RU2312583C2 - Method for detecting the direction of rehabilitation impacts upon psychophysiological state in sanatorium patients - Google Patents

Abstract

FIELD: medicine, psychology, health resort treatment.

SUBSTANCE: it is necessary to carry out initial evaluation of a patient's psychophysiological state due to testing, moreover, it is necessary to detect the factor of self-regulation by the following formula: FS=(0.36*IMw/c+0.33*IMno/c)-(0.27*A+0.32*D), where IMw/c - the duration of individual minute with counting, sec; IMno/c - the duration of individual minute at no counting, sec; A and D - the values of self concept of anxiety and depression; 0.27; 0.32; 0.36 and 0.33 - the coefficients of factor loadings; then one should calculate the value of the factor of arterial pressure (FAP) that characterizes the state of physical adaptation systems by the formula: FAP=0.38*SAP+0.42*DAP, where SAP - systolic arterial pressure; DAP - diastolic arterial pressure; 0.38 and 0.42 - coefficients of factor loading; and at any FS and FAP values it is necessary to prescribe restorative curative procedures and physiotherapeutic procedures according to somatic indications, moreover, at FS values being 26-47 and those of FAP being below 70 one should choose algorithm N1 "prophylactic activating", at FS value being 26-47 and FAP being 71-90 one should choose algorithm N2 "prophylactic restorative", at FS value ranged 26-47 and FAP being above 91 one should choose algorithm N3 "prophylactic relaxing"; at FS values being below 25 and those of FAP being below 70 - algorithm N4 "psychotherapeutic activating", at FS values being below 25 and FAP ranged 71-90 one should choose algorithm N5 "psychotherapeutic normalizing"; at FS values being below 25 and FAP being above 91 one should choose algorithm N6 "psychotherapeutic relaxing"; at FS values being above 47 and at any FAP values one should choose algorithm N7 "psychotherapeutic motivating". The innovation enables to take into account the impact of a patient's subjective self concept of his state upon the state of adaptation systems and the efficiency of rehabilitation impacts while matching correspondent direction of rehabilitation impacts.

EFFECT: higher accuracy of detection.

Description

The method relates to medicine, psychology, in particular to balneology, and can be used to determine the orientation of the rehabilitation effects (psychotherapeutic and prophylactic) to improve the psychophysiological state of the patients of the sanatorium.

There are many approaches and methods of healing people, but they are not always effective, as they do not take into account the subjective assessment of a person’s psychophysiological state.

There is a method of determining the complex of rehabilitative effects on the human body, carried out on the basis of assessing the state of the body according to clinical indicators and data obtained by activating the links between the central nervous system and areas of projection of organs on the skin (patent RU 2173131 C2, 09/10/2001, A61B 5/00) . The disadvantage of this method is its complexity, the requirement for special training of a specialist. The method allows to eliminate the secondary signs of the disease, and not the cause, which reduces its effectiveness.

Closest to the claimed method according to the technical result is a method for determining the complex of rehabilitation effects (patent RU 2195858 C2, 01/10/2003, А61В 5/02), selected using the hardware-software complex "Integral Health Index" based on an assessment of the visceral and psychoemotional sphere , conditions and lifestyle of a person. Testing of the patient’s condition is carried out, which includes assessing the state of the body’s adaptation systems through a mathematical analysis of the heart rhythm in physiological adaptation tests, taking into account indicators of the functions of external respiration and psychoemotional status. Interpretation of the test results is carried out taking into account gender, age, height, weight, blood pressure. Based on the test results, the degree of visceral and psychoemotional health is calculated according to special formulas, which form the integral indicator of health. The disadvantage of this method is the underestimation of the impact of a subjective assessment by a person of his psychophysiological state, which reduces the effectiveness of rehabilitation effects.

It is known that there is a direct correlation between a person’s subjective assessment of his condition, expressed through self-assessment of anxiety and depression levels, with hypernosognosia and hyponosognosia (S. Ovcharenko et al. "Features of the subjective perception of somatic diseases." // Russian Medical Journal, 1999. No. 2, pp. 19-24). Moreover, high levels of anxiety and depression correspond to a low level of subjective control of a person in relation to his somatic state and a tendency to exaggerate the importance of somatic distress. This necessitates the need for psychotherapeutic care for patients with high levels of anxiety and depression.

