高位脛骨骨切り術後患者に対する理学療法士によるPain Neuroscience Education の試み：パイロットスタディ
Pain Neuroscience Education（PNE）は，慢性疼痛患者の疼痛や心理要因の改善に有効だが，理学療法と術後のPNE の併用効果は不明である。本研究の目的は，高位脛骨骨切り術（以下，HTO）患者に対し術後早期から理学療法士が提供するPNE の取り組みを報告することである。 対象は，HTO 施行予定の50歳以上の変形性膝関節症患者32名（年齢64．6±7．7歳，女性 68．8％）とした。介入は，理学療法と理学療法士による小冊子を用いた術後早期からのPNE を術後1週目より週1～2回，計5セッションを集団療法にて実施した。 主要アウトカムは安静時と歩行時の疼痛（Numerica...
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| Published in | ヘルスプロモーション理学療法研究 Vol. 9; no. 1; pp. 31 - 37 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本ヘルスプロモーション理学療法学会
22.04.2019
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| Subjects | |
| Online Access | Get full text |
| ISSN | 2186-3741 2187-3305 |
| DOI | 10.9759/hppt.9.31 |
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| Abstract | Pain Neuroscience Education（PNE）は，慢性疼痛患者の疼痛や心理要因の改善に有効だが，理学療法と術後のPNE の併用効果は不明である。本研究の目的は，高位脛骨骨切り術（以下，HTO）患者に対し術後早期から理学療法士が提供するPNE の取り組みを報告することである。 対象は，HTO 施行予定の50歳以上の変形性膝関節症患者32名（年齢64．6±7．7歳，女性 68．8％）とした。介入は，理学療法と理学療法士による小冊子を用いた術後早期からのPNE を術後1週目より週1～2回，計5セッションを集団療法にて実施した。 主要アウトカムは安静時と歩行時の疼痛（Numerical Rating Scale：NRS），副次アウトカムはPain Catastrophizing Scale（PCS），Pain Self-Efficacy Questionnaire（PSEQ），膝伸展筋力と10m 歩行時間とし，術前と術後5週の比較を対応のあるt 検定で分析し，平均値と標準偏差から効果量（d）を求めた。 術後5週で有意な改善は，安静時痛（d＝0．49），歩行時痛（d＝1．28），PCS（d＝1．05），PSEQ（d＝0．47）で認めたが，膝伸展筋力と10m 歩行時間では認めなかった。今後，対 照群を設定し検討する必要がある。 |
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| AbstractList | 要旨 : Pain Neuroscience Education (PNE) は, 慢性疼痛患者の疼痛や心理要因の改善に有効だが, 理学療法と術後のPNEの併用効果は不明である. 本研究の目的は, 高位脛骨骨切り術 (以下, HTO) 患者に対し術後早期から理学療法士が提供するPNEの取り組みを報告することである. 対象は, HTO施行予定の50歳以上の変形性膝関節症患者32名 (年齢64.6±7.7歳, 女性68.8%) とした. 介入は, 理学療法と理学療法士による小冊子を用いた術後早期からのPNEを術後1週目より週1～2回, 計5セッションを集団療法にて実施した. 主要アウトカムは安静時と歩行時の疼痛 (Numerical Rating Scale : NRS) , 副次アウトカムはPain Catastrophizing Scale (PCS) , Pain Self-Efficacy Questionnaire (PSEQ) , 膝伸展筋力と10m歩行時間とし, 術前と術後5週の比較を対応のあるt検定で分析し, 平均値と標準偏差から効果量 (d) を求めた. 術後5週で有意な改善は, 安静時痛 (d=0.49) , 歩行時痛 (d=1.28) , PCS (d=1.05) , PSEQ (d=0.47) で認めたが, 膝伸展筋力と10m歩行時間では認めなかった. 今後, 対照群を設定し検討する必要がある. Pain Neuroscience Education（PNE）は，慢性疼痛患者の疼痛や心理要因の改善に有効だが，理学療法と術後のPNE の併用効果は不明である。本研究の目的は，高位脛骨骨切り術（以下，HTO）患者に対し術後早期から理学療法士が提供するPNE の取り組みを報告することである。 対象は，HTO 施行予定の50歳以上の変形性膝関節症患者32名（年齢64．6±7．7歳，女性 68．8％）とした。介入は，理学療法と理学療法士による小冊子を用いた術後早期からのPNE を術後1週目より週1～2回，計5セッションを集団療法にて実施した。 主要アウトカムは安静時と歩行時の疼痛（Numerical Rating Scale：NRS），副次アウトカムはPain Catastrophizing Scale（PCS），Pain Self-Efficacy Questionnaire（PSEQ），膝伸展筋力と10m 歩行時間とし，術前と術後5週の比較を対応のあるt 検定で分析し，平均値と標準偏差から効果量（d）を求めた。 術後5週で有意な改善は，安静時痛（d＝0．49），歩行時痛（d＝1．28），PCS（d＝1．05），PSEQ（d＝0．47）で認めたが，膝伸展筋力と10m 歩行時間では認めなかった。今後，対 照群を設定し検討する必要がある。 |
| Author | 出口, 直樹 井澤, 渉太 横山, 一仁 村木, 啓人 鴛渕, 亮一 檜垣, 靖樹 平川, 善之 |
