Dziedzic Krysia, Stevenson Kay, Thomas Elaine, Sim Julius, Hay Elaine
Arthritis Research Campaign National Primary Care Centre, Keele University, UK.
Musculoskeletal Care. 2009 Jun;7(2):67-77. doi: 10.1002/msc.151.
To develop a package of physiotherapy treatment for a randomized controlled trial in primary care for shoulder pain and audit its use within the trial.
A survey of current physiotherapy approaches to the management of shoulder pain was conducted. The most frequently reported treatments were proposed as a package of care for a physiotherapy intervention in a trial of shoulder pain. The package was refined by a subgroup of 13 physiotherapists. For patients receiving the physiotherapy intervention in the main trial (n = 98), the frequency of use of modalities over the treatment period was calculated by percentages of modality usage per number of patient contacts. Treatment details were recorded by the physiotherapist at each patient visit.
The physiotherapy intervention included passive movements/mobilizations, active movement/mobilizations, a home exercise programme, education and advice, and ultrasound. The most frequently used modality at the assessment visit was the standardized education and advice leaflet for shoulder pain (85%) followed by the home exercise programme (79%), which was reinforced throughout the trial treatment course. The most frequently used modalities over the treatment period were ultrasound (42%), active mobilizations (41%) and passive mobilizations (41%). The mean number of trial treatment visits was 6.2 (SD: 2.1; range 1-8). Additional trial treatments (1-8) were delivered to 12 patients. Eighty-five patients were given only one therapeutic diagnosis, and 13 were given two. The most common diagnoses were tendonitis (32%) and capsulitis (25%). Pain was the major problem in 78% of patients, 15% had stiffness and 7% of patients reported both pain and stiffness.
Physiotherapists complied well with the trial protocol. Few treatments were used in isolation. This report demonstrates how physiotherapists can agree and deliver a standardized package of treatment, which reflects current practice, as part of a randomized controlled trial.
制定一套用于基层医疗中肩痛随机对照试验的物理治疗方案，并审核其在试验中的使用情况。
对当前肩痛管理的物理治疗方法进行了一项调查。在一项肩痛试验中，将最常报告的治疗方法作为物理治疗干预的一套护理方案提出。该方案由13名物理治疗师组成的小组进行了完善。对于在主要试验中接受物理治疗干预的患者（n = 98），通过每次患者接触时各治疗方式的使用百分比来计算治疗期间各治疗方式的使用频率。物理治疗师在每次患者就诊时记录治疗细节。
物理治疗干预包括被动运动/松动术、主动运动/松动术、家庭锻炼计划、教育与建议以及超声治疗。评估就诊时最常用的治疗方式是肩痛标准化教育与建议手册（85%），其次是家庭锻炼计划（79%），在整个试验治疗过程中都得到了强化。治疗期间最常用的治疗方式是超声治疗（42%）、主动松动术（41%）和被动松动术（41%）。试验治疗就诊的平均次数为6.2次（标准差：2.1；范围1 - 8次）。12名患者接受了额外的试验治疗（1 - 8次）。85名患者仅得到一种治疗诊断，13名患者得到两种治疗诊断。最常见的诊断是肌腱炎（32%）和关节囊炎（25%）。78%的患者主要问题是疼痛，15%的患者有僵硬症状，7%的患者同时报告有疼痛和僵硬症状。
物理治疗师很好地遵守了试验方案。很少单独使用某种治疗方法。本报告展示了物理治疗师如何达成并实施一套标准化的治疗方案，该方案反映了当前的治疗实践，作为随机对照试验的一部分。
