Lee Augustine C, Harvey William F, Price Lori Lyn, Han Xingyi, Driban Jeffrey B, Wong John B, Chung Mei, McAlindon Timothy E, Wang Chenchen
Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA.
Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA.
Arch Phys Med Rehabil. 2017 Nov;98(11):2265-2273.e1. doi: 10.1016/j.apmr.2017.04.014. Epub 2017 May 12.
To examine the association between baseline mindfulness and response from exercise interventions in knee osteoarthritis (OA).
Cohort study; responder analysis of a clinical trial subset.
Urban tertiary care academic hospital.
Participants with symptomatic, radiographic knee OA (N=86; mean age, 60y; 74% female; 48% white).
Twelve weeks (twice per week) of Tai Chi or physical therapy exercise.
Treatment response was defined using Osteoarthritis Research Society International criteria indicating meaningful improvements in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, WOMAC function, or Patient Global Assessment scores. At baseline, participants completed the Five Facet Mindfulness Questionnaire (mean total score, 142±17) and were grouped into 3 categories of total mindfulness: higher, medium, or lower. Relative risk (RR) ratios were used to compare treatment response across groups.
Participants with higher total mindfulness were 38% (95% confidence interval [CI], 1.05-1.83) more likely to meet responder criteria than those with lower mindfulness. We found no significant difference between medium and lower mindfulness groups (RR=1.0; 95% CI, 0.69-1.44). Among the 5 mindfulness facets, medium acting-with-awareness was 46% (95% CI, 1.09-1.96) more likely to respond than lower acting-with-awareness, and higher acting-with-awareness was 34% more likely to respond, but this did not reach significance (95% CI, 0.97-1.86).
In this study, higher mindfulness, primarily driven by its acting-with-awareness facet, was significantly associated with a greater likelihood of response to nonpharmacologic exercise interventions in knee OA. This suggests that mindfulness-cultivating interventions may increase the likelihood of response from exercise.
探讨膝关节骨关节炎（OA）患者基线时的正念水平与运动干预反应之间的关联。
队列研究；对一项临床试验子集进行反应者分析。
城市三级医疗学术医院。
有症状的、经影像学检查确诊的膝关节OA患者（N = 86；平均年龄60岁；74%为女性；48%为白人）。
为期12周（每周两次）的太极拳或物理治疗运动。
使用国际骨关节炎研究学会标准定义治疗反应，该标准表明西安大略和麦克马斯特大学骨关节炎指数（WOMAC）疼痛、WOMAC功能或患者整体评估得分有显著改善。在基线时，参与者完成了五因素正念问卷（平均总分142±17），并被分为正念总分的3个类别：高、中或低。相对风险（RR）比率用于比较各组的治疗反应。
正念总分高的参与者达到反应者标准的可能性比正念总分低的参与者高38%（95%置信区间[CI]，1.05 - 1.83）。我们发现正念总分中等和低的组之间没有显著差异（RR = 1.0；95% CI，0.69 - 1.44）。在五个正念方面中，中等的有意识行动比低的有意识行动有46%（95% CI，1.09 - 1.96）更有可能产生反应，高的有意识行动有34%更有可能产生反应，但未达到显著水平（95% CI，0.97 - 1.86）。
在本研究中，较高的正念水平，主要由其有意识行动方面驱动，与膝关节OA患者对非药物运动干预产生反应的可能性更大显著相关。这表明培养正念的干预措施可能会增加运动产生反应的可能性。
