Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
J Man Manip Ther. 2021 Jun;29(3):158-167. doi: 10.1080/10669817.2020.1821327. Epub 2020 Sep 15.
The purpose of this case series was to describe the effects of a biopsychosocial approach that embeds pain neuroscience education (PNE) within physical therapy for improving foot and ankle function, pain, and psychosocial factors in patients with chronic plantar fasciitis.
Seven female patients (mean [SD] age = 49.0 [11.4] years) receiving physical therapy for chronic plantar fasciitis were enrolled. Along with formal physical therapy, patients received six 15-minute PNE sessions. Knowledge of pain neuroscience was assessed before and after PNE with the Revised Neurophysiology of Pain Questionnaire. Patients completed questionnaires for foot and ankle function (Activities of Daily Living subscale of the Foot and Ankle Ability Measure), pain intensity (Numeric Rating Scale), pain catastrophizing (Pain Catastrophizing Scale), and fear of movement (Tampa Scale for Kinesiophobia) at baseline (before treatment) and 6 and 12 weeks. Local and remote pain sensitivity was assessed using a pressure algometer at baseline and 6 weeks.
Patients attended a mean (range) of 8.7 (7 to 12) physical therapy sessions over a mean (range) of 46.7 (42 to 56) days. After PNE, six (86%) patients demonstrated increased knowledge of pain neuroscience. At 12 weeks, six (86%) patients met or exceeded minimally clinically important difference (MCID) for foot and ankle function and pain. Five (71%) patients met or exceeded MCID for pain catastrophizing and fear of movement. Local pain sensitivity was reduced in six (86%) patients.
Physical therapy integrating PNE is potentially beneficial for patients with chronic plantar fasciitis. Future studies should examine the efficacy of PNE in randomized trials with larger representative samples.
本病例系列研究的目的是描述一种将疼痛神经科学教育（PNE）嵌入物理治疗中的生物心理社会方法对改善慢性足底筋膜炎患者足部和踝关节功能、疼痛和心理社会因素的影响。
纳入 7 名（平均[标准差]年龄 49.0[11.4]岁）接受慢性足底筋膜炎物理治疗的女性患者。除了常规的物理治疗外，患者还接受了 6 次 15 分钟的 PNE 治疗。在接受 PNE 前后，使用修订后的疼痛神经生理学问卷评估对疼痛神经科学的了解程度。患者在基线（治疗前）和 6 周及 12 周时使用足踝能力测量的日常生活活动量表（Foot and Ankle Ability Measure 的日常生活活动量表）、疼痛强度（数字评分量表）、疼痛灾难化（疼痛灾难化量表）和运动恐惧（运动恐惧症量表）完成足部和踝关节功能问卷。在基线和 6 周时使用压力测痛仪评估局部和远程疼痛敏感性。
患者接受了平均（范围）8.7（7 至 12）次物理治疗，治疗时间平均（范围）为 46.7（42 至 56）天。接受 PNE 后，6 名（86%）患者对疼痛神经科学的了解程度增加。在 12 周时，6 名（86%）患者的足部和踝关节功能及疼痛达到或超过最小临床重要差异（MCID）。5 名（71%）患者的疼痛灾难化和运动恐惧达到或超过 MCID。6 名（86%）患者的局部疼痛敏感性降低。
整合 PNE 的物理治疗可能对慢性足底筋膜炎患者有益。未来的研究应在更大的代表性样本中进行随机试验，以检验 PNE 的疗效。
