Prospective study on the effects of resistance training with elastic band at home on muscle function and walking ability of severely burned children
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摘要:
目的 探讨居家弹力带抗阻训练对严重烧伤患儿的肌肉功能和步行能力的作用。 方法 采用前瞻性非随机对照研究方法。2022年1月—2023年4月，武汉大学同仁医院暨武汉市第三医院收治40例符合入选标准的严重烧伤患儿，根据患儿或其家属意愿将患儿分为常规康复组和联合康复组，研究过程中脱落8例，最终常规康复组纳入17例患儿［男6例、女11例，年龄（8.5±2.4）岁］，联合康复组纳入15例患儿［男5例、女10例，年龄（9.6±2.5）岁］。2组患儿在院内均接受常规烧伤康复治疗，包括主、被动活动训练和瘢痕按摩及压力治疗等。联合康复组患儿在出院后行每周3~5次的弹力带抗阻训练，常规康复组患儿出院后进行日常活动能力训练。在居家康复训练前（出院前1周）和居家康复训练12周后，采用手持握力仪测量握力，采用便携式肌力测量仪测量上肢和下肢肌力，采用生物电阻抗测量仪测量瘦体重，测量6 min步行距离。对数据行独立样本 t检验、配对样本 t检验、Mann-Whitney U检验、Fisher确切概率法检验。 结果 居家康复训练12周后，联合康复组和常规康复组患儿握力分别为（15±4）、（11±4）kg，明显大于居家康复训练前的（10±4）、（9±4）kg（ t值分别为-9.99、-11.89， P值均<0.05）；联合康复组患儿的握力明显大于常规康复组（ t=3.24， P<0.05）。居家康复训练12周后，联合康复组患儿上肢和下肢肌力（ t值分别为-11.39、-3.40， P<0.05）、常规康复组患儿上肢和下肢肌力（ t值分别为-7.59、-6.69， P<0.05）均明显大于居家康复训练前，联合康复组患儿上肢和下肢肌力均明显大于常规康复组（ t值分别为3.80、7.87， P<0.05）。居家康复训练12周后，联合康复组患儿瘦体重明显大于居家康复训练前（ t=0.21， P<0.05）。居家康复训练12周后，常规康复组和联合康复组患儿6 min步行距离均明显长于居家康复训练前（ t值分别为-5.33、-3.40， P<0.05），联合康复组患儿6 min步行距离明显长于常规康复组（ t=3.81， P<0.05）。 结论 在院内进行常规烧伤康复治疗，出院后进行12周的居家弹力带抗阻训练能显著增强严重烧伤患儿的肌肉功能和步行能力。 Abstract:Objective To explore the effects of resistance training with elastic band at home on muscle function and walking ability of severely burned children. Methods A prospective non-randomized controlled study was conducted. From January 2022 to April 2023, 40 children with severe burns who met the inclusion criteria were admitted to Tongren Hospital of Wuhan University ＆ Wuhan Third Hospital. According to the willingness of the children or their families, the children were assigned to conventional rehabilitation group and combined rehabilitation group. During the study, 8 children dropped out of the study, 17 children were finally included in the conventional rehabilitation group with 6 males and 11 females, aged (8.5±2.4) years, and 15 children were included in the combined rehabilitation group with 5 males and 10 females, aged (9.6±2.5) years. The children in the 2 groups received conventional burn rehabilitation treatment in the hospital, including active and passive activity training, scar massage, and pressure therapy. The children in combined rehabilitation group received resistance training with elastic band of 3 to 5 times per week after discharge, and the children in conventional rehabilitation group received daily activity ability training after discharge. Before home rehabilitation training (1 week before discharge) and 12 weeks after home rehabilitation training, the grip strength was measured using a handheld grip dynamometer, the muscle strengths of the upper and lower limbs were measured using a portable dynamometer for muscle strength, lean body mass was measured by bioelectrical impedance measuring instrument, and the 6-min walking distance was measured. Data were statistically analyzed with independent sample t test, paired sample t test, Mann-Whitney Utest, or Fisher's exact probability test. Results After 12 weeks of home rehabilitation training, the grip strengths of children in combined rehabilitation group and conventional rehabilitation group were (15±4) and (11±4) kg, respectively, which were significantly higher than (10±4) and (9±4) kg before home rehabilitation training (with t values of -9.99 and -11.89, respectively, Pvalues all <0.05); the grip strength of children in combined rehabilitation group was significantly higher than that in conventional rehabilitation group ( t=3.24, P<0.05). After 12 weeks of home rehabilitation training, the muscle strengths of upper and lower limbs of children in combined rehabilitation group (with t values of -11.39 and -3.40, respectively, P<0.05) and the muscle strengths of upper and lower limbs of children in conventional rehabilitation