Is there a connection between spine alignment, chest mobility, shoulder joint and respiratory parameters of patients with ankylosing spondylitis?

INTRODUCTION: Ankylosing spondylitis is chronic progressive disease, which decrease functions of musculoskeletal system including chest area. Those changes influences respiratory mechanics, worsen conditions of proper ventilation of lungs. OBJECTIVES: Rating of functional and respiratory parameters and dependence between them at patients with ankylosing spondylitis. MATERIALS & METHODS: The study included 45 patients with diagnosed ankylosing spondylitis. Chest and upper limbs mobility, resting spinal curvature alignment were assessed, and respiratory parameters were measured in a plethysmographic chamber JAGGER MasterScreen Body. RESULTS: Ankylosing spondylitis patients had lower respiratory parameters especially sReff, and FRC. Restriction of chest and upper limbs mobility was also demonstrated. Forward head extension was observed based on the occipital wall test. Correlations between functional parameters and correlations between functional and respiratory parameters were shown, in particular MIP, MEP, sReff, Rtot, TLC, ERV. CONCLUSIONS: The study confirmed a decrease in functional and respiratory parameters in the examined patients with ankylosing spondylitis compared to the applicable standards. A significant relationship was found between functional parameters in the upper body and respiratory parameters, which worsen with increasing thoracic dysfunction. The obtained results indicate the directions of therapy that should be taken into account to improve respiratory parameters and reduce respiratory dysfunction in these patients. Chest-focused physiotherapy appears to be an important element in improving function in patients with ankylosing spondylitis.

Emotional and cognitive states of geriatric patients during the COVID-19 pandemic - an observational study.

Introduction: The authors of the study assessed the emotional and cognitive state of geriatric patients during the COVID-19 pandemic and tried to answer the question: were there any differences in this state in geriatric patients at different stages of the pandemic? Material and methods: The study included 518 patients of 60 years old and above of the Department of Geriatrics in Warsaw. To collect data, the following tools of psychological measurement were applied: the Mini-Mental State Examination scale and Geriatric Depression Scale. In order to test the differences in the means between the groups, a Chi-square test (with Yates's correction for continuity when the class size did not exceed 8 items) was used. For the comparison of the three groups, the Kruskal-Wallis (ANOVA) test was performed. Results: It was found that the majority of geriatric patients (73% of respondents) do not show symptoms of depressed mood. But there are statistically significant differences in the results of the patients' cognitive state tests depending on the time of examination. Patients examined before the pandemic tended to demonstrate a better cognitive state than patients at the beginning of the pandemic and in its later stages. Nevertheless, there are no significant differences in the cognitive functioning of patients examined at the beginning and later in the pandemic. Conclusions: The number of geriatric patients with symptoms of depression significantly increased when visits of relatives prohibition were introduced. However, the number of patients with depression returned to its previous level later in the pandemic.This phenomenon may indicate psychological adaptation to the situation. The presented results of observation suggest that the introduction of limitations is less important than the particular perception of one's situation and adaptation to that.

The 4DBODY system as a new tool for chest mobility assessment in patients with ankylosing spondylitis.

Introduction: Ankylosing spondylitis (AS) is a chronic inflammatory, progressive disease, which leads to deterioration of chest and spine mobility and decrease of physical capacity with abnormal chest movement patterns. We aimed to assess the usefulness of the 4DBODY technology for evaluation of the effectiveness of AS treatment. Material and methods: The 4DBODY technology was assessed on single AS patient with axial involvement. The patient was examined twice, before and after 14 days of rehabilitation. Physiotherapeutic and plethysmographic examinations were used, as well as angular measurement of spine curvatures and measurement of chest mobility. Chest activity measured using the 4DBODY system and the quality of movement were visualized. Results: There was observed an increase of chest mobility from 18 mm to 27.9 mm (up 55%) in the 4DBODY system measurement. The quality of the chest movement also improved, the required phases of inspiration were synchronized. The angular position of the spine has also changed. The chest expansion improved from 25 mm to 50 mm measured on the level of the fourth intercostal space and from 30 mm to 50 mm at the Th10 level. Inspiratory and expiratory muscle strength increased respectively from 80% to 93% and from 46% to 86% of the predicted values. Total airway resistance (Rtot) - increase from 59% to 67%, whereas functional residual capacity (FRC) and total lung capacity (TLC) did not change significantly. Conclusions: The new 4DBODY technology was found to be an effective method of examination and assessment of the effectiveness of rehabilitation of patients with AS.

