Rehabilitation of Rheumatic Patients in Primary Care


Liudmyla Khimion
Oleksandr Burianov
Oksana Yashchenko
Svitlana Danylyuk
Tetiana Sytyuk
Nataliia Kicha


The evidence base for use of different rehabilitation programs is discussed in the article. The most effective approaches to the rehabilitation organization and patients education are presented together with the different types of physical rehabilitation, ergotherapy and physical activities useful for the development of the maximum functional ability and social integration of rheumatic patients. The positive impact of the motivational interview in work with rheumatic patients, the results of the clinical studies on evaluation of the patients education influence on their functional abilities and psychologic status; recommendations on ortheses use are discussed in the article.

The recommendations of the leading international expert groups about exercises, physiotherapy, ergotherapy prescribing to the patients with rheumatoid arthritis, osteoarthritis and connective tissue systemic diseases are given; the attention is drown to the methods of evaluation of patients physical status; patients education about energy saving technologies use for maximum possible functional and physical loads and patients autonomy at hom aend social life realization.

Implementation of the given rehabilitation algorithms can help to realize holistic patient-centered approach, improve patients quality of life and functional capacity.


How to Cite
Khimion, L., Burianov, O., Yashchenko, O., Danylyuk, S., Sytyuk, T., & Kicha, N. (2020). Rehabilitation of Rheumatic Patients in Primary Care. Family Medicine, (5-6), 8–13.
Distance learning
Author Biographies

Liudmyla Khimion, P.L. Shupyk National Medical Academy of Postgraduate Education

Liudmyla V. Khimion,

Department of Family Medicine

Oleksandr Burianov, Bogomolets National Medical University

Oleksandr A. Burianov,

Department of Traumatology and Orthopedics

Oksana Yashchenko, P. L. Shupyk National Medical Academy of Postgraduate Education

Oksana B. Yashchenko,

Department of Family Medicine

Svitlana Danylyuk, P. L. Shupyk National Medical Academy of Postgraduate Education

Svitlana V. Danylyuk,

Department of Family Medicine

Tetiana Sytyuk, P. L. Shupyk National Medical Academy of Postgraduate Education

Tetiana O. Sytyuk,

Department of Family Medicine

Nataliia Kicha, P. L. Shupyk National Medical Academy of Postgraduate Education

Nataliia V. Kicha,

Department of Family Medicine


Наказ МОЗ України №243 від 15.12.1993 «Про організацію і удосконалення ревматологічної допомоги населенню України»

Наказ МОЗ України №455 від 13.11.2001 «Про затвердження Інструкції про порядок видачі документів, що засвідчують тимчасову непрацездатність громадян».

Наказ МОЗ України No183 від 07.04.2004 «Про затвердження Інструкції про встановлення груп інвалідності»

Наказ МОЗ України №189 від 09.04.2008 «Про затвердження Положення про експертизу тимчасової непрацездатності»

Постанова Кабінету міністрів України No1317 від 03.12.2009 «Питання медико-соціальної експертизи»

2018 EULAR recommendations for physical activity in people with in amatory arthritis and osteoarthritis / Rausch Osthoff A-K, Karin Niedermann, Jürgen Braun et al. Ann Rheum Dis 2018;77:1251–1260. doi:10.1136/annrheumdis-2018-213585

2019 ACR/AF guideline for the management of OA of the hand, hip and knee / Kolasinski SL, Neogi T, Hochberg MC, et al. [published online January 6, 2020]. Arthritis Care Res. doi:10.1002/acr.24131

Aysen Akinci, Gamze Kiliç. Future of Rehabilitation Interventions for Rheumatic Patients in the Mediterranean Region. – Mediterr J Rheumatol 2017; 28(2):70–4

Beardmore T.D. (2008) Rehabilitation of Patients with Rheumatic Diseases. In: Klippel J.H., Stone J.H., Crofford L.J., White P.H. (eds) Primer on the Rheumatic Diseases. Springer, New York, NY.

Bearne L M, Byrne A M, Segrave H, White C M. Multidisciplinary team care for people with rheumatoid arthritis: a systematic review and meta-analysis. Rheumatol Int 2016;36:311–24.

