Department of Clinical Sciences Lund, Ortopedics, Lund University, Lund, Sweden.
Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden.
PLoS One. 2019 Sep 19;14(9):e0222657. doi: 10.1371/journal.pone.0222657. eCollection 2019.
We evaluated a structured education- and exercise-based self-management program for patients with knee or hip osteoarthritis (OA), using a registry-based study of data from 44,634 patients taken from the Swedish "Better Management of Patients with Osteoarthritis" registry. Outcome measures included a numeric rating scale (NRS), EuroQol five dimension scale (EQ-5D), Arthritis self-efficacy scale (ASES-pain and ASES-other symptoms), pain frequency, any use of OA medication, desire for surgery, fear-avoidance behavior, physical activity, and sick leave were reported at baseline, 3 and 12 month. Changes in scale variables were analyzed using general linear models for repeated measures and changes in binary variables by McNamara's test. All analyses were stratified by joint. At the 3-month follow-up, patients with knee (n = 30686) and hip (n = 13948) OA reported significant improvements in the NRS-pain, the EQ-5D index, the ASES-other symptoms, and ASES-pain scores with standardized effect size (ES) ranges for patients with knee OA of 0.25-0.57 and hip OA of 0.15-0.39. Significantly fewer patients reported pain more than once weekly, took OA medication, desired surgery, showed fear-avoidance behavior, and were physically inactive. At the 12-month follow-up, patients with knee (n = 21647) and hip (n = 8898) OA reported significant improvements in NRS-pain, EQ-5D index, and a decrease in ASES-other symptoms and ASES-pain scores with an ES for patients with knee OA of -0.04 to 0.43 and hip OA of -0.18 to 0.22. Significantly fewer patients reported daily pain, desired surgery (for hip OA), reported fear-avoidance behavior, and reported sick leave. Following these interventions, patients with knee and hip OA experienced significant reductions in symptoms and decreased willingness to undergo surgery, while using less OA medication and taking less sick leave. The results indicate that offering this program as the first-line treatment for OA patients may reduce the burden of this disease.
我们评估了一种基于结构化教育和锻炼的膝关节或髋关节骨关节炎（OA）患者自我管理计划，使用了一项基于登记的研究，该研究的数据来自瑞典“更好管理骨关节炎患者”登记处的 44634 名患者。结果测量包括数字评分量表（NRS）、欧洲五维健康量表（EQ-5D）、关节炎自我效能量表（ASES-疼痛和 ASES-其他症状）、疼痛频率、任何 OA 药物的使用、手术意愿、回避行为、身体活动和病假。这些数据在基线、3 个月和 12 个月时报告。使用重复测量的一般线性模型分析量表变量的变化，使用 McNamara 检验分析二项变量的变化。所有分析均按关节分层。在 3 个月的随访中，膝关节 OA（n=30686）和髋关节 OA（n=13948）患者报告 NRS-疼痛、EQ-5D 指数、ASES-其他症状和 ASES-疼痛评分显著改善，膝关节 OA 的标准化效应大小（ES）范围为 0.25-0.57，髋关节 OA 的 ES 范围为 0.15-0.39。报告每周疼痛超过一次、使用 OA 药物、希望手术、表现出回避行为和身体不活跃的患者明显减少。在 12 个月的随访中，膝关节 OA（n=21647）和髋关节 OA（n=8898）患者报告 NRS-疼痛、EQ-5D 指数显著改善，ASES-其他症状和 ASES-疼痛评分降低，膝关节 OA 的 ES 范围为-0.04 至 0.43，髋关节 OA 的 ES 范围为-0.18 至 0.22。报告每天疼痛、希望手术（髋关节 OA）、回避行为和病假的患者明显减少。在这些干预措施之后，膝关节和髋关节 OA 患者的症状显著减轻，手术意愿降低，同时 OA 药物使用减少，病假减少。结果表明，为 OA 患者提供这种方案作为一线治疗可能会减轻这种疾病的负担。
