Stanciu Cristina-Teodora, Velimirovici Milan Daniel, Vermesan Dinu, Pilut Ciprian Nicolae, Stana Loredana, Bratosin Felix, Pop Daniel Laurentiu, Hogea Bogdan
Doctoral School, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
Department I Nursing, Faculty of Nursing, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
Healthcare (Basel). 2025 Jun 23;13(13):1496. doi: 10.3390/healthcare13131496.
Negative-pressure wound therapy (NPWT) expedites tissue repair, yet functional recovery depends on adjunct rehabilitation. Evidence from high-resource settings is difficult to translate to Romanian county hospitals, where advanced devices are scarce. The objective of this study is to determine whether two tiers of low-technology, therapist-delivered exercise improve mobility, oedema resolution, pain and quality-of-life (QoL) beyond NPWT alone in adults with acute lower-limb wounds.
A single-centre, prospective observational study (January 2021-June 2024) enrolled 92 patients and randomised them unevenly into: Group A, NPWT only (n = 39); Group B, NPWT + routine physiotherapy (n = 33); Group C, NPWT + enhanced manual programme (n = 20). All received -125 mmHg continuous suction; rehabilitation started 48 h post-operation. Primary outcomes were ankle dorsiflexion and knee flexion at 12 weeks. Secondary outcomes included calf circumference, ultrasound oedema depth, Manual Muscle Testing (MMT), pain (VAS), analgesic use and SF-36 domains through 24 weeks.
Baseline characteristics were similar ( > 0.40). At 12 weeks dorsiflexion reached 20.1 ± 1.8° in Group C, surpassing Group B (18.4 ± 2.1°; = 0.004) and Group A (16.0 ± 2.3°; < 0.001). Knee flexion followed the same gradient (140.8 ± 3.2°, 137.6 ± 3.4°, 133.4 ± 3.8° respectively). Oedema depth fell fastest in Group C (0.4 ± 0.2 mm by day 42) versus B (0.6 ± 0.2 mm) and A (0.8 ± 0.3 mm). Week-12 MMT grade ≥ 4.5 was attained by 95% of Group C, 85% of B and 72% of A (χ = 10.9, = 0.004). VAS pain fell more steeply with each rehabilitation layer, paralleled by a stepwise decline in daily tramadol. All SF-36 domains were highest in Group C at 24 weeks (Physical Function 88.7 ± 4.8 vs. 85.1 ± 5.4 vs. 78.2 ± 5.9; < 0.001). Mobility correlated positively with QoL (r = 0.66) and inversely with pain and oedema.
In a resource-constrained Romanian setting, adding structured manual physiotherapy to NPWT produced meaningful functional and patient-centred gains, while an "enhanced" programme incorporating daily PNF and elastic-band strengthening delivered the largest observed benefit. These findings justify prioritising therapist-led interventions even where sophisticated equipment is unavailable.
负压伤口治疗（NPWT）可加速组织修复，但功能恢复取决于辅助康复治疗。高资源环境下的证据难以应用于罗马尼亚的县级医院，因为那里先进设备匮乏。本研究的目的是确定在急性下肢伤口的成年人中，两层由治疗师指导的低技术锻炼是否能在单纯NPWT的基础上改善活动能力、水肿消退、疼痛和生活质量（QoL）。
一项单中心前瞻性观察研究（2021年1月至2024年6月）纳入了92名患者，并将他们不均衡地随机分为：A组，仅接受NPWT（n = 39）；B组，NPWT + 常规物理治疗（n = 33）；C组，NPWT + 强化手法治疗方案（n = 20）。所有患者均接受-125 mmHg的持续吸引；康复治疗在术后48小时开始。主要结局指标是12周时的踝关节背屈和膝关节屈曲。次要结局指标包括小腿围度、超声水肿深度、徒手肌力测试（MMT）、疼痛（视觉模拟评分法[VAS]）、镇痛药使用情况以及24周内的SF-36量表各维度得分。
基线特征相似（P > 0.40）。在12周时，C组的背屈角度达到20.1 ± 1.8°，超过了B组（18.4 ± 2.1°；P = 0.004）和A组（16.0 ± 2.3°；P < 0.001）。膝关节屈曲也呈现相同趋势（分别为140.8 ± 3.2°、137.6 ± 3.4°、133.4 ± 3.8°）。C组的水肿深度下降最快（第42天时为0.4 ± 0.2 mm），优于B组（0.6 ± 0.2 mm）和A组（0.8 ± 0.3 mm）。C组95%的患者在12周时MMT等级≥ 4.5，B组为85%，A组为72%（χ² = 10.9，P = 0.004）。随着康复治疗层级的增加，VAS疼痛评分下降更显著，同时每日曲马多的使用量也逐步减少。在24周时，C组的所有SF-36量表维度得分最高（生理功能：88.7 ± 4.8 vs. 85.1 ± 5.4 vs. 78.2 ± 5.9；P < 0.001）。活动能力与生活质量呈正相关（r = 0.66），与疼痛和水肿呈负相关。
在罗马尼亚资源有限的环境中，在NPWT基础上增加结构化的手法物理治疗可带来有意义的功能改善和以患者为中心的获益，而包含每日本体神经肌肉促进法（PNF）和弹力带强化训练的“强化”方案带来的益处最为显著。这些发现证明，即使在没有先进设备的情况下，也应优先考虑由治疗师主导的干预措施。
