Complex Rehabilitation Program Research Articles

Dynamics of the electrospondilography indices of the individuals with back pain under the influencing of the physical rehabilitation program. Physical rehabilitation of the individuals with back pain

Back pain (BP) is an important link in neurological pathology and one of the most common complaints in general medicine practice. The purpose of the research was: scientifically and strategically substantiate and develop a comprehensive physical rehabilitation program of persons with dorsalgia in the thoracic spine and to prove its effectiveness according to the data of the electrospondilography. Materials and methods. The study was conducted on the basis of the sports and rehabilitation club “Fifth Element” in Kyiv, 67 patients (25 men and 42 women) were taking part in our research, of the working-age with BP on the thoracic level. Results. Based on the results of previous studies, we have developed a complex physical rehabilitation program for patients with BP on the thoracic spine, which included various tools and forms of physical rehabilitation, elements of modern fitness techniques, soft tissue and connective tissue manipulative techniques, and a cognitive method -conductive therapy. Conclusion. The effectiveness of the developed program of patients with BP in the thoracic department was evaluated after the completion of the course – after 12 weeks. According to the data of ESG, the positive dynamics of indicators K1, K2, K3, К4 was observed in both the MG and CG. However, only in the MG of changes in K3 and K4 indicators were statistically significant.

Disability due to arterial hypertension and alimentary factors, determining cardiovascular risk

The problem of disability is associated with the problem of socially significant diseases, the main feature and at the same time the key characteristic of which is mass character. The epidemic nature of the spread and the medical and social burden of arterial hypertension (AH) leads to the assignment of this pathology to the number of socially significant diseases. The aim of the study was to analyze primary disability due to AH in Moscow and clinical and pathogenetic parallels between the level of arterial pressure and alimentary factors determining cardiovascular risk (CVR). Material and methods. The object of study was the data on the primary disability of the population of Moscow during the period 2011-2017 according to the form of state statistical observation #7-sobes and data of the Ministry of Health of Russia. The study was retrospective. The subject of a selective study was an analysis of the nosological spectrum of causes of disability, the nature of functional impairment and the degree of disability of elderly people who underwent inpatient treatment at the hospital for war veterans of the Rostov region in 2018-2019. The analysis of the spectrum of factors that determine the CVR. Results and discussion. The total number of newly recognized disabled (NRD) due to hypertension amounted to 11,069 people. The growth of the share of NRD of young age (6.8-11.7%), a decrease in the proportion of NRD of middle age (45.3-41.7%) and elderly in 2015-2016 (39.1-39.9%), but the growth of this indicator in this contingent in 2017 to 46.6% were noted. The proportion of NRD group III increased (to 69.1%), NRD group II decreased (to 20.3%) with a negative trend of growth in the proportion of VPI of the most severe group I. Selective survey data among people with disabilities undergoing inpatient treatment at the hospital for war veterans of the Rostov Region (2018-2019) indicated that they had a wide range of factors determining the CVR. Conclusion. The persistence of patients with hypertension triggers, supporting its further progression, is the cause of the low effectiveness of therapy and exacerbates the prognosis. It is advisable to have a unified approach to improving the efficiency of dietary use at the stages of complex treatment, prophylactic and rehabilitation programs with the goal of primary and secondary prevention of hypertension and disability due to this socially significant pathology.

1681P - Qualitative study of patients’ experiences of living with and beyond a soft tissue sarcoma diagnosis: The impact of sarcoma specialist services

