CHANGES IN THE PSYCHO-EMOTIONAL STATE AND FUNCTIONALITY FOREARM AND WRIST AS A MARKER OF EFFICIENCY OF PHYSICAL THERAPY OF PATIENTS WITH POST-MOBILIZATION CONTRACTURES BECAUSE OF DISTAL FOREARM FRACTURES
Objectives: to determine the effectiveness of the developed program of physical therapy based on the results of the functioning of the forearm and wrist in patients with postimmobilization contractures of the radial wrist joint.
Methods. 56 people with postimmobilization contracture of the radial wrist joint were examined. They were divided into two groups: the comparison group (practiced according to the principles of outpatient rehabilitation) and the main group (practiced according to the developed program of physical therapy - a combination of warm moist compress combined with postisometric relaxation of forearm and hand muscles; massage of hand, wrist, forearm, shoulder functional forearms, hands with the use of wrist simulators and expanders, position treatment with dynamic orthoses; kinesiological taping). The program was created on the basis of the modern patient-centric approach and principles of the International classification of functioning on the basis of the changes revealed with the help of the presented instruments of assessment with individualization by definition of short- and long-term rehabilitation goals.
The effectiveness of the program was evaluated by comparing the condition of healthy and injured hands based on the results of goniometry of forearm and wrist movements, manual muscle testing of forearm and wrist muscles, as well as standard questionnaires ABILIHAND, DASH, HADS.
Results. The re-examination, conducted after the rehabilitation intervention, revealed an improvement in the studied indicators in both groups, but with differences in the effectiveness of the programs used in favor of ours.
In patients of main group, almost complete normalization of the pattern of movements of the wrist compared to a healthy limb. In patients of comparison group the progress was not so significant, they failed to achieve the amplitude of movements of a healthy limb (p> 0.05)
The improvement of the structural and functional characteristics of the muscles involved in the movements of the forearm and wrist joint was manifested in the positive changes in their strength and tone, diagnosed by manual muscle testing. Both groups of patients found a significant improvement in its results for all muscle groups studied, but patients in main group also had an advantage over the results in comparison group (p <0.05).
The results of testing on the ABILIHAND questionnaire showed an improvement in comparison group by 46.49%, in main group - by 65.88%.
According to the DASH questionnaire, patients in comparison group reached the level of hand function "good", patients in main group - "excellent".
Improved forearm and hand function led to a decrease in the intensity of psycho-emotional stress, which turned out to be an improvement in the parameters of both HADS scales in all studied patients relative to baseline (p <0.05). However, the digital expressions of anxiety and depression in comparison group decreased only to the level of subclinical signs, while in patients of main group reached the normа.
Conclusions. The developed complex program of physical therapy created from the point of view of the patient-centric model of rehabilitation with application of functional training with use of wrist exercise machines and expanders, author's composition of warm damp compresses and postisometric relaxation, massage, kinesiological taping of demonstration capabilities of the forearm and wrist compared to general outpatient rehabilitation action program for all studied indicators (p <0.05).
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