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Programa SPLIT: Resultados e fatores de prognóstico para os resultados de sucesso em utentes com lombalgia
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Abstract(s)
Introdução: A lombalgia é a principal causa de incapacidade no mundo. A maioria dos episódios de lombalgia têm uma duração curta, mas os episódios recorrentes são comuns. A evidência recomenda um programa de intervenção estratificada (SPLIT), que consiste em categorizar os utentes com lombalgia não especifica em três grupos tendo em conta o risco de desenvolver dor persistente e incapacitante e aplicar estratégias de intervenção adaptadas para cada grupo. Objetivo: Analisar os resultados clínicos da implementação de um modelo de tratamento estratificado em indivíduos com lombalgia não especifica em Portugal (SPLIT) e identificar os fatores de prognóstico para os resultados de sucesso. Metodologia: Foi realizado um estudo observacional de coorte prospetivo com indivíduos com lombalgia não especifica, que receberam uma intervenção estratificada no âmbito do projeto SPLIT. Os utentes foram avaliados sobre os resultados na dor (END), incapacidade funcional (RMDQ) e perceção de melhoria (GPES) aos 2 e 6 meses de follow up. Foram utilizadas as características sociodemográficas e clínicas da amostra para identificar os fatores de prognóstico associados a resultados de sucesso nestas 3 medidas de resultado. Resultados: Foram incluídos 123 participantes. Houve uma diminuição na média da intensidade da dor e da incapacidade aos 2 e 6 meses após intervenção (p<0.01). O fator de prognóstico associado de forma independente com a presença de dor persistente e incapacitante, definida pelo critério RMDQ≥7, aos 2 meses, foi incapacidade funcional na baseline (OR=1.14; 95% IC: 1.04-1.24, p<0,01) e aos 6 meses foram a idade (OR=1.09, 95% IC=1.02-1.17, p<0.05) e o sexo (OR=0.10, 95% IC=0.02-0.47, p<0.01). O fator de prognóstico associado de forma independente com a presença de uma melhoria clinicamente importante, definida pelo critério RMDQ≥30%, aos 2 meses foi ter dor irradiada para o membro inferior (OR=2.97 95% IC: 1.04-8.50, p<0,05), aos 6 meses foram a idade (OR=0.94, 95% IC= 0.89-1.0, p<0.05), o sexo (OR=8.17, 95% IC= 2.15- 31.05, p<0.01) e a incapacidade funcional (OR=1.09, 95% IC= 1.00-1.19, p<0.05). Os fatores de prognóstico associados de forma independente com a presença de uma melhoria clinicamente importante, definida pelo critério END ≥30%, aos 2 meses, foram a duração dos sintomas (OR=3.35; 95% IC: 1.19-9.46, p<0.05), intensidade da dor na baseline (OR=1.42; 95% IC: 1.10-1.82, p<0.01) e a toma de medicação para a lombalgia (OR=0.34; 95% IC: 0.13-0.93, p<0.05), aos 6 meses foi estar ausente do trabalho devido à lombalgia (OR=3.27, 95% IC= 1.11-9.63, p<0.05). O fator de prognóstico associado de forma independente com a presença de uma melhoria clinicamente importante, definida pelo critério GPES ≥3, aos 2 meses, foi o sexo (OR=4.14; 95% IC: 1.42-12.08, p<0,01), aos 6 meses foram o sexo (OR=3.72, 95% IC=1.24-11.14, p<0.05) e estar de baixa remunerada (OR=7.07, 95% IC=1.53-32.75, p<0.05). Conclusão: Os resultados deste estudo vão ao encontro de outros similares, tanto sobre os resultados clínicos da intervenção estratificada como sobre os fatores de prognóstico para os resultados de sucesso encontrados.
