网络出版日期: 2016-04-18
Evaluation of physical function for the end-stage osteoarthritis patient waiting for the total knee replacement
Online published: 2016-04-18
目的:采集终末期骨关节炎患者接受全膝关节置换术前的功能全面评价指标,并与轻度骨关节炎患者进行比较,评价疼痛、患者自我报告量表、基于表现的躯体功能以及实际日常活动水平之间的相关性。方法: 前瞻性研究设计,获取87例因终末期骨关节炎而接受单侧全膝关节置换术患者术前的全面躯体功能参数,并招募年龄接近的60例轻度骨关节炎患者[Kellgren-Lawrence (K-L)分级0~2级]采集相同的躯体功能参数。所采集的数据包括患者的年龄、身高、体重、30秒座椅站立测试(30 s chair stand test, 30-CST)、40米快速步行测试(40 m fast-paced walk test,40-FPWT)、12级爬楼梯测试(12 steps stair climb test,12-SCT)、3米起立行走测试(timed up & go test,TUG)、6分钟步行测试(6 minute walk test,6-MWT)、美国西部Ontario和McMaster大学骨关节炎指数评分(The Western Ontario and McMaster Universities Osteoarthritis Index,WOMAC)、美国膝关节协会评分(knee society score,KSS)、可视化疼痛评分(visual analogue scale,VAS)以及连续7 d的每日步数。使用SPSS 22.0软件进行统计学分析,首先对各项数据的观察值进行描述性报告,使用KolmogorvSmirnov检验每一变量是否符合正态分布,结果两组的每一变量均不符合正态分布,因而采用非参数MannWhitney检验两组间差异,应用Spearman相关分析评估各项参数之间的相关性。结果: 轻度骨关节炎组患者的VAS评分、WOMAC评分、KSS评分、日均步数以及各项基于表现的躯体功能测试结果均优于终末期骨关节炎组患者,两组间差异有统计学意义(P<0.05)。轻度骨关节炎组内,各项躯体功能测试均与各项自我报告量表无显著相关性或有较弱相关性;终末期骨关节炎组内,各项躯体功能测试与各项自我报告量表之间有着不同强度的相关性。结论: 描述了多项躯体功能参数在中国轻度骨关节炎与终末期骨关节炎患者中的应用,基于表现的躯体功能、实际日常活动水平、患者自我报告量表以及疼痛评分之间并不一定有较好的相关性,需要对骨关节炎患者进行更全面地评估并制定相应的全膝关节置换术手术决策标准。
李志昌 , 姜龙 , 张舒 , 秦雪英 , Daniel K. White PT , 侯云飞 , 周之伟 , 林剑浩 . 终末期骨关节炎患者全膝关节置换术前的躯体功能客观测定[J]. 北京大学学报(医学版), 2016 , 48(2) : 257 -262 . DOI: 10.3969/j.issn.1671-167X.2016.02.014
Objective:To collect comprehensive data of the physical function of the end-stage osteoarthritis (OA) patients, and compare it with patients with mild OA. To evaluate the correlations among pain, self-reported questionnaire, performance based physical function and actual daily life activity level. Methods: In this prospective study, the comprehensive physical function parameters of 87 end stage OA patients waiting for total knee replacement, and that of 60 patients with mild OA [Kellgren-Lawrence (K-L) grade 0-2] were collected. The comprehensive physical function parameters including: age, height, body weight, 30 s chair stand test (30-CST), 40 m fast-paced walk test (40-FPWT), 12 steps stair climb test (12-SCT), timed up & go test (TUG), 6 minutes walk test (6-MWT), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), knee society score (KSS), visual analogue scale (VAS) pain scale, and everyday steps counts for continuous 7 days. The data were analyzed with the soft ware SPSS 22.0. The descriptive report of all the parameters was made. Because the Kolmogorv-Smirnov test results for all the parameters were negative for normal distribution, nonparative Mann-Whitney test was used to analysis the differences between the two groups, as well as the Spearman test for the correlations. Results: All the parameters of the mild OA group were better than those of the end stage group, and the differences were significant (P<0.05). In the mild OA group, there were no correlations or weak correlations between all the physical function test and questionnaire, however, in the end stage group, the correlations were weak, moderate, or strong. Conclusion: The usage of lots of different physical parameters from Chinese OA patients were reported in this study. The results showed that there are no good correlations among performance based physical function test, actual daily activity level, self reported questionnaires, and the pain scales. More comprehensive evaluation for the OA patients needs to be made, in order to make better decision for arthroplasty.
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