Ефективність Програми Фізичної Терапії Та Ерготерапії Із Застосуванням Vr-Технологій У Пацієнтів Із Вогнепальними Пораненнями Верхніх Кінцівок Після Реконструктивних Втручань

Introduction. To evaluate the effectiveness of a differentiated physical therapy and occupational therapy program incorporating VR technologies in patients with gunshot wounds to the upper extremities according to injury severity and the type of reconstructive intervention. Materials and Methods. A prospective single-group pre–post study was conducted at the Rehabilitation Department of the State Institution “National Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine” (Kyiv). The study included 120 patients with polystructural gunshot wounds to the upper extremities who had undergone reconstructive surgery and were undergoing rehabilitation during the post-acute phase. Patients were stratified by injury severity into Groups I and II and a combined Group III–IV, with subgroups IV-a and IV-b. All patients underwent a 21-day differentiated physical therapy and occupational therapy program incorporating VR technologies. Upper extremity function was assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Box and Block Test (BBT), and the Nine-Hole Peg Test (9-HPT). Statistical analysis was performed using TIBCO Statistica 14. The normality of data distribution was assessed using the Shapiro-Wilk test; paired comparisons were performed using the Wilcoxon signed-rank test, and effect size was estimated using the r coefficient. Results. DASH scores improved significantly across all severity groups (n = 120; p ≤ 0.001; r = 0.72–0.87), with the greatest improvement observed in Group I (Δ = 13.2%). The Box and Block Test demonstrated a significant improvement in gross manual dexterity of the affected upper limb across all groups (p < 0.05; r = 0.65–0.85), accompanied by an increase in the Limb Symmetry Index (LSI) (p < 0.001; r = 0.63–0.77). On the Nine-Hole Peg Test, completion time for the affected upper limb decreased significantly across all groups (p < 0.001; r = 0.65–0.88), with a corresponding increase in LSI (p ranging from < 0.001 to 0.008; r = 0.51–0.78). Function of the unaffected upper limb remained unchanged (p > 0.05), supporting the specificity of the observed improvements to the affected limb. Severity level IV-b represented the most functionally impaired group and simultaneously demonstrated the most pronounced relative improvement (BBT: +25% in score and +37.1% in LSI; 9-HPT: 22.8% reduction in completion time and +31.1% in LSI). Conclusions. The integration of VR technologies into a differentiated, severity-stratified physical therapy and occupational therapy program was associated with significant improvements in upper extremity function in patients with polystructural gunshot wounds following reconstructive surgery. The findings provide initial empirical evidence supporting the use of this approach, particularly in the most severely affected clinical groups, which may require prolonged rehabilitation.