Modelo cognitivo, comportamental e emocional da dor: avaliação em adultos com diferentes condições dolorosas
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Data
2017-09-29
Autores
Bonafé, Fernanda Salloume Sampaio [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
O objetivo deste estudo foi avaliar um modelo teórico cognitivo, comportamental e emocional relacionado à percepção da intensidade da dor e sua interferência no cotidiano e à qualidade de vida de indivíduos adultos com diferentes condições dolorosas. Para tanto, avaliaram-se as propriedades psicométricas dos instrumentos de medida utilizados. Trata-se de estudo transversal. Participaram 1.103 indivíduos que buscaram atendimento à Faculdade de Odontologia de Araraquara – UNESP nos anos de 2015 e 2016. Foram incluídos indivíduos adultos e os mesmos foram classificados segundo o relato de ausência de dor nas últimas 24 horas (G0), dor nas últimas 24 horas presente há menos de 3 meses (G1), dor recorrente presente há mais de 3 meses (G2) e dor contínua há mais de 3 meses (G3). Foram levantadas informações demográficas. As informações foram coletadas por meio de entrevista pessoal. A percepção da intensidade da dor e sua interferência no cotidiano foram avaliadas utilizando o Inventário Breve de Dor (BPI Forma Curta) adaptado, com período de referência “última experiência dolorosa”. A percepção da qualidade de vida foi obtida a partir do Questionário de Qualidade de Vida da Organização Mundial de Saúde (WHOQoL-Bref). Para mensuração das variáveis cognitivas, foram utilizados os instrumentos Questionário de Vigilância e Consciência relacionado à Dor (PVAQ) e a Escala de Catastrofização da Dor (PCS). Para as variáveis comportamentais, utilizou-se o Questionário de Autoeficácia relacionado à Dor (PSEQ) e a Escala Multidimensional de Locus de Controle da Saúde – Forma C (MHLC Forma C). Para as variáveis emocionais, foram utilizadas a Escala de Alexitimia de Toronto – 20 itens (TAS-20) e a Escala de Depressão, Ansiedade e Estresse – 21 itens (DASS-21). As validades de face, de conteúdo e de construto (fatorial, convergente e discriminante) dos instrumentos foram avaliadas. Realizou-se análise fatorial confirmatória (AFC) com os índices x2/gl, CFI e RMSEA. A confiabilidade também foi avaliada (alpha, confiabilidade composta). Para verificar a invariância da medida, foi realizada análise multigrupos. Foi proposto cômputo do escore global utilizando-se a matriz dos pesos de regressão da AFC. Construiu-se modelo estrutural para cada grupo segundo a condição dolorosa e utilizou-se o método de análise de trajetórias. Adotou-se nível de significância de 5%. Dos participantes, a maioria eram mulheres, com média de idade de 38,2±10,6 anos, casados/união estável, de nível econômico C. Os instrumentos foram válidos e confiáveis para a amostra após refinamento dos modelos. O modelo cognitivo, comportamental e emocional da dor ajustou-se para todos os grupos (G0, G1, G2 e G3) e explicou de 23 a 36% da variabilidade da percepção da intensidade da dor, 63 a 73% da variabilidade da percepção da interferência da dor no cotidiano e 33 a 62% da variabilidade da qualidade de vida dos indivíduos. Houve grande contribuição das variáveis cognitivas na percepção da intensidade da dor e das variáveis comportamentais e emocionais na percepção da interferência da dor no cotidiano e na qualidade de vida.