The authors propose an effective way to determine the orientation of rehabilitative influences (psychotherapeutic and prophylactic) by determining the factor of self-regulation (FS), consisting of the combined influence of subjective assessment of anxiety and depression levels and individual human perception of time. The authors found that the factor of self-regulation reflects a person’s ability to realize and regulate his condition, to influence well-being.

The technical result of the proposed method for determining the direction of the rehabilitation effects on the patients of the sanatorium is to increase efficiency due to the determination of the mutual influence of the factor of self-regulation and the state of the physical adaptive systems of the body.

The technical result is achieved by calculating the factor of self-regulation, determined through the levels of anxiety and depression (according to the GOTD test) and indicators of individual perception of time (according to the tests "Individual minute with a count" and "Individual minute without a count"), and the blood pressure factor, as indicator of the state of physical adaptation systems; and based on their combination, the direction of the rehabilitative influences is chosen. As an auxiliary test, the breath holding time is used for the functional test of Stange adaptation.

The method is as follows: the determination method takes 15-20 minutes and consists of 5 consecutive steps: 1) determination of levels of anxiety and depression; 2) performance of the tests "Individual minute with account" (IM s / s) and "Individual minute without account" (IM b / s); 3) calculation of the factor of self-regulation (FS); 4) measurement of systolic (SBP) and diastolic (DBP) blood pressure and calculation of blood pressure factor (FAD); 5) determination of the time of holding the breath in the functional test adaptation of the Stange.

First step

Testing of anxiety and depression levels is carried out according to the hospital anxiety and depression questionnaire GOTD (Zigmond A.S. Snaith R.P. The Hospital Anxiety and Depression scale. // Acta Psychiatr. Scand. 1983. - Vol. 67. - P.361-370). The advantages of the scale are its ease of use and processing: filling the scale does not require a long time and does not cause difficulties for the patient, which allows us to recommend it for use in somatic practice for the initial detection of anxiety and depression levels (screening). The scale has a high discriminant validity for two disorders: anxiety and depression. The GOTD scale form is issued for self-completion to the patient and is accompanied by instructions. The scale is made up of 14 statements serving 2 subscales: “anxiety” (odd points - 1, 3, 5, 7, 9, 11, 13) and “depression” (even points - 2, 4, 6, 8, 10, 12 , 14) (see Appendix 1). Each statement corresponds to 4 response options that reflect gradations of the severity of the symptom and are encoded by the increase in the severity of the symptom from 0 (absence) to 3 (maximum severity). After completing the test, the number of points is calculated separately for the levels of anxiety and depression.

Second phase

Two parameters of the flow of an individual minute are studied with the registration of the results by a stopwatch:

1) the duration of an individual minute with a count (MI s / s), characterizing the awareness of time by a person, - a uniform count of up to 60;

2) the duration of an individual minute without counting (IM b / s), characterizing the feeling of time — guessing, “feeling” without counting the time interval of 1 minute (60 seconds).

Each indicator is measured twice and the average of two measurements is taken for calculation.

Third stage

The calculation of the factor of self-regulation (FS) is carried out according to the formula:

FS = (0.36 · IM s / s + 0.33 · IM b / s) - (0.27 · T + 0.32 · D),

Where

T and D - indicators of self-assessment of anxiety and depression levels;

IM s / s - the duration of an individual minute with the account, s;

IM b / s - the duration of an individual minute without an account, s;

0.27; 0.32; 0.36 and 0.33 are factor load factors.

Moreover, for the values of FS from 26 to 47 points, the patient has self-regulation of the state; with FS values less than 25 points - violation of self-regulation of the state in the field of emotions management; and with values of more than 48 points, a violation of self-regulation is due to the rigidity of thinking processes.

Fourth stage

Measurement of blood pressure indicators is carried out in the generally accepted way: pressure is measured using a Korotkov medical tonometer, on the right hand in a sitting position at least twice. If the indicators of the second dimension coincide with the first or are close, then they are used for calculation. If the indicators differ (which is possible with a strong emotional reaction of the patient to the check situation), the pressure is measured a third time and the average of the last two measurements is taken to calculate.

