Effects of internet-based pain coping skills training before home exercise for individuals with hip osteoarthritis (HOPE trial): a randomised controlled trial
Effects of internet-based pain coping skills training before home exercise for individuals with hip osteoarthritis (HOPE trial): a randomised controlled trial
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DOI：
10.1097/j.pain.0000000000001281
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发表时间：
2018-09-01
期刊：
影响因子：
7.4
通讯作者：
Hinman, Rana S.
中科院分区：
文献类型：
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作者：
Bennell, Kim L.;Nelligan, Rachel K.;Hinman, Rana S.
这项评估者、治疗师和参与者设盲的随机对照试验评估了临床诊断为髋关节骨关节炎的患者在家庭锻炼前进行基于互联网的自动疼痛应对技能培训（PCST）的效果。144人被随机分配到PCST组或对照组。在前8周，PCST组接受在线教育和PCST，而对照组仅接受在线教育。从第8周到第24周，两组都拜访了物理治疗师5次，以获得家庭运动处方。在基线、第8、24和52周进行评估。主要结局为24周时行走时髋关节疼痛（11分数字评定量表）和身体功能（西安大略和麦克马斯特大学骨关节炎指数[WOMAC]）。次要结局是疼痛、生活质量、整体变化、自我效能、疼痛应对、疼痛灾难化、抑郁、焦虑、压力、体力活动和不良事件的其他指标。分别有137（95%）、131（91%）和127（88%）名参与者在第8、24和52周完成了主要结局。第24周时，主要结局无显著组间差异（行走疼痛[平均差异0.5个单位; 95%置信区间，-0.3至1.3]和功能[-0.9个单位; 95%置信区间，-4.8至2.9]的变化），两组均显示临床相关改善。在第8周，PCST组在功能、疼痛应对和整体改善方面的改善大于对照组。更大的疼痛应对改善持续在24周和52周。总之，在线PCST立即改善疼痛应对和功能，但没有赋予额外的好处，随后的运动计划，尽管持续的疼痛应对改善。
This assessor-, therapist-, and participant-blinded randomised controlled trial evaluated the effects of an automated internet-based pain coping skills training (PCST) program before home exercise for people with clinically diagnosed hip osteoarthritis. One hundred forty-four people were randomised to either the PCST group or the comparator group. In the first 8 weeks, the PCST group received online education and PCST, whereas the comparison group received online education only. From weeks 8 to 24, both groups visited a physiotherapist 5 times for home exercise prescription. Assessments were performed at baseline, 8, 24, and 52 weeks. Primary outcomes were hip pain on walking (11-point numerical rating scale) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) at 24 weeks. Secondary outcomes were other measures of pain, quality-of-life, global change, self-efficacy, pain coping, pain catastrophizing, depression, anxiety, stress, physical activity, and adverse events. Primary outcomes were completed by 137 (95%), 131 (91%), and 127 (88%) participants at 8, 24, and 52 weeks, respectively. There were no significant between-group differences in primary outcomes at week 24 (change in: walking pain [mean difference 0.5 units; 95% confidence interval, -0.3 to 1.3] and function [-0.9 units; 95% confidence interval, -4.8 to 2.9]), with both groups showing clinically relevant improvements. At week 8, the PCST group had greater improvements in function, pain coping, and global improvement than comparison. Greater pain coping improvements persisted at 24 and 52 weeks. In summary, online PCST immediately improved pain coping and function but did not confer additional benefits to a subsequent exercise program, despite sustained pain coping improvements.