虚拟游戏对功能性踝关节不稳患者平衡功能的即刻及短期效果观察

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目的:探讨虚拟游戏对功能性踝关节不稳(functional ankle instability,FAI)患者平衡功能的即刻及短期影响。方法:采用坎伯兰踝关节不稳问卷(cruamberland ankle instability tool,CAIT)选取2020年9-12月华北理工大学FAI受试者56例作为研究对象,按照计算机随机数字法将56例受试者随机分为对照组和观察组各28例,采用前瞻性队列研究方法进行研究。对照组接受常规平衡训练,观察组在对照组基础上进行虚拟游戏训练。分别在干预前、干预后即刻和干预4周后采用Tecnobody平衡仪评估比较两组受试者静态平衡能力,采用星状平衡偏移测试(star excursion balance test,SEBT)评估比较两组受试者动态平衡能力,记录比较两组受试者CAIT评分。符合正态分布的计量资料以n xˉ±s表示,采用独立样本n t检验或配对n t检验。计数资料采用χn 2检验。n 结果:干预后即刻,观察组SEBT 8个方向评分较干预前显著改善:前:(69.06±7.57)%与(63.69±8.05)%、前外:(61.14±6.68)%与(55.77±7.39)%、外:(67.71±7.99)%与(62.93±7.56)%、后外:(76.43±6.98)%与(71.31±7.86)%、后:(75.45±6.78)%与(68.72±6.65)%、后内:(79.13±8.09)%与(72.72±9.03)%、内:(72.67±7.43)%与(65.67±8.16)%、前内:(67.75±8.30)%与(63.18±8.95)%(n t值分别为8.03、11.88、9.72、6.43、19.53、9.36、11.06、6.46,均n P<0.001),且观察组优于对照组[干预后即刻SEBT 8个方向评分分别为(63.24±6.72)%、(55.41±7.74)%、(61.49±8.37)%、(70.02±6.81)%、(69.06±9.46)%、(72.41±7.20)%、(66.37±6.57)%和(62.15±6.89)%],两组比较差异均有统计学意义(n t值分别为3.04、2.97、2.84、3.47、2.90、3.28、3.36、2.75,n P值分别为0.004、0.004、0.006、0.001、0.005、0.002、0.001、0.008)。干预4周后,观察组睁眼及闭眼状态下各项静态平衡指标较干预前均显著降低[睁眼:前后方向速度:(24.68±6.85)mm/s与(27.57±7.15)mm/s、左右方向速度(26.25±6.20)mm/s与(30.61±6.99)mm/s、运动椭圆面积(915.75±356.08)mm与(1 286.54±530.05)mm、运动长度(823.82±173.80)mm与(1 142.89±297.03)mm(n t值分别为4.02、3.09、4.89、6.74,均n P<0.001);闭眼:前后方向速度(66.82±15.02)mm/s与(73.71±11.12)mm/s、左右方向速度(76.93±13.36)mm/s与(84.39±10.05)mm/s、运动椭圆面积(3 318.54±958.75)mm与(4 174.21±1 310.54)mm、运动长度(2 156.96±665.80)mm与(2 817.75±528.22)mm(n t值分别为3.23、3.29、4.95、5.02,n P值分别为0.003、0.003、<0.001、<0.001)],其中观察组左右方向速度[睁眼:(26.25±6.20)mm/s]、运动椭圆面积[睁眼:(915.75±356.08)mm;闭眼:(3 318.54±958.75)mm]和运动长度[睁眼:(823.82±173.80)mm;闭眼:(2 156.96±665.80)mm]均低于对照组[分别为(30.68±9.81)mm/s、(1 137.25±423.27)mm、(3 973.36±1 306.61)mm、(1 038.79±242.90)mm、(2 603.43±703.81)mm],两组比较差异均有统计学意义(n t值分别为2.02、2.12、2.14、3.81、2.44,n P值分别为0.049、0.039、0.037、<0.001、0.018);干预4周后,两组受试者SEBT 8个方向评分较干预前均显著提高[前:观察组(72.84±6.76)%与(63.69±8.05)%,对照组(69.05±6.16)%与(62.96±6.56)%。前外:观察组(65.24±7.68)%与(55.77±7.39)%,对照组(60.65±8.11)%与(54.65±8.98)%。外:观察组(73.97±8.80)%与(62.93±7.56)%,对照组(68.34±9.14)%与(61.24±9.42)%。后外:观察组(81.68±6.69)%与(71.31±7.86)%,对照组(76.39±6.78)%与(69.74±8.11)%。后:观察组(81.41±7.86)%与(68.72±6.65)%,对照组(75.21±8.48)%与(68.45±9.96)%。后内:观察组(82.77±8.69)%与(72.72±9.03)%,对照组(78.38±6.84)%与(72.36±7.34)%。内:观察组(77.47±7.85)%与(65.67±8.16)%,对照组(72.66±6.93)%与(65.95±7.09)%。前内:观察组(73.33±8.91)%与(63.18±8.95)%,对照组(68.35±6.53)%与(61.66±6.80)%(n t值分别为14.19、10.17、12.71、12.35、12.32、8.99、11.38、6.95、12.66、7.94、9.54、11.53、11.89、12.87、11.69、12.53,均n P<0.001],且观察组优于对照组,差异均有统计学意义(n t值分别为2.19、2.18、2.35、2.94、2.84、2.10、2.43、2.38,n P值分别为0.033、0.034、0.023、0.005、0.006、0.040、0.018、0.021);干预4周后,两组受试者CAIT评分较干预前均显著改善:观察组(18.89±3.62)分与(14.93±4.09)分,对照组(16.96±3.18)分与(15.25±3.81)分(n t值分别为10.54、5.65,均n P<0.001),且观察组CAIT评分高于对照组,差异有统计学意义(n t=2.12,n P=0.039)。n 结论:虚拟游戏能即刻改善FAI患者的动态平衡能力,结合常规平衡训练干预4周后显著改善FAI受试者的静动态平衡能力及踝关节稳定性。