Relação entre testes clínicos e desfechos de dor e incapacidade de pacientes com dor lombar crônica não específica submetidos ao programa de controle motor
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Data
2015-12-21
Autores
Oliveira, Crystian Bitencourt de [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Alterações referentes a instabilidade clínica em indivíduos com dor lombar crônica não específica estão bem estabelecidas na literatura. Para diminuir estas alterações, os exercícios de controle motor têm como objetivo restaurar a função estabilizadora dos músculos profundos da coluna lombar. Evidências recentes mostram que alguns pacientes com características específicas podem responder melhor ao programa de execícios de controle motor. Portanto, os objetivos desta dissertação foram investigar a reprodutibilidade intra examinador dos testes clínicos propostos e a relação preditiva destes com os desfechos clínicos – dor e incapacidade funcional – de pacientes com dor lombar crônica não específica submetidos ao programa de exercícios de controle motor. Foram inclusos 70 pacientes com dor lombar crônica não específica sendo que 64 completaram a intervenção. Na avaliação inicial foram coletados dados antropométricos e socio-demográficos, avaliações referentes aos desfechos clínicos - dor e incapacidade - e aplicação dos testes clínicos (ECC – Escala de Classificação Clínica; TCDT – Teste Clínico de Dissociação Toracolombar; TIP – Teste de Instabilidade em Prono; e TPEL – Teste Passivo de Extensão Lombar). Após uma semana os testes foram reaplicados, e em seguida inicio-se o programa exercícios de controle motor, com duração de 8 semanas, duas vezes por semana. Ao final deste programa, os desfechos de dor e incapacidade foram coletados novamente. Regressões lineares univariadas foram utilizadas para as análises de predição e Coeficiente de Correlação Intraclasse (CCI3,1) e o Coeficiente de Kappa (k) para as análises de reprodutibilidade. O TIP foi o único teste que apresentou valores de reprodutibilidade baixos (k = 0,28) e, por essa razão, não foi incluído nas análises de seguintes. O TPEL demonstrou capacidade de explicar os níveis de dor após o tratamento sendo que os pacientes com o teste positivo reportaram maiores níveis de dor do que aqueles com teste negativo. Futuros estudos devem validar estes resultados comparando com outros tipos de tratamento, considerando o TPEL, ou testar a eficácia de outras abordagens específicas para esse tipo de paciente.
Changes with respect to clinical instability in individuals with chronic nonspecific low back pain are well established in literature. To reduce these alterations, the motor control exercises are intended to restore the stabilizer function of the deep muscles of the lumbar spine. Recent evidence show that some patients with specific characteristics could respond better to the motor control exercises program. Thus, the objectives of this dissertation was to investigate the intrarrater reliability of clinical tests proposed and their predictive relation with the clinical outcomes - pain and functional disability – of patients with chronic nonspecific low back pain submitted to the motor control exercises program. Were included 70 patients with chronic nonspecific low back pain, that 64 completed the intervention. In the baseline assessment were collected anthropometric and sociodemographic data, assessment regarding clinical outcomes - pain and disability - and the application of the clinical tests (CCS - Clinical Classification Scale; CTDT - Clinical Test to Thoracolumbar Dissociation; PIT – Prone Instability Test; and PLET – Passive Lumbar Extension Test). After one week the tests were reapplied, and then began the motor control exercises program, with duration of eight weeks, twice per week. At the end of this program, the outcomes, pain and disability, were collected again. Univariate linear regressions were used to prediction analysis and Intraclass Coeficient Correlation (ICC3,1) and Kappa Coefficient (k) to reliability analysis. PIT was the only test that presented low values of reliability (k = 0,28) and for this reason, it was not included in the following analysis. PLET demonstrated ability to explain the pain levels after the treatment, where the patients with positive test reported higher pain levels of those with negative test. Further studies should validate these results comparing with other forms treatment forms, considering PLET, or to test the efficacy of others specific approaches to these type of patient.
Changes with respect to clinical instability in individuals with chronic nonspecific low back pain are well established in literature. To reduce these alterations, the motor control exercises are intended to restore the stabilizer function of the deep muscles of the lumbar spine. Recent evidence show that some patients with specific characteristics could respond better to the motor control exercises program. Thus, the objectives of this dissertation was to investigate the intrarrater reliability of clinical tests proposed and their predictive relation with the clinical outcomes - pain and functional disability – of patients with chronic nonspecific low back pain submitted to the motor control exercises program. Were included 70 patients with chronic nonspecific low back pain, that 64 completed the intervention. In the baseline assessment were collected anthropometric and sociodemographic data, assessment regarding clinical outcomes - pain and disability - and the application of the clinical tests (CCS - Clinical Classification Scale; CTDT - Clinical Test to Thoracolumbar Dissociation; PIT – Prone Instability Test; and PLET – Passive Lumbar Extension Test). After one week the tests were reapplied, and then began the motor control exercises program, with duration of eight weeks, twice per week. At the end of this program, the outcomes, pain and disability, were collected again. Univariate linear regressions were used to prediction analysis and Intraclass Coeficient Correlation (ICC3,1) and Kappa Coefficient (k) to reliability analysis. PIT was the only test that presented low values of reliability (k = 0,28) and for this reason, it was not included in the following analysis. PLET demonstrated ability to explain the pain levels after the treatment, where the patients with positive test reported higher pain levels of those with negative test. Further studies should validate these results comparing with other forms treatment forms, considering PLET, or to test the efficacy of others specific approaches to these type of patient.
Descrição
Palavras-chave
Dor lombar, Modalidade de fisioterapia, Instabilidade articular, Terapia por exercício, Avaliação de processos e resultados (cuidados de saúde), Low Back Pain, Physical Therapy Modalities, Joint Instability, Exercise therapy, Outcome and process assessment (Health Care)