Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.
Medpace Inc., Cincinnati, Ohio, USA.
PM R. 2022 Jul;14(7):837-854. doi: 10.1002/pmrj.12654. Epub 2021 Aug 14.
To synthesize available evidence that has examined the relationship between physical therapy (PT) and opioid use. TYPE: Scoping Review LITERATURE SURVEY: Data sources including Google Scholar, Embase, PubMed, Cochrane Library, and CINAHL were searched for English articles up to October 24, 2019 using terms ("physical therapy"[Title/Abstract] OR physiotherapy[Title/Abstract] OR rehabilitation[Title/Abstract]) AND (opiate*[Title/Abstract] OR opioid*[Title/Abstract]).
Included studies evaluated a PT intervention and reported an opioid-use outcome. Data were extracted to describe the PT intervention, patient sample, opioid-use measurement, and results of any time or group comparisons. Study quality was evaluated with Joanna Briggs checklists based on study design.
Thirty studies were included that evaluated PT in at least one of these seven categories: interdisciplinary program (n = 8), modalities (n = 3), treatment (n = 3), utilization (n = 2), content (n = 3), timing (n = 13), and location (n = 2). Mixed results were reported for reduced opioid-use after interdisciplinary care and after PT modalities. Utilizing PT was associated with lower odds (ranging from 0.2-0.8) of using opioid medication for persons with low back pain (LBP) and injured workers; however, guideline-adherent care did not further reduce opioid use for persons with LBP. Early PT utilization after index visit for spine or joint pain and after orthopedic surgery was also associated with lower odds of using opioid medications (ranging from 0.27-0.93). Emergency department PT care was not associated with fewer opioid prescriptions than standard emergency department care. PT in a rehabilitation center after total knee replacement was not associated with lower opioid use than inpatient PT.
The relationship between timing of PT and opioid use was evaluated in 13 of 30 studies for a variety of patient populations. Eight of these 13 studies reported a relationship between early PT and reduced subsequent opioid use, making the largest sample of studies in this scoping review with supporting evidence. There is limited and inconclusive evidence to establish whether the content and/or location of PT interventions improves outcomes because of heterogeneity between studies.
综合现有证据，考察物理治疗（PT）与阿片类药物使用之间的关系。
范围综述
使用术语（“物理治疗”[标题/摘要]或物理疗法[标题/摘要]或康复[标题/摘要]）和（鸦片类药物*[标题/摘要]或阿片类药物*[标题/摘要]）在 Google Scholar、Embase、PubMed、Cochrane Library 和 CINAHL 等数据来源中搜索截至 2019 年 10 月 24 日的英文文章。
纳入的研究评估了 PT 干预措施，并报告了阿片类药物使用结果。提取数据以描述 PT 干预、患者样本、阿片类药物使用测量以及任何时间或组比较的结果。根据研究设计，使用 Joanna Briggs 清单评估研究质量。
共纳入 30 项研究，评估了至少以下 7 个类别的 PT：跨学科方案（n=8）、方式（n=3）、治疗（n=3）、利用（n=2）、内容（n=3）、时间（n=13）和地点（n=2）。跨学科护理和 PT 方式后阿片类药物使用减少的结果喜忧参半。对于腰痛（LBP）和受伤工人，利用 PT 与使用阿片类药物的可能性较低（范围从 0.2 到 0.8）相关；然而，对于 LBP 患者，遵循指南的护理并没有进一步减少阿片类药物的使用。脊柱或关节疼痛和骨科手术后首次就诊后早期接受 PT 治疗以及手术后早期接受 PT 治疗与使用阿片类药物的可能性降低（范围从 0.27 到 0.93）相关。与标准急诊护理相比，急诊部 PT 护理并没有减少阿片类药物的处方。全膝关节置换术后康复中心的 PT 与住院 PT 相比，使用阿片类药物的可能性没有降低。
在 30 项研究中，有 13 项研究评估了 PT 时机与阿片类药物使用之间的关系，涉及多种患者人群。其中 8 项研究报告了早期 PT 与随后阿片类药物使用减少之间的关系，这是该范围综述中具有支持证据的最大样本研究。由于研究之间存在异质性，因此，关于 PT 干预内容和/或地点是否能改善结果的证据有限且不明确。
