Delayed timing of physical therapy initiation increases the risk of future opioid use in individuals with knee osteoarthritis: a real-world cohort study.
Delayed timing of physical therapy initiation increases the risk of future opioid use in individuals with knee osteoarthritis: a real-world cohort study.
复制标题
物理治疗开始时间的延迟会增加膝骨关节炎患者未来使用阿片类药物的风险：一项现实世界的队列研究。
DOI：
10.1136/bjsports-2022-106044
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发表时间：
2023
影响因子：
18.4
通讯作者：
Dubreuil,Maureen
中科院分区：
文献类型：
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作者：
Kumar,Deepak;Neogi,Tuhina;Peloquin,Christine;Marinko,Lee;Camarinos,James;Aoyagi,Kosaku;Felson,DavidT;Dubreuil,Maureen
我们评估了物理治疗（PT）的晚期与早期启动是否与接受PT的膝关节骨关节炎（OA）患者未来使用阿片类药物的风险更大有关。方法我们使用了1999年至2018年的商业和医疗保险优势索赔数据，这些数据来自美国成年人，在诊断后1年内发生膝关节OA。我们根据先前的处方将人们分类为阿片类药物初治者或阿片类药物使用者。我们研究了PT启动的时间与任何和慢性阿片类药物使用超过1 year.ResultsOf的67 245个人与事件膝关节OA，35 899阿片类药物初治和31 346阿片类药物的经验。在阿片类药物初治组中，与1个月内PT相比，诊断后PT 1至<3、3至<6、6至<9、9 - 12个月与校正风险比相关任何阿片类药物使用的（aRR（95% CI））1.18（1.10至1.28）、1.49（1.37至1.61）、1.73（1.58至1.89）和1.93（1.76~2.12）;长期阿片类药物使用的aRR（95% CI）分别为1.25（1.01 - 1.54）、1.83（1.48 - 2.26）、2.29（1.82 - 2.89）和2.50（1.96 - 3.19）。使用阿片类药物的结果相似;任何阿片类药物使用的aRR（95% CI）为1.19（1.14至1.24）、1.32（1.26至1.37），1.39（1.32至1.45）和1.54（1.46至1.61）;慢性阿片类药物使用的aRR（95% CI）为1.25（1.17至1.34）、1.43（1.33至1.54），1.53（1.41至1.66）和1.65（1.51~1.80）。结论与1个月内开始PT治疗相比，延迟PT治疗与膝关节OA患者使用阿片类药物的风险增加相关。PT启动延迟时间越长，风险越大。
ObjectiveWe assessed whether late versus early initiation of physical therapy (PT) was related to greater risk of future opioid use in people with knee osteoarthritis (OA) who receive PT.MethodsWe used Commercial and Medicare Advantage claims data from 1999 to 2018 from American adults with incident knee OA referred for PT within 1 year of diagnosis. We categorised people as opioid naïve or opioid experienced based on prior prescriptions. We examined the association of timing of PT initiation with any and chronic opioid use over 1 year.ResultsOf the 67 245 individuals with incident knee OA, 35 899 were opioid naïve and 31 346 were opioid experienced. In the opioid naïve group, compared with PT within 1 month, PT 1 to <3, 3 to <6, 6 to <9, 9–12 months from diagnosis was associated with adjusted risk ratio (aRR (95% CIs)) for any opioid use of 1.18 (1.10 to 1.28), 1.49 (1.37 to 1.61), 1.73 (1.58 to 1.89) and 1.93 (1.76 to 2.12), respectively; aRRs (95% CIs) for chronic opioid use were 1.25 (1.01 to 1.54), 1.83 (1.48 to 2.26), 2.29 (1.82 to 2.89) and 2.50 (1.96 to 3.19). Results were similar among opioid experienced; aRRs (95% CIs) for any opioid use were 1.19 (1.14 to 1.24), 1.32 (1.26 to 1.37), 1.39 (1.32 to 1.45) and 1.54 (1.46 to 1.61); aRRs (95% CIs) for chronic opioid use were 1.25 (1.17 to1.34), 1.43 (1.33 to 1.54), 1.53 (1.41 to 1.66) and 1.65 (1.51 to 1.80).ConclusionCompared with PT initiation within 1 month, delayed PT initiation was associated with higher risk of opioid use in people with incident knee OA. The longer the delay in PT initiation, the greater was the risk.