“,”Objective:To investigate the immediate and short-term effects of virtual games on balance function in patients with functional ankle instability(FAI).Methods:Fifty-six FAI subjects from North China University of Science and Technology from September 2020 to December 2020 were selected by cruamberland ankle instability tool(CAIT). According to the computer random number method,the 56 subjects were randomly divided into the control group and the observation group with 28 subjects in each group,and the prospective cohort study method was used for this study. Control group accepted routine balance training,observation group based in the control group carries on the virtual game training. Before and immediately after intervention and 4 weeks after intervention,the static balance ability of subjects in the two groups was evaluated and compared by Tecnobody balance instrument,and the dynamic balance ability of subjects in the two groups was evaluated and compared by star excursion balance test(SEBT),and the CAIT score of subjects in the two groups was recorded and compared. The measurement data conforming to normal is expressed in n xˉ ± n s means independent sample n t-test or paired t-test. n χ2 test was used for counting data.n Results:Immediately after intervention,the 8 directions of SEBT scores in the observation group are significantly improved compared with those before intervention: Anterior(69.06±7.57)% and (63.69±8.05)%, Anterolateral (61.14±6.68)% and (55.77±7.39)%, Lateral (67.71±7.99)% and (62.93±7.56)%, Posterolateral (76.43±6.98)% and (71.31±7.86)%, Posterior (75.45±6.78)% and (68.72±6.65)%, Posteromedial (79.13±8.09)% and (72.72±9.03)%, Medial(72.67±7.43)% and (65.67±8.16)%, Anteromedial (67.75±8.30)% and (63.18±8.95)% (n t values were 8.03, 11.88, 9.72, 6.43, 19.53, 9.36, 11.06 and 6.46, respectively; all n P<0.001), and the observation group was significantly better than the control group (63.24±6.72)%, (55.41±7.74)%, (61.49±8.37)%, (70.02±6.81)%, (69.06±9.46)%, (72.41±7.20)%, (66.37±6.57)% and (62.15±6.89)%. There were significant differences between the two groups (n t values were 3.04, 2.97, 2.84, 3.47, 2.90, 3.28, 3.36 and 2.75, respectively; n P values were 0.004, 0.004, 0.006, 0.001, 0.005, 0.002, 0.001 and 0.008,respectively). After 4 weeks of intervention,the static balance parameters in the observation group were significantly reduced compared with before intervention under the condition of opened eyes and closed eyes (open eyes: average AP speed of COP (24.68±6.85) mm/s and (27.57±7.15) mm/s,average ML speed of COP (26.25±6.20) mm/s and (30.61±6.99) mm/s, ellipse area of COP (915.75±356.08) mm and (1 286.54±530.05) mm, perimeter of COP (823.82±173.80) mm and (1 142.89±297.03) mm (n t values were 4.02, 3.09, 4.89 and 6.74, respectively; all n P<0.001); closed eyes:average AP speed of COP (66.82±15.02) mm/s and (73.71±11.12) mm/s, average ML speed of COP (76.93±13.36) mm/s and (84.39±10.05) mm/s, ellipse area of COP (3 318.54±958.75) mm and (4 174.21±1 