類別:

高能雷射治療對運動引發疲勞後肌肉位移特徵與被動移行量的改變

2025-09-09T16:08:08Z

標題: 高能雷射治療對運動引發疲勞後肌肉位移特徵與被動移行量的改變; High-Intensity Laser Therapy Alters Muscle Displacement and Excursion Following Exercise-Induced Fatigue 作者: 洪瑋; Wei Hung 摘要: 研究背景：肌肉疲勞指急性運動中或後肌肉力量或功率的下降，易增加受傷風險，因此運動前的肌肉疲勞預防策略至關重要。高能雷射治療已被證實可減少疲勞後的力量流失，同時可是一種可以用於操控肌肉疲勞的工具。評估肌肉疲勞的非侵入性量測工具中，超音波斑點追蹤技術是一種能即時量測深層肌肉在動態主動收縮下位移特徵的工具，並能定量評估疲勞狀態下肌肉被動伸展的移行特徵。目前已有文獻發現，疲勞後肌肉在收縮時會出現主動收縮位移量下降的現象。然而，目前針對高能雷射是否是一種可以用於操控疲勞後肌肉主動收縮之收縮位移量以及被動伸展之移行量的研究仍相對有限，此外，也無相關研究證實，以上肌肉收縮位移量以及肌肉被動移行量恢復到疲勞前狀態，在時序上，與其他可用於監測肌肉疲勞的神經肌肉量測工具相比，是否有所不同。改善以上現況除可探討高能雷射治療對肌肉收縮位移量與肌肉被動移行量的影響外，並有助於解釋肌肉疲勞恢復到疲勞前狀態的過程中，神經肌肉依序恢復的順序。研究目的：本研究旨在探討高能雷射治療在減緩或操控肌肉疲勞後肌肉收縮位移量與被動移行量的效果，以及分析各項監測肌肉疲勞之工具，其有關神經肌肉之數據，在恢復到肌肉疲勞前狀態的時序，以及肌力與各量測工具結果之相關性。本研究企圖透過肌肉收縮位移量定量評估疲勞狀態下肌肉的主動收縮能力，並以肌肉被動移行量測量肌肉在被伸展之條件下其被動延展之大小。本研究同時量測肌肉的力量輸出、神經肌肉活化程度及肌肉微循環的變化，以分析有無高能雷射治療介入時，在肌肉疲勞時與後，以上數據的特徵及恢復的作用，並且分析肌力與肌肉收縮位移量、被動移行量與其他動態生理指標（如表面肌電訊號之中位頻率變化、峰值力矩等）之間的相關性，以確認超音波影像技術在運動疲勞評估中的適用性。研究方法：本研究採隨機、交叉、虛假療法對照實驗設計，預計收錄20位健康生理男性，將隨機分為A、B兩組，並進行兩次間隔15天的等速向心收縮運動（疲勞運動），其中A組會先接受高能雷射介入，15天後接受虛假雷射介入；B組則是先接受虛假雷射介入，15天後接受高能雷射介入。兩組均以等速向心運動誘發疲勞，兩組均於運動前、運動後立即、5、10、20分鐘測量：股外側肌肌肉收縮位移量、股外側肌肌肉被動移行量、膝伸直最大自主等長收縮力矩、表面肌電訊號、肌肉微循環。結果：肌肉組織在經由高能雷射介入的條件下，在肌肉疲勞後，於等長收縮時，向近端移動的收縮位移量顯著大於虛假雷射（高能雷射介入：8.61 ± 3.15 mm、虛假雷射介入：5.71 ± 2.82 mm，P 值 < 0.001），且發現在高能雷射介入條件下，其肌肉收縮位移量在疲勞前後的變化量顯著小於虛假雷射介入（高能雷射介入：2.56 ± 2.12 mm、虛假雷射介入：5.30 ± 2.41 mm，P 值 < 0.001）；此外，於被動屈曲時，向遠端移動的被動移行量顯著大於較虛假雷射（高能雷射介入：16.01 ± 5.05 mm、虛假雷射介入：13.89 ± 6.16 mm，P 值 < 0.001），同時發現在高能雷射介入條件下，其肌肉被動移行量在疲勞前後的變化量顯著大於虛假雷射介入（高能雷射介入：3.56 ± 2.17 mm、虛假雷射介入：1.48 ± 2.46 mm，P 值 < 0.001）。同時發現在中位頻率、膝伸直力矩、帶氧血紅素、氧飽和度等數據，皆在高能雷射介入後，其結果下降或改變之幅度顯著低於虛假雷射介入。針對以上各項參數恢復到疲勞前狀態之時序，發現在高能雷射介入後，肌肉收縮位移量與膝伸直力矩於運動後5分鐘內恢復到疲勞前狀態，早於虛假雷射介入；中位頻率、帶氧血紅素與氧飽和度在兩個介入條件中皆於5分鐘內恢復，且中位頻率於20分鐘後顯著上升；肌肉被動移行量則在兩個介入條件中皆未於20分鐘內恢復。最後，透過皮爾森相關性分析發現肌肉收縮位移量的變化量與峰值力矩變化量呈現低度負相關（r = -0.238，P值 = 0.005）。結論：高能雷射治療介入可有效減緩肌肉疲勞後在肌肉機械行為與神經生理參數上的變化，並加速肌肉收縮位移量與膝伸直力矩的恢復。其潛在機制可能包括促進局部血液循環、提升粒線體活化、加速代謝副產物的清除，以及增強神經肌肉活化表現。整體而言，本研究結果發現高能雷射治療介入具作為非侵入性疲勞恢復介入方式的可能途徑，並提出以超音波斑點追蹤技術作為監測肌肉動態收縮與疲勞狀態工具的可行性。; Background: Muscle fatigue is defined as a decline in muscle force or power during or after acute exercise, which increases the risk of injury and highlights the importance of implementing preventive strategies before exercise. High-intensity laser therapy (HILT) has been shown to attenuate strength loss induced by fatigue and may serve as a potential tool for modulating muscle fatigue; however, its effects on muscle contractile behaviors—specifically muscle shortening and displacement during fatigue—remain unclear. Several non-invasive tools are available to assess muscle fatigue, each providing unique insights into the fatigue process. Among these, speckle tracking ultrasonography is a promising technique that allows real-time, quantitative measurement of muscle displacement during dynamic active contractions. It can also evaluate muscle contractility and passive excursion during fatigue. However, limited research has investigated the effects of HILT on muscle displacement and muscle excursion. Moreover, limited research has examined whether the recovery timeline of these parameters differs from other neuromuscular indicators used to monitor muscle fatigue. Addressing these knowledge gaps not only helps to clarify the biomechanical and neurophysiological mechanisms of HILT during recovery but also contributes to understanding the chronological recovery processes of neuromuscular function following fatigue. Purpose: This study aimed to investigate the effects of high-intensity laser therapy (HILT) on the modulation of muscle displacement and