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| References | 3) Zhang W, Moskowitz RW, Nuki G, et al.: OARSI recommendations for the management of hip and knee osteoar thritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage, 2008, 16(2): 137-162. 31) Beaupre LA, Lier D, Davies DM, et al.: The effect of a preoperative exercise and education program on functional re covery, health related quality of life, and health service utilization following primary total knee arthroplasty. J Rheumatol, 2004, 31(6): 1166-1173. 26) Katoh M, Yamasaki H.: Comparison of reliability of isometric leg muscle strength measurements made using a hand held dynamometer with and without a restraining belt. J Phys Ther Sci, 2009, 21(1): 37-42. 19) Louw A, Diener I, Butler DS, et al.: The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil,2011, 92(12): 2041-2056. 23) Matsuoka H, Sakano Y.: Assessment of CognitiveAspect of Pain; Development, Reliability, and Validation of Japanese Versionof Pain Catastrophizing Scale. Jpn Jsychosm med,2007, 47(2). 95-102. 33) Almeida GJ, Khoja SS, and Piva SR.:Physical activity after total joint arthroplasty: a narrative review. Open Access J Sports Med, 2018, 15(9): 2018: 55-68. 2) Kurtz SM, Lau E, Ong K, et al.: Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res. 2009,467(10): 2606-2612. 6) Kim KI, Kim DK, Song SJ, et al.: Medial Open-Wedge High Tibial Osteotomy May Adversely Affect the Patellofemo ral Joint. Arthroscopy, 2017, 33(4): 811-816. 29) Lluch E, Dueñas L, Falla D, et al.: Preoperative Pain Neuroscience Education Combined With Knee Joint Mobilization for Knee Osteoarthritis: A Randomized Controlled Trial. Clin J Pain, 2018, 34(1): 44-52. 1) Yoshimura N, Muraki S, Oka H, et al.: Prevalence of knee osteoarthritis, lumbar spondylosis, and osteoporosis in Japa nese men and women: the research on osteoarthritis/osteoporosis against disability study. J Bone Miner Metab,2009, 27(5): 620-628. 22) Sullivan HJL, Bishop SR, Haythornthwaite JA, et al.: The Pain Catastrophizing Scale: development and validation. Psychol Assess, 1995, 7(4): 524-532. 11) Sobol-Kwapinska M, Babel P, Plotek W, et al.: Psychological correlates of acute postsurgical pain: A systematic review and meta-analysis. Eur J Pain, 2016, 20(10): 1573-1586. 17) Tattersall RL.: The expert patient: a new approach to chronic disease management for the twenty-first century. Clin Med (Lond), 2002, 2(3): 227-229. 34) Brand CA, Harrison C, Tropea J, et al.: Management of osteoarthritis in general practice in Australia. Arthritis Care Res (Hoboken), 2014, 66(6): 551-558. 27) Graham JE, Ostir GV, Fisher SR, et al.: Assessing walking speed in clinical research: a systematic review. J Eval Clin Pract, 2008, 14(4): 552-562. 9) 平川善之，藤原明，花田弘文・他．：Open-Wedge HTO 術後の痛みを予測する術前因子の検討．JOSKAS，2018，43（3）：781‐786 20) Geenen R, Overman CL, Christensen R, et al.: EULAR recommendations for the health professionalʼs approach to pain management in inflammatory arthritis and osteoarthritis. Ann Rheum Dis, 2018, 77(6): 797-807. 18) APA Presidential Task Force on Evidence-Based Practice. Evidence-based practice in psychology. Am Psychol, 2006,61(4): 271-285. 25) Adachi T, Nakae A, Maruo T, et al.: Validation of the Japanese version of the pain self-efficacy questionnaire in Japa nese patients with chronic pain. Pain Med, 2014, 15(8); 1405- 1417. 10) Lewis GN, Rice DA, McNair PJ, et al.: Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth, 2015, 114(4): 551-561. 