Medical and psychological rehabilitation of patients with post traumatic stress disorder: determinants of effectiveness

Authors:

Sobolev Andrey Valentinovich — PhD in Medical Sciences (Cand. Med. Sci.), Director of the Sanatorium and resort complex “Moscow region”, 2A/17 Sanatornaya Street, village Marfino, Mytishchi urban district, 141052, Russian Federation; e-mail: skk_pm_39@mil.ru; https://orcid.org/0000-0002-0186-8165.

Trishkin Dmitriy Vyacheslavovich — Honored worker of Healthcare of Russian Federation, Grand PhD in Medical sciences (Dr. Med. Sci), Associate Professor, Main Military Medical Directorate of the Russian Ministry of Defense, 21 Bolshoy Znamenskiy Ln, 119019 Moscow, Russian Federation.

Ponomarenko Gennadiy Nikolaevich — Corresponding Member of the Russian Academy of Sciences, Honored Scientist of the Russian Federation, Grand PhD in Medical sciences (Dr. Med. Sci), Professor, Director General of the Albrecht Federal Scientific and Educational Centre of Medkal and Social Expertise and Rehabilitation, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; Head of the Department of Physical and Rehabilitation Medicine of the North-Western State Medical University named after I.I. Mechnikov, 47 Piskarevskiy Avenue, 195067 St. Petersburg, Russian Federation; e-mail: ponomarenko_g@mail.ru; https://orcid.org/0000-0001-7853-4473.

Grigorev Stepan Grigorevich — Grand PhD in Medical sciences (Dr. Med. Sci), Professor, senior researcher, All-Army Medical Register of the Ministry of Defense of the Russian Federation, SM Kirov Military Medical Academy, 6 Akademika Lebedeva Street, 194044 St. Petersburg, Russian Federation; e-mail: gsg_rj@mail.ru; https://orcid.org/0000-0003-1095-1216.

Annotation:

Introduction. The choice of technologies for medical and psychological rehabilitation of patients with PTSD based on the prediction of its effectiveness is an urgent scientific task.

Aim. The aim of the study: to determine the prognosis of the effectiveness of medical and psychological rehabilitation in patients with post-traumatic stress disorder and to identify its determinants

Materials and methods. 71 patients aged 33 (20-49) years with post-traumatic stress disorder (ICD-X code F43.1) were studied. Patients were prescribed a set of physical exercises, a course of audiovisual polysensory relaxation, transcranial magnetic stimulation, chromotherapy, hydrobalneotherapy, climatotherapy, therapeutic nutrition and psychotherapy. Clinical, instrumental, psychophysical, and integral methods of assessing the condition of patients were used. The total duration of the course is 20-30 days.
To determine the relationship between integral health parameters and individual clinical and functional signs of overwork, correlation analysis was performed, canonical correlation analysis was used to select the most informative signs, and discriminant analysis was used to determine the prognosis of MPR and the dominants of its effectiveness.

Results. The effectiveness of MPR in patients with PTSD is 69 %. The determinants of effectiveness are indicators characterizing the level of DBP, BMI, age, the value of the double product, hemodynamic response to physical activity and the level of anxiety of the patient.

Discussion. A significant improvement in clinical and psychological status, an increase in adaptive potential, the level of physical health, a significant increase in physical performance, and an improvement in vegetative regulation were revealed. Significant average correlations of improvement of adaptive potential and physical performance with instrumental and psychophysical indicators of patients have been established.

Conclusion. Various components of the pathogenesis of PTSD determine the choice of different physical methods of treatment, the combination of mechanisms of therapeutic action of which determine the high effectiveness of the final result of MPR in patients with PTSD.

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