Rehabilitation Objectives Research Articles

Changes in the quality of life and activities limitations of subacute hemiplegics patients in Cotonou

To study evolution of quality of life and activities limitations of hemiplegics patients the first three months after the onset of their disease. Prospective, longitudinal study aimed to be descriptive and analytical type. It consisted in evaluation quality of life (using EuroQOL and SF 36 scale), activities limitations (using Barthel and MRS scores) and superiors functions (with MMSE) of 38 hemiplegics patients, once a month for three months, from August 2015 to January 2016. They were without impairment of comprehension, in acute phase, residing in Cotonou or its surroundings and having consented to participate to the study. Evolution of their parameters was evaluated for each month by comparing changes in scores of parameters for the evaluation period with the mean of recovery score of patients. Disorders of superior functions were observed 89.5%. It was about hemineglect, apraxia, asomatognosia, anosognosia and expression aphasia. Already in the first month, whether activities limitations or quality of life, they have improved. As for disorders of superior functions, they were generally stable in the first month (85.3%) or the second one (64.8%). Evolution of patients quality of life was significantly associated with their activities limitations. This study allowed to consider early the prognostic factors of the functional recovery and to set rehabilitation objective in order to optimize management of hemiplegics patients.

Evaluation of Cognitive Functioning in the Context of Rehabilitation for Visual Impairment in Older Adults: A Case Series

ABSTRACTAims: As the risk of visual impairment increases with age, so does the risk of developing cognitive impairment. Detection of cognitive deficits in people with visual impairments is a challenge and it remains unclear to what extent cognitive issues impact daily habits and the rehabilitation process. The present study aimed to (1) verify the consistency between the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) (“Blind” versions) and the therapist's observations of elderly individuals in low-vision rehabilitation (LVR), and (2) document how cognitive difficulties may influence LVR and the satisfactory carrying-out of life habits. Methods: Six elderly individuals who received LVR completed the MMSE and MoCA (“Blind” versions) and Assessment of Life Habits (LIFE-H). The therapist rated the achievement of rehabilitation objectives, clients' cognitive functioning and its impact on the rehabilitation process. Results: All participants obtained scores within the normative score range for both tests except for one participant on the MoCA. The therapist perceived that four out of six participants had cognitive difficulties significant enough to hinder the rehabilitation process and these persons required more adaptations to therapy. All participants were satisfied with their life habits despite remaining functional limitations and the need for assistance. Conclusions: In this sample, standardized cognitive tests had limited utility to predict the complexity of LVR. Even if present, cognitive difficulties do not preclude rehabilitation for even severe visual impairment in elderly persons and does not imply significantly longer or more intense rehabilitation.

Facilitators and barriers to physical activity in people with chronic low back pain: A qualitative study.

BackgroundFor medical teams, one of the main objectives of rehabilitation for people with chronic low back pain is adherence to physical activity (PA).ObjectiveThe objective of this study was to identify PA barriers and facilitators in this population.MethodsThis qualitative study included 4 discussion groups and 16 semi-structured interviews conducted among people with non-specific chronic low back pain who were involved in a specific rehabilitation program or seen in primary care settings.ResultsThree main themes were identified: physical factors, psychological factors and socio-environmental factors. The main barrier to PA practice is pain. Psychological barriers were associated with the difficulty in integrating PA in the person’s daily life. Environmental barriers were dominated by lack of time. Facilitators identified associated the supervised nature of the physical activity (supervision by professionals) and group practice, which improved people’s adherence.ConclusionThe results of this study will allow teams to target relevant educational objectives for these people and develop dedicated self-management programs.

