Inpatient Medical Rehabilitation Research Articles

Medical rehabilitation of patients after surgical treatment of prostate adenoma at the third outpatient stage of medical rehabilitation with inclusion of extracorporeal magnetic stimulation

Medical rehabilitation of patients after surgical treatment of prostate adenoma at the third outpatient stage of medical rehabilitation with inclusion of extracorporeal magnetic stimulation

Prediction of cervicalgia regression after surgery for cervical osteochondrosis

In the medical rehabilitation of patients with cervical osteochondrosis, a surgery is one of the stages in the treatment of this spinal pathology. However, the use of modern high-tech diagnostic and treatment methods does not always make it possible to achieve such a result of surgical intervention that would satisfy both the patient and the attending physicians. Due to this, we are obliged to constantly study and develop new diagnostic and therapeutic measures that could help improve the quality of treatment of clinical manifestations of cervical osteochondrosis. The multifactorial analysis of data about patients with cervical osteochondrosis allowed creating a database of various diagnostic and prognostic factors, on the basis of which the «Method for predicting the regression of cervicalgia intensity after surgery for cervical osteochondrosis» was developed depending on the severity of the identified diagnostic and prognostic factors and the volume of the upcoming surgical intervention. The proposed method of predicting the regression of cervicalgia intensity after surgery for cervical osteochondrosis can serve as an integral part of a comprehensive preoperative examination of patients with this spinal pathology. As a result of applying the proposed diagnostic method, additional opportunities arise to guide the surgeon to an individual set of surgical measures with the most promising outcome. Moreover, comfortable psychological conditions are created for the patient as fear and uncertainty in the result of the upcoming treatment are eliminated, which gives him / her confidence in the outcome of the upcoming operation and helps to improve treatment results and reduce the disability of patients. The work is based on the analysis of the results of a comprehensive clinical examination, treatment, and follow-up of 457 patients who underwent surgical treatment for cervical osteochondrosis. The reliability of predicting the regression of cervicalgia intensity after surgery for cervical osteochondrosis is 96.9 %.

Osteoporotic Vertebral Compression Fractures: Medical, Social Aspects, Clinical Picture, Treatment and Medical Rehabilitation. A Review

INTRODUCTION. Osteoporosis is one of the most common metabolic skeletal diseases in the world, which is characterized by a decrease in bone tissue strength and an increased risk of fractures with minimal trauma, including pathological vertebral compression fractures (VCFs). VCFs are accompanied by a decrease in the quality of life of patients with osteoporosis due to a pronounced pain syndrome, sleep problems, decreased motor and social activity, a high risk of falls and fractures, the development of pathological spinal deformities, decreased lung capacity and increased number of comorbid diseases. In this regard, timely treatment and medical rehabilitation in patients with osteoporosis and VCFs are of particular importance to restore functionality, reduce the risk of developing new fractures, disability and death.
 MAIN CONTENT OF THE REVIEW. The literature review is the analysis of 7 domestic and 49 foreign literary sources, which was used to describe the prevalence, medical and social significance and clinical picture of osteoporotic VCFs. It provides data on modern methods of drug and non-drug treatment of patients with VCFs. The effectiveness and limitations of the use of physical therapy methods in the rehabilitation of patients with pathological spinal fractures are described in detail.
 CONCLUSION. It is concluded that VCFs pose a significant healthcare burden due to their high prevalence and negative impact on the quality of life of older patients with osteoporosis. Osteoporotic VCFs lead to the development of severe back pain, limited mobility, spinal deformities, loss of height and permanent disability. An effective strategy for the treatment and rehabilitation of patients with osteoporotic VCFs should include the use analgesics, orthotics, correction of nutritional deficiency, elimination of vitamin D and calcium deficiency, modern methods of physical therapy, fall prevention and timely prescription of effective drugs for pathogenetic therapy of osteoporosis to reduce the risk of pathological fractures in the future and ensure a high level of functioning and of the quality of life.

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.

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. 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). 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. 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.

