Change of immune status parameters, clinical symptoms and health related quality of life patients with postmastectomy syndrome depending on the used rehabilitation complexes

Abstract

To assess the effectiveness of the use of some physiotherapy methods in the rehabilitation of patients with PMES according to clinical parameters, markers of endothelial dysfunction, and the results of a questionnaire. 185 patients suffering from PMES were examined. They were divided into 4 groups: in the 1st group (control, 61 patients) basic treatment was used (physiotherapy exercises, photomatrix therapy, manual lymphatic drainage massage of the affected upper limb, pneumatic compression); in the 2nd group (43 patients) - basic treatment + sinusoidal modulated currents to the area of the muscles of the thoracic girdle; in group 3 (42 patients) - basic treatment + electrostatic therapy of the upper limb on the side of the operation; in the 4th group (39 patients) - basic treatment + SMC therapy + electrostatic therapy. Before and after the rehabilitation course, clinical symptoms, blood counts for interleukins (IL) 6, 8, 10, homocysteine were assessed, testing was carried out according to the SF-36 (Short Form Medical Outcomes Study) questionnaire, WAM (Well-being, activity, mood) questionnaire, Hamilton depression scale. There was a tendency to a decrease in the quantitative parameters of the immune status: the mediators of the acute phase of inflammation - pro-inflammatory interleukins (IL-6, IL-8), homocysteine and anti-inflammatory interleukin (IL-10). A statistically significant decrease of length of circumference of the affected upper limb was recorded in patients of groups 3 and 4, which electrostatic therapy was used in the rehabilitation program. Lymphatic edema of the upper limb was decreased statistically significant by 33.25% in the 3rd group, by 35.45% in the 4th group. According to the data of the Mirage multicenter study, parameters of the physical and mental components of health of the SF-36 questionnaire after a course of rehabilitation therapy ware significantly approached to the average population parameter in all groups. There was an objective improvement in the general well-being of the patients, an increase in activity and mood according to the data of the WAN questionnaire and psychological state according the Hamilton scale. Inclusion of electrostatic therapy procedures, sinusoidal modulated currents in the rehabilitation program, significantly enhances the therapeutic effect, promote to reduce the edema of the upper limb, increase the range of motion of the shoulder joint, which has a positive effect on the quality of life andemotional state of patients. The level of IL-6, IL-8 tends to decrease, which indicates the absence of tumor growth and systemic inflammatory reactions. Decrease of the level of IL-10 and homocysteine confirms the safety of the use of physical factors in the treatment of PMES.