Development and initial evaluation of the usefulness of a question prompt list to promote patients' level of information about work-related medical rehabilitation: a pilot study

Introduction

The purpose of this study was to develop a question prompt list (QPL) to support patients undergoing work-related medical rehabilitation in obtaining relevant information and to explore how patients and physicians rate the QPL regarding its usefulness, practicability, and perceived (additional) effort.

Methods

An initial item pool was assessed by rehabilitation patients (N = 3) in cognitive interviews, rated by physicians and other health professionals (N = 11), and then further modified. The final QPL version (16 items) was used by patients (N = 36) in medical admission interviews in an inpatient medical rehabilitation facility and then evaluated. Physicians evaluated the QPL after each interview with a study participant (N = 6; k = 39 interviews).

Results

The QPL was used by 50% of patients who rated its usefulness and comprehensibility positively. Neither the need for information nor satisfaction with the information received was correlated with QPL use. The physicians' assessment showed a positive evaluation regarding the provision of information and structuring of the conversation, but also a higher perceived time expenditure.

Discussion

While initial testing of the QPL in work-related medical rehabilitation as a tool to support patient-provider communication generally showed a favorable evaluation by patients using it and physicians, future research should address its validity and effectiveness.

[Rehabilitative technologies in patients after total endoprosthesis of lower limbs' major joints: scientometric analysis]

Dynamically developing sphere of physical and rehabilitative medicine raises an important issue on implementation of technologies with proven effectiveness to recover neuromuscular, skeletal and movement-related functions, activity and partipation of traumatological patients into rehabilitation practice. The aim of this review is the consistent information analysis and synthesis of evidence-based researches of current effective methods in the context of medical rehabilitation after endoprosthesis of lower limbs' major joints, as well as the provision of structured information that helps to influence on decision-making for doctors of physical and rehabilitative medicine and other professionals who take part in multidisciplinary interaction.

[Functional status of patients after myocardial revascularization combined with chronic low back pain at the sanatorium-resort stage of medical rehabilitation]

Chronic ischemic heart disease (CIHD) is the leading cause of morbidity and mortality, increasing in proportion to the growth of the older population. Rehabilitative measures in patients who have undergone the myocardial revascularization, with back pain currently have insufficient evidence base. The differentiated program of medical rehabilitation (MR) at the stage of sanatorium-resort treatment is not regulated. A description of the comorbid patients' functional status will create a differentiated system of individual rehabilitation program set up.

OBJECTIVE

To develop an algorithm for assessing the functional status of patients after myocardial revascularization with chronic low back pain.

MATERIAL AND METHODS

The single-center cross-sectional cohort study (September 2021 - May 2022 yrs) included 50 patients after a myocardial revascularization with chronic low back pain (36 women, 14 men; median age 63.5 [55.5; 67.5] years), who were the study group and 10 patients with CIHD (5 women, 5 men; median age 65.0 [62.0; 68.0] years) who joined the control group. All patients underwent clinical (neurological and therapeutic examination), functional (clinical tests, echocardiography) and laboratory (general and biochemical blood analysis, blood cytokine levels) investigations, the functional class of impairment was defined.

RESULTS

There are 4 groups with combined pain syndrome (cardiogenic and vertebrogenic) in different ratios due to different functional and laboratory status among patients after the myocardial revascularization with chronic back pain. The presence of cardiogenic pain syndrome was associated with an increase in leukocyte and peripheral blood glucose levels, interleukin-6, myocardial mass enlargement, while vertebrogenic pain syndrome correlated with personal anxiety.

CONCLUSION

The evaluation of the functional status of patients according to the degree of severity of cardiogenic and vertebrogenic pain syndrome has revealed a simple method of pathogenetically based differentiation selection for individual rehabilitation program of patient development.

[International Classification of Health Interventions of World Health Organization as the basis for a new nomenclature of medical rehabilitation services]

The development of health care system, including medical rehabilitation, in the Russian Federation is required updating nomenclature of simple and complex medical services and establishing its detailed list. The latter should integrate international experience and features of domestic health care system.

OBJECTIVE

To analyze the structure of International Classification of Health Interventions (ICHI) of World Health Organization (WHO) and the possibilities of its practical application in domestic medical rehabilitation system.

MATERIAL AND METHODS

The role of ICHI and its structural logical correlations with other classifications of the WHO international classifications section has been determined. Analysis of ICHI application areas, comparison of ICHI codes and new nomenclature of medical services were performed.

RESULTS

Analysis of ICHI and new nomenclature project of medical services in the Russian Federation showed, that ICHI formed the basis for the development of a new medical services nomenclature, including a section on medical rehabilitation. The basic principles of ICHI (structure by axes: aim, action, means; codes uniqueness; hierarchical method of classification formation) and ICHI fragment associated with purposes for systems and organism functions are presented in the new nomenclature of medical services. It has been established that ICHI can be a basis for developing domestic list of rehabilitation services, the formation of which is planned in the near future.

CONCLUSION

The development of medical services nomenclature in the Russian Federation will significantly increase the availability, funding and effectiveness of medical rehabilitation assistance.

Predictors of Dropout Among Psychosomatic Rehabilitation Patients During the COVID-19 Pandemic: Secondary Analysis of a Longitudinal Study of Digital Training

BACKGROUND

High dropout rates are a common problem reported in web-based studies. Understanding which risk factors interrelate with dropping out from the studies provides the option to prevent dropout by tailoring effective strategies.

OBJECTIVE

This study aims to contribute an understanding of the predictors of web-based study dropout among psychosomatic rehabilitation patients. We investigated whether sociodemographics, voluntary interventions, physical and mental health, digital use for health and rehabilitation, and COVID-19 pandemic-related variables determine study dropout.

METHODS

Patients (N=2155) recruited from 4 psychosomatic rehabilitation clinics in Germany filled in a web-based questionnaire at T1, which was before their rehabilitation stay. Approximately half of the patients (1082/2155, 50.21%) dropped out at T2, which was after the rehabilitation stay, before and during which 3 voluntary digital trainings were provided to them. According to the number of trainings that the patients participated in, they were categorized into a comparison group or 1 of 3 intervention groups. Chi-square tests were performed to examine the differences between dropout patients and retained patients in terms of sociodemographic variables and to compare the dropout rate differences between the comparison and intervention groups. Logistic regression analyses were used to assess what factors were related to study dropout.

RESULTS

The comparison group had the highest dropout rate of 68.4% (173/253) compared with the intervention groups' dropout rates of 47.98% (749/1561), 50% (96/192), and 42.9% (64/149). Patients with a diagnosis of combined anxiety and depressive disorder had the highest dropout rate of 64% (47/74). Younger patients (those aged <50 y) and patients who were less educated were more likely to drop out of the study. Patients who used health-related apps and the internet less were more likely to drop out of the study. Patients who remained in their jobs and patients who were infected by COVID-19 were more likely to drop out of the study.

CONCLUSIONS

This study investigated the predictors of dropout in web-based studies. Different factors such as patient sociodemographics, physical and mental health, digital use, COVID-19 pandemic correlates, and study design can correlate with the dropout rate. For web-based studies with a focus on mental health, it is suggested to consider these possible dropout predictors and take appropriate steps to help patients with a high risk of dropping out overcome difficulties in completing the study.

The Role and Importance of Using Sensor-Based Devices in Medical Rehabilitation: A Literature Review on the New Therapeutic Approaches

Due to the growth of sensor technology, more affordable integrated circuits, and connectivity technologies, the usage of wearable equipment and sensing devices for monitoring physical activities, whether for wellness, sports monitoring, or medical rehabilitation, has exploded. The current literature review was performed between October 2022 and February 2023 using PubMed, Web of Science, and Scopus in accordance with P.R.I.S.M.A. criteria. The screening phase resulted in the exclusion of 69 articles that did not fit the themes developed in all subchapters of the study, 41 articles that dealt exclusively with rehabilitation and orthopaedics, 28 articles whose abstracts were not visible, and 10 articles that dealt exclusively with other sensor-based devices and not medical ones; the inclusion phase resulted in the inclusion of 111 articles. Patients who utilise sensor-based devices have several advantages due to rehabilitating a missing component, which marks the accomplishment of a fundamental goal within the rehabilitation program. As technology moves faster and faster forward, the field of medical rehabilitation has to adapt to the time we live in by using technology and intelligent devices. This means changing every part of rehabilitation and finding the most valuable and helpful gadgets that can be used to regain lost functions, keep people healthy, or prevent diseases.

Impact of a Finnish reform adding new sickness absence checkpoints on rehabilitation and labor market outcomes: an interrupted time series analysis

OBJECTIVES

In 2012, new checkpoints were introduced in the Finnish sickness absence system to improve early detection of long-term work disability and hasten return to work after illness. We examined whether the reform affected participation in rehabilitation and labor market outcomes over a one-year period.

METHODS

We used interrupted time series analysis among persons who started receiving sickness allowance up to three years before and up to two years after the reform. Separate analyses were conducted among those who passed 30, 60, and 90 sickness allowance days. Poisson regression analysis was used, controlling for seasonal variation, gender, age, and educational level.

RESULTS

After the reform, participation in rehabilitation within one year of passing 30 sickness allowance days increased by 5.1% [incidence rate ratio (IRR) 1.051, 95% confidence interval (CI) 1.015-1.086]. The increase after 60 and 90 sickness allowance days was slightly larger. Looking at the type of rehabilitation, vocational rehabilitation from the earnings-related pension scheme increased most. Regarding the rehabilitation provided by the Social Insurance Institution of Finland (Kela), vocational rehabilitation, medical rehabilitation, and discretionary rehabilitation increased, but the increase was statistically significant only in the last case. Post-reform changes in employment, unemployment, sickness absence and disability retirement were negligible.