Using Performance Status to Identify Risk of Acute Care Transfer in Inpatient Cancer Rehabilitation

ObjectiveTo identify patient factors associated with acute care transfer (ACT) among cancer survivors admitted for inpatient medical rehabilitation. DesignAn exploratory, observational design was used to analyze retrospective data from electronic medical records. SettingData were obtained from 3 separate inpatient rehabilitation hospitals within a private rehabilitation hospital system in the Northeast. ParticipantsMedical records were reviewed and analyzed for a total of 416 patients with a confirmed oncologic diagnosis treated in 1 of the inpatient rehabilitation hospitals between January and December 2020. InterventionsNot applicable. Main Outcome MeasuresThe primary outcome measure was the incidence of an ACT. Covariates included the adapted Karnofsky Performance Scale (KPS) for inpatient rehabilitation, demographic information, admission date, re-admission status, discharge destination, and cancer-related variables, such as primary cancer diagnosis and presence/location of metastases. ResultsOne in 5 patients (21.2%) were transferred to acute care. Patients with hematologic cancer had a higher risk of ACT compared with those with central nervous system (CNS) cancer. Lower functional status, measured by the adapted KPS, was associated with a higher likelihood of ACT. Patients with an admission KPS score indicating the need for maximum assistance had the highest transfer rate (59.1%). ConclusionsThese findings highlight the medical complexity of this population and increased risk of an interrupted rehabilitation stay. Considering patients’ performance status, cancer type, and extent of disease may be important when assessing the appropriateness of IRF admission relative to patient quality of life. Earlier and improved understanding of the patient's prognosis will allow the cancer rehabilitation program to meet the patient's unique needs and facilitate an appropriate discharge to the community in an optimal window of time.

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.

Assessment of Long COVID in Medical Rehabilitation

The aim of the study was to provide an insight into the care situation of long COVID patients in inpatient medical rehabilitation facilities in Germany. For this purpose, a standardized online survey was conducted among 1,080 inpatient medical rehabilitation facilities in Germany. A total of 338 cases were available for the analysis. Of these, 173 (51%) reported treating long COVID. The cumulative total number of rehabilitants with long COVID treated in the facilities up to the time of the survey was 11,948. The results showed that rehabilitation facilities were mostly prepared for the care of patients with Long COVID. Lack of capacity was reported especially by those rehabilitation facilities that treated rehabilitants with long COVID in pneumology departments. Furthermore, capacity bottlenecks were related to the total number of patients with long COVID in the rehabilitation facility ("proportion of rehabilitants with long COVID to all rehabilitants in the department"). Heterogeneity was found in the treatment concept for long COVID and the allocation of patients to a specific department. The results of the long COVID inventory underline the importance of medical rehabilitation in the treatment of the long-term health and participation-related consequences of COVID-19.

Effectiveness of Physiotherapy Methods in Medical Rehabilitation of Patients with Shoulder and Scapular Pain Syndrome in a Sanatorium: a Randomized Clinical Study

INTRODUCTION. The high prevalence of shoulder pain syndrome (SPS) determines the relevance of the development of new comprehensive methods of rehabilitation of this category of patients.
 AIM. To evaluate the clinical effectiveness of shockwave therapy (SWT) and pulsed low-frequency electrostatic field (PLEF) in patients with SPS undergoing medical rehabilitation in a sanatorium-resort organization in comparison with traditional health resort treatment.
 MATERIALS AND METHODS. The comparative analysis of medical rehabilitation efficiency was carried out in 90 patients with SPS aged 31–68 years undergoing medical rehabilitation in the health resort complex “Vulan” — a clinical branch of National Medical Research Center for Rehabilitation and Balneology. All patients were divided into 3 groups of 30 persons each by the method of simple randomization. Group 1 patients (control) received traditional health resort treatment, including ozokeritotherapy, physical exercise therapy, electrotherapy with sinusoidal modulated currents and manual massage. Patients of the second group (comparison) received against the background of the above complex 3 SWT procedures on the shoulder joint once a week. Group 3 patients (main group) received, in addition to traditional treatments, 3 SWT and 8 field PLEF treatments administered every other day. The effectiveness of rehabilitation was evaluated according to the severity of pain syndrome (VAS scale), Swanson’s scale for the shoulder. Movement volume before and after rehabilitation was measured with an orthopedic angle gauge. Microcirculation state was assessed by laser Doppler flowmetry (LDF). Leukert scale was used to assess the state of well-being. The results of the study were assessed 18 days after the beginning of rehabil itation measures.
 RESULTS AND DISCUSSION. Patients who additionally received SWT and PLEF against the background of traditional health resort treatment noted a significant reduction in the severity of pain syndrome, while in the main group pain regression was noted earlier (on day 4–5), whereas in the comparison group the same results were obtained by the day 14th . In the control group, patients noted significant changes on the VAS scale only by the end of the rehabilitation course. On the Swanson scale, the most significant positive results were also obtained by the patients in the main group: the pain decreased on average 2.6-fold, the volume of active movements in the shoulder joint increased 2.7-fold, and activity in everyday life 1.9-fold. Statistical differences in the Swanson Scale scores with the comparison group were obtained with regard to pain syndrome and volume of active movements. When comparing with the control group, reliable differences were revealed in all Swanson’s scale indicators in both the main group and the comparison group. When studying the dynamics of microcirculation according to LDF data, it was noted that reliable changes in the main indices of the LDF-gram were revealed only in the groups that received innovative physical therapy interventions.
 CONCLUSION. Thus, the inclusion of modern physiotherapeutic techniques of SWT and PLEF into the program of health resort treatment of patients with SPS allows to increase significantly the efficiency of medical rehabilitation carried out in the sanatorium organization.

