A randomized controlled trial on the effect of exercise prescription based on a progressive mode in treating elderly patients with lower limb dysfunction after deep burns
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摘要:
目的 探讨基于渐进模式的运动处方治疗深度烧伤后下肢功能障碍老年患者的效果。 方法 采用随机对照试验方法。2021年1月—2023年1月，空军军医大学第一附属医院收治60例符合入选标准的深度烧伤后下肢功能障碍老年患者。将患者按照随机数字表法分为常规康复组［30例，男17例、女13例，年龄（65±3）岁］和联合康复组［30例，男16例、女14例，年龄（64±3）岁］。对2组患者于下肢创面愈合后或散在残余创面总面积<1％体表总面积时，开始进行红光治疗。于红光治疗2周后，对常规康复组患者行关节牵伸、抗阻及平衡训练等常规康复治疗；对联合康复组患者在常规康复治疗基础上进行每周3次的基于渐进模式的运动处方训练，主要包括哑铃推举、Bobath球水平支撑、高位下拉训练等。2组患者训练时间均为12周。于训练前（红光治疗2周后）及训练12周后，采用简易Fugl-Meyer量表评定患者上肢与下肢的运动功能，采用简易体能状况量表评定患者体适能，通过计时-起立行走测试耗时评定患者跌倒风险。记录患者训练期间发生的不良事件；训练12周后，自行设计满意度调查表调查患者对训练效果的满意度。对数据行独立样本 t检验、配对样本 t检验、Mann-Whitney U检验、Wilcoxon符号秩检验、 χ 2检验。 结果 训练前，2组患者上肢与下肢运动功能评分均相近（ P>0.05）。训练12周后，常规康复组、联合康复组患者上肢运动功能评分均较训练前明显升高（ t值分别为-11.42、-13.67， P<0.05），但2组间比较，差异无统计学意义（ P>0.05）；联合康复组患者下肢运动功能评分为（28.9±2.6）分，明显高于常规康复组的（26.3±2.6）分（ t=-3.90， P<0.05），且常规康复组、联合康复组患者下肢运动功能评分均较训练前明显升高（ t值分别为-4.14、-6.94， P<0.05）。训练前，2组患者体适能各单项评分及总评分均相近（ P>0.05）；训练12周后，常规康复组、联合康复组患者体适能中的平衡能力评分、步行速度评分、椅子坐立评分及总评分均较训练前明显升高（ Z值分别为-4.38、-3.55、-3.88、-4.65与-4.58、-4.68、-4.42、-4.48， P<0.05），且联合康复组患者体适能中的平衡能力评分、步行速度评分、椅子坐立评分及总评分均明显高于常规康复组（ Z值分别为-3.93、-3.41、-3.19、-5.33， P<0.05）。训练前，2组患者针对跌倒风险的计时-起立行走测试耗时相近（ P>0.05）。训练12周后，联合康复组患者针对跌倒风险的计时-起立行走测试耗时为（28.0±2.1）s，明显短于常规康复组的（30.5±1.8）s（ t=4.94， P<0.05）；且常规康复组、联合康复组患者针对跌倒风险的计时-起立行走测试耗时均较训练前明显缩短（ t值分别为14.80、15.86， P<0.05）。所有患者训练期间均未发生肌肉组织拉伤、水肿或跌倒等不良事件。训练12周后，联合康复组患者对治疗效果的满意度评分为（13.5±1.2）分，明显高于常规康复组的（8.5±1.4）分（ t=21.78， P<0.05）。 结论 基于渐进模式的运动处方训练可以明显促进深度烧伤后下肢功能障碍老年患者下肢运动功能、体适能恢复，可有效降低患者跌倒风险，且训练期间不引发不良事件，使得患者对训练效果的满意度较高。 Abstract:Objective To explore the effect of exercise prescription based on a progressive mode in treating elderly patients with lower limb dysfunction after deep burns. Methods A randomized controlled trial was conducted. From January 2021 to January 2023, 60 elderly patients with lower limb dysfunction after deep burns who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University. The patients were divided into conventional rehabilitation group (30 cases, 17 males and 13 females, aged (65±3) years) and combined rehabilitation group (30 cases, 16 males and 14 females, aged (64±3) years) according to the random number table. For patients in both groups, the red-light treatment was started after the lower limb wounds healed or when the total area of scattered residual wounds was less than 1% of the total body surface area. After 2 weeks of red-light treatment, the patients in conventional rehabilitation group were given conventional rehabilitation treatments, including joint stretching, resistance, and balance training; in addition to conventional rehabilitation treatments, the patients in combined rehabilitation group were given exercise prescription training based on a progressive mode three times a week, mainly including dumbbell press, Bobath ball horizontal support, and high-level pulldown trainings. The training time for patients in both groups was 12 weeks. Before training (after 2 weeks of red-light treatment) and after 12 weeks of training, the upper limb and lower limb motor