Early Rehabilitation Of Patients Research Articles

Investigation of the comfort situation and influencing factors of patients with lumbar disc herniation after UBE surgery

[Objective] To explore the first time out of bed comfort of patients after lumbar surgery and its influencing factors. [Methods] A total of 158 patients with lumbar disc herniation and sciatica were selected from March 2023 to August 2023. [Results] Among the 158 patients, 56 cases underwent early inclusion of ambulation, 102 cases did not complete early ambulation. The first ambulation time is 12 hours after operation and concentrated on the second day after operation. Single factor analysis showed that two groups of 24 h postoperatively in patients with early pain, fatigue, upright intolerance, sleep quality, early ambulation will, total protein level, anxiety, depression score, postoperative rehabilitation self-efficacy comparison, the difference was statistically significant (P<0.05).logistic regression analysis showed that postoperative pain score, early fatigue, orthostatic intolerance, sleep quality, anxiety and depression score, and rehabilitation self-efficacy score had great influence on early ambulation. [Conclusion] The current situation of early ambulation comfort of patients with lumbar disc herniation after surgery is not good. Nursing staff should strengthen postoperative pain management, encourage patients to enhance confidence, improve the ambulation mode of patients to reduce upright intolerance and fatigue, so as to promote early ambulation of patients and speed up early rehabilitation of patients.

Cerebral oxymetry in patients with ischemic stroke and concomitant obstructive sleep apnea syndrome

Cerebral stroke is an important medical and social problem of our time and the most common cause of permanent disability. In patients with brain damage due to ischemic stroke and concomitant obstructive sleep apnoea, numerous episodes of hypoventilation and apnoea cause significant «failures» in saturation and changes in cerebral perfusion, which negatively affects immediate and long-term treatment outcomes. Cerebral oximetry is widely used in clinical practice in various fields of surgery (cardiovascular, paediatric, neurosurgery, etc.), but its potential as a method of monitoring secondary brain damage and controlling treatment in patients with ischaemic cerebral stroke is poorly understood. Objective — to evaluate the effect of non-invasive CPAP support (Continuous Positive Airway Pressure — a method of non-invasive respiratory support in which positive pressure is created in the patient’s airways) on cerebral oximetry in the treatment of patients with ischaemic stroke and concomitant obstructive sleep apnoea syndrome. Materials and methods. Patients with verified mild to moderate ischaemic stroke underwent screening diagnostics to confirm the presence of obstructive sleep apnoea syndrome (SomnoChek micro, Weinman, Germany). We studied 60 patients with obstructive sleep apnoea in the setting of ischemic stroke, who were divided into two groups depending on the treatment method: control (n = 30), in which only conventional stroke treatment was used, and experimental (n = 30), in which the traditional treatment regimen and respiratory support (auto-SAPP) during night sleep with the ResMed Air Sencei apparatus (Australia) were used. To monitor the effectiveness of respiratory support, along with other methods of objective control, cerebral oximetry was used using the Masimo Root apparatus (Masimo, USA). The average rSO2 values on the side of the stroke-affected hemisphere were recorded at the following times: at the beginning of the study, on the 3rd, 5th and 7th day of treatment. The data obtained were processed statistically. Results. The initial average values of rSO2 of the affected by stroke hemisphere in patients of groups I and II were in the range of pathological values, and were (49.27 ± 4.98) and (50.60 ± 5.40) %, respectively, that is, the groups at the beginning of the study were compared to each other. It was found, that in group I patients statistically significant changes in rSO2 % in the intervals of the 1st and 3rd days, the 3rd and 5th days, and the 5th and 7th days — were not observed. Only during the 7th day of observation we’ve recorded statistically significant rSO2 growth at 15.6 % compared to the initial values up to the mark of (57.03 ± 7.01) %. Instead, the rSO2 changes in patients of group II (who were performed СРАР-support at night against the traditional treatment of a stroke), were dynamic and statistically probable: a controlled index during the 3rd day of observation has increased at 12.2 %, during the 5th day — at 26.5 %, during the 7th day — at 33.6 % compared to the initial values up to the level of (67.64 ± 3.02) % compared to the initial values. Conclusions. Standardized medicinal therapy and early rehabilitation of patients with ischemic stroke does not affect the course and severity of concomitant obstructive sleep apnea syndrome and requires a supplement with the methods of non-invasive respiratory support during night sleep. Patients with ischemic stroke against the background of autoCPAP-therapy, were recorded positive dynamics in terms of correction of obstructive sleep apnea syndrome and stable normalization of cerebral oxymetry.