The value of the blood pressure factor (FAD), which characterizes the state of the physical adaptation systems, is calculated:

FAD = 0.38 · GARDEN + 0.42 · DBP,

Where

GARDEN - systolic blood pressure;

DBP - diastolic blood pressure;

0.38 and 0.42 - factor load factors.

Moreover, for values less than 70 points - physical adaptation is reduced, inhibition processes dominate, the parasympathetic autonomic nervous system is activated, lack of energy in the body; from 71 to 90 - the normal state of adaptation systems, the balance of body functions; over 91 - tension of the body's adaptation systems, the dominance of excitation processes, the sympathetic autonomic nervous system is activated; in the latter case, effective restoration of body functions requires, first of all, drug hypotensive therapy.

Fifth stage

Measurement of the breath-holding time is carried out using the functional test Stange and is used as an auxiliary, verification test. The patient takes a shallow breath-exhale, on the next breath holds his breath, pinching his nose with his hand. The stopwatch measures the breath holding time in seconds.

The critical value of the breath-holding time - less than 20 seconds - indicates a high level of anxiety and depression, a decrease in adaptation reserves. To restore the condition, it is necessary to use physiotherapeutic procedures, physiotherapy exercises and psychotherapeutic techniques that restore respiratory functions.

By the values of the self-regulation factor (FS) and the blood pressure factor (FAD), the orientation (algorithms) of the rehabilitation effects is determined.

1. When the values of the FS 26-47, FAD less than 70: algorithm No. 1 "Preventive activating."

2. When the values of the FS 26-47, FAD 71-90: algorithm No. 2 "Preventive restorative."

3. With FS 26-47, FAD greater than 91: algorithm No. 3 “Preventive relaxing”.

4. With FS values less than 25, FAD less than 70: algorithm No. 4 “Psychotherapeutic activating”.

5. When the FS values are less than 25, FAD 71-90: algorithm No. 5 "Psychotherapeutic normalizing."

6. When the FS is less than 25, the FAD is greater than 91: algorithm No. 6 "Psychotherapeutic relaxing."

7. With FS values greater than 47 and any FAD values: Algorithm No. 7 “Psychotherapeutic motivating”.

For convenience, the choice of algorithm can be carried out according to the table of algorithms (Appendix 2).

Description of the algorithms of rehabilitation effects

Algorithm No. 1 "Preventive activating"

1. A prerequisite for effective rehabilitation: physiotherapeutic procedures that activate the activity of the sympathetic autonomic nervous system (for example, drug electrophoresis, DDT, SMT, balneotherapy).

2. Physiotherapeutic procedures for somatic indications.

3. The procedures restoring breathing are prescribed if the time of holding the breath in the functional test of the Stange is less than 20 s.

4. General strengthening wellness procedures.

Characterization of the condition of patients: there is self-regulation of psychological and physiological functions, adequate self-esteem of the state of adaptation and health. Reduced mood background, fatigue. The need for recovery. 22 ± 4.5% of patients of the sanatorium of general therapeutic profile.

Algorithm No. 2 "Preventive restorative"

1. Physiotherapeutic procedures for somatic indications.

2. General strengthening wellness procedures.

Characterization of the condition of patients: there is self-regulation of psychological and physiological functions, adequate self-esteem of the state of adaptation and health. The need for outdoor activities. 28 ± 5.3% of patients of the sanatorium of general therapeutic profile.

Algorithm No. 3 "Preventive relaxing."

1. A prerequisite for effective rehabilitation: drug hypotensive therapy; hypoxytherapy.

2. Physiotherapeutic procedures that activate the activity of the parasympathetic autonomic nervous system (for example, electrophoresis with bromine, nicotinic acid, reflexology, balneotherapy).

3. Physiotherapeutic procedures for somatic indications.

4. General strengthening wellness procedures.

Characterization of the condition of patients: there is self-regulation of psychological and physiological functions, adequate self-esteem of the state of adaptation and health. Stress of physical adaptation systems after overloads. Need for peace and relaxation. 17 ± 3.7% of patients of the sanatorium of general therapeutic profile.

Algorithm No. 4 “Psychotherapeutic activating”

1. A prerequisite for effective rehabilitation: group and individual psychotherapy, obtaining information on the availability of health; stress resistance training in health schools; psychotherapeutic procedures: audiovisual relaxation, psycho-emotional discharge, body-oriented therapy.

