Fraenkel Liana, Fried Terri
Clinical Epidemiology Research Center, VA CT Healthcare System, West Haven, CT.
Patient. 2008 Jan 1;1(1):21-26. doi: 10.2165/01312067-200801010-00005.
Exercise is an important adjunctive treatment for knee OA; however it is underutilized, in part because of the known difficulties related to initiating and adhering to exercise programs. Although there are ample data documenting the latter, patient preferences for exercise in comparison to other options have not been examined. METHODS: Participants were recruited as part of an intervention trial to improve decision-making in knee OA. Patients with knee pain on most days of the preceding month completed an Adaptive Conjoint Analysis interactive computer survey designed to elicit patient preferences for a cream (capsaicin), oral medications, [acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs)], intra-articular (IA) injections (up to four times per year) and exercise (low impact aerobic exercise and/or strength training three times per week). Preferences were determined based on individual respondent's trade-offs between: route of administration, probability of having less pain, probability of improved strength and endurance, risk of dyspepsia, and risk of ulcer. Preferences were calculated as "shares" which sum to 100. RESULTS: 90 subjects completed the computer tool; mean age ± SD = 68 ± 9 (range = 53-87). Patients preferred exercise over other treatment options whether IA injections and NSAIDs were described as being 20% or 50% more effective at decreasing symptoms compared to other options. The relative importance assigned to treatment benefits and risks were 29% and 41% respectively. Patient demographic characteristics were not related to preferences; however, patients with more self reported knee pain were less likely to prefer exercise compared to their counterparts (r = -0.3, p=0.004). CONCLUSIONS: In this study, patients preferred exercise over pharmacologic options for treatment of knee OA. Preferences were driven by patients' unwillingness to accept the risk of adverse effects. Our findings also suggest that subjects with greater knee pain may be more reluctant to exercise compared to their counterparts. Presentation of exercise in the context of other available therapies might increase patient willingness to try exercising by making the trade-offs between exercise and medications more apparent.
运动是膝骨关节炎的重要辅助治疗方法；然而其应用不足，部分原因是启动和坚持运动计划存在已知困难。尽管有大量数据记录了后者，但与其他选择相比，患者对运动的偏好尚未得到研究。方法：参与者作为一项旨在改善膝骨关节炎决策的干预试验的一部分被招募。在前一个月大多数日子有膝关节疼痛的患者完成了一项适应性联合分析交互式计算机调查，该调查旨在引出患者对一种乳膏（辣椒素）、口服药物[对乙酰氨基酚和非甾体抗炎药（NSAIDs）]、关节内（IA）注射（每年最多4次）和运动（低强度有氧运动和/或每周3次力量训练）的偏好。偏好是根据个体受访者在以下方面的权衡来确定的：给药途径、疼痛减轻的可能性、力量和耐力改善的可能性、消化不良风险和溃疡风险。偏好以“份额”计算，总和为100。结果：90名受试者完成了该计算机工具；平均年龄±标准差=68±9（范围=53 - 87）。无论IA注射和NSAIDs被描述为与其他选择相比在减轻症状方面效果高20%还是50%，患者都更喜欢运动而非其他治疗选择。赋予治疗益处和风险的相对重要性分别为29%和41%。患者的人口统计学特征与偏好无关；然而，与同行相比，自我报告膝关节疼痛更多的患者不太可能更喜欢运动（r = -0.3，p = 0.004）。结论：在本研究中，患者在治疗膝骨关节炎时更喜欢运动而非药物选择。偏好是由患者不愿接受不良反应风险驱动的。我们的研究结果还表明，与同行相比，膝关节疼痛更严重的受试者可能更不愿意运动。在其他可用疗法的背景下呈现运动可能会通过使运动和药物之间的权衡更加明显，从而增加患者尝试运动的意愿。
