居家弹力带抗阻训练对严重烧伤患儿肌肉功能和步行能力影响的前瞻性研究

霍婷; 阮晶晶; 蒋梅君; 雷芳; 黄伟; 汤文倩; 谢卫国; 徐向阳; 王松; 刘淑华

doi:10.3760/cma.j.cn501225-20230729-00022

居家弹力带抗阻训练对严重烧伤患儿肌肉功能和步行能力影响的前瞻性研究

doi: 10.3760/cma.j.cn501225-20230729-00022

1.
武汉大学同仁医院暨武汉市第三医院烧伤科，武汉　　430060
2.
华中科技大学同济医学院附属梨园医院放射科，武汉　　430077
3.
武汉体育学院运动医学院，武汉　　430079

基金项目:

国家重点研发计划 2019YFE0196800

武汉市科技局知识创新专项 2023020201010190

详细信息

通讯作者:
刘淑华，Email：liushuhua32@hotmail.com

计量
- 文章访问数: 114
- HTML全文浏览量: 40
- PDF下载量: 16
- 被引次数: 0
出版历程
- 收稿日期: 2023-07-29

Prospective study on the effects of resistance training with elastic band at home on muscle function and walking ability of severely burned children

1.
Department of Burns, Tongren Hospital of Wuhan UniversityWuhan Third Hospital, Wuhan 430060, China
2.
Department of Radiology, Liyuan Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, China
3.
College of Sports Medicine, Wuhan Sports University, Wuhan 430079, China

Funds:

National Key Research and Development Program of China 2019YFE0196800

Knowledge Innovation Special Project of Wuhan Science and Technology Bureau 2023020201010190

More Information

Corresponding author: Liu Shuhua, Email: liushuhua32@hotmail.com

摘要

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。
- 烧伤 /
- 儿童 /
- 康复 /
- 弹力带 /
- 肌肉功能 /
- 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.
- Burns /
- Child /
- Rehabilitation /
- Elastic band /
- Muscle function /
- Walking ability
霍婷：弹力带抗阻训练方案设计、研究设计、数据采集、文章撰写；阮晶晶、蒋梅君、雷芳、黄伟、汤文倩：数据采集、论文修改；谢卫国、徐向阳、王松：弹力带抗阻训练方案设计、研究设计、研究指导、论文审阅；刘淑华：研究指导、论文审阅、经费支持

所有作者均声明不存在利益冲突

HTML全文

下载: 全尺寸图片幻灯片

1 弹力带抗阻训练的5个上肢动作。1A.站姿臂弯举；1B.站姿侧平举；1C.站姿前平举；1D.直立划船；1E.拉伸胸肩部

下载: 全尺寸图片幻灯片

2 弹力带抗阻训练的5个下肢动作。2A.深蹲；2B.硬拉；2C.站姿髋外展；2D.后弓箭步；2E.仰卧位腿举

下载: 全尺寸图片幻灯片

3 弹力带抗阻训练的3个核心动作。3A.站姿侧拉；3B.站姿侧弯；3C.仰卧位屈髋

下载: 全尺寸图片幻灯片

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， x ¯ ± s ）	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， x ¯ ± s ）
组别	例数	男	女	年龄（岁， x ¯ ± s ）	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， x ¯ ± s ）
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

下载: 导出CSV

表2 2组严重烧伤患儿居家康复训练前后的握力比较（kg， x ¯ ± s ）

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

下载: 导出CSV

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， x ¯ ± s ）

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
组别	例数	训练前	训练12周后	训练前	训练12周后	t ₂值	P ₂值	t ₃值	P ₃值
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

下载: 导出CSV

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， x ¯ ± s ）

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

下载: 导出CSV

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， x ¯ ± s ）

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

下载: 导出CSV

参考文献(36)