310.54) mm, perimeter of COP (2 156.96±665.80) mm and (2 817.75±528.22) mm (n t values were 3.23,3.29,4.95,5.02, respectively; n P values were 0.003, 0.003,<0.001,<0.001,respectively). Average ML speed of COP (open eyes:(26.25±6.20) mm/s), ellipse area of COP (open eyes: (915.75±356.08) mm;closed eyes: (3 318.54±958.75) mm and perimeter of COP (open eyes: (823.82±173.80) mm; closed eyes: (2 156.96±665.80) mm) in the observation group were lower than those of the control group(30.68±9.81) mm/s, (1 137.25±423.27) mm, (3 973.36±1 306.61) mm, (1 038.79±242.90) mm, (2 603.43±703.81) mm, the differences were statistically significant (n t values were 2.02,2.12,2.14,3.81,2.44,respectively;n P values were 0.049,0.039,0.037, <0.001,=0.018, respectively). After 4 weeks of intervention,the 8 directions of SEBT scores in both groups were significantly improved compared with those before intervention (Anterior:observation group (72.84±6.76)% and (63.69±8.05)%,control group (69.05±6.16)% and (62.96±6.56)%. Anterolateral:observation group (65.24±7.68)% and (55.77±7.39)%,control group (60.65±8.11)% and (54.65±8.98)%. Lateral: observation group(73.97±8.80)% and (62.93±7.56)%, control group (68.34±9.14)% and (61.24±9.42)%. Posterolateral: observation group (81.68±6.69)% and (71.31±7.86)%, control group (76.39±6.78)% and (69.74±8.11)%. Posterior: observation group (81.41±7.86)% and (68.72±6.65)%, control group (75.21±8.48)% and (68.45±9.96)%. Posteromedial: observation group (82.77±8.69)% and (72.72±9.03)%,control group (78.38±6.84)% and (72.36±7.34)%. Medial:observation group (77.47±7.85)% and(65.67±8.16)%, control group (72.66±6.93)% and (65.95±7.09)%. Anteromedial:observation group(73.33±8.91)% and (63.18±8.95)%, control group (68.35±6.53)% and (61.66±6.80)% ( n t values were 14.19, 10.17, 12.71, 12.35, 12.32, 8.99, 11.38, 6.95, 12.66, 7.94, 9.54, 11.53, 11.89, 12.87, 11.69 and 12.53, respectively; all n P<0.001)), and the observation group was significantly better than the control group,the differences were statistically significant (n t values were 2.19, 2.18, 2.35, 2.94, 2.84, 2.10, 2.43 and 2.38, respectively; n P values were 0.033, 0.034, 0.023, 0.005, 0.006, 0.040, 0.018 and 0.021, respectively). After 4 weeks of intervention,the CAIT score of subjects in both groups was significantly improved compared with before intervention (observation group (18.89±3.62) points and (14.93±4.09) points,control group (16.96±3.18) points and (15.25±3.81) points (n t values were 10.54 and 5.65; all n P<0.001), and The CAIT score in observation group was higher than that in control group,the differences were statistically significant (n t=2.12, n P=0.039).n Conclusion:Virtual games could immediately improve the dynamic balance ability of FAI patients,which combined with conventional balance training intervention for 4 weeks significantly also improved the balance ability and ankle joint stability of FAI patients.
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