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Caracterização da intervenção da Fisioterapia em indivíduos com dor crónica lombar e seus resultados a nível da dor e capacidade funcional
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Advisor(s)
Abstract(s)
Objectivo: Este trabalho teve como objectivo contribuir para o processo de adaptação cultural da
Quebec Back Pain Disability Scale (QBPDS), através do estudo da sua Validade de Constructo e
Poder de Resposta, e caracterizar a intervenção realizada pela fisioterapia (FT) e os resultados obtidos
em utentes com dor crónica lombar (DCL). Introdução: A redução da incapacidade funcional
associada à DCL é um dos principais objectivos e resultados da intervenção da FT nestes utentes.
Com o intuito de proceder à sua avaliação, pode recorrer-se a um conjunto de diferentes instrumentos
de medida, sendo a QBPDS uma das escalas mais utilizadas para medir a incapacidade. Embora esta
tenha sido anteriormente adaptada para a população portuguesa, não foram determinadas as suas
propriedades psicométricas. Por outro lado, apesar da literatura referir que os serviços de FT são
bastante procurados por indivíduos com DCL, em Portugal, a informação existente sobre a prática da
FT nesta condição clínica e sobre os resultados obtidos é ainda escassa. Metodologia: Recorreu-se a
um estudo de coorte prospectivo com uma amostra de conveniência, constituída por 119 indivíduos
com DCL, que iniciaram fisioterapia em 16 centros/ hospitais/ clínicas de Fisioterapia/ utentes no
domicílio, e cumpriam os critérios de inclusão e exclusão estabelecidos. Os utentes foram avaliados
no momento pré-intervenção e num segundo momento até 6 semanas depois. As propriedades
psicométricas da Quebec Back Pain Disability Scale –Versão Portuguesa (QBPDS-VP) avaliadas
foram a Validade de Constructo e o Poder de Resposta. Posteriormente procedeu-se à caracterizar a
prática da FT quanto às modalidades utilizadas, número de sessões de tratamento e duração do
episódio de cuidados. Adicionalmente descreveu-se os resultados obtidos após a intervenção da FT,
ao nível da dor e incapacidade. Resultados: Os resultados revelaram um resultado positivo para a
Validade de Constructo da QBPDS-VP e um elevado Poder de Resposta (área abaixo da curva ROC =
0,736; IC95%=0,639-0,833). Apresenta ainda uma diferença mínima clinicamente importante
(DMCI) de 7 pontos (sensibilidade =72,4% e especificidade = 69,8%). Aquando da intervenção da FT
em casos de DCL, existe uma grande diversidade de modalidades realizadas combinadas em
diferentes pacotes de intervenção, e verificou-se um número médio de sessões realizadas de 14,22
visitas por utente, numa duração de episódio de cuidados maioritariamente superior a 6 semanas. Os
resultados da intervenção revelaram uma redução significativa da incapacidade funcional e da
intensidade da dor (z= -7,440 e z=-6,625; respectivamente, p=0,000). Conclusão: Os resultados do
presente estudo revelam que a QBPDS-VP possui uma boa Validade de Constructo e Poder de
Resposta. Revela ainda que a intervenção da FT em casos de DCL, apesar de apresentar grande
diversidade nas modalidades utilizadas por vezes até divergentes das recomendações dadas pelas
normas de orientação clínica, e uma duração do episódio de cuidados aparentemente superior aos
dados fornecidos pela literatura; proporciona uma redução significativa dos níveis de dor e incapacidade em utentes com DCL.
