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Avaliação e Tratamento da Lombalgia nos Cuidados de Saúde Primários: Projeto SPLIT
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Advisor(s)
Abstract(s)
Introdução: A lombalgia permanece um desafio para os cuidados de saúde primários (CSP). Em Portugal desconhece-se como é desenvolvida a prática atual nos CSP na gestão de utentes com lombalgia de origem não específica (LNe), e se esta integra as recomendações atuais para o diagnóstico e intervenção nesta população, relativamente à prescrição de exames complementares de diagnóstico, medicação e certificados de incapacidade pelos médicos de medicina geral e familiar (MG&F).
Objetivo: Caraterizar a prática atual de diagnóstico e tratamento, e avaliar os resultados clínicos obtidos aos 2 e 6 meses após consulta, em utentes com LNe que recorrem aos CSP, de acordo com a decisão clínica dos médicos de MG&F das Unidades de Saúde Familiar e Unidades de Cuidados de Saúde Personalizados do Agrupamento de Centros de Saúde da Arrábida.
Metodologia: Realizou-se um estudo cohort prospetivo observacional com 115 utentes recrutados durante consulta médica. O outcome primário foi a incapacidade funcional, e os secundários foram a intensidade da dor, qualidade de vida relacionada com a saúde e perceção global de melhoria, tendo os dados sido recolhidos e o seu curso clínico analisado na baseline e aos 2 e 6 meses. Foram definidos critérios para a melhoria clínica importante e recuperação.
Resultados: Foram prescritos exames complementares de diagnóstico a 48% dos utentes e a principal estratégia de tratamento utilizado foi a medicação (85,1%%), com apenas 8,3% dos utentes referenciados para Fisioterapia. Apenas 12% dos utentes alcançou o critério de recuperação estabelecido para a incapacidade funcional, 38% para a intensidade da dor e 10% para a perceção global de melhoria, e cerca de 54% apresentou pontuações compatíveis com uma elevada probabilidade de desenvolver uma condição crónica. A percentagem de utentes que reportou melhorias clinicamente importantes nos diferentes outcomes aos 2 e 6 meses foi semelhante (cerca de 50%), sendo maioritariamente registadas em utentes com dor aguda/subaguda. Dos 2 para os 6 meses as alterações registadas nos diferentes outcomes foram mínimas, indicando que os principais ganhos são obtidos até aos 2 meses.
Conclusões: Os resultados sugerem que o padrão de prática usual não está alinhado com as recomendações das normas de orientação clínica atuais e pode não estar a proporcionar os melhores resultados aos utentes com LNe.
Introduction: Low back pain (LBP) remains a challenge for primary health care. In Portugal it is unknown how the current practice is developed in the primary health care in the management of patients with non-specific low back pain (NsLBP), and whether if it integrates the current recommendations for diagnosis and intervention in this population, regarding the prescription of imaging exams, medication and certificates of incapacity by the general and family medicine doctor. Objective: Characterize the current practice of diagnosis and referral for treatment of patients with NsLBP at baseline, 2 and 6 months after consultation, according to the clinical judgment of general and family medicine doctor from the Unidades de Saúde Familiar of the Agrupamento de Centros de Saúde da Arrábida. Methodology: A prospective observational cohort study was carried out with 115 patients recruited during medical consultations. Primary outcome was functional disability, and secondary outcomes were pain intensity, health-related quality of life, and overall perception of improvement. Data was collected and clinical course assessed at baseline, 2 and 6 months. Criteria for an important clinical improvement and recovery were defined. Results: Imaging exams were prescribed to 48% of the patients, and the main treatment strategy used was medication (85.1%), with only 8.3% of the patients being referred to Physiotherapy. Only 12% of the patients achieved the established recovery criteria for functional disability, 38% for pain intensity and 10% for overall perception of improvement, and about 54% presented scores compatible with a high probability of developing a chronic condition. The percentage of patients who reported clinical important improvements and who recovered at 2 and 6 months were similar (about 50%), being the majority registered in patients with acute/subacute pain. From 2 to 6 months, the changes registered in the different outcomes were minimal, indicating that the main gains are obtained up to 2 months. Conclusions: The results suggest that the usual practice does not follow the current clinical guideline recommendations and may not be providing the best results for patients with NsLBP.
Introduction: Low back pain (LBP) remains a challenge for primary health care. In Portugal it is unknown how the current practice is developed in the primary health care in the management of patients with non-specific low back pain (NsLBP), and whether if it integrates the current recommendations for diagnosis and intervention in this population, regarding the prescription of imaging exams, medication and certificates of incapacity by the general and family medicine doctor. Objective: Characterize the current practice of diagnosis and referral for treatment of patients with NsLBP at baseline, 2 and 6 months after consultation, according to the clinical judgment of general and family medicine doctor from the Unidades de Saúde Familiar of the Agrupamento de Centros de Saúde da Arrábida. Methodology: A prospective observational cohort study was carried out with 115 patients recruited during medical consultations. Primary outcome was functional disability, and secondary outcomes were pain intensity, health-related quality of life, and overall perception of improvement. Data was collected and clinical course assessed at baseline, 2 and 6 months. Criteria for an important clinical improvement and recovery were defined. Results: Imaging exams were prescribed to 48% of the patients, and the main treatment strategy used was medication (85.1%), with only 8.3% of the patients being referred to Physiotherapy. Only 12% of the patients achieved the established recovery criteria for functional disability, 38% for pain intensity and 10% for overall perception of improvement, and about 54% presented scores compatible with a high probability of developing a chronic condition. The percentage of patients who reported clinical important improvements and who recovered at 2 and 6 months were similar (about 50%), being the majority registered in patients with acute/subacute pain. From 2 to 6 months, the changes registered in the different outcomes were minimal, indicating that the main gains are obtained up to 2 months. Conclusions: The results suggest that the usual practice does not follow the current clinical guideline recommendations and may not be providing the best results for patients with NsLBP.
Description
Dissertação de Mestrado em Fisioterapia em Condições Músculo-Esqueléticas
Keywords
Lombalgia Caraterização da prática Curso clínico Cuidados de saúde primários Tomada de decisão clínica Low back pain Practice characterization Clinical course Primary health care Clinical decision making