School of Health Professions, Division of Physiotherapy, Bern University of Applied Sciences, Bern, Switzerland.
PhysioMetrics GmbH, Biberist, Switzerland.
J Bodyw Mov Ther. 2024 Apr;38:211-253. doi: 10.1016/j.jbmt.2023.11.063. Epub 2023 Dec 23.
Persistent musculoskeletal pain (PMP) is multifactorial and causes both societal and financial burdens. Integration of multifactorial management in patients with PMP remains challenging. A single-case experimental design was performed on three patients suffering from high impact PMP (lumbar spine, shoulder and knee) to i) assess the potential for Cognitive Functional Therapy (CFT) in interdisciplinary care, ii) describe in detail the clinical journey patients experienced during the intervention, and iii) evaluate the changes and associations in relation to the outcome measures of pain, disability, maladaptive movement behavior, subjective overall improvement, health related quality of life and work status. These were monitored over one year, at the end of each of the six intervention modules.
After introducing the intervention systematic changes were seen, with medium to large changes (Non-overlap of All Pairs 0.67-1) for all outcome measures. Associations between changes of the outcome measures were large (r ≥ 0.50) and changes occurred concurrently. Minimally clinically important difference thresholds were exceeded for all outcome measures and two patients achieved relevant improvements related to work reintegration.
The positive results of this study are comparable with recent CFT studies. However, the difference regarding the number of sessions and duration of the intervention is evident. The length of the intervention in this study seemed to enable continuous significant improvements up until 12 months post onset and follow-up.
CFT in interdisciplinary care was effective for all measures. The detailed descriptions of the clinical processes aim to improve clinical care.
持续性肌肉骨骼疼痛（PMP）是多因素的，会给社会和经济带来负担。整合多因素管理对于患有 PMP 的患者仍然具有挑战性。对 3 名患有高影响性 PMP（腰椎、肩部和膝关节）的患者进行了单病例实验设计，以评估认知功能疗法（CFT）在跨学科护理中的潜力，详细描述患者在干预过程中经历的临床历程，评估与疼痛、残疾、适应性运动行为、主观整体改善、健康相关生活质量和工作状态等结果测量相关的变化和关联。这些变化在一年的时间内，每个干预模块结束时进行监测。
在引入干预措施后，系统地观察到了变化，所有结果测量的变化幅度为中等至较大（所有对的非重叠 0.67-1）。结果测量的变化之间存在较大的关联（r≥0.50），并且同时发生变化。所有结果测量的最小临床重要差异阈值都被超过，两名患者在工作再融入方面取得了相关的改善。
这项研究的积极结果与最近的 CFT 研究相当。然而，在疗程和干预持续时间方面存在差异。本研究中干预的长度似乎使连续的显著改善能够持续到发病后 12 个月和随访。
跨学科护理中的 CFT 对所有措施都是有效的。临床过程的详细描述旨在改善临床护理。
