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Efetividade dos cuidados estratificados (Programa SPLIT) na qualidade de vida relacionada com a saúde em utentes com lombalgia que recorrem aos cuidados de saúde primários
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Abstract(s)
Introdução: A lombalgia é a principal causa de incapacidade no mundo. Atualmente,
a prática usual de intervenção dos utentes com lombalgia nos cuidados de saúde
primários utiliza excessivamente intervenções de baixo valor e que são insuficientes
para um tratamento efetivo da lombalgia. A melhor evidência científica disponível
recomenda a implementação de um modelo de estratificado de cuidados que seja
ajustado às necessidades de cada utente. Objetivo: Comparar os ganhos de qualidade
de vida relacionada com a saúde (QVRS) entre um grupo de utentes com lombalgia não
específica que recebeu cuidados usuais e outro que recebeu o mesmo tipo de cuidados
ao qual foi adicionado uma intervenção estratificada de fisioterapia (Programa SPLIT),
em contexto de cuidados de saúde primários. Metodologia: Foram realizados dois
estudos independentes e consecutivos de coorte prospetivo que incluíram 238
indivíduos com lombalgia não específica nos cuidados de saúde primários portugueses.
Estes indivíduos foram avaliados no início do estudo e aos 2 e 6 meses pela escala
numérica da dor (END), Roland Morris Disability Questionnaire (RMDQ) e o
EuroQuol-5D-3L. Resultados: A coorte SPLIT mostrou índices de QVRS
significativamente superiores tanto no início do estudo, bem como as 2 e 6 meses de
seguimento quando comparado com a prática usual. Em ambas as coortes, a evolução
global do EQ-5D-3L foi estatisticamente significativa (p<0.001), como também quando
comparado o momento inicial e os 2 meses (p<0.001) e 6 meses (p<0.001). Os
resultados da regressão linear múltipla mostram que, nos utentes que adicionaram o
programa SPLIT à prática usual, a QVRS é 1.55 vezes superior (IC95%: 0.09-0.22,
p<0.005) aos 2 meses de seguimento e 1.68 vezes superior (IC95%: 0.10-0.24, p<0.005)
aos 6 meses de seguimento. Conclusões: Os resultados sugerem que a adição de um
programa de fisioterapia estratificado (SPLIT) resulta numa melhor QVRS, aos 2 e 6
meses de seguimento, quando comparado com a prática usual.
Background: Low back pain is the leading cause of disability worldwide. Currently, the usual practice of intervention of patients with low back pain in primary health care overuses low-value interventions and that are insufficient for an effective treatment of low back pain. The best available scientific evidence recommends the implementation of a stratified care model that is adjusted to the individual needs of each patient. Aim: To compare the gains in the health-related quality of life (HRQoL) between a group of patients with non-specific low back pain that received usual care and another that received the same type of care supplemented with an stratified physiotherapy intervention (SPLT program), in the context of primary health care. Methods: Two independent and consecutive prospective cohort studies were carried out that included 238 individuals with non-specific low back pain in Portuguese primary health care setting. These participants were assessed at baseline and at 2 and 6 months using the Numerical Pain Scale (NPS), Roland Morris Disability Questionnaire (RMDQ) and EuroQuol-5D-3L. Results: The SPLIT cohort showed significantly higher HRQoL both at baseline, as well as at 2- and 6-months follow-up when compared to usual practice. In both cohorts, the global evolution of the EQ-5D-3L was statistically significant (p<0.001), as well as when comparing the baseline and the 2 months (p<0.001) and 6 months (p<0.001). The results from the linear multiple regression show that in patients that added the SPLIT program to the usual practice that the HRQoL was 1.55 times superior (95%CI: 0.09-0.22, p<0.005) at 2 months follow-up and 1.68 times superior (95% CI: 0.10-0.24, p<0.005) at 6 months follow-up. Conclusions: The results suggest that the addition of a stratified physiotherapy program (SPLIT) results in better HRQoL at 2 and 6 months of follow-up when compared with usual care.
Background: Low back pain is the leading cause of disability worldwide. Currently, the usual practice of intervention of patients with low back pain in primary health care overuses low-value interventions and that are insufficient for an effective treatment of low back pain. The best available scientific evidence recommends the implementation of a stratified care model that is adjusted to the individual needs of each patient. Aim: To compare the gains in the health-related quality of life (HRQoL) between a group of patients with non-specific low back pain that received usual care and another that received the same type of care supplemented with an stratified physiotherapy intervention (SPLT program), in the context of primary health care. Methods: Two independent and consecutive prospective cohort studies were carried out that included 238 individuals with non-specific low back pain in Portuguese primary health care setting. These participants were assessed at baseline and at 2 and 6 months using the Numerical Pain Scale (NPS), Roland Morris Disability Questionnaire (RMDQ) and EuroQuol-5D-3L. Results: The SPLIT cohort showed significantly higher HRQoL both at baseline, as well as at 2- and 6-months follow-up when compared to usual practice. In both cohorts, the global evolution of the EQ-5D-3L was statistically significant (p<0.001), as well as when comparing the baseline and the 2 months (p<0.001) and 6 months (p<0.001). The results from the linear multiple regression show that in patients that added the SPLIT program to the usual practice that the HRQoL was 1.55 times superior (95%CI: 0.09-0.22, p<0.005) at 2 months follow-up and 1.68 times superior (95% CI: 0.10-0.24, p<0.005) at 6 months follow-up. Conclusions: The results suggest that the addition of a stratified physiotherapy program (SPLIT) results in better HRQoL at 2 and 6 months of follow-up when compared with usual care.
Description
Keywords
Lombalgia não específica Tratamento estratificado Fisioterapia Cuidados de saúde primários Portugal Nonspecific low back pain Stratified care Physiotherapy Primary healthcare