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<VAS¿Í SF-36¸¦ »ç¿ëÇÑ´Ù¸é, Ä¡·áÈ¿°ú°¡ ÀÖ´Ù°í ¸»Çϱâ À§ÇÑ ÃÖ¼ÒÇÑÀÇ È£Àü Á¤µµ´Â ¾ó¸¶Àΰ¡? >

[Ãâó] Lauche R, Langhorst J et al. Clinically meaningful differences in pain, disability and quality of life for chronic nonspecific neck pain - a reanalysis of 4 randomized controlled trials of cupping therapy. Complement Ther Med. 2013 Aug;21(4):342-7

[°³¿ä] ¸ñÅëÁõÀº ¹Ì±¹¿¡¼­ CAMÀÌ µÎ ¹ø°·Î ¸¹ÀÌ »ç¿ëµÇ´Â ºÐ¾ßÀÔ´Ï´Ù. ¸¹Àº ¿¬±¸µé¿¡¼­ Ä¡·áÈ¿°ú°¡ Åë°èÀûÀ¸·Î À¯ÀÇÇÑÁö ¾Æ´ÑÁö¿¡¸¸ °ü½ÉÀ» ±â¿ïÀÌÁö¸¸ ÀÓ»ó¿¡¼­ Áß¿äÇÑ °ÍÀº CID(Clinically Important differences) °³³äÀÔ´Ï´Ù.

Åë°èÀûÀ¸·Î´Â Â÷ÀÌ°¡ ÀÖÁö¸¸ ±× Â÷ÀÌ°¡ ÀÓ»óÀûÀ¸·Î´Â º° Àǹ̰¡ ¾ø´Â °æ¿ìµµ Á¾Á¾ Àֱ⠶§¹®ÀÔ´Ï´Ù. CID¶ó´Â °ÍÀº ÃøÁ¤ÇÏ·Á´Â Æò°¡µµ±¸¿¡¼­ ȯÀÚ°¡ ÀÓ»óÀûÀ¸·Î È¿°ú°¡ ÀÖ´Ù°í ´À³¥ ¼ö ÀÖ´Â ÃÖ¼ÒÇÑÀÇ Â÷À̸¦ ¸»ÇÕ´Ï´Ù.

µû¶ó¼­ Àӻ󿬱¸¿¡¼­ CID °³³äÀÌ °í·ÁµÇ¾î¾ß¸¸ InterventionÀÇ ÁøÁ¤ÇÑ È¿°ú¸¦ È®ÀÎÇÒ ¼ö ÀÖ½À´Ï´Ù. ÃÖ±Ù¿¡´Â CID ¿¡ °üÇÑ ¿¬±¸°¡ ¸¹ÀÌ ÀÌ·ïÁ³À¸¸ç °æÇâÅë¿¡¼­´Â NRS (Numeric Rating Scale)ÀÇ CID´Â 1.5~2.5Á¡, NDI(Neck Disability Index)ÀÇ CID´Â 0~50Á¡ ½ºÄÉÀÏÀÇ 3.5~7.5Á¡À¸·Î ¾Ë·ÁÁ® ÀÖ°í VAS³ª SF-36¿¡ ´ëÇؼ­´Â ¾Ë·ÁÁø ¹Ù°¡ ¾ø¾ú½À´Ï´Ù.

µ¶ÀÏÀÇ Duisburg-Essen ´ëÇÐÀÇ Department of Internal and Intergrative Medicine¿¡¼­ ÃÖ±Ù ÀڽŵéÀÌ ¼öÇàÇß´ø ¸ñÅëÁõ¿¡ °üÇÑ 4°³ÀÇ ºÎÇ׿¬±¸¸¦ ÅëÇÕÇؼ­ ¸ñÅëÁõÀÇ ºÎÇ×Ä¡·á¿¡ °üÇÑ Minimal Clinically important difference(MCID)¿Í Substantial clinical benefit(SCB)¸¦ Ãß»êÇÏ°íÀÚ ¿¬±¸¸¦ ¼öÇàÇÏ¿´À¸¸ç ±×¿¡ ´ëÇØ ¼Ò°³ÇÏ°Ú½À´Ï´Ù.

