背景:肌肉骨骼疾病是全球残疾和健康负担的主要原因。临床指南中通常推荐手动治疗(MT)干预措施,并用于肌肉骨骼疾病的管理。传统的手动治疗系统(TMT),包括物理治疗,骨病,脊椎按摩疗法,软组织治疗建立在以临床医生为中心的评估等原则基础上,病理解剖推理,和技术特异性。这些历史原则没有得到当前证据的支持。然而,临床试验的数据支持手动治疗作为肌肉骨骼疾病干预的临床和成本效益,当用作护理包的一部分时。
目的:本文的目的是为MT的教学和实践提出一个现代的证据指导框架,避免参考和依赖TMT的过时原则。该框架基于医疗保健各个方面常见的三个基本人文维度:安全、comfort,和效率。这些实践元素是通过积极的沟通来实现的,协作环境,和以人为本的护理。该框架促进了最佳实践,推理,和沟通,这里用两个案例研究来举例说明。
方法:由一种新的手动疗法教学方法激发的文献综述,反映当代证据,正在英国教育学院试用。一群经验丰富的人,国际学者,临床医生,并召集了来自人工治疗领域的研究人员。通过对当代文学的评论和迭代过程中的讨论,得出了观点。向多学科小组作了公开介绍,并纳入了反馈。通过反复讨论相关要素达成了共识。
结论:手动治疗干预应包括被动和主动,个人赋权干预措施,如锻炼,教育,和生活方式的适应。这些应该在一个背景的治疗环境中与一个发达的人-从业者治疗联盟一起提供。教学手工疗法应遵循这种模式。
BACKGROUND: Musculoskeletal conditions are the leading contributor to global disability and health burden. Manual therapy (MT) interventions are commonly recommended in clinical guidelines and used in the management of musculoskeletal conditions. Traditional systems of manual therapy (TMT), including physiotherapy,
osteopathy, chiropractic, and soft tissue therapy have been built on principles such as clinician-centred assessment, patho-anatomical reasoning, and technique specificity. These historical principles are not supported by current evidence. However, data from clinical trials support the clinical and cost effectiveness of manual therapy as an intervention for musculoskeletal conditions, when used as part of a package of care.
OBJECTIVE: The purpose of this paper is to propose a modern evidence-guided framework for the teaching and practice of MT which avoids reference to and reliance on the outdated principles of TMT. This framework is based on three fundamental humanistic dimensions common in all aspects of healthcare: safety, comfort, and efficiency. These practical elements are contextualised by positive communication, a collaborative context, and person-centred care. The framework facilitates best-practice, reasoning, and communication and is exemplified here with two case studies.
METHODS: A literature review stimulated by a new method of teaching manual therapy, reflecting contemporary evidence, being trialled at a United Kingdom education institute. A group of experienced, internationally-based academics, clinicians, and researchers from across the spectrum of manual therapy was convened. Perspectives were elicited through reviews of contemporary literature and discussions in an iterative process. Public presentations were made to multidisciplinary groups and feedback was incorporated. Consensus was achieved through repeated discussion of relevant elements.
CONCLUSIONS: Manual therapy interventions should include both passive and active, person-empowering interventions such as exercise, education, and lifestyle adaptations. These should be delivered in a contextualised healing environment with a well-developed person-practitioner therapeutic alliance. Teaching manual therapy should follow this model.