社区医疗中运动疗法治疗膝骨关节炎的疗效分析

目的评价运动疗法治疗膝骨关节炎患者的疗效。 方法北京市东城区第一人民医院从2019年1月至10月纳入76例膝骨关节炎患者(114膝)，进行为期6周的运动疗法，训练地点为社区居委会或社区养老驿站。该研究纳入标准为确诊为膝关节骨关节炎且可配合完成6周运动疗法课程的患者；排除标准为膝关节屈伸肌肌力2级及以下或存在炎症性膝关节炎或重要脏器功能衰竭者。分别于治疗开始前、6周和12周后对患者进行疗效评定，评定内容包括膝关节主动活动度(AROM)、40 m步行试验、30 s椅子坐起试验；并利用量表对膝关节功能(HSS)、欧洲5维健康量表(EQ-5D)评分、疼痛视觉模拟评分(VAS)进行评价，使用单因素重复测量方差分析比较基线与6周、12周随访的结果变化，组间比较则采用Bonferroni检验。此外在治疗结束时询问患者对治疗课程的满意度，并使用秩和检验进行统计学分析。 结果在76例患者中，71例患者(109膝)完成了12周随访。109膝不同时点膝关节AROM(F＝137.55，P<0.001)、HSS评分(F＝108.81，P<0.001)及VAS评分(F＝179.72，P<0.001)治疗后均比治疗前有改善；71例患者不同时点的EQ-5D生活质量评分(F＝99.53，P<0.001)、40 m步行试验(F＝199.54，P<0.001)、30 s椅子坐起试验(F＝170.62，P<0.001)治疗后均比治疗前有改善，差异有统计学意义。患者总体满意率达100%，K/L分级为Ⅰ、Ⅱ级患者与Ⅲ、Ⅳ级患者相比，对该项目的满意度更高(U＝401.5，P＝0.044)。 结论运动疗法可缓解膝关节疼痛，改善膝关节功能，提高患者的生活质量，且在社区训练中取得良好效果，利于在社区的推广普及。

Feasibility study of implementation of exercise therapy for knee osteoarthritis in communities

ObjectiveTo evaluate the effectiveness of implementing exercise therapy for knee osteoarthritis in the community. MethodsFrom January to October 2019, 76 patients with knee osteoarthritis in the First People’s Hospital of Dongcheng District of Beijing were consecutively enrolled for a six-week exercise therapy. They were all treated in neighborhood communities pension station. Those with clinical diagnosis of knee osteoarthritis who could complete the six-week exercise therapy course were included. The patients with knee joint flexor extensor muscle strength lower than grade two, inflammatory arthritis or major organ failure were excluded. Active range of motion (AROM), 40 m walking test and 30 s sit-to-stand (STS) test were evaluated before and at six and 12 weeks after treatment. The hospital for special surgery knee score (HSS), Europe quality of life five dimensions questionnaire(EQ-5D)and visual analog scale (VAS) were acquired before and at six and 12 weeks after treatment. One-way repeated measures analysis of variance was used to compare the results and Bonferroni test for inter group comparison. Satisfaction for the treatment was also recorded and analyzed by rank sum test. ResultsSeventy-one patients (109 knees) were followed up at 12 weeks with a follow-up rate of 93.4% (71/76). Significant improvement in AROM(F=137.55, P<0.001), HSS score(F=108.81, P<0.001) and VAS score(F=179.72, P<0.001) was observed. VAS score statistically significantly decreased after treatment. The difference in EQ-5D(F=99.53, P<0.001), 40 m walking test (F=199.54, P<0.001) and 30 s STS (F=170.62, P<0.001) were also statistically significant at 12 weeks and six weeks compared with baseline. The score of EQ-5D increased after treatment. The results of 40 m walking test and 30 s STS test also improved. The overall satisfaction rate was 100%. The patients with Kellgren-Lawrence(K-L) grade ⅠorⅡ were more satisfied with exercise therapy than those with K-L grade Ⅲ or Ⅳ(U=401.5, P=0.044). ConclusionExercise therapy in community can relieve the pain and improve range of motion of knee joint, thus improve the quality of life, indicating that exercise therapy can be an effective intervention for patients with knee in the community.