Physical Therapy Use, Costs, and Value for Latent Classes of Good vs Poor Outcome in Patients Who Catastrophize About Their Pain Prior to Knee Arthroplasty.
Physical Therapy Use, Costs, and Value for Latent Classes of Good vs Poor Outcome in Patients Who Catastrophize About Their Pain Prior to Knee Arthroplasty.
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DOI：
10.1016/j.apmr.2021.02.004
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发表时间：
2021-07
影响因子：
4.3
通讯作者：
Riddle DL
中科院分区：
文献类型：
--
作者：
Orndahl CM;Perera RA;Hung A;Dumenci L;Riddle DL
检查亚组中 PT 的使用、成本和价值。我们对疼痛应对技能干预随机试验的数据进行了观察性研究。良好和不良结果亚组是根据西安大略大学和麦克马斯特大学骨关节炎指数 (WOMAC) 疼痛和身体功能评分确定的。报告了 PT 护理的使用和费用，以及一年随访期间四个时间段内 WOMAC 疼痛和身体功能评分的变化。比较了两个潜在亚组的 PT 就诊次数、总 PT 成本以及 WOMAC 评分每提高一单位的成本。五个学术医疗中心。在膝关节置换术之前对疼痛感到灾难性的患者。疼痛应对技能培训、关节炎教育和日常护理。 WOMAC 疼痛量表是主要结果。 KA 后 2 个月开始，对于结果较差的亚组和结果良好的亚组，PT 的价值较低，PT 的成本较高。例如，在 2-6 个月期间，结果不佳亚组的参与者 WOMAC 疼痛每改善一单位，其 PT 成本为 5,181.22 美元，而结果良好亚组的 WOMAC 疼痛每改善一单位，PT 成本为 437.87 美元 (p<0.001)。从 6 到 12 个月期间，预后不良亚组的 WOMAC 评分恶化，表明物理治疗没有任何益处。两个潜伏类别的患者在 PT 值上表现出临床上重要的差异。未来的研究应该确定基于康复的干预措施，以减少高危患者的使用并提高其效果。
To examine use, costs, and value of PT among subgroups. We conducted an observational study of data from a randomized trial of a pain coping skills intervention. Good and poor outcome subgroups were determined based on Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) Pain and Physical Function scores. The use and costs of PT care, as well as changes in WOMAC Pain and Physical Function scores over four time periods during a one-year follow-up were reported. Number of PT visits, total PT costs and cost per one-unit improvement in WOMAC scores for the two latent subgroups were compared. Five academic medical centers. Patients who catastrophized about their pain prior to knee arthroplasty. Pain coping skills training, arthritis education and usual care. The WOMAC Pain Scale was the primary outcome. The value of PT was lower and the cost of PT was higher for poor versus good outcome subgroups beginning 2 months after KA. For example, during the 2–6 month period, participants in the poor outcome subgroup incurred a PT cost of $5,181.22 per one-unit improvement in WOMAC Pain as compared to $437.87 per one-unit improvement in WOMAC Pain for the good outcome subgroup (p<0.001). From the 6–12 month period, WOMAC scores worsened for the poor outcome subgroup, indicating no benefit from physical therapy. Patients in two latent classes demonstrated clinically important differences in value of PT. Future research should identify rehabilitation-based interventions that reduce utilization and enhance effectiveness for patients at high risk for poor outcome.
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影响因子：
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