Annals of Physical and Rehabilitation Medicine最新文献_第3页

Differences and Interplay between serendipitous and theory-driven discoveries in treating disorders of consciousness 在治疗意识障碍的偶然发现和理论驱动发现之间的差异和相互作用。

IF 3.9 3区医学 Q1 REHABILITATION

Annals of Physical and Rehabilitation Medicine

Pub Date : 2025-01-10 DOI: 10.1016/j.rehab.2024.101918

Jacques Luauté, Caroline Herault , Daphné Rimsky Robert , Abdulrahman Alnuaimi, Nathalie André-Obadia, Lionel Naccache, Hugo Ardaillon

引用次数: 0

Nitrous oxide analgesia for rehabilitation after anterior cruciate ligament reconstruction: A randomized controlled trial 一氧化二氮镇痛用于前交叉韧带重建后的康复：一项随机对照试验。

IF 3.9 3区医学 Q1 REHABILITATION

Annals of Physical and Rehabilitation Medicine

Pub Date : 2025-01-10 DOI: 10.1016/j.rehab.2024.101897

Ziyang Wang , Lingjun Zhou , Fei Wang , Xiaochen Jiang , Weifeng Wang , Xueling Qiu , Yihui Xing , Chongjian Fu , Ping Zhong , Lu Tang

Background

Although there is increasing emphasis on rehabilitation training after ligament reconstruction, little is known about the pain induced by the procedure itself. Procedural success may be limited by pain and anxiety. Nitrous oxide is widely used to alleviate procedural pain. However, few studies have been conducted to show the efficacy and safety of nitrous oxide for rehabilitation training.

Objectives

To explore the short-term efficacy and safety of nitrous oxide for acute pain elicited by rehabilitation training.

Methods

A double-blinded randomized placebo-controlled trial was conducted in the department of rehabilitation medicine. People willing to participate in the trial and sign informed consent, ≥18 years old, who had acute pain (self-reported pain score ≥4) caused by rehabilitation training after anterior cruciate ligament reconstruction were recruited. Participants undergoing rehabilitation training were randomized to receive either 65 % nitrous oxide or 100 % oxygen. The primary outcome was the pain score. Secondary outcomes were sedation score, range of motion, vital signs, physician and participant satisfaction, acceptance, and side effects.

Results

120 people were enrolled; 60 received nitrous oxide and 60 received oxygen. The nitrous oxide group had a significantly lower pain score than the placebo group (P < 0.001, median difference -3, 95 % CI -4 to -2, effect size η² = 0.369) and sedation scores (P < 0.001, median difference 1, 95 % CI 1 to 1, η² = 0.263) during the procedure. Both physician (P < 0.001) and participant (P < 0.001) satisfaction were significantly higher in the intervention group than the placebo group. Acceptance (willingness to use the same gas next time) differed between groups (P < 0.001). No serious side effects occurred.

Conclusion

This study provides evidence supporting the efficacy and safety of self-administered nitrous oxide to reduce procedural pain during rehabilitation training after anterior cruciate ligament reconstruction.

背景：虽然人们越来越重视韧带重建后的康复训练，但对手术本身引起的疼痛知之甚少。手术的成功可能受到疼痛和焦虑的限制。一氧化二氮被广泛用于减轻程序性疼痛。然而，很少有研究表明氧化亚氮用于康复训练的有效性和安全性。目的：探讨氧化亚氮治疗康复训练引起的急性疼痛的近期疗效和安全性。方法：在康复内科进行双盲随机安慰剂对照试验。招募愿意参加试验并签署知情同意书的患者，年龄≥18岁，前交叉韧带重建后因康复训练引起急性疼痛（自述疼痛评分≥4分）。接受康复训练的参与者随机接受65%的氧化亚氮或100%的氧气。主要结果是疼痛评分。次要结局是镇静评分、活动范围、生命体征、医生和参与者满意度、接受度和副作用。结果：入组120人；60人接受氧化亚氮，60人接受氧气。在手术过程中，氧化亚氮组的疼痛评分明显低于安慰剂组（P < 0.001，中位数差值-3,95% CI -4 ~ -2，效应大小η2 = 0.369）和镇静评分（P < 0.001，中位数差值1,95% CI 1 ~ 1, η2 = 0.263）。干预组的医师满意度（P < 0.001）和参与者满意度（P < 0.001）均显著高于安慰剂组。接受度（下次使用相同气体的意愿）在两组之间存在差异（P < 0.001）。没有发生严重的副作用。结论：本研究支持自体氧化亚氮减少前交叉韧带重建术后康复训练过程疼痛的有效性和安全性。

