Newell Dave, Lothe Lise R, Raven Timothy J L
Anglo European College of Chiropractic, Bournemouth, UK.
Kiropraktorene i Grimstad & Lillesand, Grimstad, Norway.
Chiropr Man Therap. 2017 Feb 13;25:6. doi: 10.1186/s12998-017-0137-z. eCollection 2017.
The chiropractic profession emerged when scientific explanations for causes of health and disease were still in infancy and the co-existence of notions such as innate healing and vitalism were perhaps admissible within such a historical context. Notwithstanding, within the scientific culture of the 21 Century all healthcare paradigms require evidential support which in regard these early concepts are in large part, absent. Nevertheless, a large body of emerging scientific evidence supports the existence of innate healing phenomena that may explain a plethora of clinical outcomes observed during chiropractic care. However, in contrast to the notion that removing the putative subluxation constitutes the mechanism by which this healing is initiated, the evidentially supported explanation is one that invokes the impact of contextual factors inherent in the skilful care and authority of the healthcare provider. This perspective is presented here as the scientific model of Contextually Aided Recovery (CARe).
This paper contends that;Contextual effects are powerful and desirable and are triggered by contextual factors present in all therapeutic encounters including those encountered in chiropractic practice.These factors can elicit large clinical effects with substantive evidence supporting pain, immune and motor modulation.The compartmentalisation of specific and non-specific effects is a biologically and scientifically false dichotomy, erroneously invoked to de-legitimise treatment approaches that expertly construct contextual healing scenarios.The use of factors to construct contextual healing scenarios that maximise positive (placebo) and minimize negative (nocebo) effects is a skilful clinical art within the multimodal approach that describes modern chiropractic care and should be presented and defended as a legitimate component of orthodox healthcare Clinical improvement during chiropractic care, beyond any biologically specific treatment effects of manipulation and other modalities, may be largely understood considering contextual factors as described by a Contextually Aided Recovery (CARe) model.
整脊疗法出现时,关于健康与疾病成因的科学解释尚处于萌芽阶段,在这样的历史背景下,诸如先天自愈和活力论等观念的共存或许是可以接受的。尽管如此,在21世纪的科学文化中,所有医疗保健模式都需要有证据支持,而对于这些早期概念而言,在很大程度上是缺乏证据的。然而,大量新出现的科学证据支持先天自愈现象的存在,这或许可以解释整脊治疗过程中观察到的大量临床结果。然而,与移除假定的半脱位构成这种自愈启动机制的观念不同,有证据支持的解释是,它涉及到医疗服务提供者熟练的护理和权威中所固有的背景因素的影响。这一观点在此作为情境辅助康复(CARe)的科学模型呈现。
本文认为:情境效应强大且有益,由包括整脊治疗实践中所遇到的所有治疗接触中的情境因素触发。这些因素可引发显著的临床效应,有大量证据支持对疼痛、免疫和运动的调节作用。将特定效应和非特定效应区分开来是一种生物学和科学上的错误二分法,错误地被用来使那些巧妙构建情境性治疗方案的治疗方法失去合法性。利用各种因素构建情境性治疗方案以最大化积极(安慰剂)效应并最小化消极(反安慰剂)效应,是现代整脊治疗多模式方法中的一门精湛临床艺术,应作为正统医疗保健的合法组成部分加以呈现和辩护。整脊治疗过程中的临床改善,除了手法和其他治疗方式的任何生物学特定治疗效果之外,很大程度上可以根据情境辅助康复(CARe)模型所描述的情境因素来理解。