日常体力活动与膝骨关节炎患者疼痛的关系：疼痛灾难化的调节作用。
The Association Between Daily Physical Activity and Pain Among Patients with Knee Osteoarthritis: The Moderating Role of Pain Catastrophizing.
机构信息
Department of Anesthesiology, Perioperative, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, USA.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
出版信息
Pain Med. 2019 May 1;20(5):916-924. doi: 10.1093/pm/pny129.
OBJECTIVE
The primary objective of this study was to examine the day-to-day association between physical activity and pain intensity among a sample of patients with knee osteoarthritis (KOA) and the potential moderation of this association by negative cognitive processes.
METHODS
In this micro-longitudinal daily diary study, KOA patients (N = 121) completed questionnaires assessing pain (Brief Pain Inventory) and psychosocial functioning (pain catrophizing scale, WOMAC McMaster Universities Osteoarthritis Index function, Patient-Reported Outcomes Measurement Information System [PROMIS; anxiety and depression], the Godin-Shephard Leisure-Time Physical Activity questionnaire, the six-minute walking test) and were then asked to report their levels of physical activity and pain intensity once per day for a period of seven days using an electronic diary.
RESULTS
Multilevel modeling analyses indicated that day-to-day increases in physical activity were associated with heightened levels of pain intensity (B = 0.13 SE = 0.03, P < 0.001). In addition, it was revealed that the association between physical activity and pain intensity was moderated by catastrophizing (B = -0.01 SE = 0.002, P < 0.05), with patients scoring higher in catastrophizing showing a relatively stronger link between day-to-day physical activity and increased knee pain. This effect was specific to catastrophizing, as depression and anxiety did not moderate the activity-pain relationship (P > 0.05).
CONCLUSIONS
Our findings suggest that increases in daily physical activity are associated with concurrent increases in KOA patients' levels of knee pain, particularly among patients reporting higher levels of pain catastrophizing. These results may have clinical implications for the design and testing of interventions targeted at reducing catastrophizing and increasing physical activity among patients with chronic osteoarthritis pain.
目的
本研究的主要目的是考察膝关节骨关节炎（KOA）患者样本中，日常身体活动与疼痛强度之间的关联，以及负面认知过程对这种关联的潜在调节作用。
方法
在这项微观纵向的日常日记研究中，KOA 患者（N=121）完成了问卷，评估疼痛（简明疼痛量表）和心理社会功能（疼痛灾难化量表、WOMAC 麦克马斯特大学骨关节炎指数功能、患者报告的结果测量信息系统[PROMIS；焦虑和抑郁]、Godin-Shephard 休闲时间体力活动问卷、六分钟步行测试），然后被要求使用电子日记每天报告一次他们的身体活动水平和疼痛强度，为期七天。
结果
多层次模型分析表明，身体活动的日常增加与疼痛强度的升高有关（B=0.13 SE=0.03，P<0.001）。此外，还发现身体活动与疼痛强度之间的关联受到灾难化的调节（B=-0.01 SE=0.002，P<0.05），灾难化得分较高的患者在日常身体活动与膝关节疼痛增加之间表现出相对更强的联系。这种效应是特定于灾难化的，因为抑郁和焦虑并没有调节活动-疼痛关系（P>0.05）。
结论
我们的研究结果表明，日常身体活动的增加与 KOA 患者膝关节疼痛水平的增加有关，尤其是在报告更高水平疼痛灾难化的患者中。这些结果可能对设计和测试针对减少慢性骨关节炎疼痛患者的灾难化和增加身体活动的干预措施具有临床意义。
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