Vol 23, No 4 (2024)
- Year: 2024
- Published: 07.10.2024
- Articles: 14
- URL: https://journals.eco-vector.com/2078-1962/issue/view/9399
Full Issue
Articles
Greetings from Editor-in-Chief of the Journal "Bulletin of Rehabilitation Medicine", Acting Director of the National Medical Research Center for Rehabilitation and Balneology, President of National Association of Experts in Spa Treatment Anatoliy D. Fesyun
9-9
Greetings from Minister of Health of the Chechen Republic Adam R. Alkhanov
10-10
Natural Therapeutic Resources of the Russian Federation: Updated Legislation and Medical Aspects of their Application
Abstract
The article outlines the provisions of the modern regulatory framework that regulates the work of health spa (sanatorium) organizations and the use of natural healing resources for therapeutic purposes. The legislative innovations, the main tasks and problems of the development of the spa and resort industry from a medical point of view are described. The historical background of the development of the spa and resort medical industry in the context of natural resources is presented. It describes the development of health resort business in Russia from the emergence of the first sanatorium to the present day.
11-15
Innovative Processes in the Sanatorium and Resort Sector of the Republic of Belarus
Abstract
INTRODUCTION. The introduction of innovative processes in sanatorium-resort activities helps to approach the individual treatment of a citizen’s disease or preventive measures aimed at reducing the incidence of the population in a sanatorium-resort area, simplify the functioning of health resorts and their provision of high-quality services for sanatorium treatment and rehabilitation.
AIM. To determine the level of public awareness about sanatorium-resort organizations in the Republic of Belarus and to propose an algorithm for introducing innovative processes into their activities.
MATERIALS AND METHODS. The survey method was used in the study. The research tool was a questionnaire. The representativeness of the sample was ensured by calculating the required number of respondents, taking into account the population of the regions of the Republic of Belarus (923 people) account the power of the study at the level (1 – β) = 80 %. A mobile application has been developed in the Visual Studio Code environment to improve the activities and optimize organizational processes in the health resort in order to raise public awareness, based on a study conducted in the health resorts of the republic to assess the quality of services provided for sanatorium treatment and wellness.
RESULTS AND DISCUSSION. To identify the factors influencing the choice of a health resort by the population, cluster analysis, showed the closest correlation between the factors “doctors’ recommendations” and “medical services” influencing the choice of a health resort. The distribution of health resort awareness assessment in the regional context varied from 10.5 % (Grodno region) to 17.7 % (Minsk). The following are proposed: a system for informing the population and an algorithm for meeting the needs of the population in treatment and rehabilitation, the participation of information in sanatorium and resort activities. A selective assessment of the quality of spa treatment and wellness services in health resorts was carried out. A mobile application has been developed.
CONCLUSION. The level of awareness of the population of the Republic of Belarus about the activities of sanatorium-resort organizations was assessed using a survey method — regional differences were identified. A model of the public information system and an algorithm for meeting the needs of the population and health improvement, the participation of information in sanatorium and resort activities are presented. A mobile application has been developed for sanatorium-resort organizations.
23-29
Medical Rehabilitation and Health Resort Treatment at the Resort “Sernovodsk-Kavkazsky”
Abstract
INTRODUCTION. Medical rehabilitation and health resort treatment are important parts of the health care system of the Chechen Republic, which are actively developing with high potential and competitiveness. Studies on the treatment of patients with chronic non-communicable diseases show the effectiveness of natural therapeutic resources and other innovative non-medication methods.
AIM. To analyze and identify the most promising for the development of the Resort “Sernovodsk-Kavkazsky” directions of treatment of patients with chronic non-infectious diseases.
MATERIALS AND METHODS. Data from information-analytical systems of the sanatorium-resort industry of the Russian Federation and the data of our own research were used for the analysis.
