Bulletin of Rehabilitation Medicine

Introduction. Health resort complex (HRC) of the Russian Federation has the potential to successfully implement the topical tracks of our time. The achievements of Russian balneology are universally recognized all over the world, as they are associated with evidence-based approaches to the development of therapeutic techniques and complex programs using natural therapeutic resources.

Aim. Analysis of the current structure and role of the main elements of the health resort complex, its resource and scientific potential, created in the process of building the continuity of health resort treatment (HRT) with the provision of quality and affordable primary and specialized medical care to the population of Russia.

Materials and methods. The tools used were medical and statistical analysis of the development of infrastructure, bed stock, resources for health resort treatment in Russia; SWOT-analysis methodology of strengths and weaknesses of the Russian health care system; theoretical foundations of management and scientific approaches to public health and health care organization.

Results and discussion. The analysis relevant to the current situation of development of health resort organizations in Russia has shown some trends and problems faced by the balneology of the country in recent years. Currently, there is an increase in the risks of changing the traditional legal status of therapeutic and recreational areas, resorts and resort territories. There are other unresolved issues related to insufficient development of infrastructure, digitalization, staffing, and others. At the same time, one should note many strengths of Russian balneology, primarily related to high scientific and methodological support and introduction of the latest effective non-medication technologies into health resort practice. In the near future it will be necessary to develop strategic objectives for the development of the health resort complex up to 2036, that will lead to the development of new opportunities of balneology to provide answers to the current challenges of public health of the country’s population.

Conclusion. To achieve Russia’s national development goals in the medium term, the health resort complex is of great importance. The experience accumulated over many decades in the application of natural therapeutic resources in various therapeutic, preventive and rehabilitation programs confirms the potential of health resort treatment in preserving the population and strengthening people’s health.

Introduction. Functional activity and independence of elderly people with type 2 diabetes mellitus (DM2) depend not only on the glycaemic control, but also on the severity of geriatric syndromes. This subanalysis was conducted to study the peculiarities of the effect of individual geriatric rehabilitation (GR) programs on functional status in patients with type 2 DM2 and frailty.

Aim. Evaluation of the effect of geriatric rehabilitation on the level of functional activity in patients with DM2 and frailty.

Materials and methods. A subanalysis of data from POSTSCRIPTUM, a multicentre, prospective study, was conducted to evaluate the effectiveness of 21-day geriatric rehabilitation programmes for patients aged 60 years and over with senile asthenia syndrome. The subanalysis included 475 patients, who were divided into two groups: 91 patients with type 2 diabetes mellitus (DM2+ group) and 384 patients without DM (DM2– group). On visit 1, a comprehensive geriatric assessment (CGA) was performed, and a personalized 21-day GR program was developed. Visit 2 took place after the completion of GR to evaluate the effectiveness of the course.

Results and discussion. The frequency of diagnosing geriatric syndromes (GS) and the distribution of frailty severity were comparable in the DM2+ and DM2– groups. Frailty was found in 38 % in the DM2+ group and 34 % in the DM2– group. Median age in the DM2+ and DM2– groups was 76 [71; 81.5] vs 80 [73; 84] years, p = 0.001. After the 3-week GR program, the DM2+ group showed an improvement in a brief battery of physical functioning tests (p < 0.001), an increase in the mean MoCA (Montreal Cognitive Assessment) score of 2.06 ± 0.38 (p < 0.001), a decrease in pain intensity in self-assessments according to the visual analog scale in the last week (p < 0.001), decreased insomnia severity index p = 0.03), and improved MNA (Mini Nutritional Assessment) score (p = 0.006). The subgroup of patients with preasthenia gravis additionally demonstrated improvements in baseline activities of daily living, nutritional status, and a decrease in the insomnia severity index.

Conclusion. The POSTSCRIPTUM study demonstrated the effectiveness of short-term individualized GR programs based on CGA results in patients with DM2 and frailty in improving physical and cognitive status; pain severity; while the subgroup of patients with preasthenia gravis showed improvement in baseline activities of daily living, nutritional status, and a decrease in the insomnia severity index.

Introduction. The current problem lies in developing and evaluating the effectiveness of new rehabilitation methods for patients with ischaemic stroke during the acute phase.

Aim. To evaluate the result of a prospective (6 month) follow-up of patients with ischemic stroke after rehabilitation using virtual reality on the dynamics of mobility and motor functions of the lower extremities.

Materials and methods. On the basis of Regional Hospital No. 23 (Yalutorovsk), in the primary vascular department (neurological profile), a single-center prospective randomized trial was conducted to evaluate the effectiveness of integrated rehabilitation methods using virtual reality in patients with ischemic stroke. By the method of blind randomization, after receiving written consent to participate in the study, the patients were divided into 3 groups. All three groups underwent an identical rehabilitation course according to clinical recommendations after the end of the acute period of stroke. The main group (n = 30) patients received immersive virtual (VR) and augmented reality (AR) in addition to the basic rehabilitation course. The comparison group (n = 30) — patients received basic rehabilitation, etc. The control group (n = 30) — patients received a basic course of rehabilitation without AR and VR. The effectiveness was assessed using identical clinical and functional scales after the rehabilitation course and after 6 months.