Magnetic field application in bone tissue regeneration: issue current status and prospects for method development

Relevance. Magnets have long been used to treat various diseases, especially in inflammatory processes. According to existing historical data, magnetotherapy was already used in ancient times by the Chinese, Egyptians and Greeks. Different magnetic field strengths affect cells in different ways, with medium-strength magnetic fields being the most widely used. The review presents a brief history and current state of the issue of using a magnetic field in bone tissue regeneration. Modern knowledge about the mechanisms of physiological and reparative regeneration, restoration of bone tissue is clarified, and modern areas of bone tissue engineering are considered, taking into account the characteristics of microcirculation and the effect of a magnetic field on the physiology of bone tissue and reparative regeneration. One of the key findings of the review is that the magnetic field improves bone tissue repair by influencing the metabolic behavior of cells. Studies show that magnetotherapy promotes the activation of cellular processes, accelerates the formation of new bone tissue and improves its quality. It is also noted that the magnetic field has a positive effect on microcirculation, improving the blood supply to tissues and facilitating a better supply of nutrients to the site of injury. This contributes to faster wound healing and early rehabilitation of patients. Conclusion. Magnetotherapy is one of the effective physical and rehabilitation methods of treatment that will become increasingly important in modern medicine. However, further research is needed to better understand the mechanisms of action of a magnetic field on bone tissue and to determine the optimal parameters for its application.

Psycho-Emotional Aspect in Early Rehabilitation of Patients Who Have Suffered Ischemic Stroke in a Specialized Hospital in Bishkek

The psycho-emotional aspect during early rehabilitation of patients who have suffered an ischemic stroke is an important factor in determining an individual rehabilitation program. For successful rehabilitation treatment, it is necessary to adequately determine the state of impaired functions in each person, taking into account the likelihood of its independent recovery, duration, nature and degree of the existing defect. The period of recovery of neurological functions after a stroke can last differently, from several months to several years.

[Rationale for early rehabilitation of patients with uterine corpus cancer].

To study the dynamics of hemorheologic changes and the frequency of early complications of laparoscopic radical hysterectomy in patients with uterine corpus cancer depending on conducting rehabilitation activities in the early postoperative period. The number of patients with uterine corpus cancer equal 49 (mean age 54.8±2.2 years), divided into 2 comparable groups, was examined: experimental group - 23 patients, who received local magnetotherapy since the first day after surgery for 5-6 days, and control group - 26 patients without physiotherapy. Comparative group included 24 healthy women. The basic rheological parameters, namely blood viscosity at high and low shear rate, hematocrit, erythrocytes' aggregation and deformability, erythrocytes and platelets electrophoretic mobility, were evaluated in all patients initially, on the 1st and 5th days after surgery and in comparison group. There were changes in the rheological properties of the blood before surgery in patients of both groups: increase of blood viscosity, enhancement of aggregation activity of its formed elements, decrease of erythrocytes' deformability properties. The laparoscopic radical hysterectomy was accompanied by the exacerbation of these disorders. The early magnetotherapy in patients reduced hemorheological abnormalities up to the preoperative parameters (p<0.05) for 5 days, as well as reduced the incidence of early postoperative complications by 2.4 times compared to the control group. The application of local low-frequency low-intensity magnetotherapy since the first postoperative day allows to reduce the level of postoperative hemorheological abnormalities up to the level of preoperative parameters, as well as the frequency of early postoperative complications.

