Association of Physical Therapy Interventions With Long-term Opioid Use After Total Knee Replacement.
Association of Physical Therapy Interventions With Long-term Opioid Use After Total Knee Replacement.
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DOI：
10.1001/jamanetworkopen.2021.31271
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发表时间：
2021-10-01
影响因子：
13.8
通讯作者：
Kumar D
中科院分区：
文献类型：
--
作者：
Aoyagi K;Neogi T;Peloquin C;Dubreuil M;Marinko L;Camarinos J;Felson DT;Kumar D
全膝关节置换术（TKR）前后的物理治疗（PT）干预是否与术后长期使用阿片类药物的风险降低相关？在这项队列研究中，包括 67-322 名接受 TKR 的个体，接受任何 TKR 前后 PT 护理、接受超过 5 次 TKR 后 PT 疗程以及 TKR 后 30 天内开始 PT 护理与长期使用阿片类药物的风险较低相关。这项研究表明，接受 PT 干预可能与 TKR 后长期使用阿片类药物的风险降低有关；这些数据可能有助于了解 TKR 后 PT 干预的有效剂量和时间。许多接受全膝关节置换术 (TKR) 的人在 TKR 后成为长期阿片类药物使用者。 TKR 之前或之后的物理治疗 (PT) 干预与长期使用阿片类药物的关系尚不清楚。评估 TKR 前后 PT 干预与 TKR 后长期使用阿片类药物的关系。这项队列研究使用了 OptumLabs 数据仓库中 67~322 名 40 岁或以上的个体的数据，这些个体从 2001 年 1 月 1 日到 2016 年 12 月 31 日接受了 TKR，并按阿片类药物使用史进行分层。研究分析包括 1999 年 1 月 1 日至 2018 年 12 月 31 日的数据。TKR 之前或之后 90 天内的任何 PT 干预、TKR 后 PT 剂量（即 1-5、6-12 和≥13 次）、TKR 后 PT 时间为开始护理的天数（即 <30 天、31-60 天或TKR 后 61-90 天），以及 TKR 后 PT 类型（即主动与被动）。使用逻辑回归评估 TKR 前后 PT 与 TKR 后 90 天以上长期使用阿片类药物的风险之间的关系，同时调整混杂因素，包括年龄、性别、种族和民族（亚洲人、黑人、西班牙裔或白人）、肥胖、保险类型、地理位置以及身心健康合并症。总共包括 38~408 名未使用过阿片类药物的个体（21~336 名女性 [55.6%]；平均 [SD] 年龄，66.2 [9.2] 岁）和 28~914 名使用过阿片类药物的个体（18~426 名女性 [63.7%]；平均 [SD] 年龄，64.4 [9.3] 岁）。在首次使用阿片类药物（调整后比值比 [aOR]，0.75 [95% CI，0.60-0.95]）和使用过阿片类药物（aOR，0.75 [95% CI，0.70-0.80]）队列中，在 TKR 之前接受任何 PT 与长期使用阿片类药物的几率较低相关。在使用过阿片类药物的队列中，接受任何 TKR 后 PT 与长期使用阿片类药物的几率较低相关（aOR，0.75 [95% CI，0.70-0.79]）。与 TKR 后 1 至 5 次 PT 疗程相比，6 至 12 次疗程（aOR，0.82 [95% CI，0.75-0.90]）和 13 次或更多疗程（aOR，0.71 [95% CI，0.65-0.77）与阿片类药物使用队列中较低的几率相关。与 TKR 后 30 天内开始 PT 相比，TKR 后 31 至 60 天或 61 至 90 天开始 PT 与未使用阿片类药物的几率更大（31-60 天：aOR，1.45 [95% CI，1.19-1.77]；61-90 天：aOR，2.15 [95% CI， 1.43-3.22]）和使用过阿片类药物（31-60 天：aOR，1.10 [95% CI，1.02-1.18]；61-90 天：aOR，1.32 [95% CI，1.12-1.55]）队列。与被动 PT 相比，在未使用阿片类药物（aOR，1.00 [95% CI，0.81-1.24]）或使用过阿片类药物（aOR，0.99 [95% CI，0.92-1.07]）队列中，主动 PT 与长期使用阿片类药物无关。这项队列研究表明，在 TKR 前后接受 PT 干预、TKR 后接受 6 次或以上 PT 护理以及 TKR 后 30 天内开始 PT 护理与长期使用阿片类药物的几率较低相关。这些发现表明 PT 可能有助于降低 TKR 后长期使用阿片类药物的风险。这项队列研究评估了美国成年人全膝关节置换术前后物理治疗干预与全膝关节置换术后长期使用阿片类药物的关系。
Are physical therapy (PT) interventions before and after total knee replacement (TKR) associated with lower risk of postoperative long-term use of opioids? In this cohort study that included 67 322 individuals who underwent TKR, receipt of any pre- and post-TKR PT care, receipt of more than 5 post-TKR PT sessions, and initiation of PT care within 30 days after TKR were associated with lower risk of long-term opioid use. This study suggests that receipt of PT interventions may be associated with lower risk of long-term opioid use after TKR; these data may help inform effective dose and timing of PT interventions after TKR. Many individuals who undergo total knee replacement (TKR) become long-term opioid users after TKR. Associations of physical therapy (PT) interventions before or after TKR with long-term use of opioids are not known. To evaluate associations of