BackgroundTreatment of sarcoma often involves long-term hospitalisation, extensive surgery, loss of mobility and complex rehabilitation programmes. Subsequently, poorer patient-reported outcomes are recorded in comparison to patients with other cancer types. A national patient experience survey shows that enhanced levels of reassurance are obtained by access to trusted quality information about sarcoma. Research also shows that patients are more likely to understand their treatment plan, access services, and cope with their illness if they have professionals supporting care coordination. We aim to explore the role of professional’s expertise, practical and emotional support on patients’ experiences. MethodsParticipants across the UK were recruited by healthcare teams or through charities to share their experience of living with and beyond a sarcoma diagnosis. Patients took part in a semi-structured interview or focus group. These were analysed using Framework analysis. ResultsA total of 68 patients with soft tissue sarcoma (STS) participated (59% female; aged 23-82 years; 56% extremity STS; 62% diagnosed within 4 years; 25% with metastatic recurrence). Access to specialist clinical teams had a considerable role in patient’s experience; this restored patient’s trust in the healthcare profession, especially if their route to diagnosis had been long and complex. They shared receiving trusted quality information from specialists. The clinical nurse specialist (CNS) was described as both an expert and approachable professional who gave them practical and emotional support. It was in the absence of clear communication, coordination or when local rehabilitation services lacked the expertise to support patients that worse experiences were reported. ConclusionsThis study showed that having access to professionals with sarcoma expertise, quality trusted information, support from a CNS and access to services in specialist hospitals has an impact on patients’ physical and emotional wellbeing. In contrast, the lack of access to teams with sarcoma expertise/knowledge had a negative impact on patient’s experience. STS is a rare type of cancer and patients benefit from access to specialist services. Legal entity responsible for the studyUCLH. FundingSarcoma UK. Phase I Stage 1 received additional support from Bone Cancer Research Trust. DisclosureAll authors have declared no conflicts of interest.

The role of the balneo-physical-kinetic treatment on the ligamentous stability in osteoarthritis of the knee

Osteoarthritis of the knee is one of the disabling conditions with a major impact on the quality of life of the patients. Existing therapies focus on reducing pain and disability caused by the disease. The existence of scores that evaluate the different aspects of patients quality of life are often used in monitoring the treatment and its results. The study is performed on a batch of 21 patients, between June 2017 and June 2018. They performed a complex rehabilitation program being evaluated every six months by applying the WOMAC questionnaire and performing specific maneuvers. The study has shown that by performing complex rehabilitation treatments the patients ability to perform some actions as well as their quality of life is improved and the effect following repeated treatments every six months is maintained during two treatments successive treatment.

Complex Program of Neurocognitive Rehabilitation for Elderly Patients Suffering from Mild Cognitive Impairment Syndrome in Medical Rehabilitation Department «Memory Clinic»

The article introduces a complex program of neurocognitive rehabilitation into the system of dementia prevention in patients with mild cognitive impairment syndrome. It took about a year to prepare and form a complex program of neurocognitive rehabilitation (the Program). The researchers have also developed clear algorithms of the specialized medical rehabilitation unit Memory Clinic. The conducted study has proved the effectiveness of cognitive functions improvement in patients with mild cognitive impairment after participation in the Program in Memory Clinic. The authors, Professor Kostyuk, and Research Institute for Healthcare Organization and Medical Management have prepared Medical Rehabilitation Guidelines for Elderly Patients with Early Signs of Cognitive Deficits (Structural and Functional Model). The guidelines serve as a tool for practice distribution and transforming them into a project Memory Clinic.

Clinical and Psychosocial Characteristics of HIV-Positive and HIV-Negative Females with Opiate Dependence