CONCLUSIONS

The introduction of new sickness absence checkpoints was associated with an increase in participation in rehabilitation but did not affect labor market outcomes one year later. The reform thus was only partially successful in achieving its objectives. Future research should focus on identifying the most effective approaches for utilizing rehabilitation to enhance labor market participation after sickness absence.

A Novel Active Device for Shoulder Rotation Based on Force Control

This article describes a one-degree-of-freedom haptic device that can be applied to perform three different exercises for shoulder rehabilitation. The device is based on a force control architecture and an adaptive speed PI controller. It is a portable equipment that is easy to use for any patient, and was optimized for rehabilitating external rotation movements of the shoulder in patients in whom this was limited by muscle-skeletal injuries. The sample consisted of 12 shoulder rehabilitation sessions with different shoulder pathologies that limited their range of shoulder mobility. The mean and standard deviations of the external rotation of shoulder were 42.91 ± 4.53° for the pre-intervention measurements and 53.88 ± 4.26° for the post-intervention measurement. In addition, patients reported high levels of acceptance of the device. Scores on the SUS questionnaire ranged from 65 to 97.5, with an average score of 82.70 ± 9.21, indicating a high degree of acceptance. The preliminary results suggest that the use of this device and the incorporation of such equipment into rehabilitation services could be of great help for patients in their rehabilitation process and for physiotherapists in applying their therapies.

[Current approaches in the treatment and rehabilitation of patients with neurological diseases after COVID-19. Resolution of the International Experts Forum]

Despite the significant shift in global attention away from the pandemic, the problem of a new coronavirus infection remains important in the medical community. Almost 3 years after the start of the COVID-19 pandemic the issues of rehabilitation and management of delayed manifestations and sequelae of the disease are especially important. According to numerous available data, the new coronavirus infection is characterized by multiorgan lesions. Respiratory dysfunction, clotting disorders, myocardial dysfunction and various arrhythmias, acute coronary syndrome, acute renal failure, GI disorders, hepatocellular damage, hyperglycemia and ketosis, dermatological complications, ophthalmological symptoms and neurological disorders may be found. Significant prevalence of the latter in the post-coronavirus period necessitated this International Expert Forum to develop unified approaches to the management of patients with neurological complications and sequelae of new coronavirus infection based on practical experience and considering the scientific information available on COVID-19. The expert council developed a resolution formulating the tactics for the management of patients with neurological manifestations of COVID-19.

(Randomized controlled trial)]

INTRODUCTION

In order to optimize rehabilitation measures for post-traumatic stress disorder (PTSD) it is advisable to use natural therapeutic factors in the medical rehabilitation programmes of this category of patients, which is due to the pronounced psycho-corrective effects of climatic landscape therapy and nitrogen-thermal waters.

AIM

To study psycho-corrective effects of a new rehabilitation technique for the patients suffering from PTSD using natural therapeutic factors of Nalchik resort.

MATERIAL AND METHODS

Thera has been carried out a randomized controlled trial that included 74 patients with PTSD. Two groups were formed by simple randomization: in the control group (CG/n=38) the patients had standardized pharmacotherapy, physical training and individual psychocorrection in accordance with federal clinical recommendations; in the main group (MG/n=36) terrencourt in the natural park of Nalchik resort and nitrogen-thermal baths were additionally prescribed. The effectiveness of rehabilitation measures was monitored using a questionnaire to assess the therapeutic dynamics of PTSD, the Beck Hopelessness scale, as well as the Neurotech Kolibri wireless BFB complex (Russia).

RESULTS

A comparative analysis of monitoring of psycho-emotional status indicators proved the feasibility of the developed medical rehabilitation programme for PTSD patients. A significant improvement in psychoemotional status was observed according to the questionnaire for assessing the therapeutic dynamics of PTSD (on average by 2 times, p<0.01), according to the Beck hopelessness scale, according to which the clinically assessed suicidal risk and hopelessness level were reduced by 1.7 (p<0.01) times with the patients in the MG. According to the analysis of brain biopotentials during the primary training, the patients had insufficient control over the course of mental activity (63%), and at the end of the course the indicator improved to 97% (p<0.01). In the CG positive dynamics on both scales of psychological testing and analysis of brain biopotentials was significantly lower (by 12-15%, p<0.05-p<0.01).

CONCLUSION

After including in the standardized rehabilitation programme controlled walking in the mid-mountain Natural Park and nitrogen-thermal baths of Nalchik resort, there was a significant improvement in the psycho-emotional status of the patients suffering from PTSD, which indicates their psychocorrective effects and provides great opportunities to improve the effectiveness of medical rehabilitation.

[Medical rehabilitation of patients with spinal muscular atrophy]

Rehabilitation of patients with spinal muscular atrophy (SMA) is a long-term strategy of healthcare service of Russian Federation, which is aimed at slowing down the progression of the pathological process, maximal reduction of disability and improving patients' quality of life. The development of targeted programs of medical rehabilitation for patients with SMA, aimed at the reduction of the disease's main symptoms, is relevant.

OBJECTIVE

To develop and scientifically establish therapeutic effects of complex medical rehabilitation of type II and III SMA patients.

MATERIAL AND METHODS

A prospective comparative study of the therapeutic effects of rehabilitation techniques, including 50 patients aged from 1.3 to 15.3 (average age 7.2±2.4 years) with type II and III SMA (ICD-10: G12), was done. Examined set included 32 patients with type II SMA and 18 patients with type III SMA. In patients of both groups had targeted rehabilitation programs (kinesiotherapy, mechanotherapy, splinting, use of spinal support, electric neurostimulation). Status of patients was determined by functional, instrumental and sociomedical research methods, the results of which were adequate statistically analyzed.

RESULTS

The comprehensive medical rehabilitation of patients with SMA demonstrated significant therapeutic effects with such manifestations as improvement of clinical status, stabilization and increase in joint motion, improvement of motor function of limbs' muscles, head and neck. Medical rehabilitation reduces the degree of disability, increases rehabilitation potential and the need for the technical means of rehabilitation in patients with type II and III SMA. Rehabilitation techniques help to achieve the main aim of rehabilitation - independence in daily living - for 15% of patients with type II SMA and for 22% of patients with type III SMA.

CONCLUSION

Medical rehabilitation of patients with type II and III SMA forms significant locomotor-corrective and vertebral-corrective therapeutic effects.

[Therapeutic effects of medical rehabilitation in patients suffered from coronary heart disease with lower limb amputation]

Disabled persons, who have undergone lower limb amputation (LLA) due to obliterating atherosclerosis, are a special group among patients with coronary heart disease (CHD). In the developed countries, 25-35% of patients was performed high LLA in the first year of critical ischemia, ant the number of interventions is steadily increasing. The development of personalized medical rehabilitation programs (MR) for such patients is relevant.

OBJECTIVE

To scientifically substantiate the therapeutic effects of MR in patients with CHD and LLA.

MATERIAL AND METHODS

The research design was a prospective cohort comparative study of MR therapeutic effects. The research subject was a change of physical activity tolerance (PAT) in patients during the implementation of recommended MR programs. The study object was 102 patients aged from 45 to 74 years. All patients were distributed by the random numbers method. The examined sample of patients was divided into two clusters. The first cluster consisted of 52 patients with CHD and LLA: study group included 1 - 26 patients, who were performed MR (kinesitherapy, manual mechanokinesitherapy, breathing exercises) and comparison group consisted of 1 - 26 patients, who were performed the preparation to prosthetics). The second cluster included 50 patients with CHD (study group consisted of 2 - 25 patients, who were performed MR and pharmacotherapy, and comparison group consisted of 2 - 25 patients, who were performed only pharmacotherapy). Clinical, instrumental and laboratory methods of examination were used in the research, as well as indicators of psychophysiological status and life quality, subjected to adequate statistical analysis.

RESULTS

Dosed physical activities improve clinical and psychophysical statuses, as well as life quality of patients with CHD and LLA, increase contractility and optimize diastolic myocardial function, raise PAT, improve central and intracardial hemodynamics levels, neurohumoral regulation and lipid metabolism. The efficacy of personalized MR programs for patients with CHD and LLA is 88%, and standardized programs is 76%. The determinants of MR efficacy are base PAT values, as well as indicators of myocardial contraction and diastolic function.

CONCLUSION

The MR in patients with CHD and LLA forms obvious cardiotonic, vegetative correcting and lipid lowering healing effects.

[Current approaches to medical-psychological rehabilitation of military personnel of the Russian Federation Armed Forces. (Literature review)]

Improving the medical and psychological rehabilitation system is a priority area for restoring the military personnel's working capacity and combat capabilities after fulfilling special tasks. Changes in the psychoemotional state due to significant psychic and emotional tension can cause mental impairments, which has negative impact not only on military personnel themselves, but also on their combat working capacity. The article presents an overview of forms and methods of medical and medical-psychological rehabilitation used in sanatorium-resort organizations of the Ministry of Defence of the Russian Federation.

[Application of exoskeleton with functional electrostimulation for rebalancing of patients in acute and early recovery periods of ischemic stroke]

Static motor disorders are the main cause of falls and decrease of daily activity in patients after previous ischemic stroke.

OBJECTIVE

To study impact of robotic mechanotherapy with functional electrostimulation (FES) on rebalancing in patients in acute and early recovery periods of ischemic stroke.

MATERIAL AND METHODS

The number of patients equal 60, divided into 2 groups, were examined. Study group included 30 patients, who were treated in an exoskeleton with FES; control group consisted of 30 patients, whose walking and balance recovering was carried out with exercise therapy.

