Vol 22, No 3 (2023)

BACKGROUND: Post-COVID syndrome ostcoid syndrome is a consequence of the multimodal systemic effect of the SARS-CoV-2 virus on the human body, and leads to a variety of clinical symptoms that require correction. In particular, there is an increase in the level of allostatic load and the risk of maladaptation. One of the means of effective non-drug effects on the separated consequences of COVID-19 is the use of hydrobalneotherapy methods as part of a rehabilitation course.

AIM: To study the influence of various hydrobalneotherapy methods as part of comprehensive outpatient rehabilitation on the clinical-functional and psychoemotional status of patients with post-COVID syndrome.

MATERIALS AND METHODS: 160 patients undergoing outpatient rehabilitation for manifestations of post-COVID syndrome, 74 men and 86 women, with a median age of 50 [43; 55.1] years, were comprehensively examined. Patients were randomized to 4 groups of 40, depending on the non-drug exposure method in the rehabilitation program: 1st group ― with the inclusion in the individual rehabilitation program of a course of chloride-sodium mineral baths in the amount of 10 procedures, 2nd group ― patients who were assigned a 10-day course of hot tubs, 3rd group ― 40 patients, along with exercise therapy, who underwent a 10-day course of general baths "Biolong", and 4th, control group of patients who did not undergo outpatient rehabilitation.

RESULTS: The most frequent complaints were increased fatigue ― 88.8% of subjects, memory loss ― 46.9%, headache and dizziness ― 38.8%, dyspnea during physical activity ― 35.6%. The most frequent electrocardiogram parameters were sinus tachycardia (4.4%) and sinus bradycardia (8.1%). The mean allostatic load index of all patients was 3 [2; 3], which corresponds to the average allostatic overload. Against the background of rehabilitation measures with the inclusion of preformed physical factors, regression of the main complaints (weakness was detected in 24.2% of cases, memory decline ― in 20%, headache, dizziness ― in 17.5%, dyspnea ― in 15%, sleep disturbance ― in 10%, tachycardia and discomfort in the heart area ― in 7.5%) and improvement of electrocardiogram parameters were noted: sinus tachycardia and ventricular extrasystole were not noted, bradycardia was recorded in 2.5% of cases instead of 8.1%, repolarization process disorders ― in 2.5% instead of 8.1% before rehabilitation. In the group of patients who received whirlpool baths, improvement of external respiratory function parameters was noted: forced vital capacity of lungs increased by 12.1% (p <0.01), forced expiratory volume in the 1st second ― by 9.6% (р <0.05), the distance traveled according to the results of the test with 6-minute walking increased by 2.2% (р <0.05). In the group of those who received general baths with the preparation "Biolong", there was registered an increase in forced expiratory volume in the 1st second by 9.4% (р <0.05), an increase in the distance traveled during the 6-minute walk test by 8, 3% (р <0.05), decrease in norepinephrine level by 17.4% (р <0.05), adrenaline level by 13% (р <0.05) and cortisol level by 26.2% (р <0.01), glutathione peroxidase activity level by 13.6% (р <0.05). In the group of patients who received sodium chloride baths, there was a tendency to improvement of central hemodynamic parameters, reduction of adrenaline and noradrenaline parameters by 14.5% and 19.7% respectively (р <0.05). All rehabilitation groups showed a decrease in the Beck depression scale and Spielberger anxiety scale, K. Maslach questionnaire (emotional exhaustion and reduction of personal achievements), Bass–Perry aggression level questionnaire and Schulte table (mental stability), as well as a decrease in the level of allostatic load. In the control group, no dynamics of complaints and indicators was noted.

CONCLUSION: In patients with post-COVID syndrome, a variety of complaints and a number of electrocardiogram disorders, clinical and functional parameters were identified. The study revealed positive dynamics against the background of the rehabilitation course with the inclusion of hydrobalneotherapy methods in the form of significant regression of complaints, clinical and functional disorders and changes in psychoemotional background and cognitive status. A decrease in allostatic load was noted after a course of non-drug rehabilitation.

BACKGROUND: Osteoarthritis is one of the most common forms of pathology of the musculoskeletal system with significant impairment of motor function, which is one of the main causes of disability in the population.

AIM: This study was aimed at testing the effectiveness of the portable device "ALMAG+" with pulsed electromagnetic fields in the treatment of pain in patients with osteoarthritis of the knee joint.

