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Fatores de prognóstico para os resultados de sucesso da fisioterapia multimodal em utentes com dor cervical crónica
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Authors
Advisor(s)
Abstract(s)
Introdução: O conhecimento acerca da influência das características dos indivíduos
com dor cervical crónica (DCC) no prognóstico dos resultados alcançados com a
Fisioterapia é ainda inconsistente, sendo escassos os estudos desenvolvidos neste
âmbito. Objetivo: Este relatório pretende determinar se um modelo baseado em fatores
de prognóstico é capaz de prever os resultados de sucesso da Fisioterapia, a curto prazo,
em utentes com DCC, ao nível da incapacidade funcional, intensidade da dor e perceção
global de melhoria. Metodologia: Trata-se de estudo de coorte prospetivo com 112
participantes. Os utentes foram avaliados na primeira semana de tratamento e sete
semanas após o início da intervenção. Os instrumentos utilizados foram o Neck
Disability Index–Versão Portuguesa (NDI-PT) e a Escala Numérica da Dor (END) nos
dois momentos de avaliação, um Questionário de Caracterização Sociodemográfica e
Clínica da Amostra na baseline e a Patient Global Impression Change Scale–Versão
Portuguesa (PGIC-PT) no follow-up. As características sociodemográficas e clínicas
foram incluídas como potenciais fatores de prognóstico e estes foram definidos com
base nas diferenças mínimas clinicamente importantes (DMCI) dos instrumentos NDIPT
(DMCI≥6) e END (DMCI≥2) e no critério de pontuação ≥5 na PGIC-PT. A análise
dos dados foi realizada através do método de regressão logística (backward conditional
procedure) para identificar as associações entre os indicadores e as variáveis de
resultado (p<0.05). Resultados: Dos 112 participantes incluídos no estudo, 108
completaram o follow-up (média de idade: 51.76±10.19). No modelo multivariado
relativo à incapacidade funcional, os resultados de sucesso encontram-se associados a
elevados níveis de incapacidade na baseline (OR=1.123; 95% IC 1.056–1.194) e a
duração da dor inferior a 12 meses (OR=2.704; 95% IC 1.138–6.424). Este modelo
explica 30.0% da variância da melhoria da funcionalidade e classifica corretamente
74.1% dos utentes (sensibilidade: 75.9%; especificidade: 72.0%). O modelo relativo à
intensidade da dor identificou apenas a associação do outcome com níveis elevados de
intensidade da dor na baseline (OR=1.321; 95% IC 1.047–1.668), explicando 7.5% da
variância da redução da mesma e classificando corretamente 68.2% dos utentes
(sensibilidade: 94.4%; especificidade: 16.7%). O modelo final referente à perceção
global de melhoria apresentou uma associação com a intensidade da dor na baseline
(OR=0.621; 95% IC 0.465–0.829), com a presença de cefaleias e/ou tonturas
(OR=2.538; 95% IC 0.987–6.526) e com a duração da dor superior a 12 meses
(OR=0.279; 95% IC 0.109–0.719). Este modelo explica 27.5% da variância dos
resultados de sucesso para este outcome e classifica corretamente 73.1% dos utentes
(sensibilidade: 81.8%; especificidade: 59.5%). Conclusões: Utentes com DCC com
elevada incapacidade na baseline e queixas de dor há menos de 12 meses apresentam
maior probabilidade de obter melhorias ao nível da incapacidade funcional. Elevados
níveis de intensidade da dor na baseline predizem resultados de sucesso na redução da
dor após sete semanas de tratamento. Utentes com DCC com baixos níveis de dor na
baseline, com cefaleias e/ou tonturas e com queixas de dor há mais de 12 meses
apresentam maior probabilidade de obter uma melhor perceção de melhoria.
