DYNAMICS OF THE LEVEL OF ANXIETY OF PATIENTS WITH ACUTE CALCULOUS CHOLECYSTITIS BEFORE AND AFTER CHOLECYSTECTOMY UNDER THE UNDER THE INFLUENCE OF REHABILITATION INTERVENT

Abstract

The aim to determine the dynamics of the anxiety level of patients with acute calculous cholecystitis (ACC) before and after cholecystectomy under the influence of rehabilitation intervention. 120 patients were included in the study. Inclusion criteria: patients with acute calculous cholecystitis. All patients urgently underwent LHC in the surgical department of the Ivano-Frankivsk Central City Clinical Hospital in 2019-2020. Patients were divided by age categories: group A from 18 to 44 years old (n=40), of which women (n=34) and men (n=6); group B – patients from 45 to 59 years old (n=40), of whom women (n=34) and men (n=6); group C – patients aged 60 to 74 years (n=40), of whom women (n=31) and men (n=9). The study is simple, randomized. Groups A1, B1, C1 were controls, and patients of groups A2, B2, C2 underwent rehabilitation intervention according to the rehabilitation programs developed by us. Randomization by simple random selection by drawing lots divided into groups A2, B2, C2, which underwent rehabilitation intervention and control groups A1, B1, C1. Exclusion criteria: refusal of patients to participate in the study and the presence of neuropsychological pathology in patients. In terms of clinical manifestations, age, gender, the groups were homogeneous. Spielberger's State- Trait Anxiety Inventory (STAI), which includes the Situational Anxiety Scale (ST) and the Personality Anxiety Scale (OT). Patients filled out printed questionnaires upon admission to the surgical department before LHC and on the day of discharge from the department. Mathematical statistics methods: Student's t-test for dependent and independent samples, significance level p<0.05. Rehabilitation intervention in control groups (A1, B1, C1) included early mobilization of patients on the first day after surgery. After LHC, patients of groups A2, B2, C2 underwent rehabilitation intervention (RV), which consisted of 3 stages: initial examination, goal setting, intervention, final examination, determination of intervention effectiveness, and formulation of recommendations. RB included early mobilization of patients, teaching the correct technique of moving from the initial lying position to the sitting and standing position, the technique of correct expectoration, teaching the correct breathing technique, and therapeutic exercises. For elderly patients with an increased risk of falls, special measures were proposed. According to the results of the primary survey, there was no statistically significant difference between groups A1-A2, B1-B2, C1-C2 (p>0,05). The levels of ST and OT in groups A1, A2, B1, B2 (young and middle-aged) were in the range of anxiety of a moderate degree, and in patients of groups C1 and C2 (elderly) – of a high degree. After rehabilitation interventions, only in the group of patients A2 (young age) who received RV, a statistically significant decrease (р<0,05) of ST and OT was established, however, patients of this group did not achieve a decrease in anxiety to a moderate degree. When re-interviewing patients of groups A1, B1, C1, and B2, C2 on the day of discharge, the level of anxiety did not statistically decrease (p>0,05). In all groups, after discharge, the level of OT and ST was moderate. Rehabilitation intervention, which included involving the patient in the formation of long-term and short-term rehabilitation goals, forms and methods of rehabilitation, postoperative training in early verticalization, mobilization, respiratory, etc. therapeutic exercises contributed to the reduction of ST and OT only in the group of A2 young patients (p<0,05).