ЭФФЕКТИВНОСТЬ МЕДИЦИНСКОЙ РЕАБИЛИТАЦИИ ПАЦИЕНТОВ С ПОСЛЕДСТВИЯМИ ТРАВМ И ЗАБОЛЕВАНИЯМИ КОСТНО-МЫШЕЧНОЙ СИСТЕМЫ В РЕСПУБЛИКЕ ТАТАРСТАН

Abstract. Introduction. Musculoskeletal and connective-tissue disorders rank the third among diseases leading to primary disablement among adults in the Republic of Tatarstan. They are characterized by long healing periods and contractures. Timely rehabilitation of patients allows preventing many complications and restoring their former activity levels. Aim: To assess changes in the medical rehabilitation for patients with musculoskeletal and peripheral nervous disorders in the Republic of Tatarstan in 2020-2022. Materials and Methods. Clinical and expert-assessment statistical processing techniques, generalization method, and comparative analysis were used to process the data of patients with musculoskeletal and peripheral nervous disorders, who underwent medical rehabilitation in the Republic of Tatarstan in 2020-2022. We also used the statistical data made available by the Head Office of Medical and Social Expert Assessment in the Republic of Tatarstan at the Ministry of Labor and Social Protection of the Russian Federation. Ministry of Health of the Republic of Tatarstan. Statistical analysis was performed using the GraphPad Prism 9 software. Quantitative variables are presented as medians and quartiles, while the qualitative one as percentages. Comparative analysis (for dependent samples) was based on identifying the statistical significance of differences between indicators using Wilcoxon criterion. Differences at p < 0.05 were considered statistically significant. Results and Discussion. In 2022, there was a 49-% increase in the number of patients who were provided with medical rehabilitation in the Republic of Tatarstan, including a 69-% increase in the number of patients with diseases relating to musculoskeletal and peripheral nervous systems. Number of first-declared disabled people (disability group 3) decreased by 3.8% in 2022, since as medical rehabilitation of patients with musculoskeletal and peripheral nervous disorders increased by 42% in inpatient hospital conditions and by 76% in outpatient and polyclinic conditions in 2022. Conclusions. Increasing number of patients with musculoskeletal and connective-tissue disorders, who had undergone medical rehabilitation at the inpatient and outpatient stages, led to a decrease in the number of first-declared enabled people (disability group 3) by 3.8%. This substantiates the need for further development of medical rehabilitation in traumatology and orthopedics to preserve the labor potential, stabilize the disability levels, return the patient to social and domestic activities, and create optimal conditions for their active engagement in social activities and health resumption.

Medical Rehabilitation of Patients with Post-COVID-19 Syndrome-A Comparison of Aerobic Interval and Continuous Training.

