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Curso Clínico de Utentes com Dor Cervical Crónica de Origem Não-Específica Após Intervenção em Fisioterapia
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Introdução: A dor cervical crónica (DCC) é uma condição clínica com grande
prevalência a nível mundial, representando um elevado número de anos vividos
com incapacidade (DALY). Uma substancial percentagem de indivíduos não tem
completa resolução dos sintomas após tratamento, sendo importante conhecer o
curso clínico da dor cervical crónica após a alta. Objectivo: Este estudo teve como
objectivo caracterizar o curso clínico de utentes com dor DCC de origem não específica após serem submetidos a um programa de prática clínica usual em
Fisioterapia (Coorte I) e Terapia Manual e Exercício (Coorte II). Metodologia:
Realizou-se um estudo observacional, analítico de Coorte prospectivo com 103
participantes divididos em duas Coortes, após a alta de diferentes tratamentos.
Foram realizados 5 momentos de avaliação: na baseline, aos 3, 6, 9 e 12 meses
após alta. Os instrumentos utilizados foram: a Escala Numérica da Dor (END), o
Neck Disability Index-versão Portuguesa (NDI-PT), a Patient Global Impression
Change Scale-versão Portuguesa (PGIC-PT) e avaliado o recurso a cuidados de
saúde em todos os momentos de avaliação. A análise dos dados foi realizada
através da estatística descritiva e inferencial usando o software Statistical Package
for the Social Science (SPSS). Resultados: Os resultados revelam que o curso
clínico dos utentes com DCC nas várias variáveis tem tendência a melhorar desde
a alta até um ano de follow-up, embora a Coorte I apresente significância estatística
apenas em relação à intensidade da dor (p<0,001). Utentes que realizaram
tratamentos de Terapia Manual e Exercício tiveram melhores resultados em todos
os momentos de avaliação e recorreram menos a cuidados de saúde do que os
que foram expostos à prática clínica usual em Fisioterapia. Foram ainda
encontradas, na Coorte I, no momento da alta associadas ao recorrer a cuidados
de saúde as seguintes características: cefaleias (p=0,036), tonturas (p=0,022),
níveis elevados de intensidade da dor (p=0,002) e incapacidade funcional
(p=0,001). Conclusão: O curso clínico de utentes com DCC da Coorte II tem uma
tendência, ao longo dos 12 meses após a alta, para uma melhoria significativa em
todas as variáveis estudadas, contudo, na Coorte I essa tendência só acontece a
nível da intensidade da dor. Utentes submetidos a práticas usuais em Fisioterapia
têm valores mais elevados de intensidade de dor e incapacidade assim como maior
tendência a recorrer a cuidados de saúde após a alta clínica.
Introduction: Chronic neck pain (CNP) is a clinical condition with a high prevalence worldwide, representing a high number of years living with disability (DALY). A substantial percentage of individual’s does not have a complete recover after treatment, becoming important to know the clinical course of chronic neck pain after discharge. Objective: The objective of this study was to characterize the clinical course of patients diagnosed with non-specific CNP after discharge of a usual Physiotherapy care (cohort I) or Manual Therapy and Exercise program (cohort II). Methodology: This is an observational, prospective cohort study with a sample of 103 patients divided in two cohorts, after discharge from two different physiotherapy treatment programs. They were submitted to 5 different assessments: on baseline, 3, 6, 9 and 12 months after discharge. The assessment instruments used were the Numeric Pain Rating Scale, Neck Disability Index (Portuguese version) and the Patient Global Impression Chage Scale (Portuguese version). Data analysis was performed by descriptive and inferential statistics using the Statistical Package for the Social Science software. Results: Our results show that the clinical course of patients with CNP in regards to the outcomes have a global tendency to improve from the moment of discharge until a year of follow-up, however, in cohort I, only the variable intensity of pain had statistical significance. Patients subjected to a Manual therapy and exercise program had better outcomes in all moments of assessment and few utilize health services comparing to the ones subjected to a usual Physiotherapy program. It was also found in Cohort I at discharge, some significant associations to utilization of health services in Cohort I and the following characteristics: headaches (p=0,036), dizziness (p=0,022), high levels of intensity of pain (p=0,002) and functional disability (p=0,001). Conclusion: The clinical course of patients with CNP in cohort II has a tendency, 12 months after discharge, to improve significantly in all studied variables, however, in Cohort I, that tendency only happens at intensity of pain level. Patients subjected to usual Physiotherapy care programs have higher levels of intensity of pain and disability and a bigger tendency to utilize health services after discharge.
Introduction: Chronic neck pain (CNP) is a clinical condition with a high prevalence worldwide, representing a high number of years living with disability (DALY). A substantial percentage of individual’s does not have a complete recover after treatment, becoming important to know the clinical course of chronic neck pain after discharge. Objective: The objective of this study was to characterize the clinical course of patients diagnosed with non-specific CNP after discharge of a usual Physiotherapy care (cohort I) or Manual Therapy and Exercise program (cohort II). Methodology: This is an observational, prospective cohort study with a sample of 103 patients divided in two cohorts, after discharge from two different physiotherapy treatment programs. They were submitted to 5 different assessments: on baseline, 3, 6, 9 and 12 months after discharge. The assessment instruments used were the Numeric Pain Rating Scale, Neck Disability Index (Portuguese version) and the Patient Global Impression Chage Scale (Portuguese version). Data analysis was performed by descriptive and inferential statistics using the Statistical Package for the Social Science software. Results: Our results show that the clinical course of patients with CNP in regards to the outcomes have a global tendency to improve from the moment of discharge until a year of follow-up, however, in cohort I, only the variable intensity of pain had statistical significance. Patients subjected to a Manual therapy and exercise program had better outcomes in all moments of assessment and few utilize health services comparing to the ones subjected to a usual Physiotherapy program. It was also found in Cohort I at discharge, some significant associations to utilization of health services in Cohort I and the following characteristics: headaches (p=0,036), dizziness (p=0,022), high levels of intensity of pain (p=0,002) and functional disability (p=0,001). Conclusion: The clinical course of patients with CNP in cohort II has a tendency, 12 months after discharge, to improve significantly in all studied variables, however, in Cohort I, that tendency only happens at intensity of pain level. Patients subjected to usual Physiotherapy care programs have higher levels of intensity of pain and disability and a bigger tendency to utilize health services after discharge.
Descrição
Palavras-chave
Dor Cervical Crónica Curso Clínico Intensidade da Dor Incapacidade Funciona Percepção Global de Melhoria Recurso aos Serviços de Saúde Chronic neck pain Clinical course Pain intensity Functional disability Patient global impression of change Health services utilization