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运动疗法和患者教育对髋骨关节炎患者功能障碍及活动受限的长期影响:一项随机临床试验的次要结局分析

Long-Term Effect of Exercise Therapy and Patient Education on Impairments and Activity Limitations in People With Hip Osteoarthritis: Secondary Outcome Analysis of a Randomized Clinical Trial.

作者信息

Svege Ida, Fernandes Linda, Nordsletten Lars, Holm Inger, Risberg May Arna

机构信息

I. Svege, PT, PhD, Norwegian Research Center for Active Rehabilitation, Department of Orthopaedics, Oslo University Hospital, Kirkeveien 166, 0450 Oslo, Norway.

L. Fernandes, PT, PhD, Norwegian Research Center for Active Rehabilitation, Department of Orthopaedics, Oslo University Hospital, and Department of Orthopaedic Surgery and Traumatology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.

出版信息

Phys Ther. 2016 Jun;96(6):818-27. doi: 10.2522/ptj.20140520. Epub 2015 Dec 17.

Abstract

BACKGROUND

The effect of exercise on specific impairments and activity limitations in people with hip osteoarthritis (OA) is limited.

OBJECTIVE

The study objective was to evaluate the long-term effect of exercise therapy and patient education on range of motion (ROM), muscle strength, physical fitness, walking capacity, and pain during walking in people with hip OA.

DESIGN

This was a secondary outcome analysis of a randomized clinical trial.

SETTING

The setting was a university hospital.

PARTICIPANTS

One hundred nine people with clinically and radiographically evident hip OA were randomly allocated to receive both exercise therapy and patient education (exercise group) or patient education only (control group).

INTERVENTION

All participants attended a patient education program consisting of 3 group meetings led by 2 physical therapists. Two other physical therapists were responsible for providing the exercise therapy program, consisting of 2 or 3 weekly sessions of strengthening, functional, and stretching exercises over 12 weeks. Both interventions were conducted at a sports medicine clinic.

MEASUREMENTS

Outcome measures included ROM, isokinetic muscle strength, predicted maximal oxygen consumption determined with the Astrand bicycle ergometer test, and distance and pain during the Six-Minute Walk Test (6MWT). Follow-up assessments were conducted 4, 10, and 29 months after enrollment by 5 physical therapists who were unaware of group allocations.

RESULTS

No significant group differences were found for ROM, muscle strength, predicted maximal oxygen consumption, or distance during the 6MWT over the follow-up period, but the exercise group had less pain during the 6MWT than the control group at 10 months (mean difference=-8.5 mm; 95% confidence interval=-16.1, -0.9) and 29 months (mean difference=-9.3 mm; 95% confidence interval=-18.1, -0.6).

LIMITATIONS

Limitations of the study were reduced statistical power and 53% rate of adherence to the exercise therapy program.

CONCLUSIONS

The previously described effect of exercise on self-reported function was not reflected by beneficial results for ROM, muscle strength, physical fitness, and walking capacity, but exercise in addition to patient education resulted in less pain during walking in the long term.

摘要

背景

运动对髋骨关节炎(OA)患者特定功能障碍和活动受限的影响有限。

目的

本研究的目的是评估运动疗法和患者教育对髋OA患者的关节活动范围(ROM)、肌肉力量、身体素质、步行能力以及步行时疼痛的长期影响。

设计

这是一项随机临床试验的次要结局分析。

地点

研究地点为一家大学医院。

参与者

109例临床和影像学检查确诊为髋OA的患者被随机分为两组,一组接受运动疗法和患者教育(运动组),另一组仅接受患者教育(对照组)。

干预措施

所有参与者均参加了由2名物理治疗师主持的3次小组会议组成的患者教育项目。另外2名物理治疗师负责提供运动疗法项目,包括在12周内每周进行2或3次的强化、功能和伸展运动。两种干预措施均在运动医学诊所进行。

测量指标

结局指标包括ROM、等速肌肉力量、通过阿斯兰德自行车测力计测试测定的预测最大摄氧量,以及六分钟步行试验(6MWT)中的步行距离和疼痛程度。由5名对分组情况不知情的物理治疗师在入组后4、10和29个月进行随访评估。

结果

在随访期间,两组在ROM、肌肉力量、预测最大摄氧量或6MWT中的步行距离方面均未发现显著差异,但运动组在10个月(平均差值=-8.5mm;95%置信区间=-16.1,-0.9)和29个月(平均差值=-9. mm;95%置信区间=-18.1,-0.6)时6MWT中的疼痛程度低于对照组。

局限性

本研究的局限性在于统计效力降低以及运动疗法项目的依从率为53%。

结论

运动对自我报告功能的上述影响并未体现在ROM、肌肉力量、身体素质和步行能力的有益结果上,但在患者教育的基础上进行运动可使长期步行时的疼痛减轻。

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