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Vol 20, No 3 (2021)

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Original studies

The dynamics of allodynia in the treatment of patients with diabetic polyneuropathy using transcutaneous electroneurostimulation

Al-Zamil M.K., Kulikova N.G., Vasilieva E.S., Elfimov M.A.


BACKGROUND: Allodynia, hyperalgesia, and positive sensory symptoms are the main symptoms of neuropathic pain. Studying these symptoms and their dynamics in the treatment of neuropathic pain broadens our understanding of neuropathic pain and how it can be treated.

AIMS: To study the effect of different TENS modalities on allodynia in patients with severe neuropathic pain syndrome developed against the background of diabetic distal polyneuropathy of the lower extremities.

MATERIAL AND METHODS: 75 patients with allodynia on the background of distal polyneuropathy of the lower extremities (DPLE) were treated with pharmacotherapy (n=26), high-frequency TENS (n=25), and low-frequency TENS (n=24).

RESULTS: Immediately after treatment, we observed a more pronounced decrease in allodynia after the application of high-frequency TENS (by 72.2%) and low-frequency TENS (by 61.1%). Moreover, in the control group, the regression of allodynia averaged 28.6%. At the 2nd month of the long-term period, the severity of allodynia continued to decrease more rapidly against the background of high-frequency TENS (26.7%) than after low-frequency TENS (19%) and remained without significant dynamics against the background of pharmacotherapy.

CONCLUSION: The use of TENS 1.3 times enhances the therapeutic effect of pharmacotherapy in treatment of neuropathic pain in patients with diabetic DPLE. High-frequency TENS is more effective than low-frequency TENS in the treatment of allodynia by 18.2% immediately after treatment and by 40% at the end of the 2nd long-term period. By the 6th month of the long-term period, the results of treatment in both groups did not differ significantly.

Russian Journal of Physiotherapy, Balneology and Rehabilitation. 2021;20(3):187-192
pages 187-192 views

Analgesia by laserophoresis of herbal extracts in treatment of patients with lumbosacral dorsopathy

Korchazhkina N.B., Kupeev R.V.


BACKGROUND: The article describes the pharmaco-physiotherapeutic method of analgesia for pain in the lumbosacral spine. The possibilities of introducing the method of transcutaneous analgesia into therapy using laserophoresis of a biological complex of water extracts of field horsetail and St. John's wort are shown. These phytoextracts were used in the laser phoresis method due to the fact that they have analgesic, decongestant and adaptogenic effects, as well as reduce the metabolic activity of chemical agents, including inflammatory ones.

AIMS: Study of the analgesic effect of the developed method of phytocomplex laserphoresis in comparison with the standard scheme of nonsteroidal anti-inflammatory drugs.

MATERIAL AND METHODS: The study included 48 patients with a confirmed diagnosis of lumbosacral dorsopathy accompanied by pain syndrome were under observation. The main group consisted of 28 people who underwent phytocomplex laserphoresis procedures as a local treatment. The control group consisted of 20 people, where the standard treatment with NSAID drugs was prescribed. The study included observation and control before and after the course of treatment conducted in a polyclinic. To assess the severity of pain was applied to the visual analogue pain scale and the method of tensoalgometry.

RESULTS: All patients underwent treatment well, there were no cases of interruption of the course of treatment. As a result of dynamic analysis of indicators performed before and after treatment, pain scale and tenzoalgometry indicators showed results indicating faster and more effective relief of pain in patients of the main study group. When summing up the results of treatment, the improvement in pain scale indicator showed an 83% improvement in the main group (p <0.05), while the improvement in the control group was only 39%. According to the control tensoalgometry, in the main group, pain thresholds improved by 32% (p <0.05), while in the control group the improvement was only 12%.

CONCLUSION: The resulting analgesic effect is formed due to the anti-inflammatory effect of low-intensity laser radiation, as well as the therapeutic properties of the phytocomplex used, which can replace the use of NSAIDs for analgesia of pain in the lumbosacral region.

Russian Journal of Physiotherapy, Balneology and Rehabilitation. 2021;20(3):193-198
pages 193-198 views

Long-term results of non-drug treatment of patients with scarring of the skin on the background of metabolic syndrome

Kazantseva C.V., Frolkov V.K., Nagornev S.N., Gusakova E.V., Nagorneva M.S.