Improving the quality of life of patients with rheumatoid arthritis after rehabilitation irrespective of the level of disease activity.

Due to the exacerbation of the disease, the rehabilitation of patients with rheumatoid arthritis is often limited. The aim of the study was to analyze the impact of a comprehensive rehabilitation on a subjective perception of pain and quality of life in patients with rheumatoid arthritis depending on the level of disease activity. The study involved 58 women with rheumatoid arthritis aged 18-60, who underwent a 4-weeks comprehensive rehabilitation program. The assessment included the disease activity level on the DAS28 scale, pain intensity on the 10-point pain scale (VAS) and the value of the CRP protein. The HAQ-DI and KALU questionnaire were used to assess the quality of life. In both groups (group A-DAS28 < 4.2, group B-DAS28 ≥ 4.2) the statistically significant effects in decreasing the level of pain and improvement of quality of life were observed. This indicates the need and effectiveness of rehabilitation regardless of the level of activity of rheumatoid arthritis according to the DAS28 scale. There were no significant changes in the CRP protein level. In conclusion, the rehabilitation of patients with moderate to high disease activity is effective and the success of comprehensive rehabilitation is demonstrated by the decrease of the DAS28 score and the pain level reported by patients, as well as improving self-assessment of health and quality of life.

Temporomandibular joint disorders in patients with rheumatoid arthritis.

OBJECTIVES: The aim of this study is to draw the attention of patients, doctors and therapists to the importance of temporomandibular joint (TMJ) problems in rheumatoid arthritis (RA). MATERIAL AND METHODS: The research was conducted at the National Institute of Geriatrics Rheumatology and Rehabilitation in Warsaw. The study involved 60 subjects. The test group consists of 30 patients with diagnosed RA. The control group (n = 30) consisted of healthy participants of similar age. The study analyzed the occurrence of problems in TMJ joints, acoustic phenomena and the level of pain. Masseter muscle development, range of abduction motion and pain during palpation of soft tissues were assessed on the basis of the joint pain map of Prof. Mariano Rocabado. RESULTS: In the RA group, more than half (56.7%) had problems with the TMJ, 70% of them had masseter hypertrophy and clicks in the TMJ, and 46.7% had tinnitus (in the control group: 10%, 30%, and 30%, respectively). Patients also had a limited range of abduction movement in the TMJ (38.0 ±6.1 mm). Analysis of the pain map of Prof. Mariano Rocabado in RA patients indicates a significantly greater number of pain structures. In the control group no pain was observed in structures such as the posterosuperior synovial and bilaminar zone, posterior ligament, or retrodiscal area. CONCLUSIONS: Temporomandibular joint problems in RA patients were more serious than in the control group and these differences were statistically significant for most tests. The awareness of the problem with the TMJ in RA patients is very low; participants of our study were 100% unaware that the function of the TMJ could be improved. Additionally, there are no guidelines for the treatment and rehabilitation of these joints.

Effects of whole body cryotherapy in patients with rheumatoid arthritis considering immune parameters.

OBJECTIVES: Whole body cryotherapy (WBC) is widely used in inflammatory diseases of the joints, including rheumatoid arthritis (RA), but the mechanism(s) of its action is not fully understood. The aim of the study was to compare the effects of WBC and conventional rehabilitation (CR) on the clinical and immune status of RA patients. MATERIAL AND METHODS: Rheumatoid arthritis patients were classified into 2 groups according to the rehabilitation method used: the study group (CT, n = 25) and control group (CR, n = 25). To measure disease activity, the disease activity score (DAS28) was used, while to assess the morning stiffness and pain intensity, the visual analogue scale (VAS) was applied. Selected laboratory parameters, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, were also determined. The serum concentrations of pro- (interleukin 6 [IL-6], tumor necrosis factor α [TNF-α], macrophage migration inhibitory factor [MIF]) and anti-inflammatory (IL-10) cytokines were measured to assess the patient's immune status. RESULTS: After rehabilitation disease activity (DAS28), morning stiffness and pain intensity (VAS) decreased in both patient groups and no statistically significant differences were observed between them. However, statistically significant improvement in the CRP serum level was observed in the CT group only. No differences were observed in the serum concentrations of tested cytokines either before and after rehabilitation, or between patient groups. CONCLUSIONS: We report that regardless of the type of therapy, comprehensive rehabilitation improves the patient's clinical status, but has no effect on the levels of circulating cytokines, such as IL-6, IL-10, TNF-α, and MIF, despite significant reduction of a systemic inflammatory marker (CRP), especially in the CT group.

