively); one trial reported no difference in immediate pain scores versus sham mobilization. The ischemic compression study showed statistically significant immediate decreases in 100-mm pain VAS (average = −14.6 mm). There is moderate-to-high quality evidence that immediate clinically important improvements are obtained from a single session of spinal manipulation. The evidence for mobilization is less substantial, with fewer studies reporting smaller immediate changes. There is insufficient evidence for ischemic compression to draw conclusions. There is no evidence for a single session of massage or manual traction for chronic neck pain.     

推拿手法治疗腰椎间盘突出症的概况

腰椎间盘突出症(以下简称LDH)广泛采用推拿按摩、正骨手法治疗.由于推拿、按摩、牵引、正骨手法治疗LDH的方法,类型、流派很多.下面就一些主要、常用的核心手法分别叙述.     

Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis

Background Context

Mobilization and manipulation therapies are widely used to benefit patients with chronic low back pain. However, questions remain about their efficacy, dosing, safety, and how these approaches compare with other therapies.

Comparison of manipulation and stabilization exercises in patients with sacroiliac joint dysfunction patients: A randomized clinical trial

Background

Manual therapy and exercise therapy are two common treatments for low back pain. Although their effects have been discussed in several studies, the superiority of one over the other for patients with sacroiliac joint dysfunction is still unclear.

腹部易筋九宫推拿理论基础及其临床应用

目的探讨腹部易筋九宫推拿防治疾病的理论基础,为通过腹部易筋九宫推拿防治疾病提供理论支持。方法通过九宫力网理论分析人体核心结构,阐述腹部易筋九宫推拿防治机制,并通过临床案例来验证防治效果。结果临床案例经以腹部九宫力网理论为指导的易筋九宫推拿治疗后均取得满意临床效果。结论核心结构力网失衡是导致疾病发生的主要原因,经腹部易筋九宫推拿可矫正力网失衡状态,从而为腹部易筋九宫推拿防治颈肩腰腿痛提供理论支持。     

国医大师韦贵康手法治疗脊柱源性血糖异常的经验总结

韦贵康教授在脊柱及相关疾病的手法治疗方面具有独到的治疗理念及丰富的治疗经验,文章介绍了韦贵康教授对脊柱源性血糖异常的相关认识,从"脊督一体观"出发认为脊柱与督脉是一个整体,而血糖水平的异常与及督脉密切相关,进而与脊柱的异常(如脊柱失稳错位与局部软组织的病变等)息息相关,故而对于因脊柱异常所导致的血糖水平异常,则需从调整脊柱相关病变出发,如筋骨调手法等以从根本上祛除血糖水平异常的病因。同时附医案1则。     

多重评价模式在急救护理操作技能考核中的应用

目的 :探讨急救护理操作技能考核的多重评价模式 ,促进急救护理操作技能教学效果的提高。方法 :选择 98级护理大专生 5 0人为对照组 ,采用传统的单一的教师考评评价模式 ;选择 99级护理大专生 5 0人为研究组 ,采用学生自评、学生互评、教师考评以及电脑测评等多重评价模式。由急诊科带教老师量化考评两组学生实习阶段的分析判断能力、应急配合能力及急救动手能力。结果 :研究组在急救应急能力、急救动手能力方面均高于对照组 (P均 <0 .0 1)。结论 :多重评价模式有助于改善或提高教学效果 ,提高学生临床急救能力