Elena Valentinovna Melnikova

Objective. Evaluation of the comparative efficacy and safety of ethylmethylhydroxypyridine succinate therapy with Mexidol, solution for intravenous and intramuscular administration, 50 mg/ml, and Mexidol FORTE 250, film-coated tablets, 250 mg, during their sequential use in patients in the acute and early recovery periods of ischemic stroke (IS) compared to placebo. Material and methods. The clinical trial was conducted as a prospective international multicenter randomized double-blind placebo-controlled parallel-group trial. Data from the randomized patients in the acute and early recovery periods of ischemic stroke were collected at 4 visits. Patients were divided into two equal groups: the main group (standard therapy+Mexidol at a dose of 500 mg twice a day administered intravenously in 100—200 ml of 0.9% NaCl solution for 10 days, followed by Mexidol FORTE at a dose of 250 mg three times a day for 60 days) and the placebo group (standard therapy+placebo administered following the same scheme as the main group). The primary efficacy endpoint was the amount of change in patient status assessed with the Modified Rankin Scale (mRS) at the end of the therapy compared to the baseline level (measured in scores). Results. A total of 304 patients in the acute and early recovery periods of IS were randomized into the trial. The trial groups were matched for sex, age and anthropometric characteristics. The statistically significant differences confirming the efficacy of therapy with Mexidol were obtained. The Mexidol group showed a significant reduction in the degree of disability, according to the Modified Rankin Scale (mRS), a neurological improvement, according to the National Institutes of Health Stroke Scale (NIHSS), an increase in mobility, according to the Rivermead Mobility Index, and a strong tendency to the reduction of cognitive deficit, according to the Montreal Cognitive Assessment (MoCA). Statistically significant differences in favor of Mexidol compared to placebo were observed for the difference in median mRS scores at Visit 4 against the baseline level (p=0.003), the difference in median NIHSS scores (p<0.001) and in median Rivermead Mobility Index scores (p=0.014). Treatment with Mexidol was also associated with a reduction in the number of disabled patients (p=0.016) and an increase of patients with scores of 0—1 on the mRS at Visit 4 (p=0.002) when compared to placebo. Adverse events (AEs) were reported in 35 patients (23%) in the Mexidol group (42 AEs in total) and in 35 patients (23%) in the placebo group (43 AEs in total) (p=1.000). Conclusion. According to the clinical trial results, statistically significant differences were obtained, which confirm the greater efficacy of therapy using Mexidol compared to placebo in patients in the acute and early recovery periods of IS of moderate severity. This was observed in terms of reducing the degree of patients’ disability and the severity of neurological symptoms, in terms of improving motor capabilities and increasing mobility. A similar safety profile was demonstrated for the long-term sequential therapy with Mexidol and Mexidol FORTE 250 and placebo.

The aim of the study was to assess how the use of the International Classification of Functioning, Disability and Health (ICF) affects the formulation of a rehabilitation diagnosis.Materials and methods. Three patient groups were formed: the first group (n=130) did not use the ICF, the second (n=130) used the paper-based ICF, and the third (n=54) used the ICFreader software.Results. The use of ICF leads to more rehabilitative problems in the diagnosis that can be solved within the rehabilitation course. The highest number of clinically insignificant function domains was found in group 1. The number of activity and participation domains and environmental factor domains was significantly higher in groups two and three compared to group one. In group two the team spent between 8 and 15 minutes for the initial discussion per patient and between 2 and 5 minutes for repeated discussions.Conclusion. Applying the ICF in paper form and using the ICF-reader software leads to more rehabilitative problems in the rehabilitation diagnosis, which can be solved within the rehabilitation course.

