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平衡训练联合常规训练对重度烧伤后下肢运动及平衡功能障碍患者影响的前瞻性随机对照研究

[A prospective randomized controlled study of the effects of balance training combined with routine training on patients with lower limb motor and balance dysfunction after severe burns].

作者信息

Ru T F, Li F F, Xie W G, Chen P, Yuan L

机构信息

Institute of Burns, Tongren Hospital of Wuhan University&Wuhan Third Hospital, Wuhan 430060, China.

Department of Rehabilitation, Hubei Provincial Organ Hospital, Wuhan 430071, China.

出版信息

Zhonghua Shao Shang Za Zhi. 2021 Apr 20;37(4):312-318. doi: 10.3760/cma.j.cn501120-20201018-00441.

Abstract

To observe the effects of balance training combined with routine training on patients with lower limb motor and balance dysfunctions after severe burns. A prospective randomized controlled study was conducted. From January 2016 to January 2020, sixty-four patients with lower limb motor and balance dysfunction after severe burns who met the inclusion criteria were admitted to Tongren Hospital of Wuhan University&Wuhan Third Hospital. According to the random number table, the patients were divided into routine training (RT) group and combined training (CT) group. There were 32 cases in each group, 22 males and 10 females in RT group, aged 40.5 (35.5, 52.8) years, and 24 males and 8 females in CT group, aged 37.0 (30.0, 44.0) years. Patients in RT group performed conventional treatment including knee joint stretch, continuous passive motion, lower limb muscle strength training, and pressure therapy etc., while patients in CT group received balance training in addition to RT treatment including sitting balance, center of gravity transfer, pelvic stability, standing alternately on one leg, and standing on balance pad. Patients in both groups were treated for 4 months. Before treatment and after 4 months of treatment, the Berg Balance Scale, Lower Extremity Function Scale, and Activities-specific Balance Confidence Scale were used to evaluate the balance function, lower limb function, and balance activity self-confidence of patients respectively. Data were statistically analyzed with independent sample test, paired sample test, Mann-Whitney test, Wilcoxon signed rank test or chi-square test. Before treatment, the Berg balance score of patients in RT group was (25±9) points, which was similar to (25±7) points in CT group (=-0.154, >0.05). After 4 months of treatment, the Berg balance score of patients in CT group was (43±6) points, which was significantly higher than (40±6) points in RT group (=2.028, <0.05). The Berg balance scores of patients in RT and CT groups after 4 months of treatment were obviously higher than those before treatment (=-15.189, -26.200, <0.01). Before treatment, the lower limb function score of patients in RT group was 25.0 (16.5, 30.0) points, which was similar to 23.0 (10.3, 28.8) points in CT group (=-1.575, >0.05). After 4 months of treatment, the lower limb function score of patients in CT group was 55.0 (35.0, 60.0) points, which was significantly higher than 43.0 (36.0, 53.0) points in RT group (=-2.744, <0.01). The lower limb function scores of patients in RT and CT groups after 4 months of treatment were obviously higher than those before treatment (=-4.943, -4.955, <0.01). Before treatment, the balance activity self-confidence scores of patients in the two groups were similar (=-0.966, >0.05). After 4 months of treatment, the balance activity self-confidence scores of patients in CT group was significantly higher than that in RT group (=3.343, <0.01). The balance activity self-confidence scores of patients in RT and CT groups after 4 months of treatment were obviously higher than those before treatment (=-19.611, -34.300, <0.01). Conventional treatment combined with balance training for patients with lower limb motor and balance dysfunctions after severe burns can effectively promote the recovery of their lower limb motor and balance function.

摘要

观察平衡训练联合常规训练对重度烧伤后下肢运动及平衡功能障碍患者的影响。进行一项前瞻性随机对照研究。2016年1月至2020年1月,将64例符合纳入标准的重度烧伤后下肢运动及平衡功能障碍患者收入武汉大学同仁医院及武汉市第三医院。根据随机数字表,将患者分为常规训练(RT)组和联合训练(CT)组。每组32例,RT组男22例,女10例,年龄40.5(35.5,52.8)岁;CT组男24例,女8例,年龄37.0(30.0,44.0)岁。RT组患者进行包括膝关节伸展、持续被动运动、下肢肌力训练及压力治疗等常规治疗,而CT组患者除RT治疗外还接受平衡训练,包括坐位平衡、重心转移、骨盆稳定性、单腿交替站立及在平衡垫上站立。两组患者均治疗4个月。治疗前及治疗4个月后,分别采用Berg平衡量表、下肢功能量表及特定活动平衡信心量表评估患者的平衡功能、下肢功能及平衡活动自信心。数据采用独立样本t检验、配对样本t检验、Mann-Whitney U检验、Wilcoxon符号秩检验或卡方检验进行统计学分析。治疗前,RT组患者的Berg平衡评分为(25±9)分,与CT组的(25±7)分相似(t=-0.154,P>0.05)。治疗4个月后,CT组患者的Berg平衡评分为(43±6)分,显著高于RT组的(40±6)分(t=2.028,P<0.05)。RT组和CT组患者治疗4个月后的Berg平衡评分均明显高于治疗前(t=-15.189,t=-26.200,P<0.01)。治疗前,RT组患者的下肢功能评分为25.0(16.5,30.0)分,与CT组的23.0(10.3,28.8)分相似(t=-1.575,P>0.05)。治疗4个月后,CT组患者的下肢功能评分为55.0(35.0,60.0)分,显著高于RT组的43.0(36.0,53.0)分(t=-2.744,P<0.01)。RT组和CT组患者治疗4个月后的下肢功能评分均明显高于治疗前(t=-4.943,t=-4.955,P<0.01)。治疗前,两组患者的平衡活动自信心评分相似(t=-0.966,P>0.05)。治疗4个月后,CT组患者的平衡活动自信心评分显著高于RT组(t=3.343,P<0.01)。RT组和CT组患者治疗4个月后的平衡活动自信心评分均明显高于治疗前(t=-19.611,t=-34.300,P<0.01)。重度烧伤后下肢运动及平衡功能障碍患者采用常规治疗联合平衡训练可有效促进其下肢运动及平衡功能恢复。

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