تأثير تمرينات توانبخشي ورزشي شخصي سازي شده براساس سطوح مختلف ناتواني بر آمادگي جسماني و خستگي بيماران مبتلا به مولتيپل اسكلروزيس

The Effect of a Personalized Comprehensive Rehabilitation Program Based on Different Disability Levels on Physical Fitness, Fatigue and Quality of Life in Patients with Multiple Sclerosis

مقدمه: در طب توانبخشي استفاده از رويكردهاي هاي هدفمند و شخصي سازي شده مطرح است و غالباً مداخلات استاندارد كلي و عمومي نتايج مناسب و مطلوب را نخواهند داشت. لذا هدف اين پژوهش بررسي تأثير يكدوره تمرينات توانبخشي ورزشي شخصي سازي شده براساس سطوح مختلف ناتواني بر آمادگي جسماني و خستگي بيماران مبتلا به اماس بود. روش كار: اين تحقيق از نوع نيمه تجريي با گروه شاهد و مداخله بود. واحدهاي مورد پژوهش را بيماران زن مراجعه كننده به انجمن مولتيپل اسكلروزيس شهرستان شهركرد تشكيل ميدادند. 96 نفر زن مبتلا به مولتيپل اسكلروزيس با توجه به نمره مكتسبه از مقياس وضعيت گسترش ناتواني به سه گروه ناتواني خفيف (44 نفر)، ناتواني متوسط (26) و ناتواني شديد (26) تقسيم بودند و سپس آزمودني هاي هر گروه با استفاده از نمونه گيري تصادفي به دو گروه شاهد و مداخله تقسيم شدند. ابزارهاي مورد استفاده در مطالعه آزمون سنجش قدرت و استقامت عضلاني، انعطاف پذيري بود. تمرينات توانبخشي ورزشي شخصي سازي شده براساس سطوح مختلف ناتواني طي 36 جلسه يك ساعته كه هفته اي سه جلسه برگزار ميشد انجام گرديد. در صورتيكه گروههاي شاهد تنها تمرينات كششي دريافت كردند. تجزيه و تحليل دادهها با استفاده از نسخه 21 نرم افزار SPSS و با استفاده از تحليل كوواريانس و مقايسه زوجي ميانگين هاي تعديل شده انجام گرديد. يافته ها: بر اساس نتايج حاصل، انجام تمرينات توانبخشي ورزشي جامع موجب كاهش ناتواني جسماني و خستگي بيماران و افزايش انعطاف پذيري، استقامت عضلاني و قدرت عضلاني آزمودني هاي هر سه گروه مداخله گرديده بود (0/05> P). اما در بيماران گروه شاهد تفاوت معني داري مشاهده نشد (0/05< P). نتيجه گيري: از يافته هاي تحقيق ميتوان نتيجه گيري كرد كه اجراي تمرينات توانبخشي ورزشي جامع بر روند بهبود بيماران مولتيپل اسكلروزيس تأثير گذار بود و موجب بهبود عوامل منتخب آمادگي بدني، ناتواني جسماني و خستگي بيماران گرديد. لذا توصيه ميشود متخصصان از اين تمرينات به عنوان يك درمان مكمل در كنار ساير درمانهاي دارويي استفاده نمايند.

Introduction: In rehabilitation medicine, using targeted and personalized approach is general, and standard interventions often do not have appropriate results. Most researches have been conducted on the effects of rehabilitation exercises on patients with multiple sclerosis (MS) with mild to moderate disabilities. Research on patients with different levels of disability has not been carefully considered yet. So, this study aimed to investigate the effect of a personalized comprehensive rehabilitation program on physical fitness and fatigue in patients with MS. Methods: This research was an experimental and applied study. From female patients admitted to the MS Society in Shahrekord, Iran, 96 subjects were divided into three groups, as sampling was based on physical disability scale scores (EDSS) (i.e. less than 4.5, 56.5, and higher than 6.5). Afterwards, each group was randomly divided into experimental and control groups. In the first group (the scale of disability was less than 4.5) n = 44 and in the second group (the scale of disability was 56.5) n = 26. Also, 26 patients were in the third group (the scale of disability was 6.5 and above). In addition, they were divided into six experimental and control groups. Training programs for the experimental groups were 12 weeks, three sessions per week and one hour per session. Factors such as physical fitness as well as psychological and physical disabilities of patients were measured with appropriate tools before and after the training. The experimental groups of 1, 2 and 3 each had their own interventions, while the control groups only received stretching exercises. The analysis of data obtained from 96 patients was conducted using descriptive statistics as well as the analysis of covariance and paired comparing of the adjusted means (P < 0.05). Subjects of the three groups progressed in dependent variables; while the difference was not statistically significant in the control group. Results: Based on the results, the comprehensive rehabilitation exercises reduced physical disability and fatigue and increase flexibility, muscular endurance, muscular stren>h and the quality of life in patients with MS. The difference of the impact of these exercises on the above cases was statistically significant (P < 0.05). Conclusions: The implementation of the comprehensive rehabilitation exercises affected the recovery of patients with MS and caused a significant difference in physical fitness factors, psychological factors and physical disabilities of patients. According to the results, it is recommended that experts use these exercises as a complementary therapy alongside drug treatments for patients with MS.