muscle excursion after fatigue. Additionally, analyze the recovery timelines of neuromuscular parameters in comparison with baseline states. Moreover, correlation among muscle strength and various fatigue-related indicators were explored. Muscle displacement was quantitatively assessed to evaluate active contractile capacity under fatigued conditions, while muscle excursion was measured to assess passive mobility. Simultaneously, muscle force output, neuromuscular activation, and microcirculatory changes were measured to characterize the fatigue response and recovery process, with and without HILT. Correlations between muscle force output, muscle displacement, muscle excursion and other physiological indicator – such as surface electromyography (median frequency) and peak torque – were examined to evaluate the feasibility of ultrasound imaging for fatigue monitoring. Methods: A randomized, crossover, sham-controlled design was employed with 20 healthy male participants. Each participant was randomly assigned to two group (Group A and Group B) and completed two fatigue protocols, 15 days apart, receiving either HILT or a sham laser (SHAM) intervention in a randomized order. Measurements were taken at baseline and at multiple time points post-fatigue (immediately, and at 5, 10, and 20 minutes), including vastus lateralis muscle displacement, muscle excursion, maximal isometric knee extension torque, neuromuscular activation, and microcirculation. Results: Under the HILT conditions, the muscle displacement during maximal voluntary isometric contraction testing at immediately post-fatigue significantly greater than SHAM (HILT: 8.61 ± 3.15 mm; sham: 5.71 ± 2.82 mm). The study also found that under HILT conditions, the change in muscle displacement before and immediately after fatigue was significantly smaller than that under SHAM conditions (HILT: 2.56 ± 2.12 mm, SHAM: 5.30 ± 2.41 mm). Moreover, during the passive knee flexion testing, muscle excursion was significantly greater than SHAM (HILT: 16.01 ± 5.05 mm; sham: 13.89 ± 6.16 mm; P < 0.001). Also, under HILT conditions, the change in muscle excursion before and immediately after fatigue was significantly greater than that under SHAM conditions (HILT: 3.56 ± 2.17 mm, SHAM: 1.48 ± 2.46 mm). Additionally, HILT resulted in significantly attenuated reduction or changes in peak torque, median frequency, oxygenated hemoglobin, and oxygen saturation compared to SHAM. Regarding recovery timelines, muscle displacement and torque returned to baseline within 5 minutes post-exercise under HILT, earlier than under SHAM. Median frequency, oxygenated hemoglobin, and oxygen saturation recovered within 5 minutes under both conditions. However, muscle excursion did not fully recover within 20 minutes. A weak negative correlation was found between the change of muscle displacement and peak torque (r = -0.238, P = 0.005). Conclusion: HILT effectively attenuates alterations in muscle mechanical behavior and neurophysiological parameters following muscle fatigue, and accelerates the recovery of muscle displacement and knee extension torque. The underlying mechanisms may involve enhanced local blood circulation, improved mitochondria activation, accelerated clearance of metabolic byproducts, and enhanced neuromuscular activation. Overall, these findings highlight the potential of HILT as a non-invasive intervention to promote fatigue recovery and support the use of speckle tracking ultrasonography as a reliable tool for monitoring dynamic muscle contraction to provide real-time information on muscle fatigue.

