An integrated indicator for assessing the severity of functional disorders

Introduction . The issue of assessing quality of care is quite acute for all professionals, and osteopathies are no exception. The New Order of the Ministry of Health of Russia from № 203n 14.04.2025 has established criteria for assessing the quality of primary health care for adults and children with somatic dysfunction (SD). According to one of the provisions of this Order, the conformity of the performed osteopathic correction of SD with the osteopathic conclusion is evaluated. This further emphasizes the importance of timely and correct completion of medical records in general, and of the osteopathic report in particular. As part of ongoing research, osteophatic physicians most often analyze the frequency of detection of certain SD, the structure of dominant SD, and the change in these indicators compared to the treatment being conducted. In some cases, specialists analyze the average SD rate of a patient and its change during treatment. However, in the latter case, SD levels and their severity are completely ignored — a very serious omission. Moreover, in routine clinical practice this approach is not used because of its low informational value. It is thus clear that there is a need to develop some kind of criterion or integrative indicator that could be used in both research and clinical practice, including for assessing the quality of care. The aim of the study : to develop an integrated indicator for assessing the severity of functional disorders. Materials and methods . The development and practical application of the integrative indicator were carried out at the Department of Osteopathy with a Course in Functional and Integrative Medicine at the I. I. Mechnikov North-Western State Medical University, as well as at the Medical Clinics LLC «Mokhov Institute of Osteopathy» from 2020 to 2023. Results . In the developed integrative indicator, each SD is assigned so-called scores of functional significance depending on its level of manifestation and degree of intensity. The greater the value in scores, the greater the functional and clinical significance of SD. Each global-level SD with a 1-point elevation has a functional significance level of 3; global-level SD with a 2-point elevation has a functional significance level of 6; global-level SD with a 3-point elevation has a functional significance level of 9. Each regional biomechanical disorder, both structural and visceral, has a 1-point degree of functional significance 2; a regional biomechanical disorder has a 2-point degree of functional significance 4; regional biomechanical disturbance of 3 points has a functional significance level 6. The same grading is chosen for regional neuro-dynamic disturbances: 1 point — functional significance level 2; 2 points — functional significance level 4; 3 points — functional significance level 6. Locallevel SDs do not have degrees of elevation in points and can be acute or chronic. Chronic SDs correspond to functional significance level 1 and acute local SDs correspond to functional significance level 2. An integrative measure of functional significance is the sum total of all SD scores ascertained during the examination of each specific patient. For ease of reference, the term «functional significance index» (FSI) was used in medical records. The minimum FSI may be 0, assuming that no SD has been detected during examination, and the maximum is greater than 100. In general, the lower the FSI value, the better clinically for the patient. Conclusion . The developed integrative indicator allows a comprehensive approach to the analysis of osteopathic conclusion, it is convenient for tracking changes in level and degree of intensity of SD during the course of treatment, can be used as in practice, including both in the analysis of the quality of medical care by the profile «osteopathy», as well as in the conduct of scientific studies with evaluation of the osteopathic status of patients. Further work in this direction looks promising.