Objective: The aim of this study is to contribute to the process of cultural adaptation of the Quebec Back Pain Disability Scale (QBPDS), through the study of its Construct Validity and Responsiveness, and characterize the intervention performed by physical therapy (PT) and the results in patients with chronic low back pain (CLBP). Introduction: The reduction in functional disability associated with CLBP is one of the main purpose and results of physical therapy intervention in these patients. With the intention of evaluating them, the professionals can resort to a set of different measuring instruments, and the QBPDS is one of the most commonly used scales for measuring disability. Although this has been previously adapted for the Portuguese population, it was not determined its psychometric properties. Moreover, despite the literature noted that services for PT are quite sought by individuals with CLBP, in Portugal, the existing information on the practice of PT in this clinical condition and the results obtained are still scarce. Methodology: It was used a prospective cohort study with a convenience sample consisting of 119 individuals with CLBP, who started therapy at 16 centers / hospitals / Physiotherapy clinics / household physiotherapy, and fulfilled the inclusion and exclusion criteria established . The patients were assessed at pre-intervention and a second time after 6 weeks. Psychometric properties of the Quebec Back Pain Disability Scale-Portuguese version (QBPDS-VP) were evaluated to construct validity and responsiveness. Subsequently, it was proceeded to the characterization the practice of FT regarding to the modalities used, the number of treatment sessions and duration of the episode of care. Additionally it was described the results obtained after the intervention of the PT, the level of pain and the disability. Results: The results revealed a positive result for the Construct Validity of the QBPDS- VP and a high responsiveness (area under the ROC curve = 0.736, 95% CI 0.639 to 0.833). Minimal clinically important difference (MCID) also presents a 7-point (sensitivity = 72.4% and specificity = 69.8%). In the PT intervention in cases of CLBP there is a great diversity of procedures performed combined in different packages intervention, and it was found an average number of sessions of 14.22 visits per user, with a duration of the episode of care mostly higher to 6 weeks. The results of the intervention showed a significant reduction of disability and pain intensity (z = -7.440 z = -6.625, respectively, p = 0.000).Conclusion: The results of this study show that QBPDS-VP has a good construct validity and responsiveness. It also reveals that the PT intervention in cases of CLBP, despite showing great diversity in the methods used, that sometimes are also divergent to the recommendations given by clinical guidelines, and with a duration of episode of care apparently superior to data provided by the literature, provides an significant reduction in the levels of pain and disability in patients with DCL.
Objective: The aim of this study is to contribute to the process of cultural adaptation of the Quebec Back Pain Disability Scale (QBPDS), through the study of its Construct Validity and Responsiveness, and characterize the intervention performed by physical therapy (PT) and the results in patients with chronic low back pain (CLBP). Introduction: The reduction in functional disability associated with CLBP is one of the main purpose and results of physical therapy intervention in these patients. With the intention of evaluating them, the professionals can resort to a set of different measuring instruments, and the QBPDS is one of the most commonly used scales for measuring disability. Although this has been previously adapted for the Portuguese population, it was not determined its psychometric properties. Moreover, despite the literature noted that services for PT are quite sought by individuals with CLBP, in Portugal, the existing information on the practice of PT in this clinical condition and the results obtained are still scarce. Methodology: It was used a prospective cohort study with a convenience sample consisting of 119 individuals with CLBP, who started therapy at 16 centers / hospitals / Physiotherapy clinics / household physiotherapy, and fulfilled the inclusion and exclusion criteria established . The patients were assessed at pre-intervention and a second time after 6 weeks. Psychometric properties of the Quebec Back Pain Disability Scale-Portuguese version (QBPDS-VP) were evaluated to construct validity and responsiveness. Subsequently, it was proceeded to the characterization the practice of FT regarding to the modalities used, the number of treatment sessions and duration of the episode of care. Additionally it was described the results obtained after the intervention of the PT, the level of pain and the disability. Results: The results revealed a positive result for the Construct Validity of the QBPDS- VP and a high responsiveness (area under the ROC curve = 0.736, 95% CI 0.639 to 0.833). Minimal clinically important difference (MCID) also presents a 7-point (sensitivity = 72.4% and specificity = 69.8%). In the PT intervention in cases of CLBP there is a great diversity of procedures performed combined in different packages intervention, and it was found an average number of sessions of 14.22 visits per user, with a duration of the episode of care mostly higher to 6 weeks. The results of the intervention showed a significant reduction of disability and pain intensity (z = -7.440 z = -6.625, respectively, p = 0.000).Conclusion: The results of this study show that QBPDS-VP has a good construct validity and responsiveness. It also reveals that the PT intervention in cases of CLBP, despite showing great diversity in the methods used, that sometimes are also divergent to the recommendations given by clinical guidelines, and with a duration of episode of care apparently superior to data provided by the literature, provides an significant reduction in the levels of pain and disability in patients with DCL.
Description
Dissertação de Mestrado em Fisioterapia
Keywords
Dor Crónica Lombar Incapacidade Funcional Quebec Back Pain Disability Scale Prática da Fisioterapia Chronic Low Back Pain Functional Disability Physical Therapy Practice
Citation
Publisher
Escola Superior de Saúde do Instituto Politécnico de Setúbal