Dekker Carolien, Goossens Mariëlle, Winkens Bjorn, Remerie Silvia, Bastiaenen Caroline, Verbunt Jeanine
Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands.
Department of Epidemiology, Care and Public Health Research Institute, Maastricht University, Peter Debyeplein 1, 6229 HA Maastricht, The Netherlands.
Children (Basel). 2020 Dec 11;7(12):288. doi: 10.3390/children7120288.
(1) Background: Chronic musculoskeletal pain (CMP) in adolescents can negatively affect physical, psychological, and social functioning, resulting in functional disability. This randomized controlled trial (RCT) aimed to evaluate the effectiveness of an outpatient rehabilitation program based on graded exposure in vivo (EP) compared with care as usual (CAU: interdisciplinary outpatient rehabilitation care). Both EP and CAU aim to improve functional ability in adolescents with CMP. (2) Methods: Pragmatic multicenter RCT with 12-month follow-up. Adolescents (12-21 years) with CMP were invited to participate. Primary outcome: functional disability; secondary outcomes: perceived harmfulness; pain catastrophizing; pain intensity. Data analysis: intention-to-treat linear mixed model. (3) Results: Sixty adolescents (mean 16 years) were randomized; data for 53 were analyzed. Adolescents in EP showed relevant and significant decreases in functional disability (estimated mean difference at least -8.81, ≤ 0.01) compared with CAU at all times. Significant differences in favor of EP were found for perceived harmfulness at all times ( ≤ 0.002), for pain catastrophizing at 2 months ( = 0.039) and for pain intensity at 4 and 10 months ( ≤ 0.028). (4) Conclusion: EP leads to a significant and clinically relevant decrease in functional disability compared with usual care.
(1) 背景：青少年慢性肌肉骨骼疼痛（CMP）会对身体、心理和社会功能产生负面影响，导致功能残疾。本随机对照试验（RCT）旨在评估基于现场分级暴露（EP）的门诊康复计划与常规护理（CAU：跨学科门诊康复护理）相比的有效性。EP和CAU的目标都是提高患有CMP的青少年的功能能力。(2) 方法：进行为期12个月随访的实用多中心RCT。邀请患有CMP的青少年（12 - 21岁）参与。主要结局：功能残疾；次要结局：感知有害性；疼痛灾难化；疼痛强度。数据分析：意向性治疗线性混合模型。(3) 结果：60名青少年（平均16岁）被随机分组；分析了53人的数据。与CAU相比，EP组青少年在所有时间点的功能残疾均有显著且相关的降低（估计平均差异至少为 - 8.81，P≤0.01）。在所有时间点，EP组在感知有害性方面均有显著差异（P≤0.002），在2个月时疼痛灾难化方面有显著差异（P = 0.039），在4个月和10个月时疼痛强度方面有显著差异（P≤0.028）。(4) 结论：与常规护理相比，EP可导致功能残疾显著且具有临床意义的降低。
