Novel Stepped Care Approach to Provide Education and Exercise Therapy for Patellofemoral Pain: Feasibility Study
Novel Stepped Care Approach to Provide Education and Exercise Therapy for Patellofemoral Pain: Feasibility Study
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DOI：
10.2196/18584
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发表时间：
2020-07-22
影响因子：
7.4
通讯作者：
Barton, Christian J.
中科院分区：
文献类型：
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作者：
Silva, Danilo De Oliveira;Pazzinatto, Marcella F.;Barton, Christian J.
背景：髌股关节痛(PFP)损害关节和健康相关的生活质量，并可能与膝骨性关节炎有关。我们开发了一种新的两阶段分级护理方法，将(1)自我导向的基于网络的教育和运动疗法与(2)物理治疗师支持的教育和运动疗法相结合。这项研究的目的：(1)确定我们的阶梯式护理方法的可行性；(2)探索患者在自我导向的网络教育和运动治疗后的结果(第一阶段)；(3)评估面对面和远程康复之间的治疗效果的差异，以支持在自我指导的护理后未完全康复的人的进一步教育和运动治疗(第二阶段)。第二阶段包括随机分配，再进行12周的物理治疗师指导(最多8次)教育和运动治疗，面对面或通过远程康复治疗那些在第一阶段后未将自己评价为完全康复的参与者。收集过程、依从性和参与者留存的可行性指标作为主要结果，并收集患者报告的全球变化和膝关节疼痛、残疾、与膝关节相关的生活质量、疼痛灾难、运动恐惧症和膝关节自我效能的结果。所有参与者在基线、6周和18周进行评估。结果：共筛选71名参与者，确定35名符合亲子关系的参与者进入研究。总体而言，100%(35/35)和88%(31/35)的参与者分别在6周和18周得到了随访。在研究的第一阶段，参与者平均访问我的膝盖帽网站6(7.5)天，并平均每周进行2.5(3.6)次锻炼。共有20%(7/35)的参与者报告说他们在6周时完全恢复。此外，93%(26/28)接受随访且在6周后仍未完全康复的参与者同意进入第二阶段。面对面康复组和远程康复组之间的任何结果都没有发现统计学上的显著差异。新的阶梯式护理方法与第一阶段后40%(14/35)的参与者和第二阶段后71%(25/35)的参与者显著改善或完全恢复相关。结论：本研究中实现的参与者保留率和家庭锻炼依从性较高，自我导向的基于网络的教育和运动疗法对PFP患者是可行的。此外，20%(7/35)的人报告在6周时完全恢复。面对面和远程康复理疗对于那些继续寻求治疗的人都应该考虑，因为这两种交付模式在结果上没有区别。确定阶梯式保健模式的效果可能有助于指导更有效的亲子保健服务。
Background: Patellofemoral pain (PFP) impairs joint- and health-related quality of life and may be associated with knee osteoarthritis. We developed a novel, 2-phase, stepped-care approach for PFP, combining (1) self-directed web-based education and exercise therapy with (2) physiotherapist-supported education and exercise therapy. Physiotherapy sessions can be provided using 2 different modalities: face-to-face and telerehabilitation.Objective: This study aims to (1) determine the feasibility of our stepped-care approach, (2) explore patient-reported outcomes following self-directed web-based education and exercise therapy in people with PFP (phase 1), and (3) estimate the differences in treatment effects between face-to-face and telerehabilitation to support further education and exercise therapy (phase 2) in those who had not completely recovered following self-directed care.Methods: Phase 1 involved 6 weeks of self-directed web-based education and exercise therapy. Phase 2 involved random allocation to a further 12 weeks of physiotherapist-led (up to 8 sessions) education and exercise therapy delivered face-to-face or via telerehabilitation to participants who did not rate themselves as completely recovered following phase 1. Feasibility indicators of process, adherence, and participant retention were collected as primary outcomes alongside patient-reported outcomes on Global Rating of Change and knee pain, disability, knee-related quality of life, pain catastrophism, kinesiophobia, and knee self-efficacy. All participants were assessed at baseline, 6 weeks, and 18 weeks.Results: A total of 71 participants were screened to identify 35 participants with PFP to enter the study. Overall, 100% (35/35) and 88% (31/35) of the participants were followed up with at 6 and 18 weeks, respectively. In phase 1 of the study, participants accessed the My Knee Cap website for an average of 6 (7.5) days and performed the exercises for an average of 2.5 (3.6) times per week. A total of 20% (7/35) of the participants reported that they had completely recovered at 6 weeks. Furthermore, 93% (26/28) of the participants who were followed up and had not completely recovered at 6 weeks agreed to be enrolled in phase 2. No statistically significant differences were found between the face-to-face and telerehabilitation groups for any outcome. The novel stepped-care approach was associated with marked improvement or complete recovery in 40% (14/35) of the participants following phase 1 and 71% (25/35) of the participants following phase 2.Conclusions: Self-directed web-based education and exercise therapy for people with PFP is feasible, as noted by the high rate of participant retention and home exercise adherence achieved in this study. Furthermore, 20% (7/35) of people reported complete recovery at 6 weeks. Both face-to-face and telerehabilitation physiotherapy should be considered for those continuing to seek care, as there is no difference in outcomes between these delivery modes. Determining the efficacy of the stepped-care model may help guide more efficient health care for PFP.