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

Publication History

Received: 07 October 2020

Accepted: 08 October 2021

Article published online:
07 December 2021

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