基于群组的运动、个体监督的运动和基于家庭的运动对肩峰下疼痛患者具有相似的临床效果和成本效益：一项随机试验。

Group-based exercise, individually supervised exercise and home-based exercise have similar clinical effects and cost-effectiveness in people with subacromial pain: a randomised trial.

机构信息

Department of Occupational Medicine, University Research Clinic, Danish Ramazzini Centre Regional Hospital Gødstrup, Herning, Denmark; Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark.

Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark.

出版信息

J Physiother. 2021 Apr;67(2):124-131. doi: 10.1016/j.jphys.2021.02.015. Epub 2021 Mar 17.

DOI:10.1016/j.jphys.2021.02.015

PMID:33744191

Abstract

QUESTION

What are the relative effects of group-based exercise, individual exercise and home-based exercise on clinical outcomes and costs in patients with subacromial pain?

DESIGN

Multicentre, three-arm, randomised controlled trial with concealed allocation and intention-to-treat analysis.

PARTICIPANTS

A total of 208 patients referred to municipal rehabilitation for management of subacromial pain in six municipalities in the Central Denmark Region.

INTERVENTIONS

Patients were randomly allocated to group-based exercise rehabilitation (GE), individual exercise rehabilitation (IE) or home exercise rehabilitation (HE) for a period of 8 weeks.

OUTCOME MEASURES

The primary outcome measure was the shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire (Quick-DASH). The secondary outcome measures included the EQ-5D-5L index, pain intensity, fear avoidance, psychological wellbeing, and the participant's perception of improvement and satisfaction. Healthcare and productivity costs were extracted from national health and social registers.

RESULTS

There was no important between-group difference in Quick-DASH scores at 6 months: adjusted mean differences GE minus IE -2 (95% CI -9 to 5), GE minus HE -2 (95% CI -9 to 5) and HE minus IE 1 (95% CI -6 to 7). The estimates of the between-group differences were able to exclude any clinically important differences in the three regimens' effects on health benefits according to the EQ-5D-5L index and other secondary outcomes. The total average costs were highest for the IE group and lowest for the HE, but not statistically different across groups.

CONCLUSION

In people with subacromial pain, group-based exercise, individually supervised exercise and home-based supervised exercise regimens have similar benefits. The home exercise intervention was associated with lowest costs.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT03055117.

摘要

问题

在肩峰下疼痛患者中，小组锻炼、个体锻炼和家庭锻炼对临床结果和成本的相对影响是什么？

设计

多中心、三臂、随机对照试验，采用隐藏分组和意向治疗分析。

参与者

共有 208 名患者被转诊到丹麦中部地区的六个市的市立康复机构接受肩峰下疼痛管理。

干预措施

患者被随机分配到小组锻炼康复（GE）、个体锻炼康复（IE）或家庭锻炼康复（HE）组，进行为期 8 周的康复治疗。

结果测量

主要结果测量指标是手臂、肩部和手残疾问卷的缩短版（Quick-DASH）。次要结果测量指标包括 EQ-5D-5L 指数、疼痛强度、恐惧回避、心理福利，以及参与者对改善和满意度的感知。医疗保健和生产力成本从国家健康和社会登记册中提取。

结果

在 6 个月时，Quick-DASH 评分在三组之间没有重要的组间差异：GE 减去 IE 的调整平均差异为-2（95%CI-9 至 5），GE 减去 HE 的调整平均差异为-2（95%CI-9 至 5），HE 减去 IE 的调整平均差异为 1（95%CI-6 至 7）。这些组间差异的估计值能够排除三种方案在根据 EQ-5D-5L 指数和其他次要结果评估健康获益方面的任何临床重要差异。总平均成本以 IE 组最高，HE 组最低，但组间无统计学差异。