疼痛前对膝关节置换术患者进行的应对技能训练：一项多中心随机临床试验。
Pain Coping Skills Training for Patients Who Catastrophize About Pain Prior to Knee Arthroplasty: A Multisite Randomized Clinical Trial.
机构信息
Department of Physical Therapy, Orthopaedic Surgery and Rheumatology, West Hospital (D.L.R.), and Department of Biostatistics (R.A.P.), Virginia Commonwealth University, Richmond, Virginia.
Pain Prevention and Treatment Research, Department of Psychiatry and Behavioral Sciences (F.J.K. and D.M.), and Duke Clinical Research Institute (S.D.R.), Duke University, Durham, North Carolina.
出版信息
J Bone Joint Surg Am. 2019 Feb 6;101(3):218-227. doi: 10.2106/JBJS.18.00621.
BACKGROUND
Pain catastrophizing has been identified as a prognostic indicator of poor outcome following knee arthroplasty. Interventions to address pain catastrophizing, to our knowledge, have not been tested in patients undergoing knee arthroplasty. The purpose of this study was to determine whether pain coping skills training in persons with moderate to high pain catastrophizing undergoing knee arthroplasty improves outcomes 12 months postoperatively compared with usual care or arthritis education.
METHODS
A multicenter, 3-arm, single-blinded, randomized comparative effectiveness trial was performed involving 5 university-based medical centers in the United States. There were 402 randomized participants. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Scale, measured at baseline, 2 months, 6 months, and 12 months following the surgical procedure.
RESULTS
Participants were recruited from January 2013 to June 2016. In 402 participants, 66% were women and the mean age of the participants (and standard deviation) was 63.2 ± 8.0 years. Three hundred and forty-six participants (90% of those who underwent a surgical procedure) completed a 12-month follow-up. All 3 treatment groups had large improvements in 12-month WOMAC pain scores with no significant differences (p > 0.05) among the 3 treatment arms. No differences were found between WOMAC pain scores at 12 months for the pain coping skills and arthritis education groups (adjusted mean difference, 0.3 [95% confidence interval (CI), -0.9 to 1.5]) or between the pain coping and usual-care groups (adjusted mean difference, 0.4 [95% CI, -0.7 to 1.5]). Secondary outcomes also showed no significant differences (p > 0.05) among the 3 groups.
CONCLUSIONS
Among adults with pain catastrophizing undergoing knee arthroplasty, cognitive behaviorally based pain coping skills training did not confer pain or functional benefit beyond the large improvements achieved with usual surgical and postoperative care. Future research should develop interventions for the approximately 20% of patients undergoing knee arthroplasty who experience persistent function-limiting pain.
LEVEL OF EVIDENCE
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
背景
疼痛灾难化已被确定为膝关节置换术后预后不良的预测指标。据我们所知，针对疼痛灾难化的干预措施尚未在接受膝关节置换术的患者中进行测试。本研究的目的是确定在接受膝关节置换术的中度至高度疼痛灾难化患者中进行疼痛应对技能训练是否比常规护理或关节炎教育在术后 12 个月时改善结果。
方法
这是一项多中心、3 臂、单盲、随机对照有效性试验，涉及美国 5 家大学医疗中心。共有 402 名随机参与者。主要结局是使用 Western Ontario 和 McMaster 大学骨关节炎指数（WOMAC）疼痛量表进行测量，在手术前、2 个月、6 个月和 12 个月进行测量。
结果
参与者于 2013 年 1 月至 2016 年 6 月期间招募。在 402 名参与者中，66%为女性，参与者的平均年龄（标准差）为 63.2±8.0 岁。346 名参与者（所有接受手术的参与者的 90%）完成了 12 个月的随访。所有 3 个治疗组在 12 个月时 WOMAC 疼痛评分均有较大改善，3 个治疗组之间无显著差异（p>0.05）。在 12 个月时，疼痛应对技能组和关节炎教育组的 WOMAC 疼痛评分之间（调整后的平均差异，0.3[95%置信区间（CI），-0.9 至 1.5]）或疼痛应对组和常规护理组之间（调整后的平均差异，0.4[95% CI，-0.7 至 1.5]）没有发现差异。次要结局也显示 3 组之间没有显著差异（p>0.05）。
结论
在接受膝关节置换术且有疼痛灾难化的成年人中，基于认知行为的疼痛应对技能训练并未在通常的手术和术后护理所带来的显著改善之外带来疼痛或功能方面的益处。未来的研究应该为接受膝关节置换术但仍存在持续功能受限疼痛的约 20%的患者开发干预措施。
证据水平
治疗水平 I. 请参阅作者说明，以获取完整的证据水平描述。
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