Peculiarities of rehabilitation of the patents presenting with coxosteoathritis and gonosteoathritis

Abstract

Under the term of osteoarthritis (OA) is currently meant the clinical condition with the predominant syndrome that manifests itself as the combination of joint pain and compromised functional activity leading to the deterioration of the quality of life for the affected patients. The principal objective of rehabilitation of the patients presenting with OA which practically all of them strongly need after each next aggravation of the pathological process consists in the reduction of the pain syndrome, elimination of synovitis, restoration of the functional ability of the joints lost during the exacerbation, and, eventually, the improvement of the quality of life in the patients experiencing the constantly progressing degenerative process in the musculoskeletal apparatus. The effectiveness of the rehabilitative treatment was evaluated based on the following criteria: the degree of pain alleviation, the increase in the levels of joint functional activity, and the improvement of the general condition of the patients. These criteria were chosen according to the recommendations of the OMERACT (Outcome measures in Rheumatology) international working group. Also, the quality of life related to the health status and side effects of the rehabilitative measures were estimated. One of the most important aspects of the treatment of the patients with osteoarthritis bearing in mind frequent cases of co-morbidity is the scientifically-sound substantiation of the application of the non-medicinal technologies of physical therapy, remedial gymnastics, and massage for the management of the secondary aseptic inflammatory process and the subsequent rehabilitation for the restoration of the compromised locomotory stereotype and, as the result, the improvement of the quality of life in these patients. One of the effective methods for physical therapy used in the treatment and rehabilitation of patients with OA is hyperbaric gas cryotherapy (HBGCT). This method is based on the rapid withdrawal of heat from the organism that responds by the compensatory and/or reflective activation of the heat production processes in the tissues as a consequence of stimulation of metabolic processes, vascular, neuroendocrine and immune systems of regulation of homeostasis producing the desirable therapeutic effect in the form of elimination of secondary aseptic inflammation and progression of the OA-associated degenerative process. In this context, the objective of the present research consisted of the scientific substantiation of hyperbaric gas cryotherapy as a component of the combined treatment of the patients presenting with gonosteoathritis and coxosteoathrosis. The article was designed to report the results of the combined treatment of 110 patients (22 men and 88 women) at the age from 40 to 75 years suffering gonosteoathritis and coxosteoathrosis of the II-III stages (based on the classification of Kellgren). They were randomly divided into two groups (each comprised of 55 patients). The patients of the main group, unlike those in the control one (group of comparison) were given, in addition to the traditional treatments such as instrumental physical therapy, balneotherapy, remedial gymnastics, and massage, hyperbaric gas cryotherapy with the assessment of the results based on the Lequesne, WOMAC, Likert international indexes. Such an approach allowed to identify the predictors for the use of hyperbaric gas cryotherapy and to raise by 33%, in comparison with controls, the effectiveness of the combined treatment of the patients with osteoarthrosis of the large joints. The dispersion analysis has demonstrated the high clinical efficiency of the proposed therapeutic modality in 90% of the cases of gonosteoathritis and in 64% of the patients presenting with coxosteoathritis. These data were not statistically different from those characterizing the effectiveness of HBGCT in the patients with coxosteoathritis included in the group of comparison.