College of Pharmacy & Health Sciences, Physical Therapy Program, Campbell University, Lillington, NC.
Division of Physical Therapy, Duke Department of Orthopaedic Surgery, Duke Clinical Research Institute, Durham, NC.
Am J Med. 2021 Mar;134(3):351-360.e1. doi: 10.1016/j.amjmed.2020.08.006. Epub 2020 Sep 12.
This study aimed to report compliance with stepped care management of patellofemoral pain and determine whether adherence to stepped care results in decreased recurrence and lower health care utilization.
A total of 60,730 participants were included, using data from the Military Health System Data Repository, a large single-payer government health system. Outcomes included total knee-related care visits and costs, knee surgeries, opioid prescriptions, and 2-year recurrence. Stepped care was based on interventions delivered within the appropriate timing and in the appropriate order (low risk/cost before high risk/cost).
A total of 54,460 (89.7%) participants received adherent Step 1 care, 10,964 (18.1%) received step 2, and 4168 (6.9%) received step 3. A total of 32.0% and 50.8%, respectively, of all patients in Step 2 and Step 3 care were adherent. Of the 2385 participants (3.9% of cohort) that received both Step 2 and Step 3 care, 24.8% of participants received adherent care. For participants receiving both Step 2 and Step 3 care, adherence resulted in cost savings (mean difference [MD] $1708; 95% confidence interval [CI]: $1241, 2175), fewer knee-related visits (MD 3.4; 95% CI 2.2, 4.7), fewer episodes of knee pain (MD 0.7; 95% CI 0.5, 0.8), fewer knee surgeries (adjusted odds ratio 0.4; 95% CI 0.3, 0.5), and fewer opioid prescriptions (adjusted odds ratio 0.6; 95% CI 0.5, 0.8).
These findings demonstrate the value of following stepped care guidelines for pain management in patients with patellofemoral pain.
本研究旨在报告髌股疼痛阶梯式护理管理的依从性，并确定是否遵循阶梯式护理可降低复发率和降低医疗保健利用。
共纳入 60730 名参与者，数据来自大型单一支付方政府医疗系统的军事健康系统数据存储库。结果包括与全膝关节相关的就诊次数和费用、膝关节手术、阿片类药物处方和 2 年复发率。阶梯式护理基于在适当的时间内按适当的顺序提供的干预措施（低风险/成本在前，高风险/成本在后）。
共有 54460 名（89.7%）参与者接受了依从性第 1 步护理，10964 名（18.1%）接受了第 2 步护理，4168 名（6.9%）接受了第 3 步护理。分别有 32.0%和 50.8%的第 2 步和第 3 步护理患者是依从的。在接受第 2 步和第 3 步护理的 2385 名参与者（队列的 3.9%）中，24.8%的参与者接受了依从性护理。对于接受第 2 步和第 3 步护理的参与者，依从性可节省成本（平均差值[MD]为 1708 美元；95%置信区间[CI]：1241 美元，2175 美元），减少膝关节相关就诊次数（MD 为 3.4；95%CI 为 2.2，4.7），减少膝关节疼痛发作次数（MD 为 0.7；95%CI 为 0.5，0.8），减少膝关节手术次数（调整后的优势比为 0.4；95%CI 为 0.3，0.5），减少阿片类药物处方数量（调整后的优势比为 0.6；95%CI 为 0.5，0.8）。
这些发现表明，对于髌股疼痛患者的疼痛管理，遵循阶梯式护理指南具有重要价值。
