Vol 5, No 1 (2023)


Comparative efficacy of a day-stay hospital and telerehabilitation treatment: A retrospective study in 180 patients with COVID-19

Pinchuk E.A., Belkin A.A., Zakharov Y.Y., Aslamova A.V., Kulakova A.A., Safonova T.Y., Tkachuk M.M., Shelyakin V.A.


BACKGROUND: Growing evidence indicates that coronavirus disease 2019 (COVID-19) is associated with long-term virus transmission by patients during the convalescence period. This fact required changes in the existing procedures of rehabilitation treatment while maintaining its staging. Particularly, the transformation of in-person rehabilitation to telerehabilitation is recommended. The previous experience allowed us to organize telerehabilitation for patients with COVID-19 in the early days of the pandemic. We have summarized the findings of our study in this article.

AIM: to compare the effectiveness of two technologies for the rehabilitation treatment of patients with post-COVID: an in-person treatment (a day-stay hospital) and telerehabilitation

MATERIALS AND METHODS: This retrospective single blind study included patients with post-COVID, who received day hospital or telerehabilitation treatment between May 2020 and February 2021. The efficacy was estimated by the intensity level of physical activity measured according to the Borg scale and by the generic quality of life by EQ-5 (European Quality of Life 5-Dimension Questionnaire). The choice of these metrics is justified by the possibility of their acquisition via a teleinterview.

RESULTS: 180 patients in total, including those who received a day hospital (DH) rehabilitation treatment (n=97; 64 women and 33 men; 55.1±11.9 years) and those who underwent telerehabilitation (TR) (n=83; 52 women and 31 men; 54.4±12.76 years) were included in the study. In the DH group, the mean patient-day was 12.6, mean number of sessions achieved 10. In these patients, a high compliance to the treatment was noted: only 5 (4.9%) of participants visited ≤5 sessions. As a result of treatment in the DH and the TR groups, a statistically significant improvement both according to the Borg score and to the EQ-5 was observed (p <0.05 compared to the beginning of the treatment). The mean improvement by the Borg scale achieved 3.65 in the DH group and 1.43 in the TR group (p=0.001). The between-group differences in the effectiveness of therapy by the EQ-5 were not statistically significant (p=0.341). The clinical form of COVID did not affect the effectiveness of the rehabilitation treatment. We also assessed the TR-patients' perception of the absence of a physical contact during the therapy: all the participants reported a high quality of medical care. Neither a patient’s age nor the treatment time affected the level of satisfaction. 12 patients expressed their desire to repeat the TR course. No stop-signs or adverse effects were registered during the rehabilitation period in both treatment groups.

CONCLUSIONS: The use of telerehabilitation in the medical rehabilitation care for post-COVID patients is not less effective than an in-person (day-stay hospital) treatment. Given the high risks of infection during the COVID pandemic, it is possible to use such a method of rehabilitation, without an in-person medical examination. However, we emphasize that in general practice a patient should be examined manually by specialists of a multidisciplinary team at least twice: at the beginning and at the end of the rehabilitation treatment course.

Physical and rehabilitation medicine, medical rehabilitation. 2023;5(1):5-16
pages 5-16 views

Diagnostic criteria of sacroiliac joint dysfunction in children and adolescents with pain in the lumbosacral region of the spine

Zadorina-Negoda N.N., Novoselova I.N.


BACKGROUND: Back pain is addressed by physicians of many specialties. In many ways, it is associated with a decreased volume of dynamic motor activity and increased static loading. In patients with an active lifestyle, back pain often develops when the technique of physical exercises or habitual movements are violated, often leading to secondary osteoarticular disorders. One of the most common causes of non-specific back pain is sacroiliac joint dysfunction. The ambiguity of information on the types, severity and significance of sacroiliac joint dysfunction has urged us to systematize the existing data so as to create an optimal diagnostic algorithm for the discussed pathology.

AIM: To develop a system for examining patients with back pain so as to make the diagnostics of sacroiliac joint dysfunction more accurate.

MATERIALS AND METHODS: 54 patients aged 7–18 (mean age 14.6±3.32) with pain in the lumbosacral spine were included in the study. All of them had the confirmed dysfunction of sacroiliac joint; specific causes of pain were excluded. The patients were divided into 2 groups, comparable in the number, sex, and age. The patients underwent a clinical neurological and neuroorthopedic examination with additional functional muscle testing, including the assessment of their overall and local muscle strength, elasticity, coordination, biomechanical characteristics, and muscle control. The state of the respiratory muscles (tonus, type of pain, irradiation, elasticity of ribs, etc.) was evaluated during the manual testing, too. A particular attention was paid to testing using an unstable support (redcord/exarta, fitballs and balancing pads). For the better objectivity of the findings, AlterG, TecnoBody, Oxiterra test devices were used additionally.