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引用次数: 0

Combining therapeutic strategies with rehabilitation improves motor recovery in animal models of spinal cord injury: A systematic review and meta-analysis 结合治疗策略和康复改善脊髓损伤动物模型的运动恢复：一项系统回顾和荟萃分析。

IF 3.9 3区医学 Q1 REHABILITATION

Annals of Physical and Rehabilitation Medicine

Pub Date : 2025-01-10 DOI: 10.1016/j.rehab.2024.101911

Liang Zhang , Shin Yamada , Narihito Nagoshi , Munehisa Shinozaki , Tetsuya Tsuji , Masaya Nakamura , Hideyuki Okano , Syoichi Tashiro

Background

Despite the lack of clinically validated strategies for treating spinal cord injury (SCI), combining therapeutic strategies with rehabilitation is believed to promote recovery of motor function; however, current research findings are inconsistent.

Objectives

To explore whether combination therapy involving therapy and rehabilitative training (CIRT) has a synergistic effect on motor function recovery in animal models of SCI.

Methods

We conducted a systematic review and meta-analysis of studies identified in a keyword search of 6 databases and extracted open-field motor scores from the Basso Mouse Scale (BMS) and the Basso, Beattie, and Bresnahan Locomotor Rating Scale (BBB) for meta-analysis using a weighted mean difference (WMD) and 95 % CI. We also performed qualitative synthesis and analysis of secondary outcome measures related to histological improvements and adverse effects.

Results

Eighty-seven preclinical studies were included. Combination treatment with treadmill training resulted in a significant improvement in motor function (1.40, 95 % CI 0.82 to 1.98, P < 0.01, I² = 49 %), especially when initiated 1–2 weeks post-injury (1.77, 95 % CI 1.10 to 2.45, P < 0.01, I² = 33 %) in rats. In mice, CIRT lasting <6 weeks may enhance recovery (0.95, 95 % CI 0.49 to 1.40, P < 0.01, I² = 33 %). Although there is a trend toward better outcomes in the chronic phase, insufficient sample sizes prevent definitive conclusions from being drawn. Combined therapy also enhances the reorganization of inhibitory synaptic structures and functions, without aggravating allodynia or spasticity.

Conclusions

This systematic review and meta-analysis suggest that CIRT can lead to superior motor function recovery compared to single-modality therapy (SMT) in animal models of SCI, with no significant adverse effects on allodynia or spasticity. However, the efficacy of CIRT depends on various factors, and further research is needed to establish optimal treatment strategies and understand the underlying mechanisms of recovery.

背景：尽管缺乏临床验证的治疗脊髓损伤（SCI）的策略，但将治疗策略与康复相结合被认为可以促进运动功能的恢复；然而，目前的研究结果并不一致。目的：探讨包括治疗和康复训练（CIRT）在内的联合治疗是否对脊髓损伤动物模型的运动功能恢复具有协同作用。方法：我们对6个数据库中关键词搜索的研究进行了系统回顾和荟萃分析，并从Basso小鼠量表（BMS）和Basso， Beattie， and Bresnahan运动评定量表（BBB）中提取了开放场运动评分，使用加权平均差（WMD）和95% CI进行荟萃分析。我们还对与组织学改善和不良反应相关的次要结局指标进行了定性综合和分析。结果：纳入87项临床前研究。联合治疗与跑步机训练可显著改善大鼠的运动功能（1.40,95% CI 0.82至1.98,P < 0.01, I2 = 49%），特别是在损伤后1-2周（1.77,95% CI 1.10至2.45,P < 0.01, I2 = 33%）。在小鼠中，CIRT持续2 = 33%)。虽然在慢性期有较好结果的趋势，但样本量不足阻碍了得出明确的结论。联合治疗也增强了抑制性突触结构和功能的重组，而不会加重异常性疼痛或痉挛。结论：本系统综述和荟萃分析表明，在脊髓损伤动物模型中，与单模态治疗（SMT）相比，CIRT可导致更好的运动功能恢复，且对异常性疼痛或痉挛无明显不良影响。然而，CIRT的疗效取决于多种因素，需要进一步研究以建立最佳治疗策略并了解恢复的潜在机制。

