[Physiotherapy in rehabilitation of patients with degenerative disk diseases from positions of evidence-based medicine: a literature review]. / Fizioterapiya v reabilitatsii bol'nykh s degenerativnymi zabolevaniyami pozvonochnika s pozitsii dokazatel'noi meditsiny: obzor literatury.

Back pain is one of the most urgent problems of rehabilitation. Patients with this pathology have a leading place among neurological patients in terms of the number of days of disability. The high economic costs in society are explained by the need for lumbar surgery (discectomy, spinal fusion and disc prosthesis) and rehabilitation after it. The effectiveness of rehabilitative measures is determined both by the patient's rehabilitative potential and by the choice of rehabilitative methods. OBJECTIVE: To evaluate the effectiveness of physiotherapy in patients with degenerative disk diseases from positions of evidence-based medicine according to the scientific and technical literature. MATERIAL AND METHODS: The analysis of scientific and technical literature sources and the study of materials of meta-analyses, systematic reviews (depth of search was 20 years) on the evaluation of effectiveness of physiotherapeutical methods in the rehabilitation of patients with degenerative disk diseases have been conducted. RESULTS: The ability of pulsed magnetic field to reduce the intensity of pain and improve the functional capacities of the spine in patients with low back pain has been identified. There was a pronounced analgesic end-point of low-level laser therapy in acute and chronic back pain at short and medium-term (up to 12 months) observation, as well as the ability of the method to reduce temporary disability in degenerative disk diseases. CONCLUSION: The use of magnetotherapy and low-level laser therapy can be recommended for the treatment of patients with degenerative disk diseases (C grade of recommendations, 3rd level of evidence). The recommendation is based on the results of 10 RCTs (1.111 patients with degenerative disk diseases), 3 meta-analyses, 1 systematic review and 1 Cochrane review (a total of 3.431 patients).

[Sacral magnetic stimulation in overactive bladder syndrome: comparative analysis of protocols with a frequency of 1 and 5 Hz]. / Sakral'naya magnitnaya stimulyatsiya pri sindrome giperaktivnogo mochevogo puzyrya: sravnitel'nyi analiz protokolov s chastotoi 1 i 5 Gts.

Peripheral magnetic stimulation (pMS) has shown its effectiveness in the treatment of lower urinary tract symptoms, such as symptoms of an overactive bladder (OAB). The perineal region (pelvic floor) and the sacral roots area (projection S3 of the root) are used as the locus of stimulation. The published literature presents protocols with different parameters of stimulation, while each of them reliably demonstrates clinical efficacy, however, no comparative studies have been found to select priority stimulation modes when analyzing available sources. OBJECTIVE: To compare the efficacy and safety of different frequency - 1 and 5 Hz - modes of sacral MS in patients with symptoms of OAB. MATERIAL AND METHODS: A single blind prospective randomized comparative clinical study included 59 patients with OAB symptoms. The patients were divided by simple randomization into the group 1 (n=30), which received MS 3 times a week for 5 weeks with a frequency of 1 Hz per sacral root area (S2-S4), and the group 2 (n=29), in which stimulation was performed at a frequency of 5 Hz, while the remaining parameters and duration of therapy were identical to group 1. RESULTS: Sacral pMS with different frequency modes (1 and 5 Hz) is reliably equally effective against the clinical symptoms of OAB, which is confirmed by the absence of significant intergroup differences. In patients receiving MS with a frequency of 5 Hz, there was a more pronounced increase in maximum cystometric capacity, normalization of the maximum and average urine flow velocity and regression of the residual urine volume (p<0.001, p=0.007, p=0.011 and p=0.012 compared with group 1). The greatest difference in indicators was observed in the increase in the maximum cystometric capacity - +31±25 ml at MS with a frequency of 1 Hz and +109±96 ml at MS with a frequency of 5 Hz (p<0.001). MS is a safe procedure and is well tolerated by patients. CONCLUSION: pMS when exposed to the area of S2-S4 roots for 20 minutes 3 times a week with a course for 5 weeks is reliably effective against the clinical symptoms of OAB at different frequency modes (1 and 5 Hz). At the same time, MS with a frequency of 5 Hz may have an advantage over stimulation of 1 Hz in terms of its effect on urodynamic parameters (maximum cystometric capacity, peak and average urine flow velocity and residual urine volume), which may be associated with a large inhibitory effect on detrusor.