RESULTS. The analysis and the main results confirming the effectiveness of treatment of patients with chronic non-infectious diseases with the use of natural healing resources and other innovative non-medication methods realized in the Resort “Sernovodsk-Kavkazsky” are presented. The most promising ways of development of health resort treatment and medical rehabilitation are determined.
CONCLUSION. The increasing activity of unfavorable environmental factors, which negatively affect the functional state of the organism and the level of health of the population as a whole, require from the health care system continuous improvement, including in the sanatorium and resort industry.
16-22
Greetings from Assistant to the Head of the Chechen Republic Khutmat R. Kadyrova
8-8
Use of the ECG-Controlled Six-Minute Walk Test to Assess Exercise Capacity: a Comparative Cohort Study
Abstract
INTRODUCTION. In clinical practice, stress tests are carried out to draw up an individual patient rehabilitation plan, assess tolerance and optimize the load, and evaluate its clinical effectiveness. The Six-minute walk test (6MWT), in the presence of contraindications to the bicycle ergometer test or the impossibility of performing it, is a tool for assessing the response of the cardiovascular and respiratory systems to the load being performed. There is no description in the literature of the relationship between the distance traveled during 6MWT and the peak metabolic equivalent (MET) assessed during the bicycle ergometer test.
AIM. Study the relationship between 6MWT indicators and the results of bicycle ergometer test in patients who have suffered a myocardial infarction.
MATERIALS AND METHODS. During the examination, 56 patients underwent a symptom limited bicycle ergometer test and 6MWT, the peak MET and the distance traveled during 6MWT, as well as changes in the ECG during both tests were assessed.
RESULTS AND DISCUSSION. The average values of maximum heart rate during the bicycle ergometer test and ECG-controlled 6MWT did not differ significantly. The distance in meters during 6MWT and the power of the exercise performed during bicycle ergometer test in MET have a significant relationship, which indicates the comparability of the data from these tests as a criterion of exercise tolerance.
CONCLUSION. The use of 6MWT and bicycle ergometer test allows us to assess various aspects of cardiorespiratory function and physical fitness in patients undergoing a cardiac rehabilitation program. Further study of the possibility of using ECG-controlled 6MWT in the early stages of rehabilitation is necessary to create the most effective and safe physical training for patients who have suffered a myocardial infarction.
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Analysis of Biomechanical Gait Parameters in Patients after Total Hip Replacement in the Early Recovery Period
Abstract
INTRODUCTION. The widespread use of total hip arthroplasty (THA) places high demands on the restoration of a normal gait pattern and is one of the key goals of rehabilitation.
AIM. Determination of key parameters of walking in patients after THA to assess the effectiveness of restoration of the physiological gait pattern.
MATERIALS AND METHODS. In a control prospective study, the main group consisted of 23 patients (11 men, 12 women, aged from 41 to 75 years, mean age 63.9 ± 9.4 years), who in the first 8 weeks after planned THA, moved with the help of assistive devices. supports (two crutches or walkers) who underwent stage II of medical rehabilitation; control group — 27 healthy people (12 men and 15 women, aged from 42 to 73 years, average age 60.9 ± 9.9 years). Spatiotemporal and kinematic gait parameters were recorded before and after the rehabilitation course using a gait simulator with biofeedback equipped with three sensors. For each leg, spatiotemporal and kinematic biomechanical parameters were separately recorded.
RESULTS. All spatiotemporal gait parameters on both limbs and pelvic mobility in the sagittal plane in patients in the early recovery period after THA before the start of the rehabilitation course are significantly different from healthy people. After a course of rehabilitation, the studied gait parameters approach physiological values. The main asymmetry is observed in the single support phase from 16 % at the beginning of the course, to 10 % at the end; sagittal pelvic mobility are 2 times higher than the physiological normal meaning at the beginning of the course, without significant changes in dynamics.
