EFFECTS OF PHYSICAL THERAPY ON THE LEVEL OF KINESIOPHOBIA, SOMATIC MARKERS OF SARCOPENIA AND INDICATORS OF FALL RISK IN ELDERLY PERSONS WITH PARKINSON'S DISEASE
Objective: to assess the effectiveness of the impact of physical therapy on the level of kinesiophobia, somatic markers of sarcopenia and indicators of the of fall risk in elderly people with Parkinson's disease.
Methods. The study involved 57 elderly people diagnosed with Parkinson's disease in combination with sarcopenia. They were divided into two groups: 1 (they were engaged according to the principles of polyclinic rehabilitation) and 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 decrease the level of kinesiophobia and increase the compliance of patients with the implementation of active methods of physical therapy (kinesitherapy) and, thus, to maintain general physical activity; increasing muscle strength and flexibility; facilitating the initiation of movements; improving joint mobility; maintaining correct posture; improving walking and maintaining balance; prevention of pain syndromes and contractures; prevention of respiratory disorders; adaptation 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 increased compliance and 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 sarcopenia and Parkinson's disease. The effectiveness of the program was assessed by the dynamics of the Tampa Kinesiophobia Scale, Fall efficacy scale, grip strength, The Short Physical Performance Battery, Timed Up and Go test, Berg Balance Scale. Patients were examined twice - before and after rehabilitation measures (with an interval of 6 months).
Results. Elderly patients with Parkinson's disease and sarcopenia were found to have a high level of kinesiophobia, muscle weakness, impaired static and dynamic balance and, as a consequence, a high fall risk. The developed program of physical therapy caused a statistically significant better effect on the state of kinesiophobia, markers of sarcopenia and the fall risk in comparison with the general outpatient program for all the studied parameters (p <0.05). Persons of group 1 found a statistically significant improvement in their repeated results on the parameters of the balance subscale SPPB, TUG-test, Berg Balance Scale (p <0.05), without reaching the corresponding levels of the control group (p> 0.05). For all the studied parameters, during the repeated examination, the persons of group 2 showed a statistically significant improvement relative to the initial indicator (p <0.05) and repeated parameters of the OG1 (p <0.05), without reaching any level of the control group (p> 0.05).
Conclusions. Elderly patients with comorbidity Parkinson's disease and sarcopenia require the development of physical therapy programs taking into account and correcting the specificity of each disease, the presence of kinesiophobia and a high fall risk, which will increase the overall efficiency of recovery processes.
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