Department of Plastic, Reconstructive, and Hand Surgery, Erasmus Medical Center, Dr. Molewaterplein 50, Room EE 15.91b, 3015 GE, Rotterdam, the Netherlands; and Hand and Wrist Surgery, Xpert Clinic, Eindhoven, Noord-Brabant, the Netherlands.
Department of Plastic, Reconstructive, and Hand Surgery, and Department of Rehabilitation Medicine, Erasmus Medical Center; and Hand and Wrist Surgery, Xpert Clinic.
Phys Ther. 2019 May 1;99(5):570-576. doi: 10.1093/ptj/pzz009.
The current guidelines for treatment of carpometacarpal osteoarthritis recommend starting with conservative treatment before a surgical procedure is considered.
The objective was to investigate how response to conservative treatment, in terms of pain and hand function, influences the hazard that patients convert to surgical treatment.
This was a multicenter, prospective cohort study.
Participants comprised 701 patients who received 3 months of hand therapy and an orthosis. Pain and function were measured with the Michigan Hand Questionnaire (MHQ) at baseline and at 6 weeks and 3 months follow-up. Conversion to surgical treatment was recorded from clinical records. Joint modeling (a statistical method of combining prediction models) was used to perform the analysis and to calculate hazard ratios (HRs).
The joint analytical model showed that both MHQ pain score at a certain point (HR = 0.93; 95% confidence interval [CI] = 0.92-0.94) and change in MHQ pain score (HR = 1.07; 95% CI = 1.06-1.09) during conservative treatment was significantly associated with conversion to surgical treatment. The joint analytical model between functional outcome and conversion to surgical treatment showed only a significant association between MHQ function at a certain point (HR = 0.97; 95% CI = 0.95-0.99), and no significant association between the change in MHQ score for function (HR = 1.0; 95% CI = 1.0-1.0) and conversion to surgical treatment.
Missing data might have resulted in biased estimates.
Self-reported pain and function, as well as change in self-reported pain during treatment, were associated with the hazard of conversion to surgical treatment, whereas change in self-reported functioning was not associated with conversion. Because a reduction in pain during conservative treatment appears to decrease the rate of conversion to surgical treatment, it is advised to structurally monitor pain levels during treatment. Listen to the author interview at https://academic.oup.com/ptj/pages/podcasts.
目前针对腕掌关节炎的治疗指南建议在考虑手术治疗之前先采用保守治疗。
本研究旨在探究保守治疗后疼痛和手部功能的缓解情况对患者转为手术治疗的风险的影响。
这是一项多中心前瞻性队列研究。
纳入的 701 例患者接受了 3 个月的手部治疗和矫形器治疗。在基线、治疗后 6 周和 3 个月时，使用密歇根手部问卷（Michigan Hand Questionnaire，MHQ）评估疼痛和功能。从临床记录中记录手术治疗的转换情况。采用联合分析模型（一种组合预测模型的统计方法）进行分析并计算风险比（hazard ratio，HR）。
联合分析模型显示，保守治疗过程中某一时刻的 MHQ 疼痛评分（HR=0.93，95%置信区间[CI]为 0.92-0.94）和 MHQ 疼痛评分的变化（HR=1.07，95%CI 为 1.06-1.09）与手术治疗的转换显著相关。在功能结局与手术治疗转换的联合分析模型中，仅在某一时刻的 MHQ 功能评分（HR=0.97，95%CI 为 0.95-0.99）与手术治疗转换显著相关，而 MHQ 功能评分的变化（HR=1.0，95%CI 为 1.0-1.0）与手术治疗转换无显著相关性。
可能存在数据缺失导致的偏倚估计。
自我报告的疼痛和功能以及治疗过程中自我报告的疼痛变化与手术治疗转换的风险相关，而自我报告的功能变化与转换无关。由于保守治疗过程中疼痛的减轻似乎降低了手术治疗的转化率，因此建议在治疗过程中结构性地监测疼痛水平。可在 https://academic.oup.com/ptj/pages/podcasts 收听作者访谈。