EFFECTIVENESS OF APPLYING ORIGINAL METHOD OF BREATHING EXERCISES, INCLUDING TECHNIQUES FOR MOBILIZING DIAPHRAGMAL BREATHING IN COMPLEX EARLY MEDICAL REHABILITATION OF PATIENTS WHO HAVE UNDERGONE CORONARY BYPASS GRAFT

Highlights In the physical rehabilitation of patients after coronary artery bypass surgery (CABG), special attention has recently been paid to respiratory rehabilitation. The article presents the results of studies demonstrating that a course of respiratory coordination training was associated with a decrease in the incidence of hydrothorax, improved blood oxygen saturation, increased exercise tolerance and muscle strength by reducing diaphragm dysfunction and increasing respiratory muscle strength in patients in the postoperative period. AbstractAim. To analyze the clinical effectiveness of a new method of breathing exercises developed for improving breathing control in complex early rehabilitation of patients who underwent CABG.Methods. The study involved 73 patients with coronary artery disease (CAD) who underwent CABG at the Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases” (Kemerovo, Russia) in 2021. During the inpatient rehabilitation, patients were randomized into two groups comparable in anamnestic and baseline clinical and functional indicators: the experimental group (38 patients) had individual breathing exercises as a part of respiratory gymnastics (with different types of exercises), and the control group (35 patients) underwent conventional exercise training.Results. Initially, there were no statistically significant differences between the groups. After 14 days the number of patients in the main group with signs of hydrothorax was significantly lower compared with the control group: 7 (18.4%) vs 11 (31.4%), respectively, p = 0.001. The ultrasound examination of the pleural space revealed the same pattern - hydrothorax was less pronounced in the main group compared with the control group: 0.9 [0.5; 1.5] vs 1.7 [0.6; 2.5] mL, p = 0.049. Analysis of oxygen saturation (SpO₂,%), reflecting the functional status of the oxygen transport system, showed higher blood oxygen saturation rates in the main group compared with the control group: 98 [96; 99] vs 95.2[94; 97]%, p = 0.04, respectively. At the same time, the exercise tolerance (ET) estimated with bicycle ergometry was comparable at baseline in both groups, and at the end of the inpatient rehabilitation ET in the main group was significantly higher than in the control group with conventional exercise training: 74. 9 [50; 100] vs 55.1[25; 75] W, p = 0.005, respectively.Conclusion. Respiratory gymnastics facilitates cardiac and respiratory rehabilitation mainly by improving the coordination of respiratory muscles and preparing them for respiratory gymnastics within short period of early inpatient rehabilitation.

Early Rehabilitation of Patients who Suffered Ischemic Stroke in a Specialized Hospital in Bishkek

An analysis of the condition of 50 patients in Bishkek, the Kyrgyz Republic, who suffered an ischemic stroke, was carried out. The team consists of 24 women and 26 men. The age of patients ranged from 50 to 81 years, the average age was 65.3 years. The impairment and degree of recovery of neurological functions were determined using the Barthel index, the Lindmark scale and the Scandinavian scale. When using early rehabilitation in a specialized hospital, the effectiveness of rehabilitation of patients after a stroke increased.

The results of treatment of femoral diaphysis fractures using locked intramedullary osteosynthesis and extramedullary osteosynthesis (results for 10 years)

Background. Femoral diaphysis fractures are one of the most common and significant injuries to the bones of the limbs. Locked intramedullary osteosynthesis makes it possible to reduce the injury rate of the surgery and its length, as well as to carry out early rehabilitation of patients. The aim of the study. To conduct a continuous retrospective single-purpose comparative study of  the results of treatment of patients with femoral diaphysis fractures treated with locked intramedullary osteosynthesis and extramedullary osteosynthesis for 10 years. This study did not include patients with double femoral fractures treated by osteosynthesis using a combination of two implants – locked intramedullary implant and extramedullary implant. Material and methods. We conducted a retrospective study of the results of treatment of patients from 2011 to 2020. During this period, we treated 794 patients aged from 16 to 77 years with femoral diaphysis fractures. The share of people of working age was 75 %. The patients were divided into two groups depending on the method of surgical treatment. Group 1 included 500 patients who had surgical treatment using locked intramedullary osteosynthesis. Group 2 included 294 patients who had surgical treatment using extramedullary osteosynthesis. Results. In patients of group 1 treated with locked intramedullary osteosynthesis, good anatomical and functional treatment results were achieved in 70 % of cases; satisfactory treatment results – in 25.2 % of cases, unsatisfactory results – in 4.8 %. In the group 2, good results were achieved in 61.9 % of cases, satisfactory – in 29.6 %, unsatisfactory – in 8.5 %. Conclusion. The obtained results of treatment of femoral diaphysis fractures show the undeniable advantage of using locked intramedullary osteosynthesis compared to extramedullary osteosynthesis.

