Un Interventions multimodales pour la gestion de la douleur chronique chez les personnes âgées : un essai contrôlé randomisé dans des contextes de soins de santé primaires.
DOI :
https://doi.org/10.70860_abef20253344Résumé
La douleur musculo-squelettique chronique (DMSC) est une affection fréquente chez les personnes âgées, qui peut réduire considérablement la capacité fonctionnelle et la qualité de vie. Les interventions multimodales (IM), combinant des exercices d'aérobie, de résistance et d'équilibre, sont prometteuses mais peu étudiées en soins de santé primaires. Objectif : Évaluer l'efficacité d'un programme d'IM de 12 semaines pour réduire l'intensité de la douleur et améliorer les résultats fonctionnels chez les personnes âgées atteintes de DMSC. Méthodes : Un essai contrôlé randomisé a été mené auprès de 113 participants (âge moyen : 68,5 ± 5,3 ans), assignés aléatoirement à un groupe expérimental (EG, n = 57) ou à un groupe témoin (CG, n = 56). L'intensité de la douleur (échelle d'évaluation numérique), la capacité fonctionnelle (test de marche de 6 minutes ; 6MWT) et la force des membres inférieurs (test de verticalisation de 30 secondes ; 30 s-CST) ont été évaluées au départ et après l'intervention. Les données ont été analysées à l'aide d'une ANOVA à mesures répétées, avec des tailles d'effet calculées pour la pertinence clinique. Résultats : L'intensité de la douleur a diminué de 2,53 points (IC à 95 % : 2,34-2,72) dans l'EG, dépassant le seuil de 1 à 2 points du critère d'évaluation minimal important (CIMI) (p < 0,0001). La capacité fonctionnelle s'est améliorée de 23,87 mètres (IC à 95 % : 5,27-42,47) dans le 6MWT, dépassant la plage de 14 à 30 mètres du CIMI (p < 0,0001). La force des membres inférieurs a augmenté de 0,89 répétition (IC à 95 % : 0,15-1,26) dans le 30 s-CST, ce qui représente un progrès significatif malgré un nombre inférieur au seuil de 2 répétitions du CIMI. Les tailles d'effet étaient modérées à importantes pour tous les résultats. Conclusion : L'intervention multimodale a significativement réduit la douleur et amélioré la capacité fonctionnelle, démontrant son impact clinique et son utilité pratique pour la prise en charge du CMSP. D'autres recherches devraient évaluer les impacts à long terme des MI et explorer leur mise en œuvre dans divers contextes.
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