Effectiveness of Correction of the Physical Status of Patients with Comorbidity of Parkinson's Disease and Frailty by Means of Physical Therapy as a Prerequisite for Limiting Activities of Daily Living

Abstract

The purpose of the study was to assess the effectiveness of the impact of physical therapy on physical status and activities of daily living in elderly people with Parkinson's disease and senile asthenia. Materials and methods. The study involved 57 elderly people diagnosed with Parkinson's disease in combination with frailty. They were divided into two groups: group 1 – they were engaged according to the principles of polyclinic rehabilitation, and group 2 – they were engaged according to the developed program of physical therapy for 6 months, rehabilitation training was carried out three times a week. The aim of the program was to increase physical status and activities of daily living of patients with the implementation of active methods of physical therapy (kinesitherapy) and, thus, to maintain general physical activity; to increase muscle strength and flexibility; to facilitate the initiation of movements; to improve joint mobility; to maintain correct posture; to improve walking and maintain balance; to prevent pain syndromes and contractures; to prevent respiratory disorders; to adapt to the changed conditions of daily activity. The physical therapy program was created taking into account the specifics of each comorbid condition using functional training on the Prosedos platform, therapeutic exercises, massage, elements of occupational therapy, nutrition correction, patient education. We consistently achieved individual short- and long-term goals of rehabilitation in the SMART-format within the patient-centered rehabilitation model. This helped to select such elements of functional training, which made it possible to individually adjust the most affected movements in each patient, and interfere with normal functioning. The control group consisted of 24 people without signs of frailty and Parkinson's disease. The effectiveness of the program was assessed by the dynamics of the 6-minute walk test (distance traveled, level of fatigue according to the Borg scale), Mini-Balance Evaluation Systems Test, Barthel Activities of daily living Index, Lawton Instrumental activities of daily living Scale. Patients were examined twice – before and after rehabilitation measures (with an interval of 6 months). Results and discussion. In elderly patients with Parkinson's disease and sarcopenia, deterioration of physical status (expressed fatigue and a short distance according to the results of the 6-minute test), violation of indicators of static and dynamic balance and, as a result, violation of performance of instrumental and basic activities of daily life were found (p <0.05 of the parameters of the control group). The developed program of physical therapy caused a statistically significant better effect on the studied indicators of functioning and activities of daily life compared to the general polyclinic program for all studied indicators (р <0.05). Conclusion. Elderly patients with the comorbidity of Parkinson's disease and frailty need the development of physical therapy programs taking into account and correcting the specifics of each disease, which will increase the overall efficiency of recovery processes and improve the performance of activities of daily life