OP126 Clinical And Economic Evaluation Of The Effectiveness Of Cerebrolysin® In Neurological Patients With Post-Stroke Complications In Kazakhstan

IntroductionMedical rehabilitation, one of the main components in the care of patients after stroke, is currently not specified in Kazakhstan, even though neurological disorders are a frequent and potentially disabling consequence of a stroke. The study aimed to evaluate the clinical and economic effectiveness of using Cerebrolysin in patients with post-stroke complications in the Republic of Kazakhstan.MethodsAn annual cost per patient Markov model was developed to compare the use of Cerebrolysin with placebo in the medical rehabilitation of adult patients after acute ischemic stroke. Outcomes and costs were assessed at day 90. Secondary analysis was performed at the end of one year. The primary criterion for effectiveness was change in Action Research Arm Test (ARAT) scale – Hand Function Assessment Test scores. The modified Rankin Scale (mRS) was used as a secondary measure of effectiveness.ResultsThe results of the cost-effectiveness analysis showed a pharmacoeconomic advantage in using Cerebrolysin, in comparison with placebo, in the early rehabilitation of patients after stroke. Cerebrolysin resulted in a better ratio of the main cost-effectiveness ratio (CER) parameters and a negative incremental cost-effectiveness ratio (ICER), regardless of which effectiveness criterion was used. For the ARAT scale, the CER was USD63.33 versus USD148.07 and the ICER was -USD27.71; for the mRS, the CER was USD45.95 versus USD158.54 and the ICER was -USD14.93. The annual budget impact per patient of funding Cerebrolysin is expected to be an increase in the cost of purchasing the drug (an additional USD343.85) and an overall cost saving in the Cerebrolysin group due to accelerated patient rehabilitation (USD1,944.30 versus USD2,354.37).ConclusionsNew evidence has emerged on the effectiveness and safety of Cerebrolysin in patients after stroke, which has served as the basis for including this drug in many international clinical recommendations. The pharmacoeconomic advantages of Cerebrolysin make it possible to recommend its use in the medical rehabilitation of patients after stroke in Kazakhstan.

Does tranexamic acid diminish hemorrhage and pain in open elbow arthrolysis? a systematic review and meta-analysis

Background/Objective: Effective hemostasis has the potential to reduce inflammation and pain, leading to potential benefits in the early rehabilitation of patients who undergo elbow arthrolysis. In the present study, we aim to assesse the effects of tranexamic acid (TXA) on elbow arthrolysis postoperative blood loss, patients’ pain perception according to the visual analog scale (VAS), elbow range of motion (ROM), and complications.MethodsWe systematically searched PubMed, Web of Science, SCOPUS, and Cochrane Library. We included controlled trials, either randomized (RCT) or non-randomized studies of intervention (NRSI) comparing the effects of intravenous tranexamic acid (TXA) treatment with placebo/no treatment on postoperative blood loss, pain VAS score, elbow ROM, and complications, in patients who underwent open or closed elbow arthrolysis surgery.ResultsOne RCT, and three NRSIs met eligibility criteria. The meta-analysis determined that tranexamic acid application reduced drain output 34 mm on average (WMD: -34.00; 95% CI: -49.45, -18.55). There was a discrepancy among included articles in terms of intra-operative blood loss; although the study with the largest sample size (291 and 296 patients in the case and control groups, respectively) reported reduced intra-operative blood loss in patients who received TXA. The pooled estimation for the pain VAS score on the first day post-operatively indicates a reduction in pain among patients in the TXA group (WMD: -0.82; 95% CI: -1.36, -0.28). Results for ROM, and complications’ rate such as hematoma and ulnar nerve palsy were not different between the two groups.ConclusionTXA may be beneficial to reduce elbow arthrolysis bleeding volume. However, it dose not seem to affect final elbow ROM and patients’ pain score. Further high-quality clinical trials are needed to draw a robust conclusion on this topic.

