Rehabilitation Protocol For Patients Research Articles

Method to Recover from Meniscus Tearing

A torn meniscus, a prevalent knee injury, holds significant importance due to its impact on post-surgery outcomes. Failure to undergo timely and appropriate rehabilitation can result in numerous complications, including muscle atrophy and limited joint mobility. Current research has made strides in assessing the efficacy of various rehabilitation protocols for patients with meniscus tears, aiming to restore strength and functionality to the affected knee. Despite progress, challenges persist, such as determining the optimal timing and intensity of rehabilitation exercises and addressing individual variability in recovery rates. Thus, the crux lies in selecting tailored treatments that address the specific nature and severity of the meniscus injury, aiming to mitigate post-operative complications like muscle atrophy and ensure comprehensive recovery.

Musical and electrical stimulation as intervention in disorder of consciousness (DOC) patients: A randomised cross-over trial.

Disorders of consciousness (DOC), i.e., unresponsive wakefulness syndrome (UWS) or vegetative state (VS) and minimally conscious state (MCS), are conditions that can arise from severe brain injury, inducing widespread functional changes. Given the damaging implications resulting from these conditions, there is an increasing need for rehabilitation treatments aimed at enhancing the level of consciousness, the quality of life, and creating new recovery perspectives for the patients. Music may represent an additional rehabilitative tool in contexts where cognition and language are severely compromised, such as among DOC patients. A further type of rehabilitation strategies for DOC patients consists of Non-Invasive Brain Stimulation techniques (NIBS), including transcranial electrical stimulation (tES), affecting neural excitability and promoting brain plasticity. We here propose a novel rehabilitation protocol for DOC patients that combines music-based intervention and NIBS in neurological patients. The main objectives are (i) to assess the residual neuroplastic processes in DOC patients exposed to music, (ii) to determine the putative neural modulation and the clinical outcome in DOC patients of non-pharmacological strategies, i.e., tES(control condition), and music stimulation, and (iii) to evaluate the putative positive impact of this intervention on caregiver's burden and psychological distress. This is a randomised cross-over trial in which a total of 30 participants will be randomly allocated to one of three different combinations of conditions: (i) Music only, (ii) tES only (control condition), (iii) Music + tES. The music intervention will consist of listening to an individually tailored playlist including familiar and self-relevant music together with fixed songs; concerning NIBS, tES will be applied for 20 minutes every day, 5 times a week, for two weeks. After these stimulations two weeks of placebo treatments will follow, with sham stimulation combined with noise for other two weeks. The primary outcomes will be clinical, i.e., based on the differences in the scores obtained on the neuropsychological tests, such as Coma Recovery Scale-Revised, and neurophysiological measures as EEG, collected pre-intervention, post-intervention and post-placebo. This study proposes a novel rehabilitation protocol for patients with DOC including a combined intervention of music and NIBS. Considering the need for rigorous longitudinal randomised controlled trials for people with severe brain injury disease, the results of this study will be highly informative for highlighting and implementing the putative beneficial role of music and NIBS in rehabilitation treatments. ClinicalTrials.gov identifier: NCT05706831, registered on January 30, 2023.

Сlinical experience with the modified rehabilitation protocol after trapeziometa- carpal joint resection suspension interposition autotendoplasty.

Aim. The aim of this study is to assess the effectiveness of a modified postoperative rehabilitation protocol in patients who underwent their first carpometacarpal joint resection suspension interposition autotendoplasty.Materials and Methods. The study included 52 patients treated for trapeziometacarpal joint osteoarthritis stage II—IV according to the Eaton-Littler and Kellgren-Lawrence classification in the Upper Limbs Surgery Department of the Bauman City Clinical Hospital from 2017 to 2022. All patients underwent trapeziometacarpal joint resection suspension interposition autotendoplasty and a course of rehabilitation. The evaluation of surgical treatment and rehabilitation results was carried out based on indicators on the VAS, DASH, and hand grip strength scales 12 months after surgery.Results. The complex treatment resulted in the complete restoration of hand function. Twelve months after surgery, there was a significant improvement in hand functional parameters. According to the DASH scale, the improvement was 80 % compared to the preoperative level (p = 0.000). The pain syndrome, according to the VAS scale, decreased by 84 % from the baseline (p = 0.000). Affected hand grip strength reached its maximum value of 26.2 kg, exceeding the preoperative level by 67 % (p = 0.006).Conclusion. The modified rehabilitation protocol used after performing trapeziometacarpal joint resection suspension interposition autotendoplasty in clinical practice enabled the full restoration of affected hand function.

