Physical Therapist-Delivered Pain Coping Skills Training and Exercise for Knee Osteoarthritis: Randomized Controlled Trial
Physical Therapist-Delivered Pain Coping Skills Training and Exercise for Knee Osteoarthritis: Randomized Controlled Trial
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物理治疗师提供的膝骨性关节炎疼痛应对技能训练和锻炼：随机对照试验
DOI：
10.1002/acr.22744
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发表时间：
2016-05-01
影响因子：
4.7
通讯作者：
Keefe, Francis J.
中科院分区：
文献类型：
--
作者：
Bennell, Kim L.;Ahamed, Yasmin;Keefe, Francis J.
目标。目的：探讨由理疗师提供的为期12周的疼痛应对技能训练(PCST)和运动(PCST/运动)相结合的治疗膝骨性关节炎(OA)是否比单独治疗更有效和更具成本效益。这是一项评估者盲法、三臂随机对照试验，研究对象为222名50岁的膝骨性关节炎患者(73人/锻炼，75人锻炼，74人/锻炼)。所有参与者在12周内接受了10次治疗，外加一个家庭计划。PCST涵盖了认知和行为疼痛应对技能方面的疼痛教育和培训，锻炼包括加强锻炼，PCST/锻炼将两者结合起来。主要结果是12周时自我报告的平均膝关节疼痛(视觉模拟评分，范围0-100 mm)和身体功能(安大略省西部大学和麦克马斯特大学骨关节炎指数，范围0-68)。次要结果包括其他疼痛测量、全球变化、身体表现、心理健康、身体活动、生活质量和成本效益。分析采用意向处理方法，并对缺失数据进行多重归因。共有201名参与者(91%)、181名参与者(82%)和186名参与者(84%)分别完成了第12、32和52周的测量。在第12周，比较PCST/运动与运动(平均差异5.8 mm[95%可信区间(95%CI)-1.4，13.0])和PCST/运动与PCST(6.7 mm[95%CI-0.6，14.1])，组内疼痛减轻没有显著差异。PCST/运动相对于运动(3.7个单位[95%CI 0.4，7.0])和PCST/运动(7.9个单位[95%CI 4.7，11.2])的功能改善显著。这些差异在32周(两者)和52周(PCST)持续存在。有利于PCST/锻炼的好处出现在几个次要结果上。未显示PCST/演习的成本效益。这种护理模式可以改善获得心理治疗的机会，并增加膝骨性关节炎患者锻炼的结果，尽管它似乎不符合成本效益。
Objective. To investigate whether a 12-week physical therapist-delivered combined pain coping skills training (PCST) and exercise (PCST/exercise) is more efficacious and cost effective than either treatment alone for knee osteoarthritis (OA).Methods. This was an assessor-blinded, 3-arm randomized controlled trial in 222 people (73 PCST/exercise, 75 exercise, and 74 PCST) ages >= 50 years with knee OA. All participants received 10 treatments over 12 weeks plus a home program. PCST covered pain education and training in cognitive and behavioral pain coping skills, exercise comprised strengthening exercises, and PCST/exercise integrated both. Primary outcomes were self-reported average knee pain (visual analog scale, range 0-100 mm) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index, range 0-68) at week 12. Secondary outcomes included other pain measures, global change, physical performance, psychological health, physical activity, quality of life, and cost effectiveness. Analyses were by intent-to-treat methodology with multiple imputation for missing data.Results. A total of 201 participants (91%), 181 participants (82%), and 186 participants (84%) completed week 12, 32, and 52 measurements, respectively. At week 12, there were no significant between-group differences for reductions in pain comparing PCST/exercise versus exercise (mean difference 5.8 mm [95% confidence interval (95% CI) -1.4, 13.0]) and PCST/exercise versus PCST (6.7 mm [95% CI -0.6, 14.1]). Significantly greater improvements in function were found for PCST/exercise versus exercise (3.7 units [95% CI 0.4, 7.0]) and PCST/exercise versus PCST (7.9 units [95% CI 4.7, 11.2]). These differences persisted at weeks 32 (both) and 52 (PCST). Benefits favoring PCST/exercise were seen on several secondary outcomes. Cost effectiveness of PCST/exercise was not demonstrated.Conclusion. This model of care could improve access to psychological treatment and augment patient outcomes from exercise in knee OA, although it did not appear to be cost effective.