Social adaptation of vertebrological patients

Traditionally, the results of treatment of vertebrological patients are assessed based on the data of radiation examination methods, and the individual capabilities of the patient are characterized only in terms of determining the disability group. The terms "disability" and "limitation of the patient's capabilities" are interpreted differently in different countries, which does not allow for the development of their fixed gradations. In modern conditions, it seems absolutely justified to introduce another parameter characterizing the patient's condition and the effectiveness of the treatment - the quality of life indicator. Quality of life is assessed either by a person's adaptability to daily activities (Barthel scale) or by the magnitude of the patient's functional dependence on others (Functional Independence Measure FIM). We cite the description of these methods from A.N. Belova et al. (1998).

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

The Functional Independence Measure (FIM) consists of 18 items reflecting the state of motor (items 1-13) and intellectual (items 14-18) functions. The assessment is carried out on a 7-point scale, the sum of points is calculated for all items of the questionnaire, while skipping items is not allowed, and if it is impossible to assess the corresponding item, it is assessed 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 according to the following criteria:

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

Barthel Self-Assessment Scale for Activities of Daily Living

Estimated parameter	Evaluation criteria	Points
Eating	Completely dependent on others (feeding with outside help is required);	0
	I need some help, for example when cutting food;	5
	I don't need help and am able to use all necessary cutlery on my own.	10
Personal toilet (washing face, combing hair, brushing teeth, shaving)	I need help;	0
	I don't need help.	5
Dressing	I constantly need outside help;	0
	I need some help, for example, when putting on shoes, buttoning buttons, etc.;	5
	I don't need any outside help;	10
Taking a bath	I need outside help;	0
	I take a bath without any help	5
Control of pelvic functions (urination, defecation)	I constantly need help due to severe pelvic dysfunction;	0
	I periodically need help when using enemas, suppositories, and a catheter;	10
	I don't need help	20
Visiting the toilet	Need to use a vessel, duck.	0
	Need help with balance, using toilet paper, putting on and taking off pants, etc.	5
	I don't need help	10
Getting out of bed	Unable to get out of bed even with assistance;	0
	I can sit up in bed on my own, but I need a lot of support to stand up;	5
	I need supervision and minimal support;	10
	I don't need help.	15
Movement	Unable to move;	0
	I can move around with the help of a wheelchair;	5
	I can move with assistance within 500m;	10
	I can move without outside help over distances of up to 500 m.	15
Climbing the stairs	Unable to climb stairs even with support;	0
	I need supervision and support;	5
	I don't need help.	10

• 6 - limited independence (all actions are performed independently, but more slowly than usual, or outside advice is needed to perform them);
• 5 - minimal dependence (actions are performed under the supervision of staff or assistance is required in putting on the prosthesis/orthosis);
• 4 - minor dependence (outside help is needed, but 75% of the task is completed independently);
• 3 - moderate dependence (50-75% of the actions required to complete the task are performed independently);
• 2 - significant dependence (25-50% of actions are performed independently);
• 1 - complete dependence on others (less than 25% of necessary actions are performed independently).

To determine the possibilities of social adaptation of patients with spinal pathology both directly at the time of examination and during the treatment, F. Denis et al. (1984) proposed assessing the severity of pain syndrome and the postoperative performance of patients.

Scale for assessing pain syndrome and postoperative performance of patients with spinal pathology (according to F. Denis)

Pain syndrome (P - pain)

Postoperative restoration of working capacity (W - work)

P1 - no pain; P2 - periodic pain that does not require drug treatment; RZ - moderate pain that requires medication, but does not interfere with work and does not significantly disrupt the normal daily routine; P4 - moderate to severe pain with frequent medication use, with occasional inability to work and significantly changing lifestyle; P5 - the pain is unbearable and requires constant use of painkillers.

W1 - Return to previously performed work without restrictions; W2 - the opportunity to return to the previous job, full-time, but with certain restrictions (for example, no heavy lifting); WЗ - the inability to return to the previous job, but the ability to work full time at a new, easier job; W4 - inability to return to previous work and inability to work full time in a new, easier job; W5 - total disability - inability to work.

V. Lassale, A. Deburge, M. Benoist (1985) proposed their own scoring scale for assessing the results of treatment of spinal canal stenosis in the lumbar spine, based on determining the adaptive capabilities of the operated patient.

The data presented in the table can be used for quantitative assessment of the effectiveness of surgical treatment. For this purpose, the authors proposed the formula:

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

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

Spinal canal stenosis treatment outcome assessment scale (according to V. Lassale et al.)

Indicator	Diagnostic criteria	Points
1. Walking ability	Capable of walking less than 100 m	0
	Capable of walking 100-500 m	1
	Capable of walking more than 500 m	2
2. Radiculargia (pain at rest)	There is no limit on the duration of walking	3
	Constant severe pain	0
	Periodically severe pain	1
	Occasional moderate pain	2
	There is no pain	3
3. Provocative radiculalgia (pain when walking)	Severe pain that occurs immediately when trying to walk	0
	Episodic or "delayed" pain	1
	No pain	2
4. Pain in the lumbar region Sacral region	Constant severe pain	0
	Periodic severe pain	1
	Periodic moderate pain	2
	No pain	3
5. Motor and sensory disorders, sphincter dysfunction	Severe motor impairment (types A-C according to Frankel) or sphincter dysfunction (complete or partial)	0
	Minor violations	2
	There are no violations	4
6. Necessary medical assistance	Strong analgesics (narcotics)	0
	Weak analgesics	1
	Not required	2
7. Quality of life	Complete dependence on others	0
	Expressed limitations	1
	Minor restrictions	2
	Normal life	3

The clinical results were assessed by the authors as very good with postoperative improvement of more than 70%; good - with improvement from 40% to 70%; moderate - from 10% to 40%; poor - postoperative improvement of less than 10%.

The above scales are mainly aimed at adult patients. To assess the ability of self-care and social adaptation not only for adults but also for children with spinal pathology, as well as for subjective assessment of the results of the treatment, we have proposed our own scale.