[³í¹® ³»¿ë] ´ë±â±ºÀ» ´ëÁ¶±ºÀ¸·Î »ç¿ëÇÑ 4°³ÀÇ ¸¸¼º ¸ñÅëÁõÀÇ ºÎÇ×Ä¡·á ¿¬±¸ÀÇ ÀڷḦ ºÐ¼®Çß½À´Ï´Ù. Ä¡·á±º¿¡´Â 1ȸÀÇ ½ÀºÎÇ×, 5ȸÀÇ °ÇºÎÇ×, Pulsating cupping, cupping massage µîÀÌ ÀÖÀ¸¸ç VAS, NDI, SF-36(»îÀÇ Áú)À» ÃøÁ¤Çß½À´Ï´Ù. VAS¿Í NDI, SF-36ÀÇ Bodily pain(BP) Á¡¼ö¿Í Physical Component score(PCS)°¡ »îÀÇ ÁúÀ» ÃøÁ¤ÇÏ´Â µµ±¸·Î ÀÌ¿ëµÇ¾ú½À´Ï´Ù.

SF-36-CHS(Change in health status)´Â much better, somewhat better, about the same, somewhat worse, much worseÀÇ 5´Ü°è·Î ±¸¼ºµÇ¾î ÀÖÀ¸¸ç ÀÌ°ÍÀ» ¹ÙÅÁÀ¸·Î ROC Ä¿ºê ºÐ¼®À» ÇÏ°í AUCÀÇ ³ÐÀ̸¦ ±¸Çß½À´Ï´Ù. ROC Ä¿ºê´Â °¢°¢ÀÇ Outcome¸¶´Ù ±×·ÁÁ³½À´Ï´Ù. MCID´Â somewhat better, about the sameÀ» ±¸ºÐÇÏ´Â ROC Ä¿ºê ºÐ¼®À» ½ÃÇàÇÏ¿´°í, SCB´Â much better, somewhat better¸¦ ±¸ºÐÇÏ´Â ROC Ä¿ºê ºÐ¼®À» ½ÃÇàÇß½À´Ï´Ù.

´ÙÀ½ Ç¥´Â ±×¸¦ ÅëÇØ ±¸ÇØÁø °¢ ÃøÁ¤µµ±¸º° MCID¿Í SCBÀÇ ÃÖÀûÀý»ç°ªÀÔ´Ï´Ù.

   

[ÇÊÁø ÀÇ°ß]
ÀÌÀüÀÇ ¿¬±¸¿¡¼­ ¸¸¼º¸ñÅëÁõÀÇ CID¿Í SCB´Â VAS³ª SF-36¿¡ ´ëÇؼ­´Â º¸°íµÈ ¹Ù°¡ ¾ø¾ú½À´Ï´Ù. ÇÑÆí, Dworkin µîÀÇ consensus¿¡¼­ ¸¸¼ºÅëÁõÀÇ CID´Â VAS´Â -10mm(ȤÀº -10 ~ -20%) ÀÇ º¯È­°¡ ÇÊ¿äÇÏ°í SCB´Â -20 ~ -27mm(ȤÀº -50% ÀÌ»ó) °¡ ÇÊ¿äÇÏ´Ù°í [Âü°í] º¸°íÇÑ ¹Ù ÀÖÀ¸¸ç ÀÌ ¿¬±¸¿¡¼­ VASÀÇ º¯È­¿Í À¯»çÇÕ´Ï´Ù.