RESULTS

The study group showed a more pronounced improvement of balance indicators by Tinetti scale compared to the control group (11 [8; 13] against 8 [6; 12]; p=0.0281) at the end of treatment. Patients of study group demonstrated significantly better results both by Tinetti scale and stabilometrical parameters in acute period of stroke compared to the control group.

CONCLUSION

Application of exoskeleton with FES in patients in acute and early periods of ischemic stroke contributes (to a better balance recovery), which may be achieved by long-lasting verticalization and large repetition of the correct walking pattern during rehabilitative trainings.

[Medical rehabilitation of children with obstructive uropathy]

Obstructive uropathy in children is predominantly urinary system malformation and one of the leading causes of chronic renal failure. Antenatal ultrasound can detect obstructive uropathy in infants. It is important to conduct diagnostics not only to identify the obstruction level in urinary system, but to assess renal function, renal blood flow and urination. Children are given conservative and surgical treatment methods to restore urodynamics, prevent infectious complications, improve renal blood flow. Currently, there are no principles, approaches and technologies for medical rehabilitation of patients with obstructive uropathy, therefore, the use of selective chromotherapy, which has an activating effect on regional circulation, and sound stimulation improving muscles tone of pelvis and ureters, is pathogenetically reasonable and promising.

OBJECTIVE

To develop technologies of physiotherapy application (sound stimulation, selective chromotherapy) for inclusion in comprehensive medical rehabilitation of children with megaloureter.

MATERIAL AND METHODS

Clinical observations and special examinations have been performed in 90 children with megaloureter aged from 1 to 10 years. The patients were divided into 2 groups: 30 children (study group) received sound stimulation combined with selective chromotherapy; 30 children (the 1st comparison group) - sound stimulation; 30 children (the 2nd comparison group) - selective chromotherapy (blue spectrum). General clinical methods, ultrasound of kidneys and bladder with Doppler monitoring of intrarenal blood flow, functional methods of bladder examination were used.

RESULTS

The positive effects of separate and combined application of sound stimulation and selective chromotherapy on clinical and laboratory indicators, urodynamics of urinary tract and renal blood flow in children with megaloureter after surgery have been revealed. The efficacy of selective chromotherapy use in children with megaloureter and comorbid neurologic bladder dysfunction has been proven.

CONCLUSION

Modern technologies for the application of physiotherapy, namely selective chromotherapy and sound stimulation, to include them in the comprehensive medical rehabilitation of children with megaloureter, have been developed for the first time and their high efficacy has been proven.

[Realization of medical and medical psychological rehabilitation in sanatorium-resort organizations of Ministry of Defence of the Russian Federation]

Current conditions of military service demand higher standards of servicemen health status, whose professional activity in extreme combat conditions is accompanied by the impact of many adverse environmental factors on the body. One of the priority tasks of medical service of Armed Forces of the Russian Federation in 2023 yr. is to improve the system of curative and preventive measures in medical and medical psychological rehabilitation to recover health and increase working capacity of servicemen. The article includes an overview of measures given to servicemen for medical and medical psychological rehabilitation in sanatorium-resort organizations of Ministry of Defence in the Russian Federation for the period from 2013 to 2022 yrs.

[The efficacy of «School of Health: social and psychological rehabilitation of children with renal disease» within the framework of comprehensive medical rehabilitation]

The constantly high incidence of urinary system pathology in children, in which the pyelonephritis plays a leading role, requires to search the new approaches to the comprehensive medical rehabilitation of children, suffering from chronic pyelonephritis.

OBJECTIVE

To evaluate the efficacy of comprehensive medical rehabilitation of children with chronic pyelonephritis, that includes lessons in «School of Health: social and psychological rehabilitation of children with renal disease» (thereafter - «School of Health»).

MATERIAL AND METHODS

A prospective monocentric controlled randomized study has been conducted. The number of children equal 61 with chronic pyelonephritis was under observation. The study group included 32 children (mean age 9.44±0.6 years), who were performed the complex of medical rehabilitation (regimen - sparing; diet - table №1; therapeutic exercises; manual massage of lumbosacral region; sapropel's applications on lumbar region; interferential current therapy by the «AIT-01» apparatus; oxygen cocktail), that included the education in «School of Health». The comparison group consisted of 29 children (mean age was 9.45±0.7 years), who were prescribed similar complex, but without education in «School of Health». The control group included 20 somatically healthy children (mean age was 9.41±0.6 age). Methods of work used in «School of Health» contained: monitoring, questionnaires; problem-oriented education of parents; evaluation of medical and pedagogical activity of family within the framework of comprehensive medical rehabilitation; either group or individual theoretical and practical classes.

RESULTS

It was found, that absolute majority of children had psychological changes (more than 70% of children), unbalance of all capability components (cognitive, emotional, behavioral), low motivational component in addition to clinical and laboratory presentations of chronic pyelonephritis at the initial stage of rehabilitation. There was a positive clinical and laboratory dynamics (reduction of dysuric syndrome, toxidrome), favorable influence of education in «School of Health» to the childrens' psychological condition, affected by comprehensive medical rehabilitation.

CONCLUSION

Comprehensive approach to the medical rehabilitation of children, suffered from chronic pyelonephritis associated with «School of Health» organization leads to stabilization of chronic renal inflammation, psycho-emotional condition of patients, helps to prevent the progression of chronic pyelonephritis.

[The use of botulinum toxin type A in symptomatic therapy and medical rehabilitation of patients with multiple sclerosis]

The review of the current state of the problem of symptomatic therapy and medical rehabilitation (MR) of patients with multiple sclerosis (MS) is presented. The search was conducted in the databases Medline, Web of Science, PubMed and Scopus. Information is given about the most common symptoms of MS, among which sensory and motor disorders, bladder dysfunction, and pain have the greatest impact on the quality of life of patients, their functioning and independence in everyday life. The clinical characteristics of spasticity syndrome in MS and its relationship with quality of life indicators are considered. The features of the use of botulinum therapy (BT) in MS are considered. A high level of effectiveness of the use of BT in the treatment of neurogenic hyperactivity of detrusor and neurogenic bladder (the level of persuasiveness of recommendation A) and spasticity (the level of persuasiveness of recommendation B) is shown. Symptomatic treatment of MS and MR with the use of multidisciplinary programs helps to reduce disability, improve the quality of life of patients. When choosing symptomatic treatment and MR methods, it is customary to focus on the needs of patients.

Rehabilitation of Post-COVID-19 Musculoskeletal Sequelae in Geriatric Patients: A Case Series Study

The musculoskeletal system is affected in over 40% of patients with Coronavirus disease 2019 (COVID-19). There is an increased need for post-acute rehabilitation after COVID-19, especially in elderly people with underlying health problems. The aim of this study was to evaluate the benefits of an early and goal-orientated rehabilitation program using combined approaches, robotic medical devices together with other rehabilitation techniques and therapies, in elderly people after acute COVID-19. Ninety-one patients (62.64 ± 14.21 years) previously diagnosed with severe SARS-CoV-2 infection were admitted to the Medical Rehabilitation Clinical Hospital Baile Felix, Romania, for medical rehabilitation, but only six patients (85.33 ± 3.07 years) met the inclusion criteria and participated in the study. The rehabilitation treatment was complex, performed over 4 weeks, and included combined approaches: exercise therapy, robotic gait training, occupational therapy, and massages. Activity and participation evaluation were performed using the Barthel Index and Functional Independence Measure for activities of daily living (ADLs). Assessments were performed at admission and discharge from the rehabilitation clinic. Lokomat patients' reports revealed that the patients had improved motor control (with one exception). The measurement of functional ability revealed an improvement in most cases. This study presents some of the first data on outcomes of COVID-19 patients' musculoskeletal rehabilitation in our country. Early complex medical rehabilitation improved functional independence and autonomy in ADLs in very old patients, post-COVID-19.

[TOPICAL ISSUES OF MEDICAL REHABILITATION OF PATIENTS WITH THE CONSEQUENCES OF SEVERE TRAUMATIC BRAIN INJURY AT THE MUNICIPAL LEVEL]

The article presents the age-sex structure of people who have suffered severe traumatic brain injury on the example of a municipal medical organization providing medical care and medical rehabilitation in outpatient settings. The high prevalence of this type of injury among males of working age has been established. The duration of temporary disability and the timing of referral of this category of people for medical and social examination are reflected. There is a high level of disability among people who have suffered severe traumatic brain injury, and in most cases they are assigned more severe first and second disability groups. The article reflects the personnel problems of a municipal medical organization providing outpatient medical care in the formation of a multidisciplinary rehabilitation team, which require their resolution at the regional level.

[The medical rehabilitation: planning work load and number of positions]

The article presents the results of analysis of normative legal documents and their changes related to planning of volume of medical care in "medical rehabilitation" profile. The calculation of planned normative number of beds of this profile from 2014 to 2021 is presented according to the number of bed-days and planned beds turnover. The number of arithmetic errors in planned indices of specialized medical care in hospital conditions for medical rehabilitation is demonstrated in the letters of the Minzdrav of Russia related to formation and economic validation of territorial program of state guarantees. So, significant decrease (by 44%) in recommended volumes in 2021 contradicts data presented in the Decree of the Government the Russian Federation. The violations of nomenclatures of positions of medical workers, double standard of the number of positions for day-and-night work are defects of vast majority of Orders about Procedures of provision of medical care that may testify severe problems in actual health planning. At the same time, such changes in Orders on Procedures of organizing medical rehabilitation as division into adults and children, alterations of set of units, staging in provision of medical care and corresponding staff standards, increasing of standard number of positions should result in improvement of quality of medical rehabilitation, including its implementation at early stages and expanding possibilities of rehabilitation without hospitalization related to organization of day hospital.