Influence of frontal-to-parietal connectivity in pseudoneglect: A cortico-cortical paired associative stimulation study

Pseudoneglect is a set of visuospatial biases that entails a behavioral advantage for stimuli appearing in the left hemifield compared to the right one. Although right hemisphere dominance for visuospatial processing has been invoked to explain this phenomenon, its neurophysiological mechanisms are still debated, and the role of intra- and inter-hemispheric connectivity is yet to be defined. The present study explored the possibility of modulating pseudoneglect in healthy participants through a cortico-cortical paired associative stimulation protocol (ccPAS): a non-invasive brain stimulation protocol that manipulates the interplay between brain regions through the repeated, time-locked coupling of two transcranial magnetic stimulation (TMS) pulses. In the first experiment, healthy participants underwent a frontal-to-parietal (FP) and a parietal-to-frontal (PF) ccPAS. In the FP protocol, the first TMS pulse targeted the right frontal eye field (FEF), and the second pulse the right inferior parietal lobule (IPL), two critical areas for visuospatial and attentional processing. In the PF condition, the order of the pulses was reversed. In both protocols, the inter-stimulus interval (ISI) was 10 ms. Before and after stimulation, pseudoneglect was assessed with a landmark task and a manual line bisection task. A second experiment controlled for ccPAS timing dependency by testing FP-ccPAS with a longer ISI of 100 ms. Results showed that after administering the FP-ccPAS with the ISI of 10 ms, participants’ leftward bias in the landmark task increased significantly, with no effects in the manual line bisection task. The other two protocols tested were ineffective. Our findings showed that ccPAS could be used to modulate pseudoneglect by exploiting frontal-to-parietal connectivity, possibly through increased top-down attentional control. FP-ccPAS could represent a promising tool to investigate connectivity properties within visuospatial and attentional networks in the healthy and as a potential rehabilitation protocol in patients suffering from severe visuospatial pathologies.

A retrospective study of Cerebrolysin in patients with moderate to severe traumatic brain injury: Cognitive and functional outcomes.

In this retrospective study, we aimed to evaluate the effects of the neurotrophic compound Cerebrolysin on executive, cognitive, and functional performance in patients with traumatic brain injury (TBI) with a highly severe disability level. A total of 44 patients were included in the study, with 33 patients in the control group and 11 patients in the interventional group who received intravenous infusions of 30 mL Cerebrolysin. Both groups received standard rehabilitation therapy following the rehabilitation protocol for patients with TBI at Hospital Clínico Mutual de Seguridad. Functional and cognitive scales were evaluated at baseline, at four months, and at the endpoint of the intervention therapy at seven months (on average). The results revealed a significant improvement in the Cerebrolysin-treated group compared to the control group. Specifically, patients who received Cerebrolysin showed a moderate residual disability and a significant reduction in the need for care. Concerning the promising results and considering the limitations of the retrospective study design, we suggest that randomized controlled studies be initiated to corroborate the positive findings for Cerebrolysin in patients with moderate to severe brain trauma.

Cerebral circulation improvement method using boxing and orthodontic mouthguards

Due to the active hostilities in Ukraine, the rates of exacerbations of chronic diseases, trauma to the head and spinal column due to both gunshot wounds and increased force load on the musculoskeletal system have increased significantly. The issue of improving rehabilitation approaches is relevant due to the available statistics on cerebral blood supply pathologies. Given the need for affordable and effective methods of musculoskeletal rehabilitation, the study aims to investigate the effectiveness of orthodontic and boxing mouthguards on the state of cerebral blood vessels. Five patients with a history of contusion and post-traumatic stress disorder were studied at the Kyiv Regional Centre for Mental Health using a physical examination and rheoencephalography. The use of orthodontic and boxing mouthguards showed positive dynamics in the restoration of maxillofacial muscles, compensation of bite height and satisfactory blood supply to brain structures compared to the baseline data. The analysis of the encephalograms showed rheoencephalographic signs of improvement in cerebral circulation: a decrease in spasm of the arterial walls of cerebral vessels, compensation for blood supply deficit, improvement of blood circulation in the carotid basin and venous outflow in the deficit mode were detected. In the examined patients with injuries, pain syndrome and constant mechanical stress on the musculoskeletal system, a decrease in pain and improvement of muscle symmetry in the affected anatomical areas were noted while wearing orthodontic and boxing mouthguards. The obtained results can be implemented in the rehabilitation protocols for patients with concussion, brain concussion, and spinal and skull injuries. The availability and effectiveness of the proposed technique allow it to be used for patients with chronic diseases of the cardiovascular system, especially with complicated blood supply to brain structures

Early mobilization following elective ankle lateral collateral ligament reconstruction in adults.

