The purpose of the study was to assess functional disorders of the upper limbs in patients with rheumatoid arthritis using the Boston Carpal Tunnel Questionnaire. Materials and methods. To assess the functional status of the affected upper limbs of patients with rheumatoid arthritis, the Boston Carpal Tunnel Questionnaire was used, which consists of two scales: the Symptom Severity Scale and the Function Status Scale, which were filled out by the patients themselves. The study was conducted on the basis of rheumatology department of the Municipal Enterprise “Yuriy Semeniuk Rivne Regional Clinical Hospital” in Rivne during the period from 2016 to 2018. 216 patients took part in the examination, of which 178 (82%) were women and 38 (18%) were men. The patients’ age is from 25 to 59 years old (average age is 46 ± 0.24). The inclusion criteria were: the presence of an established diagnosis of rheumatoid arthritis based on the ACR/EULAR 2010 criteria, and in accordance with the Order of the Ministry of Health of Ukraine dated April 11, 2014 No. 263 “Unified clinical protocol of primary, secondary, of tertiary medical care and medical rehabilitation of patients with rheumatoid arthritis”, the presence of informed consent of patients to participate in the study. Patients' rights were respected in accordance with the Declaration of Helsinki “Ethical Principles of Medical Research Involving Human Subjects” developed by the World Medical Association, “Universal Declaration of Bioethics and Human Rights (UNESCO)”. Results and discussion. During the initial examination, it was found that the majority of patients had moderate (20.3%) and severe pain (16.6%) in the affected upper limbs (hands / wrists), which in the last two weeks had caused the patients to wake up at night: once – 10.6% of patients, 2–3 times –15.7% of patients. During the day, 20.3% of patients complained of moderate pain in a hand / wrist, and 17.5% of people were bothered by severe pain. The majority of patients (15.7%) noted that the pain lasted from 10 to 60 minutes. As for functional disorders, the greatest difficulties for patients occurred when buttoning clothes – 45.3%, doing household chores – 39.8%, and opening a bottle – 36.1% of patients. Manifestation of local symptoms of damage to the carpal tunnel affects the general physical and psychological condition of the patient. The patient loses work capacity, concentration, and the quality of his / her life decreases. Conclusion. Considering the above results, we are convinced of the need to implement the concept of physical rehabilitation/therapy, which would be able to reduce the level of existing functional disorders and improve the quality of life for patients with rheumatoid arthritis
The article explains the main issues of health and social problems of rheumatoid arthritis. It was established that the urgency of rheumatoid arthritis is caused by progressive disease, severity of the musculoskeletal system. It is noted that there is a high incidence of lesions of working age in which there are early functional abilities decline, loss of professional and social skills, the difficulties of physical and psychological adjustment of patients to violations of motor functions. There was accent an attention that the disease causes significant morbidity, decreased quality of life and high economic expenses. According to modern standards of rheumatoid arthritis treatment, the treatment goal is achieving state of prolonged remission, in addition is decreasing of pain in joints, improvement of its movement, improvement the general patient’s stage, high temperature decreasing. There were established that carefully chosen exercises, physical activity and other renewable contribute help to stop further progression of the disease, restoring function of the affected joints and improve physical and mental condition of the patient and their quality of life. There was proved the necessity to develop a theoretical justification and comprehensive rehabilitation program for early treatment of rheumatoid arthritis, which is aimed to improve the efficiency of rehabilitation, improve ability to work, physical stage and life quality.
Rheumatoid arthritis (RA) is a chronic progressive systemic disease of the connective tissue affecting the joints, mainly small, of the erosive-destructive polyarthritis type, and frequent systemic inflammatory damage to internal organs. The disease is registered in all countries of the world with a frequency from 0.4 to 1.5 %. Along with drug therapy, non-drug treatment of patients with rheumatoid arthritis is also used. In particular, an important role is given to the means of physical therapy. Determining the level of functional and organic disorders is important in the treatment and physical therapy of patients with rheumatoid arthritis, taking into account the International classification of functioning, limitations of life and health (ICF). The purpose is to determine the level of functional and organic disorders of the affected joints in patients with rheumatoid arthritis at different stages of the disease, in order to form a personalized approach to rehabilitation. Materials and methods. Analysis and generalization of data from scientific and methodological field-related literature, survey, medical history taking, objective examination, instrumental research methods (X-rays), determination of body mass index (Quetelet index), as well as methods of mathematical statistics. The study was conducted on the basis of the rheumatology department of the Municipal Enterprise “Rivne Regional Clinical Hospital named after Yuriy Semeniuk” in Rivne throughout the period from 2016 to 2018. 216 young and middle-aged patients with rheumatoid arthritis took part in the examination. Results. The authors suggested a scheme (algorithm) of the rehabilitation examination that included a survey, medical history taking, objective examination, the results of instrumental research methods (primarily X-rays), determination of the clinical form of rheumatoid arthritis, the disease stage and degree, as well as the course of the disease. During the initial examination of the patients with rheumatoid arthritis, a predominance of women was found, namely 82%. The main complaints of the patients were: stiffness in the joints of the upper and lower limbs after sleep, pain in the joints, swelling in the small joints of the hands, numbness of the fingers and toes, limitation of movements, periodic pains in the lumbar region. The radiological stage of rheumatoid arthritis was determined according to O. Steinbrocker et al. (1949). Stage I of rheumatoid arthritis was diagnosed in 50 patients (23%), stage II – in 102 patients (47%), and stage III – in 64 cases (30%). Patients with rheumatoid arthritis of the IV radiological stage were not included in the study. All patients underwent BMI (Quetelet index) during the initial examination. It was found that among young people (25 – 44 years old), the average BMI is 25.42, for middle-aged patients (45 – 49 years old) it amounts to 27.27, which corresponds to excess body weight. This is a negative factor in the development and progression of rheumatoid arthritis and a factor to which a comprehensive program of physical therapy will be directed. Conclusions. During the initial examination, it was established that the majority of patients (47 %), have the II radiological stage of the disease with characteristic radiological symptoms. One of the risk factors for the development of rheumatoid arthritis is the increased body weight [4, 6]. There is an urgent need to develop and study the effectiveness of a physical therapy program that could reduce the symptoms of the disease, the level of functional and organic disorders and improve the quality of life of patients.
The purpose, main tasks and principles of the author's concept are defined, conceptual approaches to the problems of physical therapy of patients with rheumatoid arthritis are analyzed. The main approaches to the prerequisites for the development of the author's concept of restoring the quality of life of patients with rheumatoid arthritis are considered, which include: biological, social and personal prerequisites. A system of restoration and improvement of the quality of life of patients with rheumatoid arthritis has been developed, which consists in the integrated application of rehabilitation measures, taking into account the individual and interdisciplinary approach to each patient in each of the recovery periods. The methodological approaches in accordance with the domains of the International classification of functioning, taking into account the factors that affect the level of functional impairment and quality of life of the patient, are taken into account. It is emphasised that the proposed concept was holistic in nature, based on the targeted use of a comprehensive psychological, pedagogical, medical and rehabilitation approach, physical therapy programmes were individually selected for each patient, taking into account functional joint disability, rheumatoid arthritis activity, quality of life and health status of patients. The article presents the technology of rehabilitation measures to improve the effectiveness of rehabilitation treatment of patients with rheumatoid arthritis, achieve clinical remission, reduce pain, improve joint motor function, prevent deformities and contractures, maintain performance and improve quality of life. It was noted that the realization of the restorative effect in accordance with the tasks of physical therapy varied. Each patient was given a personalized approach to rehabilitation intervention, taking into account the degree of functional joint disability, participation in work life and psychosocial issues.
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