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The world's practice has shown the importance of medical rehabilitation, which allows increasing the effectiveness of treatment of patients with COVID-19, and also significantly reduce the risks of developing complications after COVID-19. Moreover, timely medical rehabilitation reduces the frequency of disability retirement. We developed and investigated the effectiveness of the telemedicine platform “COVIDREHAB” in order to enhance the effectiveness of the recovery period during self-isolation, as well as to provide access to rehabilitation for patients residing in remote areas or unable to undergo in-person medical rehabilitation. This pilot open clinical study includes 178 patients (108 women and 70 men) aged 32 to 82 years [mean age 50 (33-56) years] who had a moderate disease of COVID-19. We used the specialised platform COVIDREHAB for remote monitoring of the rehabilitation efficiency of patients who suffered from COVID-19. During the study, the supervising doctor assigned the patient a set of specialised questionnaires, which were filled in online. The questionnaires distributed to the patient included questions specifically designed for the COVIDREHAB remote platform as well as the mMRC (Modified Medical Research Council) questionnaire. Patients who completed the remote rehabilitation programme were found to have positive dynamics of indicators of the respiratory system functional state, and complaints.Pulmonary rehabilitation is an important part of case management for patients with respiratory diseases and plays an active role in improving lung function and general well-being of patients. Patients who completed the comprehensive medical rehabilitation program using the information and analytical system COVIDREHAB, were found to have positive dynamics of indicators of the respiratory system functional state, and complaints. Hence, at the end of the course the shortness of breath severity decreased (from 34.8% to 12.4%, as well as the feeling of lack of oxygen from 32% to 17.4%, p <0.05). We anticipate the online approach to rehabilitation will improve the functioning of the respiratory and cardiovascular systems, restore physical function, reduce anxiety and depression, and restore quality of life. An essential benefit of this program is the prevention of secondary complications and reduction of serious adverse effects of COVID-19 treatment."

A variety of rehabilitation programmes can be offered to Long COVID patients, specifically physical training. Indeed 90% of these patients reports impairments of verticalization, stability and spatial orientation, making difficult exercise in the gym. The aim of our study was to assess the effectiveness and safety of aquatic exercise techniques as part of a comprehensive rehabilitation program for patients with Long COVID. The first of a two-stage program involved development of aquatic exercises technique, which was evaluated in 12 patients with impaired upright posture control before and after exercising by "Habilect" video gait analysis system. During the second phase, effectiveness and safety of aqua exercises were tested in water pool as part of a comprehensive rehabilitation programme conducted in 23 patients with Long COVID outcomes. Physical examination, 6-minute step test, Euro-QL-5D questionnaire, Borg scale, laser Doppler flowmetry, cardiointervalography, and spirometry were performed before and after the aquatic exercises program. After the training with aquatic exercises, indices of deviations of the main body axes of the head and the body mass centre ameliorated, as well as direction of body movement vector decreased (p<0.05). This study demonstrated a statistically significant improvement in exercise tolerance in both groups, as measured by the 6-minute step test after rehabilitation. The comparison group averaged 236.7 metres [126; 380] (T=8, p=0.047) after the rehabilitation course and the intervention group averaged 233.71 metres [150; 320] (T=8.0, p=0.047). When tested with the Euro-QL-5D questionnaire, a post-treatment improvement was noted in the comparison group on the anxiety/depression subscale (3 [3;3] (T=0, p=0.043)). In the intervention group, laser Doppler flowmetry revealed a statistically significant increase in microcirculation (6.36 standard units after rehabilitation) [5.54; 8.17] (T=7.0, p=0.004), and a decrease of oxidative metabolism index of 6.89 standard units. [4.76; 6.96] (T=4.0, p=0.03). No serious adverse events were reported. In conclusion, the developed aquatic exercises technique seems to contribute to recovery of impaired upright posture and motor function, normalizing the walking pattern.

The Covid-19 pandemic could reach several million people worldwide. Presumably, 5-15% of them will need medical rehabilitation after suffering from pneumonia and acute respiratory distress syndrome. A comprehensive search was performed in the databases MEDLINE, CENTRAL, EMBASE, Web of Science and MedPilot, CyberLeninka, and eLIBRARY on-drug rehabilitation methods that prevent the development of Covid-19 complications. The goals of medical rehabilitation at the preclinical stage are to achieve the correction of diseases that contribute to the development of Covid-19 complications (COPD, bronchial asthma, rhinosinusitis, diabetes mellitus), mainly due to non-drug methods. Non-drug technologies have a number of advantages over medications that have a side effect, and such as glucocorticoids and antibiotics lead to a worse prognosis of the underlying disease. Medical rehabilitation in the intensive care unit is aimed at reducing the risk of complications and increasing the functional reserves of the body, as well as reducing the area and degree of lung damage, preventing extrapulmonary complications, including secondary infection. The main goal of medical rehabilitation in a hospital is to reduce the severity of symptoms, resorption and repair in the lesion of lung tissue, reduce the development of fibrosis, and provide bronchial drainage to prevent secondary infection. In addition, timely transfer of the patient to a specialized stage of medical rehabilitation can increase the functional reserve of the respiratory muscles and exercise tolerance. The second, specialized stage of medical rehabilitation can be carried out in the conditions of a sanatorium-resort organization. The goals of this stage are not only to reduce symptoms and increase tolerance to physical activity, but also to improve the quality of life, psychological rehabilitation, and recovery.

