与仅接受教育相比，运动、教育、手法治疗和贴扎治疗髌股关节炎的效果：一项双盲随机临床试验

Exercise, education, manual-therapy and taping compared to education for patellofemoral osteoarthritis: a blinded, randomised clinical trial.

作者信息

Crossley K M, Vicenzino B, Lentzos J, Schache A G, Pandy M G, Ozturk H, Hinman R S

机构信息

Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia; Department of Mechanical Engineering, The University of Melbourne, Parkville, Victoria, Australia; School of Allied Health, College of Science, Health and Engineering La Trobe University, Bundoora, Victoria 3086, Australia.

Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.

出版信息

Osteoarthritis Cartilage. 2015 Sep;23(9):1457-64. doi: 10.1016/j.joca.2015.04.024. Epub 2015 May 7.

DOI:10.1016/j.joca.2015.04.024

PMID:25960116

Abstract

OBJECTIVE

Patellofemoral joint osteoarthritis (PFJ OA) contributes considerably to knee OA symptoms. This study aimed to determine the efficacy of a PFJ-targeted exercise, education manual-therapy and taping program compared to OA education alone, in participants with PFJ OA.

METHODS

A randomised, participant-blinded and assessor-blinded clinical trial was conducted in primary-care physiotherapy. 92 people aged ≥40 years with symptomatic and radiographic PFJ OA participated. Physiotherapists delivered the PFJ-targeted exercise, education, manual-therapy and taping program, or the OA-education (control condition) in eight sessions over 12 weeks. Primary outcomes at 3-month (primary) and 9-month follow-up: (1) patient-perceived global rating of change (2) pain visual analogue scale (VAS) (100 mm); and (3) activities of daily living (ADL) subscale of the Knee injury and Osteoarthritis Outcome Score (KOOS).

RESULTS

81 people (88%) completed the 3-month follow-up and data analysed on an intention-to-treat basis. Between-group baseline similarity for participant characteristics was observed. The exercise, education, manual-therapy and taping program resulted in more people reporting much improvement (20/44) than the OA-education group (5/48) (number needed to treat 3 (95% confidence interval (CI) 2 to 5)) and greater pain reduction (mean difference: -15.2 mm, 95% CI -27.0 to -3.4). No significant effects on ADL were observed (5.8; 95% CI -0.6 to 12.1). At 9 months there were no significant effects for self-report of improvement, pain (-10.5 mm, 95% CI -22.7 to 1.8) or ADL (3.0, 95% CI -3.7 to 9.7).

CONCLUSION

Exercise, education, manual-therapy and taping can be recommended to improve short-term patient rating of change and pain severity. However over 9-months, both options were equivalent.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ACTRN12608000288325): https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=82878.

摘要

目的

髌股关节骨关节炎（PFJ OA）在很大程度上导致膝关节骨关节炎症状。本研究旨在确定与单纯骨关节炎教育相比，针对PFJ的运动、教育、手法治疗和贴扎方案对PFJ OA患者的疗效。

方法

在初级保健物理治疗中进行了一项随机、参与者盲法和评估者盲法的临床试验。92名年龄≥40岁、有症状且经影像学检查确诊为PFJ OA的患者参与。物理治疗师在12周内分8次实施针对PFJ的运动、教育、手法治疗和贴扎方案，或骨关节炎教育（对照条件）。3个月（主要）和9个月随访时的主要结局：（1）患者自我感知的总体变化评分；（2）疼痛视觉模拟量表（VAS）（100毫米）；（3）膝关节损伤和骨关节炎结局评分（KOOS）的日常生活活动（ADL）子量表。

结果

81人（88%）完成了3个月随访，并按意向性分析进行数据分析。观察到两组参与者特征的基线相似性。运动、教育、手法治疗和贴扎方案组中报告有很大改善的人数（20/44）多于骨关节炎教育组（5/48）（治疗所需人数为3（95%置信区间（CI）2至5）），且疼痛减轻更明显（平均差异：-15.2毫米，95%CI -27.0至-3.4）。未观察到对ADL有显著影响（5.8；95%CI -0.6至12.1）。在9个月时，自我报告的改善、疼痛（-10.5毫米，95%CI -22.7至1.8）或ADL（3.0，95%CI -3.7至9.7）均无显著影响。