ÀÌ ¿¬±¸¿¡¼­´Â º¯È­ÆøÀÌ ¾à°£ ÀÛÀº °æÇâÀÌ ÀÖÁö¸¸ ¾ÖÃÊ¿¡ ȯÀÚµéÀÇ ÁßÁõµµ°¡ mild to moderate¿´±â ¶§¹®¿¡ ¿ëÀÎÇÒ ¼ö ÀÖ´Â Á¤µµ¶ó°í º¼ ¼ö ÀÖ½À´Ï´Ù. NDI´Â ±âÁ¸ÀÇ ¿¬±¸¿¡¼­ Á¦½ÃµÈ MCID°¡ 10Á¡À̳ª 20% Á¤µµÀÇ °¨¼Ò°¡ ÇÊ¿äÇÏ´Ù°í µÇ¾î ÀÖÀ¸³ª ÀÌ ¿¬±¸¿¡¼­´Â ±×¿¡ ¸ø ¹ÌÄ¡´Âµ¥ ÀúÀÚµéÀº ÇÇÇèÀÚµéÀÇ Æ¯¼º ¶§¹®ÀÏ ¼öµµ ÀÖ°í ±× ¹ÛÀÇ ¹®Á¦°¡ ÀÖÀ» ¼öµµ ÀÖ´Ù°í º¸°í ÀÖ½À´Ï´Ù.

ºñƯÀÌÀû °æÇ×ÅëÀÇ SF-36¿¡¼­ÀÇ MCIDµµ ÀÌ ³í¹®¿¡¼­ óÀ½À¸·Î Á¦½ÃµÇ¾ú½À´Ï´Ù. ÀÌÀüÀÇ Cervical spine fusion treatment ¿¬±¸¿¡¼­ Á¦½ÃµÈ ¼öÄ¡º¸´Ù´Â ³·À¸³ª ÀÌ ¿ª½Ã ÇÇÇèÀÚÀÇ ¸ñ ÅëÁõ ÁßÁõµµ Â÷ÀÌ¿¡¼­ ºñ·ÔµÈ °ÍÀÏ ¼ö ÀÖ½À´Ï´Ù.

ÀÌ ¿¬±¸ ÀÚü´Â ¸¸¼º ¸ñÅëÁõ¿¡¼­ ºÎÇ×Ä¡·áÀÇ ¿ì¼ö¼ºÀ» ÀÔÁõÇÏ°íÀÚ ÇÏ´Â ÀϹÝÀûÀÎ ¿¬±¸´Â ¾Æ´Õ´Ï´Ù. ÇÏÁö¸¸ ÀÓ»ó¿¡¼­ ½ÇÁ¦ÀûÀ¸·Î ȯÀÚ°¡ ¾î´À Á¤µµ È£ÀüÀÌ µÇ¾î¾ß Ä¡·á°¡ Àǹ̰¡ ÀÖ´À³Ä¸¦ ¸»ÇÏ°íÀÚ ÇÒ ¶§ MCID, SCB °³³äÀº ÇʼöÀûÀ̶ó°í º¼ ¼ö Àֱ⠶§¹®¿¡ MCID °³³äÀ» °í·ÁÇÏ¿© Ä¡·áÀÇ ¸ñÇ¥¸¦ ¼³Á¤ÇÏ´Â °ÍÀÌ Áß¿äÇÕ´Ï´Ù.

ƯÈ÷ ȯÀڵ鿡°Ô ¿ÏÄ¡°¡ ¾Æ´Ñ ¾î´À Á¤µµÀÇ È£ÀüÀÌ ÀÖÀ¸¸é Ä¡·á°¡ ¼º°øÀûÀ̶ó°í »çÀü¿¡ Á¦½Ã¸¦ ÇÑ´Ù¸é Ä¡·á ¸¸Á·µµ¿Í ÀÇ»ç-ȯÀÚ °ü°è¿¡ ¿µÇâÀ» ÁÙ ¼ö ÀÖÀ» °ÍÀ¸·Î »ý°¢µË´Ï´Ù. ¹°·Ð Ä¡·á ½ÃÀÛ Àü¿¡ VAS³ª NDI °°Àº °æÇ×Åë¿¡ ÈçÈ÷ »ç¿ëµÇ´Â Æò°¡ÁöÇ¥¸¦ ±â·ÏÀ» Çصδ °ÍÀÌ ¼±ÇàµÇ¾î¾ß ÇÕ´Ï´Ù.

[¸µÅ©] http://www.ncbi.nlm.nih.gov/ pubmed/23876565
[Âü°í ¸µÅ©] http://www.ncbi.nlm. nih.gov/pubmed/18055266
Dworkin RH et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain. 2008 Feb;9(2):105-21

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