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Abstract. Purpose: determination of the effectiveness of the use of physical therapy in women with metabolic syndrome who underwent caesarean section, based on changes in the structure of the daily blood pressure profile. Methods. During the research, 44 women aged 25.5±1.6 years at the end of the late postpartum period (2 months after childbirth) were examined. The control group consisted of 17 women with normal body weight who gave birth vaginally and recovered independently in the postpartum period. The comparison group consisted of 14 women with the metabolic syndrome who independently recovered in the postpartum period. The experimental group consisted of 13 women with metabolic syndrome after caesarean section, who for 3 months performed restorative measures developed as part of a proven physical therapy program. They included classes using therapeutic exercises for the muscles of the back, abdomen, and limbs, functional training with adaptation to household movements and child care taking into account obesity and the postpartum period with caesarean section, aerobic training, pressotherapy and vacuum massage for areas with the greatest deposition of fatty tissue; nutritional recommendations – reducing daily caloric intake. Daily monitoring of blood pressure was carried out to determine its profile by the types "diрper", "non-dipper", "over-dipper", "night-peaker". Results. During the initial examination, it was established that, in general, women with a normal body weight have a "dipper" daily blood pressure profile. This most favorable type of decrease in arterial pressure at night was characteristic of almost 70% of representatives of this group. At the same time, in women with metabolic syndrome after caesarean section, such a profile was established in slightly more than half of the cases. On the other hand, in the groups of women after caesarean section, a significant share (about a third) was made up of the "non-dipper" and "over-dipper" profiles, which have an unfavorable character. One of the signs of adverse daily dynamics of blood pressure in women with metabolic syndrome is the diagnosis of their circadian rhythm according to the "night-peaker" profile. The following results were revealed during the re-survey, which was conducted to assess the effectiveness of the developed physical therapy program. The share of persons with a favorable profile of "dipper" systolic blood pressure increased. This redistribution took place due to the reduction of the share of persons with unfavorable "non-dipper" profiles and the complete disappearance of persons with the daily blood pressure profile "night-peaker" profile. Similar trends were also observed in the analysis of daily diastolic blood pressure profiles. Analysis of daily blood pressure profiles of women after vaginal delivery revealed that they had a higher percentage of women with normal profiles in the early periods of observation; further dynamics were favorable. Re-examination of comparison group women showed an increase in the number of women with favorable profiles, but it was not as pronounced as in experimental group women, which demonstrates the benefits of a proven physical therapy program. Conclusion. It is advisable to prescribe physical therapy to correct the indicators of the daily profile of blood pressure in women with metabolic syndrome in the postpartum period, which prognostically reduces the risk of cardiovascular disasters in them.

Changes in the Structure of the Daily Blood Pressure Profile in Women With the Metabolic Syndrome Who Had Cesarean Sections Under the Influence of Physical Therapy

Sheremeta¹,

Sheremeta²

2023

Quality of Life of Women After Caesarean Section Who Had Coronavirus Disease During Pregnancy as an Indicator of the Effectiveness of a Physical Therapy Program

