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Curso Clínico, com base nos mecanismos de produção de dor, em utentes com dor cervical crónica, submetidos a intervenção de fisioterapia
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Advisor(s)
Abstract(s)
Introdução: A Dor Cervical Crónica (DCC) é uma das principais causas de
incapacidade no mundo. Literatura prévia sugere que, o curso clínico de utentes
com DCC poderá apresentar evoluções clínicas distintas considerando o
Mecanismo de Produção de Dor (MPD) subjacente. Objetivo: Descrever o curso
clínico de utentes com Dor Cervical Crónica Não Específica (DCCNE),
considerando os MPD (nociceptivo, misto ou neuropático), quando submetidos
a um programa de Terapia Manual e Exercício (TME) (Coorte I) ou um programa
de Prática Clínica Usual (PCU) (Coorte II). Metodologia: Realizou-se uma
análise secundária de dois grupos (Coorte I e Coorte II), num total de 103
participantes. Cada Coorte foi subdividida em 3 subgrupos, considerando o MPD
predominante na baseline. Foram realizados 5 momentos de avaliação: baseline,
3 e 6 semanas de tratamento e 3 e 6 meses após término da intervenção. As
variáveis analisadas foram: intensidade da dor, incapacidade funcional e
percepção global de melhoria (PGM). Resultados: O curso clínico dos utentes
com DCCNE tem tendência a melhorar ao longo do período em estudo. Na
comparação entre subgrupos de utentes com MPD diferentes, na Coorte I
verificaram-se diferenças significativas na variável PGM, às 3 e 6 semanas de
tratamento e aos 3 meses de follow-up (p<0,024), favorecendo o subgrupo de
dor neuropática. Na Coorte II, verificaram-se diferenças significativas na variável
PGM, em todos os momentos (p<0,022) e na variável intensidade da dor, às 3
semanas de tratamento e nos 6 meses de follow-up (p<0,026), favorecendo o
subgrupo de dor nociceptiva. Na comparação de subgrupos de utentes com MPD
semelhantes (Coortes diferentes) houve diferenças significativas na variável
intensidade da dor, incapacidade funcional e PGM suportando uma evolução
mais favorável nos subgrupos submetidos a TME (p<0,035). Conclusão: O
curso clínico de utentes com DCCNE parece apresentar uma tendência de
evolução favorável ao longo do tempo, independentemente do MPD subjacente.
Os subgrupos que receberam intervenção de TME parecem apresentar um curso
clínico mais favorável em comparação com os subgrupos que receberam PCU.
Introduction: Chronic Neck Pain (CNP) is one of the leading causes of disability in the world. Previous literature suggests that the clinical course of patients with CNP may present specific clinical evolutions, considering the underlying Pain Mechanisms (PM). Objective: To describe the clinical course of patients with Non-Specific CNP, considering PM (nociceptive, mixed or neuropathic), when submitted to a Manual Therapy and Exercise program (MTE) (Cohort I) or a Usual Care (Cohort II). Methodology: A secondary analysis was carried out analyzing two groups (Cohort I and Cohort II) in a total of 103 participants. Each Cohort was divided into 3 subgroups, considering predominantly PM at baseline. They were assessed at baseline, 3 and 6 weeks of treatment and 3 and 6 months after discharge. The measured outcomes were pain intensity, functional disability and global perception of change (GPC). Results: The outcomes, of the clinical course, of patients with non-specific CNP tend to improve over the period under study. When comparing subgroups of patients with different PM in Cohort I were found significant differences in the outcome GPC, at 3 and 6 weeks of treatment and 3 months of follow-up (p<0.024), favouring the neuropathic pain subgroup. In Cohort II, there were significant differences in GPC at all evaluated moments (p<0.022) and in pain intensity at 3 weeks of treatment and in the 6 months of follow-up (p<0.026), favouring the subgroup of nociceptive pain. When comparing subgroups of patients with similar PM, from different cohorts, there were significant differences in the outcomes pain intensity, functional disability and GPC, supporting a more beneficial evolution in the subgroups of MTE (p<0.035). Conclusion: The clinical course of users with Non-specific NP tends to evolve progressively over time, regardless of the underlying PM. However, subgroups receiving MTE intervention appear to have a more favourable clinical course than subgroups receiving Usual Care.
Introduction: Chronic Neck Pain (CNP) is one of the leading causes of disability in the world. Previous literature suggests that the clinical course of patients with CNP may present specific clinical evolutions, considering the underlying Pain Mechanisms (PM). Objective: To describe the clinical course of patients with Non-Specific CNP, considering PM (nociceptive, mixed or neuropathic), when submitted to a Manual Therapy and Exercise program (MTE) (Cohort I) or a Usual Care (Cohort II). Methodology: A secondary analysis was carried out analyzing two groups (Cohort I and Cohort II) in a total of 103 participants. Each Cohort was divided into 3 subgroups, considering predominantly PM at baseline. They were assessed at baseline, 3 and 6 weeks of treatment and 3 and 6 months after discharge. The measured outcomes were pain intensity, functional disability and global perception of change (GPC). Results: The outcomes, of the clinical course, of patients with non-specific CNP tend to improve over the period under study. When comparing subgroups of patients with different PM in Cohort I were found significant differences in the outcome GPC, at 3 and 6 weeks of treatment and 3 months of follow-up (p<0.024), favouring the neuropathic pain subgroup. In Cohort II, there were significant differences in GPC at all evaluated moments (p<0.022) and in pain intensity at 3 weeks of treatment and in the 6 months of follow-up (p<0.026), favouring the subgroup of nociceptive pain. When comparing subgroups of patients with similar PM, from different cohorts, there were significant differences in the outcomes pain intensity, functional disability and GPC, supporting a more beneficial evolution in the subgroups of MTE (p<0.035). Conclusion: The clinical course of users with Non-specific NP tends to evolve progressively over time, regardless of the underlying PM. However, subgroups receiving MTE intervention appear to have a more favourable clinical course than subgroups receiving Usual Care.
Description
Keywords
Dor Cervical Crónica Mecanismos de Produção de Dor Neck Pain Pain Mechanism