Social adaptation of vertebrological patients

Traditionally, the results of treatment of vertebrological patients are estimated from the data of radiation methods of research, and the patient's individual capabilities are characterized only from the point of view of determining the group of disability. The terms "disability" and "limitation of the patient's possibilities" are interpreted differently in different countries, which does not allow them to develop their fixed gradations. In modern conditions, it is absolutely justified to introduce one more parameter that characterizes the patient's condition and the effectiveness of the treatment - the quality of life indicator. The quality of life is assessed either by the person's fitness for daily activities (the Barthel scale) or by the functional dependence of the patient on others (Functional Independence Measure FIM). The description of these methods is cited by us according to AN Belova et al. (1998).

The Barthel scale (Machoney F., Barthel D., 1965) is used to determine a person's fitness for daily activities. The total score calculated on this scale reflects the level of the patient's daily activity, while for each of the nine parameters of the test the choice of the corresponding score is carried out subjectively by the patient himself. Depending on the degree of functional importance, each test parameter is estimated at a maximum of 5 to 15 points. The maximum score, corresponding to the total independence of a person in everyday life, is 100 points.

The Functional Independence Measure (FIM) scale consists of 18 items reflecting the state of the motor (points 1-13) and intellectual (points 14-18) functions. The evaluation is carried out on a 7-point system, the sum of points is counted for all items of the questionnaire, while passing points is not allowed, and if it is impossible to assess the corresponding item is estimated at 1 point. The total score ranges from 18 to 126 points.

The parameters used in the FIM scale are assessed on a 7-point scale in accordance with the following criteria:

7 points - complete independence in the performance of the corresponding function (all actions are performed independently, in a generally accepted manner and with reasonable time expenditure);

Barthel's scale for self-assessment of daily activities

Estimated parameter	Criteria for evaluation	Points
Food intake	Completely dependent on others (need feeding with outside help);	0
	I need help, for example, when cutting food;	5
	I do not need help, I can use all necessary utensils myself.	10
Personal toilet (face washing, combing, brushing teeth, shaving)	I need help;	0
	I do not need help.	5
Dressing	I constantly need outside help;	0
	I need help in part, for example, when dressing shoes, buttoning buttons, etc .;	5
	I do not need outside help;	10
Taking a bath	I need help from outside;	0
	I take a bath without help	5
Control of pelvic functions (urination, defecation)	I constantly need help in connection with a gross violation of pelvic functions;	0
	Periodically I need help using enema, candles, catheter;	10
	Do not need help	20
Visiting the toilet	I need the use of a ship, a duck.	0
	I need help to maintain balance, use toilet paper, remove and dress pants, etc.	5
	Do not need help	10
Getting up from bed	Not able to get out of bed, even with outside help;	0
	I can sit on my own in bed, but in order to get up, I need substantial support;	5
	I need supervision and minimal support;	10
	I do not need help.	15
Movement	Unable to move;	0
	I can move with a wheelchair;	5
	I can travel with assistance within 500m;	10
	I can travel without assistance to distances up to 500 m.	15
Climbing the stairs	Not able to climb the stairs even with support;	0
	Need supervision and support;	5
	I do not need help.	10

• 6 - limited independence (all actions are performed independently, but slower than usual, or for their implementation, an outside advice is needed);
• 5 - minimal dependence (actions are performed under the supervision of personnel or help in donning a prosthesis / orthosis);
• 4 - insignificant dependence (external assistance is necessary, however 75% of the task is performed independently);
• 3 - moderate dependence (50-75% of the actions necessary for performing the task are performed independently);
• 2 - significant dependence (25-50% of actions are performed independently);
• 1 - complete dependence on others (independently performed less than 25% of the necessary actions).

To determine the possibilities for social adaptation of patients with spine pathology both directly at the time of the examination and during the ongoing treatment, F. Denis with co-author. (1984) proposed to evaluate the severity of pain syndrome and postoperative performance of patients.

Scale of assessment of pain syndrome and postoperative performance of patients with spine pathology (according to F. Denis)

Pain syndrome (P-pain)

Postoperative restoration of working capacity (W - work)

P1 - no pain; P2 - periodic pain, not requiring medication; RZ - moderate pain, requiring medical treatment, but not interfering with the work and does not significantly interfere with the usual daily routine of life; P4 - moderate or severe pain with frequent medication, with periodic inability to work and significantly changing lifestyle; P5 - pain difficult to bear, requiring constant intake of painkillers.

W1 - Return to previous work without restrictions; W2 - the opportunity to return to the old job, full-time, but with certain restrictions (for example, excluding weight lifting); W3 - the inability to return to previous work, but the opportunity to work full-time on a new, easier job; W4 - the inability to return to previous work and the inability to work full-time on a new, easier job; W5 - complete disability - inability to work.

The own scoring scale of the results of treatment of vertebral canal stenoses in the lumbar spine based on the determination of the adaptive capabilities of the operated patient was proposed by V. Lassale, A. Deburge, M. Benoist (1985) /

The data in the table can be used to quantify the effectiveness of surgical treatment. For this purpose, the authors propose the formula:

(S2-S1) / (Sm-S1) x 100%,

Where Sm is the maximum score (always equal to 20), S1 is the initial sum of points calculated before the start of treatment, S2 is the sum of points calculated after the operation.

Scale of evaluation of the results of treatment of stenoses of the spinal canal (according to V. Lassale et al.)

Index	Diagnostic criteria	Points
1. The ability to walk	Is able to pass less than 100 m	0
	Is able to walk 100-500 m	1
	Is able to pass more than 500 m	2
2. Radiculgia (pain at rest)	Has no restrictions on the duration of walking	3
	Constant expressed pain	0
	Periodic pain	1
	Periodically mild pain	2
	There is no pain	3
3. Provocative radiculgia (pain when walking)	Expressed pains that occur immediately when trying to walk	0
	Episodic or "delayed" pain	1
	No pains	2
4. Pain in the lumbar- Sacral department	Constant expressed pain	0
	Periodic severe pain	1
	Periodic moderate pain	2
	No pains	3
5. Motor and sensory disorders, sphincter dysfunction	Pronounced motor disorders (Frankel types of AC) or sphincter function disorders (complete or partial)	0
	Light violations	2
	No violations	4
6. Necessary medication	Strong analgesics (narcotic)	0
	Weak analgesics	1
	Not required	2
7. Quality of life	Complete dependence on others	0
	Expressed limitations	1
	Minor limitations	2
	Normal life	3

Clinical results were evaluated by the authors as very good at postoperative improvement by more than 70%; as good - with improvement from 40% to 70%; moderate - from 10% to 40%; poor - postoperative improvement less than 10%.

The above scales are oriented mainly to adult patients. To assess the possibility of self-care and social adaptation of not only adults, but also children with spinal pathology, as well as for subjective evaluation of the results of the treatment, we propose our own scale.