Balance disorders are complications of stroke survivors. Aim of this study was the establish effectiveness of the biofeedback approach. In this intervention study 245 patients with early diagnosis of acute disturbance of cerebral circulation (ADCC) were examined. Patients able to move independently were treated by standard conservative ADCC therapy on an outpatient approach, but they continued to have problems with coordination of movement in upright position. Then they were submitted to an increasing physical activity based on five sessions of biofeedback, i.e., a complex rehabilitation of patients with motor pathology "Trust-M" according to TU 9442-001-63704475-2010. Mobility rates were assessed using a web camera. Patients' quality of life was evaluated by SF-36 questionnaire and the Hospital Anxiety and Depression Scale (HADS). All parameters were recorded before and after 5 sessions of biofeedback. After treatment, the stability indicators improved and all patients showed a significant increase in motion rate and quality of life. At the same time, the severity of pain and of depression and anxiety decreased. Negative correlations of average strength between the quadrant and patient HADS scaling rates were obtained. In conclusion, our work shows effectiveness of the biofeedback technique for correcting coordination in stroke survivors.

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Aim. To evaluate the effectiveness and safety of aquatic training in diluted sodium chloride bromine brine in restoring the functional state of the organism of patients with portcovid syndrome in comparison with aquatic training in fresh water. Material and methods. Specialists of the National Medical Research Centre of Rehabilitation and Balneology of the Ministry of Health of Russia conducted an open, prospective, randomized study to evaluate the effect of a course of aquatic training in a bromine sodium chloride brine pool. The study included 28 subjects, who were divided into 2 equal groups. Patients in both groups were comparable for gender (χ2 =0.45; p=0.31) and age (U=99.5; p=0.7) and all had post COVID-19 (U 09.9) as their primary diagnosis. The intervention group received a course of aquatic training (7 treatments) in a pool with bromine sodium chloride brine (well No. 69, 32 Novy Arbat Street, Moscow) with mineralization of 120 g/dm3 and its preliminary dilution to 40 g/m3. Control group – a course of aquatic-exercises (7 treatments) in a fresh water pool. Patients, after signing informed consent, underwent load tests: 6-minute walking test, laser Doppler flowmetry (“LASMA ST”, Russia), cardiointervalography (“Health Reserves-R”, Russia). Results and discussion. These data confirm the “null” hypothesis of a more favorable effect of the chemical composition of the diluted brine that acts during aquatic training on the patient’s body compared to fresh water, especially in the presence of microcirculation disorders after suffering COVID-19. The group of patients who received aquatic training in the pool with bromine sodium chloride brine revealed a significant decrease in excessive sympathetic nervous system activity (T-11.0; p=0.02) at the end of the study. According to LAZMA-ST data, there was a twofold increase in the oxidative metabolism of the cell (IOM T-16.0; p <0.01), an increase in exercise tolerance (6-minute walk test T-10.0; p =0.01). IOM increased statistically significantly threefold (U-32.0; p<0.001), mean microcirculation doubled (U 120.0; p<0.05) and BMI decreased by 20.0% (U-58.0; p<0.05) in the intervention group compared with the control group. There were no significant differences between patient groups on safety parameters (χ2= 1.36; p>0.05). These data confirm the “null” hypothesis of a more favorable effect of the chemical composition of the diluted brine that acts during aquatic training on the patient’s body compared to fresh water, especially in the presence of microcirculation disorders after suffering COVID-19. Conclusion. Aquatic training in sodium chloride bromide brine effectively reduces the sympathetic nervous system activity, increases oxidative metabolism and improves microcirculation compared to aquatic training in fresh water.

The metabolic syndrome, which covers a wide variety of pathological concerns, is rapidly becoming a global pandemic. This syndrome is difficult to treat pharmacologically. Physiotherapy techniques, which have both local and systemic effects, can be employed as a suitable substitute. The purpose of this study was to investigate the therapeutic effects of a program of simultaneous physiotherapy that included migrant transcranial magnetic stimulation (TMS) and the exposure to an alternating low-frequency electrostatic field (LFEF) in the treatment of metabolic syndrome patients. Ninety patients were randomly assigned to three study groups. While continuing the usual drug therapy the first group (30 patients) received LFEF intervention, the second group (30 patients) received TMS, and the third group (30 patients) underwent the simultaneous use of these non-invasive techniques (LFEF + TMS). All treatments involved 10 sessions with daily frequency. In all the patients before and after treatment body weight, blood pressure parameters, levels of insulin, cortisol, glucose, total cholesterol, high density lipoproteins, malondialdehyde, and Schiff bases, the activity of the antioxidant enzymes catalase and of the superoxide dismutase were studied. The changes in the outcomes assessed revealed a different reaction to therapy with LFEF or TMS, as well as a greater benefit when both treatments were used at the same time. A simultaneous LFEF and TMS intervention seems a promising resource for the treatment of the metabolic syndrome, particularly of the lipid and carbohydrate metabolism disorders. However, further studies are needed to confirm these findings and investigate the underlying mechanisms.