BACKGROUND: Solving the issues of rehabilitation of children after lower respiratory tract infections requires putting up rehabilitation diagnoses in the categories of the International Classification of Functioning, Disabilities and Health (ICF). AIMS: The study aimed to define the key problems in the ICF categories and make quantitative and qualitative assessments of the changes in the ICF domains in convalescent children with infectious diseases of the lower respiratory tract at the outpatient stage and in one month after the disease. MATERIALS AND METHODS: The assessment of rehabilitation was performed using the ICF categories for 201 convalescent children with lower respiratory tract infections. RESULTS: Most of the patients had significant impairments in the following functions: b134 Sleep functions; b152 Emotional functions; b280 Feeling of pain; b440 Respiratory functions; b450 Additional respiratory functions; b455 Exercise tolerance function; b460 Sensations associated with cardiovascular and respiratory functions; b730 Muscle strength functions; b740 Muscular endurance functions; b780 Sensations associated with muscles and motor functions, both at the time of discharge from the hospital and a month after the discharge. Environmental factors (e115 Products and technologies for personal use in daily life; e225 Climate; e260 Air quality; e310 Close relatives; e355 Medical workers; e410 Relationships with immediate family members; e450 Relationships with medical workers; e580 Medical services; e585 Services in education and training) were shown to have an influence on rehabilitation process. CONCLUSION: The identified range of functioning disorders and the influence of environmental factors indicates the need for medical rehabilitation for convalescent children with lower respiratory tract infections. The rehabilitation should be multidisciplinary and involve psychological and pedagogical techniques, work with the family, and motor rehabilitation techniques to restore workload tolerance.

After discharge from the Intensive Care Unit (ICU), more than 50 % of patients experience pathological symptoms that are not related to the primary emergency but reduce the quality of life and require rehabilitation. Post Intensive Care Syndrome (PIСS) include only those conditions that do not have a direct causal relationship with the emergency condition that gave rise to hospitalization in the ICU. The pathophysiological basis of the PICS is the phenomenon of “learned non-use”: a state of artificial limitation of the patient’s motor and cognitive activity as a result of the use of analgosedation, bed rest and immobilization. The clinical picture of PICS is determined by the severity of its individual components, detailed using a package of clinimetric scales. Based on the results of dynamic testing, the PICS severity index is calculated. The sum of the scores in the range from 0 to 10 reflects the severity and effectiveness of rehabilitation measures. For the prevention of PICS, the Union of Rehabilitologists of Russia together with the Federation of Anesthesiologists and Resuscitators of Russia has developed the rehabilitation complex “ReabICU”. In the English-language literature, such a complex is called “Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility” bundle. ReabICU is a complex of technologically therapeutic and diagnostic modules “positioning and mobilization”, “prevention of dysphagia and nutritional deficiency”, “prevention of emotional and cognitive impairment and delirium”, “prevention of loss of self-care skills”. The basis of the multidisciplinary rehabilitation team, which includes a doctor for medical rehabilitation, 2 specialists in physical rehabilitation, a specialist in occupation therapy, a medical psychologist, a medical speech therapist, a nurse for medical rehabilitation. The activity of multidisciplinary rehabilitation team is evaluated on the basis of quality criteria and the achievement of the main goal of ReabICU — the preservation of the premorbid status of the patient’s socialization.

The relevance: more than 60% of cases are due to early breast cancer (EBC). Priority is the treatment of patients with early breast cancer, provided that the maximum quality of life (QL) is maintained. During or after complex treatment, more than half of patients with EBC report the occurrence of functional disorders that reduce the QL. Aim: to evaluate the event-free survival rate (EFS) of EBC patients undergoing rehabilitation within the framework of a biopsychosocial approach in the course of complex antitumor treatment. Materials and methods: the study involved 228 patients with EBC who received complex treatment from 2015 to 2019. In the prospective part of the study, 114 patients were subjected to rehabilitation measures in the framework of a biopsychosocial approach that considers both biological features of functional restriction and psychosocial disorders, a multidisciplinary team of specialists worked with all patients. In the control group, 114 patients were selected retrospectively and underwent physical and psychological rehabilitation as prescribed by a doctor. Patients of both groups are divided into subgroups depending on the availability of preoperative chemotherapy. Event-free survival was assessed over a 2-year follow-up period. Events were accepted as censored events: relapse, metastases, the occurrence of another cancer, a new concomitant disease, an exacerbation of concomitant pathology, and death. Results: Rehabilitation measures within the framework of the biopsychosocial model improve the indicators of EFS in patients with EBC. The use of a biopsychosocial approach in rehabilitation increased EFS by 3.8 months. The results of multivariate analysis, reducing the risk of occurrence of the event EBC patients undergoing rehabilitation within the framework of the biopsychosocial approach in the presence of neoadjuvant chemotherapy was 28%, in patients of younger age group (25–44 years) was 29%, in patients in menopause – 25%.

