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Vol 20, No 5 (2021)
Original studies
Assessment of the quality of knowledge about medical rehabilitation among doctors
Abstract
BACKGROUND: every year in the world, up to 1.5 million primary cases of breast cancer are verified and more than 500 thousand women die. More than 60% of patients diagnosed with breast cancer report functional disorders both during treatment and after its completion. In recent years, the attention of scientists and doctors has been paid to the rehabilitation of cancer patients. But questions remain open concerning the awareness and qualifications of doctors working in the field of medical rehabilitation of the problem of malignant neoplasms of the breast and the organization of medical rehabilitation in medical organizations providing medical care to patients in the field of oncology.
AIMS: to determine the level of knowledge among doctors of various specialties planning to work in the field of physical and rehabilitation medicine on the problem of medical rehabilitation of patients with malignant neoplasms of the mammary gland.
MATERIALS AND METHODS: а survey was conducted on a questionnaire developed at the Department of Physical Therapy, Sports Medicine and Medical Rehabilitation of the Russian Ministry of Health, which included 211 doctors working in 38 medical institutions in the profile “medical rehabilitation”, 6 clinical specialties.
RESULTS: the questionnaire survey demonstrated the relevance of the problem for the clinical activities of specialists working in the field of physical and medical rehabilitation (89.5%), however, the lack of knowledge in 72.7% of respondents creates the need to increase the level of professional competencies of specialists, namely, conducting specialized and multidisciplinary seminars and conferences, the introduction of new training programs for advanced training.
CONCLUSION: The questionnaire created by us is a reliable tool for assessing the level of knowledge of medical professionals. The conducted research allows us to conclude that doctors are not sufficiently knowledgeable in the field of medical rehabilitation of cancer patients. In this regard, it is undoubtedly important to inform all doctors planning further work in the field of physical and rehabilitation medicine about modern research, methods of treatment and rehabilitation of patients with malignant neoplasms of the breast.
371-377
Evaluation of the effectiveness of rehabilitation of patients before coronary bypass surgery using dry carbon dioxide baths and respiratory training
Abstract
BACKGROUND: Preoperative rehabilitation of patients before coronary bypass surgery using non-drug technologies is aimed at increasing adherence to treatment, improving psychoemotional stability and the results of surgical intervention and subsequent postoperative rehabilitation.
AIMS: the aim of the study was to evaluate the effectiveness of pre-rehabilitation of patients before coronary bypass surgery, including dry carbon dioxide baths and respiratory training in a day hospital.
MATERIALS AND METHODS: Under observation were 36 male patients aged 34–55 years before surgery for coronary heart disease. Depending on the activities carried out, the subjects are divided into two groups. Patients in the control group (n=18) received a basic complex of a lipid-lowering diet with salt restriction, therapeutic exercises in a small group method, dosed walking, sessions with a psychologist, and drug therapy. Patients of the main group (n=18) received, in addition to the basic complex, dry carbonic baths and respiratory training using breathing simulators.
RESULTS: The use of dry carbon dioxide baths and respiratory training in prehabilitation before coronary bypass surgery is accompanied by an increase in physical performance, improvement of clinical, hemodynamic and psychological parameters.
CONCLUSION: The inclusion of dry carbon dioxide baths and respiratory training in the complexes of preoperative rehabilitation of patients with coronary artery disease contributes to an increase in their adherence to treatment and surgical intervention, as well as to an increase in the effectiveness of postoperative rehabilitation.
379-384
Effects of a pulsed electromagnetic field on the course of osteoporosis in postmenopausal women
Abstract
BACKGROUND: Pulsed electromagnetic field therapy is non-invasive, pain-relieving and preventing bone loss in osteoporosis. This study analyzes the effects of rehabilitation of postmenopausal women after spinal fracture after treatment with a pulsed electromagnetic field.
AIM: is to analyze the effect of pulsed electromagnetic field on fractures and osteoporosis after spinal fracture surgery.
MATERIAL AND METHODS: A randomized controlled trial was conducted, respectively, in the pulsed electromagnetic field treatment group (40 cases) and the control group (42 cases), respectively. The results of the assessment of health-related quality of life (HRQOL), back pain, body function, hip bone density at 1 month and 3 months after surgery were studied.
RESULTS: Compared with the control group, the pulsed electromagnetic field treatment group can significantly improve the psychological score, the 6-minute walk test, and the sitting position in a chair one month after surgery. And 3 months after surgery, the pulsed electromagnetic field treatment group can significantly improve health-related quality of life (HRQOL), back pain, and body function scores.