Estimation of Posturographic Trajectory Using k-Nearest Neighbors Classifier in Patients with Rheumatoid Arthritis and Osteoarthritis.

Rheumatoid arthritis (RA) and osteoarthritis (OA) are common rheumatic diseases and account for a significant percentage of disability. Posturography is a method that assesses postural stability and quantitatively evaluates postural sways. The objective of this study was to estimate posturographic trajectories applying pattern recognition algorithms. To this end, k-nearest neighbors (k-NN) classifier was used to differentiate between healthy subjects and patients with OA and RA. The following parameters of trajectories were computed: radius of sways, developed area, total length, and two directional components of sways: length of left-right and forward-backward motions. Posturographic tests were applied with eyes open and closed, and with biofeedback control. We found that in RA, the radius of sways, the trajectory area, and the biofeedback coordination were related to the patients' condition. The trajectory dynamics in OA patients were smaller compared to those in RA patients. The smallest misclassification errors were observed after feature selection in the biofeedback test compared with the eyes open and closed tests. We conclude that the estimation of posturographic trajectory with k-NN classifier could be helpful in monitoring the condition of RA patients.

Benefits of wrist splinting in patients with rheumatoid arthritis.

OBJECTIVES: The goal was to present the use of a functional wrist splint and its impact on hand function in patients with rheumatoid arthritis (RA). MATERIAL AND METHODS: The study group comprised 104 women aged 18-65 and diagnosed with RA, who were treated in the Rheumatology Clinic and Outpatient Department of the National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw. The control group consisted of 40 healthy women in the same age group. Assessment of the hand function was the research method. RESULTS: Our results revealed substantially deteriorated function of the rheumatoid hand in relation to the healthy hand. The use of a wrist stabiliser is justified in patients with RA due to its beneficial impact, such as improved hand strength and dexterity and reduced pain. Based on the results obtained, it may be assumed that it is mainly patients with moderate and high disease activity who require stabilisation. The small number of patients in remission and with low disease activity was a limitation of the study. Hands with RA require an individual approach, and the most effective methods slowing down development of deformation should be sought. The results presented in this article may provide a starting point for further research on the most favourable wrist stabilisation in order to improve hand function in RA. CONCLUSIONS: Our study showed that the hand function of women with RA is limited due to deteriorated grip quality and manual dexterity in comparison to healthy persons. Wrist stabilisation improves hand function in patients with RA.

Risk of falls in the rheumatic patient at geriatric age.

Evaluating the risk of falling of a geriatric rheumatic patient plays an essential role not only in planning and carrying out the physiotherapeutic process. The consequences of falls may be different and, although they do not always result in serious repercussions such as fractures or injuries, it is sufficient that they generate the fear of falling and cause a significant reduction in physical activity. Assessing functional capacity to define the risk of falling is of utmost importance in the case of patients after joint arthroplasty surgeries. The specificity of rheumatic patient's falls is determined by numerous factors. It is not always possible to avoid them. However, it becomes vital to include fall prevention in the rehabilitation process as well as to prepare the house for the needs of an elderly person so that they are safe and as self-dependent as possible.

The beneficial effects of rehabilitation on hand function in patients with rheumatoid arthritis.

