Herzratenvariabilitätsbasiertes Lifestyle-Coaching bei Patient*innen mit subakromialem Schmerzsyndrom – eine Pilotstudie

Zusammenfassung

Hintergrund Mehrere Studien konnten einen Einfluss von psychologischem Stress auf Schmerzmodulation und Wundheilung aufzeigen. Die Erweiterung der physiotherapeutischen Behandlung um die psychosoziale Ebene des biopsychosozialen Modells stellt komplexe Anforderungen an die behandelnden Physioherapeut*innen.

Ziel Untersucht wurde der Einfluss von auf Herzratenvariabilität (HRV) basierendem Lifestyle-Coaching auf die Entwicklung der funktionellen Einschränkungen und das Schmerzempfinden bei Patient*innen mit subakromialem Schmerzsyndrom (SAPS). Es erfolgte zudem eine Analyse der Machbarkeit für Folgestudien.

Methode 15 Proband*innen mit SAPS wurden randomisiert in 2 Gruppen eingeteilt. Die Interventionsgruppe erhielt zusätzlich zu der in beiden Gruppen durchgeführten übungstherapeutischen Intervention ein Lifestyle-Coaching. Als Kontrollparameter wurden der SPADI-Score (SPADI), das maximale Schmerzempfinden (NRS_max) und anhand der Kurzzeit-HRV-Messung die High Frequency (HF), Low Frequency (LF), LF/HF-Ratio, Root Mean Square of Successive Difference (Rmssd) sowie die Standard Deviation NN (SdNN) erhoben. Bezüglich der Machbarkeit wurden mögliche Störfaktoren, Optimierungsmöglichkeiten und eine adäquate Stichprobengröße eruiert.

Ergebnisse Einen signifikanten Unterschied zeigten die Variablen des SPADI-Scores, SPADI (95 % CI –59,3 bis –4,6; p = 0,026; d = –1,5), NRS_max (95 % CI –5,5 bis –0,1; p = 0,042; d = –1,35) und der HRV-Messwert HF (95 % CI 505,3–1753,3; p = 0,002; d = 2,23) im Vergleich zur Kontrollgruppe.

Schlussfolgerung Das Design dieser Studie ist machbar und für Folgestudien mit größeren Stichproben geeignet. Anpassungen bei der Randomisierung sowie den verwendeten Assessments sollten dabei vorgenommen werden. Für eine gültige Aussagekraft der Ergebnisse wurde die dafür nötige Stichprobengröße mit n = 66 ermittelt. Die Auswertung der klinischen Parameter weisen auf eine Steigerung der parasympathischen Aktivität (HF) sowie einer Reduktion von SPADI und NRS_max hin. Letztere können hierbei als potentiell positive Wirkung auf die Funktion und Schmerzreduktion in der Interventionsgruppe eingeschätzt werden.

Abstract

Background Several studies have shown an influence of psychological stress on pain modulation and tissue healing. The extension of patient care by including psychological factors to the known biopsychosocial model therefore complex demands on the treating therapists.

Objective Examination of the influence of heart rate variability-based lifestyle coaching on the influence of functional limitations and pain perception in patients with subacromial pain syndrome (SAPS). Analyzing of the feasibility for this study-design.

Method 15 subjects were randomized into 2 groups. The intervention group received lifestyle coaching in addition to the exercise-therapy intervention of the control group. The control parameters were the SPADI-score (SPADI), maximum pain (NRS_max), high frequency (HF), low frequency (LF), Lf/Hf ratio (LF/HF), root mean square of successive difference (Rmssd) and the standard deviation NN (Sdnn). With regard to feasibility, possible disruptive factors, optimization options and an adequate sample size were determined.

Results Significant differences were observed in the variables of the SPADI-score, SPADI (95 % CI –59,3 to –4,6; p = 0,026; d = –1,5), NRS_max (95 % CI –5,5 to –0,1; p = 0,042; d = –1,35) and the HRV measured value HF (95 % CI 505,3–1753,3; p = 0,002; d = 2,23) compared to the control group.

Conclusion This study is feasible and suitable for follow-up studies with larger sample size. Adjustments in the randomization and the assessments used here should be made for this. For the results to be valid, the sample size was determined to be n = 66. The evaluation of the clinical parameters indicates an increase in parasympathetic activity (HF) with a correlating reduction in SPADI and NRS_max. The latter can be assessed as having a potentially positive effect on function and pain reduction in the intervention group.

