THE USE OF INDICATORS OF THE INTERNATIONAL CLASSIFICATION OF FUNCTIONING TO ASSESS THE CONDITION OF PATIENTS WITH HYPERTENSION WITH COMPLICATED HYPERTENSIVE CRISES
The International Classification of Functioning, Disability and Health (ICF) is gaining a special role. Using a set of clear definitions of functions, structure, activities and participation and environmental factors, the attending (family) doctor and rehabilitation doctor will be able to objectively assess the abilities and limitations of daily life and activities, consistently determining the factors influencing human functioning.
The aim of the study: to assess the functionality, activity and participation of patients with arterial hypertension (AH) stage III, 2-3 degrees, severe risk according to the criteria of the ICF.
Materials and methods: examined 53 patients with hypertension, 15 of whom had hypertensive crisis it was complicated by STEMI myocardial infarction (MI) with a rehabilitation diagnosis according to ICF s4100.378, b4200.8, 20 patients with hypertensive crisis complicated by ischemic stroke (rehabilitation diagnosis according to ICF - s110.878, b4200.8) and 18 patients with atrial fibrillation due to hypertensive crisis and a diagnosis of ICF - s4100.878, b4101.8.
To assess the structural changes of the heart echocardiography. To assess activity and participation for all patients included in the study were offered and performed the Tinetti test (1986) with a separate assessment of balance and gait, using the Rivermead mobility index, a 6-minute walk test, and a modified Borg load perception scale. All obtained indicators were statistically processed.
Results. Studies of myocardial structure show that its the largest mass was in patients with AH and atrial fibrillation and slightly lower, although insignificantly, in patients who developed a MI on the background of hypertensive crisis and significantly (p<0.05) less in the subjects, where hypertensive crisis was complicated by ischemic stroke. At the same time MMLV of all the patients significantly (p1,2,3<0,05) exceeded the similar indicator at healthy. The same nature of changes is characteristic of IMMLV in patients examined by us.
The Tinnetti test for balance was the lowest (6.7±0.6 points) in patients with AH and hypertensive crisis complicated by ischemic stroke and 1.8 and 1.98 times higher (p1.3 <0.05) in patients with AH in whom the hypertensive crisis was complicated by MI and atrial fibrillation. The overall mobility of the subjects also depended on the nature of the complications of the hypertensive crisis and was most severely impaired in patients with ischemic stroke (6.3±0.5 points) and decreased 1.4 times (p<0.05) compared with patients with MI and 1.7 times in cases of complications of hypertensive crisis with cardiac arrhythmia.
While performing the test with a 6-minute walk, it was found that patients with AH complicated by ischemic stroke, walked 133.3 m (p<0.01) shorter distance than those examined with AH complicated by MI. The Borg scale in patients with AH and hypertensive crisis, complicated by MI and ischemic stroke was almost the same and slightly exceeded its average degree. In cases of development after a hypertensive crisis of cardiac arrhythmias (atrial fibrillation), the Borg scale showed a slight fatigue.
Thus, apart the biological model that takes into account the localization of the pathological process and its complications, a biosocial model is very important, which includes activity, participation, adaptation to everyday life and the environment, which has diverse changes and must be evaluated for rehabilitation planning in such patients.
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