4) Brouwer RW, Huizinga MR, Duivenvoorden T, et al.: Osteotomy for treating knee osteoarthritis. Cochrane Data base Syst Rev, 2014, 13(12): CD 004019. 12) ChanEY,BlythFM,NairnL,etal.:Acutepostoperative pain following hospital discharge after total knee arthro plasty. Osteoarthritis Cartilage, 2013, 21(9): 1257-1263. 14) Geneen LJ, Martin DJ, Adams N, et al.: Effects of education to facilitate knowledge about chronic pain for adults: a sys tematic review with meta-analysis. Syst Rev, 2015, 1(4): 132. 16) Szeverenyi C, Kekecs Z, Johnson A, et al.: The Use of Adjunct Psychosocial Interventions Can Decrease Postopera tive Pain and Improve the Quality of Clinical Care in Orthopedic Surgery: A Systematic Review and MetaAnalysis of Randomized Controlled Trials. J Pain, 2018, 19 (11): 1231-1252. 30) Gibson E, Sabo MT.: Can pain catastrophizing be changed in surgical patients? A scoping review. Can J Surg, 2018, 61(5): 311-318. 7) Wylde V, Trela-Larsen L, Whitehouse MR, et al.: Preoperative psychosocial risk factors for poor outcomes at 1 and 5 years after total knee replacement. Acta Orthop, 2017, 88 (5): 530-536. 8) Kehlet H, Jensen TS, Woolf CJ.: Persistent postsurgical pain: risk factors and prevention. Lancet, 2006, 367(9522): 1618-1625. 28) Salaffi F, Stancati A, Silvestri CA, et al.: Minimal clinically important changes in chronic musculoskeletal pain inten sity measured on a numerical rating scale. Pain, 2001, 94(2):149-58. 15) Blickenstaff C, Pearson N.: Reconciling movement and exercise with pain neuroscience education: A case for consis tent education. Physiother Theory Pract, 2016, 32(5): 396- 407. 24) Nicholas MK. The pain self-efficacy questionnaire, Taking pain into account. Eur J Pain, 2007, 11(2): 153-163. 32) Gustavson AM, Wolfe P, Falvey JR, et al.: Men and Women Demonstrate Differences in Early Functional Recovery Af ter Total Knee Arthroplasty. Arch Phys Med Rehabil, 2016,97(7): 1154-1162. 21) Downie WW, Leatham PA, et al.: Studies with pain rating scales. Ann Rheum Dis, 1978, 37(4): 378-381. 13) Meeus M, Nijs J, Van Oosterwijck J, et al.: Pain physiology education improves pain beliefs in patients with chronic fa tigue syndrome compared with pacing and selfmanagement education:a double-blind randomized controlled trial. Arch Phys Med Rehabil, 2010, 91(8): 1153-1159. 5) Roberts VI, Esler CN, Harper WM.: A 15-year follow-up study of 4606 primary total knee replacements. J Bone Joint Surg Br, 2007, 89(11): 1452-1456. |
| References_xml | – reference: 32) Gustavson AM, Wolfe P, Falvey JR, et al.: Men and Women Demonstrate Differences in Early Functional Recovery Af ter Total Knee Arthroplasty. Arch Phys Med Rehabil, 2016,97(7): 1154-1162. – reference: 1) Yoshimura N, Muraki S, Oka H, et al.: Prevalence of knee osteoarthritis, lumbar spondylosis, and osteoporosis in Japa nese men and women: the research on osteoarthritis/osteoporosis against disability study. J Bone Miner Metab,2009, 27(5): 620-628. – reference: 21) Downie WW, Leatham PA, et al.: Studies with pain rating scales. Ann Rheum Dis, 1978, 37(4): 378-381. – reference: 25) Adachi T, Nakae A, Maruo T, et al.: Validation of the Japanese version