Emergency departments in the UK are overwhelmed with musculoskeletal trauma, 50 % of which resulting from ligamentous injuries. Of these, ankle sprains are the most prevalent, however with poor rehabilitation in the recovery period, 20 % of patients may develop chronic instability that may necessitate operative reconstruction. At present, there are no national guidelines or protocols to help direct postoperative rehabilitation and determine weightbearing status. Our aim is to review the existing literature that investigated postoperative outcomes following different rehabilitation protocols in patients with Chronic Lateral Collateral Ligament (CLCL) instability. A literature search was performed via Medline, Embase and Pubmed databases using the terms 'ankle', 'lateral ligament', 'repair'. 'reconstruction' and 'early mobilisation'. A total of 19 studies were identified after filtering that they were English language papers. A gray literature search was also performed using the Google search engine. Based on the literature reviewed, patients undergoing early mobilisation and Range Of Movement (ROM) following lateral ligament reconstruction for chronic instability seem to have better functional outcomes and earlier return to work and sports. This is however in the short-term, and there are no medium to long-term studies evaluating the effects of early mobilisation on ankle stability. Furthermore, there may be an increased risk of postoperative complications, mainly wound related, with early mobilization compared to delayed mobilization. Further randomized studies and long-term prospective studies with larger cohorts of patients are required to improve the level of evidence available but based on current literature it would appear that controlled early ROM and weight-bearing is advisable in patients undergoing surgery for CLCL instability.

Flexible Dynamic Pressure Sensor for Insole Based on Inverse Viscoelastic Model

The quantification of the plantar arch load and its surface distribution is essential to improve locomotion in many sports as well as rehabilitation protocols for patients. This article has a threefold objective. First, it focuses on the design, fabrication, and characterization of dynamic force sensors, based on both a single and multilayer of Velostat piezoresistive polymer. A matrix of <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$9\times $ </tex-math></inline-formula> 3 flexible pressure sensors has been developed to analyze and recognize plantar movements. Second, two models linking the plantar pressure to the resistance of the piezoresistive material, with and without taking into account the viscoelastic nature of the piezoresistive material, are proposed. Finally, an inversion of the models is employed in order to estimate plantar pressure as a function of the variation in material resistance. An evaluation of the plantar pressure for various movements is also proposed.

Outcomes with Additional Mirror Theraphy to Rehabilitation Protocol in Patients with Shoulder Impingement Syndrome: A Prospective Randomized Controlled Study

Mirror therapy is a method that increases the functionality of the affected extremity and is effective in the treatment of chronic pain. In this study, we aimed to investigate the effect of mirror therapy on shoulder impingement syndrome. The study included 62 participants, including 31 in the intervention group (IG) and 31 in the control group (CG) who met the inclusion criteria. IG received mirror therapy with conventional physiotherapy while CG received only conventional physiotherapy. The patients were evaluated before treatment and immediately after treatment with Visual Analog Scale (VAS) score for pain, goniometric measurement for shoulder range of motion, modified Constant-Murley score for functionality, and Tampa Kinesiophobia Scale (TSK) for kinesiophobia. After treatment, the change in the VAS score was 5.51 ± 1.89 for IG, 2.80 ± 2.61 for CG, and the significance was p&amp;lt;0.01. The change in the TSK score was 10.83 ± 9.53 for IG and 1.66 ± 4.85 for CG (p&amp;lt;0.01). The change in the total Constant-Murley score was 23.77 ± 11.41 for IG and 9.60 ± 9.70 for CG, and the significance was calculated as p&amp;lt;0.01. This study showed that the addition of mirror therapy to conventional treatment can improve pain severity, functionality, and levels of kinesiophobia in patients with unilateral shoulder impingement syndrome. The decrease in fear of movement along with pain in impingement syndrome has shown that mirror theraphy can be used in the treatment of different diseases for which it has not been used before.