functions of the patients were evaluated using the simple Fugl-Meyer scale, the physical fitness of patients was evaluated using the simple physical fitness scale, and the patient's risk of falling was evaluated by the time consumed for the timed up and go test. The adverse events of patients that occurred during training were recorded. After 12 weeks of training, a self-designed satisfaction survey was conducted to investigate patients' satisfaction with the training effect. Data were statistically analyzed with independent sample ttest, paired sample t test, Mann-Whitney U test, Wilcoxon signed rank test, and chi-square test. Results Before training, the scores of upper limb and lower limb motor functions of patients between the two groups were similar ( P>0.05). After 12 weeks of training, the scores of upper limb motor function of patients in conventional rehabilitation group and combined rehabilitation group were significantly higher than those before training (with t values of -11.42 and -13.67, respectively, P<0.05), but there was no statistically significant difference between the two groups ( P>0.05). The score of lower limb motor function of patients in combined rehabilitation group was 28.9±2.6, which was significantly higher than 26.3±2.6 in conventional rehabilitation group ( t=-3.90, P<0.05), and the scores of lower limb motor function of patients in conventional rehabilitation group and combined rehabilitation group were significantly higher than those before training (with t values of -4.14 and -6.94, respectively, P<0.05). Before training, the individual and total scores of physical fitness of patients between the two groups were similar ( P>0.05). After 12 weeks of training, the balance ability score, walking speed score, chair sitting score, and total score of physical fitness of patients in conventional rehabilitation group and combined rehabilitation group were significantly increased compared with those before training (with Z values of -4.38, -3.55, -3.88, -4.65, -4.58, -4.68, -4.42, and -4.48, respectively, P<0.05), and the balance ability score, walking speed score, chair sitting score, and total score of physical fitness of patients in combined rehabilitation group were significantly increased compared with those in conventional rehabilitation group (with Z values of -3.93, -3.41, -3.19, and -5.33, P<0.05). Before training, the time consumed for the timed up and go test for patient's risk of falling in the two groups was close ( P>0.05). After 12 weeks of training, the time consumed for the timed up and go test for patient's risk of falling in combined rehabilitation group was (28.0±2.1) s, which was significantly shorter than (30.5±1.8) s in conventional rehabilitation group ( t=4.94, P<0.05). Moreover, the time consumed for the timed up and go test for patient's risk of falling in both conventional rehabilitation group and combined rehabilitation group was significantly shorter than that before training (with t values of 14.80 and 15.86, respectively, P<0.05). During the training period, no adverse events such as muscle tissue strain, edema, or falling occurred in any patient. After 12 weeks