Analysis of home-based rehabilitation in patients with motor impairment in primary care: a prospective observational study

BackgroundThe purpose of health and social policies is to encourage older people more longevity, remain free of disability and experience quality of life while living in their homes.The aim of this study was to describe the characteristics of 473 patients diagnosed with motor impairment in primary care, the objectives of home-based rehabilitation and its functional impact.MethodsThis prospective observational study was conducted in the Almería Health District. The analysed variables included age, gender, secondary diagnosis, Barthel Index (BI), physiotherapeutic objectives and techniques, and number of sessions.ResultsThe sample had a mean age of 83 years, and 59% were women. The assessed conditions with a high prevalence included osteoarticular pathology (55%), Alzheimer’s disease (15.1%), cardiovascular disease (13.7%) and stroke (6.5%). The techniques applied mainly consisted of functional exercises (57.1%), caregiver education (13.8%), and technical assistance (5.7%). There were statistically significant differences (t = −15.79; p < 0.001) between initial (X = 34.8) and final BI (X = 48.1), with an improvement of 13.4 points in patients’ functional capacity (95% confidence interval [CI]: −15.0 to −11.7). An equation was constructed to predict patients’ final BI as a function of the initial BI using a multiple linear regression model. The regression model explained 78% of the variance in patients with motor impairment.ConclusionsImportant improvements were obtained in terms of functional capacity with a mean of ten sessions of physiotherapy. Lower patient age was correlated with higher initial and final functional capacities in primary care. This study aimed to present a useful starting point for decision making among management and health administration regarding this population group by approaching the process from the reality of practice and in relation to the rehabilitation provided.Trial registrationClinicalTrials.gov identifier: NCT02715245; Date of registration: 18 January 2016.

Late-recovery from “permanent” vegetative state in the context of severe traumatic brain injury: A case report exploring objective and subjective aspects of recovery and rehabilitation

ABSTRACTThis article provides a detailed outline of the recovery of a young male patient during his emergence from a vegetative state (VS) 19 months after suffering a severe traumatic brain injury. Several similar cases have been documented, but these tend not to consider the subjective experience of the patient or family; our aim was therefore to provide a detailed account that emphasises our neuropsychological exploration of the impact of the injury on this person, and looks at the experience of his mother along the timeline from his accident to the end of a successful period in rehabilitation. Clinical details are presented including standardised and non-standard assessments, neuropsychological interventions, as well as reflections from the patient himself. Moreover, qualitative data from an interview with his mother is used to illustrate the emotional impact on family of such a vacillating diagnostic status and prognosis for the future. We conclude that late-emergence from VS is increasingly documented and further cases must be published to better understand this phenomenon. The present case illustrates the emotional impact this situation can have on a patient and his or her family, and gives an important insight into a patient’s view of his or her life and identity following such an event.

Rehabilitation of revision total hip replacement: A multi-centre survey of current practice.

Demand for revision total hip replacement (RTHR) is increasing. Outcomes after RTHR are varied, with reasonable pain relief but smaller gains in function and mobility. Whether sub-optimal rehabilitation contributes to poorer functional outcomes is unclear. Current rehabilitation is not well defined and there is little research into RTHR rehabilitation. To gather information about the current rehabilitation of patients undergoing planned, single-stage revision or re-revision THR surgery. An online survey was developed and sent to clinicians at 117 orthopaedic centres in England, Wales and Northern Ireland. Questions were asked about standard rehabilitation practice pre-operatively, post-operatively and immediately after discharge. The frequency (%) of responses to closed questions was analysed and free-text comments were summarized thematically. There were 133 respondents: mostly physiotherapists (92, 69%) and occupational therapists (39, 29%). Pre-operative education was common (112, 84%) but not uniform, and for 52 (46%) the same as for primary THR patients. Respondents were more likely to agree about the general objectives of rehabilitation, for example gait re-education with walking aids (93, 70%), and retraining functional mobility (92, 69%) rather than about specific elements including exercise prescription, duration of hip precautions and provision of occupational therapy. The provision of rehabilitation following discharge varied considerably. This survey adds to sparse information about rehabilitation RTHR. No consensus emerged about optimal rehabilitation. The diversity in approach and lack of clear structure suggests work is needed to develop rehabilitation interventions that are tailored to this population.