[Noninvasive peripheral magnetic stimulation in the treatment of neurogenic urination disorders in children]. / Neinvazivnaya perifericheskaya magnitnaya stimulyatsiya v terapii neirogennykh rasstroistv mocheispuskaniya u detei.

Neurogenic urination disorders in children are often clinically represented by urinary incontinence (UI). The prevalence of UI reaches 8.6%, but tends to decrease in frequency with age. One of the methods of non-drug therapy of UI is extracorporeal magnetic stimulation (ExMI) - a type of non-invasive peripheral magnetic stimulation, which is widely used in adult urological practice. However, the effectiveness of the method in children has not been studied. OBJECTIVE: To study the effectiveness and safety of ExMI in the rehabilitation of children with neurogenic UI. MATERIAL AND METHODS: A prospective open randomized comparative clinical trial included 75 children (from 5 years to 16 years and 6 months) with neurogenic UI, who were divided by simple randomization into a main group (n=39), who received a standard rehabilitation and ExMI program for 21 days, and a comparison group (n=36), in which the standard rehabilitation program did not include the use of ExMI. RESULT AND DISCUSSION: A prospective open randomized comparative study revealed that the clinical effectiveness of the ExMI method in the complex rehabilitation of children with neurogenic UI is 94.8%, which is 25.4% higher than in the comparison group. After treatment, patients in the main group had a noticeable decrease in UI episodes, an increase in the micturition volume, and an improvement in the quality of life. Patients with various background neurological pathology responded to treatment, which indicates the common pathogenetic mechanisms of the development of LUTS in these conditions and the independence of the final effect from the basic diagnosis. CONCLUSION: The use of the perineal ExMI method in children with neurogenic UI increases the effectiveness of rehabilitation and is a promising and safe direction of rehabilitation treatment.

[Effectiveness of using a hardware complex with biofeedback in the rehabilitation of children with dysfunction of the upper limbs]. / Effektivnost' primeneniya apparatnogo kompleksa s biologicheskoi obratnoi svyaz'yu v reabilitatsii detei s narusheniem funktsii verkhnikh konechnostei.

The upper limb is of exceptional importance for human life as an organ of cognitive and practical activity. Fine motor skills of hands are a set of small, highly coordinated, precise and coordinated movements of varying degrees. Diseases and injuries of the musculoskeletal and nervous systems lead to violations of fine motor skills. Effective programs for medical rehabilitation of hand and fingers include using biofeedback devices (BFB). PURPOSE OF THE STUDY: Efficiency evaluation of the hardware-software complex with BFB in restoring the impaired function of the upper limb in children. MATERIAL AND METHODS: The clinical study included 79 patients aged 4 to 18 years with dysfunction of the upper limb not higher than level III according to MACS (The Manual Ability Classification System), who were divided by simple randomization into the main group (49 patients) who received 21 days of a comprehensive rehabilitation program (physiotherapy exercises, paretic muscle massage, mechanotherapy, hydrokinesiotherapy, methods of apparatus physiotherapy) using a hardware-software complex, and a comparison group (30 patients), in which the complex rehabilitation program did not include biofeedback procedures. RESULTS: This performed prospective open randomized comparative study revealed the effectiveness of the standard rehabilitation program in combination with training on the BFB complex (main group) to be higher than using only the standard program. After treatment, patients of the main group showed a noticeable decrease in the degree of muscle spasticity in the affected limb, strengthening of muscle strength, improvement of fine and gross motor skills of the hands, and improvement of manual skills. CONCLUSION: The use of a hardware-software complex with biofeedback in children with dysfunction of upper limbs increases effectiveness of the rehabilitation program.

