以患者为中心的物理治疗对类风湿关节炎患者疲劳相关变量的影响：一项随机对照试验。

Effects of Person-Centered Physical Therapy on Fatigue-Related Variables in Persons With Rheumatoid Arthritis: A Randomized Controlled Trial.

作者信息

Feldthusen Caroline, Dean Elizabeth, Forsblad-d'Elia Helena, Mannerkorpi Kaisa

机构信息

Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; The University of Gothenburg Centre for Person-centred Care, Gothenburg, Sweden.

Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.

出版信息

Arch Phys Med Rehabil. 2016 Jan;97(1):26-36. doi: 10.1016/j.apmr.2015.09.022. Epub 2015 Oct 16.

DOI:10.1016/j.apmr.2015.09.022

PMID:26482574

Abstract

OBJECTIVE

To examine effects of person-centered physical therapy on fatigue and related variables in persons with rheumatoid arthritis (RA).

DESIGN

Randomized controlled trial.

SETTING

Hospital outpatient rheumatology clinic.

PARTICIPANTS

Persons with RA aged 20 to 65 years (N=70): intervention group (n=36) and reference group (n=34).

INTERVENTIONS

The 12-week intervention, with 6-month follow-up, focused on partnership between participant and physical therapist and tailored health-enhancing physical activity and balancing life activities. The reference group continued with regular activities; both groups received usual health care.

MAIN OUTCOME MEASURES

Primary outcome was general fatigue (visual analog scale). Secondary outcomes included multidimensional fatigue (Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire) and fatigue-related variables (ie, disease, health, function).

RESULTS

At posttest, general fatigue improved more in the intervention group than the reference group (P=.042). Improvement in median general fatigue reached minimal clinically important differences between and within groups at posttest and follow-up. Improvement was also observed for anxiety (P=.0099), and trends toward improvements were observed for most multidimensional aspects of fatigue (P=.023-.048), leg strength/endurance (P=.024), and physical activity (P=.023). Compared with the reference group at follow-up, the intervention group improvement was observed for leg strength/endurance (P=.001), and the trends toward improvements persisted for physical (P=.041) and living-related (P=.031) aspects of fatigue, physical activity (P=.019), anxiety (P=.015), self-rated health (P=.010), and self-efficacy (P=.046).

CONCLUSIONS

Person-centered physical therapy focused on health-enhancing physical activity and balancing life activities showed significant benefits on fatigue in persons with RA.

摘要

目的

探讨以患者为中心的物理治疗对类风湿关节炎（RA）患者疲劳及相关变量的影响。

设计

随机对照试验。

地点

医院门诊风湿病诊所。

参与者

年龄在20至65岁之间的RA患者（N = 70）：干预组（n = 36）和参照组（n = 34）。

干预措施

为期12周的干预，随访6个月，重点在于参与者与物理治疗师之间的合作关系以及量身定制的促进健康的体育活动和平衡生活活动。参照组继续进行常规活动；两组均接受常规医疗护理。

主要结局指标

主要结局为一般疲劳（视觉模拟量表）。次要结局包括多维疲劳（布里斯托尔类风湿关节炎疲劳多维问卷）和与疲劳相关的变量（即疾病、健康、功能）。

结果

在测试后，干预组的一般疲劳改善程度高于参照组（P = 0.042）。测试后及随访时，一般疲劳中位数的改善在组间和组内均达到最小临床重要差异。焦虑也有所改善（P = 0.0099），并且在疲劳的大多数多维方面（P = 0.023 - 0.048）、腿部力量/耐力（P = 0.024）和体育活动（P = 0.023）方面观察到改善趋势。与随访时的参照组相比，干预组在腿部力量/耐力方面有改善（P = 0.001），并且在疲劳的身体方面（P = 0.041）、生活相关方面（P = 0.031）、体育活动（P = 0.019）、焦虑（P = 0.015）、自评健康（P = 0.010）和自我效能（P = 0.046）方面的改善趋势持续存在。