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Será a catastrofização da dor um fator de prognóstico para os resultados da Fisioterapia em indivíduos com DLC?
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Abstract(s)
Introdução: Os resultados da intervenção da Fisioterapia em indivíduos com Dor
Lombar Crónica (DLC) nem sempre são satisfatórios. Uma das razões apontadas para
valores tão expressivos de resultados de insucesso da Fisioterapia são os fatores
psicológicos (cognitivos) como a catastrofização da dor. Objetivo: Este estudo
pretende investigar a relação entre os níveis de catastrofização da dor apresentados no
inicio do tratamento de Fisioterapia em utentes com DLC e os resultados obtidos com
a intervenção. Metodologia: A amostra deste estudo de coorte prospetivo foi
composta por 64 indivíduos referenciados para a Fisioterapia, avaliados no início da
intervenção e posteriormente às 4 e 8 semanas e 3 meses após o início da intervenção.
O insucesso foi determinado segundo a Diferença Mínima Clinicamente Importante
para cada instrumento de medida. Foram recolhidos dados sociodemográficos e
clínicos e aplicados os seguintes instrumentos de medida: Pain Catastrophizing Scale
(PCS-PT), Escala Numérica da Dor (END), Quebec Back Pain Disability Scale
(QBPDS-PT) e Global Back Recovery Scale (GBRS). Resultados: O perfil
catastrofizador esteve significativamente associado com a toma de medicação (p =
0,002), situação profissional (p = 0,049) e absentismo laboral (p = 0,048). Estes
indivíduos apresentaram uma média superior de idade (p = 0,027) e maior nível de
intensidade da dor (p = 0,030) e incapacidade funcional (p < 0,005) na baseline.
Considerando o curso clínico da resposta à intervenção da Fisioterapia, observou-se
uma diminuição nas pontuações médias da END e QBPDS, apontando para a
diminuição da intensidade da dor e melhoria da incapacidade funcional. A toma de
medicação apresentou uma associação estatisticamente significativa com o grupo que
obteve insucesso na END às 4 e às 8 semanas de intervenção (p = 0,016 e p = 0,001) e
na QBPDS às 4 semanas de intervenção (p = 0,034). Foi ainda possível encontrar uma
associação estatisticamente significativa entre as habilitações literárias e o insucesso
na END (p = 0,045) e na QBPDS (p = 0,045) às 8 semanas e entre o absentismo
laboral e o insucesso da END às 4 semanas (p = 0,023). Foram observadas diferenças
estatisticamente significativas relativamente à idade entre as medianas dos dois
grupos de insucesso/sucesso na QBPDS às 4 semanas (p = 0,007) e também
relativamente ao IMC na incapacidade funcional às 8 semanas (p = 0,036). Não foram
encontradas associações significativas entre a PCS e os outcomes do estudo em
nenhum dos momentos de avaliação. Conclusões: A catastrofização aparenta estar
associada a níveis mais elevados de intensidade da dor e incapacidade funcional na
avaliação inicial. Contudo, estas diferenças não se refletem na obtenção de resultados
de insucesso, não sendo possível associar maiores níveis de catastrofização na
avaliação inicial a piores resultados de intervenção.