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引用次数: 0

Effect of exercise on quality of life in people with chronic obstructive pulmonary disease: A network meta-analysis of RCTs 运动对慢性阻塞性肺疾病患者生活质量的影响：随机对照试验的网络荟萃分析

IF 3.9 3区医学 Q1 REHABILITATION

Annals of Physical and Rehabilitation Medicine

Pub Date : 2024-12-12 DOI: 10.1016/j.rehab.2024.101890

Susana Priego-Jiménez , Maribel Lucerón-Lucas-Torres , Patricia Lorenzo-García , Marta González-Molinero , Alberto Bermejo-Cantarero , Celia Álvarez-Bueno

Background

Chronic obstructive pulmonary disease (COPD) is characterized by a gradual deterioration of respiratory capacity, with worsening fatigue, weakness, activity intolerance, and dyspnea, influencing the person's emotional state and quality of life (QoL).

Objective

A network meta-analysis (NMA) was performed to determine the effects of different physical activity interventions on overall QoL in people with COPD, followed by a meta-analysis on the effect of these interventions on the different domains of the QoL scales.

Methods

A literature search was performed from inception to December 2023. Randomized controlled trials on the effectiveness of exercise programs on QoL in people with COPD were included. We assessed the risk of bias using the Cochrane Risk of Bias (RoB 2.0) tool and used the Grading of Recommendations, Assessment, Development, and Evaluation tool (GRADE) to assess the quality of the evidence. Pairwise meta-analysis and NMA for direct and indirect evidence were performed.

Results

A total of 54 studies were included in the NMA. The largest effects were for active mind-body movement therapy (AMBMT) programs versus control interventions (usual practice) for total QoL (effect size [ES] 0.87; 95 % CI 0.65–1.09), followed by endurance (END) vs control (ES 0.75; 95 % CI 0.27–1.24) and combined (COMB) versus control (ES 0.73; 95 % CI 0.02–1.43). The results reflected an improvement in all subdomains of the QoL scales, except for social support.

Conclusions

AMBMT should be considered the most effective strategy to improve overall QoL in people with COPD, followed by END and COMB interventions. Physical activity interventions produce a positive effect in all the QoL domains studied, except for social support.

PROSPERO registration number

CRD42023393463.

背景：慢性阻塞性肺疾病（COPD）以呼吸能力逐渐恶化为特征，伴有疲劳、无力、活动不耐受和呼吸困难的加重，影响患者的情绪状态和生活质量（QoL）。目的：通过网络荟萃分析（NMA）确定不同体育活动干预对COPD患者总体生活质量的影响，然后对这些干预对生活质量量表不同领域的影响进行荟萃分析。方法：从成立到2023年12月进行文献检索。纳入了关于运动项目对慢性阻塞性肺病患者生活质量影响的随机对照试验。我们使用Cochrane风险偏倚（RoB 2.0）工具评估偏倚风险，并使用分级推荐、评估、发展和评价工具（GRADE）评估证据质量。对直接和间接证据进行两两荟萃分析和NMA。结果：NMA共纳入54项研究。对总生活质量影响最大的是主动身心运动疗法（AMBMT）方案与对照干预（常规做法）(效应量[ES] 0.87；95% CI 0.65-1.09)，其次是耐力（END） vs对照组(ES 0.75；95% CI 0.27-1.24)和联合（COMB）与对照组(ES 0.73；95% ci 0.02-1.43)。结果表明，除了社会支持外，生活质量量表的所有子领域都有所改善。结论：AMBMT应被认为是改善COPD患者总体生活质量的最有效策略，其次是END和COMB干预。除了社会支持外，体育活动干预在所有研究的生活质量领域都产生积极影响。普洛斯彼罗注册号：CRD42023393463。

