PREDICTION OF THE EFFICIENCY OF PHYSICAL THERAPY AFTER THE HIP JOINT REPLACEMENT IN PATIENTS WITH A HISTORY OF CEREBRIAL STROKE

Abstract

The aim. To develop a prognostic model of the effectiveness of physical therapy on the restoration of motor functions after total hip arthroplasty in patients with a history of stroke. Material. It was included 42 patients (mean age 67,5±7,8 years) in the study after total hip arthroplasty (THA) with proximal femur fracture and a history of stroke. The patients were divided into 2 groups of 21 people each: the main and the control. The physical therapy program in the main group additionally included exercises to normalize the muscle tone of the lower limb, improve dynamic balance, neuromuscular control and coordination of movements, daily activities training, electromyostimulation with simultaneous isometric muscle tension. All patients underwent questionnaires, anthropometry, were evaluated the muscle strength of the lower limbs, range of motion in the hip, motor functions of the lower limbs, static and dynamic balance, risk of falling, level of spasticity, endurance, walking speed, level of cognitive functions, level of functioning according to the Harris index, hip mineral density, statistical methods of data analysis. The results. The most significant factors for predicting the restoration of functioning according to the value of the Harris index at the end of the inpatient rehabilitation stage were the level of pain according to VAS (regression coefficient B=-2,7), the strength of the flexor muscles of the foot and lower leg according to the manual muscle test (B=3,0 and B=2,3, respectively), the amplitude of passive flexion in the hip joint (B=0,2). In the remote period after 3 months of rehabilitation, the effectiveness of restoring functioning was determined by the pain level according to the VAS (B=-1,3), the strength of the muscles of the dorsal and plantar flexors of the foot according to the manual muscle test (B=1,7 and B=3,4, respectively), values of the static component of equilibrium according to the Tinetti index (В=0,8). The developed models predict results within 18,0% and 23,0%, respectively, of the existing actual values, which indicates satisfactory and effective work (determination coefficients 57,0% and 52,0%, p<0,05). Conclusions. It was found that in the initial stages, factors related to hip dysfunction were the most significant in terms of functional recovery, but in terms of long-term outcomes, factors resulting from neurological deficits were the leading factors. This confirms the need to take into account post-stroke motor deficits in the rehabilitation programs of such patients.