BACKGROUND: The effectiveness of physiotherapy treatment of scarring of the skin is reduced in patients with impaired carbohydrate and lipid metabolism and the use of drinking mineral water is proposed for their correction of metabolic reactions, but the long-term results of using this technology have not been studied.

AIMS: To study the long-term results of treatment of patients with scarring of the skin after the use of photothermolysis, fermencol ultraphonophoresis and internal intake of mineral water, taking into account the presence or absence of metabolic syndrome.

MATERIALS AND METHODS: We observed 120 patients with scarring of the skin, 60 of them with metabolic syndrome. The patients were randomly selected into 2 groups: with and without metabolic syndrome, each of which was further subdivided into 2 subgroups according to the treatment method: the first was standard therapy, fractional photothermolysis, fermencol ultraphonophoresis, the second was a similar complex supplemented with internal intake of Essentuki No. 17 mineral water. Glucose, insulin, body mass index, malondialdehyde were determined in the blood of all patients

RESULTS: It was found that in patients with metabolic syndrome, the duration of maintaining the achieved therapeutic effects decreases after 6 months of observation, whereas against the background of taking mineral water, this period is extended by 3–4 months. An additional course of mineral water to physiotherapy treatment effectively corrects metabolic reactions and helps to reduce insulin resistance.

CONCLUSION: The use of drinking mineral waters, which have a pronounced activating effect on the insulin regulation of metabolic reactions by reducing resistance to this hormone, allows you to maintain favorable changes in metabolism and energy for at least six months, which contributes to the consolidation of the therapeutic effects of complex physiotherapy and to a certain extent has a preventive potential.

Russian Journal of Physiotherapy, Balneology and Rehabilitation. 2021;20(3):199-207
pages 199-207 views

Complex treatment of patients with hormone-dependent atrophic scars

Talibova A.P., Gryazeva N.V., Elfimov M.A.


BACKGROUND: There are a large number of different methods of treating striae, starting with local therapy with various oils, ending with hardware techniques, but standardized treatment protocols have not yet been developed, which forces us to look for new promising combined treatment regimens

AIMS: To study the effectiveness of therapeutic complexes in patients with atrophic hormone-dependent scars.

MATERIAL AND METHODS: 145 patients with hormone-dependent scars with different AP phenotypes were followed up. In groups 1A and 1B, phototherapy was performed using broadband incoherent light-IPL therapy. In groups 2A and 2B, exposure was performed using bipolar fractional radiofrequency therapy. In groups 3A and 3B, the patient underwent a mesoroller microneedling procedure. PRP therapy was performed in groups 1B, 2B, and 3B. A visual analog scale (VAS) was used to evaluate the effectiveness.

RESULTS: Comparing the data obtained, it should be noted that, regardless of the age of the scar (red, white), the developed complex methods of therapy showed greater effectiveness than monotherapy with pulsed broadband light, RF microneedles or microneedling.

CONCLUSION: The combination of RF-therapy and PRP-therapy showed the greatest effectiveness against all clinical symptoms of AR, IPL-therapy with plasma with cells and plasma-with-cells microneedling showed a comparable high efficiency in different periods of AR existence.

Russian Journal of Physiotherapy, Balneology and Rehabilitation. 2021;20(3):209-220
pages 209-220 views

Experience of using the sensor treadmill to improve the functions of pacing, cognitive abilities and psychoemotional status in patients with ischemic stroke

Mikhailova A.A., Korchazhkina N.B., Koneva E.S., Kotenko K.V., Elfimov M.A.


BACKGROUND: Stroke in developed countries continues to be the most important medical and social problem and occupy a leading position in the structure of morbidity and mortality.

AIMS: To study the effect of the technique of robotic biomechanical rehabilitation on a sensory treadmill with built-in power platforms and biofeedback in patients with post-stroke spasticity on the main indicators of stride, cognitive function and psychoemotional status in the late recovery period.

MATERIAL AND METHODS: The study included 80 patients who underwent ischemic stroke with movement disorders in the form of hemiparesis with increased muscle tone by the type of spasticity in the upper and lower extremities in the late recovery period, who were divided into 2 groups: the control group ― 40 people, who received standard drug therapy and medical rehabilitation, including medical massage, exercise therapy and kinesitherapy, and the main group ― 40 people, who, against the background of standard drug therapy and medical rehabilitation, underwent training on a sensory treadmill with built-in power platforms and biofeedback. Objective indicators of step function, subjective indicators of cognitive impairment (Montreal Cognitive Assessment Scale, MoCA) and psychoemotional defects (Hospital Anxiety and Depression Scale, HADS) were assessed.