CONCLUSION: Pulsed electromagnetic field therapy has a positive effect on pain relief, functional changes in the body and bone loss after spinal fracture surgery.
385-395
The use of microneedling and laser therapy in patients with involutive skin changes
Abstract
BACKGROUND: Involutive skin changes are an urgent problem in the modern world, which leads to the need to find a comprehensive and effective treatment method aimed at reducing the activity of matrix metalloproteinases (MMPs) and transforming growth factor-β2 (TGF-β2), which are responsible for the degradation of extracellular matrix proteins.
AIMS: Determination of the degree of influence of microneedling monotherapy, fractional laser, as well as a combination of these methods on the content of MMP-2, MMP-3, MMP-12, TGF-β2 in the skin of patients with involutive signs.
MATERIAL AND METHODS: In a single-center, prospective, parallel, non-randomized study, 82 patients with involutive changes in the facial skin took part, which were divided into 3 groups. 26 patients (Group 1) received microneedling monotherapy (3 treatments every 3 weeks), 27 patients (Group 2) received fractional laser monotherapy (3 treatments every 4 weeks) and 29 patients (Group 3) combined therapy of microneedling and fractional laser (3 procedures every 4 weeks). The study lasted 10 weeks, before and after the start of the study, a biopsy of the skin behind the ear was taken to determine the level of MMP-2, -3, -12 and TGF-β2.
RESULTS: Comparative data of enzyme immunoassay with biotin monoclonal conjugates between the groups revealed a difference in the content of matrix metalloproteinases and TGF-β: in group 1, there was less significant dynamics in all studied parameters compared to group 3: MMP-2 (p=0.0390), MMP-3 (p=0.0466), MMP-12 (p=0.0104) and TGF-β (p=0.0080) and 2 group MMP-12 (p=0.0484) and TGF-β (p=0.0367). When comparing groups 2 and 3, more significant dynamics was observed in group 3 in terms of MMP-2 (p=0.0290), MMP-12 (p=0.0511) and TGF-β (p=0.0241). Thus, the most significant results were obtained in group 3.
CONCLUSION: Combined treatment using microneedling and fractional laser leads to a significant decrease in the level of MMP-2, -3, -12 and TGF-β2, which allows us to consider this therapeutic complex as a promising way to correct involutive skin changes.
397-404
Influence of beta-rhythm neurofeedback on the functional state of the cardiovascular system of athletes
Abstract
BACKGROUND: The study of the effects of urgent and long-term adaptation of the cardiovascular system of athletes under the influence of beta-rhythm neurofeedback expands its corrective and restorative potential for use in the practice of sports medicine and rehabilitation.
AIMS: Study of the restorative and rehabilitation potential of the influence of beta-rhythm neurofeedback on the functional state of the cardiovascular system of athletes.
MATERIAL AND METHODS: The course of neurofeedback on the beta rhythm of the brain consisted of 10 sessions, including a graphical and game version of the representation of the controlled parameter (beta rhythm) on the computer monitor screen, the success of controlling the beta rhythm with the specified conditions of voluntary muscle relaxation during the session was supported by visual and auditory biological feedback. Registration of indicators of the cardiovascular system was carried out before and after the 1st, 5th and 10th sessions of the course, the dynamics during the course and individual sessions is represented by the growth rate (%) of the indicators.
RESULTS: A course of neurofeedback on the beta-rhythm of the brain of 10 sessions were young athletes (n=1020) aged 18–21, representatives of cyclic, acyclic and game sports in the preparatory period of the training cycle.
The effects of urgent adaptation in athletes at the 1st session of the neurofeedback course according to the beta-rhythm of the brain are reflected by positive changes in the strengthening of the vagal influence of the parasympathetic nervous system on the functional state of the cardiovascular system, expressed in a decrease in heart rate, systemic pressure, performance and pumping functions of the heart, in the transition of the type of regulation of blood circulation from the unfavorable hyperkinetic type to the physiological ― eukinetic ― type. At the same time, the load on the peripheral vascular bed increased, especially on its precapillary section.
The effects of long-term adaptation at the 10th session of the neurofeedback course according to the beta-rhythm of the brain are represented by systemic rearrangements with an increased influence of the parasympathetic nervous system in the functioning of the cardiovascular system of athletes, reflected in the maximum decrease in heart rate throughout the course, in an equivalent decrease in systemic pressure, stabilization of performance and pumping function of the heart, achievement and preservation of the eukinetic type of regulation of blood circulation, achievement of a stable stable state of the central and peripheral vascular bed with a slight response to environmental factors.