group (with t values of -7.59 and -6.69, respectively, P<0.05) were significantly higher than those before home rehabilitation training, and the muscle strengths of upper and lower limbs of children in combined rehabilitation group were significantly higher than those in conventional rehabilitation group (with t values of 3.80 and 7.87, respectively, P<0.05). After 12 weeks of home rehabilitation training, the lean body mass of children in combined rehabilitation group was significantly higher than that before home rehabilitation training ( t=0.21, P<0.05). After 12 weeks of home rehabilitation training, the 6-min walking distances of children in conventional rehabilitation group and combined rehabilitation group were significantly longer than those before home rehabilitation training (with t values of -5.33 and -3.40, respectively, P<0.05), and the 6-min walking distance of children in combined rehabilitation group was significantly longer than that in conventional rehabilitation group ( t=3.81, P<0.05). Conclusions Conventional burn rehabilitation treatment in hospital and home resistance training with elastic band for 12 weeks after discharge can significantly improve the muscle function and walking ability of severely burned children. -
Key words:
- Burns /
- Child /
- Rehabilitation /
- Elastic band /
- Muscle function /
- Walking ability
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参考文献
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表1 2组严重烧伤患儿临床资料比较
表1. Comparison of clinical data between two groups of children with severe burns
组别 例数 性别（例） 年龄（岁， 烧伤总面积［%TBSA， M（ Q 1， Q 3）］ Ⅲ度烧伤面积［%TBSA， M（ Q 1 ，Q 3） ］ 伤后至开始康复治疗时间 （d， 男 女 常规康复组 17 6 11 8.5±2.4 28（23，35） 10.0（4.0，11.5） 24±9 联合康复组 15 5 10 9.6±2.5 25（21，37） 8.3（5.0，10.0） 26±8 统计量值 — t=1.29 Z=-0.32 Z=-0.39 t=0.82 P值 0.907 0.208 0.748 0.702 0.421 注：“—”表示无此项；TBSA为体表总面积；2组患儿均在院内接受相同的常规康复训练，常规康复组患儿出院后接受日常活动能力的训练，联合康复组患儿出院后行弹力带抗阻训练 
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表2 2组严重烧伤患儿居家康复训练前后的握力比较（kg，
表2. Comparison of grip strength between two groups of children with severe burns before and after home rehabilitation training
组别 例数 训练前 训练12周后 t值 P值 常规康复组 17 9±4 11±4 -11.89 <0.001 联合康复组 15 10±4 15±4 -9.99 <0.001 t值 1.30 3.24 P值 0.203 0.003 注：居家康复训练前为出院前1周；2组患儿均在院内接受相同的常规康复训练，常规康复组患儿出院后接受日常活动能力的训练，联合康复组患儿出院后行弹力带抗阻训练
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表3 2组严重烧伤患儿居家康复训练前后的上肢和下肢肌力比较（N，
表3. Comparison of upper and lower limbs muscle strength between two groups of children with severe burns before and after home rehabilitation training
组别 例数 上肢肌力 下肢肌力 t 2值 P 2值 t 3值 P 3值 训练前 训练12周后 训练前 训练12周后 常规康复组 17 58±17 84±21 109±23 137±28 -7.59 <0.001 -6.69 <0.001 联合康复组 15 60±21 108±12 108±29 199±13 -11.39 <0.001 -3.40 0.001 t 1值 0.25 3.80 -0.15 7.87 P 1值 0.808 0.001 0.882 <0.001 注：居家康复训练前为出院前1周；2组患儿均在院内接受相同的常规康复训练，常规康复组患儿出院后接受日常活动能力的训练，联合康复组患儿出院后行弹力带抗阻训练； t 1值、 P 1值为2组间比较所得； t 2值、 P 2值为组内训练前后上肢肌力比较所得， t 3值、 P 3值为组内训练前后下肢肌力比较所得
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表4 2组严重烧伤患儿居家康复训练前后的瘦体重比较（kg，
表4. Comparison of lean body mass between two groups of children with severe burns before and after home rehabilitation training
组别 例数 训练前 训练12周后 t值 P值 常规康复组 17 24±10 24±8 -0.52 0.602 联合康复组 15 25±6 27±9 0.21 0.002 t值 0.25 1.11 P值 0.802 0.272 注：居家康复训练前为出院前1周；2组患儿均在院内接受相同的常规康复训练，常规康复组患儿出院后接受日常活动能力的训练，联合康复组患儿出院后行弹力带抗阻训练
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表5 2组严重烧伤患儿居家康复训练前后的6 min步行距离比较（m，
表5. Comparison of 6-min walking distance between two groups of children with severe burns before and after home rehabilitation training
组别 例数 训练前 训练12周后 t值 P值 常规康复组 17 328±49 411±37 -5.33 <0.001 联合康复组 15 338±46 468±49 -3.40 0.001 t值 0.59 3.81 P值 0.563 0.001 注：居家康复训练前为出院前1周；2组患儿均在院内接受相同的常规康复训练，常规康复组患儿出院后接受日常活动能力的训练，联合康复组患儿出院后行弹力带抗阻训练
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