ASSESSMENT OF FUNCTIONAL MUSCLE STRENGTH PARAMETERS IN WOUNDED MILITARY PERSONNEL WITH SARCOPENIA AND SEQUELAE OF TRANSTIBIAL AMPUTATION FOLLOWING PHYSICAL THERAPY

Abstrakt

Purpose. To determine the effectiveness of the developed comprehensive physical therapy program based on functional strength parameters in wounded servicemen with sarcopenia and consequences of transtibial amputation of the lower limb.

Material and methods. The study involved 95 male servicemen. The control group included 36 apparently healthy men aged 28.4 ± 2.7 years. The study group consisted of 59 wounded servicemen aged 30.5 ± 3.0 years with transtibial amputation and sarcopenia who were randomly divided into two subgroups. Study group 1 (SG1, n=30) underwent a standard 12-week physical therapy program aimed at stump preparation for prosthetic fitting and training in the use of a temporary prosthesis. Study group 2 (SG2, n=29) followed a developed comprehensive 12-week physical therapy program that additionally included interventions targeting sarcopenia. Patient status was assessed at baseline, after 4 weeks, and after 12 weeks. Handgrip strength, deadlift strength, and isometric strength of major muscle groups of the upper and lower limbs were evaluated.

Results. At baseline, wounded servicemen with transtibial amputation and sarcopenia demonstrated a pronounced reduction in strength parameters compared with the control group. The strength deficit had a generalized pattern and involved both upper and lower limbs, although it was most pronounced in the muscles of the injured lower limb (during movements in the hip and knee). During physical therapy, both study groups demonstrated positive dynamics in most strength indicators, reflecting improvement in the functional state of the muscular system. However, in the group that followed the comprehensive physical therapy program, improvements occurred earlier and were more pronounced. Already at the intermediate stage, this group more frequently demonstrated statistically significant increases in the strength of individual muscle groups, particularly in the injured lower limb. After completion of the 12-week intervention, both groups showed significant improvement in most strength parameters compared with baseline values. Nevertheless, the increase was greater in SG2 for both local muscle strength indicators of the upper and lower limbs and integral strength parameters. The most notable intergroup advantages of the comprehensive program were observed in the strength of muscles of the injured lower limb, as well as in certain indicators of handgrip and deadlift strength. These findings indicate that the inclusion of sarcopenia-targeted interventions enhances the effectiveness of physical therapy and promotes better recovery of muscle strength.

Conclusions. Wounded servicemen with sarcopenia and transtibial amputation demonstrate a systemic deficit in muscle strength of both the upper and lower limbs. The developed comprehensive physical therapy program proved to be more effective than the standard rehabilitation approach, providing faster and more pronounced recovery of both local and integral strength parameters. These findings support the inclusion of sarcopenia-targeted interventions in rehabilitation programs for this category of patients.