Эффективность применения цифровых и телемедицинских технологий в реабилитации пациентов с дорсопатиями и хроническим болевым синдромом: обзор литературы



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Дорсопатии и хронический болевой синдром (ХБС) являются патологиями, составляющими медико-социальную проблему в связи с высокой распространенностью, тенденцией к хронизации и низкой эффективностью стандартных методов лечения, что приводит к снижению трудоспособности и инвалидизации населения. Традиционные программы реабилитации сталкиваются с рядом ограничений, включающих территориальную отдаленность, низкую доступность специализированной помощи, особенно в сельской местности, и недостаточную приверженность пациентов к лечению. Актуальность настоящего обзора обусловлена необходимостью поиска новых, более эффективных и доступных модернизаций программ реабилитации, включающих цифровые и телемедицинские технологии (ЦТ и ТМТ). На основе анализа 70 отобранных публикаций в соответствии с критериями PRISMA проведен комплексный обзор эффективности применения ЦТ и ТМТ в реабилитации пациентов с дорсопатиями и ХБС. Исходя из полученных данных можно сделать вывод о том, что различные формы ЦТ — синхронные (видеоконсультации) и асинхронные (мобильные приложения, SMS-напоминания, VR/AR-технологии, носимые устройства, работающие по принципу биологической обратной связью (БОС)) — демонстрируют сопоставимую с очным форматом эффективность в снижении интенсивности боли (по ВАШ), улучшении физической активности (исходя по анализу данных с использованием индексов Освестри, Роланда-Морриса), повышении приверженности лечению (до 90%) и качества жизни по шкале SF-36. Ключевыми механизмами положительного воздействия ЦТ являются коррекция кинезиофобии через дозированное виртуальное экспонирование, модуляция нейропластичности и нормализация паттернов движения за счет обратной связи в реальном времени. Несмотря на существующие организационные, нормативные и технологические пробелов в РФ (отсутствие регламентов оплаты в системе ОМС, проблемы лицензирования ПО, риски нарушения конфиденциальности данных, низкая цифровая грамотность), накопленная международная и отечественная доказательная база подтверждает высокий потенциал интеграции ЦТ и ТМТ в реабилитационные программы.

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