CONCLUSION: A course of neurofeedback on the beta-rhythm of the brain of 10 sessions helps to reduce stress in the functioning of the cardiovascular system of athletes by enhancing the vagal influences of the parasympathetic nervous system, has a positive effect on heart rate, systemic pressure, performance and pumping function of the heart; promotes the transition from an unfavorable hyperkinetic to a physiological eukinetic type of circulatory regulation; has a positive effect on adaptive changes in indicators of general and peripheral vascular resistance. The revealed effects of the course of neurofeedback on the beta-rhythm of the brain are of a pronounced corrective and restorative nature during the intense functioning of the cardiovascular system of athletes and can be used in sports rehabilitation and rehabilitation practice.
405-412
Physiotherapy methods in the complex of cognitive rehabilitation of patients in the late recovery period in patients after ischemic stroke
Abstract
BACKGROUND: For the purpose of early and late medical rehabilitation in recent decades, non-drug methods of physiotherapy have been actively used to restore patients who have had an ischemic stroke.
AIMS: substantiation of the inclusion of multimodal physiotherapeutic effects from the Alpha LED Ohu Light_Spa apparatus and low-frequency electrostatic massage from the Khivamat apparatus for the correction of cognitive impairment in patients who have suffered an ischemic stroke, with motor disorders in the form of hemiparesis, increased muscle tone by the type of spasticity in the late recovery period.
MATERIALS AND METHODS: The study included 120 patients who had an ischemic stroke with movement disorders in the form of hemiparesis with increased muscle tone in the form of spasticity in the late recovery period. Patients of group 3 (40 people) were prescribed standard drug therapy and medical rehabilitation, patients of group 1 (40 people in addition to standard therapy and rehabilitation, multimodal physiotherapeutic effects were used from the Alpha LED Oxy Light-Spa™ device and patients of group 2 (40 people) a low-frequency electrostatic massage from the Khivamat apparatus was added to the standard complex.
RESULTS: At all control points — after the course of treatment, after 6 and 12 months, in addition to general clinical studies, we assessed indicators of cognitive functions (according to the Montreal Cognitive Assessment Scale) and psycho-emotional state according to the HADS scale. In dynamics, it was revealed that in groups 1 and 2, where the developed rehabilitation programs were carried out, there was a significant improvement in cognitive functions (attention, memory, fluency, generalization, etc.), to a greater extent in group 1, while in patients who, against the background of drug therapy, underwent standard medical rehabilitation, only a positive trend was noted.
CONCLUSION: The inclusion in the medical rehabilitation of patients who have suffered an ischemic stroke, to a greater extent, multimodal physiotherapeutic effects and to a somewhat lesser extent, low-frequency electrostatic massage contributes to a significant improvement in cognitive functions and a reduction in anxiety and depression.
413-419
The choice of tactics of rehabilitation measures in patients with chronic paraproctitis, depending on the volume of surgical intervention based on quality of life indicators
Abstract
BACKGROUND: The development of medical technologies puts forward requirements for the improvement and optimization of treatment and rehabilitation algorithms for providing surgical care to proctological patients and, in particular, patients with chronic paraproctitis. The criteria for the effectiveness of therapy are the period of wound healing, the frequency of recurrence of the disease and the preservation of the function of the anal sphincter. The development of minimally invasive surgical technologies is a new promising area of outpatient coloproctology.
AIMS: was to evaluate the effectiveness of the use of physiotherapy programs for postoperative rehabilitation according to the SF-36 quality of life assessment scale in groups of patients operated on by various methods of surgical interventions and to develop an Algorithm for surgical treatment and postoperative rehabilitation of patients with chronic paraproctitis.
MATERIAL AND METHODS: The study included observation and control in the pre- and early postoperative period for 270 operated patients with extra- and transsphincter pararectal fistulas with various options for surgical treatment and rehabilitation programs used in the early postoperative period. As a criterion of effectiveness, an assessment of the quality of life b according to the SF-36 questionnaire was used. The surgical-physiotherapeutic Algorithm of surgical treatment and rehabilitation of patients with chronic paraproctitis” is proposed for wide introduction into clinical practice.
RESULTS: As a result of the analysis of the data obtained, it was found that the quality of life depends on the type of operation: the advantage of using minimally invasive surgical interventions and the rehabilitation program used has been proven: the advantage of using an extended 4-component rehabilitation program has been proven.
