Concordância entre avaliadores nos diferentes protocolos de estratificação de risco para reabilitação cardiovascular
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Data
2018-02-01
Autores
Haddad, Maria Isabela Ramos
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: Para aumentar a segurança dos indivíduos que estão inseridos em programas de reabilitação cardiovascular (PRC) a estratificação de risco é importante. Existem diversos protocolos que podem ser utilizados para essa finalidade e diversos avaliadores utilizam esses protocolos para estratificação, contudo, não é de nosso conhecimento estudos que avaliaram a concordância entre avaliadores na utilização desses protocolos para estratificação de pacientes participantes de PRC. Objetivo: analisar a concordância entre avaliadores na estratificação de pacientes participantes de um PRC. Métodos: Estudo do tipo transversal, desenvolvido a partir de dados obtidos dos prontuários de 72 pacientes atendidos em um PRC. Foram extraídas dos prontuários as seguintes informações: idade, sexo, peso, altura, diagnóstico clínico, história clínica, fatores de risco cardiovasculares e os resultados obtidos nos últimos exames laboratoriais e complementares dos pacientes. Posteriormente, foi realizada a estratificação de risco de todos os pacientes por dois avaliadores independentes, graduados em fisioterapia e especialistas na área de fisioterapia em cardiologia, em 7 protocolos de estratificação de risco para cardiopatas existentes na literatura sendo eles: American College of Sports Medicine (ACSM), da Sociedade Brasileira de Cardiologia (SBC), da American Heart Association (AHA), o protocolo elaborado por Frederic J. Pashkow, da American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), da Société Française de Cardiologie (SFC) e da Sociedad Española de Cardiología (SEC). Estatística descritiva foi utilizada para caracterização da amostra e a análise da concordância entre os protocolos foi feita por meio do índice Kappa com nível de significância de 5%. Resultados: Dos 7 protocolos de risco analisados o protocolo da AACVPR (0.53) apresentou concordância moderada. Os demais protocolos da SEC (0.63), AHA (0.67), SBC (0.73), PASHKOW (0.75), SFC (0.76) e ACSM (0.76) foram considerados com concordância substancial. Nenhum protocolo foi considerado com concordância fraca. Conclusão: Existe concordância moderada par ao protocolo da AACVPR, e concordância substancial nos demais protocolos (SEC, SFC, PASHOW, AHA, ACSM E SBC).
Risk stratification is important to rise safety for patients in cardiac rehabilitation (CR). There are several protocols available however there is no information regarding to inter-rater agreement of them in the literature. Objective: to analyze the inter-rater agreement in risk stratification protocols available for CR. Methods: this cross-sectional study was developed using blind records of patients (n=72) from a CR program. Age, sex, weight, height, clinical diagnostic, clinical history, cardiac risk factors and recent laboratory and complementary exams were analyzed. After this, each patient was stratified for two independent physical therapists raters, specialized in physical therapy in cardiology using seven protocols found in the literature available from 1) American College of Sports Medicine (ACSM), 2) Sociedade Brasileira de Cardiologia (SBC), 3) American Heart Association (AHA), 4) a protocol developed by Frederic J. Pashkow (PASHKOW), 5) American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), 6) Société Française de Cardiologie (SFC) and 7) from Sociedad Española de Cardiología (SEC). Descriptive statistics was used to sample characterization and the inter-rater agreement was analyzed using Kappa coefficient with significance level of 5%. Results: from the seven risk protocols found, the protocol of AACVPR presented moderate agreement (0.53). The other protocols from SEC (0.63), AHA (0.67), SBC (0.73), PASHKOW (0.75), SFC (0.76) and ACSM (0.76) presented substantial agreement. None protocol was considered with weak agreement. Conclusion: There is moderate agreement to the AACVPR protocol, and substantial agreement in the other protocols (SEC, SFC, PASHOW, AHA, ACSM and SBC).
Risk stratification is important to rise safety for patients in cardiac rehabilitation (CR). There are several protocols available however there is no information regarding to inter-rater agreement of them in the literature. Objective: to analyze the inter-rater agreement in risk stratification protocols available for CR. Methods: this cross-sectional study was developed using blind records of patients (n=72) from a CR program. Age, sex, weight, height, clinical diagnostic, clinical history, cardiac risk factors and recent laboratory and complementary exams were analyzed. After this, each patient was stratified for two independent physical therapists raters, specialized in physical therapy in cardiology using seven protocols found in the literature available from 1) American College of Sports Medicine (ACSM), 2) Sociedade Brasileira de Cardiologia (SBC), 3) American Heart Association (AHA), 4) a protocol developed by Frederic J. Pashkow (PASHKOW), 5) American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), 6) Société Française de Cardiologie (SFC) and 7) from Sociedad Española de Cardiología (SEC). Descriptive statistics was used to sample characterization and the inter-rater agreement was analyzed using Kappa coefficient with significance level of 5%. Results: from the seven risk protocols found, the protocol of AACVPR presented moderate agreement (0.53). The other protocols from SEC (0.63), AHA (0.67), SBC (0.73), PASHKOW (0.75), SFC (0.76) and ACSM (0.76) presented substantial agreement. None protocol was considered with weak agreement. Conclusion: There is moderate agreement to the AACVPR protocol, and substantial agreement in the other protocols (SEC, SFC, PASHOW, AHA, ACSM and SBC).
Descrição
Palavras-chave
Doenças cardiovasculares, Estratificação de risco, Exercício, Cardiovascular diseases, Risk stratification, Exercise