Penal reform in Africa: The case of prison chaplaincy

Penal reform is a challenge across the world. In Africa, those who are incarcerated are especially vulnerable and often deprived of basic human rights. Prison conditions are generally dire, resources are limited, and at times undue force is used to control inmates. The public attitude towards offenders is also not encouraging. Reform efforts include finding alternative ways of sentencing such as community service, making use of halfway houses and reducing sentences. These efforts have not yet yielded the desired results. The four principles of retribution, deterrence, incapacitation and rehabilitation guide penal practice in Africa. Retribution and rehabilitation stand in tension. Deterrence and incapacitation aim at forcing inmates to conform to the social order. The article argues that prison chaplaincy can make a valuable contribution to restoring the dignity and humanity of those who are incarcerated. Chaplaincy can contribute to improving attitudes and practices in the penal system and society. In addition to the social objective of rehabilitation, prison ministry can, on a spiritual level, also facilitate repentance, forgiveness and reconciliation. The aim is the holistic restoration of human beings.

Rehabilitation of a patient with stroke

Stroke is a significant cause of long-term disability world-wide. The post-stroke disabilities are due to loss of locomotion, activity of daily living, cognition and communication skills. Rehabilitation is an integral part of medical management and continues longitudinally through acute care, post-acute care and community reintegration. The objectives of stroke rehabilitation are to maximize the functional independence, minimize the disabilities, reintegrate back into the home and community and improve the self-esteem of patient. A comprehensive stroke rehabilitation service should provide early assessment of impairments and disabilities, management and prevention of complications and well-organized rehabilitation program in both in-patient and out-patient settings. A multidisciplinary or interdisciplinary team approach is necessary to reduce the post-stroke disabilities. It has many members, including physicians, physical therapists, occupational therapists, speech and language pathologists, orthotist, psychotherapists, social workers, vocational rehabilitation therapists, rehabilitation nurse, patients, families and other caregivers. Physicians caring for patients with stroke during rehabilitation must be aware of potential medical complications, as well as a number of special problems that may complicate recovery, including cognitive deficits, aphasia, dysphagia, urinary incontinence, shoulder pain, spasticity, falls and depression. Involvement of patient and caregivers in the rehabilitation process is essential. This article outlines the salient features of the early comprehensive rehabilitation after stroke.

Riparian rehabilitation planning in an urban-rural gradient: Integrating social needs and ecological conditions.

In the present context of global change and search for sustainability, we detected a gap between restoration and society: local communities are usually only considered as threats or disturbances when planning for restoration. To bridge this gap, we propose a landscape design framework for planning riparian rehabilitation in an urban-rural gradient. A spatial multi-criteria analysis was used to assess the priority of riversides by considering two rehabilitation objectives simultaneously-socio-environmental and ecological-and two sets of criteria were designed according to these objectives. The assessment made it possible to identify 17 priority sites for riparian rehabilitation that were associated with different conditions along the gradient. The double goal setting enabled a dual consideration of citizens, both as beneficiaries and potential impacts to rehabilitation, and the criteria selected incorporated the multi-dimensional nature of the environment. This approach can potentially be adapted and implemented in any other anthropic-natural interface throughout the world.

Progress Toward Lake Trout Rehabilitation at a Stocked and Unstocked Reef in Southern Lake Michigan