A need to reconsider the rehabilitation protocol in patients with idiopathic Parkinson’s disease: Review analysis

Idiopathic Parkinson’s disease is the second most debilitating and progressive neurodegenerative disease affecting the functional activities in day-to-day life. The motor and non-motor symptoms have shown to be a huge functional loss for the subject which has led to compromise their independence. There are varieties of treatment programs proposed as pharmacological, surgical, rehabilitation, allied therapies but none have proven to be the disease modifying treatments in managing the symptoms of Parkinson’s disease patients. Research has shown that discontinuity in the treatment and diminished effects of treatments have drained care givers physically, emotionally, and financially. In this study we explore the available physiotherapy treatment strategies highlighting the research gaps in articles (n=36). The articles were taken from the databases such as PubMed, Science Direct and Google Scholar by considering the inclusion and exclusion criteria. Though the present research has shown to be significant in improving the motor and non-motor symptoms there are still unanswered questions on the rehabilitation protocols whether they can modify the disease and improve the quality of life among Parkinson’s disease in long term. Exercise have proven to be beneficial, cost effective and low risk which improves the overall health and independence of the patient, however, the mechanism involved are less understood.

Expenditure of early initiation of neuromuscle electrical stimulation after orthopedic surgeries on the hip and knee joints (literature review)

Every year the number of cases of anterior cruciate ligament reconstruction, total hip and knee arthroplasty increases. This leads to the improvement of rehabilitation protocols for patients after surgery to quickly restore normal range of motion and return to normal life. Objective. Provide physical therapists with an evidence-based resource that can guide clinical decision making, thereby enabling clinicians to make effective use of electrical stimulation to improve muscle function in patients after orthopedic operations and increase awareness of the range of applications for neuromuscular electrical stimulation (NMES). Metods. Electronic databases PMC, PUBMED and SCOPUS were used to search the relevant literature, which was published in the period from the creation of databases to December 2020. Additional articles were identified by analyzing bibliographies in systematic reviews. We have reviewed the full text of selected articles to confirm that all included studies meet the stated objectives of the review. Results. In patients after orthopedic surgery on the hip and knee joints, the inclusion of NMES in standard physical therapy significantly increases the strength of the quadriceps muscle compared to conventional physical therapy. Early activation can be helpful to avoid suppression of quadriceps function and atrophy, provide the patient with the most effective course of rehabilitation, and return to active life after anterior cruciate ligament reconstruction or knee arthroplasty. It is also advisable to use NMES as an alternative mechanical prevention of deep vein thrombosis and edema in the early period after hip arthroplasty. In the presented studies, patients tolerated NMES well even when it initiated on 1–2 postoperative days. However, no standardized NMES protocols reported in the literature, so the choice of stimulation parameters is at the discretion of the physician and usually depends on the individual tolerability of the patients.

Conservative versus accelerated rehabilitation after rotator cuff repair: a systematic review and meta-analysis

BackgroundThe purpose of this systematic review and meta-analysis is to compare the conservative and accelerated rehabilitation protocols in patients who underwent arthroscopic rotator cuff repair in terms of clinical outcomes and range of motions at 3, 6, 12, and 24-month follow-up.MethodsAccording to PRISMA guidelines, a systematic review of the literature was performed. For each included article, the following data has been extracted: authors, year, study design, level of evidence, demographic characteristics, follow-up, clinical outcomes, range of motions, and retear events. A meta-analysis was performed to compare accelerated versus conservative rehabilitation protocols after arthroscopic rotator cuff repair. The retear rate, postoperative Constant-Murley score and range of motions at 3, 6, 12, and 24 months of follow-up were the outcomes measured.ResultsThe search strategy yielded 16 level I-II clinical studies. A total of 1424 patients, with 732 patients and 692 in the accelerated and conservative group, were included. The average age (mean ± standard deviation) was 56.1 ± 8.7 and 56.6 ± 9 in the accelerated and conservative group. The mean follow-up was 12.5 months, ranging from 2 to 24 months. The meta-analysis showed no statistically significant differences in terms of retear rate between the groups (P = 0.29). The superiority of the accelerated group was demonstrated in terms of external rotation (P < 0.05) at 3-month follow-up; in terms of forward elevation, external rotation, abduction (P < 0.05), but not in terms of Constant-Murley score at 6-month follow-up; in terms of forward elevation (P < 0.05) at 12-month follow-up. No significant differences between the two group were highlighted at 24-month follow-up.ConclusionsNo statistically significant differences in the retear rate among the accelerated and conservative group have been demonstrated. On the other hand, statistically and clinically significant differences were found in terms of external rotation at 3 and 6 months of follow-up in favour of the accelerated group. However, no differences between the two groups were detected at 24 months follow-up.