[1]	CuijpersMD,BaartmansM,van ZuijlenP,et al.Children's growth and motor development following a severe burn: a systematic review[J/OL].Burns Trauma,2023,11:tkad011[2023-07-29].https://pubmed.ncbi.nlm.nih.gov/37663674/.DOI: 10.1093/burnst/tkad011.
[2]	Cambiaso-DanielJ,RivasE,CarsonJS,et al.Cardiorespiratory capacity and strength remain attenuated in children with severe burn injuries at over 3 years postburn[J].J Pediatr,2018,192:152-158.DOI: 10.1016/j.jpeds.2017.09.015.
[3]	RivasE,TranJ,GutierrezIL,et al.Rehabilitation exercise increases physical activity levels in severely burned children while improving aerobic exercise capacity and strength[J].J Burn Care Res,2018,39(6):881-886.DOI: 10.1093/jbcr/irx045.
[4]	PalackicA,SumanOE,PorterC,et al.Rehabilitative exercise training for burn injury[J].Sports Med,2021,51(12):2469-2482.DOI: 10.1007/s40279-021-01528-4.
[5]	FloresO,TyackZ,StocktonK,et al.Exercise training for improving outcomes post-burns: a systematic review and meta-analysis[J].Clin Rehabil,2018,32(6):734-746.DOI: 10.1177/0269215517751586.
[6]	PorterC,HardeeJP,HerndonDN,et al.The role of exercise in the rehabilitation of patients with severe burns[J].Exerc Sport Sci Rev,2015,43(1):34-40.DOI: 10.1249/JES.0000000000000029.
[7]	ConnAS,HallMS,QuinnK,et al.An examination of a yoga intervention with pediatric burn survivors[J].J Burn Care Res,2017,38(1):e337-e342.DOI: 10.1097/BCR.0000000000000385.
[8]	KamelFAH,BashaMA.Effects of virtual reality and task-oriented training on hand function and activity performance in pediatric hand burns: a randomized controlled trial[J].Arch Phys Med Rehabil,2021,102(6):1059-1066.DOI: 10.1016/j.apmr.2021.01.087.
[9]	ElnaggarRK,OsailanAM,AlsubaieSF,et al.Graded aerobic exercise (GAEx): an effective exercise regimen to improve cardio-respiratory fitness and physical and psychosocial functioning in children with burn sequelae of the chest[J].Burns,2022,48(2):337-344.DOI: 10.1016/j.burns.2021.05.004.
[10]	苏媛媛,张伟宏,宋晓月,等.弹力带抗阻运动对老年人健康促进生活方式的研究进展[J].中国康复医学杂志,2018,33(1):105-108.DOI: 10.3969/j.issn.1001-1242.2018.01.024.
[11]	唐红斌,姚明焰,朱艳.有氧弹性阻抗练习的设计及其对青少年体质影响效果的实验研究[J].北京体育大学学报,2013(7):79-82.
[12]	SumanOE,SpiesRJ,CelisMM,et al.Effects of a 12-wk resistance exercise program on skeletal muscle strength in children with burn injuries[J].J Appl Physiol (1985),2001,91(3):1168-1175.DOI: 10.1152/jappl.2001.91.3.1168.
[13]	ChoYS,JeonJH,HongA,et al.The effect of burn rehabilitation massage therapy on hypertrophic scar after burn: a randomized controlled trial[J].Burns,2014,40(8):1513-1520.DOI: 10.1016/j.burns.2014.02.005.
[14]	中华医学会烧伤外科学分会,中国医师协会烧伤科医师分会.烧伤康复治疗指南(2013版)[J].中华烧伤杂志,2013,29(6):497-504.DOI: 10.3760/cma.j.issn.1009-2587.2013.06.001.
[15]	田凌云,李映兰,吴英,等.压力疗法治疗增生性瘢痕患者有效性的荟萃分析[J].中华烧伤杂志,2019,35(9):668-675.DOI: 10.3760/cma.j.issn.1009-2587.2019.09.005.
[16]	Garnacho-CastañoMV,DomínguezR,Muñoz GonzálezA,et al.Exercise prescription using the Borg rating of perceived exertion to improve fitness[J].Int J Sports Med,2018,39(2):115-123.DOI: 10.1055/s-0043-120761.
[17]	GittingsPM,HinceDA,WandBM,et al.Grip and muscle strength dynamometry in acute burn injury: evaluation of an updated assessment protocol[J].J Burn Care Res,2018,39(6):939-947.DOI: 10.1093/jbcr/iry010.
[18]	GittingsP,SaletM,BurrowsS,et al.Grip and muscle strength dynamometry are reliable and valid in patients with unhealed minor burn wounds[J].J Burn Care Res,2016,37(6):388-396.DOI: 10.1097/BCR.0000000000000414.
[19]	GittingsPM,WandBM,HinceDA,et al.The efficacy of resistance training in addition to usual care for adults with acute burn injury: a randomised controlled trial[J].Burns,2021,47(1):84-100.DOI: 10.1016/j.burns.2020.03.015.
