Tranzo, Tilburg University, Tilburg, the Netherlands; Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands; Department of Rehabilitation, Physiotherapy Sciences and Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht; and Expertise Center Innovation of Care, Research Group Innovation of Mobility Care, University of Applied Sciences Utrecht.
ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
Phys Ther. 2018 Jul 1;98(7):560-570. doi: 10.1093/ptj/pzy045.
BACKGROUND: Integrating physical therapy sessions and an online application (e-Exercise) might support people with hip osteoarthritis (OA), knee OA, or both (hip/knee OA) in taking an active role in the management of their chronic condition and may reduce the number of physical therapy sessions. OBJECTIVE: The objective of this study was to investigate the short- and long-term effectiveness of e-Exercise compared to usual physical therapy in people with hip/knee OA. DESIGN: The design was a prospective, single-blind, multicenter, superiority, cluster- randomized controlled trial. SETTING: The setting included 143 primary care physical therapist practices. PARTICIPANTS: The participants were 208 people who had hip/knee OA and were 40 to 80 years of age. INTERVENTION: e-Exercise is a 3-month intervention in which about 5 face-to-face physical therapy sessions were integrated with an online application consisting of graded activity, exercise, and information modules. Usual physical therapy was conducted according to the Dutch physical therapy guidelines on hip and knee OA. MEASUREMENTS: Primary outcomes, measured at baseline after 3 and 12 months, were physical functioning and free-living physical activity. Secondary outcome measures were pain, tiredness, quality of life, self-efficacy, and the number of physical therapy sessions. RESULTS: The e-Exercise group (n = 109) received, on average, 5 face-to-face sessions; the usual physical therapy group (n = 99) received 12. No significant differences in primary outcomes between the e-Exercise group and the usual physical therapy group were found. Within-group analyses for both groups showed a significant improvement in physical functioning. After 3 months, participants in the e-Exercise group reported an increase in physical activity; however, no objectively measured differences in physical activity were found. With respect to secondary outcomes, after 12 months, sedentary behavior significantly increased in the e-Exercise group compared with the usual physical therapy group. In both groups, there were significant improvements for pain, tiredness, quality of life, and self-efficacy. LIMITATIONS: The response rate at 12 months was 65%. CONCLUSIONS: The blended intervention, e-Exercise, was not more effective than usual physical therapy in people with hip/knee OA.
背景：将物理治疗课程与在线应用程序（电子运动）整合起来，可能会帮助患有髋关节炎、膝关节关节炎或两者（髋膝关节关节炎）的患者积极参与慢性疾病的管理，并减少物理治疗的次数。
目的：本研究旨在比较电子运动与常规物理治疗在髋膝关节关节炎患者中的短期和长期疗效。
设计：前瞻性、单盲、多中心、优效性、聚类随机对照试验。
设置：包括 143 个初级保健物理治疗诊所。
参与者：208 名患有髋膝关节关节炎、年龄在 40 至 80 岁之间的患者。
干预：电子运动是一项为期 3 个月的干预措施，其中约有 5 次面对面的物理治疗课程与一个在线应用程序相结合，该应用程序包含分级活动、运动和信息模块。常规物理治疗根据荷兰髋膝关节关节炎物理治疗指南进行。
测量：主要结局指标在基线、3 个月和 12 个月时进行测量，包括身体功能和自由活动的体力活动。次要结局指标包括疼痛、疲劳、生活质量、自我效能和物理治疗的次数。
结果：电子运动组（n=109）平均接受 5 次面对面治疗；常规物理治疗组（n=99）接受 12 次。电子运动组与常规物理治疗组在主要结局指标上无显著差异。两组的组内分析均显示身体功能显著改善。治疗 3 个月后，电子运动组报告体力活动增加，但未发现体力活动的客观测量差异。关于次要结局，治疗 12 个月后，电子运动组的久坐行为显著高于常规物理治疗组。两组的疼痛、疲劳、生活质量和自我效能均有显著改善。
局限性：12 个月时的应答率为 65%。
结论：在髋膝关节关节炎患者中，混合干预措施电子运动并不比常规物理治疗更有效。
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