DISCUSSION. Disturbances in the gait pattern are observed in the majority of patients undergoing THA. Step symmetry is one of the significant parameters of walking, according to which the primary global assessment of its quality is carried out. Asymmetry of the single support phase of the limbs is a natural development of compensatory motor reactions after endoprosthetics.
CONCLUSION. The gait parameters “step frequency” and “step cycle” quickly change after a course of rehabilitation and can be used to assess the locomotor activity of patients during short courses of medical rehabilitation in the early recovery period. Indicators of stance and swing phases, their symmetry changes much more slowly, can serve as criteria for assessing the effectiveness of measures taken at the stages of rehabilitation in the dynamics of gait restoration.
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Telerehabilitation Program Impact on Overactive Bladder Symptoms and Metabolic Health in Obese Women: a Randomized Controlled Trial
Abstract
INTRODUCTION. Overactive bladder syndrome is caused by many factors including obesity, insulin resistance and poor dietary habits. Since it is a chronic disease and needs time to be treated, introducing telepilates in addition to Mediterranean diet would encourage better adherence and results to the treatment program.
AIM. To assess the impact of a virtual group-based telerehabilitation program on overactive bladder symptoms and metabolic health in women with obesity.
MATERIAL AND METHODS. Eighty obese women (BMI 30.0–34.9 kg/m2) between the ages of 35 and 45 were allocated into two equal groups, 40 for each: (A) supervised telepilates and (B) unsupervised telepilates. The supervised group participated in a 12-week Pilates workout program over videoconference platforms three times a week. Meanwhile, the unsupervised group only received four online meetings. The groups’ diet was the Mediterranean style. The Hemostatic Model of Insulin Resistance (HOMA-IR), body mass index (BMI), waist circumference (WC), Patient Perception of Urgency Scale (PPIUS), Overactive Bladder Questionnaire Short Form (OAB-q SF), and Telehealth Usability Scale (TUS) were measured.
RESULTS AND DISCUSSION. The supervised telepilates group exhibited statistically significant amelioration of overactive bladder symptoms and a reduction in HOMA-IR (p < 0.001), while the unsupervised telepilates group showed insignificant changes in these measures (p > 0.05). Furthermore, the supervised telepilates group showed significantly greater reductions in BMI and WC (p < 0.001) than the unsupervised telepilates group (p < 0.05). Additionally, the supervised telegroup outperformed the unsupervised telegroup on all parameters of TUS (p < 0.001)
CONCLUSION. Women with obesity experienced decrease in overactive bladder symptoms and improved metabolic health after completing a 12-week telepilates training program.
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The Effectiveness of Dry Carbon Dioxide Baths in Menopausal Syndrome: a Randomized Clinical Study
Abstract
INTRODUCTION. Climacteric syndrome is characterized by significant disorders in the nervous, musculoskeletal, urinary and cardiovascular systems in women of the perimenopausal and postmenopausal periods. The main reason is a sharp decrease in estrogen levels. Menopausal hormone therapy is often used for treatment, but due to contraindications and complications, it does not always completely solve the problem. This has sparked interest in alternative treatments such as dry carbon dioxide baths.
AIM. To study the effectiveness of using dry carbon dioxide baths in women with menopausal syndrome and evaluate their impact on the neurovegetative, metabolic and psycho-emotional state of these patients.
MATERIALS AND METHODS. A prospective randomized study was conducted involving 70 patients with moderate climacteric syndrome aged from 48 to 60 years. Using a simple randomization method, the women were divided into 2 groups: 35 patients of the main group received 10 procedures of dry carbon dioxide baths with a CO2 concentration of 15–20 %, temperature 28–32 °C, lasting 15–20 minutes, 35 patients of the control group did not receive any treatment. To assess the effectiveness of treatment, a modified Kupperman-Uvarova menopausal index, an assessment of the effect of “hot flashes” on daily life on the HFRDIS scale, as well as daily blood pressure monitoring (SMAD) were used.