The objective of the study was to explore the clinical-psychological and social characteristics of injecting drugs women users (IDWU) with opiate dependence with different HIV status living on the territory of the Republic of Belarus based on multi-dimensional assessment of opiate dependence dynamics in order to develop therapeutic measures for relapse prevention and achievement of the long-term remission. Materials and methods: Totally 217 IDWU were examined. The research cohort was randomized into 2 groups: HIV-positive women (HPW) (104 persons, mean age 30.8 years (SD=4.86) and HIV-negative women (HNW) (113 persons, mean age 29.9 years (SD=6.67). The level of patients social functioning, quality of life, craving for narcotic substances were studied by means of the Scale of the social and functioning, SF-36 and the Scale of the craving for drugs. The particularities of the social functioning and life quality of women with opiate addiction and different HIV status were described. The results: show that the majority of IDWU were characterized by frequent work replacement and labor skipping (27/25.9% in HPW group vs 30/26.5% in HNW group; P>0.05). 21 /20.1% HPW vs 15/13.2% HNW (P<0.05) was characterized by low qualification, 43/43.3% HPW vs 41/36.2% HNW (P>0.05) - vocational education. HPW have more severely impaired psychosocial parameters compared to HNW. Family climate can be described as hostile aggressive (84/80.7% in HNW group vs 69/61.0% in HNW group; P<0.05). For women of both groups were characteristic parental alcohol abuse (18/17.3% in HPW vs 16/14.1% in HNW; P>0.05), and high level of parental divorces (24/23.1% in HPW vs 32/28.3% in HNW; P>0.05). It was found that the treatment itself allows to diminish the problems associated with drug use and HIV infection. Nevertheless, the short-term treatment course can only provide the clinical improvement but not stabilization of psychosomatic state of HIV-positive patients with opiate dependence. Conclusions: The results of the study indicates the vast majority of women who are injecting drug users, living in Belarus, can be characterized by high level of social functioning disturbances including domestic, social and professional relationship. They need for development of specific tactics of management to suit their needs, including the long-term complex treatment and rehabilitation programs.

Efficiency of magnetic therapy techniques in the treatment and rehabilitation of patients with joint diseases from the standpoint of evidence-based medicine

This article provides information on currently proven effective treatment methods for patients with joint diseases, by using magnetic fields with various physical characteristics. A wide range of biotropic parameters allows obtaining various primary physicochemical changes in biological tissues, which was a rationale for including magnetic therapy (MT) in the combination treatment of degenerative-dystrophic and inflammatory diseases. Analysis of scientific publications suggests that there are a large number of randomized, placebo-controlled studies providing evidence for reduced pain, improved joint functional activity and quality of life in patients with knee osteoarthritis under magnetic fields with varying inductions, frequencies, and exposures. There are few randomized clinical trials identifying the efficiency of MT for a number of other joint diseases and after arthroplasty. Despite the fact that there are differences in methodological approaches, it is possible to draw a general conclusion on the scientific validity of using MT in the complex treatment and rehabilitation programs for patients with joint diseases and on the prospects of further developments in this area.

Correlation between Pregnancy Related Weight Gain, Postpartum Weight loss and Obesity: a Prospective Study.

Weight gain during pregnancy can be a real risk factor for long-term obesity which has implications in all areas of medicine. This study is designed to assess pregnancy-related weight gain and postpartum weight loss, to identify a possible correlation between weight gain during pregnancy and the risk of obesity in the late postpartum period. The batch comprised 306 women, hospitalized in the Obstetrics and Gynecology Section of the “Nicolae Malaxa” Clinical Hospital between June - November 2017. During this study, we assessed the weight status using the Weight, Body Mass Index, Height, and Abdominal Circumference. These parameters were clinically assessed in three periods pre-pregnancy, early postpartum period, late postpartum period. We also collected data on the evolution of the pregnancy using the anamnesis and the personal pregnancy monitoring sheet. Pregnancy and postpartum period represent a key moment in women’s lives in which the risk of obesity is real. Understanding women experiences with weight changes during pregnancy and postpartum period can improve the management of losing weight following pregnancy, avoid long-term weight gain and so reduce the risk for obesity. Also, the correct management of obesity should include the assessment of somatic disorders that may cause major dysfunction, requiring complex rehabilitation programs.

THE IMPACT OF NON-PHARMACOLOGICAL REHABILITATION ON THE PERFORMANCE OF THE CLINICAL AND LABORATORY STATUS OF PATIENTS WITH IRRITABLE BOWEL SYNDROME

Irritable bowel syndrome belongs to the category of heavy, hard to treat diseases, which often lead to disability, therefore, the relevance of the restoration of the functional activity of the intestine is not in doubt. We carried out an evaluation of the results of sanatorium-resort treatment of 135 patients with different types of Irritable bowel syndrome (constipation, diarrhea). Age of patients ranged from 18 to 40 years, disease duration from 6 months to 5 years. High effectiveness of complex rehabilitation program in the form of recourse or relief of patient complaints, laboratory remission of the disease and stabilization of the psychological state of patients was proved. It is shown that application in complex rehabilitation of patients of Irritable bowel syndrome amplipuls therapy and millimeter therapy, contributes to more evident improvement in indices of nonspecific resistance and adaptive capacity of the organism, normalization of the intestine’s microflora, and hence increase of the colon the immune protection.