AbstractSustained efforts to restore naturally reproducing populations through the stocking of marked juvenile Lake Trout Salvelinus namaycush have occurred since the 1960s but have been largely unsuccessful in achieving that goal. Julian's Reef in southwestern Lake Michigan has been a targeted Lake Trout rehabilitation site since 1985 and was designated a first‐priority site in a revised management strategy for Lake Trout rehabilitation in 2011. We evaluated progress toward rehabilitation objectives for spawning Lake Trout at Julian's Reef and compared that progress to unstocked Waukegan Reef nearby in light of a recent increase to approximately 50% unmarked adults at both sites, as detected by annual fall spawning assessments. We observed significant progress toward meeting the rehabilitation objectives for adult Lake Trout in southern Lake Michigan. The spawning populations at Julian's Reef and Waukegan Reef did not differ in relative abundance, sex ratio, age structure, or spawner sources (stocking location; clipped or unclipped) except that the sex ratio at Waukegan Reef during the assessment period favored female spawners. These results suggest that the adult Lake Trout population is strong enough to permit natural recruitment in southern Lake Michigan, warranting the need to identify the source of natural reproduction so as to fully evaluate factors related to rehabilitation success. We propose that management agencies should consider investigating other unstocked sites where Lake Trout may be spawning and should revise their rehabilitation plans to include actions that could limit detrimental impacts on naturally reproducing populations where they exist.Received October 15, 2015; accepted July 22, 2016 Published online November 10, 2016

Effective restoration of aquatic ecosystems: scaling the barriers

The focus of ecosystem restoration has recently shifted from pure rehabilitation objectives to both improving ecological functioning and the delivery of ecosystem services. However, these different targets need to be integrated to create a unified, synergistic, and balanced restoration approach. This should be done by combining state‐of‐the‐art knowledge from natural and social sciences to create manageable units of restoration that consider both the temporal and multiple spatial scales of ecosystems, legislative units, and policy agendas. Only by considering these aspects combined can we accomplish more cost‐efficient restoration resulting in resilient ecosystems that provide a wealth of ecosystem services and the possibility for sustainable economic development in the future. We propose a novel conceptual framework that will yield more effective ecosystem restoration: the Operational Restoration Unit. This is based on scale‐dependent restoration actions that can adhere easily to the relevant environmental legislation, encompass the spatial and temporal resilience of aquatic ecosystems, and consider the sum of human pressures acting on water bodies. This opens up possibilities for an effective integration of the restoration agenda into the delivery of major policy objectives of economic growth, regional development, and human security. WIREs Water 2017, 4:e1190. doi: 10.1002/wat2.1190This article is categorized under: Water and Life &gt; Conservation, Management, and Awareness Human Water &gt; Water Governance

Return to Work: A Cut-Off of FIM Gain with Montebello Rehabilitation Factor Score in Order to Identify Predictive Factors in Subjects with Acquired Brain Injury.

Return to work (RTW) for people with acquired brain injury (ABI) represents a main objective of rehabilitation: this work presents a strong correlation between personal well-being and quality of life. The aim of this study is to investigate the prognostic factors that can predict RTW after ABI (traumatic or non- traumatic aetiology) in patients without disorders of consciousness (e.g. coma, vegetative or minimally conscious state) at the beginning of their admission to rehabilitation. At the end of a 6-month follow-up after discharge, data were successfully collected in 69 patients. The rehabilitation effectiveness (functional Recovery) between admission and discharge was assessed by Functional Independent Measure (FIM) gain, through the Montebello Rehabilitation Factor Score (MRFS), which was obtained as follows: (discharge FIM—admission FIM)/(Maximum possible FIM—Admission FIM) x 100. The cut-off value (criterion) deriving from MRFS, which helped identify RTW patients, resulted in .659 (sn 88.9%; sp 52.4%). Considering the Mini Mental State Examination (MMSE) and the MRFS data, the multivariable binary logistic regression analysis presented 62.96% of correct RTW classification cases, 80.95% of non-RTW leading to an overall satisfactory predictability of 73.91%. The results of the present study suggest that occupational therapy intervention could modify cut-off in patients with an MFRS close to target at the end of an in-hospital rehabilitative program thus developing their capabilities and consequently surpassing cut-off itself.

