【摘要】：目的采用運動療法對患職業(yè)性肌肉骨骼疾患的康復治療師進行干預,并評價運動療法的康復效果,觀察運動療法對治療師疼痛、肌肉力量及抗疲勞能力的影響,為治療師職業(yè)性肌肉骨骼疾患的康復提供參考。方法選取唐山市60名頸肩和上背有職業(yè)性肌肉骨骼疾患的康復治療師,采用隨機數(shù)字表法隨機分為對照組(n=30)與干預組(n=30)。對照組完成日常的工作后只單純休息,無系統(tǒng)治療;干預組完成日常工作后進行運動療法的干預,干預項目包括:1準備活動,以低強度活動為主,包括兩個小結:關節(jié)活動和肌肉牽伸;2力量和耐力練習,以中強度活動為主,每次干預20min,1次/天,5天/周,持續(xù)8周。兩組均在試驗前、四周后和八周后對頸部豎脊肌(CES)、斜方肌上部(UT)和斜方肌中部(MT)進行視覺模擬評分(VAS)和表面肌電(s EMG)信號的測定,運用美國DELSYS表面肌電圖測試系統(tǒng)自帶的分析軟件Acq Knowledge4.1進行分析得出表面肌電最大自主收縮(MVC)、均方根(RMS)和平均頻率(MF)的測定值。用重復測量方差分析對VAS、MVC、RMS和MF值進行統(tǒng)計學分析,時間因素和分組因素存在交互效應的進一步用多元方差分析做簡單效應分析。結果1試驗前對照組與干預組VAS、MVC、RMS和MF的比較,差異均無統(tǒng)計學意義(P0.05),試驗前兩組治療師的疼痛程度、肌肉力量和抗疲勞能力均衡可比;四周后對照組與干預組只有頸部左側的MVC和RMS,肩部右側的RMS差異有統(tǒng)計學意義(P0.05),其余指標比較均無統(tǒng)計學意義(P0.05),運動療法干預四周時干預組比對照組頸肩部肌肉力量明顯增強,但疼痛程度無明顯減輕,抗疲勞能力無明顯提高;八周后對照組與干預組VAS、MVC、RMS和MF比較差異均有統(tǒng)計學意義(P0.05),干預組經(jīng)八周運動療法干預后,比對照組疼痛程度明顯減輕、肌肉力量明顯增強、抗疲勞能力也明顯提高。2對照組VAS、MVC、RMS和MF在試驗前、四周后和八周后三個時間點上的兩兩比較均無統(tǒng)計學意義(P0.05),對照組疼痛程度、肌肉力量和抗疲勞能力均無明顯變化;而干預組VAS、MVC、RMS和MF在三個時間點上的兩兩比較均有統(tǒng)計學意義(P0.05),干預組四周后比干預前、八周后比干預前和八周后比四周后,疼痛程度明顯減輕,肌肉力量明顯增強,抗疲勞能力也明顯提高。結論運動療法干預能有效減輕治療師疼痛、增強肌肉力量、提高抗疲勞能力,從而有效緩解職業(yè)性肌肉骨骼疾患的癥狀,且運動療法干預八周比干預四周效果更好。
[Abstract]:Objective to observe the effects of exercise therapy on pain, muscle strength and anti-fatigue ability of occupational musculoskeletal diseases, and to evaluate the rehabilitation effect of exercise therapy. To provide a reference for the rehabilitation of occupational musculoskeletal disorders. Methods 60 rehabilitation therapists with occupational musculoskeletal diseases on neck, shoulder and upper back in Tangshan City were randomly divided into two groups: control group (n = 30) and intervention group (n = 30). In the control group, after completing the daily work, only rest, no systematic treatment; The intervention group carried on the intervention of exercise therapy after the completion of daily work. The intervention items included: 1 preparation activities, mainly low-intensity activities, including two small summaries: joint activity and muscle drafting; (2) strength and endurance exercises, mainly of moderate intensity activities, once a day, 5 days per week for 8 weeks. The visual analogue scores (VAS) and surface electromyography (s EMG) signals of the upper part of the (CES), trapezius muscle and (MT) of the middle trapezius muscle were measured before, four and eight weeks after the experiment in both groups. The root mean square (RMS) (RMS) and mean frequency (MF) of (MVC), with maximal spontaneous contraction of surface myography were obtained by using the software Acq Knowledge4.1, which is included in the DELSYS surface electromyogram testing system in the United States of America. The VAS,MVC,RMS and MF values were statistically analyzed by repeated measurement variance analysis, and the simple effect analysis was made by multivariate variance analysis when there was interaction between time factor and grouping factor. Results 1 there was no significant difference in VAS,MVC,RMS and MF between the control group and the intervention group before the trial (P0.05). The pain degree, muscle strength and anti-fatigue ability of the two groups were balanced before the trial. Four weeks later, the control group and the intervention group only left neck MVC and RMS, shoulder right RMS difference was statistically significant (P0.05), the other indicators were not statistically significant (P0.05). Compared with the control group, the muscle strength of neck and shoulder in the intervention group increased significantly after four weeks of exercise therapy, but the degree of pain was not obviously alleviated, and the ability of anti-fatigue was not obviously improved. After eight weeks, there were significant differences in VAS,MVC,RMS and MF between the control group and the intervention group (P0.05). After eight weeks exercise therapy, the pain degree and muscle strength in the intervention group were significantly reduced than those in the control group. The anti-fatigue ability of the control group was also significantly improved. 2There was no significant difference between VAS,MVC,RMS and MF in the control group at the three time points before, four and eight weeks after the experiment (P0.05), and the pain degree of the control group was not significant (P0.05). There was no significant change in muscle strength and anti-fatigue ability. There was significant difference between VAS,MVC,RMS and MF at three time points in intervention group (P0.05). The pain degree of intervention group was significantly reduced after four weeks than before, eight weeks after intervention and eight weeks after intervention. The muscle strength is obviously enhanced, and the anti-fatigue ability is also obviously improved. Conclusion exercise therapy intervention can effectively relieve pain, strengthen muscle strength, improve anti-fatigue ability, thus effectively alleviate the symptoms of occupational musculoskeletal diseases. The effect of exercise therapy intervention for eight weeks is better than that for four weeks.
【學位授予單位】：華北理工大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R49

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