McClinton Shane M, Cleland Joshua A, Flynn Timothy W
Physical Therapy Department, Des Moines University, Des Moines, IA, USA Orthopaedic and Sports Science Program, Rocky Mountain University of Health Professions, Provo, UT, USA
Physical Therapy Department, Franklin Pierce University, Manchester, NH, USA.
Foot Ankle Int. 2015 Apr;36(4):408-16. doi: 10.1177/1071100714558508. Epub 2014 Nov 3.
Age, weight, and duration of symptoms have been associated with a poor response to treatment for plantar heel pain (PHP), but no studies were identified that examined predictors of response to physical therapy intervention. The purpose of this investigation was to examine the influence of age, body mass index (BMI), and symptom duration on treatment response to physical therapy intervention.
Sixty participants received 6 visits over 4 weeks of physical therapy intervention that included manual therapy and exercise or electrophysiological agents and exercise. Outcomes were assessed using the Foot and Ankle Ability Measure (FAAM), Numeric Pain Rating Scale (NPRS), and Global Rating of Change Scale (GRC). Logistic regression (P < .05) was used to analyze age, BMI, and symptom duration as potential predictors of a successful response based on the minimal clinically important difference of the outcome measures. Sensitivity analysis was used to assess the influence of success based on minimal clinically important changes in the FAAM, NPRS, and GRC or only the FAAM and NPRS. Receiver operating curves were used to determine the cut point for the significant predictor.
At the 6-month follow-up to physical therapy intervention, NPRS was improved by 3 points (95% CI, 2.4-3.6) and FAAM improved by 22.5 points (95% CI, 16.8-28.2). Individuals with symptoms less than 7.2 months were 4.2 (95% CI, 1.3-13.8; P = .016) and 8.5 (95% CI, 2.5-28.9; P = .001) times more likely to respond to treatment based on the NPRS/FAAM/GRC and NPRS/FAAM success criteria, respectively. Age and BMI were not significant predictors (P ≥ .455 and P ≥ .450, respectively).
Age and BMI were not associated with outcomes and obese individuals did achieve a successful outcome with the physical therapy intervention used in the clinical trial. Individuals with PHP symptoms longer than 7 months require additional consideration and further investigation of effective strategies to improve treatment response.
Prognosis, level 2b comparative study.
年龄、体重和症状持续时间与足底足跟痛（PHP）的治疗反应不佳有关，但未发现有研究探讨物理治疗干预反应的预测因素。本研究的目的是探讨年龄、体重指数（BMI）和症状持续时间对物理治疗干预治疗反应的影响。
60名参与者在4周的物理治疗干预期间接受6次治疗，治疗包括手法治疗和运动或电生理治疗及运动。使用足踝能力测量量表（FAAM）、数字疼痛评分量表（NPRS）和总体变化评定量表（GRC）评估结果。基于结局指标的最小临床重要差异，采用逻辑回归（P <.05）分析年龄、BMI和症状持续时间作为成功反应的潜在预测因素。敏感性分析用于评估基于FAAM、NPRS和GRC或仅FAAM和NPRS的最小临床重要变化的成功影响。使用受试者工作特征曲线确定显著预测因素的切点。
在物理治疗干预6个月的随访中，NPRS改善了3分（95%CI，2.4 - 3.6），FAAM改善了22.5分（95%CI，16.8 - 28.2）。根据NPRS/FAAM/GRC和NPRS/FAAM成功标准，症状持续时间少于7.2个月的个体对治疗有反应的可能性分别高出4.2倍（95%CI，1.3 - 13.8；P =.016）和8.5倍（95%CI，2.5 - 28.9；P =.001）。年龄和BMI不是显著的预测因素（分别为P≥.455和P≥.450）。
年龄和BMI与结局无关，肥胖个体在临床试验中使用的物理治疗干预下确实取得了成功的结果。PHP症状持续时间超过7个月的个体需要额外考虑，并进一步研究改善治疗反应的有效策略。
预后，2b级比较研究。