[The use of underwater horizontal traction and mechanotherapy in the complex treatment of degenerative spondylolisthesis of the lumbosacral spine: a pilot clinical study]. / Primenenie podvodnogo gorizontal'nogo vytyazheniya i mekhanoterapii v kompleksnom lechenii degenerativnogo spondilolisteza poyasnichno-kresttsovogo otdela pozvonochnika: pilotnoe klinicheskoe issledovanie.

Underwater traction of the spine is a physiotherapeutic method that combines the effects of mechanical traction and fresh water of indifferent temperature and seems promising for the treatment of pain in the lower back, which is due to the physiological basis of the mechanism of action on the spinal motion segment by eliminating muscle spasm and restoring the biomechanics of the spine. OBJECTIVE: To study the effectiveness of underwater horizontal traction in combination with mechanotherapy in patients with non-stenosing unstable degenerative spondylolisthesis of the lumbosacral spine of the 1st degree, accompanied by pain. MATERIAL AND METHODS: The clinical study included 14 patients (mean age 50.21 years). Patients underwent underwater horizontal traction of the spine according to the modified Pushkareva-Vozdvizhenskaya method in a variable mode, the procedures were performed every other day, for a course of 6 procedures. After completion of the traction procedure, patients were recommended to put on a fixing lumbosacral corset, in which they rested for 30 minutes in the supine position. At the end of the rest period, the patients performed training of the back muscles with biofeedback on the mechanotherapeutic complex of simulators for 30 minutes daily, except for weekends, for a course of 10 procedures. RESULTS: All patients completed the course of treatment, during the procedures no side effects or deterioration were noted. During the treatment, motor and daily activity significantly improved according to the Oswestry scale (p=0.002), the severity of the pain syndrome and its effect on the patient's activity decreased, according to the Roland-Morris questionnaire (p=0.003). According to an objective assessment of the muscle strength of the lumbosacral spine at the initial level, no deviations from the normative parameters were revealed, however, during the treatment, a significant increase in strength was noted in all muscle groups. CONCLUSION: Underwater horizontal traction of the spine in variable mode according to Pushkareva-Vozdvizhenskaya is an effective and safe method of conservative treatment of unstable non-stenosing degenerative spondylolisthesis of the 1st degree, accompanied by back pain, which helps to reduce the intensity of the pain syndrome and improve the daily motor and social activity of patients. The traction method should be supplemented with therapeutic exercises using mechanotherapeutic simulators to achieve a clinical result.

[Water aerobics training: selection and control of the exercise intensity using the Borg scale]. / Vodnye aerobnye trenirovki: vybor i kontrol' intensivnosti uprazhnenii s pomoshch'yu shkaly Borga.

OBJECTIVE: To evaluate the opportunity of Borg scale using for applying and monitoring the aerobic training intensity in the pool as well as the relationship between the Borg scale and the heart rate (HR) in the aquatic environment. MATERIAL AND METHODS: The study involved 11 healthy individuals (mean age 46.4±7.5 years). After a cardiopulmonary test on a treadmill and a probation lesson the training was conducted in the pool using a set of basic aerobic exercises lasting 45 minutes. During training the subjects had to maintain a load level corresponding to 12-14 points on the Borg scale. Every 10 minutes of the main training part the heart rate was calculated and the rating of perceived exertion (RPE) was determined according to the Borg scale. RESULTS: The average heart rate in the main part of the training was 126.8±14.0 beats/min. The intensity of aerobic exercise was 82% of the maximum heart rate determined during the cardiopulmonary test and 68% of the reserve heart rate which corresponded to a high level of intensity. Between the heart rate and the Borg scale a significant correlation was found in the first period of training (r=0.67, p<0.02). At RPE 12-13 in almost 1/2 cases the subjects felt a subjectively lower intensity of the load than they actually performed (by heart rate) while at RPE 14 a high percentage of coincidences was observed between different measurement methods (p<0.05). CONCLUSION: During water aerobics training the use of the Borg scale to prescribe and maintain a level of exercise allows to achieve a sufficient intensity level which is necessary to improve cardiorespiratory fitness and physical performance in order to influence risk factors for cardiovascular disease. The Borg Scale as a stand-alone method of controlling intensity when using water-based aerobic training, especially with high-intensity training should be used with caution. Further investigation is needed to determine the relation between subjective measures of exercise intensity and HR and validity of their use during water aerobics training.