高能量聚焦磁場合併足部核心訓練對功能性扁平足族群之足部動態功能的影響

2025-09-24T17:39:37Z

標題: 高能量聚焦磁場合併足部核心訓練對功能性扁平足族群之足部動態功能的影響; Effects of High-Intensity Focused Electromagnetic Technology Combined with Foot Core Training on Dynamic Foot Function in Individuals with Pronated Foot 作者: 王翊國; Yi-Guo Wang 摘要: 研究背景：足部核心系統分為主動、被動和神經三個次系統，功能性扁平足族群因足部核心系統功能不足，使足部穩定性降低，增加累積性傷害的風險。足部動態功能測量能夠呈現動態情境下的生物力學特徵，因此對足部或下肢傷害可以提供更完整且客觀的評估。足部核心訓練透過徵召足掌內肌收縮，強化足部核心之神經次系統及主動次系統，然而足掌內肌選擇性收縮困難，對足弓高度改善效果有限，因此，利用神經肌肉電刺激能夠增進足部核心訓練的效果。高能量聚焦磁場技術已被證實能促進肌肉生長、增強肌肉功能，並且作用機制可避免電刺激所產生的副作用，目前尚無研究探討此技術在足掌內肌的應用。研究目的：本研究目的為應用高能量聚焦磁場合併足部核心訓練對足掌內肌進行訓練，探討對扁平足族群足部動態功能的介入成效。另外，透過靜態量測與動態足部測量，探討高能量聚焦磁場合併足部核心訓練分別對足部核心系統主動、被動和神經次系統的效應。研究方法：本研究招募30位功能性扁平足受試者，隨機分成三組，分別進行高能量聚焦磁場合併足部核心訓練、高能量聚焦磁場、偽高能量聚焦磁場合併足部核心訓練。高能量聚焦磁場每次20分鐘，足部核心訓練包括四種運動，每種運動一組10回、一次三組，每週兩次，總共介入六週。於介入前後，檢測行走時足底負荷與外展拇肌肌電訊號、足掌內肌型態以及靜態足部姿勢。統計方法使用廣義估計式，分析6週介入後，各組在足部負荷參數、足掌內肌型態學參數、外展拇肌肌電訊號及靜態足部姿勢的改變，顯著水平α設為0.05。研究結果：高能量聚焦磁場合併足部核心訓練組的前足內側峰值壓力（95%CI: -20.75 N/cm2 ~ -7.09 N/cm2, p<0.001）、最大受力（95%CI: -0.72 kg ~ -0.12 kg, p=0.006）、壓力時間積分（95%CI: -0.97 N*min/cm2 ~ -0.30 N*min/cm2, p<0.001），大拇趾峰值壓力（95%CI: -18.70 N/cm2 ~ -3.47 N/cm2, p=0.004）、壓力時間積分（95%CI: -0.88 N*min/cm2 ~ -0.24 N*min/cm2, p=0.001），以及前足外側最大受力（95%CI: -0.69 kg ~ -0.11 kg, p=0.007）顯著較高能量聚焦磁場組減少，壓力中心偏移指數（95%CI: 1.14% ~ 2.68%, p<0.001）較高能量聚焦磁場組顯著增加；偽高能量聚焦磁場合併足部核心訓練組前足外側最大受力（95%CI: -0.62 kg ~ -0.04 kg, p=0.026）也顯著較高能量聚焦磁場組減少。足掌內肌型態學、外展拇肌肌電訊號及靜態足部姿勢無交互作用亦無組間差異，僅高能量聚焦磁場合併足部核心訓練組在介入後，外展拇肌肌電訊號在擺盪前期顯著提升（95%CI: 6.79% ~ 40.80%, p=0.006）。結論：高能量聚焦磁場合併足部核心訓練較高能量聚焦磁場顯著減少足部負荷壓力，顯示足部核心訓練合併高能量聚焦磁場刺激足掌內肌，在6週訓練後，顯著活化外展拇肌，比起只有高能量聚焦磁場刺激足掌內肌可以顯著減少功能性扁平足步行時前足內側(大拇指)壓力。本研究證明功能性扁平足同時使用高能量聚焦磁場合併足部核心訓練，6週訓練對神經次系統得到明顯改善，有效促進扁平足動態功能。; Background: The foot core system consists of three subsystems which are active, passive, and neural subsystems. Individuals with pronated foot suffer from compromised foot stability due to an inadequate foot core system, thereby consequently increasing the risk of cumulative injury. Dynamic foot function measurements elucidate biomechanics of the foot in dynamic situations, contributing to a more comprehensive assessment of lower limb injuries. Foot core training enhances neural and active subsystems by recruiting intrinsic foot muscles. However, it is found that the difficulty in selectively contracting the intrinsic foot muscles leads to ineffectiveness in changing arch height following foot core training. Therefore, the neuromuscular electrical stimulation is used to improve the effectiveness by selectively stimulating intrinsic foot muscles. High-intensity focused electromagnetic technology has been shown to promote muscle growth, improve muscle function, and reduce the side effects of electrical stimulation. However, there is a lack of studies investigating the application of this technology targeting the intrinsic foot muscles. Purpose: The aims of this study were to use high-intensity focused electromagnetic technology combined with foot core training targeting the intrinsic foot muscles, to investigate the efficacy on dynamic foot function in individuals with pronated foot. Additionally, static measurements and dynamic