Results and discussion. Examination of patients after 10 days showed an increase in strength in the lower extremities and improved coordination in support. In the main group, after 10 days, the load distribution index on the affected side increased from 39 [13; 94] % to 46 [15; 63] % on stabilometry, compared with 31.5 [6; 88] % to 41 [9; 71] % in the control group (p < 0.05). There was a decrease in the severity of disorders in the functioning of patients in all three groups. After 6 months, it was revealed that in the main group, 50 % of the patients had moderate neurological disorders that had developed into milder grades. The results indicated a better recovery in the main group with VR and AR.

Conclusion. As a result of the study, positive effects were noted in the use of rehabilitation of patients with ischemic stroke with the inclusion of immersive and augmented virtual reality. The technique can be used for rehabilitation in the acute period of ischemic stroke in the preparation of rehabilitation programs and is subject to further study.

Introduction. Postural disorders are a significant issue among Parkinson’s disease (PD) patients. Therapeutic transcranial magnetic stimulation (tTMS), specifically theta burst stimulation (TBS) protocols, is a promising rehabilitation method. Though tTMS efficacy in terms of motor improvement was shown, its efficacy for postural disorders treatment is questionable.

Aim. To study the efficacy of bilateral primary motor core (M1) intermittent theta burst stimulation (iTBS) in PD patients.

Materials and methods. 24 PD patients, aged 42–75 years, with II and III Hoehn — Yahr stages were selected as part of this double-blinded, sham-controlled, randomized study. 10 sessions were performed both in active (M1 group) and sham (sham group) stimulation. All tests were performed both in off- and on- states, 4 times altogether: before and shortly after the course, then 1 and 3 months after the course. MDS-UPDRS, Berg balance scale, 10-meter walking test and stabilometric tests (Romberg test and dynamic stability test), performed with the Stabilan-01-2 complex, were used as assessment tools. Statistical analysis was performed with the IBM SPSS Statistics 27.

Results and discussion. In M1 group there was a short-term motor improvement by 5 points (12.6 %) according to part III of MDS-UPDRS in off state, and a long-term postural stability improvement in both states. Stabilometry results showed long-term improvement in dynamic stability test in M1 group in both states; the only significant group effect was also found. Adverse events (AE) did not significantly differ in prevalence and severity between the two groups; no life-threatening AE were observed. M1 iTBS has a moderate positive effect on motor and postural disorders in PD patients. The observed trends (mostly off state improvement and postural stability improvement) lead to suggestion of stimulation acting through both dopaminergic and dopamine-independent pathways. The protocol appears to be safe and tolerable.

Conclusion. Bilateral M1 iTBS does not appear to have a definite effect on motor and postural disorders in PD patients. Nevertheless, given its tendency to have a positive effect and its good safety and tolerability profile, further research is essential.

Introduction. Photographing patients is an affordable and justified method of diagnosis and documentation, which should be actively used when contacting patients with pathology of the musculoskeletal system. At the same time, the basic requirements for the execution of photographs have not yet been agreed upon, with the help of which a comprehensive assessment of the current state and changes can be carried out. The creation of optimal standards for photogrammetry would improve the information content of the results, would allow for exchange between specialists, including in related fields.

Aim. To substantiate standardized approaches to performing medical photography of patients with orthopedic pathology to improve qualitative and quantitative assessment of orthopedic status indicators and treatment continuity.

Materials and methods. The publication describes the experience of practical application of photogrammetry in assessing the orthopedic status of patients with musculoskeletal pathology and possible ways of standardization for performing medical photography.

Results and discussion. As a result of the work, the following conclusions can be drawn: performing 4 photos of the body (rear view, side view with full head and leg capture, Adams test from front and back) in 95–98 % of cases, it allows you to diagnose static disorders of the spine and lower extremities. When assessing the function of a limb (amplitude of movements in joints) or conducting functional tests, it is justified to document the examination area as fully as possible with the capture of conjugate segments. When photographing, it is necessary to ensure uniform, not bright illumination from the center of the photographed area in order to preserve the penumbra and the possibility of assessing the asymmetry of the body surface. When photographing a patient, the camera should be correctly oriented in three planes of space to eliminate distortions associated with its tilt. To do this, it is possible to use software solutions or photograph the patient against the background of reference rectangular objects (followed by the use of photo editors). To improve the perception and analysis of photographs, it is justified to use auxiliary tools and solutions (software applications, laser levels, markings on the patient’s body, diagnostic grids, projection of video images onto the patient’s body, uniform non-bright illumination to contrast asymmetries of the body surface, etc.).

