Stonkuvienė Vitalija, Kubilius Raimondas, Lendraitienė Eglė
Department of Rehabilitation, Faculty of Nursing, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania.
Medicina (Kaunas). 2025 Jan 24;61(2):206. doi: 10.3390/medicina61020206.
: Research on the effectiveness of different exercise programs on reducing fall risk and improving gait parameters among frail patients after open heart surgery is scarce. Therefore, the aim of this study was to evaluate and compare the effects of different exercise interventions on fall risk and gait parameters in frail patients after open heart surgery during inpatient rehabilitation. : A prospective randomized study was conducted at Kulautuva Hospital of Rehabilitation, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, from July 2021 to November 2023. A total of 105 pre-frail and frail patients were randomized into three groups: control (CG, n = 35), intervention 1 (IG-1, n = 35), and intervention 2 (IG-2, n = 35). All three groups completed a conventional rehabilitation program that included aerobic training tailored based on each person's health status six times/week. The IG-1 additionally received multicomponent dynamic aerobic balance and strength training three times/week, and the IG-2 received a combined computer-based interactive program three times/week. The overall stability index, as an outcome of fall risk, Short Physical Performance Battery (SPPB) score, and gait parameters (geometry, stance, and timing) were assessed before and after rehabilitation. : Of the 105 patients, 87 completed the study. The median age of the patients was 71 years (range: 65-88); 64.76% were male. After rehabilitation, within-group comparisons showed a significant improvement in the overall stability index, SPPB, and all phase gait parameters in all groups. Of all geometry gait parameters, none of the groups showed a significant improvement in step width, and foot rotation was significantly reduced only in the IG-2. All timing gait parameters improved in the CG and IG-2 after rehabilitation, while in the IG-1, only gait speed was significantly improved. Between-group comparisons after rehabilitation revealed significant differences in the overall stability index among the groups and in all phase gait parameters except for stance phase between the IG-1 and the IG-2. The greatest significant difference was documented for the double stance phase between the IG-1 and the IG-2, and the smallest was recorded for the single limb support phase. Significantly greater differences in step time and stride time were found in the IG-1 and the IG-2 than in the CG. : All applied interventions were effective in reducing fall risk based on the overall stability index. However, interactive exercise interventions decreased fall risk based on the overall stability index by one-fifth as compared to the conventional rehabilitation program. The incorporation of interactive exercise interventions in rehabilitation resulted in improved double stance phase, stride time, and step time parameters, but did not have any effect on gait speed as compared to other exercise interventions.
关于不同运动方案对降低心脏直视手术后体弱患者跌倒风险及改善步态参数有效性的研究较少。因此,本研究的目的是评估和比较不同运动干预对心脏直视手术后体弱患者在住院康复期间跌倒风险和步态参数的影响。
2021年7月至2023年11月,在立陶宛卫生科学大学考纳斯临床医院库劳图瓦康复医院进行了一项前瞻性随机研究。共有105名虚弱前期和体弱患者被随机分为三组:对照组(CG,n = 35)、干预组1(IG - 1,n = 35)和干预组2(IG - 2,n = 35)。所有三组均完成了常规康复计划,包括根据每个人的健康状况每周进行六次有氧训练。IG - 1组额外每周进行三次多组分动态有氧平衡和力量训练,IG - 2组每周进行三次基于计算机的交互式综合训练。在康复前后评估作为跌倒风险结果的总体稳定性指数、简易体能状况量表(SPPB)评分以及步态参数(几何形状、站立姿势和时间)。
105名患者中,87名完成了研究。患者的中位年龄为71岁(范围:65 - 88岁);64.76%为男性。康复后,组内比较显示所有组的总体稳定性指数、SPPB以及所有阶段步态参数均有显著改善。在所有几何步态参数中,没有一组的步宽有显著改善,仅IG - 组2的足部旋转显著降低。康复后,CG组和IG - 2组的所有时间步态参数均有所改善,而在IG - 1组中,仅步态速度有显著提高。康复后的组间比较显示,各组之间的总体稳定性指数以及IG - 1组和IG - 2组之间除站立阶段外的所有阶段步态参数存在显著差异。IG - 1组和IG - 2组之间双支撑阶段的差异最为显著,单肢支撑阶段的差异最小。与CG组相比,IG - 1组和IG - 2组在步时间和步幅时间上的差异显著更大。
基于总体稳定性指数,所有应用的干预措施在降低跌倒风险方面均有效。然而,与常规康复计划相比,交互式运动干预基于总体稳定性指数将跌倒风险降低了五分之一。在康复中纳入交互式运动干预可改善双支撑阶段、步幅时间和步时间参数,但与其他运动干预相比,对步态速度没有任何影响。