Significance of the second stage of medical rehabilitation after arthroplasty of large joints

BACKGROUND: Until recently, the three-level system of medical rehabilitation adopted in Russia assumed the implementation of each of the stages in various medical organizations. The lack of funding within the budget and the basic compulsory medical insurance program led to limited access for patients to the trajectory of the completed cycle of medical rehabilitation after surgical interventions, which reduced the effectiveness of the provision of profile high-tech medical care.

AIM: is to demonstrate the effectiveness of the system for organizing rehabilitation care for patients after arthroplasty of large joints of the lower extremities in a stationary (second) stage in a medical rehabilitation center.

MATERIALSAND METHODS: The data of the medical information system on patients treated for three months at the second (inpatient) stage after arthroplasty of the hip and knee joints in the conditions of the Medical Rehabilitation Center were used. The effectiveness of rehabilitation was assessed by tests and scales: rehabilitation routing scale (RRS), visual analog scale (VAS), Borg exercise tolerance scale, Hospital anxiety and depression scale (HADS), European quality of life questionnaire (EQ-5D); Medical research scale (MRS), index Leken.

RESULTS: 308 patients (306 operated) were treated after medical rehabilitation measures at the first stage with a RRS score of 4-5 points, of which about 80% — after primary and revision arthroplasty of large joints. Upon completion of rehabilitation measures, a statistically significant improvement in all functional indicators was noted. Despite the ambiguous opinion of scientists about the need for inpatient rehabilitation after arthroplasty, according to our data, arthroplasty and the subsequent stage of medical rehabilitation using modern technologies in a hospital significantly improve the clinical status, reduce or eliminate pain, increase motor activity, improve the psycho-emotional background and the patient s quality of life. Stationary (second) stage of rehabilitation was effective in 100%.

CONCLUSIONS: The results of the work of the medical rehabilitation center proved its organizational feasibility, clinical effectiveness and advantages: continuity and phasing of rehabilitation in a single institution; continuity of observation of the patient during the interaction of multidisciplinary rehabilitation team with the participation of the operating surgeon, an anesthesiologist-resuscitator. The quality of rehabilitation is improved by the concentration of high-tech therapeutic and regenerative agents and experienced specialists, the correction of concomitant pathology, explanatory work with patients to increase compliance.