Conrozier T, Marre J P, Payen-Champenois C, Vignon E
Department of Rheumatology, Hôpital Lyon-sud, Pierre-Bénite, France.
Clin Exp Rheumatol. 2008 Sep-Oct;26(5):793-8.
Guidelines for the treatment of lower limb osteoarthritis (LLOA) include non-pharmacological (NPM) and pharmacological modalities (PM). In France, general practitioners (GPs) are the main prescribers of pharmacological treatment for LLOA but little is known about the non-pharmacological modalities they usually prescribe.
To determine how French GPs prescribe non-pharmacological modalities of LLOA treatment in daily practice.
A four-point questionnaire (systematically, frequently, rarely, never) was built to assess the French GPs' opinion regarding the NPM of LLOA treatment (10 questions). The questionnaire was given between April and June 2005 to 3000 GPs, all over the French regions. The percentage reported in this abstract are those of the systematic and frequent responses.
59.2% of the questionnaires (n=1775) could be retrieved. Weight reduction recommendations (76%), joint sparing (71.7%), physical activity development (61.7%), rehabilitation (57.8%), self-exercise (46%) were the more frequently prescribed NPM. Sticks (36%), insoles (35.6%), bed relief (25.4%) and knee bracing (10.5%) were far less regularly proposed. However weight reduction and physical activity development appeared to be the patients less-well observed NPM. The main means used to improve the efficacy of the diet were the support of a nutritionist (74.5%) and the support of the GPs (70.7%) far beyond the support group and familial intervention (both 36,6%). The large majority of GPs considered that a good physical activity was essential (51.7%) or useful (43.3%) to the success of the weight reduction programme. The main recommended physical activities were walking (84.3%), swimming (74.3%), cycling (47%) and water-gymnastics (40.4%). To improve the success of the physical activity development, analgesics were recommended by 93% of GPs, settling up through rehabilitation by 57.4%, support through GPs appointments by 50%. Lastly, 68.4% of GPs recommended a systematic analgesic consumption, since a non-steroidal anti-infammatory drug (NSAID) prescription was proposed by only 30.5%, and NSAID treatment before or after physical activities by 19% and 9.3% respectively.
This large survey shows that non-pharmacological modalities are frequently prescribed by French GPs in the treatment of LLOA, in addition to analgesic therapy. However, most GPs consider that some of them are difficult to follow in the long term.
下肢骨关节炎（LLOA）的治疗指南包括非药物治疗（NPM）和药物治疗（PM）。在法国，全科医生（GPs）是LLOA药物治疗的主要开方者，但对于他们通常开出的非药物治疗方式却知之甚少。
确定法国全科医生在日常实践中如何开出LLOA治疗的非药物治疗方式。
构建了一份四分制问卷（系统地、频繁地、很少地、从不），以评估法国全科医生对LLOA治疗非药物治疗方式的看法（10个问题）。该问卷于2005年4月至6月间发放给法国各地的3000名全科医生。本摘要中报告的百分比是系统和频繁回复的百分比。
可收回59.2%的问卷（n = 1775）。减肥建议（76%）、关节保护（71.7%）、开展体育活动（61.7%）、康复治疗（57.8%）、自我锻炼（46%）是更常开出的非药物治疗方式。拐杖（36%）、鞋垫（35.6%）、卧床缓解（25.4%）和膝关节支具（10.5%）的开出频率则低得多。然而，减肥和开展体育活动似乎是患者较少遵循的非药物治疗方式。用于提高饮食疗效的主要手段是营养师的支持（74.5%）和全科医生的支持（70.7%），远远超过支持小组和家庭干预（均为36.6%）。绝大多数全科医生认为良好的体育活动对减肥计划的成功至关重要（51.7%）或有帮助（43.3%）。主要推荐的体育活动是散步（84.3%）、游泳（74.3%）、骑自行车（47%）和水中体操（40.4%）。为提高体育活动开展的成功率，93%的全科医生推荐使用镇痛药，57.4%建议通过康复治疗来解决，50%建议通过全科医生预约提供支持。最后，68.4%的全科医生建议系统服用镇痛药，因为仅30.5%的医生开出非甾体抗炎药（NSAID）处方，在体育活动前或后使用NSAID治疗的分别为19%和9.3%。
这项大规模调查表明，除了镇痛治疗外，法国全科医生在LLOA治疗中经常开出非药物治疗方式。然而，大多数全科医生认为其中一些方式长期来看难以遵循。
