ABSTRACT
Secondary focal lesions of the musculoskeletal system that occur with residual brucellosis are characterized by a variety of localizations and simultaneous damage to several groups of joints, a deterioration in the quality of life and a high percentage of disability in people of working age. At present, there are many different schemes for the treatment and rehabilitation of developed residual brucellosis, in which, in addition to the "basic" course, including systemic anti-inflammatory therapy, much attention is paid to physiotherapeutic procedures, but the choice of the most effective treatment tactics remains an unresolved problem. PURPOSE OF THE STUDY: To determine the effectiveness of the use of options for non-drug methods of treatment in the complex rehabilitation of patients with residual brucellosis with lesions of musculoskeletal system. MATERIAL AND METHODS: Study included 140 patients treated for osteoarthritis of brucellosis etiology, who were divided into three groups matched by age, gender, average duration and stage of the disease, place of residence. Patients of all groups received standard medical treatment and different sets of physiotherapeutic procedures: in the 1st group (45 patients) - electrophoresis of novocaine on the knee joints, therapeutic massage of the cervical-collar zone; in the 2nd group (45 patients) - magnetotherapy on the area of the knee joints, sinusoidal modulated currents (SMC) on the shoulder joints, decimeter wave therapy of the lumbosacral zone (DMW-therapy); in the 3rd group (50 patients) - magnetic laser therapy on the shoulder, elbow, knee joints, therapeutic massage of the lumbosacral zone. Complaints, clinical symptoms, goniometry results, and blood parameters were assessed: ESR, C-reactive protein, fibrinogen, before the start of treatment, immediately after the course of rehabilitation, and after 6 and 12 months. At the same time, testing was carried out according to the SF-36 Health Status Survey questionnaire to monitor the quality of life. RESULTS: The applied scheme of drug treatment in combination with magnetic laser therapy and therapeutic massage in the 3rd group made it possible to achieve a significant reduction in arthralgic syndrome, a statistically significant increase in the range of motion in the joints, positive dynamics of laboratory data and an improvement in the psychological state and quality of life of patients compared to other observation groups. CONCLUSION: The results of the study indicate the high efficiency of magnetic laser therapy in the complex treatment of patients with residual brucellosis with lesions of the musculoskeletal system.
Subject(s)
Brucellosis , Quality of Life , Humans , C-Reactive Protein , Knee Joint , Brucellosis/therapy , Procaine , FibrinogenABSTRACT
Regardless of the chosen methods of breast cancer treatment, more than 85% of patients develop postmastectomy syndrome (PMES) after a course of therapy, which significantly worsens their quality of life and psychological state. Relatively recently, physical factors began to be used in the conservative treatment of PMES and the results of the use of various rehabilitation therapy complexes were evaluated. OBJECTIVE: To assess the effectiveness of the use of some physiotherapy methods in the rehabilitation of patients with PMES according to clinical parameters, markers of endothelial dysfunction, and the results of a questionnaire. MATERIAL AND METHODS: 185 patients suffering from PMES were examined. They were divided into 4 groups: in the 1st group (control, 61 patients) basic treatment was used (physiotherapy exercises, photomatrix therapy, manual lymphatic drainage massage of the affected upper limb, pneumatic compression); in the 2nd group (43 patients) - basic treatment + sinusoidal modulated currents to the area of the muscles of the thoracic girdle; in group 3 (42 patients) - basic treatment + electrostatic therapy of the upper limb on the side of the operation; in the 4th group (39 patients) - basic treatment + SMC therapy + electrostatic therapy. Before and after the rehabilitation course, clinical symptoms, blood counts for interleukins (IL) 6, 8, 10, homocysteine were assessed, testing was carried out according to the SF-36 (Short Form Medical Outcomes Study) questionnaire, WAM (Well-being, activity, mood) questionnaire, Hamilton depression scale. RESULTS: There was a tendency to a decrease in the quantitative parameters of the immune status: the mediators of the acute phase of inflammation - pro-inflammatory interleukins (IL-6, IL-8), homocysteine and anti-inflammatory interleukin (IL-10). A statistically significant decrease of length of circumference of the affected upper limb was recorded in patients of groups 3 and 4, which electrostatic therapy was used in the rehabilitation program. Lymphatic edema of the upper limb was decreased statistically significant by 33.25% in the 3rd group, by 35.45% in the 4th group. According to the data of the Mirage multicenter study, parameters of the physical and mental components of health of the SF-36 questionnaire after a course of rehabilitation therapy ware significantly approached to the average population parameter in all groups. There was an objective improvement in the general well-being of the patients, an increase in activity and mood according to the data of the WAN questionnaire and psychological state according the Hamilton scale. CONCLUSIONS: Inclusion of electrostatic therapy procedures, sinusoidal modulated currents in the rehabilitation program, significantly enhances the therapeutic effect, promote to reduce the edema of the upper limb, increase the range of motion of the shoulder joint, which has a positive effect on the quality of life andemotional state of patients. The level of IL-6, IL-8 tends to decrease, which indicates the absence of tumor growth and systemic inflammatory reactions. Decrease of the level of IL-10 and homocysteine confirms the safety of the use of physical factors in the treatment of PMES.
