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Factores de prognóstico para os resultados de insucesso da intervenção multimodal em fisioterapia, em utentes com dor lombar crónica
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Abstract(s)
Introdução: As elevadas taxas de insucesso, segundo o benefício clínico da intervenção da Fisioterapia, sugerem haver características dos utentes que influenciam o sucesso/insucesso da intervenção. No entanto, os estudos dos factores de prognóstico neste âmbito são escassos e inconsistentes. Objectivo: Este estudo pretende determinar se um modelo baseado em factores de prognóstico é capaz de prever os resultados de insucesso da Fisioterapia em utentes com Dor Lombar Crónica (DLC) a curto e médio prazo, para os outcomes incapacidade funcional, intensidade da dor e percepção global de melhoria. Metodologia: A amostra deste estudo de coorte prospectivo foi composta por 95 utentes referenciados para a Fisioterapia, avaliados antes da intervenção, 6 semanas após o seu inicio e 3 meses após o seu término. O insucesso foi determinado segundo a Diferença Mínima Clinicamente Importante para cada instrumento de medida: incapacidade da funcional pela Quebec Back Pain Disability Scale (QBPDS-PT), a intensidade da dor pela Escala Visual Análoga (EVA) e a percepção global de melhoria pela Patient Global Impression of Change Scale (PGIC-PT). Foram recolhidos dados sócio-demográficos, clínicos e medo do movimento. Resultados: Dos 95 participantes, 90 completaram o follow-up de 3 meses. Através dos modelos preditivos multivariados observam-se várias associações com os outcomes. Utentes com DLC com níveis de incapacidade na baseline mais elevados têm menor probabilidade de insucesso às 6 semanas (OR=0,936; 95% IC: 0,904-0,969). Aos 3 meses utentes com níveis de incapacidade na baseline mais elevados têm menor probabilidade de insucesso (OR=0,943; 95%IC: 0,911-0,977) enquanto utentes com irradiação da dor têm maior probabilidade de insucesso na incapacidade funcional (OR=3,237; 95%IC: 1,225-8,555). Para a intensidade da dor às 6 semanas, utentes com intensidade da dor mais elevada na baseline têm menos probabilidade de ter insucesso (OR=0,928; 95%IC: 0,899-0,959) mas utentes com excesso de peso (OR=2,866; 95%IC: 1,025- 8,013) têm mais probabilidade de insucesso. Aos 3 meses, utentes com intensidade da dor mais elevada na baseline (OR=0,940; 95%IC: 0,914-0,968) têm menos probabilidade de ter insucesso, mas utentes com dor irradiada para o membro inferior (OR=3,657; 95%IC: 1,277- 10,470) têm mais probabilidade de insucesso. Na percepção global de melhoria, utentes do género feminino (OR=3,225; 95%IC: 1,039-10,194) e com excesso de peso (OR=3,334; 95%IC: 1,113-9,806) têm mais probabilidade de insucesso às 6 semanas. Aos 3 meses de follow-up o modelo preditivo não reteve quaisquer variáveis associadas significativamente com o este outcome. Conclusões: Na generalidade os modelos preditivos têm capacidades classificativas, preditivas e discriminativas razoáveis. Este estudo pode ser um contributo para futuramente se conseguir agrupar utentes segundo as suas características associadas com o insucesso, oferecendo-lhes tratamentos mais específicos que melhorem a resposta à intervenção da Fisioterapia.
