Bennell K L, Hinman R S, Metcalf B R, Buchbinder R, McConnell J, McColl G, Green S, Crossley K M
Centre for Health, Exercise and Sports Medicine, School of Physiotherapy, University of Melbourne, Parkville, Victoria 3010, Australia.
Ann Rheum Dis. 2005 Jun;64(6):906-12. doi: 10.1136/ard.2004.026526.
OBJECTIVE: To determine whether a multimodal physiotherapy programme including taping, exercises, and massage is effective for knee osteoarthritis, and if benefits can be maintained with self management. METHODS: Randomised, double blind, placebo controlled trial; 140 community volunteers with knee osteoarthritis participated and 119 completed the trial. Physiotherapy and placebo interventions were applied by 10 physiotherapists in private practices for 12 weeks. Physiotherapy included exercise, massage, taping, and mobilisation, followed by 12 weeks of self management. Placebo was sham ultrasound and light application of a non-therapeutic gel, followed by no treatment. Primary outcomes were pain measured by visual analogue scale and patient global change. Secondary measures included WOMAC, knee pain scale, SF-36, assessment of quality of life index, quadriceps strength, and balance test. RESULTS: Using an intention to treat analysis, physiotherapy and placebo groups showed similar pain reductions at 12 weeks: -2.2 cm (95% CI, -2.6 to -1.7) and -2.0 cm (-2.5 to -1.5), respectively. At 24 weeks, pain remained reduced from baseline in both groups: -2.1 (-2.6 to -1.6) and -1.6 (-2.2 to -1.0), respectively. Global improvement was reported by 70% of physiotherapy participants (51/73) at 12 weeks and by 59% (43/73) at 24 weeks. Similarly, global improvement was reported by 72% of placebo participants (48/67) at 12 weeks and by 49% (33/67) at 24 weeks (all p>0.05). CONCLUSIONS: The physiotherapy programme tested in this trial was no more effective than regular contact with a therapist at reducing pain and disability.
目的:确定包括贴扎、运动和按摩在内的多模式物理治疗方案对膝骨关节炎是否有效,以及自我管理能否维持其益处。 方法:随机、双盲、安慰剂对照试验;140名患有膝骨关节炎的社区志愿者参与试验,119人完成试验。10名私人执业物理治疗师进行为期12周的物理治疗和安慰剂干预。物理治疗包括运动、按摩、贴扎和松动术,之后是12周的自我管理。安慰剂为假超声和涂抹无治疗作用的凝胶,之后不进行任何治疗。主要结局指标为用视觉模拟量表测量的疼痛和患者整体变化。次要测量指标包括西安大略和麦克马斯特大学骨关节炎指数(WOMAC)、膝关节疼痛量表、SF-36生活质量指数评估、股四头肌力量和平衡测试。 结果:采用意向性分析,物理治疗组和安慰剂组在12周时疼痛减轻程度相似:分别为-2.2厘米(95%可信区间,-2.6至-1.7)和-2.0厘米(-2.5至-1.5)。在24周时,两组疼痛仍较基线有所减轻:分别为-2.1(-2.6至-1.6)和-1.6(-2.2至-1.0)。12周时,70%的物理治疗参与者(51/73)报告整体改善,24周时为59%(43/73)。同样,12周时,72%的安慰剂参与者(48/67)报告整体改善,24周时为49%(33/67)(所有p>0.05)。 结论:本试验中测试的物理治疗方案在减轻疼痛和残疾方面并不比定期与治疗师接触更有效。
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