| Objective:A progressive balance training program suitable for the early stage after total hip arthroplasty was constructed by systematically searching the balance exercise methods at home and abroad,preliminary formulation of the program by inquiry in hospital and adjustment of the pre-experimental program.In addition,the sample size was enlarged to explore its efficacy,safety and convenience of home training in the early stage of postoperative rehabilitation through clinical experiments.Methods:Literature retrieval and scheme adjustment.Literatures related to balanced exercise or balanced rehabilitation after THA were retrieved from databases such as CNKI,CBM,WangFang,Pubmed,Cochrane Library and JBI until October 2018.Literature screening and method extraction were conducted according to content correlation and quality grade.The method and grade of balance exercise were preliminarily formulated,which was recognized and supported by orthopedic experts in the hospital;the problems found in the preliminary test were adjusted to ensure the smooth implementation of the late intervention.Clinical experimental studies were carried out,65 patients underwent total hip arthroplasty in the Department of Orthopedic Trauma,a Grade ? Grade A Hospital in Suzhou from January to August 2019 by convenient sampling;and 36 patients were divided into experimental group and 29 patients into control group by bed arrangement.The control group was given routine exercise guidance,and the intervention group received early progressive balance training guidance for 8 weeks from the third day after surgery.The BBS,TUGT,and MFES were used to measure and compare the difference of rehabilitation between the two groups at 1,2,4 and 8 weeks after operation.Results:1.On the basis of previous studies,this study constructed an early progressive balance exercise program.A total of 8 items,including sitting exercises,toe/heel standing,one-leg standing on the healthy side and abduction/flexion/extension of the hip joint on the operated side,5-meter straight walking,5-meter-strong lateral walking,8-word walking around the chair for 2 circles,5-meter heel/toe walking,were completed in the standing and walking state.The training items and methods are divided into three levels,with difficulty from low to highs from static to dynamic,and from open to closed eyes.Increase multiple tasks such as calculation,question answering,delivery of items,etc.Start each time with 3-minute muscle strength exercise,and end with 2-minute sitting yoga.2.There were no significant differences in general data such as gender,age,body mass index,marital status,residence address,past medical history,cause of operation,anesthesia method,operation time,intraoperative bleeding,prosthetic materials,length of stay between the two groups(P>0.05).3.In terms of Berg score,The analysis of variance of intra-group effects showed that the recovery of balance force at different time points was statistically significant and the interaction between exercise methods and time was statistically significant;The analysis of variance of the effect between groups showed that there was a significant difference between the two exercise methods in promoting the recovery of patients' balance(Ftime=1645.43,Ftimexgroup=73.51,Fgroup=761.72,P<0.05).Pairwise comparison between the two groups showed that there was no significant difference in Berg score between the two groups when they first stood beside the bed(control group=18.0±1.4 vs experimental group=17.97±1.56,t=0.167,P=0.87).With the implementation of post-operative rehabilitation training,the Berg scores of both groups showed a gradual upward trend,and at 1 week after surgery,the difference in the rate of increase between groups was most obvious.And the Berg score of the intervention group was always higher than that of the control group at lweek,2weeks,4weeks and 8weeks after operation,all of which had statistical differences.4.In terms of TUG score,The analysis of variance of intra-group effect showed that the 6-meter walking duration at different time points was statistically significant and the interaction between exercise methods and time was statistically significant;The analysis of variance of the effect between groups showed that there was a significant difference between the two exercise methods in promoting the recovery of walking ability(Ftime=4289.34,Ftimexgroup=72.83,Fgroup=231.43,P<0.05).Pairwise comparison between the two groups showed that there was no significant difference in TUG score between the two groups at the first walk(control group=66.72±4.17 vs experimental group=65.75±3.70,t=0.99,P=0.32).The difference was statistically significant at lweek,2weeks and 4weeks after operation,but not at 8weeks.with the most significant difference in the rate of decline between groups at 1 week after surgery.5.In addition to the TUG score,the gait and the use of assistive devices during walking were recorded in this study.There was no significant difference in the need for help in walking and difficulty in walking and turning around between groups at 1 and 2 weeks after operation,and there was significant difference between groups at 4 and 8 weeks after operation.There was no significant difference between the four groups in terms of walking pace continuity.Whether the elevation of the affected limb is greater than 3cm during walking has statistical significance among the four groups,and the difference between the groups is the most obvious at 4W after surgery;the number of people who still use braces to assist walking at 8W after surgery is statistically analyzed.The results were as follows:there were 6 cases in the control group and 5 cases in the experimental group(?2=5.50,P=0.019),and the difference between the two groups was statistically significant.6.Because of trauma,surgery and other reasons,most patients are worried about the occurrence of falls after surgery.Before intervention,there was no significant difference in MFES score between the two groups(control group=5.45±0.56 vs experimental group=5.6±0.9,Z=-0.729,P=0.46).The MFES scores of patients in both groups increased gradually at 4 and 8 weeks after operation.And the MFES score of the intervention group was always higher than that of the control group,which was statistically significant.Conclusion:1.Under the background of China's current rehabilitation system,there is great resistance to the promotion of rehabilitation methods such as balance instrument or balance plate.However,in the routine training program,there is less elaboration on the balance training method without the aid of equipment,which makes it difficult to carry out the balance rehabilitation after THA.Although the patients can indirectly promote the recovery of balance force through the traditional joint and muscle resistance intensive training,the early speed is slow,the curative effect is not obvious,and some patients do not get a comprehensive recovery.2.1n this study,the progressive balance exercise program constructed by evidence-based,in-hospital inquiry,pre-test and other methods can be used safely and effectively in early postoperative rehabilitation THA application,the ability to balance and fall in the activity ability and efficiency of the speed,the rehabilitation effect is far superior to conventional training,to help patients back to normal life and there is a significant social effect. |
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