Poddighe Diego, Ferriero Giorgio, Corna Stefano, Bravini Elisabetta, Sartorio Francesco, Vercelli Stefano
KU Leuven, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, B-3000 Leuven, Belgium.
Physical and Rehabilitation Medicine Unit, Istituti Clinici Scientifici Maugeri, Institute of Tradate, IRCCS, Tradate (VA), Italy.
J Wound Care. 2024 Jan 2;33(1):43-50. doi: 10.12968/jowc.2024.33.1.43.
Scar adherence due to a pathological healing process can cause physical and psychological disturbance. Soft tissue mobilisation (STM) techniques are widely used to treat and prevent scar adherence, but little is known on their effects. We aimed to analyse the effect of STM in patients with subacute post-surgical scar adhesions affecting the extremities.
A single-group quasi-experimental study was conducted on consecutive patients undergoing post-surgery limb rehabilitation. Patients with a baseline Adhesion Severity (AS) index of <0.5 at the worst scar point, as measured by the Adheremeter, were eligible. All patients who completed a minimum of five manual treatment sessions were included. The primary outcome was the AS index and the secondary outcome was the Italian version of the Patient and Observer Scar Assessment Scales (POSAS-I).
A cohort of 19 patients underwent an average of eight STM sessions over a period of one month. The AS index value increased from a median of 0.12 at baseline (interquartile range (IQR): 0.05-0.25) to 0.41 post-treatment (IQR: 0.26-0.63; median change: 0.24; IQR: 0.16-0.40; p<0.001). A large effect size was observed for both AS and Observer Scar Assessment Scale (OSAS-I) (Cohen r=0.6), with a large probability of superiority (PS) (87% and 86%, respectively). A moderate effect was observed for the Patient Scar Assessment Scale (PSAS-I) (Cohen=0.4; PS=71%). Pre-post treatment changes exceeded the minimal detectable changes for the AS and OSAS-I in 68% of subjects, and for PSAS-I in 21% of subjects.
STM manual techniques may produce a large effect on the mobility of adherent subacute post-surgical scars.
病理性愈合过程导致的瘢痕粘连会引起生理和心理障碍。软组织松动术（STM）技术被广泛用于治疗和预防瘢痕粘连，但其效果却鲜为人知。我们旨在分析STM对影响四肢的亚急性术后瘢痕粘连患者的疗效。
对接受术后肢体康复的连续患者进行单组准实验研究。符合条件的患者在瘢痕最严重部位的基线粘连严重程度（AS）指数经粘连测量仪测量<0.5。所有完成至少五次手法治疗的患者均被纳入。主要结局指标为AS指数，次要结局指标为意大利版患者及观察者瘢痕评估量表（POSAS-I）。
一组19例患者在一个月内平均接受了八次STM治疗。AS指数值从基线时的中位数0.12（四分位数间距（IQR）：0.05 - 0.25）增至治疗后的0.41（IQR：0.2６ - 0.63；中位数变化：0.24；IQR：0.16 - 0.40；p<0.001）。观察到AS和观察者瘢痕评估量表（OSAS-I）均有较大效应量（科恩r = 0.6），且优势概率较大（PS）（分别为87%和86%）。患者瘢痕评估量表（PSAS-I）观察到中度效应（科恩 = 0.4；PS = 71%）。治疗前后变化在68%的受试者中超过了AS和OSAS-I的最小可检测变化，在21%的受试者中超过了PSAS-I的最小可检测变化。
STM手法技术可能对亚急性术后粘连瘢痕的活动度产生较大影响。
