MODERN VIEWS OF USE OF TELEREHABILITATION IN URINARY TRACT DYSFUNCTION IN PATIENTS WITH MULTIPLE SCLEROSIS
Authors: Markovska O. V. , Samoilova H. P. , Latohuz S. I. , Sushetska A. S. , Pavlova T. M. 
Published: October 2024

Multiple sclerosis is a chronic disease of the nervous system that often leads to various disorders, including urinary tract dysfunction. This significantly affects the quality of life of patients, causing physical and psychological complications. The term "bladder rehabilitation" summarizes treatment options aimed at restoring its function in patients with neurourological symptoms. A strong contraction of the sphincter of the urethra and/or pelvic floor, as well as anal dilatation, manipulation of the genital area, and physical activity reflexly inhibit urination. A comprehensive physical therapy program for patients with pelvic disoders includes pelvic floor vibration massage, training in proper breathing patterns, pelvic floor muscle relaxation and stabilization exercises and should last several months, during which the patient regularly visits the doctor. The pandemic and war have created barriers that affect almost every aspect of life, treatment and rehabilitation, especially for people with chronic neurological conditions. Traditional rehabilitation methods used to correct urinary tract dysfunction have their limitations, including difficulties in accessing specialists, especially in remote areas. This stimulates the development and implementation of telerehabilitation as an alternative approach. Telerehabilitation involves the use of digital technologies for the remote provision of medical services and patient monitoring. It allows doctors to monitor the condition of patients, provide recommendations and adjust treatment without the need for personal visits. Considering the existing data and our own clinical experience, we consider it appropriate to use telerehabilitation for the correction of disorders of the lower urinary tract, especially in the conditions of war, when access to rehabilitation centers may be difficult. In the department of medical rehabilitation of the University Clinic of the Kharkiv National Medical University, we successfully conducted telerehabilitation using Google Meet video conferencing for 10 patients with urinary incontinence on the background of multiple sclerosis, whose EDSS was no more than 4.0. When conducting online classes under the guidance of a physical therapist, patients noted a desire to strictly follow the recommendations and perform regular exercises. All patients kept a urination diary, according to which the frequency of urination was reduced by an average of 20-25%, which had a positive effect on their quality of life. Although our observations are not representative, in combination with existing studies, we consider telerehabilitation to be a promising direction in complex therapy and rehabilitation of this pathology.
Conclusion The use of telerehabilitation for urinary tract dysfunction in patients with multiple sclerosis is a promising direction that requires further research. This approach can significantly improve the quality of life of patients, reduce the burden on the health care system and provide a more affordable and convenient treatment. A multidisciplinary team should be involved, including a neurologist, a urologist, a gynecologist, and a physical therapist to select the optimal tactics of drug treatment and physical therapy. A promising direction of further research is the development of standard protocols for conducting telerehabilitation for patients with lower urinary tract dysfunction against the background of multiple sclerosis and other pathologies.