van Tunen Joyce A C, van der Leeden Marike, Bos Wouter H, Cheung John, van der Esch Martin, Gerritsen Martijn, Peter Wilfred F, Roorda Leo D, Tijhuis Gerard J, Voorneman Ramon E, Lems Willem F, Dekker Joost
Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands.
Amsterdam Rehabilitation Research Center, Reade, and VU University Medical Center, EMGO Institute, Amsterdam, The Netherlands.
Arthritis Care Res (Hoboken). 2016 Mar;68(3):332-40. doi: 10.1002/acr.22682.
Severe pain in patients with knee osteoarthritis (OA) hampers the ability to exercise. A protocol for the standardized optimization of analgesics in combination with exercise therapy was developed. The purpose of this protocol was to reduce pain, thereby allowing the patient to participate in exercise therapy. The objective of the present study was to evaluate the feasibility and outcome of the protocol.
Forty-nine patients with knee OA and severe knee pain (numerical rating scale for pain ≥7) were included. Analgesics were prescribed following an incremental protocol. After 6 weeks, a 12-week exercise therapy program was added. Information about analgesic use and exercise therapy content was recorded. Knee pain and activity limitations were assessed at baseline, after 6 weeks, and after 18 weeks.
Statistically significant improvements in pain and activity limitations were found in intent-to-treat analysis after 6 weeks of analgesic use and after the intervention was completed. Mean improvements from baseline were 30% (P < 0.001) for pain and 17% (P < 0.001) for activity limitations after the intervention was completed. Seventy-eight percent of the patients were able to exercise according to the protocol. In these patients, exercise therapy following 6 weeks of analgesic use resulted in a further improvement of activity limitations of 10% (P = 0.004).
The combined intervention of standardized analgesic prescription and exercise therapy allows most patients with knee OA and severe pain to participate in exercise therapy, leading to reduction of pain and activity limitations. These promising results need to be confirmed in a randomized controlled trial.
膝关节骨关节炎（OA）患者的剧痛会妨碍其运动能力。制定了一项镇痛药与运动疗法标准化优化方案。该方案的目的是减轻疼痛，从而使患者能够参与运动疗法。本研究的目的是评估该方案的可行性和效果。
纳入49例膝关节OA且膝关节剧痛（疼痛数字评定量表≥7）的患者。按照递增方案开具镇痛药。6周后，增加一个为期12周的运动疗法项目。记录镇痛药使用情况和运动疗法内容的信息。在基线、6周后和18周后评估膝关节疼痛和活动受限情况。
在镇痛药使用6周后以及干预完成后的意向性分析中，疼痛和活动受限情况有统计学意义的改善。干预完成后，与基线相比，疼痛平均改善30%（P<0.001），活动受限平均改善17%（P<0.001）。78%的患者能够按照方案进行运动。在这些患者中，使用镇痛药6周后进行运动疗法使活动受限情况进一步改善了10%（P = 0.004）。
标准化镇痛药处方与运动疗法的联合干预使大多数膝关节OA且剧痛的患者能够参与运动疗法，从而减轻疼痛和活动受限情况。这些有前景的结果需要在随机对照试验中得到证实。
