Nagasawa Yasuhiro, Oka Koichiro, Shibata Ai
Hasegawa Hospital.
Faculty of Sport Sciences, Waseda University.
Nihon Ronen Igakkai Zasshi. 2017;54(4):546-554. doi: 10.3143/geriatrics.54.546.
The present study examined the effects of individual pain coping-skills training (PCST) on knee pain, pain coping strategies, physical functions, and daily physical activity among older outpatients with osteoarthritis.
Twenty-five older adults who suffered from knee pain and had been diagnosed to have knee osteoarthritis (men: n=4; 75.4±6.3 years) were assigned to either a PCST group (n=13) or a general health education group (n=12) according to their wishes. Both groups attended 20-minutes sessions once a week for 8 weeks. At the baseline, the basic attributes (e.g. gender, age, duration of knee pain, and medical history), BMI, and the severity of knee osteoarthritis were obtained. Additionally, knee pain and limitations in mobility, pain coping strategies, pain self-efficacy, exercise self-efficacy, lower muscle strength, mobility, accelerometer -based time spent in physical activity and sedentary behavior were assessed before and after the 8-week intervention period. Analyses were performed using an intention-to-treat principle. Differences in each variable between the groups were examined using an analysis of covariance. Each participant's baseline value was used as the covariate.
Even after controlling for the baseline attributes and values, only the PCST group exhibited a significant improvement in pain self-efficacy (p=0.005), exercise self-efficacy (p=0.042), lower muscle strength (p=0.004) and mobility (p=0.027). Furthermore, the PCST showed a significant increase in moderate-to vigorous-intensity physical activity (p=0.052) and a decrease in medical behaviors as one of pain coping strategies (p=0.073).
The present study showed that PCST therefore appears to be a feasible and effective therapeutic strategy which improves self-efficacy for controlling knee pain, which may also result in increasing the self-efficacy for exercise, physical functions, and daily physical activities.
本研究探讨了个体疼痛应对技能训练（PCST）对老年骨关节炎门诊患者膝关节疼痛、疼痛应对策略、身体功能及日常身体活动的影响。
25名患有膝关节疼痛且被诊断为膝关节骨关节炎的老年人（男性：n = 4；75.4±6.3岁）根据其意愿被分为PCST组（n = 13）或一般健康教育组（n = 12）。两组均每周参加一次20分钟的课程，共8周。在基线时，获取基本属性（如性别、年龄、膝关节疼痛持续时间和病史）、体重指数（BMI）以及膝关节骨关节炎的严重程度。此外，在为期8周的干预期前后，评估膝关节疼痛、活动受限情况、疼痛应对策略、疼痛自我效能感、运动自我效能感、下肢肌肉力量、活动能力、基于加速度计的身体活动时间和久坐行为。分析采用意向性分析原则。使用协方差分析检验两组之间各变量的差异。每个参与者的基线值用作协变量。
即使在控制了基线属性和值之后，只有PCST组在疼痛自我效能感（p = 0.005）、运动自我效能感（p = 0.042）、下肢肌肉力量（p = 0.004）和活动能力（p = 0.027）方面有显著改善。此外，PCST显示中度至剧烈强度的身体活动显著增加（p = 0.052），作为疼痛应对策略之一的就医行为减少（p = 0.073）。
本研究表明，PCST似乎是一种可行且有效的治疗策略，可提高控制膝关节疼痛的自我效能感，这也可能导致运动自我效能感、身体功能和日常身体活动的增加。
