膝骨關節炎病患改變生活型態可以緩解疼痛與增加功能性


  【24drs.com】March 31, 2010 — 根據線上發表於3月30日關節炎照護&研究(Arthritis Care & Research)期刊的研究,膝骨關節炎(knee osteorarthritis,OA)病患若在診斷的6個月內從事體能活動、服用止痛藥物、或者使用鞋墊輔助,可以較有改善。
  
  研究者根據之前的先驅研究進行他們這次的研究,之前的調查顯示,社區藥師可以使用一種簡單的調查方式準確地對未診斷的病患辨識有無OA, 如同研究作者所描述的,在多數已開發國家中,藥師是現成的健康照護專業人士,他們可以輔助慢性疾病之處置以及改善病患的結果。
  
  加拿大溫哥華英屬哥倫比亞大學的研究科學家Kelly A. Gindrod博士等人寫道,這個縱向研究的目標,是描述研究對象在診斷之後的生活型態介入以及使用健康服務和產品的情況,藉以評估社區藥局藥師客戶中、最近診斷有膝關節炎者的健康相關生活品質(HRQOL)。
  
  2005年時,埃德蒙頓、亞伯大、加拿大和溫哥華等地的27個藥師詢問客戶過去一年的膝蓋疼痛與不舒適,以此完成問卷。後來有194名病患診斷有OA,多數是過重(43%)或肥胖(24%)的白人婦女,平均年紀63歲,他們之前並未診斷有OA。
  
  在間隔1、3和6個月之後,這些研究對象完成追蹤問卷,報告他們的運動情形、使用止痛藥或其他治療的情況、營養補充品攝取情況等資料,並且提供這些介入方式的建議,研究者評估開始時與每次追蹤時的HRQOL,使用的評估工具包括完整版西安大略及麥梅斯特大學骨性關節炎指標(Western Ontario and McMaster Universities Osteoarthritis Index)、紙本適性測驗(Paper Adaptive Test)以及SF-36整體健康調查問卷(Medical Outcomes Study Short Form 36 health survey)等。
  
  【研究者關注個人的藥物】
  在第6個月的評估時,93%的研究對象因為OA而就診於家庭醫師,多數有以下的生活型態改變:
  * 75% 的研究對象從事有氧、強化或耐力運動,如散步或騎腳踏車;
  * 33% 的研究對象使用一些活動輔助,如針灸、膝關節貼紮、支架或鞋墊;
  * 52% 開始使用需處方或不需處方的止痛藥物治療,50%使用非類固醇抗發炎藥物、約25% 服用乙醯胺酚;
  * 36% 開始使用天然補充品,包括葡萄糖胺單方或葡萄糖胺/軟骨素複方。
  
  超過半數研究對象指出,在無醫師建議之下改變了他們的生活型態,在6個月時,研究對象報告他們的HRQOL改善,包括:
  * SF-36整體健康調查問卷之體能組成總結,比開始時平均改善2.12 (95%信心區間[CI]為0.64 - 3.60;P = .001);
  * SF-36整體健康調查問卷之身體疼痛範圍分數平均改善2.05 (95% CI,0.27 - 3.83;P = .024),相當於改善47%;
  * 紙本適性測驗的疼痛與不適平均改變3.09 (95% CI,1.75 - 4.42),一般日常活動改善2.96 (95% CI,1.56 - 4.36;兩者的P值都 < .001),分別相當於改善63%和58%;
  * 西安大略及麥梅斯特大學骨性關節炎指標總分、疼痛分數與功能分數平均減少1.91 (95% CI,-2.72 ~-1.10;所有的P值都P < .001)。
  
  研究者關注的重點在於,越來越多病患在試用乙醯胺酚這個膝蓋OA疼痛緩解建議藥物之前,就使用非類固醇抗發炎藥物。
  
  作者們寫道,再者,病患通常是根據他們自己或家人朋友的建議而決定嘗試使用止痛藥治療,多數人可能會忽視健康專業人士有利於他們自己健康的建議。
  
  研究者提出三個研究限制:沒有控制組;研究對象自己報告生活型態的改變,這可能會導致誤差;研究者並未探討研究對象在以前的運動習慣、止痛藥使用情況或其他生活型態因素。
  
  關節炎基金會公共衛生辦公室主任Patience White醫師向Medscape Rheumatology表示,這個研究帶來相當重要的好消息,研究發現顯示,採取主動對病患而言相當重要,她建議,後續研究應減少自我報告的資料且將眼光放遠。
  
  White醫師表示,釐清人們如何開始將是很有趣的,以及了解他們在追蹤期間如何改變。
  
  雖然她對病患改變生活型態之後覺得比較好感到振奮,但White醫師指出,對於開立適合的運動處方而言,重點在於有更多醫師參與。
  
  White醫師表示,你不會要一個初期OA病患馬上出門去跑馬拉松,本篇文章的重點在於,健康照護專業人士或許應該多和病患談談這些。
  
  Merck Frosst Canada支持該研究,研究作者與White醫師皆宣告沒有相關財務關係。
  
  Arthr Care Res. 線上發表於2010年3月30日。

Lifestyle Changes Ease Pain and Increase Function in Patients with Knee Osteoarthritis

By Nancy Fowler Larson
Medscape Medical News

March 31, 2010 — Patients with knee osteorarthritis (OA) who engage in physical activity, take pain medication, or start using aids such as shoe inserts within 6 months of diagnosis experience measurable improvements, according to a study published online March 30 in Arthritis Care & Research.