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引用次数: 0

Effects of high-intensity interval training on cardiorespiratory function in coronary artery disease: An overview of systematic reviews 高强度间歇训练对冠心病患者心肺功能的影响：系统综述

IF 3.9 3区医学 Q1 REHABILITATION

Annals of Physical and Rehabilitation Medicine

Pub Date : 2024-12-09 DOI: 10.1016/j.rehab.2024.101878

Yingtian Yang , Qianyu Lv , Xirui Zhang , Qian Wu , Lanlan Li , Xuejiao Ye , Shihan Wang

Background

Exercise-based cardiac rehabilitation has been identified as a crucial component in mitigating all-cause mortality among individuals diagnosed with coronary artery disease (CAD). Nevertheless, the optimal exercise prescription remains elusive.

Objective

The purpose of this overview is to conduct a systematic evaluation and synthesis of the evidence derived from systematic reviews/meta-analyses (SRs/MAs) regarding the effects on cardiorespiratory fitness and safety of high-intensity interval training (HIIT) compared to moderate-intensity continuous training (MICT) for CAD.

Methods

SRs/MAs were searched across 5 databases from inception until March 22, 2023. We assessed methodological quality using the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2). The risk of bias, reporting, and evidence were evaluated using the Risk of Bias in Systematic Reviews (ROBIS) tool, the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA) 2020, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, respectively.

Results

In total, 9 SRs/MAs were included. Based on the AMSTAR-2 criteria, 4 and 5 studies were considered low- and critically-low quality, respectively. None of the studies reported all 27 items outlined in the PRISMA 2020 checklist. Regarding the ROBIS evaluation, 4 reviews were rated as low risk, 4 as high risk, and 1 as unclear risk. The GRADE evaluation indicated 3 high-level evidence, 20 moderate-level evidence, 28 low-level evidence, and 34 very low-level evidence studies based on 85 indicators. Moderate- to high-quality evidence supported that HIIT is superior to MICT in improving VO₂peak for CAD.

Conclusion

The efficacy and time cost of developing cardiorespiratory fitness support HIIT as an adjunct or alternative to MICT. The evidence does not permit a definitive decision regarding the adverse effects of HIIT compared to MICT. Because of the insufficient quality of the evidence, future studies should focus more on the quality of randomized controlled trials and evidence for SRs/MAs to provide scientific and robust evidence for conclusions.

Trial Registration

The review was registered at PROSPERO: CRD42023420015

背景：以运动为基础的心脏康复已被确定为降低冠心病（CAD）患者全因死亡率的关键组成部分。然而，最佳的运动处方仍然难以捉摸。目的：本综述的目的是对来自系统综述/荟萃分析（SRs/MAs）的证据进行系统评估和综合，这些证据涉及与中等强度连续训练（MICT）相比，高强度间歇训练（HIIT）对CAD的心肺健康和安全性的影响。方法：在5个数据库中检索自成立至2023年3月22日的SRs/MAs。我们使用评估系统评价方法质量2 （AMSTAR-2）来评估方法质量。分别使用系统评价偏倚风险（ROBIS）工具、系统评价和荟萃分析首选报告项目（PRISMA） 2020和建议评估、发展和评价分级（GRADE）系统评估偏倚风险、报告风险和证据风险。结果：共纳入9例SRs/MAs。根据AMSTAR-2标准，4项和5项研究分别被认为是低质量和极低质量。没有一项研究报告了PRISMA 2020清单中列出的全部27个项目。关于ROBIS评价，4篇评价被评为低风险，4篇评价被评为高风险，1篇评价被评为不明确风险。GRADE评价基于85项指标，有3项高水平证据、20项中等水平证据、28项低水平证据和34项极低水平证据研究。中等到高质量的证据支持HIIT在改善CAD的VO2peak方面优于MICT。结论：发展心肺健康支持HIIT作为辅助或替代MICT的有效性和时间成本。证据不允许对HIIT与MICT相比的不良影响做出明确的决定。由于证据质量不足，未来的研究应更多地关注随机对照试验的质量和SRs/MAs的证据，为结论提供科学和有力的证据。试验注册：本综述在PROSPERO注册：CRD42023420015。

