Prather Heidi, Fogarty Alexandra E, Cheng Abby L, Wahl Garett, Hong Barry, Hunt Devyani
Department of Physiatry, Hospital for Special Surgery, Weill Cornell Medical College, New York, USA.
Department of Neurology, Division of Physical Medicine & Rehabilitation, St. Louis, Missouri, USA.
PM R. 2023 Jan;15(1):41-50. doi: 10.1002/pmrj.12728. Epub 2021 Dec 10.
Lifestyle factors are associated with musculoskeletal pain and metabolic chronic diseases. To date, intensive lifestyle medicine programs have predominantly targeted metabolic rather than musculoskeletal conditions.
To assess the feasibility of an intensive interprofessional lifestyle medicine program for patients with musculoskeletal conditions.
Prospective observational feasibility study.
Tertiary academic medical center.
Adults diagnosed with musculoskeletal condition(s) and lifestyle-related chronic disease(s) who previously completed standard-of-care musculoskeletal treatments, enrolled from 2018 to 2020.
Patients enrolled in an intensive interprofessional lifestyle medicine program led by a physiatrist, with options to interface with an acupuncturist, dietician, massage therapist, psychologist, physical therapist, and smoking cessation specialist. The physiatrist engaged in shared decision making with patients to establish program goals related to function, overall health, and required lifestyle changes. Bimonthly interprofessional team conferences facilitated communication between treatment team and patients.
Feasibility was measured by patient participation and goal attainment. Secondary outcomes included changes from program enrollment to discharge in patient anthropometric, metabolic lab, sleep apnea risk, and Patient-Reported Outcomes Measurement Information System (PROMIS) function, pain, and behavioral health measures.
Twenty-six patients enrolled in the program (18 [69%] female, mean age 59 [SD 14.5] years, baseline hemoglobin A1c 6.0% [0.8%], high-sensitivity C-reactive protein 7.7 [12.1] mg/dL, 25-hydroxy vitamin D 32.0 [14.2] ng/mL). Of 21 (81%) patients who completed the program, 13/21 (62%) met their goal. On average, program completers presented for 26.2 (10.6) total visits over 191 (88) days. By discharge, program completers achieved clinically meaningful improvement in PROMIS Anxiety (mean difference -3.5 points, 95% confidence interval [-6.5 to 0.5], p = .035), whereas noncompleters did not (p > .05).
An intensive interprofessional lifestyle medicine program for patients with musculoskeletal conditions is feasible. With training in lifestyle intervention, physiatrists are well suited to lead interprofessional teams aimed at assisting patients in making lifestyle changes to achieve personalized function- and health-related goals.
生活方式因素与肌肉骨骼疼痛和慢性代谢性疾病相关。迄今为止，强化生活方式医学项目主要针对代谢性疾病而非肌肉骨骼疾病。
评估针对肌肉骨骼疾病患者的强化跨专业生活方式医学项目的可行性。
前瞻性观察性可行性研究。
三级学术医疗中心。
2018年至2020年招募的，被诊断患有肌肉骨骼疾病和与生活方式相关的慢性疾病且之前已完成标准护理肌肉骨骼治疗的成年人。
患者参加由物理医学与康复医师领导的强化跨专业生活方式医学项目，可选择与针灸师、营养师、按摩治疗师、心理学家、物理治疗师和戒烟专家进行交流。物理医学与康复医师与患者共同参与决策，以确定与功能、整体健康以及所需生活方式改变相关的项目目标。每两个月举行一次跨专业团队会议，促进治疗团队与患者之间的沟通。
通过患者参与度和目标达成情况来衡量可行性。次要结局包括从项目入组到出院时患者人体测量学、代谢实验室指标、睡眠呼吸暂停风险以及患者报告结局测量信息系统（PROMIS）功能、疼痛和行为健康指标的变化。
26名患者参加了该项目（18名[69%]女性，平均年龄59岁[标准差14.5]，基线糖化血红蛋白6.0%[0.8%]，高敏C反应蛋白7.7[12.1]mg/dL，25-羟维生素D 32.0[14.2]ng/mL）。在21名（81%）完成项目的患者中，13/21（62%）实现了他们的目标。平均而言，项目完成者在191天（88次）内共就诊26.2次（10.6次）。到出院时，项目完成者在PROMIS焦虑量表上取得了具有临床意义的改善（平均差异-3.5分，95%置信区间[-6.5至0.5]，p = 0.035），而未完成者则没有（p>0.05）。
针对肌肉骨骼疾病患者的强化跨专业生活方式医学项目是可行的。通过生活方式干预方面的培训，物理医学与康复医师非常适合领导跨专业团队，旨在帮助患者进行生活方式改变，以实现个性化的功能和健康相关目标。