Acute Effects of a Combined Strength and Endurance Training Rehabilitation Protocol for Patients in Different Professions with Back Pain

Abstract Objective The purpose of this study was to investigate the effects of a combined strength and endurance training rehabilitation protocol for patients in different professions with back pain. Material and Methods 162 patients (craftsman n=56, preschool teachers n=45 and nurses n=61) were included into a prospective observational study. Peak force of trunk muscles (isometric testing), endurance (PWC130) and back pain dysfunction (ODI) were assessed before (t1) and after (t2) a 3-week-period of individually tailored but not professionally clustered rehabilitation training. Results The ODI (%) disability as well as all trunk muscle peak forces and aerobic endurence improved significantly in all subsamples (p&lt;0.01), with the exception of the preschool teachers. They showed unaltered PWC130 values (p=0.255), which was in turn accompanied by a significant weight gain (+1%, p&lt;0.001), while craftsmen and nurses demonstrated no changes in weight or waist circumference (p&gt;0.05). But all analyses revealed great interindividual variations. Pre-post changes did not differ significantly among the profession groups (p&gt;0.05). Conclusions Interindividual response variations should be considered as a typical finding well known in back pain rehabilitation studies. We did not reveal benefit differences between occupational subsamples after the present combined strength and endurance training protocol. Future research should apply a randomized study design to compare the regular rehabilitation program and enriched programs including specific occupational demands.

Acromioclavicular Joint Injuries: Effective Rehabilitation.

PurposeTo perform a review of the literature focusing on rehabilitation protocols in patients with acromioclavicular (AC) joint injuries treated operatively and nonoperatively and to provide an updated rehabilitation treatment algorithm.MethodsStudies were identified by searching the MEDLINE database from 01/1995 to 09/2020. Included studies contained detailed rehabilitation protocols with physiologic rationale for AC joint injuries. Biomechanical studies, technique articles, radiographic studies, systematic reviews, case studies, editorials, and studies that compared nonoperative versus operative treatment without focus on rehabilitation were excluded. Following identification of the literature, an updated treatment algorithm was created.ResultsThe search strategy yielded 1742 studies, of which 1654 studies were excluded based on title, 60 on the abstract, and 25 on the full manuscript. One study was manually identified using article reference lists, yielding four publications presenting detailed rehabilitation protocols based on physiologic rationale. No randomized controlled trials or comparative studies were identified or cited as a basis for these rehabilitation protocols.ConclusionFew detailed rehabilitation protocols in patients with AC joint injuries have been published. These protocols are limited by their standardization, arbitrary timelines, and provide minimal assessment of individual patient characteristics. The quality of patient care can be improved with more practical guidelines that are goal-oriented and allow for critical thinking among clinicians to address individual patient needs. Three common barriers preventing successful rehabilitation were identified and addressed: Pain, Apprehension, and (anterior chest wall) Stiffness to regain Scapular control, effectively termed “PASS” for AC joint rehabilitation.Clinical RelevanceRehabilitation protocols for AC joint injuries should be less formulaic and instead allow for critical thinking and effective communication among clinicians and therapists to address individual patient needs.

