一项针对儿童过度活动症管理的一般性与靶向性物理治疗的随机对照试验。
A randomized comparative trial of generalized vs targeted physiotherapy in the management of childhood hypermobility.
机构信息
Department of Paediatric Rheumatology, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK.
出版信息
Rheumatology (Oxford). 2010 Feb;49(2):315-25. doi: 10.1093/rheumatology/kep362. Epub 2009 Nov 30.
OBJECTIVE
Joint hypermobility, common in childhood, can be associated with severe pain and significant morbidity. Physiotherapy, the mainstay of treatment, lacks a robust evidence base. This study is aimed at determining the best physiotherapy intervention in managing childhood hypermobility.
METHODS
A prospective randomized comparative trial (RCT) compared a 6-week generalized programme, improving muscular strength and fitness, with a targeted programme aimed at correcting motion control of symptomatic joints. Patients were assessed on symptom scores (pain/global-impact), function, muscle strength and fitness.
RESULTS
Fifty-seven children, aged 7-16 years with symptomatic hypermobility, were randomly assign to receive a targeted (T; n = 30) or generalized (G; n = 27) programme. Statistically significant improvements were demonstrated in both the children's and parental pain scores across both the randomized groups between baseline and follow-up assessments (P < 0.05). However, the difference in improvement between the groups was not statistically significant. Child's assessment of change in pain score: mean difference (95% CI) T - G, 3.97 (-15.59, 20.85) at the end of treatment and 9.41 at 3-month follow-up (-17.42, 36.24). At the end of treatment, parental assessment of change in pain score, T - G was: -0.27 (-15.05, 14.50) and at 3-month follow-up it was: -9.48 (-26.40, 7.43). Change in parental global assessment was statistically significant, in favour of targeted physiotherapy at final assessment: -21.29 (-40.03, -2.55).
CONCLUSION
This is the first physiotherapy RCT for treating hypermobility. It demonstrated significant and sustained reduction in pain when both groups were combined, but did not detect any difference between the groups. This study provides normative and methodological data for future studies of hypermobility.
TRIAL REGISTRATION
Current Controlled Trials, www.controlled-trials.com, ISRCTN58523390.
目的
关节过度活动在儿童中很常见，可导致严重疼痛和显著的发病率。物理疗法是主要的治疗方法，但缺乏强有力的证据基础。本研究旨在确定治疗儿童过度活动的最佳物理疗法干预措施。
方法
一项前瞻性随机对照试验（RCT）比较了为期 6 周的全身性方案，该方案旨在增强肌肉力量和健身，以及针对有症状关节运动控制的靶向方案。患者根据症状评分（疼痛/总体影响）、功能、肌肉力量和健身情况进行评估。
结果
57 名年龄在 7-16 岁、有症状性过度活动的儿童被随机分为接受靶向（T；n=30）或全身性（G；n=27）方案。在基线和随访评估中，两组儿童和父母的疼痛评分均有显著改善（均 P<0.05）。然而，两组之间的改善差异无统计学意义。儿童对疼痛评分变化的评估：治疗结束时 T-G 的平均差异（95%CI）为 3.97（-15.59，20.85），3 个月随访时为 9.41（-17.42，36.24）。治疗结束时，父母对疼痛评分变化的评估，T-G 为：-0.27（-15.05，14.50），3 个月随访时为：-9.48（-26.40，7.43）。父母对总体评估的改变具有统计学意义，靶向物理治疗在最终评估中更有利：-21.29（-40.03，-2.55）。
结论
这是第一项针对过度活动症的物理治疗 RCT。它表明，当两组联合治疗时，疼痛显著且持续减轻，但两组之间没有发现差异。本研究为未来的过度活动症研究提供了规范和方法学数据。
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