Interest of isokinetic in the rehabilitation of the knee in hemiplegic

The isokinetic is a means of objective and reproducible assessment of muscle strength, it is widely used in rehabilitation especially joint and muscle pathology. There is little applied to the neurological disease. To report the experience of our rehabilitation field service isokinetic knee of hemiplegic through three observations. Observation 1: 65 years old patient, who suffered an ischemic stroke right for 2 years, who presented a quadriceps spasticity 2, walking with a cane, he received isokinetic knee rehabilitation for a year, with exercises concentric, eccentric and proprioceptive. There was an improvement of walking and climbing and descending stairs. Observation 2: patient aged 42, suffered an ischemic stroke left for 2 years and a half, which has a quadriceps spasticity 2, slow walk unaided, after about ten therapy sessions, patients reported an improvement walking, with increase of the rate of the step, as well as ease of the ascent and descent of stairs. Observation 3: patient aged 30, suffered a stroke from left ischemic year and a half, spasticity of the quadriceps 1, slow walk unaided, after about ten therapy sessions comprising concentric and proprioceptive exercises, the patient reported improved walking and isokinetic evaluation noted improved quadriceps and hamstrings deficit of hemiplegic side. The hemiplegic lower limb recovery after stroke is often favorable. The objective of rehabilitation of the walk is ambulatory autonomy, walking simple, and performance improvement: in security, speed, autonomy, efficiency, and aesthetics. Various rehabilitation techniques are used depending on the main problems presented by the patient. The isokinetic remains one of the least used means but has shown its efficiency objective.

Improvement of walking abilities in femoral amputees with a distal weight bearing implant

Following a transfemoral (TF) amputation, the ability to walk with a prosthesis is the main objective of rehabilitation. The achieved speed of walking is considered a determining factor in the amputee's perception of quality of life. This experimental before-after study evaluates the walking abilities and improvement of important parameters such as gait, walking speed, pain and hours of prosthesis use in transfemoral amputees after placing a novel femoral implant that permits distal weight bearing of the residuum within a socket, adapted for distal load bearing. Thirty TF amputees with an amputee history of more than 12 months received an all-inside femoral implant, comprised of a femoral stem and a polyethylene spacer that allows distal load of the residuum within an adapted socket. The post-intervention follow-up period was 14 months. The applied rehabilitation schedule was our standard one, and no hardware changes were allowed during the follow-up period of 14 months, except for the adapted socket. Functionality was evaluated using the standard 2-minute walk test (2MWT) and the physiological cost index (PCI). To date 19 patients (8 trauma, 8 vascular and 3 tumour patients) have finished the follow-up period. Prior to the implant placement the mean 2MWT covered distance was 103.16 m (SD = 33.03), and at 14 months was 124.95 m (SD = 39.22), ( P = 0.00); an increase of 21.1%. The initial mean Visual Analogue Pain (VAS) score was 2.26 (SD = 2.76) and at 14 months 0.42 (SD = 0.77), ( P < 0.005), a reduction of 81.4%. The PCI reduction (D heart rate/walking speed) was not statistically significant ( P < 0.596). The observed increase of oxygen consumption in the vascular group (+ 20.15%) also indicates an additional beneficial general health improvement for this type of patients. The results of the present study show significant improvements in walking speed, pain reduction, hours of prosthesis use and general health status at 14 months after having received a femoral distal load implant in patients of different ethiology.

Comparison of individualized virtual reality- and group-based rehabilitation in older adults with chronic stroke in community settings: a pilot randomized controlled trial

IntroductionThis study aimed to compare the effects of individualized virtual reality (VR)- and group-based rehabilitation on upper extremity function, activities of daily living (ADL), and health-related quality of life (HRQoL) in older adults with chronic stroke in community settings. MethodsTwenty-six older adults with chronic stroke were randomly assigned to the VR-based rehabilitation group (VRG) or the group-based rehabilitation group (GG). In both groups, a single 30-min session was conducted 3days per week for 8 weeks. The Fugl-Meyer Assessment (FMA), Manual Function Test (MFT), Box and Block Test (BBT), Modified Barthel Index (MBI), and 12-item Short Form Health Survey (SF-12) were administered. ResultsBetween-group analysis revealed a greater improvement in the FMA (P=0.004) and MFT (P=0.008) in the VRG than in the GG. Within-group analysis confirmed an increase in the objectively measured upper extremity function, as assessed using the FMA (P<0.001) and MFT (P<0.001), in the VRG, whereas improvements in patient-reported measures, such as the MBI (P=0.020) and the physical component of the SF-12 (P=0.012), were observed in the GG. ConclusionsHealth professionals might need to consider the different effects of VR- and group-based rehabilitation programs in community settings when selecting treatment depending on the specific objective of rehabilitation.

