Cleland Joshua A, Abbott J Haxby, Kidd Martin O, Stockwell Steve, Cheney Sheryl, Gerrard David F, Flynn Timothy W
Department of Physical Therapy, Franklin Pierce University, Concord, NH 03301, USA.
J Orthop Sports Phys Ther. 2009 Aug;39(8):573-85. doi: 10.2519/jospt.2009.3036.
Randomized clinical trial.
To compare the effectiveness of 2 different conservative management approaches in the treatment of plantar heel pain.
There is insufficient evidence to establish the optimal physical therapy management strategies for patients with heel pain, and little evidence of long-term effects.
Patients with a primary report of plantar heel pain underwent a standard evaluation and completed a number of patient self-report questionnaires, including the Lower Extremity Functional Scale (LEFS), the Foot and Ankle Ability Measure (FAAM), and the Numeric Pain Rating Scale (NPRS). Patients were randomly assigned to be treated with either an electrophysical agents and exercise (EPAX) or a manual physical therapy and exercise (MTEX) approach. Outcomes of interest were captured at baseline and at 4-week and 6-month follow-ups. The primary aim (effects of treatment on pain and disability) was examined with a mixed-model analysis of variance (ANOVA). The hypothesis of interest was the 2-way interaction (group by time).
Sixty subjects (mean [SD] age, 48.4 [8.7] years) satisfied the eligibility criteria, agreed to participate, and were randomized into the EPAX (n = 30) or MTEX group (n = 30). The overall group-by-time interaction for the ANOVA was statistically significant for the LEFS (P = .002), FAAM (P = .005), and pain (P = .043). Between-group differences favored the MTEX group at both 4-week (difference in LEFS, 13.5; 95% CI: 6.3, 20.8) and 6-month (9.9; 95% CI: 1.2, 18.6) follow-ups.
The results of this study provide evidence that MTEX is a superior management approach over an EPAX approach in the management of individuals with plantar heel pain at both the short- and long-term follow-ups. Future studies should examine the contribution of the different components of the exercise and manual physical therapy programs.
Therapy, level 1b.
随机临床试验。
比较两种不同保守治疗方法在治疗足跟痛方面的有效性。
尚无足够证据确定足跟痛患者的最佳物理治疗管理策略，且关于长期效果的证据很少。
以足跟痛为主要报告症状的患者接受了标准评估，并完成了多项患者自我报告问卷，包括下肢功能量表（LEFS）、足踝能力测量量表（FAAM）和数字疼痛评分量表（NPRS）。患者被随机分配接受电物理治疗加运动（EPAX）或手法物理治疗加运动（MTEX）方法。在基线、4周和6个月随访时记录感兴趣的结果。通过方差混合模型分析（ANOVA）检验主要目标（治疗对疼痛和残疾的影响）。感兴趣的假设是双向交互作用（组×时间）。
60名受试者（平均[标准差]年龄，48.4[8.7]岁）符合纳入标准，同意参与，并被随机分为EPAX组（n = 30）或MTEX组（n = 30）。对于LEFS（P = 0.00）、FAAM（P = 0.005）和疼痛（P = 0.043），ANOVA的总体组×时间交互作用具有统计学意义。在4周（LEFS差异，13.5；95%CI：6.3，20.8）和6个月（9.9；95%CI：1.2，18.6）随访时，组间差异均有利于MTEX组。
本研究结果表明，在短期和长期随访中，MTEX在治疗足跟痛患者方面是比EPAX更优的管理方法。未来的研究应探讨运动和手法物理治疗方案不同组成部分的作用。
治疗，1b级。