Effect of oxycodone combined with ultrasound-guided thoracic paravertebral nerve block on postoperative analgesia in patients with lung cancer undergoing thoracoscopic surgery: protocol for a randomised controlled study

IntroductionPostoperative pain is a main component influencing the recovery of patients with lung cancer. The combination of patient-controlled intravenous analgesia (PCIA) and paravertebral nerve block for postoperative analgesia in patients...

Outcome of early rehabilitation of patients with traumatic brain injury during COVID-19 pandemic in The Republic of Srpska, Bosnia and Herzegovina.

The COVID-19 pandemic has placed a tremendous burden on the healthcare system. Patients with traumatic brain injury (TBI) have to get fast track treatment which is independent of environmental conditions. The aim of this study was to investigate epidemiological and clinical outcomes of early rehabilitation and compare it with the literature data during the non-COVID-19 period. A retrospective study included 174 patients with TBI, average 57 ± 19.08 years. They all underwent treatment in the University Clinical Center, Republic of Srpska, Bosnia and Herzegovina during the period January-December 2021. We have analyzed the epidemiological data and clinical course in 174 patients as well as the outcome of early rehabilitation in 107 patients. In clinical evaluation were used: Glasgow Coma Score (GCS), Functional Independence Measure (FIM) and Barthel Index on admission and at discharge, as well as Glasgow Outcome Scale (GOS) at discharge. ANOVA, SPANOVA, Student t-test and Pearson correlation coefficient were used in statistical analysis. The value (p < 0.05) was used for statistical significance. A total of 174 patients with TBI were included in this study. Most of the patients (n = 94) were older than 60, male (n = 125) and the most frequent cause of TBI was falling over (n = 88). About a half (n = 92) had a mild TBI, almost one third of the sample had moderate (n = 52), while only 30 patients had severe TBI. Total of 139 (80.3%) patients had the improved outcome, the worsening was registered in 2 (1.2%), while the fatal outcome was reported with 33 (18.5%) patients. When comparing the scores on admission and at discharge, the improvement of mean parameter values was reported for GCS (9.9 vs. 14.1), for Barthel Index (57.25 vs. 86.85), and for FIM (67.35 vs. 105.15), (p < 0.001). A complete recovery at discharge was found in 63.79%, a mild deficit in 8.62%, while serious deficit was found with 6.32%, and vegetative state with 2.29% patients. The COVID-19 pandemic had a significant effect on the epidemiological data but not on the clinical outcome of patients with TBI. Early rehabilitation proved to be effective and to contribute to positive treatment outcome.

РЕЗУЛЬТАТЫ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ЗАСТАРЕЛЫХ ПОВРЕЖДЕНИЙ СУХОЖИЛИЙ СГИБАТЕЛЕЙ ПАЛЬЦЕВ КИСТИ В КОСТНО-ФИБРОЗНЫХ КАНАЛАХ

