Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
Semin Arthritis Rheum. 2018 Apr;47(5):732-740. doi: 10.1016/j.semarthrit.2017.10.003. Epub 2017 Oct 5.
Arthritis is a leading cause of chronic pain and functional limitations. Exercise is beneficial for improving strength and function and decreasing pain. We evaluated the effect of a motivational interviewing-based lifestyle physical activity intervention on self-reported physical function in adults with knee osteoarthritis (KOA) or rheumatoid arthritis (RA).
Participants were randomized to intervention or control. Control participants received a brief physician recommendation to increase physical activity to meet national guidelines. Intervention participants received the same brief baseline physician recommendation in addition to motivational interviewing sessions at baseline, 3, 6, and 12 months. These sessions focused on facilitating individualized lifestyle physical activity goal setting. The primary outcome was change in self-reported physical function. Secondary outcomes were self-reported pain and accelerometer-measured physical activity. Self-reported KOA outcomes were evaluated by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for KOA (WOMAC scores range from 0 to 68 for function and 0 to 20 for pain) and the Health Assessment Questionnaire (HAQ) for RA. Outcomes were measured at baseline, 3, 6, 12, and 24 months. Multiple regression accounting for repeated measures was used to evaluate the overall intervention effect on outcomes controlling for baseline values.
Participants included 155 adults with KOA (76 intervention and 79 control) and 185 adults with RA (93 intervention and 92 control). Among KOA participants, WOMAC physical function improvement was greater in the intervention group compared to the control group [difference = 2.21 (95% CI: 0.01, 4.41)]. WOMAC pain improvement was greater in the intervention group compared to the control group [difference = 0.70 (95% CI: -0.004, 1.41)]. There were no significant changes in physical activity. Among RA participants, no significant intervention effects were found.
Participants with KOA receiving the lifestyle intervention experienced modest improvement in self-reported function and a trend toward improved pain compared to controls. There was no intervention effect for RA participants. Further refinement of this intervention is needed for more robust improvement in function, pain, and physical activity.
关节炎是导致慢性疼痛和功能障碍的主要原因。运动有益于改善力量和功能，减轻疼痛。我们评估了基于动机访谈的生活方式体力活动干预对膝骨关节炎（KOA）或类风湿关节炎（RA）成人自我报告身体功能的影响。
参与者被随机分配到干预组或对照组。对照组接受了简短的医生建议，以增加体力活动以符合国家指南。干预组除了在基线、3 个月、6 个月和 12 个月接受动机访谈外，还接受了相同的简短基线医生建议。这些会议的重点是促进个性化的生活方式体力活动目标设定。主要结果是自我报告身体功能的变化。次要结果是自我报告的疼痛和加速度计测量的体力活动。自我报告的 KOA 结果通过 Western Ontario 和 McMaster 大学骨关节炎指数（WOMAC）进行评估（KOA 的 WOMAC 评分范围为 0 到 68 分，用于功能，0 到 20 分用于疼痛）和健康评估问卷（HAQ）用于 RA。结果在基线、3 个月、6 个月、12 个月和 24 个月时进行测量。使用考虑重复测量的多元回归来评估整体干预对控制基线值的结果的影响。
参与者包括 155 名 KOA 成年人（76 名干预组和 79 名对照组）和 185 名 RA 成年人（93 名干预组和 92 名对照组）。在 KOA 参与者中，与对照组相比，干预组 WOMAC 身体功能的改善更大[差异=2.21（95%置信区间：0.01，4.41）]。与对照组相比，干预组 WOMAC 疼痛的改善更大[差异=0.70（95%置信区间：-0.004，1.41）]。体力活动没有明显变化。在 RA 参与者中，没有发现干预的显著效果。
接受生活方式干预的 KOA 参与者在自我报告的功能方面有适度的改善，疼痛有改善的趋势，而对照组则没有。RA 参与者没有干预效果。需要进一步改进这种干预措施，以更有效地改善功能、疼痛和体力活动。
