Skou Søren Thorgaard, Odgaard Anders, Rasmussen Jens Ole, Roos Ewa M
Ortopædkirurgisk Forskningsenhed, Aalborg Hospital, Aarhus University Hospital, Research and Innovation Center, Søndre Skovvej 15, Aalborg 9000, Denmark.
Dan Med J. 2012 Dec;59(12):A4554.
Clinical practice does not reflect current clinical guidelines recommending an early multimodal non-surgical treatment for knee and hip osteoarthritis (OA). The purpose of this study was to examine the feasibility of such an initiative (Good Life with osteoArthritis in Denmark (GLA:D) in persons with mild to moderate knee and/or hip OA-related pain.
This was a pilot study with a 36-patient cohort and three-month follow-up. The treatment consisted of two 1.5-hour sessions of patient education and six weeks of individualized supervised neuromuscular exercise according to the previously published NEuroMuscular Exercise programme. The primary outcome was pain on a visual analogue scale (0-100). Secondary outcomes were Euro-Quality-of-Life - 5 Dimensional form (EQ-5D), Arthritis Self-Efficacy Scale (ASES), 30-second chair stand test, timed 20-meter walk and body mass index. Furthermore, compliance was registered.
Thirty-four (94%) participants completed the follow-up. There were significant improvements (p < 0.05) in the primary outcome pain (-16 mm), in time in the 20-meter walk test (-0.7 s), in EQ-5D (0.053), in ASES (7.3) and in the number of complete chair stands (1.4). Compliance was high in relation to both patient education and exercise.
The pilot study demonstrated that the intervention is feasible and that it is possible to implement GLA:D in clinical care. Introducing GLA:D nationwide could improve the adherence to clinical guidelines and the quality of the treatment of knee and hip OA.
临床实践并未遵循当前临床指南中推荐的针对膝关节和髋关节骨关节炎(OA)的早期多模式非手术治疗方法。本研究的目的是检验在轻度至中度膝关节和/或髋关节OA相关疼痛患者中开展此类项目(丹麦骨关节炎美好生活项目(GLA:D))的可行性。
这是一项针对36名患者队列的试点研究,并进行了为期三个月的随访。治疗包括两次各1.5小时的患者教育课程,以及根据先前发表的神经肌肉锻炼计划进行为期六周的个体化监督下的神经肌肉锻炼。主要结局指标是视觉模拟量表(0 - 100)上的疼痛程度。次要结局指标包括欧洲生活质量五维度量表(EQ - 5D)、关节炎自我效能量表(ASES)、30秒椅子站立测试、20米定时步行测试和体重指数。此外,还记录了依从性情况。
34名(94%)参与者完成了随访。主要结局指标疼痛(降低16毫米)、20米步行测试时间(缩短0.7秒)、EQ - 5D(提高0.053)、ASES(提高7.3)以及完整椅子站立次数(增加1.4)均有显著改善(p < 0.05)。患者对患者教育和锻炼的依从性都很高。
该试点研究表明该干预措施是可行的,并且有可能在临床护理中实施GLA:D。在全国范围内引入GLA:D可以提高对临床指南的遵循度以及膝关节和髋关节OA的治疗质量。