2. Warming (thermal) and activating physiotherapeutic procedures (for example, showers, balneotherapy, electric sleep with a frequency of 40-60 Hz, darsonvalization).

3. Various types of manual and hydromassage.

4. Physiotherapeutic procedures for somatic indications.

5. The procedures that restore breathing are prescribed if the time of holding the breath in the functional test of the Barbell is less than 20 s.

6. General health-improving procedures.

Characterization of the condition of patients: violation of self-regulation in the field of emotional management. Reduced tone of the physical condition amid increased anxiety. Feel the lack of energy for action. The behavior is characterized by increased emotionality and a tendency to exaggerate its psychological and somatic distress. The need for information on the development of stress tolerance. 5.5 ± 2.6% of the total number of patients of the sanatorium of general therapeutic profile.

Algorithm No. 5 "Psychotherapeutic Normalizing"

1. A prerequisite for effective rehabilitation: group and individual psychotherapy, stress resistance training in health schools; psychotherapeutic procedures: audiovisual relaxation, psycho-emotional discharge.

2. Restoration of respiratory functions using physiotherapy (halotherapy, hypoxic therapy) and physiotherapy exercises.

3. Various types of manual and hydromassage.

4. Physiotherapeutic procedures for somatic indications.

5. General health-improving procedures. Useful physical activity, actively restoring the rhythm of breathing: walking, swimming, water aerobics, bicycle, skiing, etc.

Characterization of the condition of patients: violation of self-regulation in the field of emotional management. The condition of patients is alarming, but the state of adaptation of the physical systems of the body is normal. Hypernosognosia, high suggestibility, increased sensitivity to the words of the doctor. Inadequate emotional and somatic reactions to treatment are possible. Patients have a pronounced need for sympathy, help, and information on restoring emotional balance and maintaining health. 8.3 ± 3.7% of patients of the sanatorium of general therapeutic profile.

Algorithm No. 6 "Psychotherapeutic relaxing"

1. A prerequisite for effective rehabilitation: drug hypotensive therapy; individual psychotherapeutic help.

2. Psychotherapeutic procedures: audiovisual relaxation, psycho-emotional discharge; group body-oriented therapy.

3. Obtaining information in the field of access to health, mastering ways to relieve psycho-emotional stress and physical relaxation in health schools or psychological training.

4. Restoration of respiratory functions with the help of physiotherapy (halotherapy, hypoxytherapy) and physiotherapy exercises.

5. Various types of manual and hydromassage.

6. Physiotherapeutic procedures that activate the activity of the parasympathetic autonomic nervous system (for example, iodine-bromine baths, electro-therapy, galvanization).

7. Physiotherapeutic procedures according to somatic indications.

8. General health-improving procedures. Useful physical activity, actively restoring the rhythm of breathing: walking, swimming, water aerobics, bicycle, skiing, etc.

Characterization of the condition of patients: violation of self-regulation in the field of emotional management. The dominance of excitation processes: high psychoemotional stress and stress of physical adaptation. Increased emotionality and suggestibility, care for the disease. High risk of developing psychosomatic diseases. This group of patients requires special medical attention, as high risk of iatrogenic. In the practice of the sanatorium of a general therapeutic profile, patients of this group make up 7.6 ± 3.2% of the total.

Algorithm No. 7 “Psychotherapeutic motivating”

1. A prerequisite for effective rehabilitation: obtaining information on the awareness of their own emotional states and stereotypes of mental activity in group psychotherapeutic work.

2. Psychostimulating methods of physiotherapy.

3. Psychotherapeutic procedures: audiovisual relaxation, psycho-emotional discharge; group body-oriented therapy.

4. Alignment of emotional tone: warming physiotherapy (sauna, solarium, etc.).

5. Restoration of respiratory functions with the help of physiotherapy (group halotherapy, hypoxic therapy) and physiotherapy exercises.

6. Various types of manual and hydromassage.

7. Activization of motor activity: group sports games of various kinds: in the gym, outdoors and in the pool.

8. Physiotherapeutic procedures according to somatic indications.

9. General health-improving procedures.

Characteristics of patients: impaired self-regulation due to the rigidity of thinking processes. Hyponosognosia, lack of awareness of bodily needs. The importance of treatment is underestimated, medical advice is often ignored. Needs are expressed for restoring a reduced emotional background, searching for new motives for activity, including motives for restoring health. Physical adaptation systems are preserved, high reserves of the respiratory system. The need for information in the field of relationships with other people. 16.54 ± 3.6% of the total number of patients of the sanatorium of general therapeutic profile.

