Rehabilitation of patients after surgical treatment of pulmonary tuberculosis in a specialized sanatorium

Actuality. Surgery for patients with pulmonary tuberculosis should be accompanied by a complex of rehabilitation measures with an algorithm for the formation of rehabilitation programs depending of the patients functional state and of volume of surgical intervention.

Aim: to study the effectiveness of rehabilitation measures depending on the degree of functional impairments considering the volume of surgical interventions in patients operated on for advanced destructive pulmonary tuberculosis.

Object and methods. The study included 109 patients who were divided into 4 groups: group 1 – with lung resections and segmentectomies (73 people), group 2 – with bilateral staged atypical lung resections in combination with unilateral delayed thoracoplasty (14 people), group 3 – with lobectomies and bisegmentectomies (13 people),  group 4 – with pneumonectomies (9 people). A rehabilitation program was compiled for each observed group. The effectiveness of rehabilitation measures was assessed by spirometry, oxygen saturation, goniometry, visual analog pain scale (VAS), Borg CR10 scale, mMRC dyspnea scale.

Results. In each study group, changes in lung function indicators were observed, in groups 1-3, the indicators of VC; FEV1; FEV1/VC — the Index Tiffeneau (IT) changed, in group 4, significant changes were only from IT. The severity of shortness of breath on the mMRC scale and the severity of perceived stress on the Borg CR10 scale decreased in each group. The intensity of the pain syndrome decreased in each study group according to VAS.

Conclusion. Rehabilitation of patients who have undergone surgery of pulmonary tuberculosis in a specialized sanatorium becomes more effective and achieving positive recovery results with the use of rehabilitation programs, depending on the severity of functional disorders of patients and different volumes of surgical intervention. 

1. 1 Shilova M.V. Tuberculosis in Russia in 2007. M., 2008;152. (In Russ.).

2. 2 Tsybikova E.B. Dynamics of tuberculosis incidence in Russia in the first twenty-first century. Social aspects of public health [online edition]. 2021;67(6):14. (In Russ.). https://doi.org/10.21045/2071-5021-2021-67-6-14

3. 3 Reichrud M.V., Krasnov D.V., Avdienko K.A., Grishchenko N.G., Skvortsov D.A., Kononenko V.G. Long-term results of resection and collapse surgical interventions in pulmonary tuberculosis. Tuberculosis and lung diseases. 2018;96(12):34-40. (In Russ.).

4. 4 Ivanova G. E., Balandina I. N., Batysheva T. T. and others. Medical rehabilitation for new coronavirus infection (COVID-19). Temporary methodological recommendations of the Ministry of Health of the Russian Federation. Version 2 from 07/31/2020:150. (In Russ.). https://www.edu.rosminzdrav.ru/fileadmin/user_upload/specialists/COVID-19/dopmaterials/VMR_medreabilitacija_COVID_versija2.pdf

5. 5 Chuchalin A.G., Avdeev S.N., Aisanov Z.R., Belevsky A.S., Leshchenko I.V., Ovcharenko S.I., Shmelev E.I. Chronic obstructive pulmonary disease: federal clinical guidelines for diagnosis and treatment. Pulmonology. 2022;32(3):356–392. (In Russ.). https://doi.org/10.18093/08690189-2022-32-3-356-392

6. 6 Federal clinical guidelines on the use of the spirometry method; ed. by A.G. Chuchalin. Pulmonology. 2014;6:11-24. (In Russ.).

7. 7 Quanjer P.H., Tammeling G.J., Cotes J.E., Pedersen O.F., Peslin R., Yernault J.C. Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl. 1993;16:5-40.

8. 8 Da Silva, Thiago Santos and others. The effect of pulmonary rehabilitation on functional ability in people treated with pulmonary tuberculosis: a protocol for a systematic review. JBI evidence synthesis. 2022;20:2552-2558. https://doi.org/11/10/124/JBIES-21-00314

9. 9 Migliori G.B. et al. Clinical standards for assessment, treatment and rehabilitation after pulmonary tuberculosis. International Journal of Tuberculosis and Lung Diseases: The official Journal of the International Union against Tuberculosis and Lung Diseases. 2021;25:797-813. https://doi.org/10.5588/ijtld.21.0425

10. 10 Chushkin M.I., Struchkov P.V., Ots O.N., Karina N.L. Rehabilitation of patients with pulmonary tuberculosis and post-tuberculosis changes. Clinical medicine. 2022;100(2–3):91–96. (In Russ.).

11. 11 TadaA, Matsumoto H, Sada R, Endo S, Kawai H, Kimura G, Yamashita M, Okada C, Takahashi K. Effects of pulmonary rehabilitation in patients with the effects of pulmonary tuberculosis. Nihon Kokuyu Gakkai Zasshi. 2002 April;40(4):275-81. Japanese. PMID: 12096494.

12. 12 Zilov V.G., Khadartsev A.A., Bitsoev V.D. The effect of polychromatic visible and infrared light on biological liquid media. Bull Exp Biol Med. 2014 August;157(4):470-2. https://doi.org/10.1007/s10517-014-2593-y. Epub 2014 August 12th. PMID: 25110085.

13. 13 Taha M.M., El-Nagar M.M., Elrefaey B.H., Elkholy R.M., Alias, Alkhamees N., Felaya E.E. The effect of polarized light therapy (bioptron) on wound healing and microbiota in diabetic foot ulcer: a randomized controlled trial. Photobiomodular photomedular laser surgeon. 2022 Dec;40(12):792-799. https://doi.org/10.1089/photob.2021.0175

14. 14 Phillips WT, Benton MJ, Wagner CL, Riley S. The effect of single-breasted resistance training on strength and functional fitness in patients with lung rehabilitation. J Cardiopulm Rehab. 2006 September-October;26(5):330-7. https://doi.org/10.1097/00008483-200609000-00011

15. 15 Philip R., Betis A., Davenport D., Sakha S. Thoracoplasty: Still relevant for current practice. Asian Cardiovask Torak Ann. 2021 July;29(6):518523. https://doi.org/10.1177/0218492321100-2408