Evaluation of 3 different rehabilitation protocols after rotator cuff repair, and the effectiveness of pool therapy: a randomized control study

Objectives:Exercises performed in water have shown to improve strength and range of motion in various joint pathologies. This study aims to identify the best rehabilitation protocol for patients who undergo arthroscopic rotator cuff repair, and the effectiveness of a pool therapy protocol.Methods:Patients who underwent arthroscopic rotator cuff repair for small to medium sized rotator cuff tears, with small to moderate retraction of the affected tendon and who underwent surgery between 2013 and 2016, were randomized in 3 different groups at the time of surgical indication. Groups: 1. Patients who had rehabilitation with physical therapy and no aquatic protocol; The "Dry group", 2. Patients who had rehabilitation with physical therapy, including an aquatic protocol; The "Pool Group", 3. Patients who had self-rehabilitation alone, with no physical therapist. The "Self Group" follow-up: all patients were assessed by an independent observer. The mean outcome measures consisted of pre and postoperative SSV, Constant score, and patient satisfaction. Patients were followed-up at 4, 8 and 12 weeks postoperatively, as well as in 1 and 2 years.Results:Group 1 (Dry group) and Group 2 (Pool group) showed better Constant scores 2 months postoperatively, although this was not statistically significant. However, patients in group 2 (Pool group) showed statistically better Constant scores and overall satisfaction 3 months postoperatively. All the groups had similar results 6 months, 1 year and 2 years postoperatively, with slightly better outcomes for the Dry and Pool groups compared to the Self group.Conclusion:Water therapy after rotator cuff repair provides better early results compared to traditional "dry" rehabilitation or self-exercise therapy. The results remain better for patients who had pool or dry rehabilitation 1 and 2 years postoperatively, although the difference is not statistically significant in the long term.

Experience of application of accelerated rehabilitation programs in patients with distal pancreas resection

Introduction. The implementation of ERAS (Enhanced recovery after surgery) protocols has been shown to be effective in orthopedics, bariatric and colorectal surgery. However, the safety and feasibility of implementing accelerated rehabilitation protocols in patients underwent distal pancreatic resection is not well studied. The objective was to analyze the results of the application of accelerated rehabilitation protocols in patients underwent distal pancreatic resection. Methods and materials . A retrospective - prospective, single-center study was conducted. The study included 60 patients. Patients were divided into two groups (control group - 30 patients, perioperative management was carried out according to standard methods and the main group - 30 patients, perioperative management was carried out according to the accelerated rehabilitation protocol). All patients included in the study underwent distal pancreas resection. Results. Patients in the analyzed groups were comparable by gender, age, body mass index, and ASA score. The frequency and severity of postoperative complications in the compared groups was comparable. The frequency of early activation of patients was significantly higher in the main group (86.7 vs 56.7; p&lt;0.001). Postoperative recovery of gastrointestinal tract function was faster in the main group ((2.4±0.9) vs (3.6±1.2); p&lt;0.001). The total duration of the postoperative hospital bed in the compared groups was comparable ((12.9±6.8) vs (14.1±6.1); p=0.2), however, when analyzing a subgroup of patients without complications and with minor complications, the differences in the duration of the postoperative hospital bed in the main and control groups was statistically significant ((8.9±3.6) and (11.7±3.4), respectively, p=0.01). Conclusion. The study showed the safety and effectiveness of implementing accelerated rehabilitation protocols in patients underwent distal pancreatic resection.

Results of the Use of Accelerated Rehabilitation Protocols after Surgery in Patients with Cystic Pancreatic Formations Undergoing Resection and Resection-Draining Interventions

Introduction. The number of patients with cystic formations of the pancreas has increased significantly recently. Some of the patients need open or minimally invasive surgery. The implementation of ERAS (Enhanced recovery after surgery) protocols has been proved to be effective in orthopedics, bariatric and colorectal surgery. However, safety and feasibility of implementation of accelerated rehabilitation protocols in patients with cystic formations of the pancreas who underwent resection and resection-drainage interventions have not been sufficiently studied.The aim of the study was to assess the effectiveness and safety of implementation of the developed accelerated rehabilitation protocol in patients with cystic pancreatic formations who have undergone resection and resection-draining interventions.Material and methods. This research is a retrospective-prospective, single-center study. The study included 110 patients with cystic formations of the pancreas of various etiologies. All patients were divided into two groups: the control group consisted of 55 patients, their perioperative management was carried out according to standard protocols, and the experimental group consisted of 55 patients, their perioperative management was carried out according to the accelerated rehabilitation protocol developed in the clinic. All patients included in the study were exposed to surgery: resection and resection-draining interventions in various modifications were performed.Results. Patients in the studied groups were comparable by gender, age, body mass index, ASA score, preoperative albumin level. No statistically significant differences were found in the duration of the operation, intraoperative blood loss, or the frequency of blood transfusions. The overall complication rate was significantly lower in the experimental group compared with the control group (38,2% versus 58,2%, p = 0,03). Postoperative recovery of the gastrointestinal function was also faster in the experimental group. Thus, in the experimental group, the average time to the gas discharge was 2,1 0,8 days; in the control group - 3,1 1,1 days (p = 0,01); the average time to the first stool was 3,2 1,9 and 4,2 1,2 days, respectively (p 0,001). The total duration of the postoperative hospital bed per day was significantly lower in the experimental group compared with the control group (11,8 7,7 vs 16,2 13,2 days, respectively, p = 0,02).Conclusions. The study demonstrated safety and effectiveness of implementation of accelerated rehabilitation protocols in patients with cystic pancreatic formations who have undergone resection and resection-draining interventions. Implementation of the protocols allows reducing the duration of the postoperative hospital bed per day, incidence rate of complications, and also accelerating the gastrointestinal function recovery.

