THE INFLUENCE OF PHYSICAL THERAPY ON INDICATORS OF THE LOCOMOTIVE SYNDROME IN ELDERLY PERSONS WITH THE CONSEQUENCES OF TOTAL KNEE ARTHROPLASTY

Abstract

Objective: to evaluate the effectiveness of the developed physical therapy program on the parameters of the locomotive syndrome in elderly people with the motor consequences of total knee arthroplasty against the background of the geriatric syndrome of sarcopenia, in the remote period after the operation. Methods. 80 elderly people were examined. The control group consisted of 24 people without joint endoprostheses, with no signs of sarcopenia. The comparison group consisted of individuals with knee arthroplasty and sarcopenia with low rehabilitation compliance with regard to active rehabilitation intervention. Representatives of the main group with knee endoprosthesis and sarcopenia practiced according to a developed program of physical therapy, created taking into account the specifics of each comorbid condition. The program lasted 6 months; contained the following elements: therapeutic exercises, functional training, massage, kinesiotaping; dietary recommendations; patient education. Its purpose was: correction of the phenomena of motor stereotype violation as a consequence of total knee arthroplasty, in particular, phenomena of the locomotive syndrome, leveling of the phenomena of sarcopenia both at the level of its motor manifestations and at the level of etiopathogenesis of this geriatric condition; facilitation of activities of daily life, improvement of psycho-emotional state, and – as a result – improvement of quality of life. In the process of physical therapy, individual short- and long-term goals defined in the SMART format were consistently achieved within the framework of the patient-centered rehabilitation model. The effectiveness of the program was evaluated according to the dynamics of The Short Physical Performance Battery, Functional Gait Assessment, Fall efficacy scale, 25-question Geriatric Locomotive Function Scale. Results. In elderly patients with knee arthroplasty and sarcopenia, signs of locomotor syndrome were found in the form of impaired balance when performing simple movements (according to The Short Physical Performance Battery), violation of the normal gait stereotype and the resulting risk of falling (according to the Functional Gait Assessment), which led to awareness of the fear of falling (according to the Fall efficacy scale). The hall level of movement disorders corresponded to locomotive syndrome of the II degree (according to the 25-question Geriatric Locomotive Function Scale). The developed physical therapy program revealed a statistical improvement in the condition of patients due to the effect on the components of the locomotive syndrome due to the improvement of balance and gait parameters, reduction of the risk of falling and fear of falling compared to the initial indicators for all the studied parameters (р<0.05); however, the indicators of the control group were not reached (p>0.05). Low rehabilitation compliance in patients with knee arthroplasty and sarcopenia, despite awareness of the risks of this comorbidity, was associated with a lack of improvement over a similar follow-up period. Conclusions. Elderly patients with the consequences of total knee arthroplasty and sarcopenia require the development of physical therapy programs taking into account and correcting the specifics of each condition, the presence of physical status disorders and the risk of falling, which will increase the overall effectiveness of rehabilitation measures.