Schlüsselwörter

HRV - Stress - subakromiales Schmerzsyndrom

Key words

HRV - stress - subacromial pain syndrome

• Literatur

• 1 Luime JJ, Koes BW, Hendriksen IJM. et al Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol 2004; 3: 73-81
• 2 Lewis JS. Rotator cuff tendinopathy/subacromial impingement syndrome: Is it time for a new method of assessment?. Br J Sports Med 2009; 43: 259-264
• 3 Noten S, Struy F, Lluch E. et al Central Pain Processing in Patients with Shoulder Pain: A Review of the Literature. Pain Practice 2017; 17: 267-280
• 4 Gill TK, Shanahan EM, Allison D. et al Prevalence of abnormalities on shoulder MRI in symptomatic and asymptomatic older adults. Int J Rheumatic Dis 2014; 17: 863-871
• 5 Barreto RPG, Braman JP, Ludewig PM. et al Bilateral magnetic resonance imaging findings in individuals with unilateral shoulder pain. J Shoulder Elbow Surg 2019; 28: 1699-1706
• 6 Nazari G, MacDermid JC, Bryant D. et al The effectiveness of surgical vs conservative interventions on pain and function in patients with shoulder impingement syndrome. A systematic review and meta-analysis. PLoS ONE 2019; 14: e0216961
• 7 Lewis J. Rotator cuff related shoulder pain: Assessment, management and uncertainties. Man Ther 2015; 23: 57-68
• 8 Diercks R, Bron C, Dorrestijn O. et al Guideline for diagnosis and treatment of subacromial pain syndrome. A multidisciplinary review by the Dutch Orthopaedic Association. Acta Orthopaedica 2014; 85: 314-322
• 9 Chester R, Jerosch-Herold C, Lewis J. et al Psychological factors are associated with the outcome of physiotherapy for people with shoulder pain: a multicentre longitudinal cohort study. Br J Sports Med 2018; 52: 269-275
• 10 Østerås B, Sigmundsson H, Haga M. Perceived stress and musculoskeletal pain are prevalent and significantly associated in adolescents: An epidemiological cross-sectional study Chronic Disease epidemiology. BMC Public Health 2015; 15: 1081
• 11 Jennings EM, Okine BN, Roche M. et al Stress-induced hyperalgesia. Progress in Neurobiology 2014; 121: 1-18
• 12 Gouin JP, Kiecolt-Glaser JK. The Impact of Psychological Stress on Wound Healing: Methods and Mechanisms. Immunol Allergy Clin North Am 2011; 31: 81-93
• 13 Van De Kar LD, Blair ML. Forebrain pathways mediating stress-induced hormone secretion. Front Neuroendocrinol 1999; 20: 1-48
• 14 Akselrod S, Gordon D, Ubel AF. et al Power Spectrum Analysis of Heart Rate Fluctuation: A Quantitative Probe of Beat-To-Beat. Source: Science 1981; 213: 220-222
• 15 George SZ, Beneciuk JM, Lentz TA. et al The Optimal Screening for Prediction of Referral and Outcome (OSPRO) in patients with musculoskeletal pain conditions: A longitudinal validation cohort from the USA. BMJ Open 2017; 7: e015188
• 16 George SZ, Beneciuk JM. Psychological predictors of recovery from low back pain: A prospective study. BMC Musculoskelet Dis 2015; 16: 49
• 17 Wijma AJ, van Wilgen CP, Meeus M. et al Clinical biopsychosocial physiotherapy assessment of patients with chronic pain: The first step in pain neuroscience education. Physiother Theory Pract 2016; 32: 368-384
• 18 McEwen BS. Physiology and neurobiology of stress and adaptation: Central role of the brain. Physiolog Rev 2007; 87: 873-904
• 19 Thayer JF, Åhs F, Fredrikson M. et al A meta-analysis of heart rate variability and neuroimaging studies: Implications for heart rate variability as a marker of stress and health. Neurosci Biobehav Rev 2012; 36: 747-756
• 20 Sammito S, Thielmann B, Seibt R. et al Leitlinie. Nutzung der Herzschlagfrequenz und der Herzfrequenzvariabilität in der Arbeitsmedizin und der Arbeitswissenschaft. Deutsche Gesellschaft für Arbeitsmedizin und Umweltmedizin. AWMF online 2014. Im Internet (Stand: 06.03.2020): www.awmf.org/uploads/tx_szleitlinien/002-042l_S2k_Herzschlagfrequenz_Herzfrequenzvariabilit%C3%A4t_2014-07.pdf
• 21 Taelman J, Vandeput S, Spaepen A. et al Influence of Mental Stress on Heart Rate and Heart Rate Variability. In: Vander Sloten J, Verdonck P, Nyssen M. et al (eds) 4th European Conference of the International Federation for Medical and Biological Engineering. IFMBE Proceedings. 22.. Berlin, Heidelberg: Springer; 2009.
