Stanton Tasha R, Karran Emma L, Butler David S, Hull Melissa J, Schwetlik Sarah N, Braithwaite Felicity A, Jones Hannah G, Moseley G Lorimer, Hill Catherine L, Tomkins-Lane Christy, Maher Carol, Bennell Kim
IIMPACT in Health, Allied Health and Human Performance, The University of South Australia, Adelaide, South Australia, Australia.
Neuroscience Research Australia, Sydney, New South Wales, Australia.
Pain Rep. 2020 Sep 24;5(5):e830. doi: 10.1097/PR9.0000000000000830. eCollection 2020 Sep-Oct.
Nine of 10 people with knee osteoarthritis are inactive. Unhelpful pain beliefs may negatively influence physical activity levels. Targeting these unhelpful pain beliefs, through contemporary pain science education (PSE), may provide benefit.
To evaluate the feasibility of conducting a clinical trial to determine the effect of adding PSE (vs adding sham ultrasound) to an individualised, physiotherapist-led education and walking program in people with painful knee osteoarthritis.
Twenty participants were randomised (1:1) into the PSE group or Control group, each receiving 4 in-person weekly treatments, then 4 weeks of at-home activities (weekly telephone check-in). Clinical outcomes and physical activity (7 days of wrist-worn accelerometry) were assessed at baseline, 4 (clinical outcomes only), 8, and 26 weeks. feasibility criteria for recruitment, intervention adherence, viability of wrist-based accelerometry, and follow-up retention were set. Perceived intervention credibility, acceptability, and usefulness from participants and clinicians were assessed (ratings, written/verbal feedback).
Most feasibility criteria were met. On average, 7 adults/wk were eligible, with 70% recruited. Treatment compliance was high (in-person: 80% PSE; 100% Control; at-home: 78% PSE; 75% Control). Wrist-based accelerometry had >75% valid wear-time. Sufficient follow-up rates were not achieved (26 weeks: 65%). Participant and clinician feedback highlighted that PSE was too complex and did not match patient expectations of "physiotherapy", that sham ultrasound was problematic (clinician), but that both treatments had high credibility, acceptability, and usefulness.
Progression to a full trial is warranted. Strategies to increase participant retention, refine the PSE content/delivery, and replace/remove the sham intervention are required.
十分之九的膝关节骨关节炎患者缺乏运动。无益的疼痛观念可能会对身体活动水平产生负面影响。通过当代疼痛科学教育（PSE）来针对这些无益的疼痛观念，可能会带来益处。
评估开展一项临床试验的可行性，以确定在针对疼痛性膝关节骨关节炎患者的个体化、由物理治疗师主导的教育和步行计划中增加PSE（与增加假超声相比）的效果。
20名参与者被随机（1:1）分为PSE组或对照组，每组每周接受4次面对面治疗，然后进行4周的家庭活动（每周电话随访）。在基线、4周（仅临床结果）、8周和26周时评估临床结果和身体活动（7天佩戴在手腕上的加速度计测量）。设定了招募、干预依从性、基于手腕的加速度计的可行性以及随访保留率的可行性标准。评估了参与者和临床医生对干预的可信度、可接受性和有用性（评分、书面/口头反馈）。
大多数可行性标准得到满足。平均每周有7名成年人符合条件，招募成功率为70%。治疗依从性很高（面对面：PSE组80%；对照组100%；家庭活动：PSE组78%；对照组75%）。基于手腕的加速度计有效佩戴时间超过75%。未达到足够的随访率（26周时：65%）。参与者和临床医生的反馈强调，PSE过于复杂，不符合患者对“物理治疗”的期望，假超声存在问题（临床医生），但两种治疗的可信度、可接受性和有用性都很高。
有必要推进全面试验。需要采取策略来提高参与者保留率，完善PSE内容/实施方式，并替换/去除假干预。