Combe B, Landewe R, Daien CI, Hua C, Aletaha D, Alvaro-Gracia J M, et al. 2016 update of the EULAR recommendations for the management of early arthritis. Ann Rheum Dis 2017;76(6):948–59.

Cramp F, Hewlett S, Almeida C, Kirwan J R, Choy E H, Chalder T, et al. Non-pharmacological interventions for fatigue in rheumatoid arthritis. Cochrane Database Syst Rev 2013:CD008322.

De Almeida P H, Pontes T B, Matheus J P, Muniz L F, da Mota L M. Occupational therapy in rheumatoid arthritis: what rheumatologists need to know? Rev Bras Reumatol 2015;55:272–80.

EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis / L Fernandes, KB Hagen, JWJ Bijlsma et al., Ann Rheum Dis 2013;72:1125–1135. doi:10.1136/annrheumdis-2012-202745

Hammond A. Rehabilitation in rheumatoid arthritis: a critical review. Musculoskeletal Care 2004;2:135–51.

Hochberg M C, Altman R D, April K T, Benkhalti M, Guyatt G, Mc- Gowan J, et al. American College of Rheumatology 2012 recom- mendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken) 2012;64:465–74.

Khimion L., Burianov A., Smolina L., Omelchenko T. Platelet autologous plasma in osteoarthritis treatment // Osteoarthritis and cartilage. – 2017. - № 25. – Р. 438–439.

Masiero S, Bonaldo L, Pigatto M, Lo Nigro A, Ramonda R, Punzi L. Rehabilitation treatment in patients with anky-losing spondylitis stabilized with tumor necrosis factor inhibitor therapy: a randomized controlled trial. J Rheumatol 2011;38:1335–42.

Metsios G S, Stavropoulos-Kalinoglou A, Kitas G D. The role of exercise in the management of rheumatoid arthritis. Expert Rev Clin Immunol 2015;11:1121–30.

NICE: Rheumatoid arthritis in over 16s Quality standard Published: 28 June 2013

NICE: Spondyloarthritis. Quality standard. Published: 28 June 2018

Non-Pharmacologic Therapies for Systemic Lupus Erythematosus / Monthida Fangtham, Shanthini Kasturi, Raveendhara R. Bannuru / Lupus. 2019 May;28(6):703–712. doi:10.1177/0961203319841435.

Rehabilitation for patients with rheumatic diseases: Patient experiences of a structured goal planning and tailored follow-up programme / Turid Nygaard Dager, Ingvild Kjeken, Gunnhild Berdal et al., Sage open Med. – 2017. – p.1–9

Rehabilitation in health systems: guide for action. Geneva: World Health Organization; 2019, 72 p.

Roddy E, Zhang W, Doherty M, Arden N K, Barlow J, Birrell F, et al. Evidencebased recommendations for the role of exercise in the management of osteoarthritis of the hip or knee – the MOVE consensus. Rheumatology (Oxford) 2005;44:67–73.

Steultjens E M, Dekker J, Bouter L M, van Schaardenburg D, van Kuyk M A, van den Ende C H. Occupational therapy for rheumatoid arthritis. Cochrane Database Syst Rev 2004:CD003114.

The British Society for Rheumatology guideline for the management of systemic lupus erythematosus in adults. Caroline Gordon, Maame-Boatemaa Amissah-Arthur, Mary Gayed et al., Rheumatology 2018;57:e1–e45 doi:10.1093/rheumatology/kex286

Uhlig T, Bjorneboe O, Kroll F, Palm O, Olsen I C, Grotle M. Involvement of the multidisciplinary team and outcomes in inpatient rehabilitation among patients with in amatory rheumatic disease. BMC Musculoskelet Disord 2016;17:18.

Use of intraarticular injections of platelet-rich plasma in the treatment pf-knee OA: a review article / N Baloch, O Hasan, Z Baig et al., Orthop Rev (2019). – Sep 24;11(3):7747

Ward M M, Deodhar A, Akl E A, Lui A, Ermann J, Gensler L S, et al. American College of Rheumatology / Spondylitis Association of America / Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis Rheumatol 2016;68:282–98.

WHO. World Health Organization: health topics rehabilitation, 2013,