Background. Restoration of finger flexor tendons in fibro-osseous canals in the long term after injury is a difficult task due to scarring blockage and the impossibility of early active rehabilitation. Therefore, it is important to develop methods for durable tendon reconstruction that can provide early rehabilitation of patients without the risk of rupture of the suture zone. Aim. To evaluate the clinical effectiveness of surgeries on the flexor tendons of fingers in case of chronic injuries in fibro-osseous canals with the creation of strong connections in the sutured zone. Material and methods. The study included 66 patients with chronic injuries of 104 flexor tendons in fibro-osseous canals of the fingers. The main group consisted of 29 patients who underwent restoration of 47 tendons using new methods within 3 to 11 weeks after injury: subgroup A included 23 cases of reconstruction of the deep flexor tendon with a hidden transosseous suture in zone I; subgroup B included 24 sutures with isolation with dissected polymeric tube in zone II. Control group included 37 patients with tendon injuries on 49 fingers within fibro-osseous canals with injury term from 3 weeks to 30 years who underwent classical surgeries: secondary flexor digitorum profundus suture on 31 fingers, 2-stage tendoplasty – on 13, distal phalanx tenodesis – on 4 and reinsertion by Bunnell – on 1 finger. Also, as a control, 8 fingers were evaluated in 7 patients of the main group on which 4 secondary sutures, 2 tendoplasties and 2 tenodeses were performed. Finger function was determined by J.W. Strickland before 3, 6 months and 1 year after surgery, qualitative parameters were analyzed using two-tailed Fisher's exact test. Hand function was evaluated using the DASH questionnaire before surgery and 1 year later, the significance of differences was checked using the Mann-Whitney U-test. Results. The use of durable tendon reconstruction methods in patients of the main group enables to obtain results on average in 3 months similar to the results of 2-stage tendoplasty 10-12 months after the start of treatment in the control group. The results of reinsertion with a hidden transosseous suture and suture with temporary isolation with dissected polymer tubes did not differ significantly in terms of the degree of range of motion recovery and hand function assessment by patients. Conclusions. The developed methods showed better results in restoring the function of the fingers in comparison with classical surgeries. A strong tendon connection combined with an early start of movement increases the number of good and excellent functional outcomes and ensures patients’ satisfaction with treatment results.

HEALTH CARE TECHNOLOGIES IN CREATING OPTIMAL WORKING CONDITIONS IN HIGHER EDUCATION INSTITUTIONS

Neck-shoulder syndrome is a real problem in general clinical practice, manifested by pain, reflex myotonic symptoms in the cervical spine and upper limbs. The goal of our research was a comprehensive study of the clinical and instrumental aspects of the neck-shoulder syndrome for the development of a preventive program and rehabilitation tactics. Materials and methods. We examined 103 people aged 18 to 50 years with clinical manifestations of reflex syndromes of cervical osteochondrosis in the form of cervicocranial pains, who underwent outpatient examination on the basis of National University «Yuri Kondratyuk Poltava Polytechnic» and the Skalyansky Clinic. Among them, 84 (78.64%) patients were women, 22 (21.36%) were men. The duration of having the neck-shoulder syndrome was from 1 to 10 years. The analysis of the obtained data revealed a mixed (musculovascular) mechanism of cervicocranial pain, which is a clinical manifestation of reflex syndromes of cervical osteochondrosis in young people. In this regard, it is advisable to include anti-inflammatory drugs (xefokam, denebol, olfen, nimesil, sigan, etc.), muscle relaxants (midokalm, sirdalud), vascular and venotonics (L-lysine escinat, troxevasin, actovegin) in the complex treatment of this category of patients , nicotinic acid preparations, etc.), vegetotropic drugs, as well as drugs that reduce irritative-paroxysmal phenomena and affect the pain syndrome (gabantine, lamotrine), antidepressants (amitriptyline, fluoxetine, etc.), physiotherapeutic methods and physical therapy. Conclusions. Modern diagnostics and a rational approach to treatment will further lead to early rehabilitation of patients and increase the working capacity of young patients with cervicocranial pain on the background of osteochondrosis of the cervical spine.

The association between early rehabilitation and ambulatory ability at discharge in patients with hip fractures at acute-phase rehabilitation wards: a survey of the Japan Association of Rehabilitation Database.

This study aimed to examine the effectiveness of early rehabilitation in patients with femoral neck fractures admitted to acute care settings in Japan using the data registered with the Japan Association of Rehabilitation Databases (JARD). We included data for 401 patients (out of 3088 patients) aged ≥ 65 years (85 males, 316 females) from nine hospitals who sustained a femoral neck fracture between July 2005 and September 2015. Using the number of days until surgery or the number of days until the start of rehabilitation or both as the explanatory variables, and the indoor mobility at discharge as the outcome variable, we calculated the adjusted rate ratio (ARR) and 95% confidence interval (CI) using Poisson regression analysis (age, sex, cognitive impairment, concurrent symptoms, and previous history of fracture adjusted as covariates). The ARR for independent walking at the discharge of the early-rehabilitation group (starting rehabilitation within two days after the injury) was significantly higher (ARR: 2.01, 95% CI: 1.34-3.02) than that of the non-early rehabilitation group. These results suggest that early acute-phase rehabilitation after a femoral neck fracture in older patients allows for better ambulatory ability at discharge, regardless of the time to surgery.