The purpose of this study was to evaluate a theoretical cognitive, behavioral, and emotional model for pain that considers individuals’ perceptions of the intensity of pain and its interference in daily function and their quality of life among adults with different pain conditions. To achieve this, the psychometric properties of the measurement instruments used herein were evaluated. This was a cross-sectional study. This study involved 1,103 adults who sought treatment at the School of Dentistry of São Paulo State University (UNESP), Araraquara in 2015 and 2016. The adults included in the study were classified based on their reports of a lack of pain the last 24 hours (G0), of pain in the previous 24 hours and had been experiencing pain for less than three months (G1), of recurrent pain for three months or more (G2), and of continuous pain for three months or more (G3). Demographic information was also collected through personal interviews. Perceptions of pain intensity and interference in daily function were evaluated using an adapted version of the Brief Pain Inventory (BPI-Short Form) for which the period of reference was “the last painful experience”. Perceptions of quality of life were obtained using the World Health Organization Quality of Life Questionnaire (WHOQoL-BREF). The cognitive variables were measured using the Pain Vigilance and Awareness Questionnaire (PVAQ) and the Pain Catastrophizing Scale (PCS). Behavioral variables were assessed using the Pain Self-Efficacy Questionnaire (PSEQ) and the Multidimensional Health Locus of Control (MHLC Form C). For the emotional variables, the instruments used were the 20-Item Toronto Alexithymia Scale (TAS-20) and the short version of the Depression Anxiety Stress Scales (DASS-21). Face, content, and construct validity of the instruments (including factor, convergent, and discriminant validity) were also determined. Confirmatory factor analysis (CFA) was performed with x2/df, CFI and RMSEA. Reliability was also evaluated (alpha, composite reliability). Multigroup analysis was used to determine the invariance of models’ parameters. The overall score was calculated using the regression weight matrix obtained in the CFA. A structural model was constructed for each group based on their pain conditions using path analysis. A significance level of 5% was adopted. Of the participants, the majority were women, the average age was 38,2±10,6 years, the majority were married or in a common-law marriage, and they reported an average monthly income of US$ 670.28. The instruments were valid and reliable for the sample after model refinement. The cognitive, behavioral, and emotional models for pain were fit to all of the groups (G0, G1, G2, and G3) and explained 23% to 36% of the variability in perceptions of pain intensity, 63% to 73% of the variability in perceptions of the interference of pain in daily function, and 22% to 62% of the variability in the participants' quality of life. The cognitive variables made a substantial contribution to perceptions of pain intensity, and the behavioral and emotional variables made substantial contributions to perceptions of the interference of pain in daily function and of quality of life.
The purpose of this study was to evaluate a theoretical cognitive, behavioral, and emotional model for pain that considers individuals’ perceptions of the intensity of pain and its interference in daily function and their quality of life among adults with different pain conditions. To achieve this, the psychometric properties of the measurement instruments used herein were evaluated. This was a cross-sectional study. This study involved 1,103 adults who sought treatment at the School of Dentistry of São Paulo State University (UNESP), Araraquara in 2015 and 2016. The adults included in the study were classified based on their reports of a lack of pain the last 24 hours (G0), of pain in the previous 24 hours and had been experiencing pain for less than three months (G1), of recurrent pain for three months or more (G2), and of continuous pain for three months or more (G3). Demographic information was also collected through personal interviews. Perceptions of pain intensity and interference in daily function were evaluated using an adapted version of the Brief Pain Inventory (BPI-Short Form) for which the period of reference was “the last painful experience”. Perceptions of quality of life were obtained using the World Health Organization Quality of Life Questionnaire (WHOQoL-BREF). The cognitive variables were measured using the Pain Vigilance and Awareness Questionnaire (PVAQ) and the Pain Catastrophizing Scale (PCS). Behavioral variables were assessed using the Pain Self-Efficacy Questionnaire (PSEQ) and the Multidimensional Health Locus of Control (MHLC Form C). For the emotional variables, the instruments used were the 20-Item Toronto Alexithymia Scale (TAS-20) and the short version of the Depression Anxiety Stress Scales (DASS-21). Face, content, and construct validity of the instruments (including factor, convergent, and discriminant validity) were also determined. Confirmatory factor analysis (CFA) was performed with x2/df, CFI and RMSEA. Reliability was also evaluated (alpha, composite reliability). Multigroup analysis was used to determine the invariance of models’ parameters. The overall score was calculated using the regression weight matrix obtained in the CFA. A structural model was constructed for each group based on their pain conditions using path analysis. A significance level of 5% was adopted. Of the participants, the majority were women, the average age was 38,2±10,6 years, the majority were married or in a common-law marriage, and they reported an average monthly income of US$ 670.28. The instruments were valid and reliable for the sample after model refinement. The cognitive, behavioral, and emotional models for pain were fit to all of the groups (G0, G1, G2, and G3) and explained 23% to 36% of the variability in perceptions of pain intensity, 63% to 73% of the variability in perceptions of the interference of pain in daily function, and 22% to 62% of the variability in the participants' quality of life. The cognitive variables made a substantial contribution to perceptions of pain intensity, and the behavioral and emotional variables made substantial contributions to perceptions of the interference of pain in daily function and of quality of life.
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Palavras-chave
Psicometria, Psicologia, Psychometrics, Psychology, Pain measurement, Medição da dor