Визначення стану базових активностей повсякденного життя у пацієнтів з морбідним ожирінням як аспект ефективності програми фізичної терапії

Abstract

The main reasons for the restriction of activities of daily life in individuals with morbid obesity are limited mobility due to deterioration in flexibility and strength, deterioration in balance, and concomitant pathology of the musculoskeletal system. The data available in the current literature predominantly highlight disorders of activities of daily life in obese elderly people. At the same time, there are almost no studies highlighting the limitations of activities of daily life in morbid obesity, as well as the gender characteristics of these limitations. The purpose of the study was to determine the nature of daily life activity disturbances in men and women with morbid obesity and the effectiveness of their correction by means of physical therapy against the background of different levels of therapeutic alliance. Materials and methods. 74 adults of the second adult age (39.6 ± 1.4 years) were examined with a morbid obesity established by body mass index (more than 40) (43 women and 21 men). According to the results of determining the therapeutic alliance, they were divided into two groups. The comparison group consisted of individuals with a low level of therapeutic alliance who refused to actively participate in the program of weight loss. The main group consisted of patients with a high level of therapeutic alliance, they underwent a correction program using dietary and lifestyle modifications, therapeutic exercises, massage, acupuncture, psychocorrection lasting one year. The main principle of the program was an individual approach taking into account the physical capabilities, comorbidities, psycho-emotional state of the patient with constant monitoring of body functions against the background of maintaining a high level of therapeutic alliance. The performance of daily life activities was characterized by the dynamics of the Barthel index parameters. Results and discussion. In patients with morbid obesity, a deterioration in the performance of daily life activities (according to the Barthel index) was revealed. The use of kinesitherapy against the background of a decrease in body weight as a part of a physical therapy program allowed the patients to restore their independence when performing activities of daily life (according to the Barthel index). The low level of therapeutic alliance led to poor implementation or non-implementation of the recommendations provided (aimed at reducing body weight, increasing physical activity), which was associated with a lack of improvement in the performance of daily life activities. Conclusion. As a result of one-year implementation of the developed program of physical therapy, a statistically significant (p<0.05) improvement in the studied indicators of daily life activities in patients with morbid obesity and restoration of functional independence in this indicator was determined compared to the initial result