Introduction: The outcomes of Physiotherapy treatment in patients with Chronic Lower Back Pain (CLBP) are not always successful. One of the reasons given for such expressive poor outcomes are the psychological (cognitive) factors as pain catastrophizing. Aim: The aim of this study was to investigate the relationship between pain catastrophizing assessed in the baseline and the outcomes obtained with the Physiotherapy treatment. Methodology: The sample of this prospective cohort study comprised of 64 CLBP patients, referred for Physiotherapy treatment. The patients were assessed at baseline, 4 and 8 weeks later, and at 3 months follow-up. The poor outcome was defined according to the Minimal Clinically Important Difference for each outcome measures. Sociodemographic and clinical data were collected and the following measurement instruments were applied: Pain Catastrophizing Scale (PCS-PT), Numeric Rating Scale for pain (NRS), Quebec Back Pain Disability Scale (QBPDS-PT) and Global Back Recovery Scale (GBRS). Results: The catastrophizing profile was significantly associated with medication (p = 0.002), work status (p = 0.049) and work absenteeism (p = 0.048). These patients had higher mean age (p = 0.027), and higher pain intensity (p = 0.030) and functional disability (p < 0.005) at baseline. Considering the clinical course of the response to the treatment, there was a decrease in the mean scores of NRS and QBPDS, indicating a decrease in pain intensity and improvement of disability. In the poor outcome group, medication had statistically significant association with the NRS, at 4 and 8 weeks of treatment (p = 0.016 and p = 0.001), and QBPDS at the 4 week treatment period (p = 0.034). It was also possible to find a statistically significant association between education and poor outcome group at NRS (p = 0.045) and QBPDS (p = 0.045) at 8 weeks and between work absenteeism and NRS at 4 weeks (p = 0.023). There were statistically significant differences between the medians of poor and good outcomes groups in the QBPDS at 4 weeks (p = 0.007) and between BMI at functional disability at 8 weeks (p = 0.036). No significant associations were found between PCS and study outcomes in any moment of this study. Conclusions: Pain catastrophizing appear to be associated with higher levels of pain intensity and functional disability at baseline. However, these differences are not reflected in poor outcomes and it is not possible to associate higher levels of pain catastrophizing in the baseline with worst treatment results.
Introduction: The outcomes of Physiotherapy treatment in patients with Chronic Lower Back Pain (CLBP) are not always successful. One of the reasons given for such expressive poor outcomes are the psychological (cognitive) factors as pain catastrophizing. Aim: The aim of this study was to investigate the relationship between pain catastrophizing assessed in the baseline and the outcomes obtained with the Physiotherapy treatment. Methodology: The sample of this prospective cohort study comprised of 64 CLBP patients, referred for Physiotherapy treatment. The patients were assessed at baseline, 4 and 8 weeks later, and at 3 months follow-up. The poor outcome was defined according to the Minimal Clinically Important Difference for each outcome measures. Sociodemographic and clinical data were collected and the following measurement instruments were applied: Pain Catastrophizing Scale (PCS-PT), Numeric Rating Scale for pain (NRS), Quebec Back Pain Disability Scale (QBPDS-PT) and Global Back Recovery Scale (GBRS). Results: The catastrophizing profile was significantly associated with medication (p = 0.002), work status (p = 0.049) and work absenteeism (p = 0.048). These patients had higher mean age (p = 0.027), and higher pain intensity (p = 0.030) and functional disability (p < 0.005) at baseline. Considering the clinical course of the response to the treatment, there was a decrease in the mean scores of NRS and QBPDS, indicating a decrease in pain intensity and improvement of disability. In the poor outcome group, medication had statistically significant association with the NRS, at 4 and 8 weeks of treatment (p = 0.016 and p = 0.001), and QBPDS at the 4 week treatment period (p = 0.034). It was also possible to find a statistically significant association between education and poor outcome group at NRS (p = 0.045) and QBPDS (p = 0.045) at 8 weeks and between work absenteeism and NRS at 4 weeks (p = 0.023). There were statistically significant differences between the medians of poor and good outcomes groups in the QBPDS at 4 weeks (p = 0.007) and between BMI at functional disability at 8 weeks (p = 0.036). No significant associations were found between PCS and study outcomes in any moment of this study. Conclusions: Pain catastrophizing appear to be associated with higher levels of pain intensity and functional disability at baseline. However, these differences are not reflected in poor outcomes and it is not possible to associate higher levels of pain catastrophizing in the baseline with worst treatment results.
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
Dor Lombar Crónica Fisioterapia Catastrofização da Dor Resultados de Insucesso Chronic Low Back Pain Physiotherapy Pain Catastrophizing Poor Outcomes
Citation
Publisher
Instituto Politécnico de Setúbal. Escola Superior de Saúde