#1
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Ôèçèîòåðàïèÿ è äîêàçàòåëüíàÿ ìåäèöèíà
Òîâàðèùè, ÿ ñåé÷àñ âîëåþ ñëó÷àÿ ñîïðèêîñíóëñÿ ñ òåìîé ôèçèîòåðàïèè. Êàê âû çíàåòå, ó íàñ ýòî - î÷åíü øèðîêîå ïîíÿòèå, âêëþ÷àþùåå â ñåáÿ è èãëîóêàëûâàíèå, è ëàçåðîòåðàïèþ, è ìàññàæ, è ìàãíèòîòåðàïèþ, è êó÷ó âñåãî îñòàëüíîãî.
Òàê âîò ó ìåíÿ òàêîé âîïðîñ: êàê ôèçèîòåðàïèÿ ñîîòíîñèòñÿ ñ ïðèíöèïàìè äîêàçàòåëüíîé ìåäèöèíû? ×òî èç ìåòîäèê ìîæíî ïðèçíàòü ïî-íàñòîÿùåìó äåéñòâåííûìè è ïî îòíîøåíèþ ê êàêèì ãðóïïàì çàáîëåâàíèé? Íàïðèìåð, êàê ÿ ïîíèìàþ, ìàññàæ ìîæåò îêàçûâàòü ìèîðåëàêñèðóþùåå äåéñòâèå, óëó÷øàòü ìåñòíîå êðîâîîáðàùåíèå, áîëü âðåìåííî ñíèìàòü. Íî íå ëå÷èòü, ê ïðèìåðó, ãàñòðîýíòåðîëîãè÷åñêèå ïðîáëåìû èëè áëèçîðóêîñòü. Ïûòàëñÿ íàéòè ïîäðîáíóþ èíôîðìàöèþ íà ôîðóìå, íî çäåñü ëèøü ïàðà ñîîáùåíèé î òîì, ÷òî ôèçèîòåðàïèÿ - áåñïîëåçíàÿ âåùü, è íèêàêèõ îáúÿñíåíèé èëè ññûëîê. Íà PubMed ïî çàïðîñó "physiotherapy" âûõîäèò îêîëî 150 000 ññûëîê, èçó÷àòü êîòîðûå íå õâàòèò íèêàêîãî âðåìåíè. ß íå ìåäèê, à áèîëîã (êàíäèäàò íàóê), ïîýòîìó íà èçó÷åíèå òàêèõ ñòàòåé ó ìåíÿ óéä¸ò çíà÷èòåëüíî áîëüøå âðåìåíè è ñèë, ÷åì ó ÷åëîâåêà ñ ìåäèöèíñêèì îáðàçîâàíèåì. Ìîæåò, êòî-òî èç âàñ, ó÷àñòíèêè ôîðóìà, äàñò êàêóþ-òî "âûæèìêó" ïî âîïðîñó, åñëè âàñ íå ñèëüíî çàòðóäíèò? ×òî-òî òèïà: òàêîé-òî ìåòîä - "-", à òàêîé-òî - "+", è ïî÷åìó. À òàêæå äëÿ ÷åãî ïðèìåíèìû "+"-ìåòîäû. Ñïàñèáî. |
#2
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Åñëè êòî-òî ïîäóìàë, ÷òî ìíå íóæíû ïîäðîáíîñòè, òî íåò - ïîäðîáíîñòè ìíå íå íóæíû! Íóæíî î÷åíü êðàòêî è îáîáù¸ííî. Òîëüêî äëÿ òîãî, ÷òîáû ïîíèìàòü, êàêèå ìåòîäû - ÷óøü, à êàêèå âïîëíå ïðèçíàíû äîêàçàòåëüíîé ìåäèöèíîé.