Post-COVID-19 syndrome (PCS) is a multisystemic disorder marked by impaired physical performance as one lead symptom. Since it has been suggested that endurance training as part of medical rehabilitation may be effective in improving physical performance capacity in PCS, this study aimed to compare different modes of aerobic endurance training. A total of 110 PCS patients (49.3 ± 11.8 years; 38% women; time after infection = 260.2 ± 127.5 days) underwent detailed clinical screening including symptom-limited cardiopulmonary exercise testing at admission and after 4-6 weeks of inpatient medical rehabilitation. Questionnaires were used to assess disease perception. Patients performed controlled isocaloric cycle ergometer training (3-5 sessions/week; 18 min) as either continuous training (CT) at 50% of maximal workload or as interval training (IT; load = 60%, relief = 30%). Outcomes of PCS patients were compared to coronary artery disease patients (CAD; n = 96) to evaluate overall training effectiveness. Training participation was comparable between the groups, with no indication of training-specific exercise-induced fatigue. Overall, PCS patients improved significantly by a mean of 6.8 ± 12.1% for W at VT1; 3.1 ± 10.0% for VO2 at VT1; 5.5 ± 14.7% for O2 pulse at VT1; 7.5 ± 15.0% for W at VO2peak; 2.7 ± 11.0% for VO2peak and 4.6 ± 12.4% for O2 pulse at VO2peak (all p < 0.05) with no significant differences between groups (p > 0.05). Both groups showed reduced levels of fatigue, anxiety, and depression as well as improved quality of life and wellbeing (all p < 0.05). Compared to guideline-based cardiac rehabilitation, PCS patients showed a similar improvement in workload and oxygen uptake compared to CAD patients. PCS patients benefit from aerobic endurance training performed as moderate continuous or interval training as part of a medical rehabilitation program in terms of improved physical exercise capacity and disease perception. The results for PCS patients are comparable to the guideline-based rehabilitation of CAD patients.

Machine learning-based identification of determinants for rehabilitation success and future healthcare use prevention in patients with high-grade, chronic, nonspecific low back pain: an individual data 7-year follow-up analysis on 154,167 individuals.

To individually prescribe rehabilitation contents, it is of importance to know and quantify factors for rehabilitation success and the risk for a future healthcare use. The objective of our multivariable prediction model was to determine factors of rehabilitation success and the risk for a future healthcare use in patients with high-grade, chronic low back pain. We included members of the German pension fund who participated from 2012 to 2019 in multimodal medical rehabilitation with physical and psychological treatment strategies because of low back pain (ICD10:M54.5). Candidate prognostic factors for rehabilitation success and for a future healthcare use were identified using Gradient Boosting Machines and Random Forest algorithms in the R-package caret on a 70% training and a 30% test set. We analysed data from 154,167 patients; 8015 with a second medical rehabilitation measure and 5161 who retired because of low back pain within the study period. The root-mean-square errors ranged between 494 (recurrent rehabilitation) and 523 (retirement) days ( R2 = 0.183-0.229), whereas the prediction accuracy ranged between 81.9% for the prediction of the rehabilitation outcome, and 94.8% for the future healthcare use prediction model. Many modifiable prognostic factors (such as duration of the rehabilitation [inverted u-shaped], type of the rehabilitation, and aftercare measure), nonmodifiable prognostic factors (such as sex and age), and disease-specific factors (such as sick leave days before the rehabilitation [linear positive] together with the pain grades) for rehabilitation success were identified. Inpatient medical rehabilitation programmes (3 weeks) may be more effective in preventing a second rehabilitation measure and/or early retirement because of low back pain compared with outpatient rehabilitation programs. Subsequent implementation of additional exercise programmes, cognitive behavioural aftercare treatment, and following scheduled aftercare are likely to be beneficial.

Biofeedback Therapy Pelvic Floor Muscle Training Program Efficacy vs. Traditional Methods of Medical Rehabilitation in Patients with Chronic Endometritis Associated with Pelvic Floor Muscle Failure: a Prospective Randomized Study