[The application of the David back concept mechanotherapy in patients survived after myocardium infarction]

The medical rehabilitation in all areas of medicine is developing actively and rapidly. In cardiology, medical rehabilitation contributes to prevention of recurrent myocardial infarction and other complications in patients with myocardial infarction. The study evaluated impact of anaerobic exercise and strength rehabilitation program on hemodynamics in patients with myocardial infarction using the David back concept mechanotherapy method.

Work ability score as predictor of rehabilitation, disability pensions and death? A German cohort study among employees with back pain

BACKGROUND

Sickness absence, disability pensions, and use of healthcare due to disabling back pain are a high economic burden in Germany. Assessment are needed to identify employees who are likely to need intensive support.

OBJECTIVE

The cohort study examined whether rehabilitation, disability pensions and death can be predicted by a simple self-reported rating of work ability in employees with back pain in Germany.

METHODS

Employees aged 45 to 59 years who reported back pain in the last 3 months completed the Work Ability Score in 2017 (0-10 points). Individual scores were categorized into poor (0-5 points), moderate (6-7) and at least good (8-10) work ability. Outcomes were extracted from administrative records covering the period until the end of 2018. Proportional hazard models were fitted to determine the prognostic benefit of the Work Ability Score.

RESULTS

Data for 6,917 participants were included (57.8% women). The median follow-up time was 20 months. Of the participants, 52.1% had a good or excellent, 27.7% a moderate, and 20.2% a poor Work Ability Score. During follow-up, 548 persons were granted rehabilitation measures, 57 persons disability pensions, and 23 died. Fully adjusted analyses showed an increased risk of a rehabilitation measure (hazard ratio = 2.65; 95% CI 2.11; 3.34) and a disability pension (HR = 4.12; 95% CI 2.02; 8.39) in employees with poor work ability. A premature death was not associated with poor work ability.

CONCLUSIONS

The Work Ability Score is a potential tool to identify individuals, reporting back pain, with an increased risk of health-related early retirement and work disability.

[Possibilities of physiotherapy methods for improving the microcirculation of the affected limb in patients with spasticity after acute cerebral circulation during the late recovery period]

The significant prevalence of acute cerebral circulatory disorders, the complexity and persistence of disorders of the functions of the upper and lower extremities, which are accompanied by prolonged and persistent disability, is an important medical and social problem.

OBJECTIVE

Development of optimized programs of medical rehabilitation in patients after acute cerebrovascular accident in the late recovery period.

MATERIAL AND METHODS

The study included 200 patients who suffered acute cerebral circulatory disorders, with increased muscle tone in the lower extremity by the type of spasticity in the late recovery period, who were divided into five groups comparable in clinical and functional characteristics and age: the 1^st group (n=40) - patients who, in addition to the standard complex of therapy and rehabilitation, the same in all five groups and including therapeutic physical culture, medical massage and kinesiotherapy, received low-frequency electrostatic massage, complex multimodal effects from the Alpha-capsule apparatus, training on a multifunctional biofeedback (BFB) platform and training of the stereotype of walking on to the track by the method of imposition; the 2^nd group (n=40) - patients who, in addition to the standard complex, received low-frequency electrostatic massage from the Khivamat apparatus and exposure to broadband modulation currents; the 3^rd group (n=40) - patients who, in addition to the standard complex, received a complex multimodal effect from the Alpha-capsule; the 4^th group (n=40) - patients who, in addition to the standard complex, received training on a multifunctional platform with barefoot and training of the stereotype of walking on the track by the method of imposition; the 5^th group (n=40) - patients who received only a standard complex of therapy and rehabilitation.

RESULTS

At all control points (after the course of treatment, after 6 and 12 months), in addition to general clinical and neurological studies, microcirculation parameters were evaluated by laser Doppler flowmetry. In dynamics, it was revealed that in the 1^st, 2^nd, and 4^th groups there was a significant improvement in microcirculation in the affected limbs, to a lesser extent, this significant improvement in microcirculation was noted in the 3^rd group; in patients of the 5^th group, only a positive trend was noted.

CONCLUSION

Inclusion in the standard rehabilitation complex of low-frequency electrostatic massage, multimodal physiotherapy and training on a multifunctional platform with BFB COBS in combination with walking stereotype training with video instruction using the system with BFB C-Mill in patients who have suffered acute cerebrovascular accident, with motor disorders in the form of hemiparesis with increased muscle tone of the lower extremity in the late recovery period causes a significant improvement in microcirculation in the arteriolar-venular bed of the affected lower extremities, which may underlie the improvement of static-locomotor indicators and contribute to the expansion of the volume of movements in the joints of the lower extremities.

[Implementation of robotic mechanotherapy for movement recovery in patients after stroke]

Lower extremity dysfunction after a stroke can vary from mild to extremely severe and significantly reduce the functional independence of patients. The restoration of walking is one of the key components of rehabilitation, it requires a balanced approach and the participation of a multidisciplinary team. In the last decade, new rehabilitation methods have appeared that meet high safety standards and have a minimum set of contraindications. One of the promising methods is robotic mechanotherapy. The article presents an overview of modern technologies of robotic mechanotherapy, its types and recommendations for use in medical rehabilitation.

[The use of magnetic therapy in the treatment and medical rehabilitation of atopic dermatitis in children and adolescents]

An urgent aspect of scientific research in atopic dermatitis is the development of new complex methods of pathogenetic and symptomatic therapy and alternative treatment options that can effectively relieve exacerbations of the disease and prolong remission between them. As a therapeutic physical factor, magnetotherapy has long been successfully used in medical practice. Promising medical technologies include transcranial application of a traveling variable magnetic field, local low-frequency magnetotherapy, and magnetophoresis. The main tasks of rehabilitation and treatment are aimed at normalizing the state of all organs, the central and autonomic nervous system of the patient, reducing hypersensitivity and itching of atopic skin, as well as normalizing sleep and relieving psycho-emotional stress.

[The use of stability training in rehabilitation programs in patients after total knee replacement in the late recovery period]

All over the world, total joint replacement is one of the most common and popular surgical technology. The frequency of knee replacement is steadily increasing. The development of new rehabilitation technologies for patients after total knee replacement is an urgent problem of modern healthcare.

OBJECTIVE

To evaluate the effect of physical training using a stabiloplatform and a standard scheme of medical rehabilitation on the restoration of the walking stereotype, the state of locomotor function and hemodynamic parameters of the affected lower limb in patients after total knee replacement in the late recovery period.

MATERIAL AND METHODS

60 patients were examined three months after total arthroplasty of the joints of the lower limb aged 55 to 80 years, who were divided into two groups comparable in clinical and functional characteristics: the 1^st group - 30 people, who in addition to the standard scheme of medical rehabilitation, were trained using a stabilometric complex with biofeedback for recovery functions of balance and symmetry of movements; the 2^nd group - 30 people, who have undergone a course of medical rehabilitation (physical therapy and medical massage according to the standard method). The state of the microcirculatory bed in the affected limb was assessed using laser Doppler flowmetry, data on static-locomotor disorders (before and after treatment) were analyzed.

RESULTS

The data obtained indicate the advantage of including physical training aimed at restoring impaired locomotor function, balance and symmetry of movements in the standard scheme of medical rehabilitation of patients after total knee replacement of the lower limb. In the course of the study, it was revealed that training with biofeedback helps to improve the overall capillary blood flow in the affected lower limb and normalize the indicators of static-locomotor functions.

CONCLUSION

The inclusion of physical training to restore static balance and symmetry of movements in the standard complex of medical rehabilitation of patients after total knee replacement in the late recovery period significantly improves microcirculation in the affected limb and normalizes motor functions and skills.

[Possibilities of complex rehabilitation of young children with epilepsy and movement disorders]

Epilepsy is a chronic disease characterized by recurrent, mostly unprovoked seizures with impaired motor, autonomic, mental or mental functions that occur as a result of excessive neuronal discharges in the gray matter of the cerebral cortex. The problem of the activity of medical rehabilitation for epilepsy in the professional community remains debatable, despite the obviousness of the arguments and judgments presented.

PURPOSE OF THE STUDY

Development of an effective and safe complex for the rehabilitation of young children with epilepsy, accompanied by impaired movement function.

MATERIAL AND METHODS

The study included 123 young children (from 9 to 24 months) with epilepsy accompanied by impaired motor function. By the method of simple randomization, all patients were divided into 4 groups: 3 main groups and a comparison group. All children of the study groups, except for the comparison group, received medical rehabilitation: in the 1st group - classical massage with the exception of the cervical-collar zone; in the 2nd group - kinesitherapy according to the method of V. Voigt; in the 3rd group - a complex effect, including classical massage with the exclusion of the neck-collar zone and kinesitherapy according to the method of V. Voigt. Children of the comparison group received basic therapy. The effectiveness of medical rehabilitation was analyzed using the Gross motor function classification system (GMFCS) and the Griffiths intellectual development scale.

RESULTS

Differences in GMFCS scores before and after medical rehabilitation were statistically significant in group 3. In patients with impaired movement function and suffering from epilepsy, the positive dynamics during complex rehabilitation was more pronounced than when using one isolated technique.

CONCLUSION

Complexity in planning and prescribing a course of rehabilitation determines the greatest efficiency in reducing the deficit of physical activity. With an increase in the index of epileptiform activity according to electroencephalography data without any clinical manifestations, it is not required to cancel rehabilitation measures, it is necessary to strengthen control over the patient.