of training, the satisfaction score of patients with the training effect in combined rehabilitation group was 13.5±1.2, which was significantly higher than 8.5±1.4 in conventional rehabilitation group ( t=21.78, P<0.05). Conclusions The exercise prescription training based on a progressive mode can significantly promote the recovery of lower limb motor function and physical fitness of elderly patients with lower limb dysfunction after deep burns, and effectively reduce the patient's risk of falling without causing adverse events during the training period, resulting in patient's high satisfaction with the training effect. -
Key words:
- Burns /
- Aged /
- Rehabilitation /
- Exercise prescription /
- Motor function /
- Physical fitness /
- Progressive mode /
- Falling risk
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参考文献
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1 行常规康复联合基于渐进模式的运动处方训练治疗深度烧伤后下肢功能障碍老年患者的效果。1A.伤后2 d，患者双下肢皮肤焦痂形成，大部分发白；1B.伤后47 d，双下肢创面基本愈合，仅残留散在小创面；1C.康复治疗开始时，行双下肢红光治疗；1D.红光治疗2周后，行下肢弹力带抗阻训练；1E.康复训练第7天，行下肢Bobath球水平支撑训练；1F.康复训练第21天，行手握哑铃水平外展情况下下肢单腿站立训练；1G.康复训练第63天，行高位下拉训练；1H.治疗结束后1年半随访，患者能使用铁锹翻土
注：常规康复包括关节牵伸、抗阻及平衡训练，运动处方训练包括哑铃推举和高位下拉等
表1 2组深度烧伤后下肢功能障碍老年患者临床资料比较
表1. Comparison of clinical data between two groups of elderly patients with lower limb dysfunction after deep burns
组别 例数 性别（例） 年龄（岁， 烧伤总面积（%TBSA， 下肢深Ⅱ度烧伤面积（%TBSA， 下肢Ⅲ度烧伤面积（%TBSA， 身体质量指数（kg/m 2， 伤后至开始康复治疗时间（d， 男 女 常规康复组 30 17 13 65±3 44±6 20±7 20±6 23±6 49±3 联合康复组 30 16 14 64±3 45±7 20±8 19±7 23±5 49±4 统计量值 χ 2=0.07 t=1.27 t=-0.59 t=0.17 t=0.63 t=0.65 t=0.67 P值 0.795 0.208 0.555 0.809 0.530 1.000 0.588 注：对常规康复组患者行关节牵伸、抗阻及平衡训练，对联合康复组患者在常规康复基础上进行包括哑铃推举和高位下拉等训练的基于渐进模式的运动处方训练；TBSA为体表总面积 
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表2 2组深度烧伤后下肢功能障碍老年患者训练前后上肢和下肢运动功能评分比较（分，
表2. Comparison of upper and lower limb motor function scores before and after training between two groups of elderly patients with lower limb dysfunction after deep burns
组别 例数 上肢运动功能评分 下肢运动功能评分 训练前 训练12周后 训练前 训练12周后 常规康复组 30 53.9±3.1 61.8±1.1 a 23.3±2.5 26.3±2.6 a 联合康复组 30 54.3±2.9 61.7±1.0 a 23.9±2.4 28.9±2.6 a t值 -0.43 0.36 -0.98 -3.90 P值 0.666 0.723 0.330 <0.001 注：训练前为进行红光治疗2周后；对常规康复组患者行关节牵伸、抗阻及平衡训练，对联合康复组患者在常规康复基础上进行包括哑铃推举和高位下拉等训练的基于渐进模式的运动处方训练；与组内训练前比较， a P<0.05
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表3 2组深度烧伤后下肢功能障碍老年患者训练前后体适能各单项评分及总评分比较[分， M（ Q 1， Q 3）]
表3. Comparison of the individual and total scores of physical fitness before and after training between two groups of elderly patients with lower limb dysfunction after deep burns
组别 例数 平衡能力评分 步行速度评分 椅子坐立评分 总评分 训练前 训练12周后 训练前 训练12周后 训练前 训练12周后 训练前 训练12周后 常规康复组 30 1.00（0，1.00） 2.00（1.00，3.00） a 1.00（1.00，2.00） 2.00（1.00，3.00） a 1.00（0.75，2.00） 2.00（1.00，3.00） a 3.00（2.00，4.00） 6.00（5.00，7.00） a 联合康复组 30 1.00（0，1.25） 3.00（2.00，4.00） a 1.00（0，2.00） 3.00（2.00，3.25） a 1.00（0.75，2.00） 3.00（2.00，4.00） a 3.00（2.00，4.00） 9.00（8.00，10.00） a Z值 -0.98 -3.93 -0.88 -3.41 -0.72 -3.19 -0.27 -5.33 P值 0.328 <0.001 0.376 <0.001 0.467 <0.001 0.789 <0.001 注：训练前为进行红光治疗2周后；对常规康复组患者行关节牵伸、抗阻及平衡训练，对联合康复组患者在常规康复基础上进行包括哑铃推举和高位下拉等训练的基于渐进模式的运动处方训练；与组内训练前比较， a P<0.05
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