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。
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.
