Vol 22, No 5 (2023)

INTRODUCTION. The limitations in mobility frequently encountered by the elderly, often linked to advanced age and concurrent medical conditions, have significant implications for their overall well-being and self-reliance. This decrease in physical activity not only curtails their independence but also elevates the likelihood of prolonged hospitalization and the accompanying complications.

AIM. To assess the impact of a home-based Full-Body in-Bed Gym program, a 10-exercise protocol consisting of three sessions per week for two months, on the quality of life of elderly individuals.

MATERIALS AND METHODS. The study involved participants of both genders aged over 65, who were classified as sedentary, engaging in less than one hour of physical activity per week. Participants with recent orthopedic conditions, severe cardiovascular or oncological diseases, and significant neurological disorders were excluded due to their potential to confound the effects of the Full-Body in-Bed Gym program and impact overall health and quality of life.

RESULTS. A total of 22 subjects, with a median age of 71.90 years, participated in the study.

Elderly individuals engaging in the Full-Body in-Bed Gym program, experienced improvements in their quality of life. These gains were noticeable in the 12-Item Short Form Health Survey (SF-12) Physical Component Summary (p = 0.07) and reached statistical significance in the Mental Component Summary (p = 0.04).

DISCUSSION. The observed gains in the quality of life among elderly participants engaging in the home-based Full-Body in-Bed Gym program are noteworthy. The positive impact on the mental component of the SF-12 is particularly significant, indicating improvements in mental well-being. This aligns with the broader understanding that physical activity in the elderly is intricately linked to various aspects of their health, including mental health. While the preliminary findings suggest positive outcomes, future research with larger and more diverse cohorts could provide a more robust understanding of the Full-Body in-Bed Gym program’s impact.

CONCLUSION. Our findings underscore the potential of a home-based Full-Body in-Bed Gym program to enhance the quality of life in elderly participants, highlighting the need for further exploration of rehabilitation and prevention strategies in this context.

INTRODUCTION. Impaired gait and balance after a stroke significantly affect patients' daily activities and quality of life. Robotic mechanotherapy and virtual reality technologies are actively studied and used to restore lower limb muscle strength, balance and gait pattern.

AIM. To assess the effectiveness and safety of rehabilitation using robotic mechanotherapy (exoskeleton) with functional electrical stimulation (FES) and virtual reality (VR) technology with plantar stimulation in the restoration of gait and balance disorders in patients in acute and early recovery periods of ischemic stroke.

MATERIAL AND METHODS. Men and women aged 39 to 75 with ischemic stroke in acute and early recovery periods with gait impairment and lower limb paresis from 0 to 4 MRC scores. The patients were randomized using the envelope method into 4 groups: Group 1 (33 people) — exoskeleton with FES, Group 2 (32 people) — combined application of robotic mechanotherapy with FES and VR with plantar stimulation, Group 3 (35 people) — VR with plantar stimulation, Control group (30 people) — conventional training.

RESULTS. Group 2 and 3 had significantly greater increases in muscle strength in the hip extensors, tibia flexors and flexors of the foot compared to the control group. Patients in the main groups also had a significant improvement in Tinetti Walking and balance Scale at follow-up. The analysis of the stabilometry results on the first and last day of the study revealed a decrease in the area of the statokinesiogram in the main groups both in the intragroup comparison and in the comparison with the control group.

DISCUSSION AND CONCLUSION. Exoskeleton gait training with FES and exercises on a VR with plantar stimulation, as well as combined use of these techniques allowed to achieve better recovery of lower limb muscle strength, walking functions and balance in patients in acute and early rehabilitation periods of stroke. This is probably due to the large number of steps or their imitation performed by the patient during rehabilitation sessions, which leads to activation of neuroplasticity and better recovery. The study demonstrated the safety and efficacy of an exoskeleton interval training system that prevents the development of orthostatic hypotension in patients in the acute period of ischemic stroke.

INTRODUCTION. An urgent problem of medical rehabilitation is the loss of results that were achieved at various stages due to the interruption of the recovery process and the absence of patients' classes at home after discharge from a medical institution. In this regard, at the third stage of medical rehabilitation, the remote (telemedicine) form of rehabilitation assistance is of particular importance, which has broad prospects for development due to the emergence of new information technologies that allow for active communication between a medical professional and a patient. Nevertheless, the issues of the effectiveness and safety of remote physical rehabilitation remain insufficiently studied, and therefore it is necessary to conduct randomized comparative trials with the analysis of long-term results.

AIM. Evaluation of the effectiveness and safety of the remote physical rehabilitation (RPR) model for a group of patients who have undergone hip (HR) or knee (KR) replacement, the study of patient adherence, as well as the selection of the most informative evaluation tools.

