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Efetividade dos cuidados estratificados na lombalgia nos cuidados de saúde primários: Programa SPLIT
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Abstract(s)
Introdução: A lombalgia é um problema major mundialmente e representa a maior causa de anos de vida perdidos ajustados à incapacidade em Portugal. A prática atual utiliza excessivamente cuidados de baixo valor e insuficientemente cuidados de elevado valor. Já foi demonstrada a efetividade duma intervenção estratificada pelo risco de desenvolver dor persistente e incapacitante, comparando com a prática atual nos Cuidados de Saúde Primários (CSP) britânicos. Contudo, desconhece-se se isso também se verifica nos CSP em Portugal. Objetivo: Comparar o Programa SPLIT (modelo de tratamento estratificado de fisioterapia) e a prática atual ao nível da efetividade na dor, incapacidade e perceção de melhoria em indivíduos com lombalgia no contexto dos CSP portugueses. Metodologia: Foram realizados dois estudos de coorte prospetivo, sequenciais e independentes com 238 indivíduos com lombalgia não específica nos CSP portugueses, sendo reavaliados aos 2 e 6 meses pela Escala Numérica da Dor e versões portuguesas da Roland Morris Disability Questionnaire e Global Perceived Effect Scale. Resultados: Aos 2 meses, 77% dos utentes do Programa SPLIT alcança uma melhoria clinicamente importante ao nível da incapacidade funcional, sendo 73% que a alcança aos 6 meses. Dos utentes da prática atual, são 49% e 51% os que o fazem em iguais períodos. O Programa SPLIT está associado a uma probabilidade de melhoria clinicamente importante 3.9 vezes superior na incapacidade funcional (IC 95%: 2.2 – 7.1, p<0.001) aos 2 meses e 3.0 (IC 95%: 1.6 – 5.5, p=0.001) aos 6 meses. A intervenção estratificada também está associada a melhores outcomes na intensidade da dor e perceção de melhoria. Conclusões: Os resultados sugerem que o Programa SPLIT obtém melhores resultados clínicos que a prática atual ao nível da incapacidade funcional, dor e perceção de melhoria aos 2 e 6 meses, estando em linha com os resultados dos estudos internacionais sobre intervenção estratificada.
Background: Low back pain is a worldwide major problem and represents the leading cause of the loss of disability-adjusted life years in Portugal. Many patients still have pain and/or disability few months later. Current practice overuses low-value care and underuses high-value care. The effectiveness of stratified care on prognostic risk of developing persistent and disabling pain has been demonstrated, when compared with the British primary healthcare current practice. However, it is unknown whether it also applies to the Portuguese primary healthcare. Aim: To compare SPLIT Programme (physiotherapy stratified care model) with the current practice in terms of effectiveness on pain, disability and patients’ perspective of recovery in patients with low back pain in Portuguese primary healthcare context. Methods: Two independent prospective sequential cohort studies were carried out with 238 nonspecific low back pain patients seeking care in Portuguese primary healthcare. Patients were followed up on 2 and 6 months through Numeric Rating Scale and the Portuguese versions of Roland Morris Disability Questionnaire and Global Perceived Effect Scale. Results: At 2 months follow-up, 77% of SPLIT Programme patients reach a clinically important change on disability and 73% at 6 months follow-up, while 49% and 51% of usual practice patients do so at the same time. SPLIT Programme is associated with a 3.9 better chance of a clinically important change on disability (95% CI: 2.2 – 7.1, p<0.001) at a 2 months period and 3.0 (95% CI: 1.6 – 5.5, p=0.001) at 6 months. Stratified intervention is also associated with better outcomes in pain intensity and patients’ perspective of recovery. Conclusions: The results suggest that SPLIT Programme has better clinical outcomes than usual practice on disability, pain and patients’ perspective of recovery at 2 and 6 months, in concordance with international studies’ results on stratified intervention.
Background: Low back pain is a worldwide major problem and represents the leading cause of the loss of disability-adjusted life years in Portugal. Many patients still have pain and/or disability few months later. Current practice overuses low-value care and underuses high-value care. The effectiveness of stratified care on prognostic risk of developing persistent and disabling pain has been demonstrated, when compared with the British primary healthcare current practice. However, it is unknown whether it also applies to the Portuguese primary healthcare. Aim: To compare SPLIT Programme (physiotherapy stratified care model) with the current practice in terms of effectiveness on pain, disability and patients’ perspective of recovery in patients with low back pain in Portuguese primary healthcare context. Methods: Two independent prospective sequential cohort studies were carried out with 238 nonspecific low back pain patients seeking care in Portuguese primary healthcare. Patients were followed up on 2 and 6 months through Numeric Rating Scale and the Portuguese versions of Roland Morris Disability Questionnaire and Global Perceived Effect Scale. Results: At 2 months follow-up, 77% of SPLIT Programme patients reach a clinically important change on disability and 73% at 6 months follow-up, while 49% and 51% of usual practice patients do so at the same time. SPLIT Programme is associated with a 3.9 better chance of a clinically important change on disability (95% CI: 2.2 – 7.1, p<0.001) at a 2 months period and 3.0 (95% CI: 1.6 – 5.5, p=0.001) at 6 months. Stratified intervention is also associated with better outcomes in pain intensity and patients’ perspective of recovery. Conclusions: The results suggest that SPLIT Programme has better clinical outcomes than usual practice on disability, pain and patients’ perspective of recovery at 2 and 6 months, in concordance with international studies’ results on stratified intervention.
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Keywords
Lombalgia não específica Tratamento estratificado Fisioterapia Cuidados de saúde primários Portugal Nonspecific low back pain Stratified care Physiotherapy Primary healthcare