The influence of NDT-Bobath and PNF methods on the field support and total path length measure foot pressure (COP) in patients after stroke

In stroke patients, the NDT – (Bobath – Neurodevelopmental Treatment) and PNF (Proprioceptive Neuromuscular Facilitation) methods are used to achieve the main objective of rehabilitation, which aims at the restoration of maximum patient independence in the shortest possible period of time (especially the balance of the body).The aim of the study is to evaluate the effect of the NDT-Bobath and PNF methods on the field support and total path length measure foot pressure (COP) in patients after stroke.The study included 72 patients aged from 20 to 69 years after ischemic stroke with Hemiparesis. The patients were divided into 4 groups by a simple randomization. The criteria for this division were: the body side (right or left) affected by paresis and the applied rehabilitation methods. All the patients were applied the recommended kinesitherapeutic method (randomized), 35 therapy sessions, every day for a period of six weeks. Before initiation of therapy and after 6 weeks was measured the total area of the support and path length (COP (Center Of Pressure) measure foot pressure) using stabilometer platform – alpha. The results were statistically analyzed.After treatment studied traits decreased in all groups. The greatest improvement was obtained in groups with NDT-Bobath therapy. NDT-Bobath method for improving the balance of the body is a more effective method of treatment in comparison with of the PNF method. In stroke patients, the effectiveness of NDT-Bobath method does not depend on hand paresis.

Outcomes after acute traumatic spinal cord injury in Botswana: from admission to discharge.

Prospective follow-up study. To increase the knowledge regarding clinical and functional outcomes after traumatic spinal cord injuries (TSCI) in a resource-constrained setting. A special focus was placed on secondary complications such as pressure ulcers. The national referral hospital in Gaborone, Botswana. The study included all patients admitted with an acute TSCI during a 2-year period (n=39). Data collection was conducted at the time of discharge, and clinical characteristics, length of stay and pressure ulcers were analysed using descriptive and inferential statistics. Completeness of injury and presence of pressure ulcers were the factors found to significantly prolong hospitalization, which was 5 months (median). One patient died before discharge and one was discharged to rehabilitation in South Africa; all other patients were living with close or distant family members after discharge. Patients were supplied with electrical or manual active wheelchairs. Self-catheterization or suprapubic catheters were the main methods for bladder management, and ano-rectal stimulation to manage the bowel. Pressure ulcers, urinary tract infections and pain were the most frequent complications during in-patient care. Rehabilitation of patients with TSCI in Botswana has been going through big changes, and new rehabilitation objectives, such as techniques used for the management of bladder and bowel dysfunctions and the provision of technical aids, have been implemented, which likely can contribute to an overall improvement in the outcomes. However, basic care at the general wards is still lagging behind, causing high rates of pressure ulcers that significantly extend hospitalization periods.

Improvement in walking abilities in transfemoral amputees with a distal weight bearing implant.

The ability to walk with a prosthesis is the main objective of rehabilitation following amputation, and distance and speed of walking achieved are considered determining factors in amputees' perception of quality-of-life. To assess walking abilities and improvement in gait distance and speed parameters in patients undergoing transfemoral amputation with a femoral implant that allows distal support of the residuum. Experimental before-and-after study. Ten transfemoral amputation patients received a titanium implant that allowed distal weight bearing of the residuum within the socket. The post-intervention follow-up period was 14 months. We evaluated the functionality using a 2-min walk test and the physiological cost index. The etiology of amputation was traumatic in six patients (60%). The mean 2-min walk test score was 98.4 ± 19.5 m prior to the femoral implant and 122.5 ± 26.1 m at 14 months ( p < 0.008), representing an improvement of 24.5%. The mean gait speed prior to the femoral implant was 0.82 ± 0.16 and 1.02 ± 0.21 m/s at 14 months ( p < 0.008). The physiological cost index showed no differences ( p < 0.55). The results of this study show an improvement in the distance walked and gait speed in amputees 14 months after having received a femoral implant. Clinical relevance This article provides additional insight into the use of a femoral implant that allows distal support of the residuum to improve walking abilities and gait distance and speed parameters in patients undergoing transfemoral amputation, mainly those of vascular origin.

