Russian Journal of Physiotherapy, Balneology and Rehabilitation

In recent years, cardioncology has rapidly become responsible for comprehensive decision-making appropriate cancer patients receiving cardiotoxic cancer therapy. Currently, the implementation of a multidisciplinary approach in the correction of adverse events using various drug antitumor therapy regimens is becoming increasingly relevant. In particular, given the widespread use of vascular-endothelial growth factor inhibitors, both at the heart of complex schemes and in mono-supportive modes. It is important to timely identify and correct such a clinically significant adverse event as an increase in blood pressure at the time of administration and in the early follow-up period. Adherence to standard drug regimens for hypertension, which usually provide satisfactory blood pressure control between cycles of administration of vascular-endothelial growth factor inhibitors, in a number of patients did not allow the same effective retention of blood pressure in the planned intervals with the administration of bevacizumab. The intensification of drug therapy for hypertension, both at the pre-infusion stage and at the time of an increase in blood pressure, was of a multidirectional nature.

Search and summarize information on the availability and development of physiotherapeutic treatment methods for the correction of hypertension during antitumor therapy in cancer patients using vascular-endothelial growth factor inhibitors. 35 literature sources were analyzed. There are no data on the development of physiotherapeutic methods for the treatment of bevacizumab-induced hypertension. Domestic sources ― 25 articles. Foreign sources ― 10 articles.

An analysis of the literature concluded that there is a lack of research on the development of physiotherapeutic methods for the treatment of bevacizumab-induced hypertension. In order to reduce the cardiotoxicity of humanized recombined monoclonal antibodies, maintain the dose interval period, improve survival and eliminate the need for dose adjustment of antihypertensive drugs, it is proposed to consider the use of preformed physical factors in the treatment of bevacizumab-induced hypertension.

BACKGROUND: In medical rehabilitation of patients with polyposis rhinosinusitis, aimed at solving the urgent strategic task of public health care to achieve and maintain an optimal level of functioning of persons suffering from partial disability through the development of effective methods of restoration of impaired functions and prevention of complications, there is a need to adequately assess the effectiveness of the measures taken. In this regard, it should be noted that the International Classification of Functioning, Disability and Health (ICF) serves as the gold standard for assessing the patient's quality of life and the effectiveness of rehabilitation measures. The category of human functioning acts as a system-forming basis and starting point of the patient's rehabilitation process in the ICF. In practice, the ICF is based on the biopsychosocial model of health (disease) assessment, which considers psychological and social factors of health (disease) and biological disorders in close interrelated unity.

AIM: To evaluate the effectiveness of complex medical rehabilitation of patients with polyposis rhinosinusitis associated with atopic dermatitis using dynamic changes in the main domains of the ICF.

MATERIALS AND METHODS: The study was performed with 89 patients with polyposis rhinosinusitis associated with atopic dermatitis. All patients were divided into 4 groups by simple fixed randomisation. The first group (control, n=22) received only basic therapy, including endonasal application of nasonex 2 doses 2 times a day, daily twice daily washing of the nasal mucosa, as well as the use of desensitising (antihistamines, topical glucocorticoids and moisturising and emollient agents) and detoxifying agents. Patients in the second group (comparison group 1, n=22) were additionally subcutaneously administered dupilumab at a dose of 300 mcg once a fortnight. In the third group (comparison group 2, n=23) against the background of dupilumab administration the combined effect of alternating magnetic field and low-intensity laser radiation of red spectrum was performed. Patients of the fourth group (the main group, n=22) received a course of phototherapy in addition to the scope of treatment of patients of the third group. The results of medical rehabilitation of patients with polyposis rhinosinusitis associated with atopic dermatitis were evaluated according to the dynamics of specialised categories of ICF, which most accurately characterise the patient's condition from the perspective of the biopsychosocial model of the disease.

RESULTS: Changes in the estimated parameters of ICF at comparable initial values had different character and were determined by the scheme of medical rehabilitation. Minimal changes were recorded in the control group. The use of dupilumab was accompanied by positive dynamics of the parameters after 1 month with a significant increase in the shifts after 6 months, indicating the recovery of a number of mental and physical functions, as well as the ICF categories characterising the organism structures, activity and participation of the patient. Supplementation of biological therapy with course magnetolaser influence was accompanied by an increase in positive changes, which were confirmed in 6 months after rehabilitation. The maximum dynamics of the considered ICF categories was noted in the 4th group, where dupilumab administration was supplemented with complex use of therapeutic physical factors.

