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Será a Escala Tampa de Cinesiofobia-13 útil na identificação precoce de utentes com dor lombar crónica, em risco de obter resultados de insucesso após a Fisioterapia?
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Introdução: A prevalência crescente de dor lombar crónica (DLC) e o elevado impacto
socioeconómico, levaram à identificação de fatores de prognóstico, associados a dor e
incapacidade persistentes, dos quais se destaca a cinesiofobia. A Escala Tampa reúne boas
capacidades psicométricas, para avaliação da cinesiofobia em utentes com DL, e o seu valor
de prognóstico, é sugerido na literatura. Este estudo propõe-se investigar a validade preditiva
da versão portuguesa da escala Tampa de cinesiofobia (TSK-13PT) e das suas componentes,
na detecção de utentes com DLC, em risco de alcançar resultados de insucesso, após o
tratamento. Metodologia: Uma coorte prospetiva de 215 utentes, com dor lombar inespecífica
foi avaliada no inicio e após 6 semanas de tratamento. Inicialmente, a cinesiofobia foi
avaliada pela TSK-13PT. As variáveis incapacidade e intensidade da dor foram mensuradas,
em ambos os momentos de avaliação e a percepção subjetiva de melhoria, no final do estudo.
Posteriormente, os utentes foram classificados consoante os resultados de sucesso ou
insucesso, para cada uma das variáveis. A validade preditiva da TSK-13PT e respetivas
componentes foi avaliada através de estatística C e do cálculo de rácios de probabilidade (RP).
Resultados: Dos 192 participantes que completaram o estudo, 38.5%, 51.6% e 31.8% foram
classificados como insucesso relativamente à dor, incapacidade e percepção de melhoria,
respetivamente. Foram identificados valores de coorte de 31 e 19 pontos para a TSK-13PT e a
componente evitamento, com uma acurácia de 0.60 e 0.59, na predição de resultados ao nível
da incapacidade. RP positivos e negativos da TSK-13PT (1.5; 0.67) e evitamento (1.4; 0.69)
revelaram que estas medidas não eram preditivas de resultados de insucesso para esta variável.
Conclusão: Este estudo não suporta a utilização TSK-13PT, na identificação precoce de
utentes com DLC, em risco de obter resultados de insucesso, após a fisioterapia.
Background:!The increasing prevalence of chronic low back pain (CLBP) and socioeconomic burden, led to the identification of prognostic factors associated with persistent pain and disability, of which kinesiophobia stands out. Tampa reveals good psychometric properties to evaluate kinesiophobia in low back patients and its prognostic value is suggested in literature. This study intends to investigate the predictive validity of the Portuguese version of Tampa Scale of Kinesiophobia (TSK-13PT) and its components, for screening CLBP patients, at risk of poor recovery. Methods: A cohort of 215 of nonspecific CLBP patients was assessed at the beginning and after 6 weeks of treatment. Initially, Kinesiophobia was measured by TSK- 13PT. Disability and pain intensity were assessed at both, initial and final assessment and global perceived effect was measured at the end. Subsequently, patients were classified according to success or failure, for each outcome. The predictive validity of the TSK-13PT and its components was evaluated through C statistics and Likelihood Ratios (LR). Results: From 192 participants who completed the study, 38.5%, 51.6% and 31.8% were classified as unsuccessful in regard to pain, disability and global perceived effect, respectively. Cohort values of 31 and 19 points were identified for the TSK-13PT and avoidance component, with an accuracy of 0.60 and 0.59, to predict disability outcomes. Positive and negative LR of TSK-13PT (1.5; 0.67) and avoidance (1.4; 0.69) revealed that these measures were not predictive of unsuccessful results for this outcome. Conclusion: The use of TSK-13 as a screening tool to identify patients with nonspecific CLBP at risk of poor outcome following physiotherapy treatment was not supported.
Background:!The increasing prevalence of chronic low back pain (CLBP) and socioeconomic burden, led to the identification of prognostic factors associated with persistent pain and disability, of which kinesiophobia stands out. Tampa reveals good psychometric properties to evaluate kinesiophobia in low back patients and its prognostic value is suggested in literature. This study intends to investigate the predictive validity of the Portuguese version of Tampa Scale of Kinesiophobia (TSK-13PT) and its components, for screening CLBP patients, at risk of poor recovery. Methods: A cohort of 215 of nonspecific CLBP patients was assessed at the beginning and after 6 weeks of treatment. Initially, Kinesiophobia was measured by TSK- 13PT. Disability and pain intensity were assessed at both, initial and final assessment and global perceived effect was measured at the end. Subsequently, patients were classified according to success or failure, for each outcome. The predictive validity of the TSK-13PT and its components was evaluated through C statistics and Likelihood Ratios (LR). Results: From 192 participants who completed the study, 38.5%, 51.6% and 31.8% were classified as unsuccessful in regard to pain, disability and global perceived effect, respectively. Cohort values of 31 and 19 points were identified for the TSK-13PT and avoidance component, with an accuracy of 0.60 and 0.59, to predict disability outcomes. Positive and negative LR of TSK-13PT (1.5; 0.67) and avoidance (1.4; 0.69) revealed that these measures were not predictive of unsuccessful results for this outcome. Conclusion: The use of TSK-13 as a screening tool to identify patients with nonspecific CLBP at risk of poor outcome following physiotherapy treatment was not supported.
Descrição
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
Palavras-chave
Escala Tampa de cinesiofobia validade preditiva cinesiofobia dor lombar crónica Tampa scale of kinesiophobia predictive validity kinesiophobia chronic low back pain
Contexto Educativo
Citação
Editora
Instituto Politécnico de Setúbal. Escola Superior de Saúde