| کلیدواژههای انگلیسی مقاله |
Rehabilitation, Muscle strength, Quality of life, Pilates training, Burns, What&,rsquo s Known Pilates does appear to improve flexibility, strength, and postural control and reduce pain in children with musculoskeletal pathology. Pilates has some potential for improving postural misalignment of the thoracic and lumbar angles in children and adolescents. What&,rsquo s New Adding Pilates exercises to a traditional physical therapy program had a positive impact on the strength of muscles in the lower limb, functional capacity, and quality of life in children with burn injury. Pilates exercises could be considered as part of a rehabilitation program for children who have suffered burn injuries. IntroductionThe World Health Organisation (WHO) reports that burn trauma is the fourth most common type of accidental injury, with approximately 11 million burn injuries and 180,000 deaths worldwide each year. 1, Burn survivors often experience long-term physical and psychological effects. Their functional level may be affected by these limitations, which may require long-term inpatient care as well as both mental and physical rehabilitation. 2, The number of burn-related surgeries, hospital-acquired comorbidities, and prolonged hospital stays negatively affects physical well-being and general quality of life. 2, , 3, Breakdown of skeletal muscle, systemic inflammation, and elevated resting energy expenditure are hallmarks of the pathophysiological response to significant burn trauma. 4, , 5, Skeletal muscle is the greatest protein reserve in humans and constitutes approximately 70% of total lean body mass in healthy people. Therefore, one of the main sources of amino acids for post-burn survival and regeneration is muscle protein. It is believed that the release of amino acids from skeletal muscle promotes wound healing, the synthesis of acute-phase and inflammatory proteins, and the provision of substrate for hepatic gluconeogenesis during burn recovery. 4, , 5, Up to two years after burn injury, this hypermetabolic and enduring catabolic reaction may continue. Consequently, the ongoing breakdown of muscles leads to a decrease in muscle mass and strength, which hinders the recovery of functional mobility. As a result, techniques that support the preservation of skeletal muscle mass and function may benefit patients in the long run as they recover from severe burns. 4, - 8, To lower hypermetabolism and speed up burn survivors&,rsquo social reintegration, muscle strength and aerobic capacity are crucial aspects of health that must be addressed in post-burn treatment as well as in the early post-burn rehabilitation phase. 8, , 9, Consequently, a successful training regimen may be necessary to improve the muscular endurance and work capacity of pediatric burn patients. Burned patients are frequently involved in a resistance and aerobic exercise program as part of their physical therapy to lessen muscle weakness and deconditioning, as well as burn-induced catabolism. 9, , 10, Among the numerous kinds of physical therapy exercises, Pilates is a popular form. Pilates is popular today not only for physical fitness but also for rehabilitation programs. It is a set of exercises composed of stretching, coordination, and strengthening exercises, which focus on developing stability, flexibility, muscle control, and muscle strength, especially the muscles of the trunk (core training), through the utilization of the body-mind-spirit connection. 11, However, there is limited data on the effects of Pilates on lower limb muscle strength, particularly in burned children. Thus, the current study sought to determine whether adding Pilates exercise to a traditional physical therapy program improves lower extremity&,nbsp muscle strength, functional capacity, and quality of life in children with lower limb burn.Patients and Methods Study Design This investigation was a controlled, randomized clinical trial performed between June 2022 and October 2023 at the outpatient physical therapy clinic of the College of Applied Medical Science, Prince Sattam bin Abdulaziz University in Saudi Arabia. The protocol was approved by the Physical Therapy Research Ethics Committee (RHPT/023/014), and the study met the 1964 Declaration of Helsinki. The parents or legal guardians of the burned children were given a brief explanation of the study&,rsquo s procedures, and they were requested to sign a consent form indicating their agreement to enroll their children in this study. This study is registered at ClinicalTrials.gov NCT06237361. Patients In this study, 60 children with healed burns between the ages of 10 and 15 (33 males and 27 females) participated. The inclusion criteria for the trial were children with lower limb healed burns, 6 months after injury, a total body surface area between 35&,ndash 55 percentages, patients involved in the study presented with second- and third-degree burns located on the anterior and posterior thighs, anterior and