Conclusion. It is advisable to photograph the patient so that the analyzed area of the body occupies 80–95 % of the screen area. The diagonal of the mobile device screen for visual evaluation is at least 8 inches (optimally 11–12 inches for tablets or more in the case of stationary monitors). The ability to scale the resulting image is important, as it allows you to detail the observed changes. The integration of photographs of patients with visible pathology of the musculoskeletal system into medical information systems with the ability to analyze images is promising.

Introduction. The use of naturally occurring hydrocolloids and hydrogels as components of biomimetic materials has a significant advantage because such biopolymers are highly biocompatible. At the same time, the large-scale introduction of natural hydrogels in tissue engineering and practical medicine is hampered by the complexity of the structure standardization and chemical composition of this class of biopolymers, and, consequently, difficulties in predicting the cellular response to hydrogel biomaterials. One way to solve this problem may be the integration of magnetic nanoparticles into the structure of hydrogel biomaterials.

Aim. To evaluate the effect of magnetite nanoparticles on the biocompatibility and adhesion of fibroblasts to the surface of alginate hydrogel.

Materials and methods. A 2 % aqueous solution of sodium alginate was used to prepare the alginate hydrogel film. Magnetite nanoparticles treated with citric acid were used to modify the biofunctional properties of alginate hydrogel. Biocompatibility of materials was evaluated by light and luminescence microscopy using fluorescent dyes (DAPI, Rhodamine) and a kit for assessing metabolic activity of cell using a tetrazolium dye (MTT assay).

Results and discussion. It was found that the introduction of magnetite nanoparticles into the alginate film increases the biocompatibility of the hydrogel material. After 48 hours of incubation, the number of cells increases from 30 ± 5 to 60 ± 7 pcs/200 μm², and the metabolic activity of fibroblasts is 93 % of the control values. The surface of the hybrid film acquires the ability to maintain the adhesion and viability of fibroblasts, the number of cells on the surface of the hybrid film is more than 10 times greater than the number of cells adhered to the alginate film. Thus, magnetite nanoparticles modified with citric acid can be used to regulate functional cellular responses to plant-derived hydrogel biomaterials.

Conclusion. A new method for the biofunctionalization of alginate hydrogel by including magnetite nanoparticles in its composition is proposed. The integration of magnetite nanoparticles with natural hydrogels and the creation of biomaterials with controlled structural and mechanical properties can be a solution to the problem of predictable cellular response to biopolymers heterogeneous in composition and structure.

Introduction. Improvements in oncological treatment strategies have led to improved survival rates for breast cancer patients, which is responsible for the increasing number of patients with Breast Cancer Related Lymphedema (BCRL). The search for effective complementary interventions, such as modified Intermittent Pneumatic Compression (IPC) programmes, that can be incorporated into stand-alone treatment programmes for patients with BCRL, including for use at home, is relevant.

Aim. To study the efficacy of different modern intermittent pneumatic compression techniques in BCRL based on the analysis of systematic reviews and meta-analyses of randomized controlled trials (RCTs).

Materials and methods. The search was conducted in the databases eLIBRARY.RU, Scopus, PubMed, Web of Science, and PEDro using the keywords “lymphedema”, “upper extremities”, “breast cancer”, and “variable pneumocompression” from 1998 to 2024. A total of 53 sources were selected for March 2024, of which 17 were systematic reviews, one was a Cochrane review, four were practice guidelines and 31 were RCTs (58.49 %).

Results and discussion. The systematic reviews analyzed were unable to demonstrate convincingly the added value of manual lymphatic drainage (MLD) as part of a Complex Decongestive Therapy (CDT). Therefore, we analyzed the results of RCTs on the use of standard and modified IPC programmes that can be included in stand-alone patient treatment programmes, including those for home use. The efficacy of IPC is supported by the results of a large number of publications evaluating the efficacy of IPC in BCRL. The studies included the following interventions: a combination of CDT and IPC or IPC alone, with the pressure used for IPC ranging from 40 to 60 mmHg and the duration of the IPC procedure varying from 30 minutes to 2 hours. The results showed that the adjunctive use of IPC to CDT could alleviate lymphedema, but there was no significant difference between conventional treatment of lymphedema with and without pneumatic pump. It was found that during the intensive phase (phase I) of treatment, CDT combined with IPC provided significantly greater mean volume reduction than CDT alone (43.1 % vs. 37.5 %; p = 0.036). In the few studies conducted, the use of the Advanced Pneumatic Compression Device (APCD) technique with simulated MLD was found to be superior to the standard ADPC technique and more adaptable to long-term home use in patients with BCRL.

Conclusion. Thus, analysis of published sources showed that CDT combined with IPC is more effective in reducing excess volume and excess circumference of the upper limb with lymphedema during a relatively short follow-up period (up to 8 weeks after the end of physiotherapy). In addition, the combined application of CDT + IPC can improve the shoulder mobility in four functional positions: extension, extension, flexion and external rotation, which can be the basis for periodic continuous supportive lymphatic drainage treatment to maintain the anti-edema effect. It has also been shown that the use of the APCD technique with simulated MLD is superior to IPC and more adapted to long-term home use in patients with BCRL.