INTRODUCTION. Inflammatory diseases of the pelvic organs are one of the main reasons for the decline in the reproductive potential of women. In this regard, modern technologies are being developed, including non-drug methods for correcting functional disorders associated with the inflammatory process. The creation of personalized programs based on the use of natural and preformed physical factors in patients with a burdened obstetric and gynecological history is still an urgent task.&#x0D; AIM. To evaluate the clinical effectiveness of the use of pelvic floor muscle training as part of a complex method for the treatment of patients with chronic endometritis, combined with pelvic floor muscle failure.&#x0D; MATERIALS AND METHODS. The randomized study included 55 patients with chronic endometritis associated with pelvic floor muscle failure. 28 women of the main group received a complex of amplipulse therapy procedures (10 procedures), sodium chloride baths (8 procedures) and pelvic floor muscle training using the biofeedback method (10 sessions). In 27 patients of the comparison group, restorative treatment was used, including only amplipulse therapy and sodium chloride baths.&#x0D; RESULTS AND DISCUSSION. In both groups, after treatment, there was a significantly significant increase in the uterine arterial perfusion index (p 0.01), as well as a significant improvement in the structure and thickness of the endometrium according to transvaginal ultrasound (p 0.001), an improvement in situational anxiety according to the Spielberger-Khanin scale (p 0.001). In addition, in patients of the main group, restoration of normal anatomical relationships of the pelvic floor muscles was observed according to translabial ultrasound of the pelvic floor (p 0.05).&#x0D; CONCLUSION. Taking into account the high efficiency of the short-term treatment program in patients of the main group, the use of pelvic floor muscle training as part of a complex rehabilitation treatment is recommended for chronic endometritis in combination with grade III genital prolapse.

Application of Magnetic Resonance Imaging in Medical Rehabilitation Еffectiveness Assessing for Patients with Knee Joint Osteoarthritis: а Review

INTRODUCTION. In recent years, magnetic resonance imaging (MRI) has been increasingly used to diagnose early osteoarthritis (OA). Taking into account the fact that nowadays pharmacological agents are not effective enough and often lead to allergization of the body, there is a need to search for new non-drug methods of treatment of patients with knee joint OA that have proven effectiveness.&#x0D; AIM. To analyze scientific evidence on the use of MRI as an objective method of assessing the effectiveness of medical rehabilitation of patients with knee OA.&#x0D; MATERIALS AND METHODS. We searched for publications in the PEDro and PubMed for the period from 2000 to March 2023. Suitable articles were to reflect the use of MRI as a criterion for the effectiveness of medical rehabilitation in patients with OA of the knee joint.&#x0D; RESULTS AND DISCUSSION. As a result of a search in electronic resources, the largest number of works on the subject under study was found in PubMed. According to the literature quantitative analysis, 7256 works were identified, which reflect the use of MRI in medical rehabilitation. The publications in which the effectiveness of medical rehabilitation of patients with knee OA was evaluated by researchers using MRI accounted for 2.5 % of the total number. Most of the publications were in international databases, while they were practically absent in the Russian ones.&#x0D; CONCLUSION. Despite the scarce research on the matter, we can distinguish the following rehabilitation medicine methods with a proven effect on the ligamentous apparatus, cartilage and soft tissues of the knee joint in patients with OA, according to MRI data: shockwave therapy, physical therapy and ultrasound therapy. However, the need for further scientific research in this direction is obvious.

The Effect of Mechanotherapy and Virtual Reality on Cardiovascular Activity and the Severity of Shortness of Breath in Patients with Post COVID-19 Syndrome: A Prospective Randomized Study

INTRODUCTION. At present, there is an urgent need to develop modern rehabilitation programs for COVID-19 patients with long-lasting residual symptoms of the disease, primarily from the cardiopulmonary system.&#x0D; AIM. To assess the impact of a comprehensive medical rehabilitation program using virtual reality technologies, robotic mechanotherapy with biofeedback and interactive balance therapy on the severity of hypoxic syndrome, shortness of breath and cardiovascular activity in patients who have undergone COVID-19 and have manifestations of post-COVID syndrome (long COVID).&#x0D; MATERIAL AND METHODS. The study sample consisted of 120 patients aged 40 to 70 years who had suffered COVID-19 within 16 months prior to inclusion in the study and had manifestations of SPCN, who were randomized into 2 groups. In the main group (n = 60), a new complex of medical rehabilitation was prescribed against the background of basic treatment: 1) sessions on the robotic biofeedback simulator for lower limb muscle training Con-Trex, #10; 2) balance therapy (sensorimotor training) using the biofeedback simulator Stabilan 012, #10; 3) training on the rehabilitation interactive markerless system with virtual reality technology Nirvana, #10. In the control group (n = 60) patients received only basic treatment: 1) a special complex of therapeutic gymnastics performed in the hall with a physical therapy instructor, № 10; 2) low-intensity laser radiation, № 10; 3) speleo-exposure, № 10; 4) medical massage on the chest area, № 10. Research methods included clinical examination, anamnesis collection and cardiopulmonary testing and assessment of dyspnea severity before the beginning of rehabilitation and immediately after its completion.&#x0D; RESULTS AND DISCUSSION. In the period from 1 to 6 months after COVID-19, 90.0 % of patients had dyspnea, as well as a decrease in peak oxygen consumption and high values of heart rate (HR), systolic and diastolic blood pressure (BP) at peak exercise. The application of a new complex of medical rehabilitation in patients with post-COVID disorder syndrome contributed to a more significant, than in the standard method of rehabilitation, increase in cardiorespiratory endurance, which is manifested in the increase in the maximum work performed by 12.9 % and oxygen consumption of the first ventilation threshold by 6.3 % and in the decrease in diastolic BP at peak load by an average of 7 mm Hg. hg according to cardiopulmonary testing, as well as an increase in the proportion of patients with mild (up to 60.0 %) or no dyspnoea (up to 26 %) and a decrease in the number of patients with moderate dyspnoea (up to 13.3 %), severe and very severe dyspnoea (up to 0 %). Most of the authors in their studies also note a high frequency of shortness of breath, along with such manifestations of post- COVID-19 syndrome as general weakness, poor exercise tolerance.&#x0D; CONCLUSION. A new comprehensive medical rehabilitation program using virtual reality technologies, robotic mechanotherapy with biofeedback and interactive balance therapy are recommended to reduce the severity of hypoxic syndrome and dyspnea and improve cardiovascular performance in patients with post-COVID syndrome.

