Hashimoto Sanshiro, Hirokado Masatsugu, Takasaki Hiroshi
Minami Shinjuku Orthopedic Clinic, Tokyo, Japan.
Department of Physical Therapy, Saitama Prefectural University, Saitama, Japan.
J Man Manip Ther. 2019 Feb;27(1):33-42. doi: 10.1080/10669817.2018.1511316. Epub 2018 Sep 12.
: To preliminarily investigate in patients with a primary complaint of non-acute knee pain for ≥ 1 month: 1) the proportion of patients with non-acute knee pain classified by Mechanical Diagnosis and Therapy (MDT) as Spinal Derangements, 2) the number of sessions taken to identify the concluding classification, and 3) the ability of MDT classifications, demographics, and symptomatic baselines to predict pain reduction at 1-month follow-up.: This study reviewed data from outpatients managed with MDT. For modeling knee pain reduction at the 1-month follow-up, 3 MDT provisional or concluding classifications (Spinal Derangement, Knee Derangement, and Non-Derangement) and the following variables were included: 1) gender, 2) symptom duration, 3) presence of low back pain (LBP), 4) the Japanese Knee Osteoarthritis Measure, 5) average pain intensity at the initial session using a 0-10 numerical rating scale, and 6) the Kellgren-Lawrence grade.: Data from 101 patients were extracted. The percentage of patients with the concluding classification of Spinal Derangement was 44.6%. This was greater in those patient's reporting concomitant LBP ( = .002) and without radiographic findings of knee osteoarthritis ( < .001). A concluding classification was determined by the fourth session in 80% of patients. Multiple regression modeling demonstrated that only the concluding classification significantly predicted the knee pain reduction at the 1-month follow-up.: These findings suggest the importance of careful screening assessments of the lumbar spine and the importance of detecting Derangements throughout the follow-up sessions for patients with a primary complaint of knee pain.
为了对以非急性膝关节疼痛为主诉≥1个月的患者进行初步调查:1)根据机械诊断与治疗(MDT)分类为脊柱紊乱的非急性膝关节疼痛患者的比例;2)确定最终分类所需的诊疗次数;3)MDT分类、人口统计学特征和症状基线对1个月随访时疼痛减轻的预测能力。
本研究回顾了接受MDT治疗的门诊患者的数据。为了模拟1个月随访时膝关节疼痛的减轻情况,纳入了3种MDT临时或最终分类(脊柱紊乱、膝关节紊乱和非紊乱)以及以下变量:1)性别;2)症状持续时间;3)是否存在腰痛(LBP);4)日本膝关节骨关节炎测量指标;5)初次就诊时使用0-10数字评分量表的平均疼痛强度;6)凯尔格伦-劳伦斯分级。
提取了101例患者的数据。最终分类为脊柱紊乱的患者比例为44.6%。在报告伴有LBP的患者中这一比例更高(P = 0.002),且在没有膝关节骨关节炎影像学表现的患者中更高(P < 0.001)。80%的患者在第四次诊疗时确定了最终分类。多元回归模型显示,只有最终分类能显著预测1个月随访时膝关节疼痛的减轻情况。
这些发现表明,对于以膝关节疼痛为主诉的患者,仔细筛查腰椎的重要性以及在整个随访过程中检测紊乱情况的重要性。