foot function evaluation will be conducted to explore the effects of the combined intervention on the active, passive, and neural subsystems of the foot core system. Methods: This study recruited 30 participants with pronated foot and randomly assigned them to three groups that were high-intensity focused electromagnetic combined with foot core training group, high-intensity focused electromagnetic group and sham high-intensity focused electromagnetic combined with foot core training group. High-intensity focused electromagnetic was performed 20 minutes per session, and the foot core training consisted of four exercises with 10 repetitions per set and three sets per session for each exercise. All participants received the interventions twice a week for six weeks. Plantar load and electromyographic signals of abductor hallucis during gait, ultrasonography for morphological analysis of intrinsic foot muscles, and static foot posture were evaluated at the baseline and six weeks after the intervention. Generalized estimating equations (GEE) was used to compare the pre- and the post-intervention measurements across the three groups, assessing both between-group and within-group interactions. The level of statistical significance was set at α=0.05. Results: High-intensity focused electromagnetic combined with foot core training group showed significant reduction in peak pressure (medial forefoot: 95%CI: -20.75 N/cm2 ~ -7.09 N/cm2, p<0.001; hallux: 95%CI: -18.70 N/cm2 ~ -3.47 N/cm2, p=0.004), maximal force (medial forefoot: 95%CI: -0.72 kg ~ -0.12 kg, p=0.006; lateral forefoot: -0.69 kg ~ -0.11 kg, p=0.007), pressure-time integral (medial forefoot: 95%CI: -0.97 N*min/cm2 ~ -0.30 N*min/cm2, p<0.001; hallux: 95%CI: -0.88 N*min/cm2 ~ -0.24 N*min/cm2, p=0.001) and increase in center of pressure excursion index (95%CI: 1.14% ~ 2.68%, p<0.001) compared to high-intensity focused electromagnetic group. Sham high-intensity focused electromagnetic combined with foot core training group showed significant reduction in maximal force (lateral forefoot: 95%CI: -0.62 kg ~ -0.04 kg, p=0.026) compared to high-intensity focused electromagnetic group. There were no group-by-time interactions in electromyographic signals of the abductor hallucis, intrinsic foot muscle morphology and static foot posture. Only high-intensity focused electromagnetic combined with foot core training group showed an increase in electromyographic signals of abductor hallucis after the intervention (95%CI: 6.79% ~ 40.80%, p=0.006). Conclusion: High-intensity focused electromagnetic combined with foot core training group showed a significant improvement in plantar load compared to high-intensity focused electromagnetic group, indicating enhancing the active and neural subsystems lead to better outcomes. High-intensity focused electromagnetic combined with foot core training group exhibited significant increases in electromyographic signals of the abductor hallucis. This demonstrated that combined approach effectively improved the active and neural subsystem respectively, thereby enhancing the dynamic foot function.