RESULTS: The anamnestic predictors for the development of sacroiliac joint dysfunction were revealed. The specifics of the postural and biomechanical disorders in children and adolescents with unspecific back pain were analyzed. Cervical disorders were found which promoted secondary osteoarticular dysfunction, including the sacroiliac joint block. A diagnostic algorithm has been developed to identify the underlying cause of back pain in the case of sacroiliac joint dysfunction.

CONCLUSION: The proposed diagnostic algorithm simplifies and systematizes the treatment of patients with sacroiliac joint dysfunction and complaints of back pain. The effectiveness of rehabilitation is improved due to a possibility to precisely select the rehabilitation technique.

Physical and rehabilitation medicine, medical rehabilitation. 2023;5(1):17-29
pages 17-29 views

Integrated training sessions by a neuropsychologist and a speech therapist in the rehabilitation of persons in chronic critical condition by the example of FRCC ICMR

Kharitoshkina E.A., Grechko A.V., Bushueva E.V.


BACKGROUND: The study relevance is associated with the significant complexity of the treatment of patients with chronic impairment of consciousness. A successful treatment of chronic impairment of consciousness is formed from a comprehensive medical and multidisciplinary rehabilitation efforts aimed at restoring the consciousness, including a combination of various pharmacological and non-pharmacological methods. Modern rehabilitation techniques, with a competent approach to their development and application, not only are characterized by a significant potential in the context of improving the quality of life, but are also capable of providing a significant progress in alleviating the severity of the disease. At the same time, there are still no reliable methods in this area, which is a significant medical and social problem.

AIM: Approbation and evaluation of the effectiveness of integrative sessions by a neuropsychologist and a speech therapist in the rehabilitation of persons in chronic critical condition, by the example of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology (FRCC ICMR).

MATERIALS AND METHODS: 40 patients with diagnosed chronic impairment of consciousness were examined — 20 patients in the main group and 20 patients in the control group. The rehabilitation work was carried out with the main group patients for 12 months, based on a developed system of integrated sessions of a neuropsychologist and a speech therapist. The evaluation of the rehabilitation work effectiveness was carried out at the time points of 6 and 12 months by monitoring the dynamics of improvement at the level of consciousness according to the CRS-R scale.

RESULTS: We describe in detail the methodology and practical experience of integrated sessions of a neuropsychologist and a speech therapist in the rehabilitation of persons in chronic critical condition provided at the FRCC ICMR. A stable improvement in the level of consciousness, according to the CRS-R scale, was shown in patients with chronic impairment of consciousness, who underwent the integrated sessions of a neuropsychologist and a speech therapist.

CONCLUSIONS: We have proven the effectiveness of an integrative approach to the rehabilitation of patients with chronically impaired consciousness, based on combined sessions of a neuropsychologist and a speech therapist. It has been confirmed that the simultaneous use of complex neuropsychological and speech therapy effects (exercises given by a neuropsychologist with a focus on the tactile gnosis in combination with the methods of active speech therapy mechanical action, known as an activating speech therapy massage) can ensure the progress in the rehabilitation of patients with chronic impairment of consciousness in comparison with the same techniques applied in a sequential manner.

Physical and rehabilitation medicine, medical rehabilitation. 2023;5(1):30-39
pages 30-39 views

A modern approach to the rehabilitation of patients with fractures of the bones of the lower extremities

Bodrova R.A., Petrova R.V., Delyan A.M., Preobrazhenskaya E.V., Nikolaev N.S., Gumarova L.S., Ivanov M.I., Kamaleeva A.R.


BACKGROUND: General injury rates tend to increase in most federal districts of Russia. The patients with fractures of the bones of the lower extremities reaches for 8.5–25% of the total number of patients with fractures. Fractures of the bones of the lower extremities are characterized by long period of reparation, persistent contractures, a violation of the congruence of the articular surfaces, and changes in the biomechanics of walking. Only full course of rehabilitation can eliminate the these complications and restore the previous motor activity.

АIMS: The study aimed to analyze the structure of injuries in patients of the traumatology department and to present and the results of the recovery of patients with fractures of the bones of the lower extremities using and algorithm of organization of medical rehabilitation in the case study.

MATERIALS AND METHODS: A retrospective analysis of statistical data on 995 patients of the traumatology department № 1 of the Kazan City Clinical Hospital, who underwent 981 operations, was carried out. Randomly selected two groups of patients ― I main (n=45) and II control (n=45). Patients of group II after the treatment at the trauma center underwent outpatient medical rehabilitation, group I received inpatient medical rehabilitation in the rehabilitation department of the Kazan City Clinical Hospital № 7. In a hospital setting, a comprehensive rehabilitation program included physiotherapy exercises, CPM-veloergometry, exercises on rehabilitation simulators, the PNF kinesiotherapy technique, etc.

