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Predição da Resposta de Sucesso a um Programa de Exercício em Meio Aquático para Utentes com Dor Lombar Crónica
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Authors
Advisor(s)
Abstract(s)
PALAVRAS-CHAVE: Dor Lombar Crónica (DLC), Factores de Prognóstico,
Intensidade da Dor, Incapacidade Funcional
Introdução e Objectivo: A evidência existente acerca de potenciais factores que
possam predizer resultados de sucesso em utentes com DLC é não só escassa, mas
sobretudo pouco consistente. O presente estudo teve como objectivo identificar factores
de prognóstico para os bons resultados da Fisioterapia, a curto e médio prazo, ao nível
da intensidade da dor, capacidade funcional e percepção de melhoria em indivíduos com
DLC, que realizaram um programa de exercício em meio aquático.
Metodologia: Foi realizado um estudo de coorte prospectivo, com 42 participantes com
DLC; os quais foram submetidos a um programa de exercício aquático, com duração de
6 semanas. Os resultados do programa foram avaliados imediatamente após o seu
término, e três meses após o final do tratamento. Os outcomes de interesse foram a
intensidade da dor, medida pela Escala Visual Analógica (EVA), a incapacidade
funcional, medida pela Quebek Back Pain Disability Scale – Versão Portuguesa
(QBPDS-PT), e a percepção global de melhoria, medida pela Patient Global Impression
Change Scale – Versão Portuguesa (PGIC-PT). As características sociodemográficas e
clínicas avaliadas no início do estudo foram incluídas como potenciais factores de
prognóstico. Como critérios de sucesso, foram utilizadas as Diferenças Clínicas
Minimamente Importantes (DCMIs) definidas na literatura para os três instrumentos
utilizados.
Resultados: Os resultados obtidos sugerem que: 1) ao nível da intensidade da dor, as
variáveis de prognóstico intensidade da dor reportada na baseline (OR= 1,049; 95% IC
1,004-1,097) e presença de irradiação para o membro inferior (OR=13,418; 95% IC 1,963-
91,716) estão significativamente associadas com os resultados de sucesso imediatamente
após o programa de exercício aquático (6 semanas); e a intensidade da dor reportada na
baseline está significativamente associada com os resultados de sucesso, três meses
após o final do tratamento (OR=1,045; 95% IC 1,004-1,089); 2) ao nível da incapacidade
funcional, apenas a pontuação na QBPDS-PT reportada na baseline se encontra
estatisticamente associada com a incapacidade funcional registada 6 semanas após o
início do estudo (OR=1,061 95% IC 1,009-1,115).
Conclusões: Utentes com níveis mais elevados de intensidade de dor e presença de
irradiação da dor para o membro inferior, no início do estudo, apresentam maior
probabilidade de sucesso, ao nível da intensidade da dor, imediatamente após um
programa de exercício aquático; e utentes com maiores níveis de intensidade da dor, no
início do estudo, apresentam maior probabilidade de sucesso, também ao nível da
intensidade da dor, três meses após o final do tratamento. Utentes com maiores níveis
de incapacidade funcional no início do estudo, apresentam maior probabilidade de
atingirem resultados de sucesso, ao nível da incapacidade funcional, imediatamente
após o final do programa de exercício aquático.
Abstract:Introduction and Objectives: There is little evidence about potential prognostic factors that can influence the successful outcomes of patients with CLBP. The aim of this study was to assess prognostic factors for the success of an aquatic exercise program, for pain intensity, disability and global impression change, in patients with CLBP; immediately after the treatment and in a 3 months follow-up. Methodology: It was used a prospective cohort study with 42 participants, who undertake an exercise aquatic program for 6 weeks. The results of the program were assessed immediately after the treatment, and at 3 months follow-up. The primary outcomes were pain intensity, measured by Visual Analogic Scale (VAS), functional disability, measured by Quebek Back Pain Disability Scale – Portuguese Version (QBPDS-PT), and the global impression of change, measured by the Patient Global Impression Change Scale – Portuguese Version (PGIC-PT). The socio-demographic and clinical data were used as potential prognostic factors. Success with the treatment was defined considering the Minimal Clinically Important Difference (MCID) reported on the literature for the three instruments used. Results: For pain intensity, the variables pain intensity in the baseline (OR= 1,049; 95% IC 1,004-1,097) and presence of irradiating pain (OR=13,418; 95% IC 1,963-91,716), were associated with successful results for pain intensity, immediately after the end of the exercise aquatic program; and the pain intensity in the baseline were associated with successful results in the 3 months follow-up (OR=1,045; 95% IC 1,004-1,089). In what concerns to functional disability, only the score obtained in the QBPDS-PT, at the baseline, was associated with the functional disability assessed immediately after the end of the treatment (OR=1,061 95% IC 1,009-1,115). Conclusions: Participants with more pain intensity and presence of irradiating pain in the baseline, were more associated with results of success in pain intensity, immediately after a program of aquatic exercise; and participants with more pain intensity, in the baseline, were more probably associated with results of success in pain intensity, at the follow-up of 3 months. Participants with more disability at the baseline were more likely to present successful results, in functional disability, immediately after the end of the treatment.
Abstract:Introduction and Objectives: There is little evidence about potential prognostic factors that can influence the successful outcomes of patients with CLBP. The aim of this study was to assess prognostic factors for the success of an aquatic exercise program, for pain intensity, disability and global impression change, in patients with CLBP; immediately after the treatment and in a 3 months follow-up. Methodology: It was used a prospective cohort study with 42 participants, who undertake an exercise aquatic program for 6 weeks. The results of the program were assessed immediately after the treatment, and at 3 months follow-up. The primary outcomes were pain intensity, measured by Visual Analogic Scale (VAS), functional disability, measured by Quebek Back Pain Disability Scale – Portuguese Version (QBPDS-PT), and the global impression of change, measured by the Patient Global Impression Change Scale – Portuguese Version (PGIC-PT). The socio-demographic and clinical data were used as potential prognostic factors. Success with the treatment was defined considering the Minimal Clinically Important Difference (MCID) reported on the literature for the three instruments used. Results: For pain intensity, the variables pain intensity in the baseline (OR= 1,049; 95% IC 1,004-1,097) and presence of irradiating pain (OR=13,418; 95% IC 1,963-91,716), were associated with successful results for pain intensity, immediately after the end of the exercise aquatic program; and the pain intensity in the baseline were associated with successful results in the 3 months follow-up (OR=1,045; 95% IC 1,004-1,089). In what concerns to functional disability, only the score obtained in the QBPDS-PT, at the baseline, was associated with the functional disability assessed immediately after the end of the treatment (OR=1,061 95% IC 1,009-1,115). Conclusions: Participants with more pain intensity and presence of irradiating pain in the baseline, were more associated with results of success in pain intensity, immediately after a program of aquatic exercise; and participants with more pain intensity, in the baseline, were more probably associated with results of success in pain intensity, at the follow-up of 3 months. Participants with more disability at the baseline were more likely to present successful results, in functional disability, immediately after the end of the treatment.
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 Lombar Crónica (DLC) Factores de Prognóstico Intensidade da Dor Incapacidade Funcional Chronic Low Back Pain (CLBP) Prognostic Factors Pain Intensity Functional Disability
Citation
Publisher
Instituto Politécnico de Setúbal. Escola Superior de Saúde.