The emergence of SARS-CoV-2 and its worldwide spread has become a challenge for healthcare professionals related to rapid diagnosis of infection caused by the new coronaviruses, provision of specialized medical care, rehabilitation and secondary prevention. Currently, there is limited information on primary, secondary prevention and medical rehabilitation of this disease. The most common clinical manifestation of the new variant of coronavirus infection is bilateral pneumonia, with 34% of patients developing acute respiratory distress syndrome (ARDS). Given the unusual pandemic situation and the peculiar COVID-19 pathogenesis, the stereotyped application of generally accepted methods may be unsafe or ineffective. The Union of Rehabilitologists of Russia has prepared Temporary guidelines that are based on the advice on medical rehabilitation of patients with COVID-19 at various stages of special medical care published by WHO specialists, analysis of reports from clinics currently involved in rehabilitation of COVID-19 patients, as well as on the results of clinical studies conducted earlier on the rehabilitation of patients with Post-intensive care syndrome and adult respiratory distress syndrome (ARDS) of non-coronavirus etiology, regulatory documents of the Russian Ministry of Health and Federal Service on Surveillance for Consumer rights protection and human well-being. A syndrome-based approach to the use of means and methods of physical and rehabilitation medicine is also considered. The guidelines are intended for heads of medical organizations and their structural divisions, general practitioners, physicians, infectious disease doctors, pediatricians, emergency physicians of intensive care units in infectious hospitals, physiotherapy and sports medicine doctors, physiotherapists, medical psychologists, physical therapy instructors, nurses and other specialists of multidisciplinary rehabilitation teams working in the field of medical care for patients with COVID-19 at various stages.

Patients with a new coronavirus infection (COVID-19) need rehabilitation. Rehabilitation approaches of patients with another pathology also require to be reviewed under the conditions of the SARS-CoV-2 epidemic. It is necessary to develop clinical recommendations for the rehabilitation care delivery in patients with COVID-19 and other diseases during a pandemic. A group of experts analyzed the data of current reviews on rehabilitation with COVID-19, as well as previous studies on rehabilitation in patients with Post-intensive care syndrome (PICS) and acute respiratory distress syndrome of non-coronavirus etiology, and developed thereupon the main positions of clinical recommendations. We discuss the main rehabilitation problems in patients with COVID-19, in particular structures and functions impairments, leading to limitations and restrictions of self-care, mobility, domestic life, communication, interpersonal interactions and relationships, professional activities and those determining care requirement. The article also provides general recommendations on medical rehabilitation management in a pandemic at all three stages, including patients routing, ensuring the infectious safety of medical personnel and patients. The necessary individual rehabilitation program components for patients with COVID-19 at all stages of rehabilitation have been identified, including patients examination, nutritional deficiency correction, restoration of respiratory function, exercise tolerance, muscle strength, self-monitoring and training in new movement conditions, psychoemotional state disorders and cognitive functions, as well as independence in everyday life recovery. Medical rehabilitation during the COVID-19 epidemic should include all rehabilitation care components and helps to optimize vital functions, to prevent complications and to improve the patients life quality.

Aim. To create and test an algorithm for rehabilitation goal setting based on international classification of functioning, disability and health (ICF) for patients with acute cerebral stroke. Materials and methods. The study included 75 patients. Rehabilitation was carried out at the first stage for patients in the acute phase of a stroke involving a multidisciplinary team, which included: neurologist, PRM, speech therapist, occupational therapist, physical therapist, clinical psychologist and nurse. For all patients, a rehabilitation diagnosis was established in the categories of ICF. Results. An algorithm of rehabilitation goal setting is based on the ICF and patient’s rehabilitation potential. Conclusions. The main element in the algorithm for determining the rehabilitation goal for a patient with cerebral stroke in the acute period is the selection of one of the most complex activities formulated by the multidisciplinary rehabilitation team in the categories of ICF activity and participation, and available to the patient by the end of the rehabilitation course. The goal of rehabilitation is established on the basis of a rehabilitation diagnosis at the conclusion of each specialist multidisciplinary team of the patient's recovery potential, and its definition is one of the most important technological components of rehabilitation. Key words: stroke, acute cerebrovascular event, goal of rehabilitation, aim, multidisciplinary team, SMART. For citation: Shmonin A.A., Maltseva M.N., Melnikova E.V. Multidisciplinary technology of rehabilitation aims definition in patients with stroke on the basis of International Classification of Functioning, Disability and Health. Consilium Medicum. 2019; 21 (2): 9–17. DOI: 10.26442/20751753.2019.2.190212