运动和手法物理疗法关节炎研究试验 (EMPART) 治疗髋关节骨关节炎：一项多中心随机对照试验。

Exercise and manual physiotherapy arthritis research trial (EMPART) for osteoarthritis of the hip: a multicenter randomized controlled trial.

机构信息

School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.

出版信息

Arch Phys Med Rehabil. 2013 Feb;94(2):302-14. doi: 10.1016/j.apmr.2012.09.030. Epub 2012 Oct 16.

DOI:10.1016/j.apmr.2012.09.030

Abstract

OBJECTIVES: To determine the effectiveness of exercise therapy (ET) compared with ET with adjunctive manual therapy (MT) for people with hip osteoarthritis (OA); and to identify if immediate commencement of treatment (ET or ET+MT) was more beneficial than a 9-week waiting period for either intervention. DESIGN: Assessor-blind randomized controlled trial with a 9-week and 18-week follow-up. SETTING: Four academic teaching hospitals in Dublin, Ireland. PARTICIPANTS: Patients (N=131) with hip OA recruited from general practitioners, rheumatologists, orthopedic surgeons, and other hospital consultants were randomized to 1 of 3 groups: ET (n=45), ET+MT (n=43), and waitlist controls (n=43). INTERVENTIONS: Participants in both the ET and ET+MT groups received up to 8 treatments over 8 weeks. Control group participants were rerandomized into either ET or ET+MT groups after 9 week follow-up. Their data were pooled with original treatment group data: ET (n=66) and ET+MT (n=65). MAIN OUTCOME MEASURES: The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function (PF) subscale. Secondary outcomes included physical performance, pain severity, hip range of motion (ROM), anxiety/depression, quality of life, medication usage, patient-perceived change, and patient satisfaction. RESULTS: There was no significant difference in WOMAC PF between the ET (n=66) and ET+MT (n=65) groups at 9 weeks (mean difference, .09; 95% confidence interval [CI] -2.93 to 3.11) or 18 weeks (mean difference, .42; 95% CI, -4.41 to 5.25), or between other outcomes, except patient satisfaction with outcomes, which was higher in the ET+MT group (P=.02). Improvements in WOMAC, hip ROM, and patient-perceived change occurred in both treatment groups compared with the control group. CONCLUSIONS: Self-reported function, hip ROM, and patient-perceived improvement occurred after an 8-week program of ET for patients with OA of the hip. MT as an adjunct to exercise provided no further benefit, except for higher patient satisfaction with outcome.

摘要

目的：比较运动疗法（ET）与运动疗法加辅助手法治疗（MT）治疗髋骨关节炎（OA）患者的疗效；并确定即刻开始治疗（ET 或 ET+MT）是否比两种干预措施的 9 周等待期更有益。

设计：评估者盲法随机对照试验，随访 9 周和 18 周。

地点：爱尔兰都柏林的 4 所学术教学医院。

参与者：招募自全科医生、风湿病学家、骨科医生和其他医院顾问的髋 OA 患者（N=131）被随机分为 3 组之一：ET（n=45）、ET+MT（n=43）和等待对照（n=43）。

干预措施：ET 和 ET+MT 组的参与者在 8 周内接受多达 8 次治疗。对照组参与者在 9 周随访后重新随机分为 ET 或 ET+MT 组。他们的数据与原始治疗组数据（ET，n=66；ET+MT，n=65）合并。

主要结局测量：主要结局是西安大略和麦克马斯特大学骨关节炎指数（WOMAC）躯体功能（PF）子量表。次要结局包括身体表现、疼痛严重程度、髋关节活动范围（ROM）、焦虑/抑郁、生活质量、药物使用、患者感知变化和患者满意度。

结果：在 9 周（平均差异，0.09；95%置信区间[CI]，-2.93 至 3.11）或 18 周（平均差异，0.42；95%CI，-4.41 至 5.25）时，ET（n=66）和 ET+MT（n=65）组之间的 WOMAC PF 无显著差异，除了患者对治疗结果的满意度，ET+MT 组更高（P=.02）。与对照组相比，两组治疗组的 WOMAC、髋关节 ROM 和患者感知改善均有所改善。

结论：对于髋骨 OA 患者，8 周的运动疗法方案后可出现自我报告的功能、髋关节 ROM 和患者感知的改善。作为运动疗法的辅助治疗，MT 除了提高患者对治疗结果的满意度外，并无进一步的益处。