髖關節骨折患者接受急性後期照護之成效與成本效果分析

2021-06-17T01:32:15Z

標題: 髖關節骨折患者接受急性後期照護之成效與成本效果分析 ; Efficacy and Cost-Effectiveness Analysis of Post-Acute Care for Patients with Hip Fractures 作者: Min-Chang Lee; 李旻璋摘要: 研究背景與目的：髖關節骨折（hip fractures）是50歲以上族群常見的骨骼創傷，會造成病人失能、低生活品質與沉重的照護壓力。人口老化與髖關節骨折人數成長使醫療支出持續增加，因此已開發國家實施急性後期照護（post-acute care, PAC）減少急性住院使用與改善病患照護品質。急性後期照護包括住院機構型與居家型，文獻指出兩者皆可顯著改善病患日常生活功能與生活品質，降低再住院與長期照顧需求，減少照護費用。2017年臺灣開始實施髖關節骨折急性後期照護，但缺乏相關文獻探討。本研究的目的是探討髖關節骨折患者接受急性後期照護計畫之成效與成本效果分析。研究方法：本研究為前瞻式世代研究，徵召臺北市立聯合醫院65歲以上髖關節骨折術後患者，分為居家組、住院組，與對照組。出院後進行兩到三週急性後期照護。評估項目包括：疼痛評估、身體功能評估，包含30秒坐站測試、巴氏量表，與Harris髖關節評分（Harris Hip Score）、歐洲五維健康量表（EuroQoL-5D, EQ-5D）、照顧者壓力指標（Caregiver Strain Index）與醫療資源使用狀況。評估時間為急性出院前一日，與急性後期照護結束時。成本效果比值（cost-effectiveness ratio, CER）為計算進步一分日常生活功能（巴氏量表）與生活品質所需花費的金額。統計分析使用SPSS第20.0版（SPSS Inc, Version 20.0. Chicago: SPSS Inc.）進行資料處理與統計分析，組間差異將以卡方（chi-square）分析或費氏精確檢定法（Fisher's exact test）、單因子獨立變異數分析（one-way independent analysis of variance, one-way independent ANOVA）或K-W檢定（Kruskal-Wallis test）。並以概化估計方程式（generalized estimating equations, GEE）比較三組治療過程差異。本研究使用雙尾檢定、顯著水準為α值<0.05。研究結果：本研究有41位受試者同意參加（平均年齡為78.5±7.8歲），分別為對照組12位、居家組17位，住院組12位。三組受試者人口學資料無顯著差異（p>0.05）。初次評估時，住院組的30秒坐站次數與EQ-index都顯著低於對照組（p<0.05），住院組的Harris髖關節評分顯著低於居家組（p=0.018）。經過急性後期照護後，三組受試者的巴氏量表皆有顯著進步，對照組從57.9±10.5分進步至67.5±17.5分（p=0.049）、居家組從56.4±11.5分進步至76.2±12.4分（p<0.001）、住院組從48.8±8.8分進步至63.3±14.8分（p=0.007），居家組改變幅度與對照組有統計上顯著差異（p=0.018）。對照組的Harris髖關節評分從48.1±8.9分進步至56.4±11.5分（p=0.016）、居家組從49.1±6.3分進步至63.5±5.8分（p<0.001）、住院組從40.4±8.8分進步至53.7±10.1分（p=0.003），居家組的改變量與對照組有統計上顯著差異（p=0.029）。介入後，EQ-index生活品質變化為對照組從0.212±0.274分進步至0.271±0.400分（p=0.374）、居家組從0.031±0.294分進步至0.298±0.371分（p=0.008）、住院組從-0.255±0.307分進步至0.146±0.433分（p=0.004），住院組改變量與對照組有顯著差異（p=0.015）。巴氏量表的平均成本效果比值分別為對照組4923元、居家組554元、住院組3165元。生活品質的平均成本效果比值為對照組801017元、居家組41948元、住院組115239元。比較遞增成本效果比值時，居家組有統計上顯著較佳的日常生活功能與生活品質之成本效果。結論：急性後期照護採用居家服務模式可顯著改善髖關節骨折患者的身體功能，住院照護組可顯著改善患者的生活品質。居家照護組的日常生活功能與生活品質之成本效果較佳。未來仍需更多大樣本數的研究瞭解急性後期照護對髖關節骨折病患的療效。; Background and purpose: Hip fracture, a common injury occurred in people aged over 50, may result in disability, poor quality of life, and higher care stress for their families. Aging population and growing number of hip fractures have increased health care costs, so many developed countries implemented post-acute care (PAC) to reduce acute hospitalization, and to improve the quality of care. PAC services can be provided through both hospital/facility-based and home-based services. Previous studies have shown that both services could significantly improve patients’ activities of daily living and quality of life, and reduce readmissions, long-term care and costs. Taiwan has implemented PAC plan for hip fractures since 2017, but relevant studies are scarce. Therefore, the purpose of this study was to analyze the efficacy and cost-effectiveness of PAC for patients with hip fractures. Methods: This was a prospective cohort study which recruited patients aged over 65 with hip fractures underwent surgical treatment in the Taipei City Hospital. They were divided into home group, hospital group, or control group. The timing of PAC was two to three weeks after the acute hospitalization. Assessments included numerical pain rating scale, physical function (30 seconds sit to