Comparative evaluation of the efficacy of five PRM programmes on functional autonomy and phantom pain in patients after lower limb amputation

Our objective was to realize a comparative evaluation of five PRM programmes of care in patients after transfemoral amputation. During last years a total of 105 amputees were observed and investigated - in-patients of the Clinic/Department of Physical and Rehabilitation Medicine (PRM). Patients were randomized into five treatment groups consisting of 21 patients each. All patients received a transfemoral amputation 1 to 6 months before rehabilitation, with stump pain and phantom pain. All patients gave written informed consent. All patients received a complex rehabilitation programme including physical therapy and patients’ education. We accentuate on: analytic exercises for hip muscles, post-isometric relaxation for ilio-psoas muscle, strengthening exercises for the paravertebral and abdominal muscles; balance and gait training. In group 1 we applied too drug therapy - paravertebral infiltrations. Patients of groups 2 & 3 received a complex rehabilitation programme, including a preformed physical modality [Deep Oscillation (DO) or LASER]. In groups 4 and 5 we applied combined analgesic techniques (gr 4 = infiltrations and DO, gr 5 = infiltrations and laser). For statistical evaluation we used t -test (ANOVA) and Wilcoxon rank test (non-parametrical correlation analysis), performed using SPSS package (statistical significance - if P -value < 0.05). The comparative analysis of results shows a significant improvement of the symptoms of the patients, concerning: quality of life and functional autonomy (Mc Gill quality of life questionnaire); pain (Visual analogue scale, faces scale and evaluation of stump tenderness), and depression (scale of Zung). Best results were obtained in groups 4 and 5. We could recommend the complex program for functional recovery of amputees.

Retrospective study about rehabilitation after lumber disk surgery in patients hospitalized during year 2016 in Balneal and Rehabilitation Sanatorium of Techirghiol

Introduction: In year 2016, in Balneal and Rehabilitation Sanatorium of Techirghiol were hospitalized 813 patients with lumbar disk surgery. Background: Complex rehabilitation programs (medical and balneal treatment, physical therapy, massage and kinesiotherapy) are available for individuals after lumbar disk surgery.in Balneal and Rehabilitation Sanatorium Techirghiol Objecives: A large screening of this patients regarding their age, number of lumbar disk surgery, level of disk surgical intervention, possible cause of disk hernia, symptoms at admission, clinic evaluation and type of medical and balneal treatment applied in Sanatorium. Method: Statistics analyses of all parameters and correlate data. Results and Conclusion: The complex treatment applied in Sanatorium reduces pain after lumbar disk surgery with positive impact on quality of life and disability and also decrease the appearance of a new disk hernia. The treatment should be individualized according to the patients and its symptoms. The patient can return faster to work and other daily activities.

Effect of a Respiratory Training Program Using Wind Instruments on Cardiopulmonary Function, Endurance, and Quality of Life of Elderly Women

BackgroundPhysical changes due to aging lead to weakening of respiratory muscles and decreased lung functions that result in increasing risk of chronic respiratory disease. A complex respiratory rehabilitation program is needed to prevent respiratory diseases and improve lung functions and quality of life. The purpose of the present study was to examine the effects of respiratory training programs on pulmonary functions, cardiovascular endurance, and quality of life in elderly women.Material/MethodsThe program was structured with respiration exercise and playing wind musical instruments for 10 weeks (n=13) and 5 weeks (n=16), respectively, for elderly women in 2 different community welfare centers. The program consisted of breathing exercises twice a week, 20 min per session, and 40 min of wind instrumentation. Effects were assessed using forced vital capacity (FVC), forced expiratory volume-one second (FEV1), FEV1/FVC ratio (FEV1%), maximum voluntary ventilation (MVV), 6-minute walk test (6MWT), modified Borg scale (MBS), and life satisfaction scale (LSS).ResultsThe 10-week program group (10WPG) showed significant differences in FVC, MVV, 6MWT, MBS, and LSS before and after interventions (p<.05), and the 5-week program group (5WPG) showed significant differences in FVC and 6MWT. MVV, MBS, and LSS were not significantly different between the 2 groups (p<.05).ConclusionsThis study confirms that the long-term respiration training program has positive effects on pulmonary functions, cardiopulmonary endurance, and quality of life. Various respiratory training programs and long-term implementations are needed to prevent respiratory illness and to improve lung functions and quality of life of respiratory patients.

