INFLUENCE OF SANATORIUM TREATMENT ON LIFE QUALITY OF ELDERLY PATIENTS WITH OSTEOARTHRITIS

Abstract

Purpose: studying of life quality indicators at elderly patients with osteoarthritis using international EuroQol questionnaire for evaluate of efficiency of sanatorium treatment.

Materials and methods. 72 patients have been included in study at the age from 60 till 78 years, mean age was 67,6±8,7 years. Patients have been divided by method of randomization on two groups. Patients of one of  groups in addition passed rehabilitation in sanatorium conditions for 18–21 days. Assessment of life quality related to health was conducted with use of international questionnaire EuroQol-5D-European Quality of Life instrument (EQ-5D).

Results. At all patients with osteoarthritis health problems of varying degree have been revealed. In 12 months according to the questionnaire, reliable positive dynamics of life quality was observed at patients passing sanatorium treatment at the expense of improvement of ability to movement, reduce pain and discomfort and increase daily activity.

Conclusions. Having of sanatorium stage of rehabilitation in complex treatment of osteoarthritis allows affect quality of life and keep remission for a longer period in comparison with outpatient treatment.

KEY WORDS: quality of life, sanatorium treatments, osteoarthritis.

Osteoarthritis (OA) is one of the most common disorders of the muscle-skeletal system, especially in  the  elderly  age group ( in every third elderly person, reaching 70% among those  who have over 65 years). During the natural aging occurs involutional  changes in the connective tissue, especially in the tendons, ligaments, cartilage,  bone tissue,  in the walls of blood vessels, muscles [2]. Thus aging of  body  contributes to the accumulation of diseases.  During the examination in elderly and senile patients  were diagnosed from  three to  five different diseases. Modern   elderly person is  - a unique clinical phenomenon  from the point of view  on   availability and the combination of  its  diverse in character and course of diseases that are competing for their prognostic significance and impact on quality of life.  OA attributed to diseases with high comorbidity, and founded  that patients with OA have a significantly higher risk of comorbid conditions than patients who do not suffering  from OA [4].

Clinical experience and numerous publications data suggest that OA is often associated with subsequent somatic disorders: hypertension, coronary heart disease, obesity, diabetes, lung diseases (chronic obstructive pulmonary disease) and gastro- intestinal tract diseases. The greatest burden on society observed in cases of combination  OA and osteodeficiency  (osteopenia, osteoporosis (OP)), which significantly decreses  the  quality of life  [5].

Quality of life - integrated description of physical, psychological, emotional and social functioning of a person based on its  subjective perception. Assessment of quality of life  at  modern stage  have more increasing  strong position in medicine, reflecting on the one hand, the presence of new medical technologies that do not affect the  life expectancy, but significantly improve its  quality, and  from the other  hand - expanding activity of the patient, increasing of  its role in choice of methods of diagnostic  and treatment [9].

When selecting the questionnaires  it is important to consider that to be used in a clinical studying  suitable only those  that give results of the evaluation  quality of  life in  a  form of a single summary score from 0 to 1.0. These includes  a generic questionnaire EQ-5D (EuroQol) [8]. This general questionnaire is  easy to fill , widely used in different countries and gives during the processing of  collected data single score to measure the quality of life, represented by values between 0 and 1, which also provides the possibility of its using  in clinical trials. This questionnaire is widely used in various clinical situations , including in assessing the quality of life patients with rheumatic diseases [7].

The aging process is controversial, because on the background of regression  processes - atrophy, degradation, etc., develops progressive trends of creating the new compensatory-adaptive mechanisms to maintain homeostasis in  an aging body, which, however, does not fully offset the growing phenomena of degradation [2]. It should be noted that the adaptive capacity of the aging body is reduced, the possibility of development various diseases increases. In this context, particularly important in cases of illness in the elderly patient is the role of sanogenetic mechanisms, their  stimulation and support.  A special interest belongs to  the sanatorium stage of rehabilitation, whose mission is the prevention of disease progression, stimulation of compensatory capacity of the muscle-skeletal system and the possible restoration of joint function.

Spa treatment  has  a special place in the treatment and preventive care of elderly  patients , as a stage in the system of rehabilitation of many chronic diseases. Multi-disciplinary nature of medical rehabilitation in spa  conditions, a wide range  of rehabilitation methods  can  embrace  patients of all age groups with the most common diseases [1].