The Effects of Early Rehabilitation and Diaphragm Kinesiotaping on Diaphragm Muscle Thickness in Patients with Severe COVID-19 Pneumonia in the Intensive Care Unit

Objective The efficacy of early rehabilitation in patients in the intensive care unit is apparent. However, it is still unclear in COVID-19 patients. Also, the effects of diaphragm kinesiotaping on outcomes and muscle thickness were not shown previously. Thus, we aimed to investigate the efficacy of rehabilitation and diaphragm kinesiotaping in patients with severe COVID-19 pneumonia by evaluating with the ultrasonography of the diaphragm.&#x0D; Methods Patients with severe COVID-19 pneumonia in intensive care unit requiring high flow oxygen therapy included in the study. Patients with severe COVID-19 pneumonia in intensive care unit requiring high flow oxygen therapy were divided into three groups: Group 1 (n = 22) rehabilitation, group 2 (n = 26) rehabilitation and diaphragm kinesiotaping, Group 3 (n = 24) control group-only standard intensive care unit care. Ultrasonographic measurements of diaphragm thickness and thickening fraction were recorded repeatedly.&#x0D; Results The demographic characteristics, mortality, and length of stay were not different between groups. However, invasive mechanic ventilation requirement and the decrease in diaphragm thickness and thickening fraction values were significantly lower in the diaphragm kinesiotaping group. Baseline diaphragm thickness and thickening fraction values were found to impact invasive mechanic ventilation requirement. Cut-off values for these parameters are 2.85 mm and 37.95%, respectively.&#x0D; Conclusion Baseline diaphragm thickness can be used to predict noninvasive ventilation failure. By the way, the patients who are more likely to develop respiratory failure should receive inspiratory muscle training exercises combined with general rehabilitation principles. Also, diaphragm kinesiotaping should be included in the rehabilitation protocol.

Effect of Early Rehabilitation on Walking Independence and Health-Related Quality of Life in Patients With Chronic Foot Wounds: A Multicenter Randomized Clinical Trial.

Rehabilitation is usually provided to patients with chronic foot wounds (CFWs) after surgery. This study aimed to assess whether early postoperative rehabilitation could maintain walking independence in hospitalized patients with CFWs. This single-blind, randomized clinical trial was performed between September 10, 2018 and March 2019, involving 60 patients who underwent both surgical procedures and rehabilitation. Participants were randomly allocated into the early rehabilitation (EG, n = 30) or the control (CG, n = 30) groups. EG received early rehabilitation immediately after surgery, while CG received late rehabilitation after wound closure. Both groups received rehabilitation sessions 5 times per week until discharge. The primary outcome was walking independence, measured via Functional Independence Measure (FIM)-gait scores. Secondary outcomes included health-related quality of life (HRQoL) using EuroQol 5 dimensions 5-level (EQ-5D-5L) and the presence of rehabilitation-related adverse events, including dehiscence of wounds and falls. Differences in intervention timing effects were analyzed using nonparametric split-plot factorial design analysis, including Fisher's exact test, Mann-Whitney U test, and Wilcoxon signed-rank test (P < .05). Out of the 60 participants, 53 patients completed the discharge follow up. Three participants (10.0%) from the EG and 4 (13.3%) from the CG dropped out due to postoperative complications unrelated to rehabilitation intervention. No rehabilitation-related adverse events were found. Participants in the EG maintained greater FIM-gait scores during hospitalization than the CG (difference, -1; P = .0001), with a difference of 0 (P = .109) at discharge. EQ-5D-5L significantly improved in both groups (EG: difference, 0.13 [P = .014], CG: difference, 0.17 [P = .0074]). The EG intervention was associated more with maintaining walking independence at discharge than CG intervention. Postoperative rehabilitation improved HRQoL without adverse events, indicating that clinicians should recommend early rehabilitation for patients with CFW to enhance walking independence.

