电话指导以加强针对膝骨关节炎的居家体育活动计划：一项随机临床试验

Telephone Coaching to Enhance a Home-Based Physical Activity Program for Knee Osteoarthritis: A Randomized Clinical Trial.

作者信息

Bennell Kim L, Campbell Penny K, Egerton Thorlene, Metcalf Ben, Kasza Jessica, Forbes Andrew, Bills Caroline, Gale Janette, Harris Anthony, Kolt Gregory S, Bunker Stephen J, Hunter David J, Brand Caroline A, Hinman Rana S

机构信息

University of Melbourne, Melbourne, Victoria, Australia.

Monash University, Melbourne, Victoria, Australia.

出版信息

Arthritis Care Res (Hoboken). 2017 Jan;69(1):84-94. doi: 10.1002/acr.22915.

DOI:10.1002/acr.22915

PMID:27111441

Abstract

OBJECTIVE

To investigate whether simultaneous telephone coaching improves the clinical effectiveness of a physiotherapist-prescribed home-based physical activity program for knee osteoarthritis (OA).

METHODS

A total of 168 inactive adults ages ≥50 years with knee pain on a numeric rating scale ≥4 (NRS; range 0-10) and knee OA were recruited from the community and randomly assigned to a physiotherapy (PT) and coaching group (n = 84) or PT-only (n = 84) group. All participants received five 30-minute consultations with a physiotherapist over 6 months for education, home exercise, and physical activity advice. PT+coaching participants also received 6-12 telephone coaching sessions by clinicians trained in behavioral-change support for exercise and physical activity. Primary outcomes were pain (NRS) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC; score range 0-68]) at 6 months. Secondary outcomes were these same measures at 12 and 18 months, as well as physical activity, exercise adherence, other pain and function measures, and quality of life. Analyses were intent-to-treat with multiple imputation for missing data.

RESULTS

A total of 142 (85%), 136 (81%), and 128 (76%) participants completed 6-, 12-, and 18-month measurements, respectively. The change in NRS pain (mean difference 0.4 unit [95% confidence interval (95% CI) -0.4, 1.3]) and in WOMAC function (1.8 [95% CI -1.9, 5.5]) did not differ between groups at 6 months, with both groups showing clinically relevant improvements. Some secondary outcomes related to physical activity and exercise behavior favored PT+coaching at 6 months but generally not at 12 or 18 months. There were no between-group differences in most other outcomes.

CONCLUSION

The addition of simultaneous telephone coaching did not augment the pain and function benefits of a physiotherapist-prescribed home-based physical activity program.

摘要

目的

探讨同步电话指导是否能提高物理治疗师开具的针对膝关节骨关节炎（OA）的居家体育活动计划的临床效果。

方法

从社区招募了168名年龄≥50岁、膝关节疼痛且数字评分量表（NRS；范围0 - 10）评分≥4的不活动成年人以及膝关节OA患者，并将他们随机分为物理治疗（PT）与指导组（n = 84）或仅物理治疗组（n = 84）。所有参与者在6个月内接受了5次每次30分钟的与物理治疗师的咨询，内容包括教育、家庭锻炼和体育活动建议。PT + 指导组的参与者还接受了由在运动和体育活动行为改变支持方面接受过培训的临床医生进行的6 - 12次电话指导。主要结局指标是6个月时的疼痛（NRS）和身体功能（西安大略和麦克马斯特大学骨关节炎指数[WOMAC；评分范围0 - 68]）。次要结局指标是12个月和18个月时的相同指标，以及体育活动、运动依从性、其他疼痛和功能指标以及生活质量。分析采用意向性分析，并对缺失数据进行多重填补。

结果

分别有142名（85%）、136名（81%）和128名（76%）参与者完成了6个月、12个月和18个月的测量。6个月时，两组之间NRS疼痛的变化（平均差值0.4单位[95%置信区间（95% CI） - 0.4, 1.3]）和WOMAC功能的变化（1.8 [95% CI - 1.9, 5.5]）无差异，两组均显示出具有临床意义的改善。一些与体育活动和运动行为相关的次要结局指标在6个月时有利于PT + 指导组，但在12个月或18个月时一般并非如此。大多数其他结局指标在组间无差异。