[On the assessment of medical rehabilitation effectiveness in patients with chronic obstructive pulmonary disease in the resort setting]

Despite significant successes of health resort rehabilitation in patients with chronic obstructive pulmonary disease (COPD), the assessment of rehabilitation effectiveness remains challenging for resort physicians in Russia.

OBJECTIVE

To perform a comparative analysis of methods for assessing the medical rehabilitation outcomes in COPD patients in the resort setting.

MATERIAL AND METHODS

The study involved 71 patients with stage I-II COPD, with bronchitis (66.2%) and mixed (COPD + asthma, 33.8%) phenotypes in the clinical remission phase. The mean age of the patients was 57.0±9.8 years, and the mean duration of disease was 7.8±5.1 years. Within 14 days, all patients received an identical set of rehabilitation measures with natural and preformed physical therapeutic resort factors. Before and after the medical rehabilitation course, clinical, laboratory, functional tests and questionnaires were performed on each patient. The effectiveness of course-based complex rehabilitation was assessed using one of three methods: CAT (COPD [chronic obstructive pulmonary disease] Assessment Test), the International Classification of Functioning, Disability and Health (ICF), the COPD control and control stability criteria system.

RESULTS

Comparison of the three methods of assessment of COPD patients' rehabilitation outcomes in resort settings showed that the CAT score is the easiest to use, the least time-consuming, highly valid, and informative. According to the CAT score, the resort medical rehabilitation effectiveness was 96.4%, with «improvement» and «significant improvement» recorded in 82.1% of cases. The use of ICF provides reliable information about the rehabilitation complex effect on the main pathogenetic links of the disease, which allows proper adjusting of rehabilitation procedures to improve effectiveness in the resort setting. Specified grades of ICF domains make it possible to translate qualitative and quantitative attributes inherent to a particular subject into points. The points trend during the medical rehabilitation indicates its effectiveness in terms of recovery of specific functions impaired by the disease. At the same time, the ICF does not allow to rank the medical rehabilitation outcomes in the resort setting in terms of the currently accepted concepts of «significant improvement,» «improvement,» «slight improvement,» «no change,» «deterioration,» which limits its application in resorts. We believe that assessment of rehabilitation outcomes based on COPD control and control stability is not applicable to resort setting due to possible discrepancy between the impression formed in a short time (14 days) about these characteristics of the pathological process and the actual status, as well as due to lack of knowledge about the effect of achieved/not achieved disease control on the choice of rehabilitation technology.

CONCLUSION

A simple and highly informative CAT score can be recommended to assess the effectiveness of resort medical rehabilitation in patients with chronic obstructive pulmonary disease.

[Virtual reality technology in medical rehabilitation of patients with ischemic stroke]

Rehabilitation of patients after an ischemic stroke is a complex and time consuming process that requires coordinated interaction between specialists of different specialisations. Functional outcomes in patients can vary from asymptomatic lesions to complete incapacity and depend on the location of the stroke, premorbid background, the time of initiation of therapy, its duration, and other factors. Goals of medical rehabilitation include not only motor rehabilitation, but also the restoration of cognitive, affective, visual, speech and many other disorders. The development of rehabilitation methods that have a minimum number of contraindications or no contraindications remains relevant. One of the promising methods that complement traditional rehabilitation is virtual reality technology. The article describes modern technologies of virtual reality and methods of their application in medical rehabilitation.

[General magnet therapy and low-frequency electrostatic field in the postoperative period in patients with breast cancer]

The high prevalence of breast cancer and the high complication rate of combined radical treatment make the issue of medical rehabilitation using physical factors in patients after surgery highly relevant and warrant the need to determine the contribution of individual factors.

OBJECTIVE

To compare the efficacy of general magnetic therapy and low-frequency electrostatic field on days 2-4 after the radical surgical treatment of breast cancer and 1.0-1.5 months after radiation therapy in combination with therapeutic physical training, motor-cognitive training, and sessions with a psychologist.

MATERIALS AND METHODS

Examination and medical rehabilitation of 131 patients after radical surgical treatment of breast cancer were performed. Age ranged from 30 to 75 years. Group 1 included 66 patients who received medical rehabilitation on days 2-4 after the surgery and 1.0-1.5 months later in addition to adjuvant radiotherapy; Group 2 included 65 patients who received medical rehabilitation only after 1.0-1.5 months in addition to adjuvant radiotherapy.

RESULTS AND CONCLUSION

It was shown that two courses of medical rehabilitation with the addition of physiotherapeutic treatment on days 2-4 and 1.0-1.5 months after radical breast cancer surgery in addition to radiation therapy contribute to a significant reduction of functional disorders severity in patients versus initiation of medical rehabilitation 1.0-1.5 months after the surgery in addition to radiation therapy. The feasibility of including general magnetic therapy procedures and low-frequency electrostatic field exposure in the medical rehabilitation course was demonstrated as it results in pain relief, postoperative edema reduction, and quicker recovery of the shoulder joint mobility that promotes long-term clinical benefit.

[Medical rehabilitation for children with scoliosis]

The article presents a literature review on the prevalence, relevance, social significance, and principles of medical rehabilitation of children with different types of scoliosis in scoliotic disease. The current classification, diagnostics features, and clinical course of the disease are addressed. Current approaches to the choice of medical rehabilitation methods for scoliotic disease in children are described: therapeutic exercise, hydrokinesiotherapy, massage, physiotherapeutic treatment, kinesiotaping, and corseting. Special consideration is given to postoperative management and stages of medical rehabilitation of children with scoliosis, including resort treatment.

[Effectiveness of physical therapy after total hip arthroplasty at the third stage of rehabilitation using a telemedicine program]

OBJECTIVE

To assess the quality of life and efficacy of telemedicine technologies for rehabilitation after total hip replacement.

MATERIAL AND METHODS

The study included 60 patients aged 40-75 years after total hip replacement. All patients were divided into two groups by simple randomization. All patients underwent a 7-day course of complex in-hospital postoperative rehabilitation. At discharge, patients of the main group received an access to telemedicine program for 3-month physical exercises (3 times a week for 30 minutes). In the control group, patients received routine recommendations for rehabilitation procedures and orthopedic recommendations.

RESULTS

A course of rehabilitation with telemedicine technologies after total hip replacement was accompanied by significant clinical effect according to EQ5D, SF-36 and STAI questionnaires.

CONCLUSION. T

Elemedicine technologies in postoperative rehabilitation after total hip replacement are accompanied by QoL improvement. It is an effective form of medical rehabilitation.

[Medical rehabilitation in patients with anal incompetence after surgery for stage IV hemorrhoids]

The choice of medical rehabilitation in patients with anal incontinence is impossible without diagnostic data revealing the mechanism of fecal incontinence. The most promising are programs of comprehensive physiotherapeutic rehabilitation based on biofeedback training. The rate of anal incompetence (AI) after hemorrhoidectomy is 1.3-12.5%. However, in addition to the organic cause (surgical trauma), functional disorders of the external sphincter and pelvic floor muscles may contribute to the pathogenesis of anal incontinence, aggravating the incontinence symptoms after surgery. Therefore, these functional disorders should be diagnosed before surgery. However, medical rehabilitation programs for anal incontinence after hemorrhoidectomy are not standardized, and functional outcomes have not been studied.

OBJECTIVE

To evaluate the outcomes of comprehensive rehabilitation in patients with AI after hemorrhoidectomy to improve quality of life after surgery.

MATERIALS AND METHODS

A retrospective study was carried out on 46 patients (mean age 53.8±15.4 years) after hemorrhoidectomy with fecal incontinence, 13 (28.3%) males and 33 (71.7%) females. The main group included 25 patients who received comprehensive rehabilitation, including biofeedback training and tibial neuromodulation (TNM) for 15 days. The control group consisted of 21 patients who received TNM at home also for 15 days. The severity of fecal incontinence was determined using the Wexner score. The functional state of the sphincter before and after surgery was assessed using the anorectal manometry (sphincterometry) (WPM Solar, the Netherlands).

RESULTS

Comprehensive rehabilitation resulted in a statistically significant clinical improvement: a decrease in the Wexner score in both males and females. No significant differences in manometry results were observed: the anal sphincter tone increased by 16.0% in females and 10.6% in males, and contractility increased by 17.7% and 15.1%, respectively. Monotherapy with TNM in control group patients improved tone indices by 8.7% in females and 6.8% in males, and contractility by 6.2 and 5.4%, respectively, which was lower than in the main group.

CONCLUSION

Contraindications to physiotherapeutic procedures based on electrical stimulation, extracorporeal magnetic stimulation, and magnetic translumbosacral neuromodulation determine the only possible choice of medical rehabilitation, which is the combination of biofeedback training and TNM (as superior to TNM monotherapy). If out-patient medical rehabilitation is not feasible, patients are recommended to complement the home course with a specially designed set of exercises for anal incontinence treatment.

[Comprehensive medical rehabilitation using therapeutic physical factors including hydrokinesiotherapy in a pool with mineral water and its effect on circadian rhythms of arterial pressure and autonomic regulation in patients with arterial hypertension and with chronic psychoemotional stress]

OBJECTIVE

To study the effect of the course-based comprehensive rehabilitation using the therapeutic physical factors of the Belokurikha resort, including hydrokinesiotherapy in a pool with mineral water on the circadian rhythms of arterial pressure and its autonomous regulation in patients with arterial hypertension (AH) associated with chronic psychoemotional stress (CPES).

MATERIAL AND METHODS

The study involved 83 patients with stage I-II grade 1-2 of AH, whose professional activities were associated with CPES. Each participant had 24-hours Holter blood pressure monitored, and cardiointervalography (CIG) was performed before and after the medical rehabilitation course. The rehabilitation complex of the main group (II) included medication therapy for AH, diet, morning hygienic gymnastics, manual massage, total magnet therapy, and hydrokinesiotherapy in a pool with mineral water. Patients in the comparison group (I) were exposed to similar therapeutic physical factors with identical parameters of the procedures, except hydrokinesiotherapy, which was replaced by full baths with mineral water.

