Rehabilitation of the patients with osteoarthritis

Abstract

Under the term "osteoarthritis" (OA) is currently meant a clinical syndrome resulting from the combined effect of articular pain and disordered functional activity leading to the deterioration of the quality of life of the patients. The principal objective of rehabilitation of the patients presenting with GA in which all patients with this condition are in need practically after each next aggravation of the pathological process is to relive pain syndrome and restore the functional ability of the joints lost or deteriorated after each exacerbation in order to eventually improve the quality of life of the patients experiencing the constantly progressing degenerative process in the musculoskeletal system. The effectiveness of pain alleviation, the degree of improvement'of the joint functional activity and the general condition of the patient are considered as the criteria for the assessment of the effectiveness of the rehabilitative treatment. These criteria have been chosen in accordance with the recommendations of the OMERACT international working group (outcome measures in rheumatology). In addition, the quality of life associated with the health status and the adverse effects of the rehabilitative measures were estimated. Bearing in mind comorbidity in the patients presenting with OA, one of the main challenges is the development of the scientifically sound rationale for the application of non-pharmacological technologies of physical therapy, remedial gymnastics and massage for the prevention and elimination of an aggravation of the secondary aseptic inflammatory process associated with OA and the subsequent rehabilitative treatment for the restoration of the lost locomotory stereotype and the quality of life of the patients. One of the effective methods of physical therapy used for the treatment and rehabilitation of the patients presenting with GA is hyperbaric gaseous cryotherapy. This method makes use of the heat rejection phenomenon to which the organism responds, either in the compensatory or/and reflectory mode, by the activation of the heat production processes in the tissues due to the stimulation of the metabolic processes as well as the vascular, neuroendocrine, and immune systems involved in the regulation of homeostasis which produces the desired therapeutic effect apparent as the cessation of secondary aseptic inflammation and progressive degeneration process associated with OA. Taking into consideration the aforesaid, the objective of the present study was the scientifically sound substantiation of the application of hyperbaric gaseous cryotherapy as a constituent of the combined rehabilitative treatment of the patients presenting with gonarthritis and a coxarthrosis. This article was designed to report the results of such combined treatment obtained in 110 patients (22 men and 88 women) with gonarthritis and a coxarthrosis of the II-III stages (based on the classification of Kellgren). The patients aged from 40 to 75 years which were randomly divided into two groups (the main and the control (comparison) groups) comprising 55 patients each. The patients of the main group, unlike those in the control one, were treated with the use of hyperbaric gaseous cryotherapy in addition to traditional physical therapy and balneotherapy, therapeutic physical exercises, and massage. The results of the treatment were evaluated making use of the Lequesne, WOMAC, Likert international indices. It allowed to identify the predictors for the use of hyperbaric gaseous cryotherapy and to increase the effectiveness of the rehabilitative treatment of the patients suffering from OA of the large joints by 33% in comparison with the control group. The highest clinical effectiveness of 90% was achieved in the cases of at a.gonarthritis; it was somewhat lower (64%) in the cases of coxarthritis.