MATERIALS AND METHODS. The study included 30 patients aged 30 to 75 years who underwent HR or KR. The study participants were distributed by the envelope method into groups for remote rehabilitation in addition to routine clinical practice of providing medical rehabilitation (RPR group) or conducting only routine medical rehabilitation (comparison group), including daily independent physical exercises at home, mastered during inpatient medical rehabilitation, lifestyle modification, taking nonsteroidal anti-inflammatory drugs with the development of pain syndrome. An assessment of the effectiveness and safety of rehabilitation measures was carried out, including an analysis of physical examination data, vital signs, as well as data from various scales, tests and questionnaires (the 10-point visual-analog scale (VAS), the Timed 25-Foot Walk (T25-FW), the "Timed Up and Go Test", the Berg Balance Scale (BBS), the Western Ontario and McMaster University Osteoarthritis Index (WOMAC)).

RESULTS AND DISCUSSION. 14 patients were randomized to the remote physical rehabilitation group (49.6 ± 12.4 years) and 16 to the comparison group (57.8 ± 11.2 years). Participation in the study was completed by 10 patients from the RPR group and all 16 patients in the comparison group. Comparing the results of rehabilitation between the groups 1 month after the inclusion of participants in the study revealed a more pronounced statistically significant improvement in the functional profile of the patient on the T25-FW (p < 0.0001), the "Timed Up and Go Test" (p = 0.0064), the Berg Balance Scale (p = 0.0008) and WOMAC (p < 0.0001) in group of RPR. The "Timed Up and Go Test", the visual analog scale and the WOMAC were selected based on the results obtained for further practical work. The most significant predictors of premature termination of RPR were older age (χ² 16.75, p < 0.0001), pensioner status (χ² 11.75, p = 0.0006) and residence in the region (χ² 11.75, p = 0.0006). The analysis of adverse events showed that 4 patients in the RPR group and 6 in the comparison group had a periodic increase in pain syndrome in the operated limb.

CONCLUSION. The results obtained demonstrate that of patients who have undergone hip or knee replacement is safe and effective in restoring functional mobility, reducing the risk of falls and the severity of pain syndrome, and increases adherence to physical exercises. The main limitations in the practical use of remote physical rehabilitation are related to the availability of high-speed Internet and the skills of using Internet portals.

INTRODUCTION. Integrating climatotherapy into health resort therapy for arterial hypertension in diverse landscapes has the potential to yield positive effects, if used in target groups and preventing the occurrence of meteopathic reactions, including a hypertensive crisis (HC). While the impact of natural healing factors on the human body has been previously studied, the utilization of modern mathematical approaches in developing HC models has enabled accurate predictions and timely prevention of HC during adverse weather periods.

AIM. To analyze publicly available meteorological data time series to construct a mathematical model for predicting high-risk situations of HC based on the influence of climatic factors on patients with arterial hypertension. This model would identify unfavorable periods for hypertensive patients staying in health resorts throughout the year, allowing for timely therapeutic and preventive measures to prevent HC during these periods.

MATERIALS AND METHODS. The study was conducted over a 22-month period, from January 1, 2019 to October 31, 2020, in Gelendzhik and Novorossiysk, renowned resort destinations located on the Black Sea coast of the Caucasus. These regions have a dry and subtropical climate. Meteorological data were obtained from Gelendzhik and Novorossiysk weather stations, and ambulance calls data were collected from Gelendzhik (12,268 calls) and Novorossiysk (12,226 calls), resulting in a total of 24,494 ambulance calls.

The model was calculated using the maximum likelihood method through nonlinear logit regression. Key factors for the model included the main indicators of climate¹ and geomagnetic conditions². The logistic regression method exhibited a sensitivity of 56.0 % and a specificity of 77.3 %, with an overall accuracy of 76.0 %.

RESULTS. According to the developed predictive model, the winter season has no more than 75.0 % of days associated with a low risk of hypertension, decreasing to 59.0 % in spring. However, the proportion increases to 89.0 % in summer and reaches 77.0 % in autumn. Model adequacy checks indicated a high degree of relevance, with Q (model quality) ranging between +0.64 and –0.117, and p > 0.3.

CONCLUSION. The developed logistic regression models provide more accurate calculations of individual risks for developing complications of hypertension and offer the opportunity to formulate individual strategies for patients. These models contribute to the field of climatotherapy and enhance the understanding of the impact of climatic factors on hypertensive patients, facilitating targeted interventions and improved management of hypertensive crises.

INTRODUCTION. Chemotherapy-induced peripheral polyneuropathy (CIPN) is one of the most frequent side effects caused by anticancer drugs, with a prevalence ranging from 19 % to 85 %. For effective multicomponent rehabilitation of patients with CIPN at different stages, a number of non-medicinal methods are recommended to improve the tolerance of chemotherapy and reduce the side effects of the antitumor treatment performed.

AIM. Study of the effect of high-intensity pulsed magnetotherapy on clinical manifestations and microcirculation state in patients with CIPN.