Ïðèâåäó ïðèìåð: "Ìàññàæ. "+". Åñòü íåêîòîðûå èññëåäîâàíèÿ, ïîäòâåðæäàþùèå ìèîðåëàêñèðóþùèé ýôôåêò, óëó÷øåíèå ìåñòíîãî êðîâîîáðàùåíèÿ, âðåìåííîå ïðèòóïëåíèå áîëè. Ëàçåðîòåðàïèÿ. "-". Íåò èññëåäîâàíèé ñ ïðàâèëüíûì äèçàéíîì ýêñïåðèìåíòîâ, ïîäòâåðæäàþùèõ ëå÷åáíûé ýôôåêò. Ìîæíî ïðèìåíÿòü â âèäå ïëàöåáî òåì, êîìó íå æàëêî ïîòðàòèòü ëèøíèå äåíüãè". Âîò òèïà òîãî. È àíàëîãèÿ. ß íåìíîãî ðàçáèðàþñü â ìèêðîáèîëîãèè, è åñëè áû ìåíÿ ñïðîñèëè, ÷òî òàì è êàê ñ àíòèáèîòèêîòåðàïèåé, ÿ áû ìîã íàïèñàòü ñëåäóþùåå: "Àíòèáèîòèêîòåðàïèÿ. "+". Äîêàçàòåëüíàÿ áàçà åñòü. Ïðèìåíÿåòñÿ â áîðüáå ñ áàêòåðèàëüíûìè èíôåêöèÿìè". Ê ñîæàëåíèþ, â îáëàñòÿõ ëàçåðîòåðàïèè, ìàãíèòîòåðàïèè, ñâåòîòåðàïèè, èãëîóêàëûâàíèÿ, ìàññàæà, ãèïåðáàðè÷åñêîé îêñèãåíàöèè è ïð. ôèçèîòåðàïèé ÿ íå ðàçáèðàþñü è ñàì ñåáå îòâåòèòü íå ìîãó. |
#3
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Ðàçáèðàòüñÿ â ñîðòàõ ëàçåðîòåðàïèè âðåìåíè è æåëàíèÿ íåò.
Ì.á., áóäåò ïîëåçíî êðàòêîå îáîáùåíèå äëÿ ïàöèåíòîâ îò àíãëèéñêèõ National Health Service - òàì, ïî êðàéíåé ìåðå, ñêàçàíî, êàêèå âèäû âîçäåéñòâèé ìîæíî ðàññìàòðèâàòü: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]. |
#4
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Ñïàñèáî çà ññûëêó!
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#5
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 êàåñòâå êîììåíòàðèÿ, õî÷ó çàìåòèòü, ÷òî âñÿ "ôèçèîòåðàïèÿ", çàíèìàâøàÿ ðàíåå öåëûé ýòàæ ñòàöèîíàðà îáëàñòíîé áîëüíèöû, ñåé÷àñ óìåùàåòñÿ â 1 (îäíîì) êàáèíåòå ïîëèêëèíèêè.... è íå ïåðåãðóæåíà....
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#6
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Íà Óêðàèíå ïîçàêðûâàëè ìàññó áîëüíèö è ïîýòîìó òóäà âîîáùå íå ïðèõîäèò íè îäíîãî ïàöèåíòà. È êàêîé èç ýòîãî âûâîä?
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#7
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Öèòàòà:
P.S. È åñëè ýòè áîëüíèöû íå ïðèøëîñü îòêðûâàòü ñíîâà, èõ ôóíêöèîíèðîâàíèå âåðîÿòíî íå îáîñíîâàíî. |
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#8
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Öèòàòà:
Âû åùå ðàç ïîäòâåðæäàåòå ñâîå "äîêàçàòåëüíîå" ìíåíèå. Ãåíåòèêà è êèáåðíåòèêà â ÑÑÑÐ òîæå êîãäà-òî áûëè íå íóæíû è ýòè íàïðàâëåíèÿ òîæå "çàêðûâàëèñü" îäíèì ðîñ÷åðêîì ïåðà. È íèêòî íå ïëàêàë ïî ýòîìó ïîâîäó. À òåõ, êòî ïëàêàë, ñëûøíî íå áûëî. È âñå áûëî íîðìàëüíî. Íåò áîëüíèö - íåò ïðîáëåì. |
#9
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Öèòàòà:
Äîêàçûâàòü âðîäå áû òðåáóåòñÿ "ýôôåêòèâíîñòü", ìîæåò íà÷íåòå ñ íèõ, ñ ýòèõ äîêàçàòåëüñòâ? |
#10
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#11
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È íå íóæíî çàáûâàòü î ëå÷åáíûõ ãèìíàñòèêàõ òîæå âõîäÿùèõ â ïîíÿòèå ôèçèîòåðàïèè. È ÷àñòü èç íèõ âïîëíå ÅÂÌ, âî âñÿêîì ñëó÷àå, åñòü âïîëíå ñåðüåçíàÿ äîêàçàòåëüíàÿ áàçà.
