Hurkmans E J, Li L, Verhoef J, Vliet Vlieland T P M
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Musculoskeletal Care. 2012 Sep;10(3):142-8. doi: 10.1002/msc.1011. Epub 2012 Apr 11.
For tailored implementation of evidence-based recommendations and guidelines on physical therapy in patients with rheumatoid arthritis (RA), insight into current physical therapy practice is needed.
Two hundred and fifty general physical therapists and 211 specialized physical therapists with advanced arthritis training were sent a questionnaire to assess the frequency with which they applied a set of assessments (n = 10) and interventions (n = 7) included in a Dutch physical therapy guideline for RA. Differences between general and specialist physical therapists were analysed using Student's t-tests or chi-square tests where appropriate.
In total, 233 physical therapists (51%) responded. Of these, 96 (41%) had completed an additional arthritis course and were designated as specialist physical therapists. Among the physical therapists who returned the questionnaire, 69% (or more) reported that they 'always' assessed limitations in daily functioning, pain, morning stiffness, muscle strength, joint range of motion, joint stability, gait and limitations in leisure activities as part of their initial assessment, and 37% and 48% reported 'always' to assess aerobic capacity and limitations in work situations, respectively. Concerning interventions, exercise therapy and education were 'always' applied by 70% and 68% of the responders, respectively. Only a minority of responders reported 'always' applying ultrasound, electrical stimulation, heat therapy, massage and passive mobilizations (0%, 0%, 5%, 5% and 14%, respectively). Apart from aerobic capacity and work limitations, all other assessments were reported as 'always' applied by significantly (p < 0.05) more specialist physical therapists than general physical therapists. Regarding interventions, significantly more specialist physical therapists reported that they 'always' applied exercise therapy and education. Significantly fewer specialist physical therapists than in the general group reported 'always' using heat therapy, massage and mobilizations (p < 0.05).
The majority of physical therapists reported that they 'always' applied most of the assessments and interventions recommended in a Dutch physical therapy guideline for the management of RA. Areas for improvement include the assessment of aerobic capacity and work limitations. The observed differences between specialist and general physical therapists support the added value of advanced arthritis courses.
为了针对性地实施类风湿关节炎（RA）患者物理治疗的循证建议和指南，需要深入了解当前的物理治疗实践情况。
向250名普通物理治疗师和211名接受过关节炎高级培训的专科物理治疗师发放问卷，以评估他们应用荷兰RA物理治疗指南中一系列评估（n = 10）和干预措施（n = 7）的频率。在适当情况下，使用学生t检验或卡方检验分析普通物理治疗师和专科物理治疗师之间的差异。
共有233名物理治疗师（51%）回复了问卷。其中，96名（41%）完成了额外的关节炎课程并被指定为专科物理治疗师。在回复问卷的物理治疗师中，69%（或更多）报告称，作为初始评估的一部分，他们“总是”评估日常功能受限、疼痛、晨僵、肌肉力量、关节活动范围、关节稳定性、步态以及休闲活动受限情况，分别有37%和48%的人报告“总是”评估有氧运动能力和工作受限情况。关于干预措施，分别有70%和68%的回复者“总是”应用运动疗法和教育。只有少数回复者报告“总是”应用超声波、电刺激、热疗、按摩和被动活动（分别为0%、0%、5%、5%和14%）。除有氧运动能力和工作受限情况外，专科物理治疗师报告“总是”应用所有其他评估的比例显著高于普通物理治疗师（p < 0.05）。关于干预措施，显著更多的专科物理治疗师报告他们“总是”应用运动疗法和教育。与普通组相比，报告“总是”使用热疗、按摩和活动的专科物理治疗师显著更少（p < 0.05）。
大多数物理治疗师报告称，他们“总是”应用荷兰RA物理治疗管理指南中推荐的大多数评估和干预措施。需要改进的方面包括有氧运动能力和工作受限情况的评估。专科物理治疗师和普通物理治疗师之间观察到的差异支持了关节炎高级课程的附加价值。
