{"title":"治疗跟腱中段病变的局部三硝酸甘油酯(GTN)和偏心运动(NEAT 试验):随机双盲安慰剂对照试验。","authors":"Paul D Kirwan, Trevor Duffy, Helen P French","doi":"10.1136/bjsports-2023-108043","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To investigate if daily treatment with glyceryl trinitrate (GTN) ointment, over 24 weeks combined with a 12-week eccentric exercise programme is more effective for chronic mid-portion Achilles tendinopathy than placebo ointment and eccentric exercise.</p><p><strong>Methods: </strong>This was a single-site randomised double-blind placebo-controlled trial at an acute hospital, Dublin, Ireland. Patients with chronic mid-portion Achilles tendinopathy were randomised to either 24 weeks of daily GTN ointment or placebo ointment. Both groups received an identical 12-week eccentric exercise programme. The primary outcome measure was the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire at 24 weeks, which measures pain, function and activity. Secondary outcomes included pain severity, self-reported physical function, calf muscle function, pressure pain thresholds and ultrasound changes. Statistical analyses were performed according to intention-to-treat principles.</p><p><strong>Results: </strong>76 patients (30 women; 46 men, mean age±SD, 45.6±8.2 years) were recruited for the trial. Significant improvements in VISA-A scores occurred in both groups at 6-week, 12-week and 24-week follow-up. The increase was not significantly different between groups, adjusted mean between-group difference from baseline to week 6, -1.33 (95% CI -6.96 to 4.31); week 12, -1.25 (95% CI -8.0 to 5.49) and week 24, -3.8 (95% CI -10.6 to 3.0); negative values favour GTN. There was no significant between-group difference in any of the secondary outcome measures at 6, 12 and 24 weeks.</p><p><strong>Conclusions: </strong>Adding daily GTN ointment over 24 weeks to a 12-week eccentric exercise programme did not improve pain, function and activity level in patients with chronic mid-portion Achilles tendinopathy when compared with placebo ointment.</p>","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":" ","pages":"1035-1043"},"PeriodicalIF":11.6000,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420712/pdf/","citationCount":"0","resultStr":"{\"title\":\"Topical glyceryl trinitrate (GTN) and eccentric exercises in the treatment of mid-portion achilles tendinopathy (the NEAT trial): a randomised double-blind placebo-controlled trial.\",\"authors\":\"Paul D Kirwan, Trevor Duffy, Helen P French\",\"doi\":\"10.1136/bjsports-2023-108043\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To investigate if daily treatment with glyceryl trinitrate (GTN) ointment, over 24 weeks combined with a 12-week eccentric exercise programme is more effective for chronic mid-portion Achilles tendinopathy than placebo ointment and eccentric exercise.</p><p><strong>Methods: </strong>This was a single-site randomised double-blind placebo-controlled trial at an acute hospital, Dublin, Ireland. Patients with chronic mid-portion Achilles tendinopathy were randomised to either 24 weeks of daily GTN ointment or placebo ointment. Both groups received an identical 12-week eccentric exercise programme. The primary outcome measure was the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire at 24 weeks, which measures pain, function and activity. Secondary outcomes included pain severity, self-reported physical function, calf muscle function, pressure pain thresholds and ultrasound changes. Statistical analyses were performed according to intention-to-treat principles.</p><p><strong>Results: </strong>76 patients (30 women; 46 men, mean age±SD, 45.6±8.2 years) were recruited for the trial. Significant improvements in VISA-A scores occurred in both groups at 6-week, 12-week and 24-week follow-up. The increase was not significantly different between groups, adjusted mean between-group difference from baseline to week 6, -1.33 (95% CI -6.96 to 4.31); week 12, -1.25 (95% CI -8.0 to 5.49) and week 24, -3.8 (95% CI -10.6 to 3.0); negative values favour GTN. There was no significant between-group difference in any of the secondary outcome measures at 6, 12 and 24 weeks.