Internet-delivered physiotherapist-prescribed exercise and pain-coping skills training is beneficial for people with chronic knee pain [commentary]

摘要

Summary of: Bennell KL, Nelligan R, Dobson F, Rini C, Keefe F, Kasza J, patient-reported outcomes measured at 3 months were: average pain et al. Effectiveness of an Internet-Delivered Exercise and Pain-Coping during walking the previous week, measured with a numerical rating Skills Training Intervention for Persons With Chronic Knee Pain. A scale (0 to 10), and physical function over the previous 48 hours, Randomized Trial. Ann Intern Med 2017;166:453-462. measured with the Western Ontario and McMaster Universities Osteo- Question: Can an internet-based intervention combining physiothera- arthritis Index (WOMAC) physical function subscale (0 to 68). Second- pist-prescribed home exercise, delivered via videoconferencing, and aryoutcomesmeasuredat3 and9 months includedkneepain,qualityof automated pain-coping skills training reduce pain and improve func- life, global change, self-efficacy, coping, and pain catastrophising. tion in persons with chronic knee pain compared with educational Results: A total of 139 participants (94%) completed 3 months, and material only? Design: Randomised, controlled trial with concealed 133 (90%)completed 9 months follow-up. At3 months, the intervention allocation. Setting: Community-dwelling participants from Australia group improved more than the control group in pain during walking recruited via print, radio, and social media. Participants: Bothmen and (mean difference 1.6 units, 95% CI 0.9 to 2.3) and physical function women were included if: aged 50 years; (mean difference 9.3 units, 95% CI 5.9 to 12.7). At 9 months, the knee pain for > 3 months and on most days of the previous month; knee pain during walking in corresponding mean differences were 1.1 units (95% CI 0.4 to 1.8) the previous week; mild-to-moderate physical dysfunction; andaccess and 7.0 units (95% CI 3.4 to 10.5), respectively. The intervention parti- to internet/email. Randomisation of 148 patients allocated 74 partici- cipants also improved more in most secondary outcomes than control pants to each group. Interventions: Both groups received online educa- participants. Conclusion: Anonline interventioncombining physiother- tional material about exercise and physical activity, pain management, apist-prescribed home exercises and interactive pain-coping skills emotions, diets, and other therapies. The intervention group received training was more effective than educational material alone for persons two other internet-delivered treatments. The first was an interactive with chronic knee pain. automated pain-coping skills training program consisting of eight Provenance: Invited. Not peer reviewed. modules and daily practising of pain-coping skills. Regular email a b reminders to complete the modules were sent. The second was seven K?re Birger Hagen and Margreth Grotle a Skype sessions with a physiotherapist over 3 months. Most sessions National Advisory Unit on Rehabilitation in Rheumatology, lasted 30 minutes and consisted of a brief assessment and prescription Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway b of a lower-limb strengthening home exercise program to be performed Oslo and Akershus University College of Applied Sciences, three times Department of Physiotherapy, Oslo, Norway per week. Participants were also encouraged to increase physical activity levels. Outcome measures: The primary http://dx.doi.org/10.1016/j.jphys.2017.07.009.