stand, Barthel index, and Harris Hip Score (HHS)), EuroQol instrument (EQ-5D), Caregiver Strain Index, and using of medical resources. The assessments were performed before and after PAC. The cost-effectiveness ratio (CER) was defined as the NTD paid per unit improvement of functional performance and quality of life. SPSS version 20.0 (SPSS Inc, Version 20.0. Chicago: SPSS Inc.) was used for statistical analysis. The differences of measured variables among groups were analyzed by chi-square test or Fisher's exact test, and one-way independent analysis of variance (ANOVA) or Kruskal-Wallis test. Generalized estimating equations (GEE) was used to examine the effects of variables after intervention among three groups. An alpha level less than 0.05 (two-tailed) was set as statistically significant. Results: In our study, 41 patients agreed to participate (mean age: 78.5±7.8 years), including 12 in the control group, 17 in the home group, and 12 in the hospital group. There were no significant differences in demographic data among groups (p>0.05). At baseline assessment, the hospital group had significantly lower times and scores in the 30-second sit-to-stand test and EQ-index than the control group (p<0.05). The hospital group had significantly lower scores than the home group in the HHS (p=0.018). After PAC, the Barthel index improved in all three groups. The control group improved from 57.9±10.5 to 67.5±17.5 (p=0.049), the home group improved from 56.4±11.5 to 76.2±12.4 (p<0.001), and the hospital group improved from 48.8±8.8 to 63.3±14.8 (p=0.007). There was a significant group and time interaction between the home group and the control group (p=0.018). The change in the HHS was as follows: the control group improved from 48.1±8.9 to 56.4±11.5 (p=0.016), the home group improved from 49.1±6.3 to 63.5±5.8 (p<0.001), and the hospital group increased from 40.4 ±8.8 improved to 53.7±10.1 (p=0.003). There was a significant group and time interaction between the home group and the control group (p=0.029). The change in EQ-index was as follows: the control group improved from 0.212±0.274 to 0.271±0.400 (p=0.374), the home group improved from 0.031±0.294 to 0.298±0.371 (p=0.008), and the hospital group From -0.255±0.307 to 0.146±0.433 (p=0.004). There was a significant group and time interaction between the hospital group and the control group (p=0.015). The average CER of the Barthel index were NTD 4923 in the control group, NTD 554 in the home group, and NTD 3165 in the hospital group. The average CER of the EQ-index were NTD 801017 in the control group, NTD 41948 in the home group, and NTD 115239 in the hospital group. In the comparison of incremental CERs, the home group had better cost-effectiveness for activities of daily living and quality of life. Conclusion: This study showed that home PAC significantly improved the physical function of patients with hip fractures, and hospital PAC can significantly improve the quality of life of patients with hip fractures. The best CER for activities of daily living and quality of life was found with the home PAC. Large-scale, well-controlled, longitudinal studies are needed to further examine the effectiveness of acute post-care on patients with hip fractures.

