Levitsky Adrian, Kisten Yogan, Lind Sara, Nordström Patric, Hultholm Helene, Lyander Jessica, Hammelin Viveka, Gentline Cidem, Giannakou Ioanna, Faustini Francesca, Skillgate Eva, van Vollenhoven Ronald, Sundberg Tobias
Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
J Manipulative Physiol Ther. 2019 Jan;42(1):34-46. doi: 10.1016/j.jmpt.2018.04.007. Epub 2019 Mar 14.
The purpose of this study was to assess the clinical feasibility and effectiveness of manual mobilization of the hands of patients with rheumatoid arthritis (RA).
A total of 320 individual hand joints were evaluated after recruiting an experimental research group of 12 participants with RA and, for clinical comparability, 8 participants with hand osteoarthritis (OA). One hand per participant was randomized to receive weekly low-grade (I-II) Kaltenborn manual mobilization, using passive sustained stretch of the metacarpophalangeal (MCP) joints II to V by licensed manual therapists. After 2 weeks, the randomized treated hand was crossed over to control (untreated) during weeks 3 to 4 and vice versa. Final assessment was at 2 months, which was 1 month after the last treatment at week 4. Primary hand outcomes included pain by visual analog scale, tender or swollen joint count, and presence of Doppler signal or synovial fluid and radiographic joint space by musculoskeletal ultrasound.
In the RA group, both the initially randomized treated hand and the contralateral hand improved significantly from baseline to crossover to follow-up at 2 months (pain outcomes and Doppler signal, P < .050; synovial fluid and MCP joint space, P ≤ .001). Hand pain and MCP joint space also improved significantly in OA. There were no dropouts or reported adverse events in either the RA or OA group.
In this study, manual mobilization of the hands of patients with RA was shown to be feasible, safe, and effective to integrate into specialized healthcare.
本研究旨在评估类风湿关节炎（RA）患者手部手法松动术的临床可行性和有效性。
招募了12名RA患者作为实验研究组，为了临床可比性，还招募了8名手部骨关节炎（OA）患者。对总共320个个体手部关节进行评估。每位参与者的一只手被随机分配接受每周一次的低级别（I-II级）卡尔滕伯恩手法松动术，由有执照的手法治疗师对第II至V掌指（MCP）关节进行被动持续拉伸。2周后，在第3至4周将随机接受治疗的手转为对照（未治疗），反之亦然。最终评估在2个月时进行，即第4周最后一次治疗后1个月。主要手部结局包括视觉模拟量表评估的疼痛、压痛或肿胀关节计数、多普勒信号或滑液的存在情况以及肌肉骨骼超声检查的关节间隙。
在RA组中，从基线到交叉期再到2个月的随访期，最初随机接受治疗的手和对侧手均有显著改善（疼痛结局和多普勒信号，P <.050；滑液和MCP关节间隙，P≤.001）。OA组的手部疼痛和MCP关节间隙也有显著改善。RA组和OA组均无退出者或报告的不良事件。
在本研究中，RA患者手部手法松动术被证明是可行、安全且有效地融入专科医疗保健的方法。