[20]	de FigueiredoTB,UtsunomiyaKF,deOliveira AMRR,et al.Mobilization practices for patients with burn injury in critical care[J].Burns,2020,46(2):314-321.DOI: 10.1016/j.burns.2019.07.037.
[21]	PalackicA,AbazieS,ParryI,et al.Comparison of six-minute walk test and modified Bruce treadmill test in paediatric patients with severe burns: a cross-over study[J].J Rehabil Med,2022,54:jrm00305.DOI: 10.2340/jrm.v54.1064.
[22]	MudawarimaT,ChiwaridzoM,JelsmaJ,et al.A systematic review protocol on the effectiveness of therapeutic exercises utilised by physiotherapists to improve function in patients with burns[J].Syst Rev,2017,6(1):207.DOI: 10.1186/s13643-017-0592-6.
[23]	AboodardaSJ,PagePA,BehmDG.Muscle activation comparisons between elastic and isoinertial resistance: a meta-analysis[J].Clin Biomech (Bristol, Avon),2016,39:52-61.DOI: 10.1016/j.clinbiomech.2016.09.008.
[24]	霍婷,徐向阳,谢卫国,等.运动康复训练在小儿烧伤康复中应用的研究进展[J].中华烧伤与创面修复杂志,2023,39(3):275-279.DOI: 10.3760/cma.j.cn501225-20220116-00008.
[25]	RivasE,HerndonDN,Cambiaso-DanielJ,et al.Quantification of an exercise rehabilitation program for severely burned children: the standard of care at Shriners Hospitals for Children®-Galveston[J].J Burn Care Res,2018,39(6):889-896.DOI: 10.1093/jbcr/iry001.
[26]	CucuzzoNA,FerrandoA,HerndonDN.The effects of exercise programming vs traditional outpatient therapy in the rehabilitation of severely burned children[J].J Burn Care Rehabil,2001,22(3):214-220.DOI: 10.1097/00004630-200105000-00006.
[27]	WurzerP,VoigtCD,ClaytonRP,et al.Long-term effects of physical exercise during rehabilitation in patients with severe burns[J].Surgery,2016,160(3):781-788.DOI: 10.1016/j.surg.2016.04.028.
[28]	PrelackK,YuYM,SheridanRL.Nutrition and metabolism in the rehabilitative phase of recovery in burn children: a review of clinical and research findings in a speciality pediatric burn hospital[J/OL].Burns Trauma,2015,3:7[2023-07-29].https://pubmed.ncbi.nlm.nih.gov/27574653/.DOI: 10.1186/s41038-015-0004-x.
[29]	RivasE,HerndonDN,PorterC,et al.Short-term metformin and exercise training effects on strength, aerobic capacity, glycemic control, and mitochondrial function in children with burn injury[J].Am J Physiol Endocrinol Metab,2018,314(3):E232-E240.DOI: 10.1152/ajpendo.00194.2017.
[30]	GittingsPM,GrisbrookTL,EdgarDW,et al.Resistance training for rehabilitation after burn injury: a systematic literature review & meta-analysis[J].Burns,2018,44(4):731-751.DOI: 10.1016/j.burns.2017.08.009.
[31]	ChaoT,PorterC,HerndonDN,et al.Propranolol and oxandrolone therapy accelerated muscle recovery in burned children[J].Med Sci Sports Exerc,2018,50(3):427-435.DOI: 10.1249/MSS.0000000000001459.
[32]	RomeroSA,MoralezG,JafferyMF,et al.Progressive exercise training improves maximal aerobic capacity in individuals with well-healed burn injuries[J].Am J Physiol Regul Integr Comp Physiol,2019,317(4):R563-R570.DOI: 10.1152/ajpregu.00201.2019.
[33]	YangS,QiuL,XiaoJ,et al.The effects of resistance training on children with burns: a meta-analysis[J].Pediatr Surg Int,2021,37(10):1323-1332.DOI: 10.1007/s00383-021-04947-6.
[34]	谢卫国.烧伤康复的普及与提高任重道远[J].中华烧伤与创面修复杂志,2022,38(12):1105-1109.DOI: 10.3760/cma.j.cn501225-20221111-00484.
[35]	贾赤宇,邹晓防.中国烧伤康复的发展现状[J].中华烧伤杂志,2015,31(3):161-163.DOI: 10.3760/cma.j.issn.1009-2587.2015.03.001.
[36]	FloresO,TyackZ,StocktonK,et al.The use of exercise in burns rehabilitation: a worldwide survey of practice[J].2020,46(2):322-332.DOI: 10.1016/j.burns.2019.02.016.