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Ñ óâàæåíèåì, Ïîëèíà Ëüâîâíà Öåíòð ðàííåé ïîìîùè Äàóíñàéä Àï ñàéò http://www.downsideup.org Ôîðóì http://downsideup.wiki/ru/forum/theme |
#12
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#13
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Öèòàòà:
Èíòåðåñóåò ñåé÷àñ, ê ïðèìåðó, "Ýëåêòðîôîðåç ñ KJ íà áðþøíóþ ñòåíêó äëÿ ïðîôèëàêòèêè ñïàå÷íîé áîëåçíè" |
#14
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Öèòàòà:
Õîòÿ åñòü î÷åíü ýôôåêòèâíàÿ ãèìíàñòèêà Ñåìåíîâîé Ê.À., î÷åíü áëèçêàÿ ïî ñâîåé ìåòîäèêå ñ Áîáàò òåðàïèåé, íî ìåíåå èãðîâàÿ ïî ôîðìå. Íå çíàþ, åñòü ëè ó íåå äîêàçàòåëüíàÿ áàçà, íî îñíîâàíà îíà ãëóáîêîì íà ïîíèìàíèè îñîáåííîñòåé ôèçè÷åñêîãî ðàçâèòèÿ äåòåé ñ ÄÖÏ.
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Ñ óâàæåíèåì, Ïîëèíà Ëüâîâíà Öåíòð ðàííåé ïîìîùè Äàóíñàéä Àï ñàéò http://www.downsideup.org Ôîðóì http://downsideup.wiki/ru/forum/theme |
#15
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Ìîæíî, êîíå÷íî. Íàïðèìåð, ýòîò Ôîðóì â òåìå: "Îòêðûòûé ïåðåëîì ðóêè. Âîïðîñû ïî ïîâîäó ñðàùåíèÿ".
Öèòàòà:
1.Hyperbaric oxygen therapy for late radiation tissue injury. Bennett MH, Feldmeier J, Hampson NB, Smee R, Milross C.Cochrane Database Syst Rev. 2016 Apr 28;4:CD005005. doi: 10.1002/14651858.CD005005.pub4. AUTHORS' CONCLUSIONS: These small trials suggest that for people with LRTI affecting tissues of the head, neck, anus and rectum, HBOT is associated with improved outcome. HBOT also appears to reduce the chance of ORN following tooth extraction in an irradiated field. 2. Hyperbaric oxygen therapy for acute coronary syndrome. Bennett MH1, Lehm JP, Jepson N. Cochrane Database Syst Rev. 2015 Jul 23;(7):CD004818. doi: 10.1002/14651858.CD004818.pub4. Authors' conclusions For people with ACS, there is some evidence from small trials to suggest that HBOT is associated with a reduction in the risk of death, the volume of damaged muscle, the risk of MACE and time to relief from ischaemic pain. 3. Hyperbaric oxygen therapy for chronic wounds. Kranke P1, Bennett MH, Martyn-St James M, Schnabel A, Debus SE. Cochrane Database Syst Rev. 2012 Apr 18;(4):CD004123. doi: 10.1002/14651858.CD004123.pub3. Authors' conclusions In people with foot ulcers due to diabetes, HBOT significantly improved the ulcers healed in the short term but not the long term and the trials had various flaws in design and/or reporting that means we are not confident in the results Ãèïåðáàðè÷åñêàÿ îêñèãåíàöèÿ îòíîñèòñÿ ê ôèçèîòåðàïèè? 4. Intermittent pneumatic compression for treating venous leg ulcers. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Authors' conclusions IPC may increase healing compared with no compression. 5.Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation. Arrich J1, Holzer M, Havel C, Müllner M, Herkner H. Cochrane Database Syst Rev. 2016 Feb 15;2:CD004128. doi: 10.1002/14651858.CD004128.pub4. AUTHORS' CONCLUSIONS: Evidence of moderate quality suggests that conventional cooling methods provided to induce mild therapeutic hypothermia improve neurological outcome after cardiac arrest, specifically with better outcomes than occur with no temperature management. We obtained available evidence from studies in which the target temperature was 34°C or lower. This is consistent with current best medical practice as recommended by international resuscitation guidelines for hypothermia/targeted temperature management among survivors of cardiac arrest. Ãèïîòåðìèÿ îòíîñèòñÿ ê ôèçèîòåðàïèè? 