髖內收合併膝伸直運動對髕股關節疼痛症候群病人其股四頭肌肌肉型態、疼痛及功能性活動能力之影響

2021-06-13T04:37:13Z

標題: 髖內收合併膝伸直運動對髕股關節疼痛症候群病人其股四頭肌肌肉型態、疼痛及功能性活動能力之影響; Effect of Hip Adduction Combination with Knee Extension Exercise on Morphology of Quadriceps Muscles, Pain and Functional Outcomes in Patients with Patellofemoral Pain Syndrome 作者: Chen-Yi Song; 宋貞儀摘要: 背景及目的：髕股關節疼痛症候群為一臨床常見之膝關節疾病，主要原因之一乃股內斜肌失能使髕骨有不正常的外側偏移，造成髕股關節的壓迫。股內斜肌為膝關節動作時髕骨的內側動態穩定者，臨床上常用保守療法即針對股內斜肌作特定性的訓練。由於股內斜肌肌纖維起始於髖內收肌群，學者認為髖內收肌的收縮能誘發股內斜肌的活動，然而文獻除了相關的肌電圖實驗外，至今仍未有臨床試驗之研究。因此，本隨機控制試驗選用超音波儀器量測股內斜肌之肌肉型態，評估在訓練介入前後的變化，探討髖內收合併膝伸直運動訓練對髕股關節疼痛症候群患者的臨床治療效益，並且和傳統末端膝伸直運動，及控制組間作療效比較。方法：本研究徵召62位年齡小於55歲之髕股關節疼痛症候群患者，隨機分配至髖內收合併膝伸直推蹬運動訓練組、傳統末端膝伸直推蹬運動訓練組、及控制組，進行每週3次、為期8週的推蹬運動訓練，然後評估股內斜肌的肌肉型態（包括股內斜肌肌纖維角度、髕骨上緣水平位之股內斜肌截面積、及髕骨上緣水平位以下之股內斜肌體積）、膝關節視評疼痛分數（包括一般疼痛分數、最嚴重疼痛分數、及活動疼痛分數）、以及Lysholm Scale功能量表分數在介入前後之改變。結果：髖內收合併膝伸直推蹬運動及傳統末端膝伸直推蹬運動訓練組患者，經過8週運動訓練後，其髕骨上緣水平位之股內斜肌截面積、髕骨上緣水平位以下之股內斜肌體積皆有顯著進步（p< .005），然進步未較控制組顯著（p= .011~ .042）。而膝關節一般疼痛分數、最嚴重疼痛分數、活動疼痛分數、及Lysholm Scale功能量表分數除了在訓練前後有顯著進步（p< .005）外，進步亦較控制組顯著（p< .005），唯髖內收合併膝伸直推蹬運動組患者之活動疼痛分數之進步，比起控制組仍未達足夠的顯著（p= .016）。此外，兩運動組之間並無組間統計顯著差異。而股內斜肌肌纖維角度則是在訓練前後並無統計顯著差異。控制組患者之股內斜肌肌肉型態、膝關節視評疼痛分數、及Lysholm Scale功能量表分數在8週前後皆無統計顯著差異。結論：閉鎖鏈髖內收合併膝伸直推蹬運動訓練，可使髕股關節疼痛症候群患者的股內斜肌肥厚，疼痛下降，並且增加下肢功能性活動能力。然而其療效與閉鎖鏈末端膝伸直推蹬運動訓練相似。建議臨床上可以任擇一運動訓練計畫，若考量方便及實用性，則可優先選擇閉鎖鏈末端膝伸直推蹬運動。; Background and purpose：Patellofemoral pain syndrome（PFPS） is a common knee disorder characterized by anterior or retropatellar pain associated with activities that load the patellofemoral joint. Previous studies reveal that the vastus medialis obliquus（VMO） is an important dynamic medial stabilizer of the patella. Insufficiency of the VMO leads to lateral shift of the patella and the increases of patellofemoral contact pressure. Thus VMO-specific training is a well-accepted clinical treatment conservatively. Hip adduction is thought to enhance VMO contraction because of its anatomic origin from hip adductors. In order to determine its training effect, we used ultrasonography as a measurement tool to examine the VMO morphology