Use and impact of a comprehensive program of physical therapy in the treatment of patients with deforming coxarthrosis of 2–3 degrees

Purpose: to study the effectiveness of physical therapy in the complex treatment of patients with deforming coxarthrosis of 2–3 degrees. Material & Methods: a comparative analysis of the use of traditional basic drug therapy and complex drug and physical therapy for 2 months in 30 patients (main and control group) with coxarthrosis of 2–3 degrees, functional insufficiency (FI) of 2 degrees using goniometry, visual analogue pain scale (VAS), Leiken index. Results: results of the analysis of goniometry indices, VAS and Leiken indices showed with statistical certainty the advantage of using physical therapy in the complex rehabilitation treatment of patients with coxarthrosis of 2–3 degrees, which was expressed in improving the dynamic function of the hip joint. Conclusion : a program of physical therapy for patients with coxarthrosis of grade 2–3 was developed and put into practice, including a set of ideomotor exercises, post-isometric muscle relaxation, gymnastic exercises with projectiles and objects, movement coordination exercises, breathing exercises with gravitational weights, exercises on block simulators and an exercise bike , as well as self-study at home.

Coxarthrosis -arthrosis of the hip joints -occupy 2nd place after lesion of the knee joints in terms of frequency of occurrence and 1st place in terms of temporary disability and persistent disability (V. A. Koryak  1st degree (moderate) -a small limitation of the range of motion in the joints (the amplitude of movements in the hip joints is reduced by 30-20 o from the volume of movements in a healthy hip joint); 2nd degree (expressed) -significant limitation of range of motion (range of motion in the hip joint does not exceed 50 o ; subluxation of joints with severe deformation due to periarticular scarring, as well as muscle atrophy, a significant stiffness throughout the day); 3rd degree (pronounced) -significant difficulty in walking (the patient can take several steps around the room) or the patient cannot get out of bed due to pain and deformities in the hip and knee joints (range of motion does not exceed 15 o or is completely absent); almost impossible self service.
The main clinical manifestation of coxarthrosis is pain, the nature, intensity, duration and location of which depend on the severity of changes in the joint. Then The main efforts of doctors should be aimed at preserving the biomechanics and the function of the affected joint (V. V. Povoroznyuk, 2009, "Vredenovskie readings", 2013). This can help physical therapy, without the use of which it is difficult to achieve a real improvement in the condition of patients. Because of the pain, many people reduce physical activity and this aggravates the process, as muscular atrophy joins, blood circulation worsens.
purpose: to study the effectiveness of physical therapy in the complex treatment of patients with deforming coxarthrosis of grade 2-3, FI grade 2.
Objectives of the study: 1. To analyze the etiology, pathogenesis, clinical characteristics and current approaches to restorative conservative treatment of patients with coxarthrosis of 2-3 degrees. 2. Develop a program of physical therapy with its subsequent application and evaluation of its effectiveness.

Material and Methods of the research
The study included 30 people with deforming coxarthrosis of grade 2-3, FI grade 2, aged 40 to 65 years (mean age 55±5,2 years), who were treated at the medical health center "Fortis" Exclusion criteria from the survey: -acute infectious diseases; -pronounced pain syndrome (from 6 cm according to VAS); -ankylosis of the joints; -pronounced impairment of the lower extremity support ability; -the presence of fresh injuries of the limbs, spine, skull.
According to the criteria for inclusion in the examination, patients were divided into two groups: 20 patients of the main group (MG) in addition to the course of drug therapy, underwent a program of physical therapy. The control group (CG) consisted of 10 patients who received only drug therapy.
The clinical efficacy of physical therapy was determined according to the results of the pain syndrome assessment by VAS, the Leiken index and the study of the amplitude of movements in the joints.
VAS pain serves as a general assessment of the intensity of pain by the patient and is a horizontal scale with marks from 0 to 10 cm, the beginning of which corresponds to the absence of pain, and the end -the most pronounced pain. The patient independently notes on the scale the degree of pain.
The Leiken index for coxarthrosis reflects the severity of the disease and is a questionnaire in the form of a table. The Leiken index is calculated based on the sum of points obtained when answering groups of questions focused on the assessment of pain and discomfort, according to the maximum distance traveled without pain and the presence of difficulties in everyday life.
The amount of movement in the joints was measured using a goniometer by the "zero-passing" method of V. O. Marx.
The obtained data were processed statistically, the methods of descriptive statistics were used: mean (M) and standard deviation (SD). Comparison between groups was performed using a T-test for independent samples and a T-test for 32 SlobozhanSkyi herald of Science and Sport paired samples.
The program of physical therapy developed and applied in the study was designed for 8 weeks (classes were held 2 times a week, the duration of classes was 60 min±15 minutes) and included therapeutic exercises in the form of: -gymnastic exercises (including with projectiles and objects) -active, passive, active-passive, exercises for the coordination of movements, breathing, exercises with a gravitational burden; -exercises on block simulators, stationary bike. The average number of repetitions of exercises was 15 times in 2 sets. Since coxarthrosis especially suffers from internal rotation and abduction in the hip joint, exercises that help restore these movements were performed at the beginning and end of the session. Excluded exercises with axial load on the hip joint; -ideomotor exercises, postisometric muscle relaxation.
MG patients were carried out at home, developed a program of gymnastic exercises, which was performed daily (duration 45±10 minutes).
In accordance with the requirements of bioethics (the Helsinki Declaration), all patients signed an informational consent to participate in the study.

results of the research
The initial condition of the patients in both groups did not differ in intensity of pain syndrome and the degree of FI (Table 1).
The use of physical therapy in the complex treatment of patients with coxarthrosis contributed to the reduction of pain in patients in the MG and CG by 35-40% for VAS and a decrease in the Leiken index by 20-25% in both CG and CG, which can be explained by the use of the same drug therapy (Table 2).
After the study, a repeated analysis of the motor function of the lower limb in the hip joint was carried out (Table 3).  There is a statistically significant increase in the range of motion in the hip joint in all planes in patients with MG. The best results on the restoration of movements in the hip joint were observed in patients of the MG: -in the sagittal plane, due to an increase in flexion by 19,5%; -in the frontal plane, by increasing the lead by 10%; -rotational movements (internal rotation increased by 38%, external rotation -by 39%).
In patients from CG, the range of motion in the hip joints did not change statistically significantly.

conclusions / discussion
A program of physical therapy for patients with coxarthrosis of grade 2-3 was developed and put into practice, including a set of ideomotor exercises, post-isometric relaxation of muscles, gymnastic exercises with shells and objects, exercises for motor coordination, breathing exercises with gravitational weights, exercises for block simulators and exercise bike and self-study at home.
Analysis of goniometry indices, VAS and Leiken indices demonstrated the advantage of using physical therapy in the complex rehabilitation treatment of patients with coxarthrosis of grade 2-3, which was expressed in improving the dynamic function of the hip joint.
prospects for further research in this direction imply consideration of issues related to the use of modern techniques of hardware mechanotherapy as an integral part of the physical therapy of patients with coxarthrosis.