RESULTS

Medical rehabilitation using the therapeutic physical factors of the Belokurikha resort with hydrokinesiotherapy in a pool promotes a decrease in the activity of a sympathetic nervous system and increase of vagal effects contribute to the regulation of vital functions of the AH patients, associated with CPES, thus minimizing the frequency of abnormal daily profiles night-peaker and over-dipper to 12.5% and 1.78% of cases, respectively, and increasing the percentage of subjects with its normal type (dipper) to 57.1% (p=0.039).

CONCLUSION

The study results show the benefits of hydrokinesiotherapy in a pool with mineral water as a part of the course-based comprehensive rehabilitation in patients with hypertension and chronic psychoemotional stress in terms of normalizing circadian rhythms of arterial pressure and optimizing the activity of higher autonomous centers, which largely determine the cardiovascular system performance in this setting.

[Natural therapeutic factors in medical rehabilitation of patients with post-COVID syndrome]

The feasibility of using therapeutic physical factors in post-COVID syndrome is due to their sanogenetic effects that ensure the restoration of impaired bodily functions, which serves as the basis for their use at various stages of medical rehabilitation of this category of patients.

OBJECTIVE

To develop a new medical technology for the 3^rd outpatient stage of medical rehabilitation of the patients with post-COVID syndrome using natural therapeutic factors of Nalchik resort.

MATERIAL AND METHODS

There has been carried out a controlled study in compliance with the principles of randomization to develop an outpatient medical rehabilitation program including 168 patients with post-COVID syndrome. All the patients were divided into four groups: the control group (n=40) was prescribed pharmacotherapy and physical therapy in the hall in accordance with federal clinical recommendations; comparison group 1 (n=43) had drinking mineral water in addition; comparison group 2 (n=43) received physical therapy on the route of Nalchik resort terrainkur in addition to the treatment in comparison group 1; the main group (n=42) included a group psychotherapy on the Terrainkur route in addition to the treatment in comparison group 2.

RESULTS

The results of the comparative analysis showed the feasibility of the developed outpatient medical rehabilitation program for the patients suffering from post-COVID syndrome: the overall effectiveness of rehabilitation measures increased compared to other follow-up groups by 10-15% due to the improvement of external breathing function (p<0.05), cognitive status (p<0.01), increased exercise tolerance (p<0.01), physical recovery (p<0.01) and mental health (p<0.01).

CONCLUSION

The summation and integration of sanogenetic effects of physical factors, psychocorrective techniques, and pharmacotherapy provide a significant improvement in the physical and mental status of the patients with post-COVID syndrome.

[Topical issues of rehabilitation of patients with osteoporotic vertebral fractures]

The literature review analyzed 20 Russian and 69 foreign publications on the rehabilitation of elderly patients with osteoporotic vertebral fractures. The article deals in detail with the prevalence, medical and social significance of pathological osteoporotic fractures, including vertebral deformities. The data confirming the importance of osteoporosis for physical and rehabilitation medicine specialists are presented. Changes in the quality of life, functional and gate disorders associated with osteoporotic vertebral fractures are described. Based on the available literature data, the principles of rehabilitation of patients with osteoporotic vertebral compression fractures are formulated, including the effectiveness of various methods of physical therapy, mechanotherapy and apparatus physiotherapy. From the standpoint of evidence-based medicine, the role of orthotics in the complex rehabilitation of such patients is described. Based on the analysis of literature data, it was concluded that the problem of osteoporosis is relevant for physicians working in the field of rehabilitation medicine; osteoporotic vertebral fractures are characterized by a high prevalence over the age of 50 years and are associated with a decrease in the quality of life, motor and functional limitations, and an increased risk of death, and well-planned medical rehabilitation programs including physical exercises, physiotherapy and orthotics can significantly improve patient functionality.

[Innovative technologies and multimodal correction in medical rehabilitation of motor and neuropsychological disturbances due to stroke]

The article presents an overview of innovative technologies based on the methods of sensorimotor retraining of the patient using various types of biofeedback (BFB) as the most promising in the medical rehabilitation (MR) of patients with cerebral stroke (CS). The works of a high level of evidence (RCTs, national and international clinical guidelines, meta-analyses, systematic reviews) of the Medline, Pubmed, PubMed Cochrane Library databases are analyzed, ClinicalTrials.gov. It is emphasized that training with multisensory effects on visual, auditory, vestibular and kinesthetic analyzers have a beneficial effect on cognitive-motor training and retraining, neuropsychological status of the patient and increase the level of motivation to achieve success in the rehabilitation process. The synergy of multimodal effects of digital technologies, BFB, virtual reality, and the brain-computer interface will expand the capabilities and improve the efficiency of MR of after stroke-patients.

[Improvement of the early diagnostic system and complex treatment elderly aged victims with severe traumatic brain injury of postoperative infectious - inflammatory complications.]

Improve the system of early diagnostic and complex treatment of postoperative infectious - inflammatory complications in victims of elderly ages with severe cranial injury. Medical institutions of Saint-Petersburg provided examination and treatment to 94 victims of elderly ages who were operated due to severe cranial injury. Examinations to identify inflammatory complications were provided from the body temperature rising and included laboratory tests, ultrasonography, X-Rays, Computer Tomography. The complex measures taken allowed to reduce severity and duration of postoperative inflammatory complications, cut the average bed-day hospital treatment from 42±6 days to 33±5 days in victims located in the neurosurgery department. Probability of infectious - inflammatory pulmonary complications development increases regardless of age. At the same time inflammatory urine tract complications most often occur among elderly age men who suffer from prostate hyperplasia and malfunction of the urination process after a long time of using intraurethral catheters. Early complex diagnostic examination allows the timely diagnosis of postoperative complications, and to begin the adequate treatment of victims.

Adherence With Online Therapy vs Face-to-Face Therapy and With Online Therapy vs Care as Usual: Secondary Analysis of Two Randomized Controlled Trials

BACKGROUND

Adherence to internet-delivered interventions targeting mental health such as online psychotherapeutic aftercare is important for the intervention's impact. High dropout rates limit the impact and generalizability of findings. Baseline differences may be putting patients at risk for dropping out, making comparisons between online with face-to-face (F2F) therapy and care as usual (CAU) necessary to examine.

OBJECTIVE

This study investigated adherence to online, F2F, and CAU interventions as well as study dropout among these groups and the subjective evaluation of the therapeutic relationship. Sociodemographic, social-cognitive, and health-related variables were considered.

METHODS

In a randomized controlled trial, 6023 patients were recruited, and 300 completed the baseline measures (T1), 144 completed T2 (retention 44%-52%), and 95 completed T3 (retention 24%-36%). Sociodemographic variables (eg, age, gender, marital status, educational level), social-cognitive determinants (eg, self-efficacy, social support), health-related variables (eg, depressiveness), and expectation towards the treatment for patients assigned to online or F2F were measured at T1.

RESULTS

There were no significant differences between the groups regarding dropout rates (χ²₁=0.02-1.06, P≥.30). Regarding adherence to the treatment condition, the online group outperformed the F2F and CAU conditions (P≤.01), indicating that patients randomized into the F2F and CAU control groups were much more likely to show nonadherent behavior in comparison with the online therapy groups. Within study groups, gender differences were significant only in the CAU group at T2, with women being more likely to drop out. At T3, age and marital status were also only significant in the CAU group. Patients in the online therapy group were significantly more satisfied with their treatment than patients in the F2F group (P=.02; Eta²=.09). Relationship satisfaction and success satisfaction were equally high (P>.30; Eta²=.02). Combining all study groups, patients who reported lower depressiveness scores at T1 (T2: odds ratio [OR] 0.55, 95% CI 0.35-0.87; T3: OR 0.56, 95% CI 0.37-0.92) were more likely to be retained, and patients who had higher self-efficacy (T2: OR 0.57, 95% CI 0.37-0.89; T3: OR 0.52, 95% CI 0.32-0.85) were more likely to drop out at T2 and T3. Additionally, at T3, the lower social support that patients reported was related to a higher likelihood of remaining in the study (OR 0.68, 95% CI 0.48-0.96). Comparing the 3 intervention groups, positive expectation was significantly related with questionnaire completion at T2 and T3 after controlling for other variables (T2: OR 1.64, 95% CI 1.08-2.50; T3: OR 1.59, 95% CI 1.01-2.51).

CONCLUSIONS

While online interventions have many advantages over F2F variants such as saving time and effort to commute to F2F therapy, they also create difficulties for therapists and hinder their ability to adequately react to patients' challenges. Accordingly, patient characteristics that might put them at risk for dropping out or not adhering to the treatment plan should be considered in future research and practice. Online aftercare, as described in this research, should be provided more often to medical rehabilitation patients.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04989842; https://clinicaltrials.gov/ct2/show/NCT04989842.

