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Modelos de sobrevivência para o estudo dos fatores de prognóstico até à ocorrência da resposta ao tratamento de fisioterapia em utentes com dor lombar crónica
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Advisor(s)
Abstract(s)
Introdução: A recuperação, da função e/ou dor, é comummente utilizada em estudos relacionados com a
dor lombar crónica não específica (DLCNE), contudo, os desenhos utilizados para medir a resposta ao
tratamento não permitem saber quando, no decorrer da intervenção, é atingido um determinado critério de
resposta ao tratamento, e consequentemente quais os fatores que aumentam o risco/ a probabilidade de
obter esse critério de resposta ao tratamento ao longo do tempo. Objetivo: Este estudo pretendeu
identificar fatores de prognóstico que influenciem significativamente o tempo até à ocorrência de um
evento de interesse, definido como resposta ao tratamento multimodal de fisioterapia na intensidade da
dor, incapacidade funcional e perceção de melhoria em indivíduos com DCLNE, recorrendo a avaliações
repetidas semanalmente, durante 8 semanas. Metodologia: Estudo observacional de coorte prospetivo
com 135 indivíduos com DLCNE referenciados para a fisioterapia, que foram avaliados no início da
intervenção de fisioterapia e semanalmente desde a segunda até à oitava semana de intervenção. O
“evento” definido foi a obtenção do critério de sucesso na resposta ao tratamento, estabelecido para cada
outcome com base no valor da respetiva DCMI, definida como a diminuição ≥ 30% na escala numérica da
dor (END) e na versão portuguesa da Quebec Back Pain Disability Scale (QBPDS-PT) e diferença
mínima de 3 pontos para a versão portuguesa da Global Back Recovery Scale (GBRS-PT), mantidas
durante um mínimo de 7 dias. Resultados: A proporção de utentes que alcançou a recuperação para a
intensidade da dor e incapacidade funcional, no período de 8 semanas de tratamento, foi de 51.11%
(n=69) e de 50.37% (n=68), respetivamente. A proporção de utentes que alcançou a recuperação na
perceção de melhoria foi de 55.56% (n=75). A mediana do tempo de recuperação para os 3 outcomes
ocorreu na 6ª semana de tratamento. Os indivíduos com maior intensidade de dor na baseline (HR:1.26,
95%IC: 1.12-1.43), que nunca ou raramente se sentiram “desamparados” (HR:2.09, 95%IC: 1.07-4.08),
têm maior possibilidade de atingir o critério de recuperação para a dor, comparativamente aos utentes que
não possuem estas características. Os indivíduos que vivem sozinhos (HR: 1.83, 95%IC: 1,05-3,19) têm
maior possibilidade de atingir o critério de recuperação para a incapacidade funcional. Os utentes com
inferior nível de ensino têm uma maior probabilidade de recuperação da perceção global de melhoria
(IR:1.65; 95%IC: 1.02-2.67) comparativamente com utentes com mais formação. Conclusão: A
recuperação da intensidade da dor e da incapacidade funcional ocorre nas primeiras 6 semanas de
tratamento, sendo que aproximadamente metade dos utentes recuperados alcançaram o critério de
resposta após as 2 primeiras semanas de tratamento. Maior intensidade da dor na baseline, baixos níveis
de fatores psicossociais, viver sozinho e ter um nível educacional mais baixo, parece favorecer a
probabilidade de recuperar destes utentes, ao longo do tempo.
