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疼痛神经科学教育、混合练习和助推课程作为膝骨关节炎患者疼痛、功能和心理因素的有效治疗方法:一项为期 6 个月随访的单盲随机对照试验的研究方案,采用 2 因子设计。

Pain neuroscience education, blended exercises and booster sessions as an effective therapy for pain, functional and psychological factors in patients with knee osteoarthritis: a study protocol for a single-blind randomised controlled trial with 2 factorial design during 6-month follow-up.

机构信息

Biomechanics and Sports Injuries, Kharazmi University - Karaj, Hesarak, Iran.

Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

BMJ Open. 2023 May 12;13(5):e070336. doi: 10.1136/bmjopen-2022-070336.


DOI:10.1136/bmjopen-2022-070336
PMID:37173101
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10186447/
Abstract

INTRODUCTION: This study aims to investigate whether a pain neuroscience education (PNE) combined with a blended exercises programme including aerobic, resistance, neuromuscular, breathing, stretching and balance exercises and diet education provides greater pain relief and improvement in functional and psychological factors than PNE and blended exercises alone and whether 'exercise booster sessions (EBS)' approach may improve outcomes and increase adherence in patients with knee osteoarthritis (KOA) (by telerehabilitation (TR)). METHODS AND ANALYSIS: In this single-blind randomised controlled trial, 129 patients (both genders; age >40) diagnosed with KOA will be randomly assigned to one of the 2 treatment combinations as: (1) blended exercises alone (36 sessions over 12 weeks), (2) PNE alone (three sessions over 2 weeks), (3) combination of PNE with blended exercises (exercise three times a week for 12 weeks combined with three sessions of PNE) and (4) a control group. Outcome assessors will be blinded towards group allocation. The primary outcome variables are the visual analogue scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis index in knee osteoarthritis (WOMAC) score. Secondary outcomes include Pain Self-Efficacy Questionnaire (PSEQ), Depression, Anxiety and Stress Scale (DASS), Tampa Scale for Kinesiophobia (TSK), Short Falls Efficacy Scale International (FES-I), Pain Catastrophising Scale (PCS), Short Form Health Survey (SF-12) and Exercise Adherence Rating Scale (EARS), 30 s sit-to-stand test (30CST), Timed Up and Go (TUG), lower limbs' muscle strength and lower limb joints' active range of motion (AROM) will be performed at baseline, 3 and 6 months' postinterventions. The primary and secondary outcomes will assess at baseline, 3 months and 6 months postinterventions.The findings will be useful in establishing an effective treatment strategy covering multiple aspects behind KOA. The study protocol is conducted in clinical settings, thereby enhancing the possibility of future implementation of the treatments in the healthcare systems and self-care management. Results in comparison between groups will help to clarify the most effective of mixed-method TR (blended exercise, PNE, EBS with diet education) on more improvement in pain, functional and psychological factors in patients with KOA. This study will combine some of the most critical interventions, to be able to introduce a 'gold standard therapy' in the treatment of KOA. ETHICS AND DISSEMINATION: The trial has been approved by the ethics committee for research involving human subjects of the Sport Sciences Research Institute of Iran (IR.SSRC.REC.1401.021). The study findings will be published in international peer-reviewed journals. TRIAL REGISTRATION NUMBER: IRCTID: IRCT20220510054814N1.

摘要

简介:本研究旨在探究疼痛神经科学教育(PNE)与包括有氧运动、阻力运动、神经肌肉运动、呼吸运动、伸展运动和平衡运动以及饮食教育在内的混合运动方案相结合是否比单独的 PNE 和混合运动更能缓解疼痛,并改善功能和心理因素,以及“运动增强课程(EBS)”方法是否可以改善膝骨关节炎(KOA)患者的结局并提高其依从性(通过远程康复(TR))。

方法和分析:在这项单盲随机对照试验中,将 129 名(男女;年龄>40 岁)被诊断为 KOA 的患者随机分配到以下 2 种治疗组合之一:(1)单独混合运动(12 周内 36 次),(2)单独 PNE(2 周内 3 次),(3)PNE 与混合运动相结合(每周运动 3 次,持续 12 周,结合 3 次 PNE),(4)对照组。结果评估者将对分组情况保持盲态。主要结局变量是视觉模拟评分(VAS)和膝关节骨关节炎的西部安大略省和麦克马斯特大学骨关节炎指数(WOMAC)评分。次要结局包括疼痛自我效能问卷(PSEQ)、抑郁、焦虑和压力量表(DASS)、运动恐惧症量表(TSK)、国际跌倒效能量表(FES-I)、疼痛灾难化量表(PCS)、健康调查简表(SF-12)和运动依从性评定量表(EARS)、30 秒坐立试验(30CST)、计时起立行走试验(TUG)、下肢肌肉力量和下肢关节主动活动度(AROM)将在基线、3 个月和 6 个月的干预后进行。主要和次要结局将在基线、3 个月和 6 个月的干预后进行评估。

研究结果将有助于建立一种有效的治疗策略,涵盖膝骨关节炎背后的多个方面。该研究方案在临床环境中进行,从而提高了在医疗保健系统和自我保健管理中实施这些治疗方法的可能性。组间比较的结果将有助于阐明混合方法 TR(混合运动、PNE、EBS 与饮食教育)在改善膝骨关节炎患者疼痛、功能和心理因素方面最有效的方法。本研究将结合一些最关键的干预措施,为膝骨关节炎的治疗引入一种“黄金标准疗法”。

伦理和传播:该试验已获得伊朗运动科学研究所人体研究伦理委员会的批准(IR.SSRC.REC.1401.021)。研究结果将发表在国际同行评议期刊上。

试验注册:IRCTID:IRCT20220510054814N1。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0001/10186447/7d1998263943/bmjopen-2022-070336f10.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0001/10186447/7d1998263943/bmjopen-2022-070336f10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0001/10186447/e082d28e2b62/bmjopen-2022-070336f01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0001/10186447/a0ab38ab192e/bmjopen-2022-070336f02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0001/10186447/e67d033101d4/bmjopen-2022-070336f03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0001/10186447/8a0c93f2d1ae/bmjopen-2022-070336f04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0001/10186447/a7adfbd86995/bmjopen-2022-070336f05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0001/10186447/c965ee1f85bf/bmjopen-2022-070336f06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0001/10186447/56ac914fa6f5/bmjopen-2022-070336f07.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0001/10186447/c73adeed763f/bmjopen-2022-070336f08.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0001/10186447/25abe07ae8d5/bmjopen-2022-070336f09.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0001/10186447/7d1998263943/bmjopen-2022-070336f10.jpg

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本文引用的文献

[1]
Comparative efficacy of exercise therapy and oral non-steroidal anti-inflammatory drugs and paracetamol for knee or hip osteoarthritis: a network meta-analysis of randomised controlled trials.

Br J Sports Med. 2023-8

[2]
Effectiveness of Interventions Based on Pain Neuroscience Education on Pain and Psychosocial Variables for Osteoarthritis: A Systematic Review.

Int J Environ Res Public Health. 2022-2-23

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BMC Musculoskelet Disord. 2022-2-14

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Int J Environ Res Public Health. 2021-6-4

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