Comparative assessment of clinical efficacy of different methods of medical rehabilitation in patients with rhinosinusitis polyposa

The article presents the results of a comparative assessment of the effectiveness of the course application of therapeutic physical factors (alternating magnetic field and low-intensity laser radiation) in complex medical rehabilitation of patients with moderate and severe rhinosinusitis polyposa with uncontrolled course. It was shown that the use of genetically engineered biological therapy (GEBT) with dupilumab contributed to the positive dynamics of the clinical parameters of sinonasal polyposis. Complementing GEBT with the course application of an alternating magnetic field was accompanied by an increase in the regression of the main clinical manifestations of rhinosinusitis polyposa. The maximum corrective activity was noted in the group with the complex use of therapeutic physical factors — an alternating magnetic field and low-intensity laser radiation against the background of GEBT. The growth is based on the ability of the complex use of physiotherapeutic factors to cause the development of synergistic phenomena through the use of corrective effects of different modality, having different mechanisms of action. The physical factors under consideration are able to improve hemo- and microcirculation in the area of chronic inflammation, exhibit anti-inflammatory, analgesic, and trophic-stimulating effects, which, together with the inactivation of the main pro-inflammatory interleukins of type 2 inflammation, enhances the sanogenetic potential that determines the duration of remission. Taking into account the chronic relapsing nature of the rhinosinusitis polyposa course, it is planned to conduct prolonged studies covering a follow-up period of 1.5–2 years.

Possibilities of personalized pharmacotherapy and medical rehabilitation of patients with long COVID from the perspective of clinical metabolomics

Introduction. The material presents the results of the study of the effectiveness of the drug Ethylmethylhydroxypyridine malate in patients with long COVID, based on the dynamics of clinical manifestations and metabolomic parameters responsible for the level of oxidative stress. Aim. Evaluation of efficacy and registration of adverse reactions of ethylmethylhydroxypyridine malate administration to decrease oxidative stress level and reduce symptoms of asthenia and cognitive disorders in patients with long COVID. Materials and methods. 24 patients diagnosed with U09.9 “Condition after COVID-19 unspecified” were included in a non-randomized controlled prospective study, Patients were divided into 2 groups of 12 each. The experimental group received Ethylmethylhydroxypyridine malate tablets chewable 100 mg in a dosage of 400 mg/day. Clinical assessment by scales (mMRC dyspnea scale; 6-minute walk test (6MWT); MFI-20 subjective asthenia assessment scale; Montreal Cognitive Assessment Scale (MoCA); Barthel Baseline Functional Activity Rating Scale), and determination of metabolomic parameters were performed on days 1 and 14–18 of the study. Results. Use of the drug ethylmethylhydroxypyridine malate in patients with long COVID, led to a decrease in the level of oxidative stress, and normalization of mitochondrial function, as well as more pronounced improvements of the clinical picture. According to the scale of evaluation of asthenia (MFI-20) in the group of patients who received ethylmethylhydroxypyridine malate improvement of 21% was noted, in the control group improvement of 13% was noted. According to cognitive impairment assessment scale (MoCA), the drug group showed 20% improvement, while the control group showed 12,5% improvement. Conclusion. The drug ethylmethylhydroxypyridine malate tablets chewable 100 mg in a dosage of 400 mg/day demonstrates clinical efficacy characterized by, among other things, a decrease in oxidative stress, as well as clinical safety due to the absence of development of adverse reactions in patients with long COVID.