DESIGN. This is a randomized controlled study.

SETTING. Randomization, organization of the study and data analysis were performed on the premises of the Department of Medical Rehabilitation in National Medical Research Centre for Rehabilitation and Balneology, Moscow, Russia.

POPULATION. Sixty patients with CIPN were included in this study and were randomized by a simple random distribution method in a ratio of 1:1 into 2 groups of 30 people.

METHODS. Sixty patients with CIPN four weeks after completion of chemotherapy were examined. The first group, the main group, included patients who received high-intensity pulsed magnetotherapy (HIPMT) in combination with drug therapy. In the second group (control group), the patients received only drug therapy. The EORTC-QLQ-C30 questionnaire (version 3) was used to assess the quality of life. The HADS scale was used to assess the severity of anxiety and depression symptoms. The state of microcirculation was assessed using laser Doppler flowmetry (LDF). The severity of CIPN was assessed according to the CTS-NCIC scale, version 3.0.

RESULTS. According to the results of this study, there is a statistically significant difference in the scores on the EORTC-QLQ-C30 questionnaire (version 3), HADS scale and LDF data between the groups in favour of the group receiving HIPMT in combination with drug therapy.

CONCLUSION. Based on the LDF study, significant disturbances at the microcirculatory level were detected for the first time in patients with CIPN. The obtained results convincingly demonstrate that the use of HIPMT in patients with CIPN leads not only to improvement of microcirculation in the extremities due to normalisation of arterial vessel tone, elimination of venous stasis and increase in the nutritive blood flow, but also has an analgesic effect, improves initially impaired sensitivity, and improves the quality of life of these patients.

CLINICAL REHABILITATION IMPACT. The use of HIPMT in combination with drug therapy in patients with CIPN was more effective than drug therapy alone.

In my research I have often found myself on the wrong side of the flow of international beliefs. I have generally been wrong and wasted my time and resources and my co-workers, but, sometimes, we have been on the right side. Such was the case with the role of apoptosis, also known as the programmed cell death, in biology and pathology of skeletal muscle tissue. Indeed, our original and pioneering findings have led to a change of direction in this research area. This role had been dismissed by the leading myologists, but using electron microscopy and molecular analyzes we demonstrated that accepted markers of apoptosis were present in mouse skeletal muscles two days after one night of voluntary running (up to 5 km during the first night). In a few years we have extended this fundamental observation to other experimental models in vivo and in vitro and in human cases of muscular dystrophies. In this paper I will give an overview of how the story began, but I must emphasize that Marzena Podhorska-Okolow and Marco Sandri deserve the highest praise for their most notable roles in the beginning and after, the roles and services that are still notable today.

INTRODUCTION. More than 36 million people die from NCDs each year (63 % of deaths worldwide), of which 14 million people die prematurely, that is, before the age of 70 years, the majority could be prevented through the organization of continuity and consistency in the organization of health care. In 2021, based on the experience of developed countries of the world, a standard form of the «Algorithm» for patient care in an outpatient setting after hospital treatment was developed (including stages of observation, periods of clinical examination and mechanisms for organizing rehabilitation services, including diet, exercise therapy and sanatorium-based treatment). A study was conducted among patients diagnosed with coronary heart disease regarding the organization of continuity and consistency of rehabilitation services after inpatient treatment in conditions outpatient clinics in the Yakkasaray district of Tashkent.

AIM. To study the practice of applying the organization of continuity and consistency in the provision of medical care for NCDs in Uzbekistan.

MATERIALS AND METHODS. The materials were the results of a study of patients diagnosed with coronary heart disease in 2021 — 537 patients and in 2022 — 596 patients in the Yakkasaray district of Tashkent. Retrospective, analytical research methods were used for the analysis.

RESULTS. In 2021, a total of 537 patients diagnosed with coronary heart disease received inpatient treatment in family clinics of the Yakkasaray district, and only 195 (36 %) brought discharge summaries, 195 (100 %) patients were taken for treatment as prescribed by doctors at outpatient clinics — control, 173 (88 %) 10 (5 %) underwent ECG and EchoCG, respectively, and 12 (6 %) patients were sent to sanatorium treatment. In 2022, in family clinics of the Yakkasaray district, a total of 596 patients received inpatient treatment, of which 535 (89 %) brought a discharge summary of inpatient treatment, 535 (100 %) patients were taken for D-control as prescribed by doctors from outpatient clinics, 535 (100 %) active patronage was established with an explanation of proper nutrition, physical activity, physiotherapeutic treatment, and 84 (16 %) patients were sent to sanatorium treatment.

CONCLUSION. Continuity and consistency are important in improving the quality of medical care, so healthcare organizers need to introduce new methods and improve existing approaches to improve the relationship between inpatient and outpatient clinics.