Bennell Kim L, Rini Christine, Keefe Francis, French Simon, Nelligan Rachel, Kasza Jessica, Forbes Andrew, Dobson Fiona, Abbott J Haxby, Dalwood Andrew, Vicenzino Bill, Harris Anthony, Hinman Rana S
K.L. Bennell, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Alan Gilbert Building, 161 Barry St, Carlton, Victoria 3053, Australia.
C. Rini, PhD, Thurston Arthritis Research Center and Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina at Chapel Hill, Raleigh, North Carolina.
Phys Ther. 2015 Oct;95(10):1408-22. doi: 10.2522/ptj.20150119. Epub 2015 May 28.
Persistent hip pain in older people is usually due to hip osteoarthritis (OA), a major cause of pain, disability, and psychological dysfunction.
The purpose of this study is to evaluate whether adding an Internet-based pain coping skills training (PCST) protocol to a standardized intervention of education followed by physical therapist-instructed home exercise leads to greater reductions in pain and improvements in function.
An assessor-, therapist-, and participant-blinded randomized controlled trial will be conducted.
The study will be conducted in a community setting.
The participants will be 142 people over 50 years of age with self-reported hip pain consistent with hip OA.
Participants will be randomly allocated to: (1) a control group receiving a 24-week standardized intervention comprising an 8-week Internet-based education package followed by 5 individual physical therapy exercise sessions plus home exercises (3 times weekly) or (2) a PCST group receiving an 8-week Internet-based PCST protocol in addition to the control intervention.
Outcomes will be measured at baseline and 8, 24, and 52 weeks, with the primary time point at 24 weeks. Primary outcomes are hip pain on walking and self-reported physical function. Secondary outcomes include health-related quality-of-life, participant-perceived treatment response, self-efficacy for pain management and function, pain coping attempts, pain catastrophizing, and physical activity. Measurements of adherence, adverse events, use of health services, and process measures will be collected at 24 and 52 weeks. Cost-effectiveness will be assessed at 52 weeks.
A self-reported diagnosis of persistent hip pain will be used.
The findings will help determine whether adding an Internet-based PCST protocol to standardized education and physical therapist-instructed home exercise is more effective than education and exercise alone for persistent hip pain. This study has the potential to guide clinical practice toward innovative modes of psychosocial health care provision.
老年人持续性髋部疼痛通常归因于髋骨关节炎（OA），这是疼痛、残疾及心理功能障碍的主要原因。
本研究旨在评估在由物理治疗师指导家庭锻炼的标准化教育干预基础上，增加基于互联网的疼痛应对技能训练（PCST）方案是否能更大程度地减轻疼痛并改善功能。
将开展一项评估者、治疗师和参与者均为盲法的随机对照试验。
研究将在社区环境中进行。
参与者为142名50岁以上自我报告有与髋OA相符的髋部疼痛的人。
参与者将被随机分配到：（1）对照组，接受为期24周的标准化干预，包括为期8周的基于互联网的教育套餐，随后进行5次个体物理治疗锻炼课程加家庭锻炼（每周3次）；或（2）PCST组，除接受对照干预外，还接受为期8周的基于互联网的PCST方案。
在基线、8周、24周和52周进行结果测量，主要时间点为24周。主要结果是行走时的髋部疼痛和自我报告的身体功能。次要结果包括与健康相关的生活质量、参与者感知的治疗反应、疼痛管理和功能的自我效能、疼痛应对尝试、疼痛灾难化以及身体活动。在24周和52周收集依从性、不良事件、卫生服务使用情况及过程指标的测量数据。将在52周评估成本效益。
将采用自我报告的持续性髋部疼痛诊断。
研究结果将有助于确定在标准化教育和物理治疗师指导的家庭锻炼基础上增加基于互联网的PCST方案，对于持续性髋部疼痛是否比单纯的教育和锻炼更有效。本研究有可能为临床实践提供创新的心理社会保健模式指导。