{"title":"Effects of high-intensity interval training on cardiorespiratory function in coronary artery disease: An overview of systematic reviews","authors":"Yingtian Yang , Qianyu Lv , Xirui Zhang , Qian Wu , Lanlan Li , Xuejiao Ye , Shihan Wang","doi":"10.1016/j.rehab.2024.101878","DOIUrl":"10.1016/j.rehab.2024.101878","url":null,"abstract":"<div><h3>Background</h3><div>Exercise-based cardiac rehabilitation has been identified as a crucial component in mitigating all-cause mortality among individuals diagnosed with coronary artery disease (CAD). Nevertheless, the optimal exercise prescription remains elusive.</div></div><div><h3>Objective</h3><div>The purpose of this overview is to conduct a systematic evaluation and synthesis of the evidence derived from systematic reviews/meta-analyses (SRs/MAs) regarding the effects on cardiorespiratory fitness and safety of high-intensity interval training (HIIT) compared to moderate-intensity continuous training (MICT) for CAD.</div></div><div><h3>Methods</h3><div>SRs/MAs were searched across 5 databases from inception until March 22, 2023. We assessed methodological quality using the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2). The risk of bias, reporting, and evidence were evaluated using the Risk of Bias in Systematic Reviews (ROBIS) tool, the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA) 2020, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, respectively.</div></div><div><h3>Results</h3><div>In total, 9 SRs/MAs were included. Based on the AMSTAR-2 criteria, 4 and 5 studies were considered low- and critically-low quality, respectively. None of the studies reported all 27 items outlined in the PRISMA 2020 checklist. Regarding the ROBIS evaluation, 4 reviews were rated as low risk, 4 as high risk, and 1 as unclear risk. The GRADE evaluation indicated 3 high-level evidence, 20 moderate-level evidence, 28 low-level evidence, and 34 very low-level evidence studies based on 85 indicators. Moderate- to high-quality evidence supported that HIIT is superior to MICT in improving VO<sub>2</sub>peak for CAD.</div></div><div><h3>Conclusion</h3><div>The efficacy and time cost of developing cardiorespiratory fitness support HIIT as an adjunct or alternative to MICT. The evidence does not permit a definitive decision regarding the adverse effects of HIIT compared to MICT. Because of the insufficient quality of the evidence, future studies should focus more on the quality of randomized controlled trials and evidence for SRs/MAs to provide scientific and robust evidence for conclusions.</div></div><div><h3>Trial Registration</h3><div>The review was registered at PROSPERO: CRD42023420015</div></div>","PeriodicalId":56030,"journal":{"name":"Annals of Physical and Rehabilitation Medicine","volume":"68 2","pages":"Article 101878"},"PeriodicalIF":3.9,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effect of exercise interventions on oxygen uptake in people with chronic obstructive pulmonary disease: A network meta-analysis of randomized controlled trials 运动干预对慢性阻塞性肺病患者摄氧量的影响：随机对照试验的网络荟萃分析。

IF 3.9 3区医学 Q1 REHABILITATION

Annals of Physical and Rehabilitation Medicine

Pub Date : 2024-11-01 DOI: 10.1016/j.rehab.2024.101875

Susana Priego-Jiménez , Maribel Lucerón-Lucas-Torres , Marta Carolina Ruiz-Grao , Mª José Guzmán-Pavón , Patricia Lorenzo-García , Felipe Araya-Quintanilla , Celia Álvarez-Bueno

Background

Although aerobic training leads to physiological improvements in people with chronic obstructive pulmonary disease (COPD), measured by the VO2 peak, there is no evidence as to which type of physical exercise intervention is the most effective in improving the VO₂ peak or max.

Objective

A network meta-analysis (NMA) was performed to determine the effects of different physical interventions on oxygen uptake in people with COPD.

