Department of Social Sciences, Université Paris Descartes, Paris, France.
BMC Musculoskelet Disord. 2011 Jul 22;12:172. doi: 10.1186/1471-2474-12-172.
The expectations of patients for managing pain induced by exercise and mobilization (PIEM) have seldom been investigated. We identified the views of patients and care providers regarding pain management induced by exercise and mobilization during physical therapy programs.
We performed a qualitative study based on semi-structured interviews with a stratified sample of 12 patients (7 women) and 14 care providers (6 women): 4 general practitioners [GPs], 1 rheumatologist, 1 physical medicine physician, 1 geriatrician, 2 orthopedic surgeons, and 5 physical therapists.
Patients and care providers have differing views on PIEM in the overall management of the state of disease. Patients' descriptions of PIEM were polymorphic, and they experienced it as decreased health-related quality of life. The impact of PIEM was complex, and patient views were sometimes ambivalent, ranging from denial of symptoms to discontinuation of therapy. Care providers agreed that PIEM is generally not integrated in management strategies. Care providers more often emphasized the positive and less often the negative dimensions of PIEM than did patients. However, the consequences of PIEM cited included worsened patient clinical condition, fears about physical therapy, rejection of the physical therapist and refusal of care. PIEM follow-up is not optimal and is characterized by poor transmission of information. Patients expected education on how better to prevent stress and anxiety generated by pain, education on mobilization, and adaptations of physical therapy programs according to pain intensity.
PIEM management could be optimized by alerting care providers to the situation, improving communication among care providers, and providing education to patients and care providers.
患者对运动和活动引起的疼痛管理（PIEM）的期望很少被调查。我们确定了患者和护理提供者对物理治疗计划中运动和活动引起的疼痛管理的看法。
我们进行了一项基于半结构化访谈的定性研究，对 12 名患者（7 名女性）和 14 名护理提供者（6 名女性）进行了分层抽样：4 名全科医生[GP]、1 名风湿病专家、1 名物理医学医师、1 名老年病学家、2 名骨科医生和 5 名物理治疗师。
患者和护理提供者对疾病整体管理中的 PIEM 有不同的看法。患者对 PIEM 的描述多种多样，他们将其体验为健康相关生活质量下降。PIEM 的影响很复杂，患者的观点有时是矛盾的，从否认症状到停止治疗。护理提供者一致认为，PIEM 通常不纳入管理策略。护理提供者比患者更经常强调 PIEM 的积极方面，而较少强调消极方面。然而，PIEM 所提到的后果包括患者临床状况恶化、对物理治疗的恐惧、对物理治疗师的拒绝和拒绝护理。PIEM 的随访不理想，其特点是信息传递不佳。患者希望接受有关如何更好地预防疼痛引起的压力和焦虑、有关活动的教育以及根据疼痛强度调整物理治疗计划的教育。
通过提醒护理提供者注意这种情况、改善护理提供者之间的沟通以及对患者和护理提供者进行教育，可以优化 PIEM 的管理。