RESULTS AND DISCUSSION. After treatment, patients in the main group observed a significantly significant (p < 0.05) improvement in the patients’ condition in the form of a decrease in integral indicators of the modified menopausal index and an assessment of the impact of hot flashes on daily activity on the HFRDIS scale by 28.2 and 43.1 %, respectively, as well as in the form of a decrease in average daily systolic blood pressure by 13.7 %.
CONCLUSION. The use of dry carbon dioxide baths is recommended for use in women with moderate climacteric syndrome, since this method significantly improves the quality of life of patients and is an effective non-drug that can reduce the drug load on the body of a woman suffering from neurovegetative disorders.
55-61
Efficacy of Hydrogen Sulfide Baths in Complex Burn Rehabilitation: a Single-Center Observational Study
Abstract
INTRODUCTION. The healing of burn wounds often leads to pathological scars and scar contractures, significantly deteriorating the quality of life for patients who have experienced burn trauma. In comprehensive anti-scar therapy, balneotherapy with sulfide (hydrogen sulfide) waters can be applied alongside primary methods. However, due to a lack of modern information on its effectiveness, this method is not frequently included in rehabilitation programs.
AIM. To determine the significance of hydrogen sulfide baths in comprehensive rehabilitation and improve treatment outcomes for patients with hypertrophic post-burn scars.
MATERIALS AND METHODS. In the years 2021–2022, 110 patients, including adults and children, participated in an observational study at the Matsesta Balneological Resort (Sochi, Russia) titled “Evaluation of the Effectiveness of Balneotherapy for Post-Burn Scars in Adults and Children”. All patients received a course of 10 hydrogen sulfide irrigations or baths at the Matsesta Balneological Resort. Before the start of the procedure and after completion, scar tissue assessment using the Vancouver Scar Scale and patient surveys were conducted by a physiotherapist.
RESULTS AND DISCUSSION. Among the patients, there were 40 adults and 60 children. The age of patients ranged from 2 to 61 years, with an average of 19.8 years; 49 were male, and 51 were female. The burn area in patients ranged from 5 to 90 % (average 33.1 %) of the body surface. After the first course of sulfide irrigations, the scar tissue assessment on the Vancouver Scar Scale decreased by 2.1 points in children and 2.2 points in adults. After a repeat course of sulfide irrigations, scar tissue assessment decreased by 1.3 points in children and 1.8 points in adults. According to surveys based on the Dermatology Life Quality Index, before treatment, patients subjectively rated their condition on average at 3.45 points, and after treatment, at an average of 2.76 points. The decrease in scores was mainly due to the reduction or disappearance of symptoms such as dryness, burning, pain, and paresthesia in the scar.
CONCLUSION. Balneotherapy with sulfide waters for patients with hypertrophic post-burn scars within the first 24 months after burn trauma is effective for both children and adults.
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Hydrotherapy Application for Women with Polycystic Ovary Syndrome: a Randomized Study
Abstract
INTRODUCTION. Recently, alternative methods of treating patients with menstrual disorders have become increasingly in demand. One of these methods is hydrotherapy, which has a complex effect on the body.
AIM. To evaluate the effectiveness of contrast baths and underwater shower-massage as part of complex treatment of women with polycystic ovary syndrome.
MATERIAL AND METHODS. A prospective randomized study was conducted in 120 women with polycystic ovary syndrome, grade 1 obesity, and menstrual irregularities. During the study, 2 groups were allocated by randomization: the first (main) included 60 patients, whose treatment included a special diet and a 24-day course of hydrotherapy, consisting of a single daily intake of fresh water contrast baths (12 days), alternating every other day with underwater shower-massage procedures (12 days). The second group, the control group, was represented by 60 patients who received only a special diet.
