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Intervenção mínima de educação ao utente para utentes com lombalgia e baixo risco de dor persistente e incapacitante: curso dos resultados e potenciais preditores do efeito
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Advisor(s)
Abstract(s)
Introdução: A lombalgia (LG) é a principal causa de incapacidade em Portugal e
no mundo. Para melhorar a sua gestão nos serviços de saúde, uma abordagem de
cuidados estratificados tem sido sugerida. Esta define para o subgrupo de utentes
com baixo risco de desenvolver LG persistente e incapacitante uma intervenção
mínima (sessão única) de educação ao utente (IMEU), contudo os seus efeitos são
ainda conflituosos. Objetivo: Examinar o curso dos resultados obtidos pelos
utentes com LG e baixo risco de desenvolver dor persistente e incapacitante que
receberam a IMEU e identificar potenciais preditores de uma resposta desfavorável
à mesma. Metodologia: Foi realizado um estudo de coorte prospetivo com 177
utentes com LG e baixo risco que receberam a IMEU. O curso da incapacidade,
intensidade da dor, qualidade de vida relacionada com a saúde e perceção global
de melhoria entre a avaliação inicial e os 2 e 6 meses após a IMEU foi analisado.
Potenciais preditores de uma resposta desfavorável à IMEU nestes resultados
foram explorados através de modelos de regressão logística uni e multivariável.
Resultados: O curso dos resultados após a IMEU foi favorável, com os utentes a
apresentarem mudanças significativas entre a avaliação inicial e os 2 e 6 meses
(p≤0.05). Apesar disso, cerca de metade não recuperou dos seus sintomas. A
presença de dor superior a 12 semanas em conjunto com elevados níveis de
incapacidade e intensidade de dor na avaliação inicial foram os preditores
considerados mais preponderantes para uma resposta desfavorável à IMEU.
Conclusões: Os resultados sugerem que a IMEU pode não ser suficiente para
todos os utentes com LG e baixo risco, especialmente para aqueles com maior
duração de sintomas. Futuros estudos que confirmem os resultados obtidos e que
procurem testar intervenções alternativas para estes utentes são necessários.
Background: Low back pain (LBP) is the leading cause of disability in Portugal and worldwide. A stratified care approach has been suggested to improve its management in health services. This defines a minimal intervention (single session) of patient education (MIPE) for the subgroup of patients with low risk of developing persistent disabling LBP, but its effects are still conflicting. Aim: To examine the course of the outcomes obtained by patients with LBP and a low risk of developing persistent and disabling pain after MIPE and to identify potential predictors of its effect. Methods: A prospective cohort study was carried out with 177 patients with LBP and low-risk who received MIPE. The course of disability, pain intensity, health- related quality of life and perceived effect of treatment between baseline and 2 and 6 months follow-ups were analysed. Potential predictors of an unfavourable response to MIPE were explored using uni and multivariable logistic regression models. Results: The course of outcomes after MIPE was favourable, with patients showing significant changes between the baseline and 2 and 6 months follow-ups (p≤0.05). Despite this, around half of them did not recover from their symptoms. The presence of pain for more than 12 weeks, as well as higher levels of disability and pain intensity at the baseline, were the most significant predictors of an unfavourable response to MIPE. Conclusions: The results suggest that MIPE may not be sufficient for all patients with LBP and low-risk, especially those with longer duration of symptoms. Future studies confirming these results and seeking to test alternative interventions are needed.
Background: Low back pain (LBP) is the leading cause of disability in Portugal and worldwide. A stratified care approach has been suggested to improve its management in health services. This defines a minimal intervention (single session) of patient education (MIPE) for the subgroup of patients with low risk of developing persistent disabling LBP, but its effects are still conflicting. Aim: To examine the course of the outcomes obtained by patients with LBP and a low risk of developing persistent and disabling pain after MIPE and to identify potential predictors of its effect. Methods: A prospective cohort study was carried out with 177 patients with LBP and low-risk who received MIPE. The course of disability, pain intensity, health- related quality of life and perceived effect of treatment between baseline and 2 and 6 months follow-ups were analysed. Potential predictors of an unfavourable response to MIPE were explored using uni and multivariable logistic regression models. Results: The course of outcomes after MIPE was favourable, with patients showing significant changes between the baseline and 2 and 6 months follow-ups (p≤0.05). Despite this, around half of them did not recover from their symptoms. The presence of pain for more than 12 weeks, as well as higher levels of disability and pain intensity at the baseline, were the most significant predictors of an unfavourable response to MIPE. Conclusions: The results suggest that MIPE may not be sufficient for all patients with LBP and low-risk, especially those with longer duration of symptoms. Future studies confirming these results and seeking to test alternative interventions are needed.
Description
Keywords
Baixo risco de LG persistente e incapacitante Educação ao utente Intervenção mínima Lombalgia não-específica Preditores de efeito Low risk of persistent and disabling LBP Minimal intervention Non-specific low back pain Patient education Predictors of effect