[General hydro galvanic baths in the treatment of patients with lumbosacral radiculopathy]. / Obshchie gidrogal'vanicheskie vanny v lechenii patsientov s poyasnichno-kresttsovoi radikulopatiei.

INTRODUCTION: Hydrogalvanic baths are a hydrotherapy method based on the combined effect of electric current and fresh water on the body. AIM OF STUDY: Scientific evidence and evaluation of the effectiveness of use of general hydrogalvanic baths in the treatment of patients with lumbosacral radiculopathy with the background of degenerative spinal disorder. MATERIALS AND METHODS: A randomized comparative clinical trial included 84 patients. The 1st (active) group included 43 patients, the 2nd (control) had 41 patients. Patients of the 1st group received general hydrogalvanic baths. Patients in the control group - drug treatment, including NSAIDs, muscle relaxants, anticonvulsants. The assessment was carried out before treatment, at the end of the course (on the 14th day) and 3 months after the end of treatment according to the results of neurological examination, VAS questionnaires, Pain DETECT, Beck scale, Oswestry scale, SF-36 scales, electroneuromyography (nerve conduction study). RESULTS: In patients receiving general hydrogalvanic baths, in comparison with the control group, there was an improvement in sensitivity (the incidence of hypesthesia decreased from 77 to 11%, p=0.008) and conductivity in peripheral sensory fibers. A decrease in pain was observed in both groups, however, a decrease in neuropathic pain was recorded only in patients receiving drug treatment. In the 1st group during therapy, an improvement in the emotional state in patients and a decrease in the level of depression were revealed. An analysis of long-term results showed that the delayed effect of non-drug treatment significantly increased in patients of the 1st group in comparison with the control group (p<0.05). CONCLUSIONS: Exposure to general hydrogalvanic baths is an effective way to treat lumbosacral radiculopathy, the main registered effects are: improvement of sensitivity, reduction of pain and stabilization of the emotional background. However, the studied method does not affect neuropathic pain.

[Balneotherapy and modification of risk factors in cardiovascular disease prevention programs]. / Bal'neoterapiia i modifikatsiia faktorov riska v programmakh profilaktiki serdechno-sosudistykh zabolevanii.

Cardiovascular disease (CVD) is the leading cause of death in the Russian Federation, as in many other countries. Taking into consideration the observed increase in the spread of risk factors, modern demographic trends (an increase in the proportion of elderly people), and a high economic burden of circulatory system diseases, the search for new forms and effective strategies of prevention is becoming relevant. OBJECTIVE: To provide the data available in the scientific literature on the effectiveness of the measures to modify risk factors and lifestyle, which are implemented during balneotherapy under both resort and in non-resort conditions, and to define areas for further investigators in this field. Investigations evaluating the effectiveness of these measures were sought in the Embase, PubMed, PEDro, Web of Science, eLIBRARY databases in January 2012 to August 2018. The analysis included seven trials that showed an improvement of estimated endpoints (blood pressure, body mass index, lipid profile, physical activity, and morbidity and mortality rates). The generalization of results of the analyzed trials was limited by the high heterogeneity of their protocols and methodological quality, which does not allow for a final conclusion on the effectiveness of preventive measures implemented during balneotherapy. Future research should provide more evidence of the benefits of this approach. The analysis will be able to take into account the existing experience and to develop a strategy to enhance the effectiveness of cardiovascular disease prevention programs based on high-quality randomized clinical trials.

[The specific methodological features of scientific research in the field of balneotherapy]. / Metodologicheskie osobennosti provedeniia nauchnykh issledovanii v oblasti bal'neoterapii.