CONCLUSION: The data obtained made it possible to determine the tactics of rehabilitation measures in patients with chronic paraproctitis depending on the volume of surgical intervention and display it in a visual, schematic form ― Algorithm for surgical treatment and rehabilitation of patients with chronic paraproctitis.
421-428
Review
New opportunities of therapeutic hyperthermia (literature review)
Abstract
An electronic search for publications on the results of the use of hyperthermia in medicine was carried out using the Scopus, Web of Science, MedLine, The Cochrane Library, EMBASE, Global Health, CyberLeninka,RSCI, international and regional journals, materials of international congresses, congresses and conferences.
The review analyzes the results of experimental and clinical studies of the therapeutic effect of hyperthermia or in various non-inflammatory diseases. Experimental studies have shown a pronounced damaging effect of hyperthermia on some types of parasites and therapeutic effect on mice genetically predisposed to type 1 and 2 diabetes mellitus. Clinical studies have shown that hyperthermia significantly improves the condition of patients with cardiovascular and pulmonary insufficiency, depressive syndrome, chronic fatigue syndrome, psoriasis, benign prostatic hyperplasia, limb lymphedema, post-radiation fibrosis and Peyronie's disease. It has been shown that the effectiveness of hyperthermia is associated with a wide range of biological and physiological reactions of cells and tissues to heat exposure, including the expression of heat shock proteins. At the same time, the results obtained in an experiment and in a clinic without randomization require further research and confirmation.
429-448
The role of macroelements in the development and progression of a new coronavirus infection (literature review)
Abstract
The article provides a brief overview of the data on the effect of changes in the content of the main macronutrients (sodium, calcium, potassium and magnesium) on the incidence and course of COVID-19. The features of imbalance of mineral substances in patients with new coronavirus infection were analyzed, the role of electrolyte disturbances in increasing the incidence of complications and increasing mortality among patients with COVID-19 was demonstrated. Possible mechanisms of macronutrient imbalance arising from infection with SARS-CoV-2 are described.
The search for publications on changes in the content of magnesium, potassium, calcium and sodium in patients with COVID-19, as well as their impact on the development and progression of the disease, was carried out using the Web of Science, Scopus, MedLine, The Cochrane Library, Embase, Global Health, CyberLeninka, RSCI databases. In addition, publications from journals peer-reviewed by the Higher Attestation Commission, as well as international and regional journals were analyzed.
449-459
Guidelines for practitioners
Principles of sanatorium-resort treatment of adult and pediatric patients who have undergone COVID-19
Abstract
Spa treatment plays an important role in the recovery process of both adult and pediatric patients after a coronavirus infection. Currently, medical rehabilitation programs of this stage are being worked out and, as the accumulated data show, an integrated approach with the inclusion of various methods is more effective. Sanatorium-resort care for patients who have undergone COVID-19 is provided on a planned basis and is based on the principles of phasing, continuity and continuity between medical organizations. Treatment of patients with the consequences of a coronavirus infection in sanatorium conditions is carried out in the late recovery period at the III stage of rehabilitation care. The main advantage of spa treatment is the use of natural therapeutic factors: climate, landscape, balneo- and peloidotherapy. An important part of the comprehensive treatment program is the methods of physical rehabilitation, which should be selected individually, taking into account the functional reserves and patient tolerance. Also, the program of spa treatment includes diet therapy, according to indications, hardware physiotherapy, psychotherapy.
461-471
Method of dynamic modeling of the femoral head
Abstract
The mechanism of action of therapeutic exercises can be considered as a universal form of exercise. Therapeutic physical exercises can provide both a direct load on the contact and articular surfaces (walking and exercises with crutches), and muscle load (concentric muscle contractions, motor system). The high sensitivity of the bone to mechanical signals is the basis for non-drug interventions, including physical therapy.
The article presents the author’s method of physical therapy for patients with femoral head aseptic necrosis. The gymnastics was based on a set of exercises for dynamic modelling of the femoral head, developed by Huang Keqin, a doctor of the Beijing Specialized Clinic for the Treatment of Femoral Head Necrosis, and modern concepts of bonne tissue biomechanics and physiology. The set includes 3 types of exercises. The first type is based on the principle of autogravity burden. The second type consists of the exercises with an accelerated rhythm of small amplitude. Type 3 is based on the muscles post-isometric relaxation principle.
In this article the recommendations are given regarding the exercises use depending on disease stage.
473-480
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