Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians University of Munich, Munich, Germany
Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
Dtsch Arztebl Int. 2019 Mar 8;116(10):159-166. doi: 10.3238/arztebl.2019.0159.
We evaluated a team-based program of exercises for patients with panic disorder with or without agoraphobia (PDA) in primary care.
419 patients with PDA (mean age 46.2 years, standard deviation 14.4 years; 74% female) were included in this cluster-randomized, controlled intervention trial. The patients were blinded with respect to their group assignment at baseline. Patients in the intervention group (36 primary-care practices, 230 patients) underwent a 23-week exercise program combined with case management, while patients in the control group (37 practices, 189 patients) received standard care. Symptoms of anxiety (according to the Beck Anxiety Inventory, BAI) at six months were the primary endpoint. Patients were followed up at six months (n = 338, 81%) and at twelve months (n = 318, 76%). The analysis was by intention to treat.
Symptoms of anxiety improved to a significantly greater extent in the intervention group (p = 0.008). The intergroup dif- ference in the reduction of the BAI score (range: 0-63) was 3.0 points (95% confidence interval [-5.8; -0.2]) at six months and 4.0 points [-6.9; -1.2] at twelve months. In the intervention group, there was a significantly greater reduction in the frequency of panic attacks (p = 0.019), in avoidant behavior (p = 0.016), and in depressiveness (p<0.001), as well as a greater improvement of the quality of treatment (p<0.001).
In primary-care patients who have panic disorder with or without agoraphobia, a team-based exercise program combined with case management can improve symptoms to a greater extent than standard primary-care treatment.
我们评估了一项针对伴有或不伴有广场恐惧症的惊恐障碍患者的基于团队的锻炼计划，该计划在初级保健中进行。
共有 419 名伴有惊恐障碍的患者（平均年龄 46.2 岁，标准差 14.4 岁；74%为女性）参与了这项基于群组的随机对照干预试验。患者在基线时对其分组情况进行了盲法处理。干预组（36 个初级保健实践，230 名患者）接受了为期 23 周的锻炼计划，同时还接受了病例管理，而对照组（37 个实践，189 名患者）则接受了标准护理。六个月时的焦虑症状（根据贝克焦虑量表，BAI）是主要终点。对 338 名患者（81%）进行了六个月的随访，对 318 名患者（76%）进行了十二个月的随访。分析采用意向治疗。
干预组的焦虑症状显著改善（p = 0.008）。干预组和对照组在 BAI 评分降低（范围：0-63）方面的差异在六个月时为 3.0 分（95%置信区间 [-5.8；-0.2]），在十二个月时为 4.0 分[-6.9；-1.2]）。在干预组中，惊恐发作的频率显著降低（p = 0.019），回避行为显著降低（p = 0.016），抑郁程度显著降低（p<0.001），治疗质量显著提高（p<0.001）。
在伴有或不伴有广场恐惧症的惊恐障碍患者中，与标准初级保健治疗相比，基于团队的锻炼计划结合病例管理可以更有效地改善症状。