</p><p><strong>Conclusions: </strong>Adding daily GTN ointment over 24 weeks to a 12-week eccentric exercise programme did not improve pain, function and activity level in patients with chronic mid-portion Achilles tendinopathy when compared with placebo ointment.</p>\",\"PeriodicalId\":9276,\"journal\":{\"name\":\"British Journal of Sports Medicine\",\"volume\":\" \",\"pages\":\"1035-1043\"},\"PeriodicalIF\":11.6000,\"publicationDate\":\"2024-09-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420712/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"British Journal of Sports Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/bjsports-2023-108043\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"SPORT SCIENCES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"British Journal of Sports Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/bjsports-2023-108043","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SPORT SCIENCES","Score":null,"Total":0}
引用次数: 0
摘要
研究目的研究每日使用三硝酸甘油酯(GTN)软膏治疗 24 周,并结合为期 12 周的偏心运动计划是否比安慰剂软膏和偏心运动对慢性中段跟腱病更有效:这是一项在爱尔兰都柏林一家急症医院进行的单点随机双盲安慰剂对照试验。慢性跟腱中段病变患者被随机分配到每天使用GTN软膏或安慰剂软膏24周的治疗组。两组患者均接受为期 12 周的相同偏心运动计划。主要结果是在24周时进行的维多利亚体育研究所跟腱评估(VISA-A)问卷调查,该问卷调查用于测量疼痛、功能和活动。次要结果包括疼痛严重程度、自我报告的身体功能、小腿肌肉功能、压痛阈值和超声波变化。统计分析按照意向治疗原则进行:试验共招募了 76 名患者(30 名女性;46 名男性,平均年龄(±SD)为 45.6±8.2 岁)。在 6 周、12 周和 24 周的随访中,两组患者的 VISA-A 评分均有显著改善。从基线到第6周,调整后的组间平均差异为-1.33(95% CI -6.96至4.31);第12周为-1.25(95% CI -8.0至5.49);第24周为-3.8(95% CI -10.6至3.0);负值有利于GTN。在6周、12周和24周的次要结果测量中,组间差异均不明显:结论:与安慰剂软膏相比,在为期12周的偏心运动计划中添加24周的每日GTN软膏并不能改善慢性跟腱中段病变患者的疼痛、功能和活动水平。
Topical glyceryl trinitrate (GTN) and eccentric exercises in the treatment of mid-portion achilles tendinopathy (the NEAT trial): a randomised double-blind placebo-controlled trial.
Objectives: To investigate if daily treatment with glyceryl trinitrate (GTN) ointment, over 24 weeks combined with a 12-week eccentric exercise programme is more effective for chronic mid-portion Achilles tendinopathy than placebo ointment and eccentric exercise.
Methods: This was a single-site randomised double-blind placebo-controlled trial at an acute hospital, Dublin, Ireland. Patients with chronic mid-portion Achilles tendinopathy were randomised to either 24 weeks of daily GTN ointment or placebo ointment. Both groups received an identical 12-week eccentric exercise programme. The primary outcome measure was the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire at 24 weeks, which measures pain, function and activity. Secondary outcomes included pain severity, self-reported physical function, calf muscle function, pressure pain thresholds and ultrasound changes. Statistical analyses were performed according to intention-to-treat principles.
Results: 76 patients (30 women; 46 men, mean age±SD, 45.6±8.2 years) were recruited for the trial. Significant improvements in VISA-A scores occurred in both groups at 6-week, 12-week and 24-week follow-up. The increase was not significantly different between groups, adjusted mean between-group difference from baseline to week 6, -1.33 (95% CI -6.96 to 4.31); week 12, -1.25 (95% CI -8.0 to 5.49) and week 24, -3.8 (95% CI -10.6 to 3.0); negative values favour GTN. There was no significant between-group difference in any of the secondary outcome measures at 6, 12 and 24 weeks.
Conclusions: Adding daily GTN ointment over 24 weeks to a 12-week eccentric exercise programme did not improve pain, function and activity level in patients with chronic mid-portion Achilles tendinopathy when compared with placebo ointment.
期刊介绍:
The British Journal of Sports Medicine (BJSM) is a dynamic platform that presents groundbreaking research, thought-provoking reviews, and meaningful discussions on sport and exercise medicine. Our focus encompasses various clinically-relevant aspects such as physiotherapy, physical therapy, and rehabilitation. With an aim to foster innovation, education, and knowledge translation, we strive to bridge the gap between research and practical implementation in the field. Our multi-media approach, including web, print, video, and audio resources, along with our active presence on social media, connects a global community of healthcare professionals dedicated to treating active individuals.