RESULTS: A more pronounced statistically significant positive dynamics at the end of the course of medical rehabilitation was noted in patients of group I (reduction of pain syndrome, increased joint mobility, degree of dependence on others, increased mobility index, the ability to dress independently, maintain body position in space, reduced dysfunction in lifting and carrying objects, walking disorders, and caring for body parts). The dynamics of motor function and psycho-emotional sphere also improved to a greater extent in patients of group I.

CONCLUSIONS: The effectiveness of the presented algorithm of organization of medical rehabilitation of patients with fractures of the bones of the lower extremities is confirmed by the results of present study. It is revealed that patients in the I (main) group showed more significant improvement in functions, activity and participation, a decrease of disability, reduce of pain, anxiety and depression, as well as an increase of the level of quality of life compared to patients of group II (control), who did not receive comprehensive medical rehabilitation in the hospital (p <0.1).

Physical and rehabilitation medicine, medical rehabilitation. 2023;5(1):40-51
pages 40-51 views


«Long COVID»: the current state of the problem. A review of foreign scientific and medical publications

Sсherbak S.G., Vologzhanin D.A., Kamilova T.A., Golota A.S., Makarenko S.V.


Not all the patients diagnosed with COVID-19 can completely recover; some of them experience various persistent symptoms which wax and wane. As the COVID-19 pandemic continues, the number of people with long-term symptoms is rapidly increasing, adding to the burden on the healthcare and society.

The prevalence of the COVID-19 consequences varies between studies, with some researchers reporting that more than half of hospitalized patients suffer from long-lasting symptoms for at least 6 months after the acute SARS-CoV-2 infection, and others observing such symptoms for more than 12 months. The overall prevalence of residual symptoms in patients infected with SARS-CoV-2 is currently estimated as 10–30%. This clinical syndrome is commonly referred to as post-acute COVID syndrome (PACS) or long COVID.

This multifactorial syndrome is characterised by a variety of debilitating symptoms, including fatigue, brain fog, postural hypotension with tachycardia, and post-exertional malaise. Many of the post COVID-19 condition observations, including changes in the immune, cardiovascular, gastrointestinal, nervous and autonomic systems, are shared with those for myalgic encephalitis/chronic fatigue syndrome (ME/CFS) patients. A comprehensive longitudinal symptom monitoring is required to confirm the diagnosis, uncover the mechanisms of post-COVID-19-associated ME/CFS, and develop the prevention and treatment measures. The current absence of an effective treatment reflects the unclear causes of the post COVID-19 conditions which cannot be targeted properly until the mechanism is established and confirmed.

The multisystem aspects of long COVID remain poorly understood. The COVID-19 pandemic has exposed a significant gap in the knowledge about the post-acute consequences of infectious diseases and the need for a unified nomenclature and classification, diagnostic criteria, and a reliable assessment of post-COVID conditions. Unraveling the complex biology of PACS relies on the identification of biomarkers in the plasma and tissue samples harvested from individuals infected with SARS-CoV-2 that will allow classification of the phenotypes of patients who develop PACS.

For a comprehensive treatment of patients with post-COVID syndrome, multidisciplinary therapy and rehabilitation are required. Understanding the physiological mechanisms underlying the long-term clinical manifestations of COVID-19 and the post-COVID-19 state is vital for the development of appropriate effective therapies.

Physical and rehabilitation medicine, medical rehabilitation. 2023;5(1):52-79
pages 52-79 views


The course of post intensive care syndrome in patients with severe cerebral insufficiency and predictors of recovery. Clinical observation

Karpova O.V., Kruglyakov N.M., Zhalnina N.D., Eroshkin K.E.


Post-intensive care syndrome (PICS) is currently a problem affecting the entire intensive care strategy. The study of its mechanisms becomes most relevant in regard to the prevention of its development and influence on the disease course in patients with impaired respiratory function, neuromuscular transmission and cognitive disorders requiring long-term protection of the vital functions. The severity of the systemic inflammatory response as an individual reaction of the body has a significant influence on the PICS development and severity, that predetermines the degree of neurological and psychological deficiency. The presence of background somatic diseases, such as diabetes mellitus (including that in the framework of metabolic syndrome), significantly aggravates the course of PICS and contributes to the deceleration of the recovery process. The earliest possible start of rehabilitation with both passive and active measures on the basis of an intensive care unit, followed by an expanded individual rehabilitation program on the basis of a specialized department, leads to the most favorable prognosis for the restoration of both impaired vital functions and for the emerging disorders in the cognitive, motor, and affective spheres. Such an approach reduces the length of stay in the hospital and improves the patient’s quality of life after the discharge from the hospital.

The article describes three clinical cases of PIT syndrome. Based on the analysis of the course and severity of this syndrome, the conclusions are drawn about the relationship between the course of the inflammatory process and its effect on the restoration of the impaired functions.

Physical and rehabilitation medicine, medical rehabilitation. 2023;5(1):80-92
pages 80-92 views

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