在风险老兵中治疗术后疼痛和功能障碍的ACT:多站点,双盲,集群RCT
Lilian Dindo1, Katherine Hadlandsmyth2, Lauren Garvin3
1Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America; South Central Mental Illness, Research and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America.
Journal of psychosomatic research
|October 1, 2025
概括
接受和承诺治疗 (ACT) 和教育支持在全膝关节整形术 (TKA) 后改善了疼痛和功能. 对处于危险的退伍军人来说,ACT可能会提供更早的疼痛减轻和阿片类药物逐渐减少的好处.
科学领域:
- 整形外科 整形外科 整形外科
- 康复医学 康复医学 康复医学
- 行为医学是一种行为医学.
背景情况:
- 在全膝关节整形术 (TKA) 后,持续的术后疼痛 (PPSP) 和功能限制是常见的.
- 接受TKA的退伍军人患PPSP和功能缺陷的风险较高.
- 术前干预可以减轻PPSP并改善结果.
研究的目的:
- 为了将接受和承诺治疗 (ACT) 与积极的教育控制 (AC) 进行比较,用于在TKA之后面临PPSP风险的退伍军人.
- 评估这些干预措施对疼痛严重程度,日常生活活动 (ADL),生活质量 (QoL) 和阿片类药物戒断时间的影响.
主要方法:
- 一个多站点,双盲随机受控试验,涉及336名退伍军人接受单方面TKA.
- 参与者接受了为期1天的手术前小组研讨会 (ACT或AC) 和手术后的增强疗程.
- 主要结局包括疼痛严重程度,ADL和QoL;次要结局是停用阿片类药物的时间.
主要成果:
- 在ACT和AC两组中,疼痛严重程度显著降低,ADL功能有所改善.
- 在TKA后的3个月内,ACT显示了更大的疼痛减轻的趋势.
- 在各组之间,阿片类药物戒断的中位时间相似,在没有并发症的人群中,ACT组的早期戒断趋势较为明显.
结论:
- 简短的,手术前的小组干预 (ACT或教育支持) 改善了TKA后的疼痛和功能.
- 对于处于危险状态的退伍军人来说,ACT可能会提供额外的早期益处,减少疼痛和逐渐减少阿片类药物.
- 这些发现支持使用手术前的心理和教育干预措施来增强TKA结果.
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