CONCLUSION: The obtained results prove the high informativeness of the system approach realised with the help of ICF in assessing the effectiveness of medical rehabilitation measures. The comparative evaluation of rehabilitation results convincingly showed the advantages of the complex programme including dupilumab target therapy in combination with physiotherapeutic effects.

BACKGROUND: Therapeutic exercises are the method of choice for conservative treatment of subacromial impingement syndrome. However, due to poor content reporting of exercise in clinical trials there are limitations in interpretation and replication of these trials’ methods and results. In 2016 the CERT (Consensus on Exercise Reporting Template) was developed to address this problem.

AIM: To evaluate the completeness of content reporting of exercise interventions in clinical trials for patients with subacromial impingement syndrome using CERT and implement the principles of CERT into our own practice by describing an original therapeutic exercise protocol.

MATERIALS AND METHODS: A search was conducted for scientific articles published from October 2016, that mentioned therapeutic exercises as a treatment method for subacromial impingement syndrome. Then, the CERT was applied to 34 selected publications, the data was analyzed and compared with similar studies. A description of an original therapeutic exercise protocol was conducted in accordance with the principles of CERT.

RESULTS: The mean CERT score was 9,9 (52,17%); median 10; range 4–18; 19 (55,88%) trials had a CERT score of ≥10, while the remaining 15 (44,12%) scored <10. The most poorly reported items were description of instructor qualifications (2), individual or group (3), motivation strategies (6), progression rule (7a), adverse events (11), tailored (how) (14b), starting level rule (15), adherence (planned and actual) (16a, 16b). Only 50% of studies included data on adherence report (5).

CONCLUSION: The description of therapeutic exercises for patients with subacromial impingement syndrome in published trials remains poorly reported. Proper critical analysis of studies using CERT should be taken into account when assessing the effectiveness of ongoing research investigating therapeutic gymnastics.

BACKGROUND: At the stage of chemoradiotherapy of malignant neoplasms of the head and neck, in 90% of cases, the development of radiation dermatitis and mucositis is observed. The resulting acute radiation reactions negatively affect not only the quality of life of the patient, but also the planned treatment. A multidisciplinary approach with the inclusion of basic treatment, physical therapy, physical factors, psychological correction, and nutritional support is an effective strategy for improving the patient's quality of life at this stage of treatment.

AIM: To assess the quality of life of patients in complex medical rehabilitation who underwent chemoradiotherapy for malignant neoplasms of the head and neck.

MATERIALS AND METHODS: An interventional prospective randomized study was conducted with the participation of 60 patients with malignant neoplasms of the oral cavity, larynx, oropharynx, larynx undergoing chemoradiotherapy. The main group (n=30) received a course of medical rehabilitation: exposure to low-temperature argon plasma, general magnetic therapy, physical therapy, training on the support reaction on a barefoot platform, nutritional support and classes with a medical psychologist. In patients of the comparison group (n=30), plasma exposure was not included in the rehabilitation course. The effect of chemoradiotherapy for head and neck cancer on the patient's quality of life was assessed by the severity of pain syndrome, physical functioning, and limitations of daily activities using Visual Analogue Scale (VAS), Hospital Anxiety and Depression Scale (HADS) techniques, a questionnaire developed by C.D. Spielberger and adapted by Y.L. Khanin, the SF-36 questionnaire.

RESULTS: After a course of chemoradiotherapy, patients began to complain of pain, burning in the mouth, complaints of dry mouth, pain when swallowing, eating, limited mouth opening, redness and peeling of the skin, voice changes, difficulty falling asleep, frequent awakenings at night, embarrassment of one’s appearance. In patients of both groups, there was a decrease in the level of reactive and personal anxiety, the increased level of anxiety and depression decreased by the end of the course of chemoradiotherapy with a decrease in indicators after 6 months. Despite the increase in pain intensity during chemoradiation treatment, an increase in vital activity indicator was recorded, as well as an indicator of self-assessment of one’s health by the end of the course of chemoradiation treatment.

CONCLUSION: The resulting radiation mucositis and epidermitis at the stage of chemoradiotherapy for head and neck cancer lead to physical and psychological limitations, worsening the patient's quality of life, which determines the need to accompany this stage of treatment with comprehensive medical rehabilitation. The study of the dynamics of the parameters of the quality of life of patients is the basis for the selection of individual rehabilitation treatment programs.