Hunt Michael A, Keefe Francis J, Bryant Christina, Metcalf Ben R, Ahamed Yasmin, Nicholas Michael K, Bennell Kim L
Department of Physical Therapy, University of British Columbia, Vancouver, Canada.
Knee. 2013 Mar;20(2):106-12. doi: 10.1016/j.knee.2012.07.008. Epub 2012 Aug 24.
Osteoarthritis (OA) of the knee is associated with a number of physical and psychological impairments. Unfortunately, very few treatment strategies are capable of addressing both types of impairments concurrently. We performed a pilot, randomized controlled, proof of principle trial investigating the feasibility and effects of an intervention combining physical exercise and pain coping skills training (PCST).
Twenty patients with a clinical and radiographical diagnosis of tibiofemoral OA were randomized to receive either 10 weeks of physiotherapist supervised exercises (lower limb strengthening and walking) combined with non-directive counseling (NDC) or the same exercise program delivered concurrently with PCST. Primary outcomes included self-reported pain and pain coping, while secondary outcomes included self efficacy and self-reported physical function.
Ten participants were randomized to each group and both groups exhibited significant improvements in isometric knee strength, self-reported knee pain and physical function, self efficacy for control of pain management and other arthritis symptoms. Only those in the exercise + PCST group reported statistically significant improvements in pain control coping and rational thinking. No between-group differences existed in any outcome (0.07 < p < 0.98). Based on our findings, 63 participants per group would be needed for future large-scale studies using similar outcome measures and design.
Our study showed that an intervention that combines exercise and PCST within the same treatment session and delivered by specially-trained physiotherapists is feasible and can improve both physical and psychological outcomes in individuals with knee OA.
Level II Clinical Trials Registry number: ACTRN12609000623291.
膝关节骨关节炎（OA）与多种身体和心理损伤相关。不幸的是，很少有治疗策略能够同时解决这两种损伤问题。我们进行了一项先导性、随机对照、原理验证试验，以研究将体育锻炼与疼痛应对技能训练（PCST）相结合的干预措施的可行性和效果。
20例经临床和影像学诊断为胫股关节OA的患者被随机分为两组，一组接受为期10周的由物理治疗师指导的锻炼（下肢强化训练和步行）并结合非指导性咨询（NDC），另一组接受相同的锻炼计划并同时进行PCST。主要结局指标包括自我报告的疼痛和疼痛应对情况，次要结局指标包括自我效能感和自我报告的身体功能。
每组各有10名参与者，两组在等长膝关节力量、自我报告的膝关节疼痛和身体功能、控制疼痛管理及其他关节炎症状的自我效能感方面均有显著改善。只有锻炼+PCST组在疼痛控制应对和理性思维方面有统计学意义的显著改善。在任何结局指标上两组之间均无差异（0.07 < p < 0.98）。根据我们的研究结果，未来使用类似结局指标和设计的大规模研究每组将需要63名参与者。
我们的研究表明，在同一治疗疗程中由经过专门培训的物理治疗师实施的将锻炼与PCST相结合的干预措施是可行的，并且可以改善膝关节OA患者的身体和心理结局。
II级临床试验注册号：ACTRN12609000623291。