Психологические особенности пожилых как объект социальной реабилитации ветеранов труда

Психологические особенности пожилых как объект социальной реабилитации ветеранов труда

Peculiarities of rehabilitation of the patents presenting with coxosteoathritis and gonosteoathritis

Under the term of osteoarthritis (OA) is currently meant the clinical condition with the predominant syndrome that manifests itself as the combination of joint pain and compromised functional activity leading to the deterioration of the quality of life for the affected patients. The principal objective of rehabilitation of the patients presenting with OA which practically all of them strongly need after each next aggravation of the pathological process consists in the reduction of the pain syndrome, elimination of synovitis, restoration of the functional ability of the joints lost during the exacerbation, and, eventually, the improvement of the quality of life in the patients experiencing the constantly progressing degenerative process in the musculoskeletal apparatus. The effectiveness of the rehabilitative treatment was evaluated based on the following criteria: the degree of pain alleviation, the increase in the levels of joint functional activity, and the improvement of the general condition of the patients. These criteria were chosen according to the recommendations of the OMERACT (Outcome measures in Rheumatology) international working group. Also, the quality of life related to the health status and side effects of the rehabilitative measures were estimated. One of the most important aspects of the treatment of the patients with osteoarthritis bearing in mind frequent cases of co-morbidity is the scientifically-sound substantiation of the application of the non-medicinal technologies of physical therapy, remedial gymnastics, and massage for the management of the secondary aseptic inflammatory process and the subsequent rehabilitation for the restoration of the compromised locomotory stereotype and, as the result, the improvement of the quality of life in these patients. One of the effective methods for physical therapy used in the treatment and rehabilitation of patients with OA is hyperbaric gas cryotherapy (HBGCT). This method is based on the rapid withdrawal of heat from the organism that responds by the compensatory and/or reflective activation of the heat production processes in the tissues as a consequence of stimulation of metabolic processes, vascular, neuroendocrine and immune systems of regulation of homeostasis producing the desirable therapeutic effect in the form of elimination of secondary aseptic inflammation and progression of the OA-associated degenerative process. In this context, the objective of the present research consisted of the scientific substantiation of hyperbaric gas cryotherapy as a component of the combined treatment of the patients presenting with gonosteoathritis and coxosteoathrosis. The article was designed to report the results of the combined treatment of 110 patients (22 men and 88 women) at the age from 40 to 75 years suffering gonosteoathritis and coxosteoathrosis of the II-III stages (based on the classification of Kellgren). They were randomly divided into two groups (each comprised of 55 patients). The patients of the main group, unlike those in the control one (group of comparison) were given, in addition to the traditional treatments such as instrumental physical therapy, balneotherapy, remedial gymnastics, and massage, hyperbaric gas cryotherapy with the assessment of the results based on the Lequesne, WOMAC, Likert international indexes. Such an approach allowed to identify the predictors for the use of hyperbaric gas cryotherapy and to raise by 33%, in comparison with controls, the effectiveness of the combined treatment of the patients with osteoarthrosis of the large joints. The dispersion analysis has demonstrated the high clinical efficiency of the proposed therapeutic modality in 90% of the cases of gonosteoathritis and in 64% of the patients presenting with coxosteoathritis. These data were not statistically different from those characterizing the effectiveness of HBGCT in the patients with coxosteoathritis included in the group of comparison.