Medical-Expert, Rehabilitation, and Clinical-Functional Aspects of Disability Due to Chronic Obstructive Pulmonary Disease in the Republic of Dagestan

Respiratory diseases represent a large group of disorders of various etiologies and pathogeneses, characterized by the localization of the pathological process in the respiratory tract. They are among the most common diseases in the population. Statistical data indicate that in the Russian Federation, the incidence of respiratory diseases significantly exceeds that of other classes of diseases and continues to grow steadily. Since the beginning of the 21st century, the incidence of respiratory diseases has increased from 317.2 per 100,000 population in 2000 to 407.1 in 2021 [1]. According to various researchers, this group of diseases affects from 4–6% to 10–25% of the adult population and shows a consistent upward trend in prevalence in both developed and developing countries. It is among the ten diseases with the highest economic burden. Chronic obstructive pulmonary disease (COPD) remains the only disease for which mortality continues to rise. COPD is a steadily progressive disorder leading to disability and mortality among individuals of working age [2,3,6,8]. In the current literature, the issue of assessing the rehabilitation potential of patients with chronic obstructive pulmonary disease who have undergone medical and social expertise remains insufficiently studied [4,5,7,9,10,11].

Purpose of the study.

Based on the analysis of the clinical-functional and medical-expert and rehabilitation characteristics of persons with disability due to chronic obstructive pulmonary disease, necessary for conducting medical and social expertise to assess the severity of impaired body functions, the study aimed to evaluate the degree of their limitations in vital activity.

Results.

To investigate the medical-expert and rehabilitation as well as clinical-functional aspects of persons with disability due to COPD, a sample of records and protocols was analyzed for individuals aged 18 years and older who underwent assessment at the Bureau of Medical and Social Expertise (MSE) of the Federal State Institution “Main Bureau of MSE for the Republic of Dagestan” under the Ministry of Labor of Russia, based on Form 088/u-06, including 324 patients.

For statistical processing of the primary documentation, three data blocks were created:

1. Socio-demographic and physical data,

2. Clinical-functional and laboratory data,

3. Medical-social data, which were analyzed within the scope of the study.

The degree of severity of persistent impairments of body functions in persons with disability (DSPIFPD) was assessed according to four levels: mild, moderate, severe, and significantly severe. The main categories of vital activity (MCVA)—self-care, independent mobility, orientation, communication, behavioral control, learning ability, and work activity—and their degrees of limitation (first, second, and third) were evaluated in accordance with Sections II and III of Order № 585n of the Ministry of Labor of the Russian Federation, dated August 27, 2019, “Classifications and Criteria Used in Conducting Medical and Social Expertise by Federal State Institutions of Medical and Social Expertise.”

The data prepared for analysis in XLSX format were uploaded into the R environment. Data processing and analysis were performed using R scripts. In the presented results, different indicators have varying numbers of observations (N), since not all medical records contained complete data for every parameter. Only patients with non-missing values were included in comparative analyses.

For continuous normally distributed variables, the mean (M) and standard deviation (SD) were calculated. When comparing two groups, the Student’s t-test was used, and its p-value (p_t) was determined. For continuous non-normally distributed variables, the median (Me), 1st (Q1) and 3rd (Q3) quartiles were calculated. When comparing groups, the Mann–Whitney U-test and its p-value (p_mu) were applied. If the compared variables were ordinal or numerical, the Spearman correlation coefficient and its p-value (r(p)) were calculated for each pair of variables. To identify relationships between categorical variables, the Chi-square test of the corresponding contingency table and its p-value (p(χ²)) were used. When the expected frequency in some cells was less than 5, Yates’ continuity correction was applied

Table 9 – Characteristics of activity limitations in patients with chronic obstructive pulmonary disease by disease stage (absolute number; %)

Table 10 – Statistically significant correlation coefficients between activity limitations and impaired body functions in patients with chronic obstructive pulmonary disease

A direct weak correlation was observed between impairment of neuromuscular, skeletal, and movement-related functions and activity limitation: in self-care (r = 0.18), mobility (r = 0.23), and work activity (r = 0.22). Between cardiovascular function impairment and activity limitation, there was a direct weak correlation for self-care(r = 0.23), a direct moderate correlation for mobility (r = 0.25), and a direct moderate-to-strong correlation for work activity (r = 0.44). For respiratory function impairment, there was a direct strong correlation with work activity (r = 1.0), a direct moderate correlation with self-care (r = 0.6), and a direct weak correlation with mobility (r = 0.24). Between total body function impairments and self-care, a direct moderate correlation was found (r = 0.61); with mobility, a direct weak correlation (r = 0.25); and with work activity, a direct strong correlation (r = 1.0) (Table 10).

Author contributions:
Conceptualization – N.S. Zapariy;
Statistical data processing – N.E.Nagieva;
Manuscript writing and editing – N.E.Nagieva;
Selection and review of publications on the research topic – N.S. Zapariy;
Manuscript review and editing – N.S. Zapariy, G.N. Ponomarenko.

The authors declare no conflict of interest.

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12.   Information about the authors

13.   Nagieva Nasiyat Esedullakhovna — Physician in Medical and Social Expertise, Federal State Institution “Main Bureau of Medical and Social Expertise for the Republic of Dagestan,” Ministry of Labor and Social Protection of the Russian Federation, Makhachkala, Russia.

14.   E-mail: nne55506@mail.ru; ORCID: 0009-0004-1807-6238

15.   Ponomarenko Gennadiy Nikolaevich — Corresponding Member of the Russian Academy of Sciences, Honored Scientist of the Russian Federation, Doctor of Medical Sciences, Professor, Director General of the Federal Scientific and Educational Center of Medical and Social Expertise and Rehabilitation named after G. A. Albrecht, 50 Bestuzhevskaya St., St. Petersburg, 195067, Russian Federation; Head of the Department of Physical and Rehabilitation Medicine, North-Western State Medical University named after I. I. Mechnikov, 47 Piskarevsky Ave., St. Petersburg, 195067, Russian Federation. E-mail: ponomarenko_g@mail.ru; ORCID: 0000-0001-7853-4473

16.   Zapariy Natalia Sergeevna — Head of the Educational and Organizational Department, Educational and Methodological Center, Federal State Budgetary Institution “Federal Bureau of Medical and Social Expertise,” Ministry of Labor and Social Protection of the Russian Federation, Doctor of Medical Sciences, Associate Professor, 3 Ivan Susanin St., Moscow, 127486, Russian Federation. E-mail: Zapariy_N@fbmse.ru; ORCID: 0000-0002-7687-763X