A modern approach to the rehabilitation of patients with fractures of the bones of the lower extremities

BACKGROUND: General injury rates tend to increase in most federal districts of Russia. The patients with fractures of the bones of the lower extremities reaches for 8.525% of the total number of patients with fractures. Fractures of the bones of the lower extremities are characterized by long period of reparation, persistent contractures, a violation of the congruence of the articular surfaces, and changes in the biomechanics of walking. Only full course of rehabilitation can eliminate the these complications and restore the previous motor activity.&#x0D; АIMS: The study aimed to analyze the structure of injuries in patients of the traumatology department and to present and the results of the recovery of patients with fractures of the bones of the lower extremities using and algorithm of organization of medical rehabilitation in the case study.&#x0D; MATERIALS AND METHODS: A retrospective analysis of statistical data on 995 patients of the traumatology department № 1 of the Kazan City Clinical Hospital, who underwent 981 operations, was carried out. Randomly selected two groups of patients ― I main (n=45) and II control (n=45). Patients of group II after the treatment at the trauma center underwent outpatient medical rehabilitation, group I received inpatient medical rehabilitation in the rehabilitation department of the Kazan City Clinical Hospital № 7. In a hospital setting, a comprehensive rehabilitation program included physiotherapy exercises, CPM-veloergometry, exercises on rehabilitation simulators, the PNF kinesiotherapy technique, etc.&#x0D; RESULTS: A more pronounced statistically significant positive dynamics at the end of the course of medical rehabilitation was noted in patients of group I (reduction of pain syndrome, increased joint mobility, degree of dependence on others, increased mobility index, the ability to dress independently, maintain body position in space, reduced dysfunction in lifting and carrying objects, walking disorders, and caring for body parts). The dynamics of motor function and psycho-emotional sphere also improved to a greater extent in patients of group I.&#x0D; CONCLUSIONS: The effectiveness of the presented algorithm of organization of medical rehabilitation of patients with fractures of the bones of the lower extremities is confirmed by the results of present study. It is revealed that patients in the I (main) group showed more significant improvement in functions, activity and participation, a decrease of disability, reduce of pain, anxiety and depression, as well as an increase of the level of quality of life compared to patients of group II (control), who did not receive comprehensive medical rehabilitation in the hospital (p 0.1).

Complex electrocerebral therapy in medical rehabilitation of patients with dry eye syndrome associated with the novel coronavirus infection

The purpose of the study is to evaluate the effectiveness of complex medical rehabilitation using integrated electrocerebral therapy with patients suffering from a dry eye syndrome associated with the novel coronavirus infection. Material and methods. There have been examined 62 patients with a dry eye syndrome associated with the novel coronavirus infection. They were divided into 2 groups by simple randomization. In the group of comparison/GC (30 people), the patients were prescribed exercise therapy, small-group psychotherapy, dry carbon dioxide baths, and tear replacement therapy (Systane-Balance); in the main group/MG (32 people), the patients additionally had a complex electrocerebral therapy — transcranial micropolarization (TCMP) and diencephalic brain stimulation (DEBS). The efficacy was monitored by the dynamics of the ocular auxiliary function study (Schirmer’s and Norn’s tests) and quality of life assessment using the Ocular surface disease index (OSDI). Results. The comparative analysis of biomicroscopy parameters showed that the patients of the MG experienced hyperemia leveling, reduced swelling of the eyelid margins, reduction of scaly and sebaceous deposits, and restoration of the corneal epithelium to a greater extent. Notably, the differences with the final values of the GC were statistically significant (t=12.3; p&lt;0.001). The analysis of Schirmer I test scores and the Norn samples showed that in the GC the dynamics of the indicators was lower by 8–10 %, while the preservation of the treatment effect was only 3 months, compared to 6 months in the MG. Notably, the contingency of these indicators with OSDI visual quality data was revealed with a high degree of reliability (r = 74; r=72; p &lt; 0.001). Conclusion. Carrying out rehabilitation measures for patients with a dry eye syndrome associated with the novel coronavirus infection using combined electrocerebral therapy ensures the preservation of vision and restoration of their quality of life.