6. Electrical stimulation with non-implanted electrodes for overactive bladder in adults. Stewart F1, Gameiro OL, El Dib R, Gameiro MO, Kapoor A, Amaro JL.Cochrane Database Syst Rev. 2016 Apr 2;4:CD010098. doi: 10.1002/14651858.CD010098.pub3. AUTHORS' CONCLUSIONS: Electrical stimulation appeared to be more effective than both no treatment and drug treatment for OAB. 7. Electrical stimulation and electromagnetic field use in patients with diabetic neuropathy: systematic review and meta-analysis. Stein C, Eibel B, Sbruzzi G, Lago PD, Plentz RD.Braz J Phys Ther. 2013 Mar-Apr;17(2):93-104. doi: 10.1590/S1413-35552012005000083. CONCLUSIONS: We found that TENS improved pain relief in patients with diabetic neuropathy, while no such improvement was observed with the use of electromagnetic field treatment. 8.Systematic review of efficacy of TENS for management of central pain in people with multiple sclerosis. Sawant A, Dadurka K, Overend T, Kremenchutzky M. Mult Scler Relat Disord. 2015 May;4(3):219-27. doi: 10.1016/j.msard.2015.03.006. Epub 2015 Apr 8. CONCLUSION: TENS is a safe and effective non-pharmacological alternative in the management of central pain in people living with MS. 9. Percutaneous Tibial Nerve Stimulation (PTNS) efficacy in the treatment of lower urinary tract dysfunctions: a systematic review. Gaziev G1, Topazio L, Iacovelli V, Asimakopoulos A, Di Santo A, De Nunzio C, Finazzi-Agrò E. BMC Urol. 2013 Nov 25;13:61. doi: 10.1186/1471-2490-13-61. Conclusions: PTNS is an effective and safe option to treat OAB patients. 10. Effects of pulsed electromagnetic field on knee osteoarthritis: a systematic review. Ryang We S1, Koog YH, Jeong KI, Wi H. Rheumatology (Oxford). 2013 May;52(5):815-24. doi: 10.1093/rheumatology/kes063. Epub 2012 Apr 13. Conclusion. The present study provided suggestive evidence supporting PEMF efficacy in the management of knee OA. 11. Pulsed electromagnetic fields in knee osteoarthritis: a double blind, placebo-controlled, randomized clinical trial. Gian Luca Bagnato, Giovanni Miceli, Natale Marino, Davide Sciortino and Gian Filippo Bagnato. Rheumatology, Volume 55, Issue 4, p. 755-762. Conclusion. These results suggest that PEMF therapy is effective for pain management in knee OA patients and also affects pain threshold and physical functioning. 12. Electromagnetic fields for treating osteoarthritis. Li S, Yu B, Zhou D, He C, Zhuo Q, Hulme JM. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD003523. DOI: 10.1002/14651858. CD003523.pub2. Authors' conclusions Current evidence suggests that electromagnetic field treatment may provide moderate benefit for osteoarthritis sufferers in terms of pain relief. 13. Effects of Pulsed Electromagnetic Field on Knee Osteoarthritis A Systematic Review Seo Ryang We; Yun Hyung Koog; Kwang-Il Jeong; Hyungsun Wi Rheumatology. 2013;52(5):815-824. Conclusion. The present study provided suggestive evidence supporting PEMF efficacy in the management of knee OA. |