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Abstract(s)
Introdução: A lombalgia é a principal causa de incapacidade, exigindo cuidados de saúde de elevado valor. No entanto, a prática em fisioterapia mantém-se heterogénea e muitas vezes não alinhada com a evidência. Em Portugal, coexistem dois modelos de acesso (convencionado-SNS e privado), cuja efetividade comparativa e padrões de dose-resposta são desconhecidos. Objetivos: (1) comparar o padrão de dose (frequência, tempo, tipo) da fisioterapia na lombalgia entre o contexto convencionado e privado; e (2) examinar a relação destas variáveis de dose com os resultados clínicos. Metodologia: Foi realizado um estudo observacional de coorte prospetivo com 56 utentes (30 convencionado; 26 privado) com lombalgia. Os utentes foram avaliados no baseline (T0) e às 6 semanas (T3) com a Escala Numérica da Dor (END), Roland-Morris Disability Questionnaire (RMDQ) e EQ-5D-3L. A dose e as modalidades foram registadas pelos fisioterapeutas. Foram usados testes não-paramétricos (Mann-Whitney U, Qui-Quadrado). Resultados: O contexto privado obteve resultados clínicos significativamente superiores na incapacidade (Dif.RMDQ, p=0,003) e uma maior proporção de utentes atingiu a Diferença Mínima Clinicamente Importante (DMCI) na dor (p=0,009) e incapacidade (p=0,003). Este resultado foi alcançado com menos sessões totais (Mediana 4 vs. 12, p<0,001) mas sessões significativamente mais longas (Mediana 60 vs. 40 min, p<0,001). A Duração da Sessão foi a única variável de dose associada à DMCI (p<0,05). O privado utilizou significativamente mais Educação (100% vs. 63,3%) e menos modalidades passivas (Eletroterapia, p<0,001). Os grupos não eram comparáveis na baseline, com o grupo convencionado a apresentar maior severidade (Dor Contínua, p<0,001). Conclusão: O contexto de prática influencia a dose e os resultados. A superioridade clínica do privado associou-se a um modelo alinhado com a evidência (sessões longas, foco na educação e intervenção ativa), em contraste com o modelo de alto volume e passivo do convencionado. Os resultados devem ser ponderados pelo viés de seleção (severidade inicial) entre grupos.
Introduction: Low back pain (LBP) is the leading cause of disability, requiring high-value healthcare. However, physiotherapy practice remains heterogeneous and often misaligned with evidence. In Portugal, two access models (conventioned-SNS and private) coexist, whose comparative effectiveness and dose-response patterns are unknown. Objectives: (1) To compare the dose pattern (frequency, time, type) of physiotherapy for LBP between contexts; and (2) to examine the relationship between these dose variables and clinical outcomes. Methodology: A prospective observational cohort study was conducted with 56 LBP patients (30 conventional; 26 private). Patients were assessed at baseline and at 6 weeks using the Numeric Pain Rating Scale (NPRS), Roland-Morris Disability Questionnaire (RMDQ), and EQ-5D-3L. Dose and modalities were recorded by physiotherapists. Non-parametric tests (Mann-Whitney U, Chi-Square) were used. Results: The private context achieved significantly superior clinical outcomes across all outcomes and a higher proportion of patients reached the Minimal Clinically Important Difference (MCID) in pain (p=0.009) and disability (p=0.003). This was achieved with fewer total sessions (Median 4 vs. 12, p<0.001) but significantly longer sessions (Median 60 vs. 40 min, p<0.001). Session Duration was the only dose variable associated with achieving MCID (p<0.05). The private context used significantly more Education (100% vs. 63.3%) and fewer passive modalities (Electrotherapy, p<0.001). The groups were not comparable at baseline, as the conventional group presented greater severity (Continuous Pain, p<0.001). Conclusion: Practice context influences dose and results. The clinical superiority of the private setting was associated with an evidence-aligned model (long sessions, focus on education and active intervention), in contrast to the high-volume, passive model of the conventional setting. Results must be weighed against the significant selection bias (initial severity) between groups.
Introduction: Low back pain (LBP) is the leading cause of disability, requiring high-value healthcare. However, physiotherapy practice remains heterogeneous and often misaligned with evidence. In Portugal, two access models (conventioned-SNS and private) coexist, whose comparative effectiveness and dose-response patterns are unknown. Objectives: (1) To compare the dose pattern (frequency, time, type) of physiotherapy for LBP between contexts; and (2) to examine the relationship between these dose variables and clinical outcomes. Methodology: A prospective observational cohort study was conducted with 56 LBP patients (30 conventional; 26 private). Patients were assessed at baseline and at 6 weeks using the Numeric Pain Rating Scale (NPRS), Roland-Morris Disability Questionnaire (RMDQ), and EQ-5D-3L. Dose and modalities were recorded by physiotherapists. Non-parametric tests (Mann-Whitney U, Chi-Square) were used. Results: The private context achieved significantly superior clinical outcomes across all outcomes and a higher proportion of patients reached the Minimal Clinically Important Difference (MCID) in pain (p=0.009) and disability (p=0.003). This was achieved with fewer total sessions (Median 4 vs. 12, p<0.001) but significantly longer sessions (Median 60 vs. 40 min, p<0.001). Session Duration was the only dose variable associated with achieving MCID (p<0.05). The private context used significantly more Education (100% vs. 63.3%) and fewer passive modalities (Electrotherapy, p<0.001). The groups were not comparable at baseline, as the conventional group presented greater severity (Continuous Pain, p<0.001). Conclusion: Practice context influences dose and results. The clinical superiority of the private setting was associated with an evidence-aligned model (long sessions, focus on education and active intervention), in contrast to the high-volume, passive model of the conventional setting. Results must be weighed against the significant selection bias (initial severity) between groups.
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Keywords
Lombalgia Fisioterapia Dose-Resposta Contexto de Prática Low Back Pain Physiotherapy Dose-Response Practice Setting