Medical rehabilitation of patients with flat feet after surgical treatment: scientometric analysis

Background: In the postoperative rehabilitation of patients operated on for a flat foot, an important task is to relieve pain and locomotor dysfunction syndrome, since these disorders reduce the quality of life of patients, and can also lead to relapse and the appearance of new deformities. Currently, an urgent issue is the choice of rehabilitation technologies that have a high level of evidence. In order to determine the totality of such technologies, it is necessary to conduct a scientometric analysis of publications in available databases. The purpose of the study: to conduct a scientometric analysis of evidence-based studies with high methodological quality on the use of rehabilitation technologies in patients with flat feet after surgical treatment. Methods: The analysis included the publications for the period from 2000 to 2023 from 4 databases: eLibrary, PubMed, Cochrane Library, and PEDro. Publications were evaluated on a ten-point PEDro score. The level of evidence was assessed according to GOST R 56034–2014 in accordance with the Order of the Ministry of Health of the Russian Federation No. 103n dated 28.02.2019. Results: 4,187 unique publications on flat feet were extracted from the databases. Of these, 479 were devoted to rehabilitation and conservative treatment. The final analysis included 4 publications devoted to the conservative treatment of a flat foot. According to the results of the analysis, a decrease in pain syndrome and an improvement in the quality of life in patients were revealed with the use of physical exercises, orthotics, and myofascial release in conservative therapy of the flat foot. There was also an improvement in biomechanical parameters when using orthotics and myofascial release. The data on the effect of orthotics and physical exercises on foot deformities are contradictory. Conclusion: Due to the common pathogenesis of pain syndrome and biomechanical disorders in patients with flat feet and in patients in the postoperative period, physical exercises, orthotic insoles, and myofascial release can be used as rehabilitation techniques, but evidence of their effectiveness for this group of patients requires additional research.

Advanced Application of Digital Technologies for Rehabilitation and Remote Monitoring of Patients with Post-Covid Syndrom: a Review

AIM. To describe modern technologies for telerehabilitation and remote monitoring of the condition of patients who have undergone a new coronavirus infection COVID-19, and to show the experience of the National Medical Research Center for Rehabilitation and Balneology of the in the clinical testing and development of these technologies. MATERIAL AND METHODS. A consistent analysis of 39 modern sources of scientific literature (including systematic reviews and original researches), selected by the keywords of this article and including the most up-to-date publications in rating peer-reviewed journals, allows us to conclude the following. The use of digital methods of rehabilitation and diagnostics in institutions of restorative medicine in patients who have had a new coronavirus infection can reduce the risks of undesirable outcomes and the burden on medical personnel, reduce the severity of manifestations of post-COVID-19 syndrome and improve the quality of life of patients. RESULTS AND DISCUSSIONS. The article describes the prospects for the use of modern intelligent technologies (virtual reality, biofeedback mechanotherapy and remote analysis of the cardiovascular system, motor activity and psychoemotional sphere) in the treatment and rehabilitation programs of patients who have suffered a new coronavirus infection COVID-19. The clinical aspects of the new coronavirus infection that determine the use of digital technologies and remote monitoring in the medical rehabilitation of patients with postcovid syndrome are presented. The technologies of virtual reality, biofeedback mechanotherapy and remote monitoring developed for the rehabilitation of patients with postcovid syndrome at the National Medical Research Center for Rehabilitation and Balneology are described in detail, data on their effectiveness, as well as limitations and difficulties possible with the introduction of digital methods of rehabilitation and telemedicine methods are given. The analysis of psychological factors of distress caused by a new coronavirus infection and approaches to their remote telemonitoring were carried out. CONCLUSION. The effectiveness of new digital rehabilitation methods that have recently appeared in clinical practice allows us to conclude that the use of modern intelligent technologies is promising. Among them, it should be noted such technologies as virtual reality, mechanotherapy with biofeedback and remote analysis of the performance of the cardiovascular system, motor activity and psycho-emotional sphere in the treatment and rehabilitation programs of patients with post-ovoid syndrome.