posterior legs, and the foot, and the capacity to walk securely without assistance. Exclusion from the study was justified in cases of any lower limb joint range of motion limits, mental illnesses, significant behavioral or cognitive impairments, incapacity to exercise, metabolic diseases, neuropathy, visual or vestibular abnormalities, and medical instability. Sample Size Calculation and Randomization The sample size calculation was performed before the study commenced using G*POWER statistical software (version 3.1.9.2 Germany). The sample size was estimated based on, [F tests- multivariate analysis of variance, repeated measures, within-between interaction Type I error(&,alpha )=0.05, power=80%, effect size=0.37]. The effect size was calculated for the quality-of-life total score from unpublished data in a pilot study with five subjects per group, where mean and standard deviation (mean&,plusmn SD) were 72.25&,plusmn 4.45 and 70.69&,plusmn 3.99 for the Pilates and the control groups, respectively. The estimated sample size was calculated to be 60 participants. To accommodate potential dropouts, the sample size was increased by 5%, resulting in a final study sample size of 63 participants. Participants were randomly allocated to the Pilates training group (which received Pilates training in addition to the traditional physical therapy program) and the control group (which received the traditional physical therapy program) after baseline assessment. Simple randomization was done by allocating patients with odd numbers into the Pilates training group and those with even numbers into the control group. To reduce allocation bias, the assignments were concealed in sequentially numbered, opaque, sealed envelopes, which were opened only after baseline assessment by an author not involved in outcome evaluation. Outcome assessments were conducted by a separate author blinded to group allocation. To ensure the assessor&,rsquo s blindness, participants were requested not to discuss their intervention during follow-up. Outcome Measures Measurements of lower limb muscle strength, functional capacity, and quality of life were made at baseline (6 months post injury) and after the group intervention (12 weeks) by an independent researcher who was not aware of it. Muscle Strength Assessment Using a calibrated handheld dynamometer (Micro FET2, Hoggan Health Technologies Inc., UT, USA), the maximum voluntary isometric muscular strength of hip flexors, extensors, abductors, external rotators, flexors and extensors of the knee, as well as the ankle dorsi- and plantar flexors, was measured. All participants attended a demonstration session to become more familiar with the assessment processes. Each participant was urged to put in their best effort. Three 5-sec contractions were made for each muscle group, and the average score in kilogram-force was then calculated and used for the study. The placement of the dynamometer and the position of the child were explained in our previous research. 12, The handheld dynamometer provides good to excellent intra-rater reliability (ICCs ranging from 0.80 to 0.96) and inter-rater reliability (ICCs between 0.83 and 0.95). 13, Functional Capacity The 6-minute walk test was used to evaluate functional capacity. It is a submaximal test that has been demonstrated to be useful and well-tolerated in burn victims. 14, The assessor timed the participants and gave them 6 min to walk as far as they could along a straight course. They were not allowed in any way to run, jump, or hop. The 6-min walk test reported high test-retest reliability, with an intraclass correlation coefficient (ICC) of 0.94, indicating consistent results upon repeated administrations. 15, Quality of Life The Arabic version of the self-reported Pediatric Quality of Life InventoryTM 4.0 generic core scale was implemented to assess health-related quality of life. The Pediatric Quality of Life Inventory was successfully validated in children who have experienced trauma and has shown excellent psychometric characteristics in children and adolescents between 2 to 18, as Cronbach&,rsquo s alpha coefficients exceed 0.70 across total scores and subscales, indicating satisfactory internal consistency and high test-retest reliability, with coefficients exceeding 0.90, confirming the instrument&,rsquo s stability over time. 16, , 17, It is a 23-item scale with four functional domains that include physical, emotional, social, and school function. Items were graded on a five-point Likert scale (0 for never, 4 for almost always). Entries are reverse-scored and linearly interpreted to a 0-100 scale, with 0=100, 1=75, 2=50, 3=25, and 4=0. Domain-specific scores are then calculated as follows, 1) Physical health the sum of the items over the number of answers in the physical function subscale 2) Psychosocial health=the sum of the items over the number of answers in the emotional, social, and school function subscales and 3) Total score=the sum of all the items over the number