Compared with medication treatment, natural and artificial physical factors, when  they are properly used,  characterized by the absence of allergies, lower incidence and severity of side effects, the ability of positively influencing  on the number of pathological processes and the whole body, thus helping to improve the quality of life and  are important in the prevention of premature aging [2]. In the resort conditions further rehabilitation is indicated for patients with initial stages of OA, disabled (groups I and II),  patients with resistant synovitis and comorbidity with the possibility of self-servicing  (including general contraindications for  a  spa treatment) [3].

The aim of the study. To investigate the quality of life in elderly patients with osteoarthritis  using  international EuroQol  questionnaire to evaluate the effectiveness of spa treatment.

Materials and methods. In study were  included  72 patients aged from  60 to 78 years, middle age was 67,6 ± 8,7 years. Among the  patients  predominates  women - 88.4 %. I radiographic stage of osteoarthritis by J.H. Kellgren-Lawrence [ 6] was diagnosed in 23,3 % of patients , II stage - in 76,7 %. In  the view of modern geriatric approaches  applying of the physical factors in patients with OA who were in the spa rehabilitation  stage in the appointment of  balneotherapeutic procedures we  gave preference to ultrasonic inhalation of mineral waters and baths , from physiotherapy usually prescribed magnetic-lazer therapy, interferential therapy, patients also performed massage and physical rehabilitation . In order to prevent climate-adaptational and reaclimate-adaptational reactions and  optimization process of climate-adaptation were  included  into  the treatment complex ( based on established risk factors) adaptogens and  treatment procedures that have adaptogenic action ( phytoaeroionisation , singlet-oxygen therapy).  In the process of rehabilitation treatment in sanatorium conditions , we have selected the most effective combination of different methods of rehabilitation , which caused the most significant treatment effectiveness : a combination  of  balneotherapy , physiotherapy and exercise therapy. To improve continuity during medical rehabilitation, at discharging  from the sanatorium patients  were given written (in the form of special attractions ) recommendatitons  about further treatment,  lifestyle, physical activity, diet etc.

By  the  method of randomization, patients were divided into two groups. A marked difference for the main source of clinical and functional parameters between the groups were  not observed. The control group consisted of 14 patients of the same age without joint pathology. Treatment regimens differed between the studying groups  the presence in one of the groups sanatorium stage of rehabilitation. In the first group (n=34) patients received Structum 500 mg 2 times a day ( within 6 months of the year ) and courses of NSAID, including mainly patients treated with meloxicam ( at a dose of 7,5 mg/d) or nimesulide (in dose of 100-200 mg/d) for 7-10 days during  worcening. The patients of the second group (n=38) during the 18-21 day were on spa treatment ( once a year ), in the scheme of rehabilitation were: sitting hydrogen sulfide baths, a concentration of 80 mg/L for 10 minutes at a temperature of 36⁰C , the course of 8 procedures  every other day or ultrasonic inhalation by hydrogen  sulfide  water,  period of 5 minutes; blue clay  applications  every other day  at 26⁰C temperature; interferential therapy and magnet-lazer therapy  on the affected joints to 8 treatments alternately every other day ; pneumomassage ; classes of  physical rehabilitation therapy, aromatherapy , singlet -oxygen therapy . After the sanatorium stage of rehabilitation  patients are  taking drugs containing chondroitin sulfate (within 6 months of the year), at worcening  of  NSAIDs.

Assessment  quality of life related to health , was conducted using an  international EuroQol-5D-European Quality of Life instrument (EQ-5D), which consists of two parts. At  first part the patient self- assessed his condition by 5 parameters: mobility, self-care , usual activities, pain and discomfort , anxiety and depression. In  each variant patients could give three possible answers : No problem - 1 , there is some problem - 2, much of the problem - 3.  In the second part of the questionnaire , patients assessed their health on a scale from 0 to 100 on the VAS, the so-called thermometer , where 0 means the worst condition , 100 - the best state of health of  the patient. This part of the questionnaire is a quantitative assessment of general health.

Statistical analysis of the results was done in  the department of  statistical system  research at    SHEE "Ternopil State Medical University by  I. Y.  Gorbachevsky Ministry of Health of Ukraine" in the software  package  Statsoft  STATISTIC. To determine the reliability of the differences in the change of certain indicators  were  used parametric and non-parametric methods: criterion Wilkoksona, two-sided Fisher's criterion. A significant differences were considered when the degree of probability of error-free prognosis is (p) 95% (p <0.05).

 Results and discussion. General description of the health status of patients studied with OA according to EQ-5D questionnaire is given in the table.

