EFFECTIVENESS OF THE IMPACT OF REHABILITATION MEASURES ON THE RESTORATION OF UPPER LIMB FUNCTION IN PATIENTS WITH RHEUMATOID ARTHRITIS

Abstract

Materials and methods. To determine the muscle strength of the affected upper limbs, dynamometry was used (using a hand dynamometer). The strength index (relative strength index) was calculated as a percentage to evaluate the functional capacity of the affected limb. The results of the measurements and their evaluation were carried out before the beginning of the course of the physical therapy, after three months, and after six months during the rehabilitation process. 188 patients with rheumatoid arthritis, whose average age was 44.9 ± 7.6 years old, were examined. All patients were randomly assigned to control (n=92, 16 men, 76 women) and experimental (n=96, 16 men, 80 women) groups. For the experimental group, a technology of rehabilitation measures lasting six months was developed and implemented, which included the following elements: therapeutic exercises, therapeutic massage and self-massage, physiotherapeutic procedures, hydrotherapy, orthotics, kinesio taping of the upper limbs, mechanotherapy and psychological support of patients. Research results. During the initial examination of the patients, a deviation in the initial indicators of dynamometry of the affected upper limbs from normal values of muscle strength was observed, which indicated the development of muscle atrophy. A decrease in the strength of the affected joints was also observed, which was confirmed by low indicators of the strength index and affected the decrease in the functional capacity of the upper limbs. Both standard treatment and physical therapy after three months contributed to the improvement of dynamometry indicators in the affected upper limbs (both right and left) of all patients. However, in patients of the experimental group, engaged in the recommended technology of rehabilitation measures, the changes were more pronounced than in patients of the control group, where the indicators were significantly lower (р<0.05). Analysis of the dynamometry indicators after six months of rehabilitation measures showed their significant improvement in patients of the experimental group. Thus, the muscle strength in the affected right limb increased from 32.8 kg to 36.6 kg, in the left one – from 28.5 ± 3.5 kg to 32.2 kg ( x ±S) (р<0.05). In patients of the control group, the dynamometry indicators were significantly lower: from 30.7 kg to 33.2 kg in the right limb, from 25.8 kg to 28.1 kg in the left one. Accordingly, there was an increase in the strength index of the right limb in patients of the experimental group from 42.1% to 48.9%, of the left one – from 36.2% to 42.1%, which is probably higher than in patients of the control group – from 39.3% to 44.5% (right limb) and from 33.4% to 37.8% (left limb) (р<0.05). Conclusions. The developed technology of rehabilitation measures showed a much better effect on indicators of hand muscle strength and strength index, in contrast to conventional restorative treatment. This was expressed in an increase in the functional capacity of the upper limbs of patients in the experimental group, which confirms the effectiveness of the applied rehabilitation measures.