This review was undertaken for the objective of highlighting and assessing the approaches to obtaining, analysis, and reporting the results of randomized controlled trials (RCT) in balneotherapy. The review covers the following topics: the specific features of the organization of the controlled randomized studies in the field of balneotherapy, the main methodological approaches used for these purposes that should be taken into consideration at different stages of the planning and performance of the studies together with other issues including sample size calculation, sequence generation modes, the application of the distribution concealment technique, types of randomization, blinding of the outcome assessment, the choice of the comparator group, and endpoint selection. We emphasize the importance of the appropriate statistical analysis and the comprehensive reporting of the results of the investigations. Special attention is given to the current approaches to the estimation of the quality of RCTs and to the preparation of the systematic reviews. The examples of the analysis of the relevant publications presented in the review will hopefully help the researchers to take advantage of the currently available experience and improve the compliance of the locally conducted balneotherapeutic trials with the international criteria for the methodological quality.

[Hydrogalvanic baths as a method of medical rehabilitation: a literature review and the prospects for the clinical application].

The hydrogalvanic baths provide a tool for the combined application of warm fresh water and low frequency electric current. These procedures are suitable for both systemic and local treatments. The mechanism behind their therapeutic action is based on synergistic effect of two therapeutic agents. This article presents the literature and historical review of the method as well as the current concept of hydrohalvanic therapy. The history of its development is associated with the improvement of the technical equipment and accumulation of clinical experience. Numerous studies carried out up to the present time have demonstrated that hydrohalvanic therapy can be effectively applied for the treatment of diabetic angiopathy, rheumatoid and gouty arthritis, fibromyalgia, ankylosing spondylitis. At the same time, the high potential of this method remains underestimated. At present, one of the most promising approaches to its clinical applications is the treatment of lumbosacral radiculopathy caused by degenerative vertebral disk lesions. The hydrogalvanic baths have analgesic, anti-inflammatory, and decongestant effects, improve microcirculation, and reduce sensory impairment. It is necessary to continue clinical investigations to obtain further evidence of the effectiveness of the method under consideration for the treatment of lumbosacral radiculopathy and to evaluate its short- and long-term effects. Their results will hopefully provide an opportunity to include the hydrogalvanic baths in the programs of medical rehabilitation of the patients presenting with lumbosacral radiculopathy.

[The role of physiobalneotherapy in the prevention of weather-dependent exacerbations in the patients presenting with chronic obstructive pulmonary disease].

The present publication presents the available data concerning the mechanisms of the development of enhanced meteosensitivity in the patients presenting with chronic broncho-obstructive pulmonary pathology with special reference to the characteristics of the most important biotropic weather factors acting on the population of the Moscow region. The possibility is substantiated for the introduction of non-medicamental methods (such as gas-air sodium dioxide bathtubs, whole body bathtubs with the use of mitofen preparations, and interval hypoxic trainings) into the prophylactic programs designed to prevent weather-dependent exacerbations of the chronic obstructive pulmonary disease.

[The biotropic weather conditions and changing the clocks as the extraneous risk factors of weather-dependent exacerbations of chronic diseases].

This paper reports the results of medico-meteorological investigations suggesting the influence of biotropic (unfavourabe) weather conditions characteristic of transient seasons in combination with the abolition of on the frequency of application for emergency medical aid. It was shown that the abolition of during the period from 2009 to 2013 resulted in a significant rise in the frequency of application for the emergency treatment of exacerbation of cardiovascular diseases. The sociological studies involving the responders of various social and age groups carried out parallel to the medical ones demonstrated that most of them (77%) considered the abolition of to be the main cause of the deteriorated of the sense of wellbeing and emphasized the necessity of winter time reversal.

[The natural resources of the expedition bay as a basis for the creation of the health resort centre at the coast of the Peter the Great Bay, the Sea of Japan].