Methods

A literature search was performed from database inception to February 2024. Randomized controlled trials on the effectiveness of exercise programs on oxygen uptake with COPD were included. We assessed the risk of bias using the Cochrane Risk of Bias (RoB 2.0) tool and the quality of the evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. Pairwise meta-analyses and NMAs were performed for direct and indirect evidence.

Results

A total of 22 studies were included in this NMA. The highest effects for improvement in oxygen uptake scores were for continuous, moderate-intensity endurance exercise versus a control (effect size [ES]: 1.17; 95% CI 0.59 to 1.74), followed by continuous, high-intensity endurance exercise versus a control (ES: 0.47; 95% CI 0.08 to 0.85), and combined exercise versus a control (ES: 0.41; 95% CI 0.18 to 0.64).

Conclusions

Continuous, moderate-intensity endurance exercise should be considered the most effective strategy to improve oxygen uptake in people with COPD, followed by continuous, high-intensity endurance exercise and combined exercise. Due to the importance of VO₂ as a predictor of quality of life and mortality in people with COPD, it is essential to include its assessment in clinical guidelines and to include the most effective physical activity interventions to improve it.

Trial Registration

PROSPERO database: CRD42023425893

背景：虽然有氧训练能改善慢性阻塞性肺病（COPD）患者的生理状况（以VO2峰值衡量），但没有证据表明哪种体育锻炼干预对提高VO2峰值或最大值最有效：目的：进行了一项网络荟萃分析（NMA），以确定不同体育干预措施对慢性阻塞性肺病患者摄氧量的影响：方法：对从数据库开始到 2024 年 2 月的文献进行了检索。方法：从数据库开始到 2024 年 2 月，我们对文献进行了检索，纳入了有关运动项目对慢性阻塞性肺病患者摄氧量效果的随机对照试验。我们使用科克伦偏倚风险（RoB 2.0）工具评估了偏倚风险，并使用建议、评估、发展和评价分级（GRADE）工具评估了证据质量。对直接和间接证据进行了配对荟萃分析和近似荟萃分析：结果：共有 22 项研究被纳入 NMA。持续、中等强度的耐力运动与对照组相比，摄氧量评分的改善效果最高（效应大小 [ES]：1.17；95% CI 0.59 至 1.74），其次是持续、高强度的耐力运动与对照组相比（ES：0.47；95% CI 0.08 至 0.85），以及综合运动与对照组相比（ES：0.41；95% CI 0.18 至 0.64）：结论：持续、中等强度的耐力运动应被视为改善慢性阻塞性肺病患者摄氧量的最有效策略，其次是持续、高强度的耐力运动和综合运动。由于容氧量是预测慢性阻塞性肺病患者生活质量和死亡率的重要指标，因此必须将其评估纳入临床指南，并采用最有效的体育锻炼干预措施来提高容氧量：试验注册：PROSPERO 数据库：试验注册：PROSPERO 数据库：CRD42023425893。

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引用次数: 0

Validation of the French Arthritis Self-Efficacy Scale short form (ASES-8-F) in people with knee osteoarthritis 在膝关节骨性关节炎患者中验证法国关节炎自我效能量表简表（ASES-8-F）

IF 3.9 3区医学 Q1 REHABILITATION

Annals of Physical and Rehabilitation Medicine

Pub Date : 2024-10-28 DOI: 10.1016/j.rehab.2024.101888

Shenhao Dai, Charlotte Lanhers, Nicolas Coste, Chloé Gay, Loic Bareyre, Bruno Pereira, Emmanuel Coudeyre

引用次数: 0

A biopsychosocial approach to phenotyping people with knee osteoarthritis awaiting total knee arthroplasty: A secondary cohort analysis 用生物心理社会学方法对等待进行全膝关节置换术的膝关节骨性关节炎患者进行表型分析：二次队列分析

IF 3.9 3区医学 Q1 REHABILITATION

Annals of Physical and Rehabilitation Medicine

Pub Date : 2024-10-28 DOI: 10.1016/j.rehab.2024.101895

Sophie Vervullens , Lotte Meert , Rob J.E.M. Smeets , Gavin van der Nest , Jonas Verbrugghe , Peter Verdonk , Frank Th.G. Rahusen , Mira Meeus

Background

Previous research showed chronic post-total knee arthroplasty (TKA) pain in 20% of people with knee osteoarthritis (KOA). Various preoperative biopsychosocial-related factors have been described, but phenotyping people with KOA awaiting TKA based on these factors is still lacking. This could be relevant to understanding differences in TKA surgery responses.