Совершенствование межведомственного взаимодействия в программе комплексной реабилитации инвалидов

Совершенствование межведомственного взаимодействия в программе комплексной реабилитации инвалидов

A theoretical model for exercise progressions as part of a complex rehabilitation program design

A theoretical model for exercise progressions as part of a complex rehabilitation program design

Aspecte clinice, paraclinice şI abordarea terapeutică interdisciplinară la un pacient tânăr, cu hemiplegie post accident vascular ischemic (AVC), adenom hipofizar şI tromboză venoasă profundă (TVP) crurală

Introduction. Stroke is a pathological condition that generates “neurological clinical signs, global or localized, of cerebral dysfunction with symptoms that last more 24 hours, having vascular origin” and it is considered the first cause of disability at global level and the second one for mortality worldwide. Stroke can deter-mine severe or rather permanent sequels, which need, for patients' recovery and rehabilitation, important medical support. Material and method. This paper presents the case of a young 39-year-old patient, hospitalized at the Neurosurgery Clinic (NS) III of TEHBA for left hemiplegia and consciousness crises, and after specific paraclinical investigations (cerebral CT, cerebral Angio- MRI) is discovered in addition to the right ischemic sylvian stroke, an intracranial expansive seller and paraseller process with extension into the left ventricular sinus (pituitary adenoma). Initially, a neurological treatment and a rehabilitation nursing was performed in the Neuro-Muscular Rehabilitation Clinic Division of SCUBA until neurological stabilization, after which, in NS III Clinic, after an endocrinological control followed by specialized treatment, transsphenoidal surgery was performed, practicing subtotal ablation of the tumor. Subsequently, in our clinic, the patient continued the rehabilitation treatment. He was evaluated functionally in dynamic using the scales: Glasgow outcome scale (GOS), Rankin scale, Functional Independence Measure (FIM), Mini Mental State Examination (MMSE), Quality of Life (QOL) Evaluation, modified Ashworth scale, FAC International scale, instrumental/activities of daily living (ADL/IADL). During hospitalization, he presented a high-left deep vein thrombosis (DVT) episode that was confirmed by Doppler ultrasound, monitored by ultrasound re-evaluations and treated with low molecular weight heparin. Results. After DVT remission, the patient benefited from a complex neuro-muscular rehabilitation program, having a favorable evolution, with an increase in the scores of the evaluated scales and thus with a final performance of walking with a quad-point support cane, including climbing/descending stairs. Discussions and conclusions. The interdisciplinary therapeutic approach at a young patient with neuro-endocrine pathology, complicated by DVT, culminating with a specific rehabilitation program, results in neuro-locomotor improvements with an increase in patient’s quality of life.

Effects of a complex rehabilitation program on edema status, physical function, and quality of life in lower-limb lymphedema after gynecological cancer surgery.

