选择对谁有效的方法：在临床实践中更好地运用机制性知识。
Choosing what works for whom: towards a better use of mechanistic knowledge in clinical practice.
作者信息
Alaiti Rafael K, Saragiotto Bruno T, Fukusawa Leandro, D A Rabelo Nayra, de Oliveira Anamaria S
机构信息
Nucleus of Neuroscience and Behavior and Nucleus of Applied Neuroscience, Universidade de São Paulo, São Paulo, Brazil.
Research, Technology, and Data Science Office, Grupo Superador, São Paulo, Brazil.
出版信息
Arch Physiother. 2021 Dec 1;11(1):26. doi: 10.1186/s40945-021-00122-1.
BACKGROUND
Clinicians commonly try to use mechanism-based knowledge to make sense of the complexity and uncertainty of chronic pain treatments to create a rationale for their clinical decision-making. Although this seems intuitive, there are some problems with this approach.
DISCUSSION
The widespread use of mechanism-based knowledge in clinical practice can be a source of confusion for clinicians, especially when complex interventions with different proposed mechanisms of action are equally effective. Although the available mechanistic evidence is still of very poor quality, in choosing from various treatment options for people with chronic pain, an approach that correctly incorporates mechanistic reasoning might aid clinical thinking and practice.
CONCLUSION
By explaining that not all evidence of mechanism is the same and by making a proposal to start using mechanism-based knowledge in clinical practice properly, we hope to help clinicians to incorporate mechanistic reasoning to prioritize and start choosing what may best work for whom.
背景
临床医生通常试图运用基于机制的知识来理解慢性疼痛治疗的复杂性和不确定性，从而为其临床决策提供依据。尽管这似乎是直观的，但这种方法存在一些问题。
讨论
基于机制的知识在临床实践中的广泛应用可能会使临床医生感到困惑，尤其是当具有不同作用机制的复杂干预措施同样有效时。尽管现有的机制证据质量仍然很差，但在为慢性疼痛患者选择各种治疗方案时，正确纳入机制推理的方法可能有助于临床思维和实践。
结论
通过解释并非所有机制证据都是相同的，并提议在临床实践中正确开始使用基于机制的知识，我们希望帮助临床医生纳入机制推理，以便确定优先级并开始选择对谁可能最有效的治疗方法。
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