OBJECTIVES: The hand is one of the main elements of the rehabilitation of patients with rheumatoid arthritis (RA) due to deformities, which occur in approximately 90% of patients. It is a serious problem, both in the psychological and functional aspect, connected with muscle strength reduction, a limited range of motion and non-acceptance of the changes in the shape of the limb. The study aimed to assess the effect of rehabilitation on the function of the hand in rheumatoid arthritis. MATERIAL AND METHODS: The study group consisted of 40 women with RA. The patients had been previously treated at the Rehabilitation Department of the National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw. The study group underwent 3 weeks of rehabilitation involving individual therapy, exercises with equipment, patient education and physical therapy. The control group included women without a diagnosis of RA, hands pain-free and fully mobile. In both groups the hand was assessed for grip value, grip quality and manipulative ability. In the study group the basis of pain intensity was noted. The measurements were performed twice - prior to the rehabilitation and after 3 weeks of rehabilitation in women with RA and once in women without hand problems. RESULTS: The results obtained revealed marked limitation of hand function in patients with rheumatoid arthritis. The treatment resulted in an improvement of all assessed parameters except cylindrical grip, in which only a part of the findings was statistically significant. CONCLUSIONS: The analysis of the study material showed that appropriately adjusted and conducted hand physiotherapy in women with rheumatoid arthritis contributed to the improvement of its function by pain reduction, improved value and quality of grip, and also increased manipulative ability.

A machine learning approach to evaluate the impact of virtual balance/cognitive training on fall risk in older women.

Introduction: Novel technologies based on virtual reality (VR) are creating attractive virtual environments with high ecological value, used both in basic/clinical neuroscience and modern medical practice. The study aimed to evaluate the effects of VR-based training in an elderly population. Materials and methods: The study included 36 women over the age of 60, who were randomly divided into two groups subjected to balance-strength and balance-cognitive training. The research applied both conventional clinical tests, such as (a) the Timed Up and Go test, (b) the five-times sit-to-stand test, and (c) the posturographic exam with the Romberg test with eyes open and closed. Training in both groups was conducted for 10 sessions and embraced exercises on a bicycle ergometer and exercises using non-immersive VR created by the ActivLife platform. Machine learning methods with a k-nearest neighbors classifier, which are very effective and popular, were proposed to statistically evaluate the differences in training effects in the two groups. Results and conclusion: The study showed that training using VR brought beneficial improvement in clinical tests and changes in the pattern of posturographic trajectories were observed. An important finding of the research was a statistically significant reduction in the risk of falls in the study population. The use of virtual environments in exercise/training has great potential in promoting healthy aging and preventing balance loss and falls among seniors.

Is Balance Training Using Biofeedback Effective in the Prophylaxis of Falls in Women over the Age of 65?

The paper aims to investigate the usefulness of training in improving mobility and reducing the risk of falls of patients with osteoarthritis by using a force plate and virtual reality as rehabilitation tools. The study involved 72 women randomly divided into two equal groups: the force plate training group, which underwent virtual balance training with visual motor feedback, and the gym training group, which received conventional balance training only. The functional balance assessment was performed before and after the rehabilitation by computerized posturography in a relaxed upright position with open and closed eyes, with visual motor feedback. In the FPT group in the feedback measurement, the mean radius of sways was 30% smaller after rehabilitation (p < 0.00002); the feedback coordination coefficient was more than 10% bigger after rehabilitation (p < 0.001) and reached 92%, which is excellent for elderly people. Total stagnation and stumbling reported by patients decreased after rehabilitation compared to the first examination. Both tested forms of training can contribute to reducing the risk of falls. However, a more significant improvement was obtained in the force plate training group perhaps because the physical effort on a force plate trains the precise movements needed to reposition the centre of gravity without generating excessive inertia forces responsible for loss of balance and falls. Perhaps the most desirable method of intervention is to train a person's ability to perform slow but definite body movements.

Complex rehabilitation and the clinical condition of working rheumatoid arthritis patients: does cryotherapy always overtop traditional rehabilitation?

