| Lumbar Disc Herniation(LDH)is a common and difficult disease in Tuina clinic.It is a long-term concern to improve the efficacy and safety of Tuina in the treatment of lumbar disc herniation.In Tuina education and clinical communication,the standardization and standardization of Tuina techniques,school characteristics and innovative techniques are emphasized at the same time;because the research on the curative effect mechanism of Tuina manipulation is weak and the clinical evidence-based evidence is insufficient,the research on the standardization and standardization of Tuina manipulation is in a dilemma.In recent years,the clinical practice guidelines and expert consensus of lumbar disc herniation have been continuously formulated and updated,focusing on the common problems in diagnosis and treatment.The recommended grades were evaluated from the aspects of daily work style,exercise therapy,manual therapy,acupuncture,physiotherapy,medication and so on,so as to provide the best and effective diagnosis and clinical diagnosis and treatment for professional doctors.However,up to now,there is still a blank in the guidelines or expert consensus on the treatment of lumbar disc herniation by Tuina.There are a variety of manipulation combinations of Tuina in the treatment of lumbar disc herniation,which to a certain extent affects the standardization of Tuina in the treatment of lumbar disc herniation and the design of multicenter clinical trials,thus limiting the recommended level of Tuina in evidence-based medicine.This study will combine the content analysis method and Delphi method to explore the expert consensus of Tuina in the treatment of lumbar disc herniation,in order to promote the standardization process of Tuina and provide reference for the clinical work of Tuina for lumbar disc herniation.ObjectiveTo explore the feasibility of the consensus of manipulation scheme of Tuina in the treatment of lumbar disc herniation and to form a preliminary scheme.MethodsThe content analysis method and Delphi method were combined to explore the formation of expert consensus on the manipulation scheme of Tuina for the treatment of lumbar disc herniation.Study 1 The method of content analysis was used to summarize and analyze the manipulation of Tuina in the clinical research literature on the treatment of lumbar disc herniation.Establish the inclusion criteria and exclusion criteria,search the clinical research literature of Tuina in the treatment of lumbar disc herniation from the database of CNKI,VIP and WANFANG,and screen the literature that meet the standards.the elements of the manipulation scheme were extracted and analyzed from three aspects:the purpose of operation,the location of action and the classification of manipulation,the technical framework was constructed,and the combination scheme of Tuina manipulation for lumbar disc herniation was discussed.Study 2 The Delphi method was used to conduct a questionnaire survey on experts,and a more scientific,reasonable and standardized Tuina scheme for lumbar disc herniation was preliminarily formulated by expert consensus.The first round of expert consultation questionnaire is formed on the basis of content analysis,which mainly includes manual operation process,position and time.Thirty-five experts were selected from the members or young members of the Tuina Branch of the Chinese Society of traditional Chinese Medicine,and the questionnaires were distributed and collected for the first round of statistical analysis;combined with expert opinions,the second round of expert consultation questionnaire was formed.after the questionnaire was collected,the second round of questionnaire statistical analysis was carried out to form the "expert consensus on the Tuina Scheme of Lumbar Intervertebral Disc Herniation".ResultsThe results of content analysis showed that different clinical research methods of Tuina in the treatment of lumbar disc herniation were highly coincident in treatment purpose and action site.Tuina is often used in the treatment of lumbar disc herniation,such as Tuina,friction,sports joints and other techniques,and the main sites are lumbar,hip,posterior thigh soft tissue and lumbar intervertebral joint,in which the frequency of lumbar back is the highest.the second is lumbar intervertebral joint and retrothigh soft tissue;the purpose of action mainly includes relaxing the surrounding soft tissue and adjusting the relationship between vertebrae and so on.Put aside the differences of many Tuina techniques,combined with the location and purpose of action,standardized Tuina in the treatment of lumbar disc herniation is feasible.The results of expert consensus formulation by Delphi method show that the positive coefficients of the experts in the two rounds of questionnaires are more than 85%.The experts who participated in the two rounds of expert consultation questionnaires came from 19 cities across the country,of which the chief physician accounted for 62.5%.The deputy chief physician accounted for 25%,and the attending physician accounted for 12.5%.The positive degree and authority of experts to participate in the survey are relatively high.After two rounds of consultation questionnaires,experts reached a consensus on 14 Tuina methods,including waist-hip Tuina,waist-hip rolling,lower limb Tuina,waist plucking,waist and lower limb posterior acupoint,piriformis muscle plucking,sciatic nerve traction,iliopsoas muscle plucking,femoral adductor muscle plucking,lumbar lateral pressing,lower limb lateral plucking,lumbar inclined plate,lumbar cross-rubbing,and bladder meridian Tuina.Among them,the average score of 14 Tuina techniques was more than 6,the coefficient of variation(CV)was less than 0.35,the grade and S were more than 190,and the importance percentage was more than 60%.The Tuina techniques that reached a consensus formed the expert consensus on the Tuina scheme of lumbar disc herniation in the order of preparation technique,treatment technique and ending technique.Conclusionl.The clinical study of Tuina in the treatment of lumbar disc herniation is complicated,and it is feasible to classify it from the point of view of the elements of manual treatment and standardize it by expert consensus.2.The standardization of the massage technique treatment of lumbar disc herniation combination,shall establish to the understanding of the pathogenesis of lumbar disc prolapse,on the basis of considering combination treatment parts from the operating purposes,diagnosis and treatment scheme is put forward,after two rounds of expert questionnaire form the massage technique treatment of lumbar disc herniation solution expert consensus,And to a certain extent to promote the combination of massage manipulation standardization process. |
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