Effect Of Baduanjin On Shoulder Function In Maintenance Hemodialysis Patients

Objective:To observe the incidence and relevant factors of shoulder disturbance in non-dialysis chronic kidney disease(CKD)and maintenance hemodialysis(MHD)patients.Observing the efficacy of Baduanjin in improving shoulder function in MHD patients.Method:1.There were 480 CKD patients without dialysis and 160 MHD patients enrolled in The Affiliated Hospital of Nantong University.According to glomerular filtration rate divided into mild[e GFR 60ml/(min 1.73m~2)],moderate[e GFR30-59ml/(min 1.73m~2)]and severe group[e GFR<30ml/(min 1.73m~2)].The basic document and insepection index of the patients were collected.Muscular strength,regulative Constant Murley score(CMS)and the distance between the finger and spinous process were used to mearsure the shoulder function.2.There were 38 MHD patients were recruited for Baduanjin exercise according to the inclusion criteria and then divided into the Baduanjin(n=18)and control group(n=20).The Baduanjin group were given the basic treatment and Baduanjin for a period of 6months while the control group was given the basic treatment.The changes of shoulder joint function and physical fitness index,including five-times sit-to-stand test(FTSST),timed“up and go”test(TUGT),trunk bending forward,and standing on one-leg with eyes closed test(SOLECT)before and after intervention were compared between the two groups.Results:1.The shoulder joint score of MHD group is different from that of non-dialysis CKD group.The ADL score of MHD patients decreased most significantly,which was statistically different from that of any other CKD groups(P<0.05).The most common shoulder joint activity abnormality is limited internal rotation.Compared with the mild group,the distance between the finger and spinous process in moderate,severe,and hemodialysis groups were statistical difference(P<0.05).The distance between the finger and spinous process in the hemodialysis group was higher than in other three groups,with statistical significance(P<0.05).2.The muscle strength,pain,and ROM scores were negatively correlated with creatinine and cystatin-C.The muscle strength and pain scores were negatively correlated with phosphorus and calcium-phosphorus product.The muscle strength and ROM scores were positively correlated with hemoglobin.Besides,muscle strength was negatively correlated with age.3.Multiple linear regression analysis found that hemoglobin age,dialysis years,serum creatinine before dialysis and are independent risk factors for grip strength.The pain,ROM score and regulative CMS between fistula and non-fistula statistically significant(P=0.003,P=0.009,P=0.001).The distance between the finger and spinous process of fistula side was less than that of non-fistula side in MHD patients(P=0.012).4.There was no significant difference in the grip strength between Baduanjin and control group before and after exercise,while the decrease in grip strength in Baduanjin group was lower than that in control group.Compared to before exercise,the finger and spinous process decreased after 6 months Baduanjin statistically(P=0.027),while there was no statistical differences in the control group(P>0.05).5.There was a significant difference in the trunk bending forward between the Baduanjin group before and after exercise(P=0.031).Conclusion:With the progression of chronic kidney disease,the shoulder function and muscle strength is decreased,especially in hemodialysis patients.The shoulder function on the fistual hand of MHD patients is significantly decreased compared with the non-fistula hand.Baduanjin can effectively improve the shoulder function of MHD patients,especially the internal rotation activity,enhance physical fitness and improve the quality of life.