Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, MA, USA.
Arch Phys Med Rehabil. 2011 Oct;92(10):1542-51. doi: 10.1016/j.apmr.2011.04.023.
To examine the association between physical therapy (PT) amount and type (eg, active exercise and passive modalities) received postmeniscectomy with subsequent days of work disability.
Historical prospective study.
Workers' compensation administrative claims data source.
Patients (N=3888) with a new knee injury filed between January 1, 2001, and December 31, 2003, who underwent meniscectomy within 6 months postinjury.
PT services received within 42 days postmeniscectomy. Patients were divided into 9 groups based on PT service amount and type received during the exposure period (no PT, only low active, only high active, only low passive, only high passive, low active/low passive, high active/low passive, low active/high passive, high active/high passive).
Number of disability days post-exposure period and truncated at the end of the 1.5-year outcome period based on lost-time payments.
During the exposure period, 32.5% received no PT services, 15.3% had only active, 1.5% had only passive, and 50.8% had a combination of both. After controlling for covariates (including severity indicators and physical job demands), receipt of any passive services was associated significantly with a greater number of disability days, and no significant differences were found for those who received only active PT compared with those receiving no PT. Severity indicators, including opioid use pre- and postsurgery, more disability before surgery, and greater surgery severity, were associated with more disability days, whereas physical job demands were not.
Our results suggest that passive PT services provided postmeniscectomy may be counterproductive to work resumption. In addition, disability duration was shorter or no different for those who received no PT services than for those who received any type of PT services. With better control of confounders in future studies, a beneficial effect of active PT might be found. For the development of rehabilitation guidelines, randomized controlled trials are needed to better understand the effectiveness of active and passive PT services postmeniscectomy.
研究膝关节半月板切除术（meniscectomy）后接受的物理治疗（PT）量和类型（如主动运动和被动治疗）与随后的工作日残疾天数之间的关系。
历史前瞻性研究。
工人赔偿行政索赔数据来源。
2001 年 1 月 1 日至 2003 年 12 月 31 日期间新膝关节损伤患者（N=3888），受伤后 6 个月内行膝关节半月板切除术。
半月板切除术后 42 天内接受的 PT 服务。根据暴露期内接受的 PT 服务量和类型，患者分为 9 组（未接受 PT 治疗、仅接受低强度主动治疗、仅接受高强度主动治疗、仅接受低强度被动治疗、仅接受高强度被动治疗、低强度主动/低强度被动治疗、高强度主动/低强度被动治疗、低强度主动/高强度被动治疗、高强度主动/高强度被动治疗）。
暴露期后残疾天数，根据缺勤支付情况，在 1.5 年结果期结束时进行截断。
在暴露期内，32.5%的患者未接受 PT 治疗，15.3%的患者仅接受主动治疗，1.5%的患者仅接受被动治疗，50.8%的患者接受联合治疗。在控制了协变量（包括严重程度指标和体力工作要求）后，接受任何被动治疗与残疾天数的增加显著相关，而与未接受 PT 治疗的患者相比，仅接受主动 PT 治疗的患者没有显著差异。术前使用阿片类药物、术前残疾时间更长、手术严重程度更高等严重程度指标与残疾天数增加有关，而体力工作要求则没有。
我们的结果表明，膝关节半月板切除术后提供的被动 PT 治疗可能不利于恢复工作。此外，与接受任何类型的 PT 治疗的患者相比，未接受 PT 服务的患者的残疾持续时间更短或无差异。在未来的研究中，更好地控制混杂因素，可能会发现主动 PT 的有益效果。为了制定康复指南，需要进行随机对照试验，以更好地了解膝关节半月板切除术后主动和被动 PT 服务的有效性。