RESULTS: When analyzing the data after the course of treatment in the patients of the main group, the indicators of the parameters of the walking stereotype improved significantly compared to the data in the control group, the cognitive functions normalized, and the degree of psychoemotional defect decreased, which was confirmed by the MoCA and HADS scales.

CONCLUSION: The inclusion of training on a sensory treadmill with built-in power platforms and biofeedback in the standard complex of medical rehabilitation of patients who have suffered an ischemic stroke with movement disorders in the form of hemiparesis in the lower extremities in the late recovery period contributes to a significant improvement in the biomechanical indicators of stride, cognitive functions and a decrease in the degree of psychoemotional impairment.

Russian Journal of Physiotherapy, Balneology and Rehabilitation. 2021;20(3):221-228
pages 221-228 views

Estimation of long-term results of complex application of laserotherapy and low-frequency electrostatic field in patients with postprothetic inflammatory complications during dental implantation

Livshits V.I., Nagornev S.N.


BACKGROUND: Previous studies have shown high clinical efficacy of the course combined use of a low-frequency electrostatic field and low-intensity infrared laser therapy in patients with peri-implantitis. It was shown that the use of these physiotherapeutic factors is accompanied by the development of anti-inflammatory and analgesic effects, increased tissue blood flow in the area of therapeutic exposure, as well as activation of trophic-regenerative processes that determine the degree of osseointegration of implants. However, along with resolving the issue of the current relief of clinical manifestations of peri-implantitis, an important point is the study of the long-term effect of the treatment method used. Evaluation of long-term results makes it possible to determine the duration of the preservation of the therapeutic effect, which makes it possible to determine the optimal parameters of the frequency and frequency of the therapeutic effects.

AIMS: Evaluation of complex physiotherapeutic treatment of patients with post-prosthetic inflammatory complications during dental implantation in the long-term period (after 6 and 12 months).

MATERIAL AND METHODS: The study was carried out with the participation of 132 patients aged 35 to 57 years with a clinically and radiologically confirmed diagnosis of class I and II peri-implantitis. All patients were divided into 4 groups by the method of simple fixed randomization. The first group (control group, 31 patients) received standard dental treatment, including professional oral hygiene, removal of dental plaque and granulation, and debridement of peri-implant pockets. In the second group (main I, 31 patients), in addition to the standard therapy, a course of laser therapy was carried out using the BTL-4000 physiotherapy apparatus. In the third group (main II, 30 patients), the standard treatment was supplemented with a course of low-frequency electrotherapy. The fourth group (main III, 31 patients), along with standard treatment, received low-frequency electrotherapy in combination with laser therapy. Long-term results were assessed 6 and 12 months after the end of therapy using clinical-functional, biochemical and psychological methods.

RESULTS: The course combined use of a laser and a low-frequency electrostatic field as a supplement to the standard treatment protocol for patients with peri-implantitis ensures the maximum preservation of higher indicators characterizing the restoration of the functions of the dentition, aesthetic parameters of the face and an increase in the quality of life of patients in general.

CONCLUSION: Taking into account the risk of developing a possible exacerbation of the inflammatory process, as well as the dynamics of the studied clinical and functional parameters in patients with peri-implantitis in the long-term period, it was concluded that it is necessary to conduct repeated courses of combined use of an infrared laser and low-frequency electrostatic therapy in 6–9 months.

Russian Journal of Physiotherapy, Balneology and Rehabilitation. 2021;20(3):237-246
pages 237-246 views

Study of the relevance of the problem of autism spectrum disorders for the clinical activities of doctors of different specialties planning to work in the field of physical and rehabilitation medicine

Zaytseva T.N., Gerasimenko M.Y.


BACKGROUND: The problem of medical rehabilitation of patients with autism spectrum disorders (ASD) is extremely urgent. The prevalence of ASD among the world's population is about 1%. It is known that children with ASD are difficult to respond to psychological and speech therapy correction and drug treatment. Today, one of the pressing issues is the choice of non-drug methods of treatment. Given the variety of functional disorders in ASD, these patients require special rehabilitation programs and therefore physicians planning work in the field of physical therapy and medical rehabilitation should be oriented in this problem.