Introduction: Low back pain is the main cause of incapacity in the world. The major of episodes of low back pain have a short duration, mas recurrencies are common. Evidence recommends a stratified intervention program (SPLIT), which consists of categorizing users with low back pain in three groups depending on the risk of developing persistent and disabling pain and applying intervention strategies adapted to each group. Objective: To analyze the clinical outcomes of a stratified treatment model in individuals with nonspecific low back pain (SPLIT) and to identify prognostic factors for successful outcomes. Methodology: An observational prospective cohort study was carried out with individuals with non-specific low back pain, who received a stratified intervention under the SPLIT project. Users were assessed on pain intensity (END), functional disability (RMDQ) and global perceived improvement (GPES) at 2 and 6 months follow-ups. The sociodemographic and clinical characteristics of the sample were used to identify the prognostic factors associated with successful outcomes. Results: 123 participants were included. There was a decrease in the mean pain intensity and disability at 2 and 6 months after the intervention (p <0.01). The prognostic factor independently associated with the presence of persistent and disabling pain, defined by the RMDQ≥7 criterion, at 2 months, was functional disability at baseline (OR = 1.14; 95% CI: 1.04-1.24, p <0, 01) and at 6 months were age (OR = 1.09, 95% CI = 1.02-1.17, p <0.05) and sex (OR = 0.10, 95% CI = 0.02-0.47, p <0.01). The prognostic factor independently associated with the presence of a clinically important improvement, defined by the RMDQ≥30% criterion, at 2 months was having pain radiated to the lower limb (OR = 2.97 95% CI: 1.04-8.50, p < 0.05), at 6 months were age (OR = 0.94, 95% CI = 0.89-1.0, p <0.05), sex (OR = 8.17, 95% CI = 2.15- 31.05, p <0.01) and functional disability (OR = 1.09, 95% CI = 1.00-1.19, p <0.05). The prognostic factors independently associated with the presence of a clinically important improvement, defined by the END criterion ≥30%, at 2 months, were the duration of symptoms (OR = 3.35; 95% CI: 1.19-9.46, p <0.05 ), pain intensity at baseline (OR = 1.42; 95% CI: 1.10-1.82, p <0.01) and taking medication for low back pain (OR = 0.34; 95% CI: 0.13-0.93, p <0.05), at 6 months, she was absent from work due to low back pain (OR = 3.27, 95% CI = 1.11-9.63, p <0.05). The prognostic factor independently associated with the presence of a clinically important improvement, defined by the GPES ≥3 criterion, at 2 months, was gender (OR = 4.14; 95% CI: 1.42- 12.08, p <0.01) , at 6 months were gender (OR = 3.72, 95% CI = 1.24-11.14, p <0.05) and being on low pay (OR = 7.07, 95% CI = 1.53-32.75, p <0.05). Conclusion: The results of this study are in line with similar ones, both on the clinical results of the stratified intervention and on the prognostic factors for the successful results found.
Introduction: Low back pain is the main cause of incapacity in the world. The major of episodes of low back pain have a short duration, mas recurrencies are common. Evidence recommends a stratified intervention program (SPLIT), which consists of categorizing users with low back pain in three groups depending on the risk of developing persistent and disabling pain and applying intervention strategies adapted to each group. Objective: To analyze the clinical outcomes of a stratified treatment model in individuals with nonspecific low back pain (SPLIT) and to identify prognostic factors for successful outcomes. Methodology: An observational prospective cohort study was carried out with individuals with non-specific low back pain, who received a stratified intervention under the SPLIT project. Users were assessed on pain intensity (END), functional disability (RMDQ) and global perceived improvement (GPES) at 2 and 6 months follow-ups. The sociodemographic and clinical characteristics of the sample were used to identify the prognostic factors associated with successful outcomes. Results: 123 participants were included. There was a decrease in the mean pain intensity and disability at 2 and 6 months after the intervention (p <0.01). The prognostic factor independently associated with the presence of persistent and disabling pain, defined by the RMDQ≥7 criterion, at 2 months, was functional disability at baseline (OR = 1.14; 95% CI: 1.04-1.24, p <0, 01) and at 6 months were age (OR = 1.09, 95% CI = 1.02-1.17, p <0.05) and sex (OR = 0.10, 95% CI = 0.02-0.47, p <0.01). The prognostic factor independently associated with the presence of a clinically important improvement, defined by the RMDQ≥30% criterion, at 2 months was having pain radiated to the lower limb (OR = 2.97 95% CI: 1.04-8.50, p < 0.05), at 6 months were age (OR = 0.94, 95% CI = 0.89-1.0, p <0.05), sex (OR = 8.17, 95% CI = 2.15- 31.05, p <0.01) and functional disability (OR = 1.09, 95% CI = 1.00-1.19, p <0.05). The prognostic factors independently associated with the presence of a clinically important improvement, defined by the END criterion ≥30%, at 2 months, were the duration of symptoms (OR = 3.35; 95% CI: 1.19-9.46, p <0.05 ), pain intensity at baseline (OR = 1.42; 95% CI: 1.10-1.82, p <0.01) and taking medication for low back pain (OR = 0.34; 95% CI: 0.13-0.93, p <0.05), at 6 months, she was absent from work due to low back pain (OR = 3.27, 95% CI = 1.11-9.63, p <0.05). The prognostic factor independently associated with the presence of a clinically important improvement, defined by the GPES ≥3 criterion, at 2 months, was gender (OR = 4.14; 95% CI: 1.42- 12.08, p <0.01) , at 6 months were gender (OR = 3.72, 95% CI = 1.24-11.14, p <0.05) and being on low pay (OR = 7.07, 95% CI = 1.53-32.75, p <0.05). Conclusion: The results of this study are in line with similar ones, both on the clinical results of the stratified intervention and on the prognostic factors for the successful results found.
Description
Keywords
Lombalgia não específica Intervenção Estratificada Fatores de prognóstico Non specific low back pain Stratified intervention Prognostic factors