Page 99 - 2023-02-中国全科医学

·220· http: //www.chinagp.net E-mail: zgqkyx@chinagp.net.cn January 2023, Vol.26 No.2

A Qualitative Study on the Factors Influencing the Treatment of Musculoskeletal Pain by Tuina Manipulation FAN
Xiran，LI Duoduo，WANG Shuangshuang，GUO Ye，YU Changhe *
Department of Tuina Pain，Dongzhimen Hospital Beijing University of Chinese Medicine，Beijing 100700，China
*
Corresponding author：YU Changhe，Attending physician；E-mail：yakno2@163.com
【Abstract】 Background Musculoskeletal disorders are one of the most prevalent chronic diseases around the world.
Additionally，they contribute significantly to the global burden of disease. Tuina manipulation played a crucial role in treating
musculoskeletal diseases from ancient times to the present. However，there are no systematic investigations on the efficacy
characteristics of Tuina manipulation for alleviating musculoskeletal pain. Objective To objective of the study was to investigate
the factors that have an influence on the effectiveness of Tuina manipulation in treating musculoskeletal pain. Methods In October
2021，we interviewed physicians from Beijing's Tuina Department using the purpose sampling method and the snowball sampling
strategy. Interviews were carried out following a semi-structured format to determine the factors influencing Tuina manipulation
for musculoskeletal pain. In accordance with the study's aims，the interview outline was drafted and discussed with the research
group，and the interview was ended when saturation of information had been reached. To develop a theoretical model，the
interview content is organized into text using three-level coding and rooted theory using the qualitative analysis software NVivo 11.
Results A total of 16 interviewees were interviewed effectively. The interviews were open coded to obtain 21 initial categories.
And The 21 initial categories were summarized into five main categories：“health care providers”“patients”“medical
environment”“regional divergence”and“advantages of disease”. In addition to selective coding，the factors of
musculoskeletal pain are summarized as the intrinsic factors of“people”（“health care provider”and“patients”），
the external factors of“environment”（“medical environment”and“regional divergence”），and the causative factors
of“disease”（“advantages of disease”）. By combing these factors with Tuina manipulation，it becomes a tree-like
model of influencing factors in the treatment of musculoskeletal pain. Conclusion The factors affecting the treatment of
musculoskeletal pain by Tuina manipulation are composed of three factors：the internal factors of“people”，the external factors
of“environment”and the causative factors of“diseases”. “Health care providers”constitute the most critical factors，as their
diagnosis，treatment plan，and technical level significantly affect the final result of treatment. The patient's compliance is largely
a secondary factor，while external factors indicate that good doctor-patient communication leads to success. From the causative
factors of“disease”，it can be seen that Tuina has a more prominent effect in the treatment of musculoskeletal diseases.
【Key words】 Tuina manipulation；Massage therapy；Musculoskeleta lpain；Chronic pain；Interviews as topic；
Treatment outcome

骨骼肌肉疾病是世界上常见的慢性病之一，其种类 展系统研究，为进一步探究推拿手法治疗骨骼肌肉疼痛
繁多，涵盖百余种，主要病因与炎性反应、自身免疫反 疗效的影响因素，本研究通过访谈经验丰富的推拿医师，
应、感染、代谢紊乱、创伤、退行性病变等因素有关， 归纳并总结推拿手法疗效的影响因素。经验丰富的推拿
临床症状表现为关节、骨骼、肌肉、软骨和其他结缔组 医师可提出更为专业且贴近临床实践的观念，为进一步
织疼痛不适，甚至出现身体运动受限 ［1］ 。 研究及其阐释提供独特的视角。
骨骼肌肉疾病及其相关疼痛是世界上疾病负担的主 1 对象与方法
要原因之一。《疾病负担研究》指出，2017 年骨骼肌 1.1 研究对象 2021 年 10 月采用目的抽样法，使用滚
肉疾病的全球发病总人数达 1.39 亿，其中腰痛患者达 6 雪球抽样策略，以北京市推拿学系的医师为访谈对象。
［2］
490万，骨关节炎患者达960万 。中国进入老龄化社会， 纳入取得执业医师资格证且从事临床推拿工作 5 年及以
骨骼肌肉疾病通过影响身心健康和活动能力对健康老龄 上者，排除近 2 年未从事临床推拿工作者。
化构成重大威胁，给个人、家庭和政府带来了巨大的经 访谈人数按照资料“饱和”的原则确定，即通过访
济和医疗负担 ［3-4］ 。 谈无法得出新的内容时认为样本饱和 ［6］ 。本研究获得
推拿缓解骨骼肌肉疼痛具有显著效果。《医宗金鉴 北京中医药大学东直门医院医学研究伦理委员会审批
（下册）》“正骨心法要旨”篇指出：“按其经络，以 （伦理审批编号：DZMYY-KY-2020-60）。
通郁闭之气，摩其壅聚，以散痰结之肿，其患可愈” ［5］ ， 1.2 方法
说明推拿具有活血化瘀、疏经通络、消肿止痛的功效。 1.2.1 访谈方法与数据收集 本研究采用半结构化访谈
目前推拿手法治疗骨骼肌肉疼痛疗效的影响因素尚未开 的方法，首先根据研究目的与课题组讨论后拟定访谈提