肩周炎患者在麻醉下进行的手法治疗：一项关于五年医疗保健利用情况及手法治疗后关节镜检查结果的病例系列研究。
Translational manipulation under anesthesia for patients with frozen shoulder: a case series study with five-year health care utilization and post-manipulative arthroscopic findings.
作者信息
Hando Ben R, Rhon Daniel I, Boyles Robert E, Whitman Julie M, English Jenny L
机构信息
Department of Orthopedics and Rehabilitation, Wilford Hall Ambulatory Surgical Center, United States Air Force, San Antonio, TX, USA.
Center for the Intrepid, United States Army, San Antonio, TX, USA.
出版信息
J Man Manip Ther. 2017 Dec;25(5):270-278. doi: 10.1080/10669817.2017.1292615. Epub 2017 Feb 16.
STUDY DESIGN
Case series study.
OBJECTIVES
Although there have been no reported complications from translational manipulation under anesthesia (tMUA) for individuals with adhesive capsulitis (AC) there are no cases reporting surgical findings post tMUA. Also, there are no studies evaluating health care utilization following tMUA. The purpose of this study was to: (1) report clinical outcomes following tMUA, (2) describe relevant health care costs and utilization following tMUA, and (3) summarize findings from two cases receiving joint arthroscopy following tMUA.
METHODS
Fourteen Individuals with AC underwent tMUA. Range of motion (ROM) and Shoulder Pain and Disability Index (SPADI) values were collected at baseline and six weeks follow-up. Shoulder-related health care cost and utilization were analyzed for a five-year period following tMUA. Two additional patients with AC underwent tMUA followed by arthroscopic assessment for evidence of iatrogenic injury.
RESULTS
Thirteen patients completed the six-week follow-up. Mean change scores for ROM and SPADI values were flexion; +38.5°, abduction; +71.1°, external rotation (shoulder abducted); +49.8°, internal rotation (shoulder abducted); +26.6°, SPADI scores; +44.4. 13 patient records were analyzed for health care utilization. Ten of the 13 patients utilized no additional shoulder-related health care. Surgical evaluation revealed no evidence of iatrogenic injury.
DISCUSSION
Clinical outcomes were similar to previous studies. Utilization data indicated that for the majority of patients, little shoulder-related health care was utilized. Surgical evaluation provided further evidence that tMUA performed by a physical therapist is safe. Future research will be required to establish a causal relationship between tMUA and the results observed in this study.
LEVEL OF EVIDENCE
Therapy, Level 4.
研究设计
病例系列研究。
目的
尽管尚无关于麻醉下平移手法治疗（tMUA）粘连性肩周炎（AC）患者出现并发症的报道，但尚无tMUA术后手术结果的病例报告。此外，也没有研究评估tMUA后的医疗保健利用情况。本研究的目的是：（1）报告tMUA后的临床结果，（2）描述tMUA后的相关医疗保健成本和利用情况，（3）总结两例tMUA后接受关节镜检查的病例结果。
方法
14例AC患者接受了tMUA。在基线和随访6周时收集活动范围（ROM）和肩痛与功能障碍指数（SPADI）值。分析tMUA后五年内与肩部相关的医疗保健成本和利用情况。另外两名AC患者接受tMUA，随后进行关节镜检查以评估医源性损伤的证据。
结果
13例患者完成了6周的随访。ROM和SPADI值的平均变化分数为：前屈+38.5°，外展+71.1°，外旋（肩部外展）+49.8°，内旋（肩部外展）+26.6°，SPADI评分+44.4。分析了13例患者的医疗保健利用记录。13例患者中有10例未使用额外的与肩部相关的医疗保健服务。手术评估未发现医源性损伤的证据。
讨论
临床结果与先前的研究相似。利用数据表明，大多数患者很少使用与肩部相关的医疗保健服务。手术评估进一步证明了物理治疗师进行的tMUA是安全的。未来需要进行研究以确定tMUA与本研究中观察到的结果之间的因果关系。
证据级别
治疗，4级。
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