[Application of the ICF in assessing the effectiveness of magnetotherapy in patients with viral pneumonia associated with COVID-19]

The number of patients who have had pneumonia caused by COVID-19 is increasing every month. However, despite the ongoing treatment, the consequences of this disease are possible, which may appear in the short term or after a while. Pneumonia associated by the new coronavirus infection COVID-19 is characterized by the presence of such complications as cough, shortness of breath, fatigue, sleep disturbances, appetite disorders, etc. Often, pneumonia leads to dysfunctions of the respiratory system, higher mental functions, functions of the cardiovascular system and, unfortunately, possible disability. The search and implementation of new methods of physical rehabilitation is an urgent task of modern medicine. Low-frequency magnetotherapy is one of the safest and most commonly recommended treatments for pneumonia. The development of new methods of medical rehabilitation for patients with pneumonia associated with COVID-19, using physical factors such as low-frequency magnetotherapy, laser therapy is one of the leading fields. Magnetotherapy is included in the recommendations of the Ministry of Health of the Russian Federation for the purpose of anti-inflammatory, decongestant, reparative-regenerative action; improvement of microcirculation, acceleration of the resorption of infiltrative changes (Temporary methodological recommendations «Medical rehabilitation for a new coronavirus infection (COVID-19)», version 2 of 31.07.2020). International rehabilitation practice of using the International Classification of Functioning, Disability and Health (ICF) advises to use it as a tool that allows you to objectively determine the state of health of patients, determine the prognosis of impaired functions and evaluate the effectiveness of ongoing rehabilitation measures.

OBJECTIVE

To assess the effectiveness of the use of low-frequency magnetotherapy in the complex medical rehabilitation of patients who have had pneumonia in the phase of convalescence according to the International Classification of Functioning, Disability and Health.

MATERIAL AND METHODS

The study included 200 patients who had suffered from pneumonia associating by COVID-19 and whose average age was 54.3±5.8 years. 1^st (main) group (n=100), against the background of standard therapy on the 16th day after discharge from the hospital, received low-frequency magnetotherapy on the ALMAG-02 apparatus («Elamed», Russia) daily for 10-20 minutes, a course of 15 procedures. The 2^nd group(control) included 100 patients who underwent low-frequency placebo-magnetotherapy on the ALMAG-02 apparatus («Elamed», Russia). In order to assess the dynamics of clinical and laboratory data and the effectiveness of treatment, control methods were used in this study in accordance with the Temporary Clinical Recommendations of the Ministry of Health of the Russian Federation. Each patient was evaluated for the severity of the initial manifestations of respiratory failure using the mMRC scale (Degree of Shortness of breath) and the Borg scale, and the quality of life of patients was assessed on the EQ-5D scale. Also, at the time of inclusion in the study and during the control examination after the completion of prospective follow-up, the Individual profile of patients was determined in accordance with the international classification of functioning (ICF) with the data of the «Individual Registration Card of the clinical trial participant».

RESULTS AND DISCUSSION

In 43% (43 people) of patients of the 1th group, an improvement in respiration functions was noted with lung auscultation and with spirometry, an increase in the vital capacity of the lungs by 28.2% (p=0.0021), an increase in chest excursion by 53.1% (p=0.0019) a decrease in the level of shortness of breath by 50% and Borg by 33.3% (p=0.0016). According to the data of the quality of life questionnaire (EQ-5D), the patients of the main group showed an improvement in the quality of life by 23% (p=0.0019). In the 1^st group of patients, there was a decrease in moderate disorders in the domains «b152 - emotion functions» in 45% of patients; «b440 - respiratory functions» in 87% of patients; «b455 - exercise tolerance functions» in 74% of patients; «b134 - sleep functions» in 30% of patients; «d450 - walking» in 100% of patients. In the general blood analysis of patients of the 1^st (main) group, there was a relief of leukocytosis, normalization of the erythrocyte sedimentation rate (ESR). In the 1^st group a decrease in the duration of being on the sick list was observed for 3.4±0.2 days.

CONCLUSION

The inclusion of low-frequency magnetic therapy in the complex rehabilitation of patients who have suffered pneumonia associated by COVID-19 contributes to improving the function of external respiration of patients, regression of residual infiltrative changes in the lungs after pneumonia, relief of residual manifestations of the inflammatory process, reducing the duration of the rehabilitation period and the duration of disability, improving the general well-being of patients, increasing tolerance to physical exertion, normalization of the psycho-emotional state and, as a result,, restoring activity in everyday life and improving the quality of life of patients. The researchers did not register any side effects and side effects of magnetic therapy from ALMAG-02 apparatus (Elamed, Russia).

[Therapeutic effects of mirror therapy in patients after stroke]

Impaired function of the upper extremity after a stroke is a common cause of persistent disability and decreased social activity. Mirror therapy is an effective method for correcting hand function after a stroke. This method triggers neuroplasticity and can accelerate the recovery of functions after a wide range of neurological disorders.

OBJECTIVE

To evaluate the effect of mirror therapy on the regression of motor disorders in the paretic arm, functional and psychological disorders, the patient's functioning and quality of life, risk factors for recurrent stroke in the early recovery period of stroke.

MATERIAL AND METHODS

We examined 219 patients after stroke, including 154 patients after ischemic stroke (IS) and 65 patients after hemorrhagic stroke (HS) in the early recovery period (21 days to 6 months). All patients received a standard medical rehabilitation course including medications, physical rehabilitation, and physiotherapeutic treatment. Patients were divided into four groups depending on the stroke type and the medical rehabilitation course received: two study treatment groups (post-IS and post-HS groups), which consisted of patients receiving the standard medical rehabilitation course and mirror therapy, and two comparison groups (post-IS and post-HS), in which patients received only the standard medical rehabilitation course. All patients before and after the medical rehabilitation course were evaluated for neurological disorders (NIHSS, Ashworth scale of muscle spasticity, Medical Research Council (MRC) Scale and handgrip test), functional limitations (Frenchay Arm Test, Hauser Ambulation Index, Rivermead Mobility Index, Functional Independence Measure (FIM), ICF), mental status («Visual Memory» and «10 Word Memory» methods, Schulte-Platonoff tables, Lüscher color test, Hospital Anxiety and Depression Scale (HADS), Locus of Control Recovery Questionnaire), quality of life (EQ-5D), arterial hypertension (Arterial Hypertension in Adults. Clinical Guidelines, 2020).

RESULTS

Addition of the mirror therapy to the standard course provided additional therapeutic effects: in patients with IS, the high tone of the paretic muscles of the arm significantly decreased (by 46%); the target blood pressure was achieved in 96% of patients; severe disorders of functional independence and depression regressed; significant changes of mental functions parameters (visual memory, shifting attention); improvement of activity and participation parameters (carrying in the hands, self-care, housekeeping). In patients with HS, the muscle strength of the paretic arm significantly increased (by 35%); the target blood pressure was achieved in all patients; improvement of mental functions (motivation, shifting attention, visual memory), activity and participation parameters (objects moving and manipulation, self-care), and decreased level of depression were observed.

CONCLUSION

The addition of mirror therapy to the standard of care for patients after stroke resulted in regression of neurological deficit, motor disorders in the paretic arm, improvement of emotions and motivation, mitigation of recurrent stroke risk factors, as well as significant impact on the cognitive functions and enhancement of patients' capabilities of self-care.

Psychosomatic Rehabilitation Patients and the General Population During COVID-19: Online Cross-sectional and Longitudinal Study of Digital Trainings and Rehabilitation Effects

BACKGROUND

The COVID-19 pandemic has largely affected people's mental health and psychological well-being. Specifically, individuals with a pre-existing mental health disorder seem more impaired by lockdown measures posing as major stress factors. Medical rehabilitation treatment can help people cope with these stressors. The internet and digital apps provide a platform to contribute to regular treatment and to conduct research on this topic.

OBJECTIVE

Making use of internet-based assessments, this study investigated individuals from the general population and patients from medical, psychosomatic rehabilitation clinics. Levels of depression, anxiety, loneliness, and perceived stress during the COVID-19 pandemic, common COVID-19-related worries, and the intention to use digital apps were compared. Furthermore, we investigated whether participating in internet-delivered digital trainings prior to and during patients' rehabilitation stay, as well as the perceived usefulness of digital trainings, were associated with improved mental health after rehabilitation.

METHODS

A large-scale, online, cross-sectional study was conducted among a study sample taken from the general population (N=1812) in Germany from May 2020 to April 2021. Further, a longitudinal study was conducted making use of the internet among a second study sample of psychosomatic rehabilitation patients at two measurement time points-before (N=1719) and after (n=738) rehabilitation-between July 2020 and April 2021. Validated questionnaires and adapted items were used to assess mental health and COVID-19-related worries. Digital trainings were evaluated. Propensity score matching, multivariate analyses of covariance, an exploratory factor analysis, and hierarchical regression analyses were performed.

RESULTS

Patients from the psychosomatic rehabilitation clinics reported increased symptoms with regard to depression, anxiety, loneliness, and stress (F_4,2028=183.74, P<.001, η²_p=0.27) compared to the general population. Patients perceived greater satisfaction in communication with health care professionals (F_1,837=31.67, P<.001, η²_p=0.04), had lower financial worries (F_1,837=38.96, P<.001, η²_p=0.04), but had higher household-related worries (F_1,837=5.34, P=.02, η²_p=0.01) compared to the general population. Symptoms of depression, anxiety, loneliness, and perceived stress were lower postrehabilitation (F_1,712=23.21, P<.001, η²_p=0.04) than prior to rehabilitation. Psychosomatic patients reported a higher intention to use common apps and digital trainings (F_3,2021=51.41, P<.001, η²_p=0.07) than the general population. With regard to digital trainings offered prior to and during the rehabilitation stay, the perceived usefulness of digital trainings on rehabilitation goals was associated with decreased symptoms of depression (β=-.14, P<.001), anxiety (β=-.12, P<.001), loneliness (β=-.18, P<.001), and stress postrehabilitation (β=-.19, P<.001). Participation in digital group therapy for depression was associated with an overall change in depression (F_1,725=4.82, P=.03, η²_p=0.01) and anxiety (F_1,725=6.22, P=.01, η²_p=0.01) from pre- to postrehabilitation.