AIMS: Of the study was to study the relevance of the ASD problem for the clinical activities of doctors of various specialties planning to work in the field of physical and rehabilitation medicine, their level of qualifications, activity and motivation in providing medical care to patients with ASD.

MATERIAL AND METHODS: A survey was conducted on the author's questionnaire of 116 doctors of 8 medical specialties who underwent primary retraining in the cycle "Physical and Rehabilitation Medicine" at the Department of Physical Therapy, Sports Medicine and Medical Rehabilitation of the RMANPO of the Ministry of Health of Russia.

RESULTS: The study showed that pediatricians and neurologists are significantly more likely to meet patients with ASD in their practice than doctors of other specialties (p <0.05). An analysis of the answers of all respondents indicates the importance of additional informing doctors about modern research on the problem of ASD. When asked "What sources of information about medical support for children with autism spectrum disorders would you definitely use" 81 (69.8%) respondents indicated seminars and conferences, 50 (43.1%) — Russian magazines, books, textbooks, 46 (39.7%) — special sites and materials of social networks, 30 (25.9%) — advanced training programs in the system of continuing professional education, the rest of the doctors preferred modern foreign literature and the experience of colleagues. Absolutely all respondents indicated the need for medical rehabilitation for children with ASD, however, 28 (24.1%) respondents believe that it is necessary to consider each case of the disease individually. The majority of the respondents indicated the expediency of sanatorium-resort treatment for patients with ASD. Doctors were also asked about the need to use basic ICF kits in the rehabilitation of patients with autism: 64 (55.2%) respondents answered positively, 44 (37.9%) found it difficult to answer and 8 (6.9%) gave a negative answer. In matters of non-drug treatment of patients with ASD, the leading positions are taken by: art therapy, hydrotherapy, music therapy, physiotherapy exercises and animal therapy. However, methods with proven effectiveness in this category of patients, such as transcranial forms of brain stimulation and biofeedback, were chosen by only 65.5% of respondents. Only 34.5% of respondents indicated the possibility of using Bobath therapy, Vojta therapy and PNF therapy in patients with ASD.

CONCLUSION: Doctors are not sufficiently knowledgeable in the field of modern methods of physical and rehabilitation medicine that can be successfully used in children with ASD. The totality of all the respondents' answers indicates the importance of additional informing doctors about modern research on the problem of ASD, as well as the need to implement educational programs that will take into account current trends in the development of physical and rehabilitation medicine for this category of patients.

Russian Journal of Physiotherapy, Balneology and Rehabilitation. 2021;20(3):229-236
pages 229-236 views

Lichen sclerosus et atrophicans in men: clinical efficacy of hydrobiont collagenase isoenzymes electrophoresis in the rehabilitation phase

Ignatovskiy A.V., Zhelonkin A.R., Zhelonkina A.O.


BACKGROUND: In view of the lacking ineffectiveness of the currently established treatment methods of men with genital lichen sclerosus (GLS), as well as the lack of evidence-based ways of managing patients at the rehabilitation stage, there exists a want for new approaches to solve this problem.

AIMS: The aim of the research was to study the possibility of applying electrophoresis of an enzyme preparation from hydrobiont collagenases at the stage of rehabilitation in men with GLS.

MATERIAL AND METHODS: Open-label randomized controlled trial comparing clinical efficacy of hydrobiont enzyme preparation and standard supportive emollient therapy at the stage of rehabilitation in men with confirmed GLS was conducted. The follow-up period lasted for 16 weeks. Clinical efficacy was estimated using specifically developed scores LS-S (surface area), LS-A (disease activity) and validated dermatologic life quality index (DLQI) at 6th and 16th week of follow-up. The primary study outcome was the comparative efficacy at 16th week as based on the evaluated scores.

RESULTS: All patients (n=27) were given topical glucocorticoids (TGCs) at the first stage of the study during the first 6 weeks. The patients were then randomly allocated into 2 groups for the rehabilitation stage that lasted from 6th to 16th week of the study. The first group (primary group, n=13) were managed with electrophoresis of an enzyme preparation from hydrobiont collagenases. The second group (control group, n=14) were managed with emollients at the rehab stage. The age of patients in the first group and in the second group was 36,62±16,04 and 41,93±9,34 years, respectively. At baseline before initiating treatment patients in both groups as judged by LS-S (p=0,110), LS-A (p=0,757) и DLQI (p=0,149) comparable. At 6th week after course of TGCs no statistically significant differences were detected. At the primary study outcome at 16th week scores LS-S (p=0,002), LS-A (р <0,001) and DLQI (р <0,001) evidenced significantly in favour of enzyme electrophoresis.