The Importance of Neuropsychology in the Early Rehabilitation of Patients with Critical Illness after Acute COVID Infection

Abstract: The current literature has insufficiently examined the potential benefits of implementing early neuropsychological interventions for critically ill patients who have experienced COVID-19. To address this research gap, we conducted a descriptive analysis of clinical and neuropsychological data from N = 29 critically ill patients with COVID-19 admitted to an early neurological rehabilitation facility. Most patients had been diagnosed with critical illness polyneuropathy (CIP), and one-third exhibited additional brain damage. Upon admission, all patients exhibited severe cognitive impairments, demonstrating significant improvement following neuropsychological therapy. Nonetheless, the neurocognitive outcomes at discharge displayed a high cognitive and psychoemotional status variability. This paper presents the neuropsychological treatment concept we employed and discusses challenges encountered while treating critically ill patients with cognitive impairments.

A study on the functional and radiological outcome with complications in the management of proximal humerus fractures operated with proximal humerus internal locking osteosynthesis system

Background: A number of opinions exist regarding the management of proximal humerus fractures starting from conservative to tension band-wiring to internal fixation with plates. The aim of this study is to assess the functional outcome, the radiological outcome and the complications associated with the management of proximal humerus fractures treated with proximal humerus interlocking osteosynthesis system (PHILOS). Methods: A prospective descriptive study was undertaken comprising of 40 patients. Closed proximal humerus fractures meeting Neer’s criteria for operative displacement were enrolled. Patients underwent open reduction internal fixation with PHILOS plate. Post-operative radiological outcome was estimated with follow-up x-rays, functional outcome using the Constant and Murley score. Results: 60% patients were female, with the most common mode of injury being fall at a ground level. Late complications were noted in 25% of patients, which were malunion 5%, joint stiffness 10%, joint instability 5% and heterotopic ossification 5%. The mean Constant and Murley score was 79.5 and it was found to be statistically significant to the type of fracture according to the Neer’s classification (Kruskal Wallis test, p=0.005). Joint stiffness was also found to be statistically significantly correlated to the type of fracture pattern (Chi square test, p=0.016). The average time to union was 10 weeks. Conclusions: Thus, by this study it can be expressed due to appropriate articular reduction by open reduction and by the use of a fixed angle implant like the PHILOS plate, operative management of proximal humerus fractures by the said implant is a viable option to enable quick and early rehabilitation of patients.

EFFICIENCY OF EARLY REHABILITATION OF PATIENTS AFTER ISCHEMIC STROKE

Introduction: the relevance of determining the effectiveness of early rehabilitation of patients after an ischemic stroke is high, as it solves a number of important medical and social problems of society.&#x0D; The aim: to determine the possibilities and effectiveness of early rehabilitation of patients after an ischemic stroke according to the data of literary sources.&#x0D; Materials and methods: the research was conducted based on the results of the analysis of the world results of scientific research and the existing mechanisms and documents of international societies for determining the possibilities and effectiveness of early rehabilitation of patients after an ischemic stroke. The search for scientific information was performed using domestic and foreign Internet resources of Google Scholar, PubMed, Medscape, Scopus and Web of Science databases, etc.&#x0D; The results of the study: It was determined that the primary and quite effective measure in the treatment of patients after an ischemic stroke is the early start of rehabilitation measures, which improves the survival of brain cells due to an increase in cerebral blood flow, which reduces ischemic necrosis of neurons and revitalizes part of neurons and significantly reduces the post-stroke level disability of patients. It was established that a significant yet undetermined issue in early rehabilitation is the effectiveness of early mobilization and its intensity, and the effectiveness of the rehabilitation strategy is entirely based on the correct combination of the time from the onset of the stroke and the intensity of mobilization&#x0D; Conclusions: the study determined that early rehabilitation intervention in ischemic stroke is significantly effective and economically feasible, and the effectiveness and feasibility of early intensive mobilization is currently a rather controversial issue.