CONCLUSIONS

This study validated the increased mental health constraints of psychosomatic rehabilitation patients in comparison to the general population and the effects of rehabilitation treatment. Digital rehabilitation components are promising tools that could prepare patients for their rehabilitation stay, could integrate well with face-to-face therapy during rehabilitation treatment, and could support aftercare.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04453475; https://clinicaltrials.gov/ct2/show/NCT04453475 and ClinicalTrials.gov NCT03855735; https://clinicaltrials.gov/ct2/show/NCT03855735.

Reduced requests for medical rehabilitation due to the SARS-CoV-2 pandemic: a difference-in-differences analysis

Objective

To examine the extent to which medical rehabilitation requests decreased because of the pandemic in Germany.

Design

Data were retrieved from the German Pension Insurance, which is the main provider for rehabilitation of working-age people in Germany. Our data represented all medical rehabilitation requests in 2019 and 2020. These requests have to be approved to use a rehabilitation program. We used a difference-in-differences model to determine the reduction in rehabilitation requests attributable to the pandemic.

Setting

General community.

Participants

We included 1,621,840 rehabilitation requests from working-age people across Germany in 2019 and 1,391,642 rehabilitation requests in 2020 (N=3,013,482).

Intervention

Medical rehabilitation in inpatient or outpatient facilities.

Main Outcome Measures

Number of medical rehabilitation requests.

Results

The number of medical rehabilitation requests decreased by 14.5% because of the pandemic (incidence rate ratio, 0.855; 95% confidence interval, 0.851-0.859). The decline in requests was more pronounced among women and in Western Germany than among men and in Eastern Germany. The reduction in requests affected non-postacute rehabilitations more clearly than postacute rehabilitation services. After the pandemic declaration by the German Bundestag in March 2020, the reduction in requests was initially strongly associated with the regional incidence of infection. This association weakened in the following months.

Conclusions

The reduction in requests will have a significant effect on the number of completed rehabilitation services. For many people with chronic diseases, failure to provide medical rehabilitation increases the risk of disease progression.

[Current issues of treatment and rehabilitation of patients with neurological disorders and the consequences of COVID-19. Resolution of Advisory Board]

Last year the global medical community faced the pandemic of the new coronavirus infection caused by SARS-CoV-2. To date, there is considerable expert experience, which indicates that the brain, along with the corresponding respiratory system, is a target organ for a new coronavirus infection. Moreover, a number of symptoms from the central and peripheral nervous system can persist for several weeks, months, and even tens of months. To designate such protracted clinical conditions, a new definition was introduced: «Post-COVID-19 Condition». Advisory Board of Neurologists and Rehabilitation Therapists met to, discuss of practical experience and taking into account scientific information about COVID-19, which was available at the time of the meeting, to develop unified approaches for the management of patients with neurological complications and the consequences of a new coronavirus infection. The Advisory Board worked out a resolution in which formulated the tactics of managing patients with neurological manifestations of COVID-19. The substantiation of the importance and expediency of the development and implementation of a special program of clinical examination of patients who have undergone COVID-19, which would include a clinical examination with a detailed assessment of cognitive functions to early identification and diagnosis of neurodegeneration and subsequent therapy, is given.

[Medical rehabilitation of children with bronchial asthma]

Medical rehabilitation of children suffering from bronchial asthma is based on the complex use of natural therapeutic factors, drug, non-drug therapy and other methods in order to achieve control over the disease and long-term remission. The use of non-drug technologies is necessary taking into account the pathogenesis of the bronchial asthma development and is aimed at relieving bronchospasm, reducing the activity of allergic inflammation in the bronchi, improving their drainage function, strengthening the respiratory muscles and increasing exercise tolerance. When carrying out rehabilitation measures it is important to observe the basic principles of medical rehabilitation. An individual medical rehabilitation program is drawn up taking into account the assessment of the child's clinical condition at each stage with the diagnosis of the initial rehabilitation status, the establishment of a rehabilitation diagnosis and an assessment of the rehabilitation potential. The article presents the data of the analysis of scientific publications and our own research allowing to draw up an algorithm for the formation of an individual program of medical rehabilitation for children with bronchial asthma.

[The relevance of the diagnosis, treatment and prevention of osteoporosis for the clinical practice of doctors working in the field of rehabilitation and spa medicine]

There is a high prevalence of osteoporosis (OP) among patients of the older age undergoing rehabilitation. Therefore, it is obvious that physicians working in the field of physical and rehabilitative medicine should be well oriented in this medical problem.

OBJECTIVE

To study the relevance of the OP problem for physicians working in the field of physical and rehabilitation medicine, their awareness of the main methods of diagnosis, treatment and prevention of OP, as well as the frequency of using these methods in daily clinical practice.

MATERIAL AND METHODS

A cross-type study was carried out using a questionnaire survey. The study included 157 doctors (male 34, female 123) of 8 medical specialties working in 27 specialized medical institutions on the profile of «medical rehabilitation» or «spa treatment». The questionnaire for doctors consisted of 21 items of special questions.

RESULTS

90.45% of doctors considered the problem of OP is relevant for their clinical activities, 100% of respondents indicated that the presence of OP significantly affects the rehabilitation prognosis, 95.54% - the effectiveness of medical rehabilitation. According to the respondents the patients with OP cover 30.0% of total patients flow on average. 145 (92.36%) doctors noted that they know the OP risk factors, 155 (98.73%) - methods for OP diagnosing, 108 (68.79%) - methods for OP treatment, 126 (80, 25%) - methods for OP prevention, 74 (47.13%) - FRAX. 55 (35.01%) respondents identified their level of awareness on the OP problem as sufficient for managing patients with this pathology. Diagnostic procedures for OP were recommended by all interviewed endocrinologists (100%), most of traumatologists-orthopedists (72.73%), obstetricians-gynecologists (66.67%) and cardiologists (64.28%), as well as on average 1/2 (50%) neurologists and therapists. OP treatment was mainly performed by endocrinologists (100%), obstetricians-gynecologists (66.67%) and therapists (60%). 32.48% of physicians in the study sample have ever referred their patients to a densitometry and the diagnosis of OP was established in 80.25% of cases on the basis of bone densitometry data.

CONCLUSION

The problem of OP is relevant for the clinical practice of doctors working in the field of rehabilitation and balneology medicine; the presence of OP significantly affects the prognosis and effectiveness of medical rehabilitation. The results of the study demonstrated the need to expand the availability of OP diagnostics methods in rehabilitation and balneology organizations, as well as the need to raise awareness of the OP problem among specialists working in this area.

[Rehabilitation problems in Top Rated Databases]

Development of medical rehabilitation technologies are the investments into «human capital». The effectiveness criterion of the scientific institutions work dealing with the problems of rehabilitation is the scientific publication activity of their employees in this subject in high-ranking international databases (DB).

Purpose of the study. Analysis of the state of the scientific publication flow in the field of rehabilitation.

MATERIAL AND METHODS

Data from the Web of Science and Scopus databases for November 2019, depth from 1991 to 2018 were used.

RESULTS

It was revealed that the high level of the publication rating of Russia, which was noted in 1991-1992, has not yet been achieved in the Scopus database for medical rehabilitation. Measures have been identified to enhance it by increasing the growth rate of the Russian publication flow. It also noted the necessity to reduce Russia's dependence on the monopoly of foreign publishing corporations by creating domestic Russian resources and borrowing the experience of foreign colleagues.

CONCLUSION

The necessary measures should be taken at the level of authors, scientific organizations, the scientific community and the State in order to increase the Russian scientific publication flow in the direction of «Rehabilitation» in foreign top-rated databases. Authors of interdisciplinary articles need to correctly present metadata indicating the relation of the work to the problem of rehabilitation. The necessity is substantiated not only to increase the share of Russian scientific journals in international databases, but also to create domestic high-rating databases, as well as to harmonize the existing regulatory legal acts in regards of terms and definitions in the field of rehabilitation, to bring the headings of the Universal Decimal Classification aligned with the headings of high-ranking international databases. Given the high social significance of the «Rehabilitation» area, it is necessary to include it in the priority list and funded areas at a level corresponding to global trends.

[Effectiveness evaluation of the psychological support inclusion in the correction of pain syndrome in patients with movement disorders at the stage of medical rehabilitation using the virtual reality technology]

OBJECTIVE

Evaluation of the comparative effectiveness of various methods of psychological support in the correction of pain syndrome in patients with degenerative-dystrophic diseases of big joints and spine in the process of medical rehabilitation.

MATERIAL AND METHODS

In conditions of hospital, the 70 patients with degenerative-dystrophic diseases of the big joints and spine who received drug and non-drug treatment were examined. The dynamics of the psycho-emotional state, subjective assessment of well-being and pain was studied in three groups: the main group (24 patients) where the psycho-correction plan included classes with a medical psychologist using a high-tech VR tool - «Vive Focus Plus EEA virtual reality helmet». A comparison group (24 patients) who received a standard format of psychological support within the patient-centered approach. The control group (22 patients) where only psycho-diagnostic measures were carried out. The «Tamp Kinesiophobia Scale», «Visual Analogue Scale of Well-Being Evaluation», «McGill Pain Questionnaire» were used as diagnostic tools. When comparing the effects of the interventions the nociceptive or mixed nature of pain was taken into account.

RESULTS AND CONCLUSION

It has been shown that psychological support improves the effectiveness of pain therapy while the inclusion of a high-tech VR tool in psycho-correctional programs is expedient for overcoming the fear of movement and pain of neuropathic and mixed genesis but ineffective for relieving nociceptive pain, i.e. pain where there is no psychological component.