Formation of a comprehensive rehabilitation program for patients considering the clinical and diagnostic features of the course of vertebral thoracic pain due to degenerative-dystrophic pathology of the thoracic spine

Aim. To determine the clinical and diagnostic features of the course of thoracic back pain syndrome, to investigate life quality data in patients with degenerative-dystrophic pathology of the thoracic spine (DDPS) depending on the indicators of vertebrodynamics in order to conduct differentiated kinesiotherapy technique. Materials and methods. Rehabilitation measures were conducted for 124 patients with DDPS complicated by thoracalgia syndrome at the post-acute stage. All patients had a functional block of the 2nd degree in the thoracic spine. They were divided into two groups. The first group (n = 56) received basic rehabilitation, including drug therapy, massage, personalized therapeutic exercises, and physical therapy. The second group (n = 68) additionally underwent post-isometric and post-reciprocal muscle relaxation, mobilization techniques (K. Lewit, R. Maigne, V. Gubenko), and original kinesiotherapy methods tailored to vertebrodynamics indicators. The outpatient rehabilitation cycle lasted 14 days. Results. Assessment of the effectiveness of patients treatment in the study groups before and after the rehabilitation measures according to the visual analogue scale for measuring pain intensity, the PainDETECT and LANSS scales for screening components of neuropathic pain in people with chronic pain, the Roland-Morris quality of life questionnaire and EQ-5D (EQ-5D-3L) indicate a statistically significant intergroup difference (p < 0.05) with higher quality of life and lower intensity of pain manifestations in patients of the 2nd group compared to patients of the 1st group. According to the results of the Spearman correlation analysis the progression of signs of mental disorders is directly proportionally associated with the intensity of manifestations of myofascial syndromes due to DDPS, as showed statistically significant relationships between the values of the results of the Spielberger anxiety and Montgomery–Asberg depression rating scales, on the one hand, and the integral indicator of the cumulative thoracic vertebral-mechanical index (Rs = +0.69 and +0.78 at p < 0.01 for all cases), confirming the important pathogenetic relationship between these pathological processes, which indicates the urgent need for rehabilitation measures according to generally accepted (A. Stoddard, K. Lewit) and optimized methods proposed by us to reduce anxiety-depressive disorders and normalize the mental state in general. According to the Pearson agreement criterion, patients with DDPS in the comparison group had significantly more frequently registered values of the five-component EuroQOL-5D system of more than 4 points (χ2 = 11.63; p < 0.01). Conclusions. Against the background of the course treatment, more than 90 % of patients with clinical manifestations of DDPS at the thoracic level achieved reliable positive results (significant reduction in pain syndrome, increased range of motion in blocked vertebral-motor segments, improved quality of life indicators).