• 22 Suvarna B, Suvarna A, Phillips R. et al Health risk behaviours and allostatic load: A systematic review. Neurosci Biobehav Rev 2020; 108: 694-711
• 23 Firstbeat Technologies Ltd, Hrsg. Stress and Recovery Analysis Method Based on 24-hour Heart Rate Variability. Firstbeat White Paper 2014. Im Internet (Stand: 22.01.2020): https://assets.firstbeat.com/firstbeat/uploads/2015/10/Stress-and-recovery_white-paper_20145.pdf
• 24 Thabane L, Ma J, Chu R. et al A tutorial on pilot studies: The what, why and how. BMC Med Res Methodol 2010; 10: 1
• 25 Bell ML, Whitehead AL, Julious SA. Guidance for using pilot studies to inform the design of intervention trials with continuous outcomes. Clinic Epidemiol 2018; 10: 153-157
• 26 Klintberg IH, Cools AMJ, Holmgren TM. et al Consensus for physiotherapy for shoulder pain. Int Orthopaed 2015; 39: 715-720
• 27 Angst F, Goldhahn J, Pap G. et al Cross-cultural adaptation, reliability and validity of the German shoulder pain and disability index (SPADI). Rheumatol 2007; 46: 87-92
• 28 Shaffer F, Ginsberg JP. An Overview of Heart Rate Variability Metrics and Norms. Front Pub Health 2017; 5: 258
• 29 Sammito S, Böckelmann I. Factors influencing heart rate variability. Int Cardiovascul Forum J 2016; 6: 18-22
• 30 Gross MJ, Shearer DA, Bringer JD. et al Abbreviated Resonant Frequency Training to Augment Heart Rate Variability and Enhance On-Demand Emotional Regulation in Elite Sport Support Staff. App Psychophysiol Biofeedback 2006; 41: 263-274
• 31 Föhr T, Tolvanen A, Myllymäki T. et al Physical activity, heart rate variability–based stress and recovery, and subjective stress during a 9-month study period. Scand J Med Science Sports 2017; 27: 612-621
• 32 Smolander J, Juuti T, Kinnunen M. et al A new heart rate variability-based method for the estimation of oxygen consumption without individual laboratory calibration: Application example on postal workers. Applied Ergonomics 2008; 39: 325-331
• 33 Booth J, Moseley GL, Schiltenwolf M. et al Exercise for chronic musculoskeletal pain: A biopsychosocial approach. Musculoskel Care 2017; 15: 413-421
• 34 Yamanaka Y, Hashimoto S, Takasu NN. et al. Morning and evening physical exercise differentially regulate the autonomic nervous system during nocturnal sleep in humans. Am J Physiol Regula Integrat Comparat Physiol 2015; 309 (09) 1112-1121
• 35 Shochat T, Cohen-Zion M, Tzischinsky O. Functional consequences of inadequate sleep in adolescents: Asystematic review. Sleep Med Rev 2014; 18: 75-87
• 36 Irwin MR. Why Sleep Is Important for Health: A Psychoneuroimmunology Perspective. An Rev Psychol 2015; 66: 143-172
• 37 Mignot E. Why we sleep: The temporal organization of recovery. PLoS Biol 2008; 6: e106
• 38 Breckenridge JD, McAuley JH. Shoulder Pain and Disability Index (SPADI). J Physiother 2011; 57: 197
• 39 Bogdány T, Boros S, Szemerszky R. et al Validation of the Firstbeat TeamBelt and BodyGuard2 systems. Magyar Sporttudományi Szemle 2016; 17: 5-12 . Im Internet (Stand: 10.01.2020): www.researchgate.net/publication/308809187Validation
• 40 Parak J, Korhonen I. Accuracy of Firstbeat Bodyguard 2 beat-to-beat heart rate monitor. Firstbeat White Paper 2013. Im Internet (Stand: 19.03.2020): https://assets.firstbeat.com/firstbeat/uploads/2015/11/white_paper_bodyguard2_final.pdf
• 41 Faul F, Erdfelder E, Lang A-G. et al G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007; 39: 175-191
• 42 JASP Team, Hrsg. JASP in publications use:2019. JASP (Version 0.12.2) [Computer software]. Im Internet (Stand: 27.11.2021): https://jasp-stats.org/
• 43 Schober P, Schwarte LA. Correlation coefficients: Appropriate use and interpretation. Anesthesia and Analgesia 2018; 126: 1763-1768
• 44 Voss A, Schroeder R, Heitmann A. et al Short-term heart rate variability – Influence of gender and age in healthy subjects. PLoS ONE 2015; 10: e0118308
• 45 Heathers JAJ. Everything Hertz: Methodological issues in short-term frequency-domain HRV. Front Physiol 2014; 5: 177
• 46 Esterling BA, L’Abate L, Murray EJ. et al Empirical foundations for writing in prevention and psychotherapy: Mental and physical health outcomes. Clinical Psychology Review 1999; 19: 79-96