مدیریت استرس: مطالعه اکتشافی از بیماران مبتلا به فن ماساژ وجابجا کردن ستون فقرات

Background: Stress is a recognized variable in the diagnosis, management, and prognosis of musculoskeletal conditions; chiropractic care is reputed to be successful in the management of stress-related visceral conditions. It may be useful for chiropractors to include stress management as a clinical care option. Objective: To explore screening tools to aid stress self-assessment, investigate patients' perceptions of stress management as a chiropractic care option, and examine which stress-management strategies chiropractic patients perceive as most useful. Design: A multiphase qualitative study with purposive sampling of chiropractic clinics to maximize the diversity of the patient population. Convenience sampling of patients was undertaken in a Western Australian case study, an inner city, and a national exploratory study. Data for the case study were collected by semistructured interview. Questionnaires and a self-assessed stress-management task were used to collect data from the inner city and national studies. Data was thematically analyzed, and results were triangulated. Results: The sample size of chiropractic patients in the West Australian case study was 48, 15 in the Western Australia exploratory study and 36 in the national study. A number of chiropractic patients participating in this study perceive themselves to be stressed and were interested in having stress-management strategies included in their chiropractic care. Individual patients preferred different stress-management options. This qualitative study found little justification for routinely using a stress-assessment technique more complex than asking the patient to rate his or her stress level as absent, minimal, moderate, or severe. Exercise, particularly walking, was found to be a prevalent pastime among participants in the case study. Conclusion: This study was too small to warrant statistical analysis; nonetheless, the results of this study are relevant because some patients believe they would benefit from chiropractic care that includes

People with stress-related conditions routinely seek and obtain chiropractic care. Chronic stress has been linked to clinical conditions ranging from musculoskeletal dysfunctions such as muscle spasm, backache, and fibromyalgia to visceral conditions including intrinsic asthma, menstrual disorders, hypertension, and migraine and tension headaches. An Australian case study found that a percentage of chiropractic patients feel stressed and a substantial number of these patients feel it would be helpful if their chiropractic care included strategies to help them cope with stress. 2 The literature supports routinely including consideration of psychologic factors in the diagnosis and management of neckshoulder, back, and noncardiac chest pain. 38 Stress-management is also effective in a number of clinical conditions. 9 Autogenic training has, for example, been found to have a positive effect on patients with migraine, insomnia, asthma, and hypertension, j° Progressive muscle relaxation and electromyographic biofeedback-assisted relaxation training, mediation, and hypnosis have been found to benefit mood, selfesteem, and certain biologic indexes in HIV-positive men. 11 A biopsychosocial approach to treatment of patients with asthma found that the majority of patients achieved sustained improvement.~2 In addition to its effective management of the musculoskeletal system, chiropractic claims a measure of success in the management of stress-exacerbated visceral conditions. 13"15 Although somatovisceral reflexes are postulated to underlie improved visceral function detected after chiropractic care, the exact mechanism remains unproven. The possibility that psychosocial stress and its management may be one factor in the chiropractic management of these conditions has not been discounted. Advances in mind-body medicine suggest that processing within the hervous system does not distinguish between symbols and physical structures and that the neurobiology of the brain can be altered by perceptions, 16,iT explaining why chiropractic patient and practitioner perceptions of improvement are not always supportedby objective measurement. 18 Furthermore, the chiropractor's ability to use the consultation, not merely the adjustment, as a wellness trigger may be mediated through the ability of the practitioner to enhance the patient's personal perception of successfully coping with his or her disorder. 19 Perceived control is regarded as a significant factor in coping with stress. 2° The selective inclusion of stress-management techniques in chiropractic care may further enhance the perceived control of chiropractic patients and add a new dimension to chiropractic care. This exploratory study was undertaken to ascertain the type of stress-management techniques chiropractic patients perceived as useful and to provide chiropractors with some insight into the stress and stress-management perceptions of a diverse group of chiropractic patients.

Although the results of this qualitative study cannot be extrapolated to all chiropractic patients, the benefits of inquiring whether a patient feels stressed and would be interested in exploring various self-care, stress-management techniques outweigh any associated costs. At the very least, patients would benefit from advice on regular exercise, such as walking, as a stress-management and health-promotion strategy. In all cases, the needs and preferences of individual patients should determine the care offered.