全膝关节置换术后高速与低速运动对预后影响的比较分析：一项随机临床试验

Comparative Analysis of High-Velocity Versus Low-Velocity Exercise on Outcomes After Total Knee Arthroplasty: A Randomized Clinical Trial.

作者信息

Kelly Marie A, Finley Margaret, Lichtman Steven W, Hyland Matthew R, Edeer Ayse Ozcan

机构信息

1Outpatient Orthopedic Physical Therapy, Helen Hayes Hospital, West Haverstraw, New York. 2Department of Physical Therapy, Dominican College, Orangeburg, New York. 3Drexel University, Physical Therapy and Rehabilitation Sciences, Philadelphia, Pennsylvania. 4Cardiopulmonary Outpatient Services, Helen Hayes Hospital, West Haverstraw, New York. 5Department of Physical Therapy, Mercy College, Dobbs Ferry, New York. 6Rye Physical Therapy & Rehabilitation, PC, White Plains, New York.

出版信息

J Geriatr Phys Ther. 2016 Oct-Dec;39(4):178-89. doi: 10.1519/JPT.0000000000000070.

DOI:10.1519/JPT.0000000000000070

PMID:26428900

Abstract

BACKGROUND AND PURPOSE

High-velocity (HV) exercise is defined as performing a concentric muscle contraction as fast as possible, or in 1 second or less. Low-velocity (LV) exercise is defined as using 2 seconds to complete the contraction. A comparison of HV to LV exercise performed by community dwelling older adults indicates that HV exercise produces greater gains in power and scores for the 8-ft up-and-go, 30-seond chair stand, and continuous scale physical function performance tests. The effectiveness of HV strengthening exercises has not been identified for individuals who undergo total knee arthroplasty (TKA). The purpose of this research study was to compare the effects of a 6-week exercise program, using either LV or HV contractions, on functional performance, gait, and pain of individuals who have undergone TKA.

METHODS

Adults aged 60 to 89 years with a mean (standard deviation) age of 71.2 (6.8) years who underwent TKA an average of 15 days prior were randomly assigned to an HV exercise (n = 19) or LV exercise (n = 19) training group. The training program lasted for 12 sessions, over 6 to 7 weeks. The primary outcome was functional performance rated with the 6-Minute Walk Test. Secondary measures were the stair climb test, Timed Up and Go test, gait velocity, gait deviations measured with the Gait Abnormality Rating Scale, and pain via a visual analog scale. A 2×2 mixed model analysis of variance (group × time) was used for all outcomes. Comparison between LV and HV groups for posttest gait velocity and Gait Abnormality Rating Scale used independent t test and Mann-Whitney U test, respectively.

RESULTS

At baseline no differences between groups were noted for sex, age, and height. The LV group weighed more and had more comorbid conditions. Spearman's ρ demonstrated that the greater comorbidities of the LV group correlated with a slower stair climb test at baseline. At posttest both groups exhibited significantly improved scores for all outcome measurements except the visual analog scale for pain. The HV group, but not the LV group, reported a significant decrease in pain at the end of the 6-week training program.

CONCLUSIONS

Both HV and LV progressive exercises equally improve functional performance. Only the HV group reported significantly decreased pain at posttest.

摘要

背景与目的

高速（HV）运动被定义为尽可能快地进行向心性肌肉收缩，即在1秒或更短时间内完成。低速（LV）运动被定义为用2秒完成收缩。对社区居住的老年人进行的HV运动与LV运动的比较表明，HV运动在8英尺起立行走、30秒坐立试验和连续量表身体功能性能测试中能带来更大的力量提升和得分提高。对于接受全膝关节置换术（TKA）的个体，HV强化运动的有效性尚未得到证实。本研究的目的是比较为期6周的运动计划，采用LV或HV收缩，对接受TKA的个体的功能性能、步态和疼痛的影响。

方法

年龄在60至89岁之间，平均（标准差）年龄为71.2（6.8）岁，平均在15天前接受TKA的成年人被随机分配到HV运动（n = 19）或LV运动（n = 19）训练组。训练计划持续12节，为期6至7周。主要结局是用6分钟步行试验评定的功能性能。次要测量指标包括爬楼梯试验、定时起立行走试验、步态速度、用步态异常评定量表测量的步态偏差以及通过视觉模拟量表测量的疼痛。所有结局均采用2×2混合模型方差分析（组×时间）。LV组和HV组在测试后步态速度和步态异常评定量表的比较分别采用独立t检验和曼-惠特尼U检验。