CONCLUSION: During staged treatment, a more pronounced and long-lasting effect was observed in the group of patients with electrophoresis of the enzyme complex during the rehabilitation stage compared to the group with emollients

Russian Journal of Physiotherapy, Balneology and Rehabilitation. 2021;20(3):247-252
pages 247-252 views


Therapeutic physical factors at chronic generalized periodontitis (literature review)

Edilbiev Z.V., Fedorov A.A., Mallaeva R.M., Edilbieva L.V.


Strengthening public health and increasing the life expectancy of Russians are the most priority tasks of the state.

Chronic generalized periodontitis occupies one of the leading places among the urgent problems of dentistry. The main therapeutic and preventive measure in this case, through which the preservation and strengthening of the health of the population is achieved, is medical rehabilitation using therapeutic physical factors. The inclusion of therapeutic physical factors in the rehabilitation treatment programs for various chronic diseases, including periodontal diseases, significantly increases the clinical effectiveness of rehabilitation programs, which is associated with the summation and mutual potentiation of their therapeutic effects, comparability and minimal side effects. So, numerous studies on the use of therapeutic physical factors in dentistry convincingly testify to the sanogenetic effects of therapeutic mud, mineral bischofite complexes, mineral waters in the treatment of inflammatory periodontal diseases.

The rationale for the development of new treatment and rehabilitation technologies for chronic generalized periodontitis is the insufficient effectiveness of the existing standardized methods of treating this category of patients.

The review article is devoted to the restorative treatment of patients with chronic generalized periodontitis. Indications and contraindications for the use of therapeutic physical factors (balneological methods, pelotherapy, apparatus physiotherapy, climatotherapy, psychotherapy, diet therapy, new forms of balneo- and phytopreparations) for this category of patients are presented. It should also be noted the role of promoting a healthy lifestyle, including training in primary and secondary prevention, in order to preserve the dental health of the Russian population.

Russian Journal of Physiotherapy, Balneology and Rehabilitation. 2021;20(3):253-261
pages 253-261 views

The prospect of using L-carnitine for modification of drinking mineral waters in order to increase their metabolic potential

Efimenko N.V., Reps V.F., Abramtsova A.V., Simonova T.M.


Currently, a search is underway for non-drug biologically active agents that help restore impaired metabolism in metabolic syndrome. The attention of many researchers is drawn to L-carnitine and its role in the metabolism of fats and carbohydrates in both normal and pathological conditions.

The review is devoted to an urgent topic — the theoretical justification of increasing the biogenic potential of drinking mineral waters in order to use them in the non-drug treatment of metabolic syndrome. The choice of a biologically active substance for the modification of drinking mineral waters, namely, L-carnitine, is based on its direct involvement in the energy exchange of body cells.

L-carnitine plays an irreplaceable role in lipid metabolism: it participates in the transport of fatty acids and products of their incomplete oxidation across the mitochondrial membrane, potentiating β-oxidation of long-chain fatty acids, which leads to the activation of energy metabolism in various tissues. Thus, it can be assumed that the addition of L-carnitine to the diet of patients with metabolic syndrome and type 2 diabetes mellitus may be an effective tool in the treatment and prevention of the progression of these diseases.

The data of experimental and clinical studies justifying the preventive effect of drinking mineral waters were analyzed. In addition, we have conducted searching for scientific publications over the past 5 years in the electronic databases PubMed, Web of Science, e-Library on the study of L-carnitine and drinking mineral waters of various compositions, taking into account their influence on the components of metabolic syndrome. The search terms provided criteria that included full text, related data, clinical trials, meta-analysis, randomized controlled trials, and systematic reviews.

Based on the results of independent scientific studies, it is unambiguous to conclude that there is both a direct (due to dissolved ions) and a more complex (mediated through regulatory systems) effect of mineral waters on impaired metabolism caused by magnesium and calcium deficiency in this group of patients.

Russian Journal of Physiotherapy, Balneology and Rehabilitation. 2021;20(3):263-271
pages 263-271 views

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