基于表面肌电图的手法治疗对老年人膝骨关节炎效果的随机对照试验

doi:10.3969/j.issn.1006-9771.2024.09.014

Abstract

Abstract:

Objective To investigate the effect of manual therapy based on surface electromyography on knee osteoarthritis (KOA) in the older people.
Methods A total of 106 outpatient with unilateral KOA were selected from Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, from August, 2023 to June, 2024, and were randomly divided into control group (n = 53) and experimental group (n = 53). The control group accepted routine manual therapy, and the experimental group accepted manual therapy based on the analysis of average electromyography (AEMG). They were assessed with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analogue Scale (VAS) for pain, Tinetti Balance and Gait Score, and 6-minute walk test (6-MWT) distances before and after treatment.
Results One case dropped down in each group. Before treatment, AEMG decreased in the rectus femoris, medial femoris and medial head of gastrocnemius on the affected side in the experimental group (|Z| > 8.647, P < 0.001), and it increased in the lateral femoris, semitendinosus and biceps femoris (|Z| > 4.808, P < 0.001). The scores of WOMAC, VAS, Tinetti Balance and Gait Score, and distances of 6-MWT improved in both groups after treatment (|t| > 3.987, P < 0.001), and improved more in the experimental group than in the control group, except the VAS score (|t| > 2.213, P < 0.05).
Conclusion Manual therapy focusing on activation of rectus femoris, medial femoris and medial head of gastrocnemius, inhibition of the lateral femoris, semitendinosus and biceps femoris, and releasing the tension of the medial and lateral collateral ligaments, according to the results of surface electromyography, can alleviate the pain of the KOA in the older people and improve the mobility of the knee.

Key words: knee osteoarthritis, aged, surface electromyography, manual therapy, randomized controlled trial

CLC Number:

R684.3

ZHU Bowen, ZHAO Suhong, LI Miaoxiu, ZHANG Shuaipan, YAO Chongjie, ZHU Qingguang, FANG Min. Effect of manual therapy based on surface electromyography on knee osteoarthritis for older people: a randomized controlled trial[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(9): 1099-1106.

Figures/Tables 6

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References 30

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组别	n	性别(男/女)/n	年龄/岁	病程/年	体质量指数/(kg·m^-2)	患侧(左/右)/n	Kellgren-Lawrence分级 (I级/II级)/n
对照组	53	17/36	60.89±7.39	5.90±2.28	23.68±2.54	22/31	13/40
试验组	53	15/38	61.79±7.09	5.38±2.55	24.25±2.43	24/29	14/39
χ²/t值		0.179	0.644	-1.120	1.180	0.154	0.050
P值		0.672	0.521	0.265	0.241	0.695	0.824

下肢肌	n	侧别	M(Q_L, Q_U)	Z值	P 值
股直肌	53	健侧	74.63(71.21, 78.04)	-8.849	< 0.001
		患侧	31.32(26.81, 35.84)
股内侧肌	53	健侧	78.64(73.57, 83.72)	-8.875	< 0.001
		患侧	20.56(19.26, 21.87)
股外侧肌	53	健侧	68.43(64.72, 72.14)	-5.519	< 0.001
		患侧	89.43(84.79, 94.07)
半腱肌	53	健侧	47.41(44.73, 50.09)	-5.134	< 0.001
		患侧	58.81(56.23, 61.39)
股二头肌	53	健侧	51.11(48.86, 53.35)	-4.808	< 0.001
		患侧	63.75(60.17, 67.32)
胫骨前肌	53	健侧	66.06(62.82, 69.30)	-1.071	0.284
		患侧	63.62(60.51, 66.72)
腓肠肌外侧头	53	健侧	39.89(39.06, 40.72)	-1.087	0.277
		患侧	40.46(39.46, 41.46)
腓肠肌内侧头	53	健侧	93.13(85.16, 101.09)	-8.647	< 0.001
		患侧	25.74(24.42, 27.07)

变量	组别	n	测试	$\bar{x}±s$	t值	P值
WOMAC疼痛	对照组	53	前测	12.43±3.82	7.533	< 0.001
			后测	7.72±2.53
	试验组	53	前测	12.94±4.15	10.931	< 0.001
			后测	5.36±2.30
	治疗前两组均值差			0.51±5.71	0.658	0.512
	治疗后两组均值差			-2.36±2.91	-5.026	< 0.001
WOMAC僵硬	对照组	53	前测	4.64±2.33	3.987	< 0.001
			后测	3.02±1.82
	试验组	53	前测	4.91±2.15	8.701	< 0.001
			后测	1.72±1.38
	治疗前两组均值差			0.26±3.05	0.607	0.545
	治疗后两组均值差			-1.30±2.66	4.146	< 0.001
WOMAC日常活动	对照组	53	前测	47.85±5.89	17.873	< 0.001
			后测	31.09±4.89
	试验组	53	前测	48.68±4.56	20.938	< 0.001
			后测	28.98±4.94
	治疗前两组均值差			0.83±7.45	0.812	0.419
	治疗后两组均值差			-2.11±8.17	-2.213	0.029
WOMAC总分	对照组	53	前测	64.92±8.56	16.890	< 0.001
			后测	41.83±6.09
	试验组	53	前测	66.52±5.27	28.353	< 0.001
			后测	36.06±5.40
	治疗前两组均值差			1.60±9.35	1.161	0.248
	治疗后两组均值差			-5.77±9.36	-5.165	< 0.001

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	53	前测	5.77±1.05	22.366	< 0.001
		后测	1.75±0.90
试验组	53	前测	5.94±1.81	21.684	< 0.001
		后测	1.68±0.76
治疗前两组均值差			0.16±1.20	0.788	0.433
治疗后两组均值差			0.57±0.84	0.350	0.727

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	53	前测	11.57±2.32	6.915	< 0.001
		后测	7.83±2.45
试验组	53	前测	11.32±2.29	13.051	< 0.001
		后测	5.87±2.18
治疗前两组均值差			-0.25±3.61	-0.547	0.586
治疗后两组均值差			-1.96±3.39	-4.355	< 0.001

Effect of manual therapy based on surface electromyography on knee osteoarthritis for older people: a randomized controlled trial

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组别	n	测试	$\bar{x}±s$	t值	P值
对照组	53	前测	320.92±32.60	-28.456	< 0.001
		后测	561.08±60.00
试验组	53	前测	326.19±23.72	-32.055	< 0.001
		后测	611.94±58.45
治疗前两组均值差			5.26±40.37	0.951	0.344
治疗后两组均值差			50.87±71.72	-4.421	< 0.001

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