RESULTS AND DISCUSSION. After treatment, a significantly significant decrease in body mass index was noted in both groups of the study (by 4.9 % in the control group and by 11.3 % in the main group). In women receiving a course of hydrotherapy, there was an improvement in lipid and carbohydrate metabolism with a decrease in the atherogenic index by 36.1 % and an insulin resistance index by 31.0 %, as well as an improvement in indicators of psycho-emotional state, characterized by a decrease in situational anxiety on the Spielberger Hanin scale (p < 0.05) and improvement in overall mood on the “Well-being, activity, mood” scale (p < 0.05).
CONCLUSION. Based on the results of the study, it was proven that the use of hydrotherapy in complex treatment programs for women with polycystic ovary syndrome is an effective and safe method that can be included in standard treatment regimens for this condition.
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Management Mechanisms of Rehabilitation Hospitals in Bulgaria. Short Communication
Abstract
In a market economy and financial crisis, the head of any medical institution has to make adequate decisions regarding the cost-effective functioning of the hospital. Along with reducing costs, the main task is to maintain a high level of medical care. In this paper, the economic efficiency of medical activities in three specialized hospitals for rehabilitation (previously called sanatoriums) in the cities of Hisar, Varna and Bankia in Bulgaria was studied. The competitiveness of the presented rehabilitation institutions lies in their ability to design, produce and offer rehabilitation services that are more attractive to patients in terms of price and quality characteristics and more fully meet their needs compared to the rehabilitation services of competitors. Based on the analysis, it was found that in rehabilitation hospitals, through long-term obligations, the purchase of short-term assets necessary for the implementation of activities is financed, and operating income is invested in long-term assets. This fact determines the increase in liabilities to the company by further minimizing free cash flows, which involve financing current activities, but are invested in non-current assets. At the same time, rehabilitation hospitals — budgetary organizations strictly comply with capital expenditures, which must be specified in the appropriate paragraph, with an approved budget according to the appropriate indicator, which proves strict compliance with budgetary discipline and control over the flow of funds.
78-82
Myelodysplasia Rehabilitation in Children: a Review
Abstract
INTRODUCTION. 1.5 thousand children with myelodysplasia (MD) are born in Russia every year. To improve the quality of life, most of them need lifelong medical supervision and rehabilitation. The topic of medical rehabilitation in MD in children is poorly covered.
AIM. To search and analysis published data on the rehabilitation of children with MD identify the most effective methods.
MATERIALS AND METHODS. The collection and analysis of publications on this topic from the PubMed and eLibrary databases published from 2014 to 2024 was carried out. Earlier fundamental works on secondary disorders in myelodysplasia and Spina bifida were also included in the review. A total of 512 publications in PubMed and 1096 publications in eLibrary were analyzed, 584 of them were unique. Publications of reviews, systematic reviews and clinical observations were included.
RESULTS AND DISCUSSION. Rehabilitation for MD in children is multidisciplinary in nature, a violation of the structure of the nervous system entails, already in utero, the formation of deformities of the musculoskeletal system, combined changes in the functioning of the lower urinary tract and intestines. It is known that rehabilitation started from an early age helps to master motor skills in a timely manner, contributes to the prevention of metabolic syndrome, contractures, pressure sores, urodynamic disorders and constipation. There are different approaches regarding the intensity of physical activity during the day and week, following the recommendations of the World Health Organization (WHO), children should exercise for more than 60 minutes a day. Physical exercises should be carried out from the perspective of the concept of neuroplasticity and enhanced by the influence of magnetic stimulation, low-intensity laser, electromyostimulation, vibration therapy. It will be possible to effectively use acupuncture and massage. In addition, it is important to include urological and orthopedic care in medical rehabilitation from an early age.
CONCLUSION. Due to the high disability, there is a question of effective methods for improving rehabilitation potential and improving the standard of living. Among the described methods, physiotherapy is distinguished, including therapeutic exercises, magnetic stimulation, low-intensity laser therapy, electromyostimulation, and ergotherapy. It is necessary to continue to study the effectiveness of the use of various physical factors in children with MD.
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