Abstract: Introduction: The influence of the characteristics of individuals with chronic neck pain (CNP) on the prognosis of physiotherapy outcomes is still inconsistent, there being few studies developed in this context. Aim: This study seeks to determine whether a model based on prognostic factors can predict the short-term physiotherapy successful outcomes in CNP patients, regarding functional disability, pain intensity and perceived recovery. Methodology: This is a prospective cohort study with 112 participants. Patients were assessed during the first week of treatment and seven weeks after the start of the intervention. The instruments used were the Neck Disability Index–Portuguese Version (NDI-PT) and the Numerical Rating Scale (NRS) at both moments of assessment, a Sample Sociodemographic and Clinical Characterization Questionnaire at baseline and Patient Global Impression Change Scale–Portuguese Version (PGIC-PT) at the follow-up. The sociodemographic and clinical characteristics were included as potential predictors of successful outcomes, and these were defined on the basis of minimal clinically important differences (MCID) of NDI-PT (MCID≥6) and END (MCID≥2) and the criteria score ≥5 on the PGIC-PT. Data analysis was performed using logistic regression (backward conditional procedure) to identify associations between predictors and outcomes (p<0.05). Results: Of the 112 participants included in the study, 108 completed the follow-up (mean age: 51.76±10.19). In the multivariate model of functional disability, the successful outcomes are associated with high levels of disability at baseline (OR = 1.123; 95% CI 1.056-1.194), and pain duration shorter than 12 months (OR=2.704; 95% CI 1.138–6.424). This model explains 30.0% of the variance of improved functional capacity and correctly classifies 74.1% of the patients (sensitivity: 75.9%, specificity: 72.0%). The model for pain intensity solely identified an outcome association with high pain intensity at baseline (OR=1.321; 95% CI 1.047- 1.668), explaining 7.5% of the variance of pain reduction and correctly classifying 68.2% of the patients (sensitivity: 94.4%, specificity: 16.7%). The final model of perceived recovery showed an association with pain intensity at baseline (OR=0.621; 95% CI 0465-0829), with the presence of headache and/or dizziness (OR=2.538; 95% CI 0.987-6.526) and the duration of pain over 12 months (OR=0.279; 95% CI 0.109- 0.719). This model explains 27.5% of the variance of successful outcomes and correctly classifies 73.1% of the patients (sensitivity: 81.8%, specificity: 59.5%). Conclusions: Patients with CNP with high disability at baseline and complaints of pain for less than 12 months are more likely to obtain improvements in functional disability. High levels of pain intensity at baseline predict successful outcomes in pain reduction after seven weeks of treatment. Patients with CNP with low levels of pain at baseline, with headache and/or dizziness and with pain complaints for more than 12 months are more likely to get a better perceived recovery.
Abstract: Introduction: The influence of the characteristics of individuals with chronic neck pain (CNP) on the prognosis of physiotherapy outcomes is still inconsistent, there being few studies developed in this context. Aim: This study seeks to determine whether a model based on prognostic factors can predict the short-term physiotherapy successful outcomes in CNP patients, regarding functional disability, pain intensity and perceived recovery. Methodology: This is a prospective cohort study with 112 participants. Patients were assessed during the first week of treatment and seven weeks after the start of the intervention. The instruments used were the Neck Disability Index–Portuguese Version (NDI-PT) and the Numerical Rating Scale (NRS) at both moments of assessment, a Sample Sociodemographic and Clinical Characterization Questionnaire at baseline and Patient Global Impression Change Scale–Portuguese Version (PGIC-PT) at the follow-up. The sociodemographic and clinical characteristics were included as potential predictors of successful outcomes, and these were defined on the basis of minimal clinically important differences (MCID) of NDI-PT (MCID≥6) and END (MCID≥2) and the criteria score ≥5 on the PGIC-PT. Data analysis was performed using logistic regression (backward conditional procedure) to identify associations between predictors and outcomes (p<0.05). Results: Of the 112 participants included in the study, 108 completed the follow-up (mean age: 51.76±10.19). In the multivariate model of functional disability, the successful outcomes are associated with high levels of disability at baseline (OR = 1.123; 95% CI 1.056-1.194), and pain duration shorter than 12 months (OR=2.704; 95% CI 1.138–6.424). This model explains 30.0% of the variance of improved functional capacity and correctly classifies 74.1% of the patients (sensitivity: 75.9%, specificity: 72.0%). The model for pain intensity solely identified an outcome association with high pain intensity at baseline (OR=1.321; 95% CI 1.047- 1.668), explaining 7.5% of the variance of pain reduction and correctly classifying 68.2% of the patients (sensitivity: 94.4%, specificity: 16.7%). The final model of perceived recovery showed an association with pain intensity at baseline (OR=0.621; 95% CI 0465-0829), with the presence of headache and/or dizziness (OR=2.538; 95% CI 0.987-6.526) and the duration of pain over 12 months (OR=0.279; 95% CI 0.109- 0.719). This model explains 27.5% of the variance of successful outcomes and correctly classifies 73.1% of the patients (sensitivity: 81.8%, specificity: 59.5%). Conclusions: Patients with CNP with high disability at baseline and complaints of pain for less than 12 months are more likely to obtain improvements in functional disability. High levels of pain intensity at baseline predict successful outcomes in pain reduction after seven weeks of treatment. Patients with CNP with low levels of pain at baseline, with headache and/or dizziness and with pain complaints for more than 12 months are more likely to get a better perceived recovery.
Description
Relatório do Projeto de Investigação apresentado para cumprimento dos requisitos
necessários à obtenção do grau de Mestre em Fisioterapia, área de especialização em
Fisioterapia em Condições Músculo-Esqueléticas.
Keywords
Dor Cervical Crónica Fatores de Prognóstico Incapacidade Funcional Intensidade da Dor Perceção Global de Melhoria Chronic Neck Pain Prognostic Factors Functional Disability Pain Intensity Perceived Recovery
Pedagogical Context
Citation
Publisher
Instituto Politécnico de Setúbal. Escola Superior de Saúde