Vypasniak¹,

Sheremeta²,

Polatayko³

2023

Abstract. Purpose: to determine the effectiveness of restoring the state of health of women with post-COVID-19 syndrome, who underwent cesarean section, based on the dynamics of parameters of quality of life. Methods 44 women were examined at the beginning of the late postpartum period. The control group consisted of 15 women who gave birth vaginally and did not suffer from COVID-19 during pregnancy and observation. The comparison group consisted of 15 women after cesarean section who suffered from COVID-19 during pregnancy, recovered during pregnancy and the postpartum period according to general recommendations for the rehabilitation of patients with coronavirus infection. The main group consisted of 14 women after caesarean section, suffered from COVID-19 during pregnancy, performed a proven program of physical therapy for 2 months using breathing therapeutic exercises, therapeutic exercises with elements of yoga for the muscles of the back, abdomen, upper and lower limbs, taking into account movement limitations due to a scar of the anterior abdominal wall; massage of the chest, back, abdomen; aromatherapy sessions; autogenic training sessions. They tried to restore the state of women through the normalizing effect of the applied agents on the hormonal background and psycho-emotional state, reducing the feeling of bodily discomfort, general strengthening of the body, accelerating the recovery of the organs of the abdominal cavity and pelvis, accelerating adaptation to changes in habitual activity due to a violation daily routine and childcare needs. The condition of the women was assessed by the results of the EQ-5D-5L and EQ-VAS. Research results In all women, regardless of the method of delivery, at the beginning of the late postpartum period, a decrease in quality of life was noted in all sections of the EQ-5D-5L questionnaire. Results in women after caesarean section compared to vaginal delivery were on average twice as bad (p<0.05) on all subscales – mobility, self-care, usual daily activities, pain/discomfort, anxiety/depression. According to the low assessment of individual subscales, women defined their general state of health quite low on a 100-point scale. At the same time, women who underwent caesarean section reported a statistically significantly worse level of health compared to women after vaginal delivery (p<0.05). During re-examination, the best result in terms of all studied parameters was found by women of the control group, who demonstrated the dynamics of the normal course of the postpartum period after vaginal delivery. The results of the women of the main group according to EQ-5D-5L subscales, EQ-VAS which were determined, were statistically significantly better than those of the women of the comparison group. This testifies to the advantages of the rehabilitation program for the correction of the symptoms of post-COVID-19 syndrome in women who underwent cesarean section, which was created taking into account their physical and psycho-emotional state, in comparison with the general rehabilitation program.. Conclusions Quality of life is a generalized indicator that takes into account various aspects of health; accordingly, its deterioration in the postpartum period is a justification for carrying out, and the positive dynamics is evidence of the effectiveness of the approved program of physical therapy of women with post-COVID-19 syndrome in the postpartum period after abdominal delivery.

Parameters of the Quality of Life of Women With Hip Arthroplasty in the Postpartum Period (Abdominal Delivery) as a Criterion for the Effectiveness of a Physical Therapy Program

Danylchenko,

Kanyhina

2023

Abstract. Purpose: to determine the parameters of the quality of life of women with an endoprosthetic hip joint in the postpartum period as a criterion for the effectiveness of the physical therapy program. Methods. In the course of the study, 9 women aged 28.5±1.6 years were examined 1 month after childbirth, which took place by caesarean section. The developed program of physical therapy lasted 1 month (from the end of the first month after childbirth). In her process, therapeutic exercises for the trunk, upper and lower limbs were used; functional training to improve movements related to child care, Proprioceptive Neuromuscular Facilitation of lower limbs, back, trunk; massage of lower limbs, back. We took into account movement restrictions associated with an incompletely formed scar after cesarean section and with the presence of an endoprosthesis (excessive bending, rotation of the hip joint); accordingly, they created safe movement strategies related to child care (lifting, carrying) and transporting a baby carriage. Individual determination of short- and long-term goals of rehabilitation contributed to the improvement of psycho-emotional mood and increased compliance of women. The effectiveness of the tested program was evaluated using the standard SF-36 quality of life questionnaire («Medical outcomes study short form»). Results. During the initial examination, all women with hip arthroplasty in the postpartum period were found to have a deterioration in the quality of life according to the SF-36. Overloading of elements of the musculoskeletal system during pregnancy and changes in the biomechanics of a woman's body, which causes certain physical discomfort, is justified by hormonal and physical processes.During repeated testing, the effectiveness of the physical therapy program was confirmed by its positive impact on both scales - physical and mental functioning. The difference between the results of Physical health at the initial and repeated examination according to the Physical Functioning scale in the examined women was 41.9%, Role-Physical – 39.4%, Bodily Pain – 26.0%, General Health – 42.2%. Accordingly, for all subscales of Physical health, a statistically significant improvement in the condition of women was obtained compared to the initial parameters (р<0.05). The improvement of Mental health in comparison with the primary result on the Vitality scale in the examined women was 26.9%, Social Functioning - 60.3%, Role-Emotional - 32.5%; Mental Health - 49.9%. Therefore, a statistically significant improvement in the condition of women compared to the initial parameters was obtained for all subscales of Mental health (р<0.05). Conclusions. In women with an endoprosthetic hip joint in the postpartum period (abdominal delivery), a significant decrease in the physical and mental components of quality of life, determined by the SF-36 questionnaire, was found. The use of physical therapy (therapeutic exercises, functional training, massage taking into account the limitations of the abdominal wall scar and the functionality of the endoprosthesis) caused a statistically significant (p<0.05) improvement in the condition of the examined women in all subscales of SF-36 - physical and role functioning, pain intensity , general state of health, vitality, social functioning, influence of emotional state on role functioning; self-assessment of mental health.