of the pain self-efficacy questionnaire in Japa nese patients with chronic pain. Pain Med, 2014, 15(8); 1405- 1417. – reference: 33) Almeida GJ, Khoja SS, and Piva SR.:Physical activity after total joint arthroplasty: a narrative review. Open Access J Sports Med, 2018, 15(9): 2018: 55-68. – reference: 12) ChanEY,BlythFM,NairnL,etal.:Acutepostoperative pain following hospital discharge after total knee arthro plasty. Osteoarthritis Cartilage, 2013, 21(9): 1257-1263. – reference: 16) Szeverenyi C, Kekecs Z, Johnson A, et al.: The Use of Adjunct Psychosocial Interventions Can Decrease Postopera tive Pain and Improve the Quality of Clinical Care in Orthopedic Surgery: A Systematic Review and MetaAnalysis of Randomized Controlled Trials. J Pain, 2018, 19 (11): 1231-1252. – reference: 19) Louw A, Diener I, Butler DS, et al.: The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil,2011, 92(12): 2041-2056. – reference: 18) APA Presidential Task Force on Evidence-Based Practice. Evidence-based practice in psychology. Am Psychol, 2006,61(4): 271-285. – reference: 17) Tattersall RL.: The expert patient: a new approach to chronic disease management for the twenty-first century. Clin Med (Lond), 2002, 2(3): 227-229. – reference: 3) Zhang W, Moskowitz RW, Nuki G, et al.: OARSI recommendations for the management of hip and knee osteoar thritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage, 2008, 16(2): 137-162. – reference: 30) Gibson E, Sabo MT.: Can pain catastrophizing be changed in surgical patients? A scoping review. Can J Surg, 2018, 61(5): 311-318. – reference: 31) Beaupre LA, Lier D, Davies DM, et al.: The effect of a preoperative exercise and education program on functional re covery, health related quality of life, and health service utilization following primary total knee arthroplasty. J Rheumatol, 2004, 31(6): 1166-1173. – reference: 5) Roberts VI, Esler CN, Harper WM.: A 15-year follow-up study of 4606 primary total knee replacements. J Bone Joint Surg Br, 2007, 89(11): 1452-1456. – reference: 34) Brand CA, Harrison C, Tropea J, et al.: Management of osteoarthritis in general practice in Australia. Arthritis Care Res (Hoboken), 2014, 66(6): 551-558. – reference: 27) Graham JE, Ostir GV, Fisher SR, et al.: Assessing walking speed in clinical research: a systematic review. J Eval Clin Pract, 2008, 14(4): 552-562. – reference: 2) Kurtz SM, Lau E, Ong K, et al.: Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res. 2009,467(10): 2606-2612. – reference: 23) Matsuoka H, Sakano Y.: Assessment of CognitiveAspect of Pain; Development, Reliability, and Validation of Japanese Versionof Pain Catastrophizing Scale. Jpn Jsychosm med,2007, 47(2). 95-102. – reference: 8) Kehlet H, Jensen TS, Woolf CJ.: Persistent postsurgical pain: risk factors and prevention. Lancet, 2006, 367(9522): 1618-1625. – reference: 28) Salaffi F, Stancati A, Silvestri CA, et al.: Minimal clinically important changes in chronic musculoskeletal pain inten sity measured on a numerical rating scale. Pain, 2001, 94(2):149-58. – reference: 6) Kim KI, Kim DK, Song SJ, et al.: Medial Open-Wedge High Tibial Osteotomy May Adversely Affect the Patellofemo ral Joint. Arthroscopy, 2017, 33(4): 811-816. – reference: 29) Lluch E, Dueñas L, Falla D, et al.: Preoperative Pain Neuroscience Education Combined With Knee Joint Mobilization for Knee Osteoarthritis: A Randomized Controlled Trial. Clin J Pain, 2018, 34(1): 44-52. – reference: 9) 平川善之，藤原明，花田弘文・他．