Objective

To identify phenotypes in people with KOA awaiting TKA and differences in post-TKA pain based on preoperative biopsychosocial factors.

Methods

People with KOA awaiting TKA in 4 hospitals in Belgium and the Netherlands were included. A cross-sectional latent profile analysis was conducted on structural, metabolic, functional, pain-related, psychological and social variables. Concurrent validity was tested using 3-step multinomial logistic regression. The difference in one-year post-TKA pain was examined with linear mixed model analysis.

Results

Two hundred and seventeen participants were included in the latent profile analysis with a mean (SD) age of 65.5 (7.7) years, including 109 women. A model with 2 phenotypes differed in 14 out of 21 variables. Participants with phenotype 2 (28%) had a higher body mass index (BMI), higher chance of having less structural damage (KOA grade), lower mean quadriceps strength and physical function (Knee Society Scoring System functional and 30-second chair stand test), higher pain intensity, number of pain locations, and indices of central sensitisation (temporal summation, central sensitisation inventory score, and lower pressure pain thresholds), higher pain catastrophising, anxiety and depression, and higher post-TKA pain intensity compared to phenotype 1 (72%). Concurrent validity was confirmed in 3 out of 4 variables.

Conclusions

Phenotype 2 (28%) with nociplastic pain characteristics in combination with worse psychological factors, BMI, functional and structural factors, and phenotype 1 (72%) not representing these characteristics were identified. Phenotype 2 had worse pain intensity scores after TKA compared to phenotype 1. Attention to the characteristics of phenotype 2 is warranted concerning post-TKA pain.

Database registration

The protocol is registered at ClinicalTrials.gov (NCT05380648).

背景以前的研究显示，20%的膝关节骨性关节炎（KOA）患者在全膝关节置换术（TKA）后会出现慢性疼痛。已经描述了各种术前生物心理社会相关因素，但仍缺乏根据这些因素对等待 TKA 的 KOA 患者进行表型分析。方法纳入比利时和荷兰 4 家医院中等待 TKA 的 KOA 患者。对结构变量、代谢变量、功能变量、疼痛相关变量、心理变量和社会变量进行了横断面潜在特征分析。使用三步多项式逻辑回归法测试了并发有效性。结果共有 217 名参与者参与了潜特征分析，平均（标清）年龄为 65.5（7.7）岁，其中包括 109 名女性。在 21 个变量中，2 种表型的模型在 14 个变量中存在差异。与表型 1（72%）相比，表型 2（28%）的参与者体重指数（BMI）较高，结构损伤（KOA 分级）较轻的几率较高，股四头肌力量和身体功能（膝关节协会评分系统功能和 30 秒椅子站立测试）平均值较低，疼痛强度、疼痛部位数量和中枢敏感指数（时间总和、中枢敏感清单评分和较低压力痛阈值）较高，疼痛灾难化、焦虑和抑郁程度较高，TKA 后疼痛强度较高。在 4 个变量中，有 3 个变量的并发有效性得到了证实。结论：表型 2（28%）具有非痉挛性疼痛特征，同时伴有较差的心理因素、体重指数、功能和结构因素，而表型 1（72%）不代表这些特征。与表型1相比，表型2在TKA术后的疼痛强度评分更差。数据库注册该方案已在ClinicalTrials.gov（NCT05380648）上注册。

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引用次数: 0

Recommendations from the French Societies of Rheumatology and Physical Medicine and Rehabilitation on the non-pharmacological management of knee osteoarthritis 法国风湿病学会和物理医学与康复学会关于膝关节骨性关节炎非药物治疗的建议