Introduction: The recovery from pain or function is usualy used in nonspecific chronic low back pain (NCLBP) studies. The designs to measure the response to treatment don’t allow to know when, whithin the intervention, the criteria of recovery is achieved and, therefore, which are the factors that increase the possibility of achieving the defined sucess along the time. Objective: The aim of this study is to identify prognosis factors that favour significantly the time until reaching the event of interest, defined as the response to the multimodal physiotherapy treatment for pain intensity, disability and global perception of recovery in patients with NCLBP, using repetitive assessments on a weekly basis for 8 weeks. Methodology: In this prospective cohort study were 135 NCLBP patients who were referred for physiotherapy and assessed 8 times (baseline and every week from 2nd to the 8th week) The event of interest was defined as the achievement of the recovery criteria on the treatment response, established for each outcome, considering the minimal important change (MIC) defined as a reduction of ≥ 30% on numeric rate scale (NRS) and portuguese version of Quebec Back Pain Disability Scale (QBPDS-PT) and a reduction of 3 points on the portuguese version of Global Back Recovery Scale (GBRS-PT), maintened for at least 7 days. Results: The proportion of patients that have acheived the recovery for pain intensity and disability, on the 8 weeks treatment was 51.11% (n=69) and 50.37% (n=68), respectivetly. The proportion of patiens that have acheived recovery for the global perception was 55.56% (n=75). The median of recovery time for the 3 outcomes occured on the 6th week. The NCLBP patients who have more pain intensity on baseline (HR: 1.26; 95%IC: 1.12-1.43) and who didn’t feel with support on the previous week (HR: 2.09; 95%IC: 1.07-4.08) have more possibility to achieve the recovery criteria for pain, compared with those that don’t have that caracteristics. The patients that live alone (HR: 1.83, 95%IC: 1,05-3,19) have more possibility of achieve the disability recovery, when compared with those who don´t. Patients with lower levels of education have more probability to recovery from global perception of recovery (IR:1.65; 95%IC: 1.02-2.67), compared with patients with higher levels of education. Conclusions: The recovery for pain intensity and disability occurs on the 6 first weeks of treatment, and approximetely half of the patients achieved the response criteria in the 2 first weeks. Higher levels of pain intensity on the baseline, lower levels for the psycosocial factors, living alone ad lower levels of education, seems to favour the probability or recovery on NCLBP patients, along the time.
Introduction: The recovery from pain or function is usualy used in nonspecific chronic low back pain (NCLBP) studies. The designs to measure the response to treatment don’t allow to know when, whithin the intervention, the criteria of recovery is achieved and, therefore, which are the factors that increase the possibility of achieving the defined sucess along the time. Objective: The aim of this study is to identify prognosis factors that favour significantly the time until reaching the event of interest, defined as the response to the multimodal physiotherapy treatment for pain intensity, disability and global perception of recovery in patients with NCLBP, using repetitive assessments on a weekly basis for 8 weeks. Methodology: In this prospective cohort study were 135 NCLBP patients who were referred for physiotherapy and assessed 8 times (baseline and every week from 2nd to the 8th week) The event of interest was defined as the achievement of the recovery criteria on the treatment response, established for each outcome, considering the minimal important change (MIC) defined as a reduction of ≥ 30% on numeric rate scale (NRS) and portuguese version of Quebec Back Pain Disability Scale (QBPDS-PT) and a reduction of 3 points on the portuguese version of Global Back Recovery Scale (GBRS-PT), maintened for at least 7 days. Results: The proportion of patients that have acheived the recovery for pain intensity and disability, on the 8 weeks treatment was 51.11% (n=69) and 50.37% (n=68), respectivetly. The proportion of patiens that have acheived recovery for the global perception was 55.56% (n=75). The median of recovery time for the 3 outcomes occured on the 6th week. The NCLBP patients who have more pain intensity on baseline (HR: 1.26; 95%IC: 1.12-1.43) and who didn’t feel with support on the previous week (HR: 2.09; 95%IC: 1.07-4.08) have more possibility to achieve the recovery criteria for pain, compared with those that don’t have that caracteristics. The patients that live alone (HR: 1.83, 95%IC: 1,05-3,19) have more possibility of achieve the disability recovery, when compared with those who don´t. Patients with lower levels of education have more probability to recovery from global perception of recovery (IR:1.65; 95%IC: 1.02-2.67), compared with patients with higher levels of education. Conclusions: The recovery for pain intensity and disability occurs on the 6 first weeks of treatment, and approximetely half of the patients achieved the response criteria in the 2 first weeks. Higher levels of pain intensity on the baseline, lower levels for the psycosocial factors, living alone ad lower levels of education, seems to favour the probability or recovery on NCLBP patients, along the time.
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
Fatores de prognóstico Modelo de sobrevivência Fisioterapia Dor lombar crónica Resultados de sucesso Outcome Prognosis Survival models Physioterapy Chronic back pain Success
Citation
Publisher
Instituto Politécnico de Setúbal. Escola Superior de Saúde