The purpose of this study was to investigate the effects of a complex rehabilitation (CR) program and complex decongestive therapy (CDT) on edema status, physical function, and quality of life in patients with unilateral lower-limb lymphedema after gynecologic cancer surgery. In this randomized pilot study, 40 patients with secondary unilateral lymphedema, after gynecologic surgery for cervical, endometrial, or ovarian cancer, that had been diagnosed based on clinical assessment and 10% volume differences between the legs were randomly assigned to the CDT (n=20) and CDT combined with CR (CRCDT; n=20) groups. CR comprised stretching, strengthening, and aerobic exercises performed for 40min, five times a week for 4weeks. Intensive CDT was administered by a physical therapist during weeks 0-2 and by the patients themselves during weeks 2-4. Limb volume, bioimpedance, muscular strength, EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30) score, 30-s chair stand test, muscular strength, and GCLQ-K (Korean version of the Gynecological Cancer Lymphedema Questionnaire) score were assessed at baseline and after 4weeks of treatment. The edema status, fatigue, pain, and GCLQ-K scores were significantly improved in both groups after the 4-week intervention (P<0.05). Physical function and fatigue in EORTC QLQ-C30 and the 30-s chair stand test and quadriceps muscle strength were significantly improved in the CRCDT group compared with the CDT group (P<0.05). CR improves physical function, fatigue, and muscular strength without increasing edema status in patients with unilateral lower-limb lymphedema after gynecologic cancer surgery.

Impact of pre-formed modalities in the post-operative rehabilitation of patients after anterior cruciate ligament tear

During last years the arthroscopic knee surgery is considered a gold standard in cases with Anterior Cruciate Ligament (ACL) tear and the early rehabilitation is an obligatory part of the protocol. GOAL. To evaluate the efficiency of the applied complex rehabilitation in patients with ACL tear after arthroscopic alloplastic surgery with estimation of the impact of elements of the protocol: cryotherapy and active kinesitherapy and different pre-formed modalities. The current controlled prospective randomized investigation was carried out during the period 2010–2017 on a total of 96 patients, divided into 4 groups. The investigation was conducted with consideration for the protection of the patients, as outlined in the Declaration of Helsinki. The evaluation protocol consists of history of the condition, clinical patterns, and functional assessment, including: goniometry of the knee joint, centimetry, manual muscle test, visual analogue scale of pain (0–20), gait test (tests of 5 & 10 m, 2 min’ Walk Test). All patients received cryotherapy and a detailed physiotherapeutic program, including active exercises oriented in training the muscles that allow the function of the knee, working hip stabilizers and increasing muscle endurance. All patients received detailed instructions for rest and rehabilitation. Group 1 received only cryotherapy and kinesiotherapy, twice a day. In groups 2–4 we added a preformed physical modality: low frequency low intensity magnetic field (group 2), interferential currents (group 3) and deep oscillation (group 4). Statistical analysis was performed with SPSS electronic package, version 17. The comparative analysis of the results demonstrates the effectiveness of the complex rehabilitation program on a lot of clinical and functional patterns. Here we present results of: pain relief (Visual analogue scale), range of motion of the knee joint (goniometry), knee oedema (centimetry), gait stability (test of 5 and 10 m; 2 min’ walk test). The post-op rehabilitation protocol in ACL patients ameliorates quality of life. The inclusion of pre-formed modalities reduces pain and oedema, improves range of motion and stimulates gait recovery. The on-time rehabilitation prevents complications: deep vein thrombosis, pulmonary embolism, altered knee, myo-hypotrophy, muscle weakness and pathological proprioceptive afferentation.

Rehabilitation of Patients with Hip Joint Arthroplasty (Late Post-surgery Period - Hospital Rehabilitation).

Hip joint replacement (endoprosthesis, alloplasty) has become one of the most frequent surgery interventions of the 20th century. To conduct rehabilitation therapy in the late post-surgery period of hospital rehabilitation (45 days after surgery), to track patients' progress and measure the results. One hundred and fifty-two patients with hip joint endoprosthesis were included in the study. All underwent surgery and rehabilitation at the Department of Clinical Rehabilitation of the Physical and Rehabilitation Medicine Clinic at Doctor G. Stranski University Hospital, Pleven. Kinesitherapy included therapeutic massage, isometric exercises for gluteal and hip muscles, isotonic exercises for the hip and the knee joint, breathing exercises, analytical gymnastics, exercises for balance and posture stability; gait control, exercises with gym equipment; occupational exercises included all activities of daily living (ADL) that were practiced at home; treatment with performed physical factors included applying magnetic field, interferential current therapy, electrostimulation of the m. quadriceps femoris and the gluteal muscles. The scores from the pain visual analog scale (VAS), the muscle strength test and the test for the movement volume of the hip joint were obtained at the beginning and at the end of the rehabilitation process and stored in an individual file for each patient. The results of the present study suggest that the complex rehabilitation program (kinesitherapy, performed physical factors and occupational therapy) can result in a considerably faster recovery and ensures that patients reach optimal functional results.