The method is effective and easy to use, allows you to evaluate the initial psychophysiological state of patients, namely, to take into account the influence of the patient's subjective self-esteem of his condition on the state of adaptation systems and on the effectiveness of rehabilitation effects. The assessment includes the determination of a self-regulation factor characterized through anxiety and depression levels (according to the GOTD test) and indicators of individual time perception (according to the tests “Individual minute with a count” and “Individual minute without a count”), it is used as a characteristic of the state of physical adaptation systems blood pressure factor. Based on the assessment, the initial state of patient self-regulation and adaptation is determined and the orientation of the rehabilitative influences: psychotherapeutic and prophylactic, is determined.

Claims (1)

The method of determining the direction of the rehabilitative effects on the patients of the sanatorium, which consists in assessing the initial psychophysiological state by testing, characterized in that they determine the factor of self-regulation according to the formula: FS = (0.36 · IM s / s + 0.33 · IM b / s) - (0.27 · T + 0.32 · D), where IM s / s is the duration of an individual minute with a count, s; IM b / s - the duration of an individual minute without an account, s; T and D - indicators of self-assessment of anxiety and depression levels; 0.27; 0.32; 0.36 and 0.33 - factor load factors; then calculate the value of the blood pressure factor (FAD), characterizing the state of the physical adaptation systems according to the formula: FAD = 0.38 · GARDEN + 0.42 · DBP, where SBP is systolic blood pressure; DBP - diastolic blood pressure; 0.38 and 0.42 - factor load factors; and for any values of FS and FAD, general health-improving procedures and physiotherapeutic procedures are prescribed according to somatic indications, while for FS 26-47 and FAD less than 70, algorithm No. 1 “preventive activating” is selected, including physiotherapeutic procedures that activate the activity of the sympathetic autonomic nervous system, in the event that the time of holding the breath in the functional test of the Shtang is less than 20 s, appoint procedures that restore breathing; when the values of FS 26-47 and FAD 71-90 choose algorithm No. 2 "preventive restorative", which includes only physiotherapeutic procedures for somatic indications, restorative wellness procedures; when the FS 26-47 and FAD are greater than 91, the algorithm No. 3 "Preventive relaxing" is chosen, including drug hypotensive therapy; hypoxytherapy, physiotherapeutic procedures that activate the activity of the parasympathetic autonomic nervous system, with a FS value of less than 25 and a FAD of less than 70 - algorithm No. 4 “psychotherapeutic activating”, including group and individual psychotherapy, stress resistance training in health schools; Audiovisual relaxation, psycho-emotional discharge, body-oriented therapy, warming and activating physiotherapeutic procedures, manual massage and hydromassage; in the event that the time of holding the breath in the functional test of Shtang is less than 20 s, procedures that restore breathing are prescribed; when the FS value is less than 25 and FAD 71-90, the algorithm No. 5 "psychotherapeutic normalizing" is chosen, including group and individual psychotherapy, stress resistance training in health schools, audio-visual relaxation, psycho-emotional discharge, when the FS value is less than 25 and the FAD is more than 91, choose algorithm No. 6 "psychotherapeutic relaxing", including drug hypotensive therapy; individual psychotherapy, audiovisual relaxation, psycho-emotional discharge; group body-oriented therapy, mastery of ways to relieve psycho-emotional stress and physical relaxation, restoration of respiratory functions using physiotherapy, manual massage and hydromassage, physiotherapeutic procedures that activate the activity of the parasympathetic autonomic nervous system, with a FS value of more than 47 and any FAD values, choose algorithm No. 7 "psychotherapeutic motivating", including obtaining information on the recognition of their own emotional states and stereotypes of mental activities in group psychotherapeutic work, psycho-stimulating methods of physiotherapy, audiovisual relaxation, psycho-emotional discharge; group body-oriented therapy, leveling the emotional tone with warming physiotherapy, restoration of breathing by physiotherapy, manual massage and hydromassage, group sports in the gym, outdoors and in the pool.

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