PT interventions before and after TKR with long-term opioid use after TKR. This cohort study used data from the OptumLabs Data Warehouse on 67 322 individuals aged 40 years or older who underwent TKR from January 1, 2001, to December 31, 2016, stratified by history of opioid use. The analyses for the study included data from January 1, 1999, to December 31, 2018. Any PT interventions within 90 days before or after TKR, post-TKR PT dose as number of sessions (ie, 1-5, 6-12, and ≥13 sessions), post-TKR PT timing as number of days to initiation of care (ie, <30 days, 31-60 days, or 61-90 days after TKR), and post-TKR PT type (ie, active vs passive). The association of pre- and post-TKR PT with risk of long-term opioid use occurring more than 90 days after TKR was assessed using logistic regression while adjusting for confounders, including age, sex, race and ethnicity (Asian, Black, Hispanic, or White), obesity, type of insurance, geographical location, and physical and mental health comorbidities. A total of 38 408 opioid-naive individuals (21 336 women [55.6%]; mean [SD] age, 66.2 [9.2] years) and 28 914 opioid-experienced individuals (18 426 women [63.7%]; mean [SD] age, 64.4 [9.3] years) were included. Receipt of any PT before TKR was associated with lower odds of long-term opioid use in the opioid-naive (adjusted odds ratio [aOR], 0.75 [95% CI, 0.60-0.95]) and opioid-experienced (aOR, 0.75 [95% CI, 0.70-0.80]) cohorts. Receipt of any post-TKR PT was associated with lower odds of long-term use of opioids in the opioid-experienced cohort (aOR, 0.75 [95% CI, 0.70-0.79]). Compared with 1 to 5 sessions of PT after TKR, 6 to 12 sessions (aOR, 0.82 [95% CI, 0.75-0.90]) and 13 or more sessions (aOR, 0.71 [95% CI, 0.65-0.77) were associated with lower odds in the opioid-experienced cohort. Compared with initiation of PT within 30 days after TKR, initiation 31 to 60 days or 61 to 90 days after TKR were associated with greater odds in the opioid-naive (31-60 days: aOR, 1.45 [95% CI, 1.19-1.77]; 61-90 days: aOR, 2.15 [95% CI, 1.43-3.22]) and opioid-experienced (31-60 days: aOR, 1.10 [95% CI, 1.02-1.18]; 61-90 days: aOR, 1.32 [95% CI, 1.12-1.55]) cohorts. Compared with passive PT, active PT was not associated with long-term opioid use in the opioid-naive (aOR, 1.00 [95% CI, 0.81-1.24]) or opioid-experienced (aOR, 0.99 [95% CI, 0.92-1.07]) cohorts. This cohort study suggests that receipt of PT intervention before and after TKR, receipt of 6 or more sessions of PT care after TKR, and initiation of PT care within 30 days after TKR were associated with lower odds of long-term opioid use. These findings suggest that PT may help reduce the risk of long-term opioid use after TKR. This cohort study evaluates associations of physical therapy interventions before and after total knee replacement with long-term use of opioids after total knee replacement among US adults.
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影响因子：
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作者：
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