In all patients with osteoarthritis  were  found  health problems of different severity degrees. Mostly  suffers ability to travel and daily activity . This data confirms that the OA in the elderly age  reduces quality of life. After  12 months, according to  questionnaire,  health status was different  in  two groups . Reliable positive  trend was in patients from  the second group 57,9 % (p < 0,05), as a result of  improving the ability to travel in space , reducing pain and discomfort and increasing of daily activity.

According to the second part of the questionnaire EQ-5D, at baseline, most patients had reduced general health assessment : the first group to 51,91 ± 1,07 ( median for «thermometer» EQ 52 points ) in the second group to 50,65 ± 1,17 ( median 48,5 points) in comparison with  the best  state of possible health.

 12 months after the  sanatorium stage of rehabilitation of patients with repeated testing  were produced the following results : The average index quality of life on the " thermometer " EQ-5D questionnaire in the first group of patients was 54,76 ± 1,23 ( median - 56 points), the second group was 69,28 ± 0,89 ( median - 70 points),  reliability differences is high : p < 0,001.

In the category  quality of life most of all patients reacted on the presence of sanatorium stage of rehabilitation in the  category " movement in space " ( GPA retesting 1,60 ± 0,08, p < 0,001), " daily activity " ( GPA retesting 1 68 ± 0,07, p < 0,001), " pain / discomfort " ( GPA retesting 1,92 ± 0,08, p < 0,001), " anxiety / depression ( GPA retesting 1 52 ± 0,08, p < 0,05).

Thus, the data suggested  that in elderly patients with OA  who  were   once  a year on a  spa treatment and took over  6 months  structure-modification drugs significantly upgraded quality of life during 12 months.

Conclusions

1. Based on the analysis  were founded  that elderly patients with OA who underwent rehabilitation treatment in sanatorium- health resorts have continued  improving  quality of  life  in comparison with patients who were treated only in outpatient conditions.

2. Availability sanatorium stage of rehabilitation in the treatment of elderly patients with OA contributes more complex  influence  on the human organism.

3. Multi-disciplinary nature of medical rehabilitation  in  spa conditions , a wide range of used restorative treatment methods  can affect the quality of life and maintain remission for more longer period  in  comparison with outpatient treatment.

4. Monitoring the quality of life can not only control  the functional state of the organism in the elderly aged people at various stages of treatment , but also to properly evaluate the effectiveness of treatment , and, if necessary, to carry out the correction of  rehabilitation  activities .

Perspectives for future research. Aimed at studying   the impact of rehabilitative and preventive measures on the quality of  life   in  elderly patients  with osteoarthritis at other stages of rehabilitation. Further work in this direction is  reasonable  and economically justified.

REFERENCES

1. Golyachenko A.O., Martynyuk V.I., Bakalyuk T.G.  Medical rehabilitation in the spa conditions // Journal of research. - 2007 . - № 4. - P. 8-9.

2. Kazymyrko V.K.,  KovalenkoV.N.,   Flehontova V.V.   Involutional  osteoarthritis and osteoporosis. - Donetsk:  Publisher  Zaslavsky A.J., 2011. - 724 p.

3. Kovalenko V.N., Bortkiewicz A.P.   Osteoarthritis . Practical guidance . - K.: Moryon , 2005. - 592 p.

4. Mendel O.I.,  Naumov A.V., Alekseeva L.I. et al  Osteoarthritis as a factor of risk in cardio-vascular catastrophes // Ukrainian Journal of Rheumatology . - 2010 . - № 3. - P. 68-73.

5. Povoroznyuk V.V. Osteoarthritis // Art  of treatments. - 2004 . - № 3. - P.16 -23.

6 . Altman R., Asch E., Bloch D. et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the knee // Arthritis Rheum. - 1986 . - № 29. - P. 1039-1049 .

7 . Harrison M.J., Davies L.M., Bansback N.J. et al. The comparative responsiveness of the EQ-5D and SF-6D to change in patients with inflammatory arthritis // Qual Life Res. - 2009 . - № 18. - P. 1195-1205.

8 . Herdman M., Gudex C., Lloyd A., et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L) // Qual Life Res. - 2011 . - № 20 . - P. 1727-1736.

9 . Langley P., Muller-Schwefe G., Nicolaou A., Liedgens H., Pergolizzi J., Varrassi G. The societal impact of pain in the European Union: health-related quality of life and healthcare resource utilization // J. Med Econ. - 2010 . - № 1. - P. 571-581.