How effective is a multimodal physical rehabilitation protocol in patients advised surgery for chronic lumbar radicular pain? A retrospective analysis of 189 patients with a minimum follow-up of 1 year

Background The purpose of this study was to determine the effectiveness of a multi-modal physical rehabilitation protocol (MPRP) in reducing pain and disability and preventing surgery in patients with chronic lumbar radicular pain (LRP) at a minimum follow-up of 12 months. Methods Pre and post-treatment NPRS score, ODI score, disability categories of 189 patients with chronic LRP treated with MPRP were analysed to determine the efficacy of the treatment. Patients were followed-up at a minimum duration of 12 months for pain, disability, surgery performed, and patient satisfaction with treatment. Results After a mean treatment of 59 days, there was significant reduction in mean NPRS (p < 0.0001) and mean ODI (p < 0.0001) scores. Of 89 patients (47%) who could be contacted at mean follow-up of 18 months, 9 patients (10%) had undergone lumbar surgery, 52 patients (58.5%) reported no pain or complaints related to their lower back and 66 patients (74%) were either very satisfied or satisfied with the outcome of their treatment. Conclusions A MPRP is effective in significantly improving pain and disability in patients advised surgery for chronic LRP. At a minimum follow-up of 12 months, pain and disability continued to be significantly lower and only 10% (9/89) patients underwent lumbar surgery.

Can physical rehabilitation in elderly patients with chronic low back pain have clinical outcomes similar to younger patients?

Purpose: Elderly patients (>65 years of age) are usually treated using protocols commonly used for younger population and there is not enough evidence supporting any particular rehabilitation program for such patients. This retrospective study aimed to determine the efficacy and clinical outcome of an integrated active, rehabilitation protocol in patients ≥65 years of age with chronic mechanical low back pain (LBP) and compare the results in similar patients in a 50-64 years age group.

Impact of navigated rhythmic transcranial magnetic stimulation on regaining consciousness in patients after severe brain injury

Background. Rehabilitation of patients with chronic disorders of consciousness is extremely important due to severity of the condition and increasing number of such patients. Disorders of consciousness have led to inability of self-care, need for constant care and complete dependence on outside assistance. Applying noninvasive brain stimulation and rhythmic transcranial magnetic stimulation seems to be perspective methods of rehabilitation.&#x0D; Aim. to evaluate the efficiency of rhythmic transcranial magnetic stimulation of left dorsolateral prefrontal cortex using local navigation in patients with chronic disorders of consciousness.&#x0D; Methods. This prospective study was carried out in patients with chronic disorders of consciousness after severe brain injury. All patients received 10-day treatment with active high-frequency rhythmic transcranial magnetic stimulations of the left dorsolateral prefrontal cortex. Revised coma recovery scale (JFK Coma Recovery Scale-Revised, CRS-R) was used to evaluate the effectiveness of the procedure.&#x0D; Results. After the treatment with rhythmic transcranial magnetic stimulations according to CRS-R 8 out of 12 patients improved their score. The best response was observed in patients in minimally conscious state. There were no cases of adverse events during the treatment.&#x0D; Conclusion. High-frequency rhythmic transcranial magnetic stimulations provide an opportunity to improve level of consciousness in patients after severe brain injury. Using navigation system allows to rule out an inaccuracy in determining the dorsolateral prefrontal cortex. As a result this study proposed the effective and safe protocol for rehabilitation of patients with chronic disorders of consciousness.