EFFECTIVENESS OF A PHYSICAL THERAPY PROGRAM FOR RESTORING LOWER LIMB RANGE OF MOTION IN INDIVIDUALS WITH PERIPHERAL NEUROPATHIES RESULTING FROM MINE-BLAST INJURIES

Abstract

Introduction. Mine-blast injuries of the lower limbs accompanied by damage to joints, muscles, and peripheral nerves represent one of the most challenging problems in modern military medicine. Such injuries are often highly complex, combining extensive soft tissue damage, neurovascular impairment, pain, and the development of secondary contractures. Restoration of the active range of motion (АROM) in the affected joints is a key indicator of successful physical therapy, as it determines the potential for regaining functional independence and achieving social reintegration.The aim. To evaluate the effectiveness of an algorithm for applying physical therapy interventions within an individualized rehabilitation program for individuals with peripheral neuropathies caused by mine-blast injuries of the lower limbs localized below the knee joint, through the analysis of ROM recovery dynamics; to identify the most effective phases of intervention and determine the clinical significance of changes occurring throughout physical therapy.Materials and Methods. A non-parametric statistical approach was applied: the Friedman test for multiple time-point comparisons, the Wilcoxon signed-rank test for pairwise comparisons, and effect size (r) calculation to determine clinical relevance. Changes in joint range of motion (flexion, extension, abduction, adduction, internal and external rotation) and functional limb asymmetry were assessed across three rehabilitation stages.Results. It was established that despite the injury being localized at the level of the lower leg, patients exhibited substantial limitations in hip joint function. A comprehensive modelling approach was conducted to evaluate the influence of proximal segment recovery (hip joint), temporal factors (rehabilitation stage), and methodological factors (physical therapy components of the individualized rehabilitation program) on the dynamics of functional asymmetry in distal segments (lower leg, foot). The study demonstrated that no universal pattern of recovery exists; instead, each of the four examined movements is characterized by a distinct set of key predictors. The most pronounced improvements occurred between the first and second observation stages, with statistically significant increases in АROM recorded across all indicators (p < 0.0001). Effect size calculations (r ≥ 0.7) confirmed a clinically meaningful impact of the intervention. Subsequently, the rate of improvement decreased, indicating a shift from the phase of intensive compensation to stabilization and consolidation of functional gains.The highest effect sizes were observed for hip flexion and extension, internal and external rotation, as well as ankle extension. The obtained data indicate the critical importance of early intervention.Conclusions. The analysis of active joint range of motion revealed fundamentally different mechanisms underlying movement limitations and recovery in the proximal and distal segments of the lower limb in servicemembers with injuries localized below the knee. Implementation of the developed physical therapy algorithm resulted in significant increases in ROM and reductions in functional asymmetry of the lower limbs. The major rehabilitative effects were achieved during the early stages of recovery, emphasizing the need to optimize intervention programs in accordance with the phased nature of rehabilitation, individual patient characteristics, and the specificity of combat-related injuries.