Jessep Sally A, Walsh Nicola E, Ratcliffe Julie, Hurley Michael V
Physiotherapy Department, Sevenoaks Hospital, West Kent Primary Care Trust, Sevenoaks TN13 3PG, UK.
Physiotherapy. 2009 Jun;95(2):94-102. doi: 10.1016/j.physio.2009.01.005. Epub 2009 Mar 21.
Chronic knee pain is a major cause of disability in the elderly. Management guidelines recommend exercise and self-management interventions as effective treatments. The authors previously described a rehabilitation programme integrating exercise and self-management [Enabling Self-management and Coping with Arthritic knee Pain through Exercise (ESCAPE-knee pain)] that produced short-term improvements in pain and physical function, but sustaining these improvements is difficult. Moreover, the programme is untried in clinical environments, where it would ultimately be delivered.
To establish the feasibility of ESCAPE-knee pain and compare its clinical effectiveness and costs with outpatient physiotherapy.
Pragmatic, randomised controlled trial.
Outpatient physiotherapy department and community centre.
Sixty-four people with chronic knee pain.
Outpatient physiotherapy compared with ESCAPE-knee pain.
The primary outcome was physical function assessed using the Western Ontario and McMaster Universities Osteoarthritis Index. Secondary outcomes included pain, objective functional performance, anxiety, depression, exercise-related health beliefs and healthcare utilisation. All outcomes were assessed at baseline and 12 months after completing the interventions (primary endpoint). ANCOVA investigated between-group differences.
Both groups demonstrated similar improvements in clinical outcomes. Outpatient physiotherapy cost pound 130 per person and the healthcare utilisation costs of participants over 1 year were pound 583. The ESCAPE-knee pain programme cost pound 64 per person and the healthcare utilisation costs of participants over 1 year were pound 320.
ESCAPE-knee pain can be delivered as a community-based integrated rehabilitation programme for people with chronic knee pain. Both ESCAPE-knee pain and outpatient physiotherapy produced sustained physical and psychosocial benefits, but ESCAPE-knee pain cost less and was more cost-effective.
慢性膝关节疼痛是老年人残疾的主要原因。管理指南推荐运动和自我管理干预作为有效的治疗方法。作者之前描述了一项将运动和自我管理相结合的康复计划[通过运动实现自我管理并应对膝关节炎疼痛（ESCAPE-膝关节疼痛）]，该计划在疼痛和身体功能方面产生了短期改善，但维持这些改善很困难。此外，该计划在最终实施的临床环境中尚未进行试验。
确定ESCAPE-膝关节疼痛计划的可行性，并将其临床效果和成本与门诊物理治疗进行比较。
实用的随机对照试验。
门诊物理治疗科和社区中心。
64名慢性膝关节疼痛患者。
门诊物理治疗与ESCAPE-膝关节疼痛计划相比较。
主要结果是使用西安大略和麦克马斯特大学骨关节炎指数评估的身体功能。次要结果包括疼痛、客观功能表现、焦虑、抑郁、与运动相关的健康信念和医疗保健利用情况。所有结果在基线时以及完成干预后12个月（主要终点）进行评估。协方差分析研究组间差异。
两组在临床结果方面都有类似的改善。门诊物理治疗每人花费130英镑，参与者1年的医疗保健利用成本为583英镑。ESCAPE-膝关节疼痛计划每人花费64英镑，参与者1年的医疗保健利用成本为320英镑。
ESCAPE-膝关节疼痛计划可以作为针对慢性膝关节疼痛患者的基于社区的综合康复计划来实施。ESCAPE-膝关节疼痛计划和门诊物理治疗都产生了持续的身体和心理社会益处，但ESCAPE-膝关节疼痛计划成本更低且更具成本效益。
