未经授权:保守治疗腰椎神经根病(LR)是首选治疗方案。迄今为止,系统评价和临床实践指南尚未考虑最合适的治疗时机.这项研究旨在就不同阶段的有效保守治疗方式达成共识(即,急性,亚急性,或慢性)LR。
UNASSIGNED:通过迭代的多级Delphi过程,专家对LR各阶段与拟议治疗模式的一致性进行评级,并可能建议其他治疗模式.使用5点Likert量表测量协议。描述性统计数据用于衡量一致性(中位数,四分位数范围,和协议的百分比)。共识标准是为每一轮事先定义的。
UNASSIGNED:十四名小组成员提出了跨LR阶段的有效治疗方式的共识列表。急性期管理应侧重于向患者提供有关病情的信息,包括疼痛教育,个性化的身体活动,和定向偏好练习,支持NSAIDs。在亚急性阶段,可以增加力量训练和神经动力动员,并考虑经椎间孔/硬膜外注射.在慢性阶段,脊椎手法治疗,具体练习,特定功能的体育锻炼应与个性化职业相结合,符合人体工程学和姿势建议。
未经评估:专家们一致认为干预措施的有效性因LR的演变而不同。对康复的影响迄今为止,保守治疗腰椎神经根病的临床指南并未考虑病情的演变。腰椎神经根病的急性期管理应着重于提供有关病情的信息,并通过止痛药支持个性化的体育锻炼。亚急性管理应在力量训练中增加神经动力动员,而经椎间孔和/或硬膜外注射可以考虑。慢性期管理应考虑脊柱操纵疗法,并着重于恢复个性化的功能能力。
Conservative management of lumbar radiculopathy (LR) is the first treatment option. To date, systematic reviews and clinical practice guidelines have not considered the most appropriate timing of management. This study aimed to establish consensus on effective conservative treatment modalities across different stages (i.e., acute, sub-acute, or chronic) of LR.
Through an iterative multistage Delphi process, experts rated agreement with proposed treatment modalities across stages of LR and could suggest additional treatment modalities. The agreement was measured using a 5-point Likert scale. Descriptive statistics were used to measure agreement (median, interquartile ranges, and percentage of agreement). Consensus criteria were defined a priori for each round.
Fourteen panelists produced a consensus list of effective treatment modalities across stages of LR. Acute stage management should focus on providing patients with information about the condition including pain education, individualized physical activity, and directional preference exercises, supported with NSAIDs. In the sub-acute stage, strength training and neurodynamic mobilization could be added and transforaminal/epidural injections considered. In the chronic stage, spinal manipulative therapy, specific exercise, and function-specific physical training should be combined with individualized vocational, ergonomic and postural advice.
Experts agree effectiveness of interventions differs through the evolution of LR.IMPLICATIONS FOR REHABILITATIONTo date clinical guideline for conservative management of lumbar radiculopathy do not consider the evolution of the condition.Acute stage management of lumbar radiculopathy should focus on providing information about the condition and support individualized physical activity with pain medication.Sub-acute management should add neurodynamic mobilization to strength training, while transforaminal and/or epidural injections could be considered.Chronic stage management should consider spinal manipulative therapy and focus on restoring personalized functional capacity.