of answers on all subscales. Higher scores indicate improved health-related quality of life. 17, Intervention Traditional Physical Therapy Program, All participants in each group completed the traditional physical therapy program, which lasted one hour per day, three days a week, for a period of twelve weeks. Range of motion exercises, aerobic exercise, resistance exercises, scar management, occupational therapy, and hand therapy are all part of the traditional physical therapy program. Scar care was accomplished using scar massage and garments. The aerobic training consisted of walking, running, jogging, biking, and swimming, while resistance exercises included eight upper and lower body exercises such as leg press, leg curl, leg squats (with or without weights), toe raises, shoulder press, bench press, and biceps and triceps curl. 18, , 19, Pilates Training Program, For 12 weeks, subjects assigned to the Pilates training group completed three sessions weekly of Pilates routines. The exercises were done in three sets of eight repetitions for the first 2 weeks, three sets of 10 repetitions for the next 5 weeks, and three sets of 15 repetitions for the following weeks.Each training session consisted of three parts, the warm-up exercises (10 repetitions of lateral neck flexion, shoulder elevation, flexion and rotation, body rotation and lateral flexion, flexion of the knees, dorsal flexion of the ankle, and mini squats). After the warm-up activities, Pilates routines were performed. Following the Pilates exercises, cool-down activities included breathing, stretching (shoulder and pectoral muscles, gastrocnemius-soleus, hip flexors and rotators, back muscles), and relaxation techniques. The subjects had spent the previous week becoming acquainted with the correct implementation of the motions as well as the concepts of the Pilates approach. 20, , 21, The Pilates exercise is detailed in Appendix 1,. Statistical Analysis The measured variables were statistically analyzed and compared using the Statistical Package for the Social Sciences programme for Windows version 25 (IBM, SPSS, Inc., Chicago, IL) with a level of significance set at 0.05. Data were screened for normality assumption, homogeneity of variance, and presence of extreme scores. To test the homogeneity of variances between the groups, Levene&,rsquo s test was used. The Shapiro-Wilk test for normality showed that the measured variables were normally distributed (P&,gt 0.5). Data were expressed as means and standard deviations for all outcomes except for gender and cause of burn (counts/percentages). Considering the data were normally distributed, parametric tests were employed for summarizing and analyzing age, height, weight, body mass index, total body surface area, hospital stay, muscle strength, functional capacity, and quality of life scores. The univariate analysis of variance with Bonferroni correction was performed for each outcome measure to protect against type I error. ResultsThe CONSORT flow diagram displays participant enrolment, the randomization process, and retention throughout the study (figure 1,). Seventy-three participants were evaluated for eligibility, and 63 participants met the inclusion criteria and were then randomly assigned to the control (n=32) or pilates (n=31) groups. Three of the participants [two in the control group and one in the study group] did not finish the study because they either relocated or had schedule conflicts, and the results they provided were not utilized in the statistical analysis. For the final analysis, data were provided for 60 patients, 30 from the control group (n=30) and 30 from the Pilates group (n=30). As shown in table 1,, there were no statistically significant differences between the Pilates group and control group, respectively as, age was (12.30&,plusmn 1.73 years vs. 12.03&,plusmn 1.54 years P=0.53), height (1.49&,plusmn 0.09 vs. 1.48&,plusmn 0.07 m P=0.71), weight (41.00&,plusmn 9.02 vs. 41.87&,plusmn 7.66 Kg P=0.69), body mass index (18.24&,plusmn 3.37 vs. 18.79&,plusmn 2.28 Kg/m2 P=0.46), total body surface area (46.83&,plusmn 5.85 vs. 45.67&,plusmn 7.02% P=0.49), and hospital stay (96.60&,plusmn 16.54 vs. 101.63&,plusmn 12.12 days P=0.18).Figure 1. The figure represents the CONSORT flow diagram of the study.VariablesPilates group (n=30)Control group (n=30)P valueAge (years)12.30&,plusmn 1.7312.03&,plusmn 1.540.53Sex (n, %)Male14 (46.7%)19 (63.3%)0.20Female16 (53.3%)11 (36.7%)Cause of burn (n, %)Thermal12 (40%)16 (53.3%)0.30Scald15 (50%)12 (40%)Chemical3 (10%)2 (6.7%)Height (m)1.49&,plusmn 0.091.48&,plusmn 0.070.71Weight (Kg)41.00&,plusmn 9.0241.87&,plusmn 7.660.69BMI (Kg/cm2)18.24&,plusmn 3.3718.79&,plusmn 2.280.46TBSA (%)46.83&,plusmn 5.8545.67&,plusmn 7.020.49Hospital Stay (day)96.60&,plusmn 16.54101.63&,plusmn 12.120.18SD, Standard deviation BMI, Body mass index TBSA, Total body surface area. Data are represented as mean&,plusmn SD and frequency (%). Independent t test and Chi square tests were used. |