運動對退化性關節炎病人疼痛是否可緩解?Can Exercise Alleviate The Pain That Osteoarthritis Patients Suffered With?

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2019-11-04 已刊登
新刊登 綜 整 預防/治療/介入類型

作  者

陳姿廷*

實證知識類別

B 類:實證健康照護應用

PICO

治療/預防性問題

治療/介入措施

風濕醫學 Rheumatology

科別

  • 感染/傳染性疾病護理 Infectious / Communicable Disease Nursing
  • 腸胃護理 Gastroenterology Nursing
  • 腫瘤護理 Oncology Nursing

中文關鍵詞

退化性關節炎、運動、疼痛

英文關鍵詞

Osteoarthritis exercise pain

機構名稱

長庚醫療財團法人嘉義長庚紀念醫院

申請單位

護理部

中文摘要

形成臨床提問:
形成臨床提問-探討使用運動對退化性關節炎病人疼痛是否可緩解?PICO- P:62歲、女性、診斷膝蓋退化性關節炎、I:運動、C:無運動、O:疼痛指數。
文獻搜尋的方法與分析:
(一)文獻搜尋資料庫包含:Cochrane、Pubmen、Embase、華藝(二)關鍵字包含:P(Osteoarthritis,Knee、Arthritis, Degenerative)、I(Exercise、sport、physical active、physical exercise 、recitation)、O(Pain Management、Improve* of pain);關鍵字和PICO符合PICO關鍵字順序:I&POC,Combine text words/keywords/MeSH term搜尋,使用布林字元”OR, AND, NOT & Truncation*”,篩選語言為中英文。
文獻的品質評讀:
(一)文獻的品質評讀-搜尋結果:中英文文獻資料庫共127篇,其中扣除重複、非RCT、非SR研究、研究設計方法不符合PICO、等級低,排除並刪除文獻後,共評讀2篇,採用2013 年版的CASP 作為評讀工具。
證據之臨床應用:
證據之臨床應用-運用實證知識轉譯之7步驟進行改善,推行同時進行結果分析。研究設計為隨機對照實驗研究,研究期間自2019年8月15日至2019年10月20 日,選擇南部某區域教學醫院門診,介入期間以運動(走路、肌肉運動)最為介入措施
成效評值:
以統計分析的方式,比較前後對照期間運動對退化性關節炎病人疼痛緩解之成效。自2019年8月15日至2019年10月20 日施介入後,收案30名新病人中,經統計檢定後,(1)基本資料:以64-70歲佔40%、51-60歲佔26.7%;性別:女性52.3%、男性46.7%;無運動習慣佔93.3%;BMI過重佔56.7%;(2)統計檢測走路與肌肉運動介入措施未施行前兩組疼痛、生活品質日常生活阻礙程度、服用藥物P值(>0.05),無差異;(3)介入措施實施後經由統計檢測研究結果,針對退化性關節炎病人,透過走路或肌肉運動介入是可以明顯降低疼痛P值<.000(95% CI 1.12-2.339)、提升生活品質。
結論與建議:
此篇旨探討運動對退化性關節炎病人疼痛是否可緩解?透由實證查詢及臨床應用,形成PICO後利用實證醫學策略,搜尋並篩選相關文獻,並經嚴格評析2篇文獻,了解運動可以緩解退化性關節炎病人疼痛,改善關節僵硬程度及提升生活品質;我們將這個答案推及臨床應用,雖然只收30位病人,但經我們實證應用後發現確實藉由運動可以緩解退化性關節炎病人疼痛、提升生活品質,不需費用且沒有副作用,此結果與Fransen(2015)及Siew(2019)相同。以期望造福更多退化性關節炎病人的照護品質。

英文摘要

Ask an answerable question (PICO):
Build up a clinical question: explore whether doing exercise is able to alleviate the pain that osteoarthritis patients suffered with. PICO: P: 62 years old, female, diagnosed with knee osteoarthritis; I: does exercise; C: no exercise; O: pain score.
The Method and Analysis of Literature Review:
(1) The literature searching database includes Cochrane, Pubmen, Embase and the Airiti Library. (2) Keywords are included as follows: P (Osteoarthritis, Knee, Arthritis, Degenerative), I (Exercise, sport, physical , physical exercise, recitation), O (Pain Management, Improve * of pain); keywords and PICO which is corresponded with ordering PICO of “I&POC”; Combine text term with searching with Boolean characters "OR, AND, NOT & Truncation*”; the languages selected are Chinese and English.
Critical Appraisal:
(1) Qualified critical appraisal of literature: for searching results: there are total 127 articles found in Chinese and English literature databases; by deducting and removing the literature with issue of duplicate, non-RCT study, non-SR research, measures of study design do not correspond with PICO, lower grade, a total of 2 articles of literature are being appraised, with the appraising tool of CASP in the version of 2013.
Clinical Application of Evidence:
Evidence of clinical application: make the improvement by applying the 7 steps of empirical knowledge translation and make the result analysis with promoting at the same. The study design was conducted as a RCT (randomized controlled experimental) study. Study period was started from August 15th to October 20th in2019; performed in the clinic of teaching hospital of Region in Southern Taiwan. During the intervention period, the most common intervention is doing exercise (walking and muscular exercise.
Evaluation of Effectiveness:
Evaluation: with the use of statistical analysis, compare the effectiveness of pain alleviated changes before and after doing exercise in osteoarthritis patients. After the intervention implemented from August 15th to October 20th in 2019, by statistically verified the 30 cases of new patients received, the result is indicated as (1) basic information: 40% of participants are aged from 64-70 and 26.7% are aged from 51-60; gender: 52.3% of participants are women, and 46.7% are men; 93.3% of participants do not have a habit of exercise and 56.7% participants are overweight indicated by the BMI; (2) with statistical examination, there is no difference observed with pain scores of P value (>0.05) before and after the interventions of walking and muscular exercise implemented; (3) the implementation of interventions, through the summarized examining study result, it indicates that doing exercise such as interventions of walking or muscular exercise is obviously decreasing pains suffered and improve living quality, especially for the patients with osteoarthritis. However, both of intervention measures of walking and muscular exercise make no difference, no significant variance on both pain relief and living quality.
Conclusions and Recommendations:
This article is aimed to find out whether doing exercise is possible to alleviate pain that osteoarthritis patients suffered with? Through the evidenced questioning and clinical application, first building up the PICO model and then searching and screening documents related by using the strategy of evidence-based medicine; afterward critical appraised and analysis the two documents to realize that doing exercise is definitely able to ease pains suffered in osteoarthritis patients and further to improve the stiffness with joints as well as the living quality; when administering this idea to the clinical application, even the number of participant is 30 patients only, we did find out that the pain scores the osteoarthritis patients suffered with is actually eased by doing exercise after the empirical applications and further to improve their living quality, without any cost and no side effects aroused. The result is the same as the Fransen (2015) and Siew (2019). It is expected to contribute some efforts in the quality of nursing care with osteoarthritis patients.