Investigators launched their research from the results of a previous pilot study. The earlier exploration showed that community-based pharmacists could accurately identify OA in undiagnosed patients using a simple survey. As described by the study authors, pharmacists are readily available healthcare professionals in most developed countries, and when they assist in management of chronic diseases, patient outcomes improve.

"The objectives of this longitudinal study were to describe the participants' lifestyle intervention as well as use of health services, and products following diagnosis, and to assess the health-related quality of life (HRQOL) of community pharmacy clients with recently diagnosed knee OA," write Kelly A. Gindrod, PharmD, MSc, research scientist, University of British Columbia, Vancouver, Canada, and colleagues.

In 2005, pharmacists in 27 locations in Edmonton, Alberta, Canada, and Vancouver asked clients who reported knee pain, aching, and discomfort during the previous year to complete a questionnaire. The 194 patients subsequently diagnosed with OA were mostly overweight (43%) or obese (24%) white women with an average age of 63 years. They did not have previously diagnosed OA.

At intervals of 1, 3, and 6 months, participants completed follow-up questionnaires. They reported on their exercise, analgesic use, other treatments, and natural supplement intake and provided the source of advice for these interventions. The investigators evaluated HRQOL at baseline and during each follow-up period with tools that included the complete Western Ontario and McMaster Universities Osteoarthritis Index, Paper Adaptive Test, and Medical Outcomes Study Short Form 36 health survey.

Investigators Are Concerned About Self-Medication

By their 6-month assessment, 93% of subjects had seen their family physician about their OA. The majority had made lifestyle changes, as follows:

  • 75% were participating in aerobic, strength, or endurance exercises such as walking or biking;
  • 33% were using activity aids including acupuncture, knee tape, braces, or shoe inserts;
  • 52% had begun prescription or nonprescription analgesic therapy, with 50% using nonsteroidal anti-inflammatory drugs and approximately 25% taking acetaminophen; and
  • 36% had started using natural supplements, either glucosamine or a glucosamine/chondroitin combination.

More than half of the subjects reported making these lifestyle changes without the advice of a physician. At the 6-month mark, participants reported improvements in their HRQOL, including:

  • a mean change of 2.12 from baseline (95% confidence interval [CI], 0.64 - 3.60; P = .001) in the Medical Outcomes Study Short Form 36 physical component summary;
  • an average modification of 2.05 (95% CI, 0.27 - 3.83; P = .024) in Medical Outcomes Study Short Form 36 bodily pain domain scores — a 47% improvement;
  • a mean alteration in the Paper Adaptive Test of 3.09 for pain and discomfort (95% CI, 1.75 - 4.42) and 2.96 for usual daily activities (95% CI, 1.56 - 4.36; P < .001 for both) — a gain of 63% and 58%, respectively; and
  • an average change of ?1.91 for Western Ontario and McMaster Universities Osteoarthritis Index total, pain, and function scores (95% CI, ?2.72 to ?1.10; P < .001 for all).

Of concern to investigators was the greater number of patients who used nonsteroidal anti-inflammatory drugs before trying acetaminophen, the recommended treatment for relief from knee OA pain.

"Furthermore, the decision to try analgesic therapy was often made on their own or on the advice of family and friends, suggesting that many may choose to disregard the advice of health professionals in favor of their own preferences of well-being," the authors write.

Three limitations were stated by the investigators: there was no control group; subjects self-reported their lifestyle changes, which can result in inaccuracies; and researchers did not investigate participants' previous exercise habits, analgesic use, or other lifestyle factors.

Calling the study "tremendously good news," Patience White, MD, MA, chief public health officer, Arthritis Foundation, told Medscape Rheumatology that the findings demonstrate the importance of patients taking initiative. She recommended that further study rely less on self-reporting and explore a bigger picture.

"It would be very interesting to find out where people were in the beginning, and to test how they were in follow-up," Dr. White said.

Although she is heartened that the study patients felt better after subscribing to lifestyle changes, Dr. White noted that greater physician involvement is critical in prescribing appropriate exercise.

"You don't want somebody with early OA to immediately run out and do a marathon," Dr. White said. "The message in this article is healthcare professionals probably ought to be talking about this more."

Merck Frosst Canada supported the study. The study authors and Dr. White have disclosed no relevant financial relationships.

Arthr Care Res. Published online March 30, 2010.

    
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