changes after hip adduction combination with knee extension exercise training compared with traditional terminal knee extension exercise training and control in patients with PFPS. Methods：62 PFPS patients with age under 55 were recruited for the study and then randomly assigned to either one training or control group. Muscle morphology of VMO（including fiber angle, cross-sectional area on patella-base level, and volume under patella-base level）, 10 cm-visual analog scale of usual pain（VAS-U）,worst pain (VAS-W), activity pain (VAS-activity), and Lysholm Scale scores were measured before and after 8-wk leg press exercise training or control periods. Results：Significant improvements of VMO cross-sectional area, volume, VAS-U, VAS-W, VAS-activity, and Lysholm Scale scores were found after 8-wk training in both exercise groups（p< .005）, but not in the control group. The improvements were also significantly different between the exercise and control groups（p< .005）, except for the VMO cross-sectional area and volume（p= .011~ .042）, and for the VAS-activity between the hip adduction combination with knee extension exercise and control groups（p= .016）. However, no differences were found between two exercise groups. In all three groups, no significant differences were found in VMO fiber angle throughout the experiment. Conclusion：The results suggest that immediate effects of VMO hypertrophy, pain reduction, and functional ability improvement occurred following hip adduction combination with knee extension exercise. Treatment effects did not show significant differences between two exercise groups; therefore, therapists could choose either of these two exercise programs. Moreover, clinical practices may consider the application of leg-press exercise with terminal knee extension alone since additional equipments are not required.

類別:

高能雷射治療對運動引發疲勞後肌肉位移特徵與被動移行量的改變

高能量聚焦磁場合併足部核心訓練對功能性扁平足族群之足部動態功能的影響

髖關節骨折患者接受急性後期照護之成效與成本效果分析

髖內收合併膝伸直運動對髕股關節疼痛症候群病人其 股四頭肌肌肉型態、疼痛及功能性活動能力之影響

髖內收合併膝伸直運動對髕股關節疼痛症候群病人其股四頭肌肌肉型態、疼痛及功能性活動能力之影響