Baumann Anthony N, Indermuhle Thad, Oleson Caleb J, Callaghan Megan E, Rogers Hudson, Pennacchio Caroline, Curtis Deven P, Leland John Martin
Department of Rehabilitation Services, University Hospitals, Cleveland, USA.
College of Medicine, Northeast Ohio Medical University, Rootstown, USA.
Cureus. 2023 Aug 6;15(8):e43027. doi: 10.7759/cureus.43027. eCollection 2023 Aug.
Introduction Glenohumeral osteoarthritis (GHOA) is a common cause of musculoskeletal pain (MSP) that can frequently lead to pain and functional disability in patients throughout the world. GHOA can be managed with conservative or surgical interventions, although conservative interventions, such as physical therapy (PT), are generally first-line interventions depending on the severity of GHOA. The purpose of this retrospective analysis was to examine how conventional PT impacts outcomes for patients with GHOA based on the severity of radiographic GHOA findings. Methods This study is a retrospective chart review of patients who were referred to PT for MSP and received PT in the outpatient setting between 2016 and 2022. Inclusion criteria were patients who received PT in the outpatient setting, received PT for MSP, had shoulder radiograph imaging within two years of initial PT evaluation, had more than one PT visit (i.e. attended a follow-up session after initial evaluation), and did not have a history of shoulder surgery. Primary outcome measures were pain, abduction active range-of-motion (AROM), and disability via the quick disabilities of the arm, shoulder, and hand (DASH). Patients were divided into the No GHOA group (n=104), Mild GHOA group (n=61), and Moderate/Severe GHOA group (n=55) based on the radiographic GHOA severity. Results All included patients (n=220) had a mean age of 62.2 ± 12.4 years old with a mean number of PT visits of 7.8 ± 4.5 visits. There was initially a significant difference in the magnitude of pain improvement between the three groups based on radiographic severity of GHOA (Kruskal-Wallis H=6.038; p=0.049); however, post hoc testing revealed no significant difference between any of the three groups for pain improvement (p=0.061 to p=1.000). There was also no significant difference in the magnitude of abduction AROM improvement between the three groups based on the radiographic severity of GHOA (Kruskal-Wallis H=2.887; p=0.236). Finally, there was no significant difference in the magnitude of disability improvement via the Quick DASH between the three groups based on the radiographic severity of GHOA (Kruskal-Wallis H=0.156; p=0.925). Conclusion Patients with GHOA referred to PT experience small but statistically significant short-term improvements in pain, abduction AROM, and disability regardless of GHOA radiographic severity. There is no significant association between the magnitude of clinical improvement and the severity of radiographic GHOA. However, despite statistically significant improvements in pain, only patients with mild GHOA experienced clinically significant improvements in pain. Patients with GHOA, regardless of severity, may or may not experience clinically significant improvements in disability after PT.
引言
盂肱关节骨关节炎（GHOA）是肌肉骨骼疼痛（MSP）的常见原因，在全球范围内常导致患者疼痛和功能残疾。GHOA可通过保守或手术干预进行管理，尽管保守干预措施，如物理治疗（PT），通常根据GHOA的严重程度作为一线干预措施。本回顾性分析的目的是根据影像学GHOA表现的严重程度，研究传统PT对GHOA患者治疗效果的影响。
方法
本研究是对2016年至2022年期间因MSP转诊至PT并在门诊接受PT治疗的患者进行的回顾性病历审查。纳入标准为在门诊接受PT治疗、因MSP接受PT治疗、在首次PT评估后两年内进行过肩部X光成像、接受过不止一次PT治疗（即初次评估后参加了随访）且无肩部手术史的患者。主要结局指标为疼痛、外展主动活动范围（AROM）以及通过手臂、肩部和手部快速残疾评估量表（DASH）评估的残疾程度。根据影像学GHOA严重程度，将患者分为无GHOA组（n = 104）、轻度GHOA组（n = 61）和中度/重度GHOA组（n = 55）。
结果
所有纳入患者（n = 220）的平均年龄为62.2±12.4岁，平均PT治疗次数为7.8±4.5次。根据GHOA的影像学严重程度，三组之间最初在疼痛改善程度上存在显著差异（Kruskal-Wallis H = 6.038；p = 0.049）；然而，事后检验显示三组之间在疼痛改善方面均无显著差异（p = 0.061至p = 1.000）。根据GHOA的影像学严重程度，三组之间在外展AROM改善程度上也无显著差异（Kruskal-Wallis H = 2.887；p = 0.236）。最后，根据GHOA的影像学严重程度，三组之间通过快速DASH评估的残疾改善程度无显著差异（Kruskal-Wallis H = 0.156；p = 0.925）。
结论
转诊至PT的GHOA患者，无论GHOA影像学严重程度如何，在疼痛、外展AROM和残疾方面均有微小但具有统计学意义的短期改善。临床改善程度与影像学GHOA严重程度之间无显著关联。然而，尽管疼痛有统计学意义的改善，但只有轻度GHOA患者在疼痛方面有临床显著改善。GHOA患者，无论严重程度如何，PT治疗后在残疾方面可能有或可能没有临床显著改善。