Abstract: Introduction: The high poor outcome rates of the physiotherapy intervention, according to the clinical benefit analysis, suggest that individual patient features can influence poor/good outcome. Aim: The aim of this paper is to determine if a model based in prognostic factors can predict poor outcome in Chronic Low Back Pain (CLBP) patients in short and medium term, for the outcomes functional disability, pain intensity and global perception of change. Methodology: The sample of this prospective cohort study comprised 95 CLBP patients referred to physiotherapy. The patients were assessed before the intervention, 6 weeks after the start and 3 months after the end of the intervention. The poor outcome was defined according to the Minimal Clinically Important Difference for each outcome measures: Functional disability was assessed with the Quebec Back Pain Disability Scale, pain intensity with the Visual Analogue Scale and global perception of change with the Patient Global Impression of Change Scale. The socio-demographic and clinical data as well as kinesiophobia were also collected. Results: Of the 95 patients, 90 completed the three months follow-up. With the multivariate regression models was observed that patients with CLBP with high levels of disability at baseline (OR=0,936; 95% CI: 0,904-0,969) are less likely to have poor outcome for functional disability at 6 weeks. At three months, patients with high levels of disability at baseline (OR=0,943; 95%CI: 0,911-0,977) are less likely to have poor outcome, though those who have pain radiation (OR=3,237; 95%CI: 1,225-8,555) are more likely to have poor outcome for functional disability. For pain intensity, patients with high levels of pain intensity at baseline (OR=0,928; 95%IC: 0,899-0,959) are less likely to have poor outcome, though being overweight (OR=2,866; 95%IC: 1,025- 8,013) predicted poor outcome at 6 weeks. At three months, patients with high levels of pain intensity at baseline (OR=0,940; 95%IC: 0,914-0,968) are less likely to have poor outcome, though having pain radiation (OR=3,657; 95%IC: 1,277- 10,470) predicted poor outcome. For global perception of change, at 6 weeks, being female (OR=3,225; 95%IC: 1,039-10,194) and overweight predited poor outcome. The 3 months follow-up didn’t show any variable with significant association with this outcome. Conclusions: In general the predictive models have reasonable classificative, predictive and discriminant properties. However, this study can be a contribute for, in the future, Physiotherapists can classify patients as “at risk” of poor outcome, according to their features, and having the possibility to give them specific interventions in order to improve their response.
Abstract: Introduction: The high poor outcome rates of the physiotherapy intervention, according to the clinical benefit analysis, suggest that individual patient features can influence poor/good outcome. Aim: The aim of this paper is to determine if a model based in prognostic factors can predict poor outcome in Chronic Low Back Pain (CLBP) patients in short and medium term, for the outcomes functional disability, pain intensity and global perception of change. Methodology: The sample of this prospective cohort study comprised 95 CLBP patients referred to physiotherapy. The patients were assessed before the intervention, 6 weeks after the start and 3 months after the end of the intervention. The poor outcome was defined according to the Minimal Clinically Important Difference for each outcome measures: Functional disability was assessed with the Quebec Back Pain Disability Scale, pain intensity with the Visual Analogue Scale and global perception of change with the Patient Global Impression of Change Scale. The socio-demographic and clinical data as well as kinesiophobia were also collected. Results: Of the 95 patients, 90 completed the three months follow-up. With the multivariate regression models was observed that patients with CLBP with high levels of disability at baseline (OR=0,936; 95% CI: 0,904-0,969) are less likely to have poor outcome for functional disability at 6 weeks. At three months, patients with high levels of disability at baseline (OR=0,943; 95%CI: 0,911-0,977) are less likely to have poor outcome, though those who have pain radiation (OR=3,237; 95%CI: 1,225-8,555) are more likely to have poor outcome for functional disability. For pain intensity, patients with high levels of pain intensity at baseline (OR=0,928; 95%IC: 0,899-0,959) are less likely to have poor outcome, though being overweight (OR=2,866; 95%IC: 1,025- 8,013) predicted poor outcome at 6 weeks. At three months, patients with high levels of pain intensity at baseline (OR=0,940; 95%IC: 0,914-0,968) are less likely to have poor outcome, though having pain radiation (OR=3,657; 95%IC: 1,277- 10,470) predicted poor outcome. For global perception of change, at 6 weeks, being female (OR=3,225; 95%IC: 1,039-10,194) and overweight predited poor outcome. The 3 months follow-up didn’t show any variable with significant association with this outcome. Conclusions: In general the predictive models have reasonable classificative, predictive and discriminant properties. However, this study can be a contribute for, in the future, Physiotherapists can classify patients as “at risk” of poor outcome, according to their features, and having the possibility to give them specific interventions in order to improve their response.
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
Prognóstico Fisioterapia Dor Lombar Crónica Insucesso Prognosis Physiotherapy Chronic Low Back Pain Poor Outcome
Citation
Publisher
Instituto Politécnico de Setúbal. Escola Superior de Saúde