AIM: Rehabilitation slows the progress of rheumatoid arthritis (RA) and prevents progression of disability. This study aimed to compare the impact of two rehabilitation programmes on pain, disease activity, locomotor function, global health and work ability forecast in RA patients. MATERIALS AND METHODS: Sixty-four employed women aged 24-65 years participated in the study. All patients underwent individual and instrumental kinesiotherapy. Thirty-two patients underwent cryogenic chamber therapy and local cryotherapy as well as non-weight-bearing, instrumental and individual kinesiotherapy. The remaining 32 patients received traditional rehabilitation in the form of electromagnetic and instrumental therapy, individual and pool-based non-weight-bearing kinesiotherapy. Rehabilitation lasted 3 weeks. Patients were examined three times: prior to rehabilitation, after 3 weeks of therapy and 3 months after completion of rehabilitation. The following study instruments were used: to assess disease activity: DAS-28; functional impairment: HAQ-DI; pain severity: VAS; patients' overall well-being: a scale from 0 to 100 (Global Health Index); and patients' own prognosis of fitness for work: the 6th question from Work Ability Index (WAI). Statistical analysis of data was performed using the STATISTICA 8.0 package. Mixed-design two-way analysis of variance was used for hypothesis testing. RESULTS: All patients improved after rehabilitation. The group of patients those who underwent cryotherapy had improved DAS-28, HAQ-DI, VAS and global health scores immediately following the 3-week rehabilitation programme (p < 0.001, p = 0.001, p = 0.007 and p < 0.001, respectively), as well as at the 3-month follow-up (p < 0.001, p < 0.001, p = 0.009 and p < 0.001, respectively). Rehabilitation using cryotherapy resulted in greater improvement in disease activity DAS-28 [F(2,105) = 5.700; p = 0.007; η(2) = 0.084] and HAQ-DI locomotor function scores [F(2,109) = 6.771; p = 0.003; η(2) = 0.098] compared to traditional rehabilitation. The impact of both forms of rehabilitation on patients' own prognosis of work ability in the next 2 years was not significant. Results of patients who underwent traditional approach showed decreased disease activity following the initial 3-week period; however, this improvement did not sustain to the end of follow-up, 3 months later. CONCLUSIONS: Complex rehabilitation in RA has a positive effect on patients' clinical condition. The rehabilitation programme that includes cryotherapy overtops traditional rehabilitation, particularly as regards improvement in locomotor function, disease activity and sustaining willingness to continue working and exerts long-lasting effect. IMPLICATIONS FOR REHABILITATION: Rehabilitation using cryotherapy is more effective in improving locomotor function, decreasing disease activity and sustaining willingness to continue working compared to traditional rehabilitation. Rehabilitation using cryotherapy significantly reduces the intensity of pain experienced by patients with RA, and this positive effect is maintained at 3 months post-rehabilitation. Complex rehabilitation, particularly treatment using cryotherapy, improves patients' subjective assessment of their overall well-being and perception of their disease. Complex rehabilitation in rheumatoid arthritis has a positive effect on patients' clinical condition.

The Effect of Comprehensive Musculoskeletal Rehabilitation on Clinical Status of Ankylosing Spondylitis Patients.

BACKGROUND: This study aimed to compare the effectiveness of conventional and cryotherapy-based rehabilitation with respect to its impact on selected clinical parameters in AS patients. MATERIAL AND METHODS: Fifty working males aged 22-66 years were included in this study. Twenty-five of them underwent cryotherapy-based rehabilitation (cryogenic chamber, local cryotherapy; individual, instrumental, and nonweight-bearing exercises) for 3 weeks. The others received 3 weeks of conventional rehabilitation (magnetic field therapy; electrotherapy; individual and instrumental exercises). The patients were examined at three time points: before rehabilitation, immediately after its completion and at a three-month follow-up visit. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was used to assess disease severity, the Bath Ankylosing Spondylitis Functional Index (BASFI) was used to assess musculoskeletal function and a visual analog scale (VAS) was used to assess pain. A global health index was also employed to assess patients' overall well-being. RESULTS: Cryotherapy-based rehabilitation improved the following parameters: BASDAI (P<0.001, P<0.001), BASFI (P<0.001, P=0.007), VAS (P<0.007, P=0.001) and global health index (P<0.001, P<0.001) at the second and third assessment, respectively. Conventional rehabilitation improved the BASDAI (P<0.001), VAS (P=0.029), and overall well-being (P<0.030) at the second assessment. Cryotherapy-based rehabilitation was more effective than conventional rehabilitation with respect to BASFI [F(2, 82)=6.571; P=0.004; eta2=0.120] and overall well-being [F(2, 96) =5.018; P=0.008; eta2=0.095)]. CONCLUSIONS: 1. Comprehensive rehabilitation in ankylosing spondylitis has a positive effect on patients' clinical status. 2. Rehabilitation involving cryotherapy is more effective in improving musculoskeletal function and overall well-being compared to conventional rehabilitation. 3. Cryotherapy-based rehabilitation significantly reduces the intensity of pain experienced by AS patients and decreases disease activity, with the positive effect maintained at 3 months post rehabilitation.