Effects of Dynamic Exercise and Dynamic Resistance Training in Rehabilitation of Patients after Surgical Coronary Revascularization

Summary Cardiac rehabilitation is an integral part of the complex therapy of cardiac patients. The aim of this study was to determine the effect of dynamic exercise and dynamic resistance training on exertion tolerance, muscle strength of the upper and lower extremities, and respiratory index in patients after surgical coronary revascularization. The study included 84 patients divided into two groups. Both groups of respondents were included in the complex cardiac rehabilitation program of the interval type. In the first group, the patients performed dynamic exercise. The second group of patients received a combination of dynamic exercise and dynamic resistance training. At the end of the rehabilitation treatment, which lasted 21 days, a statistically significant difference in muscle strength of the upper and lower limbs was observed in both groups (p &lt; 0.05); statistically significant difference was found in relation to exertion tolerance in both groups (p &lt; 0.001); a statistically significant difference in duration of exercise stress test was observed in the both groups (p &lt; 0.05); respiratory index values showed statistically significant differences in both groups (p &lt; 0.001). After the rehabilitation treatment, in both groups of patients there were statistically significant differences in increasing the muscle strength of the upper and lower extremities, exertion tolerance, and respiratory index; however, beneficial effects of physical training were more pronounced in the group of subjects included in the program of resistance exercise for the upper and lower extremities.

Cardiac rehabilitation programme as a non-pharmacological platelet inhibitory tool in acute coronary syndrome survivors.

Background Acute coronary syndrome is associated with platelet hyperactivity, which in its persistent form, promotes recurrent thrombotic events. Complex cardiac rehabilitation after acute coronary syndrome improves clinical outcome; however, its effect on platelet hyperactivity is unknown. Design and methods We enrolled 84 acute coronary syndrome patients on dual antiplatelet therapy, who underwent a new complex cardiac rehabilitation programme (NovaCord physiotherapy, lifestyle counselling, strict diet, stress management and regular coaching) and 51 control acute coronary syndrome patients with traditional cardiac rehabilitation. Platelet functionality was determined at enrolment and at three months follow-up by aggregometry, serum platelet-derived growth factor levels, total- and platelet-derived microvesicle counts (PMV; CD41a+/CD61+, CD62P+). Results Platelet aggregation parameters and platelet-derived growth factor levels were significantly decreased in the complex cardiac rehabilitation group at three months (1 µg/ml collagen, median (interquartile range): 22 (10-45) vs 14 (7.5-25.5)%, p = 0.0015; 2 µg/ml collagen: 36 (22-60) vs 26.5 (16-37)%, p = 0.0019; 1.25 µM adenosine-diphosphate: 4.5 (1-10) vs 1 (0-3)%, p = 0.0006; 5 µM adenosine-diphosphate: 27 (16-38) vs 22 (12-31)%, p = 0.0078; epinephrine: 33 (15-57) vs 27 (12-43)%, p = 0.01; platelet-derived growth factor: 434.6 (256.0-622.7) vs 224.8 (148.5-374.1) pg/ml, p = 0.0001). In contrast, these changes were absent or did not reach statistical significance in the traditional cardiac rehabilitation group. Platelet-derived microvesicle counts were significantly decreased in both groups, while total microvesicle count was significantly reduced only in the complex cardiac rehabilitation group (median (interquartile range): 3945.5 (2138-5661) vs 1739 (780-2303) count/µl; p = 0.0001). Conclusions Platelet hyperactivity three months after acute coronary syndrome significantly decreased in patients undergoing complex cardiac rehabilitation. Besides dual antiplatelet therapy, effective management and comprehensive control of cardiovascular risk factors might represent a new, non-pharmacological approach to influence platelet functionality.