MATERIALS AND METHODS: This randomized, double-blind, placebo-controlled clinical trial included patients with radiographic evidence of knee osteoarthritis and persistent pain greater than 40 mm on a visual analogue scale (VAS). The study included daily treatment with pulsed electromagnetic fields from the ALMAG+ device for 1 month in 60 patients with knee osteoarthritis. The primary outcome measure was reduction in pain intensity assessed by VAS and WOMAC scales. Secondary outcomes included the 36-item Short Form Medical Outcomes Study version 2 (SF-36 v2) quality of life, pressure pain threshold, and changes in non-steroidal anti-inflammatory drug/analgesic use.

RESULTS: Sixty-six patients were enrolled in the study, and 60 completed the study. After 1 month of treatment, pulsed electromagnetic fields caused a significant reduction in pain VAS and WOMAC scores compared to placebo. In addition, patients receiving pulsed electromagnetic fields improved pain tolerance, which was reflected in changes in pain threshold, and physical condition. We obtained a significant and statistically significant effect of the organized pulsed electromagnetic fields factor on VAS pain scores (F=47.6; p=0.00006); assessments of the severity of pain, joint function and stiffness on the scales of the WOMAC questionnaire also significantly changed under the influence of the pulsed electromagnetic fields factor (F=14.7; p=0.001). 26% of patients in the pulsed electromagnetic fields group discontinued non-steroidal anti-inflammatory drug/analgesic therapy. No adverse events were identified during treatment.

CONCLUSION: These results suggest that pulsed electromagnetic fields therapy is effective in relieving pain in patients with knee osteoarthritis and also affects pain threshold, stiffness, and physical functioning. In the future, it is desirable to conduct larger studies, including those comparing the effectiveness of pulsed electromagnetic fields therapy with standard pharmacological approaches for osteoarthritis.

Osteoarthritis is a widespread and devastating disease that leads to pain, reduced quality of life and high healthcare costs. Much practical experience has been accumulated in the use of physical factors for osteoarthritis. A large number of publications, including randomized clinical trials, systematic reviews, and meta-analyses, have been devoted to analyzing the evidence for the effectiveness of physical therapy in osteoarthritis.

We analyzed scientific and technical literature sources, including randomized clinical trials, meta-analyses and systematic reviews (search depth 20 years) on the issues of evaluating the efficacy of physical therapy (ultrasound therapy, laser therapy, electrical stimulation, cryotherapy, balneotherapy and mud treatment) in patients with osteoarthritis.

In 4 systematic reviews with meta-analysis (51 studies, 2772 patients), 1 Cochrane review (341 patients) and 3 randomized clinical trials (250 patients) it was shown that the use of ultrasound therapy in both continuous and pulsed modes in patients with osteoarthritis of the knee joint can significantly reduce the severity of pain and increase the range of active movements in the diseased joint. According to the results of systematic reviews, including meta-analysis (122 studies) and 9 randomized clinical trials (369 patients), the use of percutaneous electroneuromyostimulation in patients with osteoarthritis of the knee joint can be considered as an optimal method of non-drug therapy in terms of achieving significant analgesia in the short term. Data from 4 randomized clinical trials (414 patients) and 1 Cochrane review (3 randomized clinical trials, 179 patients) proved that the use of cryotherapy in patients with osteoarthritis of the knee joint leads to a significant reduction in the intensity of pain sensations in the affected joint, while the achieved analgesic effect is maintained for the next 3 months. The use of sulfur-containing and sodium chloride mineral waters (4 randomized clinical trials, 325 patients and systematic reviews, including meta-analysis (42 randomized clinical trials, 1766 patients), as well as peloid therapy (5 randomized clinical trials, 370 patients) in patients with osteoarthritis of the knee joint contributes to a decrease in the severity of pain, increases the functional activity of knee joints, as well as the quality of life of patients.

This article provides a review of the literature evaluating treatments for cervical disc herniation.

As the most common cause of neck pain and even disability, cervical disc herniation often requires a multifaceted approach to treatment. The author examines the effectiveness of complex exercise therapy, including a number of therapeutic exercises and methods of manual therapy and SIS-therapy, using a high-intensity magnetic field. The review contains a description of various clinical trials, and also presents comparative functional characteristics of these methods to assess the effectiveness, safety and effectiveness of treatment. The author conducted a comparative analysis of the SIS-therapy method with the exercise therapy method in the treatment of herniated discs of the cervical spine based on consideration of such aspects of their impact as the mechanism of action, effectiveness, safety, accessibility and convenience, time and cost, and overall impact on health. The results show that complex exercise therapy and SIS-therapy are the most promising non-invasive treatment methods that can significantly improve the degree of pain relief, mobility and overall quality of life of patients with cervical disc herniation. The article provides recommendations for the implementation of these treatment methods in clinical practice and suggestions for further directions of research.