：Open-Wedge HTO 術後の痛みを予測する術前因子の検討．JOSKAS，2018，43（3）：781‐786． – reference: 20) Geenen R, Overman CL, Christensen R, et al.: EULAR recommendations for the health professionalʼs approach to pain management in inflammatory arthritis and osteoarthritis. Ann Rheum Dis, 2018, 77(6): 797-807. – reference: 24) Nicholas MK. The pain self-efficacy questionnaire, Taking pain into account. Eur J Pain, 2007, 11(2): 153-163. – reference: 7) Wylde V, Trela-Larsen L, Whitehouse MR, et al.: Preoperative psychosocial risk factors for poor outcomes at 1 and 5 years after total knee replacement. Acta Orthop, 2017, 88 (5): 530-536. – reference: 14) Geneen LJ, Martin DJ, Adams N, et al.: Effects of education to facilitate knowledge about chronic pain for adults: a sys tematic review with meta-analysis. Syst Rev, 2015, 1(4): 132. – reference: 13) Meeus M, Nijs J, Van Oosterwijck J, et al.: Pain physiology education improves pain beliefs in patients with chronic fa tigue syndrome compared with pacing and selfmanagement education:a double-blind randomized controlled trial. Arch Phys Med Rehabil, 2010, 91(8): 1153-1159. – reference: 26) Katoh M, Yamasaki H.: Comparison of reliability of isometric leg muscle strength measurements made using a hand held dynamometer with and without a restraining belt. J Phys Ther Sci, 2009, 21(1): 37-42. – reference: 4) Brouwer RW, Huizinga MR, Duivenvoorden T, et al.: Osteotomy for treating knee osteoarthritis. Cochrane Data base Syst Rev, 2014, 13(12): CD 004019. – reference: 11) Sobol-Kwapinska M, Babel P, Plotek W, et al.: Psychological correlates of acute postsurgical pain: A systematic review and meta-analysis. Eur J Pain, 2016, 20(10): 1573-1586. – reference: 15) Blickenstaff C, Pearson N.: Reconciling movement and exercise with pain neuroscience education: A case for consis tent education. Physiother Theory Pract, 2016, 32(5): 396- 407. – reference: 22) Sullivan HJL, Bishop SR, Haythornthwaite JA, et al.: The Pain Catastrophizing Scale: development and validation. Psychol Assess, 1995, 7(4): 524-532. – reference: 10) Lewis GN, Rice DA, McNair PJ, et al.: Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth, 2015, 114(4): 551-561. |
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| Snippet | Pain Neuroscience Education（PNE）は，慢性疼痛患者の疼痛や心理要因の改善に有効だが，理学療法と術後のPNE の併用効果は不明である。本研究の目的は，高位脛骨骨切り... 要旨 : Pain Neuroscience Education (PNE) は, 慢性疼痛患者の疼痛や心理要因の改善に有効だが, 理学療法と術後のPNEの併用効果は不明である. 本研究の目的は, 高位脛骨... |
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| Title | 高位脛骨骨切り術後患者に対する理学療法士によるPain Neuroscience Education の試み：パイロットスタディ |
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| ispartofPNX | ヘルスプロモーション理学療法研究, 2019/04/22, Vol.9(1), pp.31-37 |
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