| Objective:With the advent of aging society,the incidence of hip fracture in the elderly is increasing year by year.After hip fracture,patients are suddenly forced to immobilize.Affected by frailty,pain,and reduced activity,elderly patients are generally affected by decreased physical function and self-care ability.Bed rest related complications such as lung infection,deep vein thrombosis,and stress injury have a high incidence,and the prognosis of patients is poor.The upper limb yoga training developed in the previous study significantly improved respiratory function and upper limb self-care ability in elderly patients with hip fractures.At present,there is a lack of training methods suitable for the upper and lower limbs of elderly patients with hip fracture.According to the rehabilitation needs of elderly patients with hip fracture in different periods,yoga training was integrated into the exercise program design of patients,audio and video materials were produced and distributed to patients,and the effect of bed yoga training on improving the physical function,self-care ability,incidence of bed-related complications and compliance of elderly patients with hip fracture was observed.Methods:This is a prospective randomized controlled clinical study.A total of 84 patients who underwent surgical treatment for hip fracture due to falls in a tertiary class A hospital in Shanxi Province from June 2021 to December 2022 were selected and divided into control group(n=42)and yoga group(n=42)by random number table method.Except for 2 patients in critical condition transferred to intensive care unit,4 patients lost in follow-up and 1 patient with arrhythmia,39 patients in the final control group and 38 patients in the yoga group completed this study.All enrolled subjects were signed by their own informed consent and their legal guardians.From the date of admission to 4 weeks after the operation,the two groups of patients underwent two different training methods each day.The patients in the yoga group were guided by special nurses and researchers to carry out specially developed"bed yoga training",while the patients in the control group were guided by the responsible nurses to carry out abdominal breathing training and limb function training(ankle pump movement and straight leg elevation).Simple body function assessment,Barthel index,peak expiratory flow rate,quadriceps muscle mass index and dominant hand strength were measured on the first day of admission,one week after admission and four weeks after surgery,respectively.At the same time,the patients were observed and asked whether discomfort occurred during the training process;the patients’mastery of the training methods was investigated one week after the operation;yoga sounds and videos were distributed to the yoga group upon discharge;a wechat group was established during the study period and training photos and videos were checked every day;the incidence of bed-related complications and training compliance of patients were followed up 4 weeks after the operation during dressing change and review.Results:1.Simple body function assessmentOn the first day of admission,due to the influence of the disease,the patients were bedridden and had limited mobility,so the simple body function of the two groups could not be evaluated.After 1 week,simple body function assessment score was(3.61±0.96)in the yoga group and(3.50±1.08)in the control group.Four weeks after surgery,the simple body function assessment score was(4.54±1.04)in the yoga group and(4.19±0.77)in the control group.After 1 week and 4 weeks after surgery,there was no significant difference in simple body function assessment between the two groups(t=0.47,P=0.638;t=1.68,P=0.097).The simple physical function assessment of the two groups gradually improved over time,showing an increasing trend,and the increase range of the yoga group was greater than that of the control group.2.Barthel IndexOn the first day of admission,the Barthel index of yoga group and control group was(19.17±4.05)points and(19.61±3.92)points respectively.After 1 week,the Barthel index of yoga group and control group was(34.03±4.28)points and(30.48±5.68)points respectively.After 4 weeks,the Barthel index of the yoga group was(71.28±2.05)and that of the control group was(67.68±3.97).On the first day of admission,there was no significant difference in Barthel index between the two groups(t=-0.48,P=0.629).After 1 week and 4 weeks after surgery,Barthel index in yoga group was higher than that in control group(t=3.09,P=0.003;t=4.98,P<0.001).The Barthel index of the two groups increased gradually over time,showing an increasing trend.3.Peak Expiratory FlowOn the first day of admission,the peak expiratory velocity was(191.21±30.84)L/min in the yoga group and(193.32±28.77)L/min in the control group.After 1 week,the peak expiratory flow rate was(205.03±26.71)L/min in the yoga group and(190.24±31.04)L/min in the control group.After 4 weeks,the peak expiratory velocity was(213.26±33.72)L/min in the yoga group and(194.82±30.53)L/min in the control group.On the first day of admission,there was no significant difference in peak expiratory velocity between the two groups(t=-0.31,P=0.757).After 1 week and 4 weeks after surgery,peak expiratory flow rate in yoga group was higher than that in control group(t=2.24,P=0.028;t=2.50,P=0.014).The peak expiratory velocity of patients in the yoga group increased gradually over time,showing an increasing trend,while that of patients in the control group showed a trend of first decreasing and then increasing,with a smaller increase than that of the yoga group.4.Quadriceps muscle mass index of affected sideOn the first day of admission,the muscle mass index of the quadriceps femoris in the yoga group was(21.30±3.32)points,and that of the quadriceps femoris in the control group was(20.24±4.87)points.After 1 week,the muscle mass index of the quadriceps femoris in the yoga group was(22.89±4.02)points,and that of the quadriceps femoris in the control group was(21.93±3.88)points.After 4 weeks,the muscle mass index of the affected quadriceps muscle in the yoga group was(24.08±3.43)points,while that of the control group was(23.02±2.63)points.There was no significant difference in the muscle mass index of the quadriceps femoris between the two groups during the study period(t=1.11,P=0.269;t=1.07,P=0.290;t=1.52,P=0.132).The muscle mass index of the quadriceps femoris on the affected side of the two groups increased gradually over time and showed an increasing trend.5.Superior grip strengthOn the first day of admission,the dominant hand grip strength was(21.84±4.25)kg in the yoga group and(22.26±5.17)kg in the control group.After 1 week,the dominant hand grip strength was(24.05±5.56)kg in the yoga group and(23.37±4.21)kg in the control group.After 4 weeks,grip strength was(26.43±4.09)kg in the yoga group and(24.11±5.24)kg in the control group.There was no significant difference in dominant hand grip strength between the two groups on day 1 and 1 week after admission(t=-0.39,P=0.698;t=0.61,P=0.546);At 4 weeks after surgery,the dominant hand grip strength of yoga group was higher than that of control group(t=2.16,P=0.034).The dominant hand grip strength of the two groups was gradually improved over time,showing an increasing trend,and the increase of the control group was less than that of the yoga group.6.Incidence of bed-related complicationsDuring the study period,the yoga group had no pneumonia and constipation,1 case of stress injury and 1 case of deep vein thrombosis,and the incidence of bed related complications was 5.26%.In the control group,1 case of pneumonia,2 cases of constipation,2 cases of stress injury,1 case of deep vein thrombosis,the incidence of bed related complications was 15.38%.There was no significant difference in the incidence of bed-related complications between the two groups(X~2=2.118,P=0.146).7.Compliance rateAt the follow-up 4 weeks after surgery,30 patients(78.95%)in the yoga group and 19 patients(48.72%)in the control group hoped to continue the current training for a long time,while the other patients expected to get other better training methods,there was a statistical difference between the two groups(~2=7.601,P=0.009).Conclusion:(1)Short-term yoga rehabilitation exercise can effectively improve patients’cognition and self-care ability for disease rehabilitation,and effectively improve patients’respiratory function.(2)Short-term yoga rehabilitation exercises have positive effects in improving body balance,lower limb function,upper limb muscle strength,etc.,but the effect is not obvious.(3)Yoga rehabilitation exercise includes movement,static resistance exercise,aerobic breathing exercise and stretching exercise for muscles of all parts of the body,rich in form,simple movement,high patient compliance,suitable for long-term performance of elderly patients with hip fracture. |
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