針對性康復治療並不能改善全膝關節置換術後高風險患者的預後
作者：
小柯機器人發布時間：2020/10/17 22:52:17
英國愛丁堡大學David F Hamilton團隊研究了針對性康復治療對有不良預後風險的全膝關節置換術後患者預後的影響。2020年10月13日，該成果發表在《英國醫學雜誌》上。
為了針對全膝關節置換術後預後較差的患者，評估門診理療的漸進性療程是否能提供優於單次理療審查後基於家庭鍛鍊的幹預效果，研究組在英國的13個二級和三級治療中心進行了一項平行組隨機對照試驗。
研究組共招募了334名膝骨關節炎參與者，根據牛津膝關節評分，在術後6周被定義為全膝關節置換術後有不良預後的風險。將其隨機分組，其中163名患者接受理療師主導的門診康復（六周內做18次），171名患者接受單次理療審查後基於家庭鍛鍊的方案。主要結局是52周時的牛津大學膝關節評分，若兩組間差異超過4分，則被認為具有臨床意義。
共有8人失訪，幹預組依從率超過85%。52周時牛津膝蓋評分的組間差異為1.91分，門診康復組略佔優勢。分析所有時間點數據後，牛津膝關節評分的組間差異為2.25分，沒有臨床意義。在52周或更早的時間點，兩組間平均疼痛、嚴重疼痛、對結果滿意度或幹預後功能等次要結局均無顯著差異。
總之，對於全膝關節置換術後有不良預後風險的患者，門診治療師主導的康復治療並不優於單次物理治療師審查後以家庭鍛鍊為基礎的治療方案。
附：英文原文
Title: Targeting rehabilitation to improve outcomes after total knee arthroplasty in patients at risk of poor outcomes: randomised controlled trial
Author: David F Hamilton, David J Beard, Karen L Barker, Gary J Macfarlane, Christopher E Tuck, Andrew Stoddart, Timothy Wilton, James D Hutchinson, Gordon D Murray, A Hamish R W Simpson
Issue&Volume: 2020/10/13
Abstract:
Objective To evaluate whether a progressive course of outpatient physiotherapy offers superior outcomes to a single physiotherapy review and home exercise based intervention when targeted at patients with a predicted poor outcome after total knee arthroplasty.
Design Parallel group randomised controlled trial.
Setting 13 secondary and tertiary care centres in the UK providing postoperative physiotherapy.
Participants 334 participants with knee osteoarthritis who were defined as at risk of a poor outcome after total knee arthroplasty, based on the Oxford knee score, at six weeks postoperatively. 163 were allocated to therapist led outpatient rehabilitation and 171 to a home exercise based protocol.
Interventions All participants were reviewed by a physiotherapist and commenced 18 sessions of rehabilitation over six weeks, either as therapist led outpatient rehabilitation (progressive goal oriented functional rehabilitation protocol, modified weekly in one-one contact sessions) or as physiotherapy review followed by a home exercise based regimen (without progressive input from a physiotherapist).
Main outcome measures Primary outcome was Oxford knee score at 52 weeks, with a 4 point difference between groups considered to be clinically meaningful. Secondary outcomes included additional patient reported outcome measures of pain and function at 14, 26, and 52 weeks post-surgery.
Results 334 patients were randomised. Eight were lost to follow-up. Intervention compliance was more than 85%. The between group difference in Oxford knee score at 52 weeks was 1.91 (95% confidence interval 0.18 to 3.99) points, favouring the outpatient rehabilitation arm (P=0.07). When all time point data were analysed, the between group difference in Oxford knee score was a non-clinically meaningful 2.25 points (0.61 to 3.90, P=0.01). No between group differences were found for secondary outcomes of average pain (0.25 points, 0.78 to 0.28, P=0.36) or worst pain (0.22 points, 0.71 to 0.41, P=0.50) at 52 weeks or earlier time points, or of satisfaction with outcome (odds ratio 1.07, 95% confidence interval 0.71 to 1.62, P=0.75) or post-intervention function (4.64 seconds, 95% confidence interval 14.25 to 4.96, P=0.34).
Conclusions Outpatient therapist led rehabilitation was not superior to a single physiotherapist review and home exercise based regimen in patients at risk of poor outcomes after total knee arthroplasty. No clinically relevant differences were observed across primary or secondary outcome measures.
DOI: 10.1136/bmj.m3576
Source: https://www.bmj.com/content/371/bmj.m3576