The present article presents characteristics of the therapeutic and health promoting potential of the Expedition Bay, (part of the Peter the Great Bay, the Sea of Japan), known to be a deposit of therapeutic sea muds. The great variety of local therapeutic natural resources, viz. sea muds, sea weeds, friendly climate, beeches, etc., can be used for the treatment and prevention of various diseases. The Expedition Bay was designated as a local area of recreational and therapeutic value that can be used as a basis for the creation and further development of the multi-field health resort centre (or medical spa) that would attract patients from other regions of Russia and the surrounding countries. The future centre would provide medical services based in the first place on the classical methods of climatic and peloid therapy, thalassotherapy (heliotherapy, aeroionotherapy, bathing, marine algae therapy, etc.) as well as the modern balneotherapeutic and spa technologies, therapeutic tourism for the purpose of rehabilitation and health promotion.

[Thermal therapy for the management of cardiovascular pathology].

This paper reports the results of analysis of the study on the effect of thermal therapy in the patients presenting with cardiovascular diseases including coronary heart disease, chronic heart failure, and myocardial infarction. It is shown that the correct application of the "Finnish" and infrared sauna taking into consideration specific clinical characteristics of the disease in question and with strict compliance to the relevant methodological recommendations can produce beneficial effects in the form of the improved endothelial function, reduced heart rate variability and oxidative stress as well as enhanced physical performance. It is concluded that full-scale studies in accordance with the principles of evidence-based medicine are needed to further improve the effectiveness of the thermal treatment of cardiovascular diseases and the reliability of the data obtained.

[The influence of carbon dioxide baths differing in the total mineralization levels on the functional state of the cardiovascular system of the patients presenting with hypertensive disease associated with coronary heart disease].

The results of the study on the influence of carbon dioxide baths differing in the total mineralization levels on the clinical course of hypertensive disease associated with coronary heart disease and on various functional systems of the body. The data obtained provide an insight into the role of salt concentrations (10 and 20 g/l) in carbon dioxide bath water (1.2 g/l) applied for the traditional treatment of the patients with hypertensive disease associated with concomitant coronary heart disease and musculoskeletal pathology. Highly mineralized bath water has a greater influence on the functional state of the cardiovascular system by causing a more pronounced decrease in peripheral vascular resistance and hypotensive effect. Baths with a salt concentration of 20 g/l markedly reduced pain and had anti-inflammatory effect in the patients with pathology of support and locomotor organs.

[Peloid therapy: the theoretical and practical aspects, problems and prospects of its development].

The present literature review contains the data on the history of peloid therapy, current concepts of the mechanisms of its action, and up-to-date methods of peloid applications. Special emphasis is laid on the lack of relevant information concerning selected aspects of peloid therapy, debatable views of its application and mechanisms of action. The review is concluded by the discussion of the prospects for further research and practical use of peloid therapy.

[Global tendencies in the development of medical spa].

The legal framework and the regulatory documents on which to base the development and activity of the medical spa in this country are practically absent which accounts for the necessity to analyse the global tendencies in this sphere. The authors review the literature data concerning the current trends in the development of health resort business and rehabilitative medicine and consider a new type of therapeutic and health-improving facilities known as "medical spa". The main aspects of the work of these centres with special reference to their therapeutic/preventive and organizational activities are discussed with due regard for the global experience and international practices in these fields.

[Carbon dioxide baths: state of the art].

Modern concepts of the mechanism of therapeutic action of carbon dioxide are reviewed with special reference to its effects on the patients with different pathologies undergoing treatment with the use of carbon dioxide baths. Further prospects for practical application of this method are discussed.

[Spa-based water procedures and complications in the course of their performance].

The scope of applications of spa-based water procedures have become considerably extended during the recent years; accordingly, the frequency of complications and accidents has increased. The present review considers the possible mechanisms underlying such complications and various factors promoting their development, such as the patients' age and chronic diseases, the use of pharmaceutical products affecting thermoregulation and cardiovascular function. Special attention is given to the influence of alcohol consumption on the frequency of complications, accidents, and sudden death associated with hyperthermal procedures, the possibility of infectious diseases and measures necessary for their prevention.