Hurley Michael V, Walsh Nicola E
King's College London, UK.
Curr Opin Rheumatol. 2009 Mar;21(2):171-6. doi: 10.1097/BOR.0b013e3283244422.
Knee osteoarthritis is a common and increasing cause of pain and disability. Exercise and self-management interventions reduce pain and improve function. These interventions are usually delivered separately but, theoretically, the benefits of the physical approach of exercise and the educational approach of self-management interventions could be additive. If correct, rehabilitation programmes that integrate exercise and self-management components might be more effective. This review summarizes and comments on the clinical effectiveness, practicality, cost and implementation of recent studies of integrated rehabilitation programmes.
The programmes varied considerably in content and duration, but in general were safe and effective (improving pain, physical function and other relevant variables). The length, complexity and burden of some programmes limit their acceptability, clinical applicability and increase costs. The most recent programmes have addressed these issues producing programmes that are more clinically and cost-effective than usual care. Implementation of these programmes will require considerable effort and commitment.
Integrated rehabilitation programmes that are acceptable, clinically effective, deliverable and affordable may be the best way of managing the large and increasing number of people suffering chronic knee pain.
膝关节骨关节炎是导致疼痛和残疾的常见且日益增多的原因。运动和自我管理干预可减轻疼痛并改善功能。这些干预通常是分开进行的，但从理论上讲，运动的身体方法和自我管理干预的教育方法的益处可能是相加的。如果正确，将运动和自我管理成分整合在一起的康复计划可能会更有效。本综述总结并评论了近期综合康复计划研究的临床有效性、实用性、成本和实施情况。
这些计划在内容和持续时间上差异很大，但总体上是安全有效的（改善疼痛、身体功能和其他相关变量）。一些计划的时长、复杂性和负担限制了它们的可接受性、临床适用性并增加了成本。最新的计划已经解决了这些问题，产生了比常规护理更具临床和成本效益的计划。实施这些计划将需要相当大的努力和投入。
可接受、临床有效、可实施且负担得起的综合康复计划可能是管理大量且不断增加的慢性膝关节疼痛患者的最佳方式。