IF 3.9 3区医学 Q1 REHABILITATION

Annals of Physical and Rehabilitation Medicine

Pub Date : 2024-10-01 DOI: 10.1016/j.rehab.2024.101883

Yves-Marie Pers , Christelle Nguyen , Constance Borie , Camille Daste , Quentin Kirren , Cyril Lopez , Gaëlle Ouvrard , Romane Ruscher , Jean-Noël Argenson , Sylvie Bardoux , Laurence Baumann , Francis Berenbaum , Aymeric Binard , Emmanuel Coudeyre , Sébastien Czernichow , Arnaud Dupeyron , Marie-Christine Fabre , Nathan Foulquier , Caroline Gérard , Vivien Hausberg , Jérémie Sellam

Background

Although non-pharmacological therapies for knee osteoarthritis (OA) are essential pillars of care, they are often poorly considered and inconsistently applied.

Objectives

Under the umbrella of the French Society of Rheumatology (SFR) and the French Society of Physical Medicine and Rehabilitation (SOFMER), we aimed to establish consensual recommendations for the non-pharmacological management of people with knee OA.

Methods

A group of fellows performed a systematic literature review on the efficacy and safety of non-pharmacological modalities (up to October 2021). The fellows then took part in discussions with a multidisciplinary group of experts to draft a list of recommendations. The list was then submitted to an independent reading committee who rated their level of agreement with each recommendation. Each recommendation was assigned a strength of recommendation and a level of evidence.

Results

Five general principles were unanimously accepted: (A) the need to combine non-pharmacological and pharmacological measures; (B) the need for personalized management; (C) the need to promote adherence; (D) the need for adapted physical activity; and (E) the need for person-centered education. Specific positive or negative recommendations were defined for 11 modalities: (1) unloading knee brace; (2) kinesiotaping or knee sleeves; (3) shoes and/or insoles; (4) using a cane; (5) physical exercise program; (6) joint mobilization; (7) electro- or thermo-therapy; (8) acupuncture; (9) weight loss; (10) thermal spa therapy; and (11) workplace accommodation.

Conclusions

These SFR/SOFMER recommendations provide important and consensual knowledge to assist health professionals in decision-making for non-pharmacological treatments for knee OA

背景虽然膝关节骨性关节炎（OA）的非药物疗法是治疗的重要支柱，但这些疗法往往未得到充分考虑，应用也不一致。在法国风湿病学会（SFR）和法国物理医学与康复学会（SOFMER）的支持下，我们旨在为膝关节OA患者的非药物治疗制定一致的建议。方法一组研究员对非药物治疗方法的疗效和安全性进行了系统的文献综述（截至2021年10月）。随后，研究员们与多学科专家小组进行了讨论，起草了一份建议清单。这份清单随后被提交给一个独立的阅读委员会，该委员会对每项建议的同意程度进行评分。结果五项一般原则得到一致认可：(A) 需要将非药物和药物措施结合起来；(B) 需要个性化管理；(C) 需要促进坚持治疗；(D) 需要适应性体育活动；(E) 需要以人为本的教育。对以下 11 种方式提出了具体的积极或消极建议：(1) 膝关节减负护具；(2) 运动塑形或膝关节套；(3) 鞋和/或鞋垫；(4) 使用拐杖；(5) 体育锻炼计划；(6) 关节活动；(7) 电疗或热疗；(8) 针灸；(9) 减肥；(10) 温泉疗法；以及 (11) 工作场所适应性。结论这些 SFR/SOFMER 建议提供了重要的共识性知识，有助于医疗专业人员对膝关节 OA 的非药物治疗做出决策。

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Responsiveness of 3 stroke-specific scales for evaluating lateropulsion, balance and gait in the early subacute phase: SCP, PASS and mFMA-gait 在亚急性早期阶段，3 种中风特异性量表在评估后期牵引、平衡和步态方面的反应能力：SCP、PASS 和 mFMA-步态。

IF 3.9 3区医学 Q1 REHABILITATION

Annals of Physical and Rehabilitation Medicine

Pub Date : 2024-10-01 DOI: 10.1016/j.rehab.2024.101876

Shenhao Dai, Dominic Pérennou

引用次数: 0