Efeitos da terapia baseada em realidade virtual sobre a motivação, engajamento, aderência e repercussões hemodinâmicas em cardiopatas
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2018-12-14
Autores
Cruz, Mayara Moura Alves da
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Universidade Estadual Paulista (Unesp)
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Introdução: apesar dos benefícios da reabilitação cardiovascular (RCV) para as doenças cardiovasculares, a baixa aderência dos pacientes é uma preocupação. Ela pode estar relacionada a diversos fatores, dentre eles, à motivação e ao engajamento ao tratamento. Terapias alternativas podem melhorar motivação, engajamento e assim refletir em melhor aderência. Nesse contexto, a terapia baseada em realidade virtual (TRV) surge como uma opção para cardiopatas, contudo nesse grupo de pacientes é necessário um maior controle dos parâmetros hemodinâmicos, visto que se ultrapassados podem causar maior risco à saúde. Objetivo: investigar engajamento, motivação, barreiras e aderência frente a aplicação de TRV em cardiopatas ou pacientes com fatores de risco que participam regularmente da RCV e avaliar suas repercussões hemodinâmicas agudas. Métodos: foram recrutados participantes de um programa de RCV e alocados de forma randomizada para as intervenções RCV ou RCV+TRV. As intervenções foram realizadas por 12 semanas. Sendo o desfecho primário a avaliação o engajamento (escala de engajamento), motivação (Behavioral Regulation in Exercise Questionnaire 3), barreiras (escala de barreiras para reabilitação cardíaca) e aderência dos pacientes (frequência registrada no prontuário). O desfecho secundário foi a avaliação das repercussões hemodinâmicas agudas antes, durante e após uma sessão por meio da pressão arterial (PA), frequência cardíaca (FC), FC de reserva, frequência respiratória (f), saturação de oxigênio e percepção subjetiva de esforço (PSE). Análise estatística: foi avaliada a homogeneidade dos dados (teste de esfericidade de Mauchley) seguida da correção de Greenhouse-Geisser, quando necessário. Posteriormente foi utilizada Anova Two-Way para medidas repetidas, p<0,05. Resultados: Os pacientes de ambos os grupos apresentaram um perfil com baixas barreiras, alto engajamento e motivação e os resultados demonstram que a TRV promoveu um aumento na aderência dos pacientes que apresentavam baixa aderência à RCV convencional, porém esse aumento não se manteve após 12 semanas da interrupção do protocolo. Em relação à análise dos dados hemodinâmicos, a TRV apresentou um padrão de respostas hemodinâmicas agudas fisiológicas semelhante à RCV. Porém houve maior magnitude durante sua execução e até 5min da recuperação após a interrupção da sessão para as variáveis de FC, f e PSE (p<0,01), observados nos momentos de repouso, até um minuto, até três minutos e até cinco minutos da recuperação respectivamente em relação à TRV. Observou-se ainda que 74,07% dos pacientes que realizaram a TRV atingiram a FC de reserva em algum momento da sessão e as respostas de FC e PSE, sugerem que a TRV promoveu maior intensidade de esforço. Conclusão: A inserção da TRV ao RCV convencional aumentou a aderência após admissão de pacientes que participavam com frequência insatisfatória, o que não aconteceu com os pacientes do programa de RCV convencional, entretanto, a aderência volta a valores próximos dos iniciais após doze semanas do fim da intervenção. Porém, a TRV não estimulou a motivação e nem influenciou as barreiras e engajamento dos pacientes. Em relação aos dados hemodinâmicos, a TRV promoveu respostas agudas fisiológicas e semelhantes à RCV, mas com maior magnitude para algumas variáveis durante a sua execução e até cinco minutos da recuperação após a interrupção da sessão.
Introduction: there is a concern regarding to the low adherence of patients in cardiovascular rehabilitation (CR), despite their benefits. It may be related to several factors, among them, motivation and engagement to treatment. Alternative therapies can improve motivation, engagement reflecting in better adherence and, in this context, virtual reality based therapy (VRBT) appears as an option for cardiac patients. However, in this population, a greater control of hemodynamic parameters is necessary, once if exceed they can cause a greater risk to health. Objective: to investigate engagement, motivation, barriers and adherence through the application of VRBT in patients with cardiovascular diseases or patients with risk factors who regularly participate in CR. In addition, to evaluate their acute hemodynamic repercussions. Methods: participants of CR program were randomized to CR or CR+ VRBT. The interventions were performed for 12 weeks. The primary endpoint was engagement (User Engagement Scale), motivation (Behavioral Regulation in Exercise Questionnaire 3), barriers (Cardiac Rehabilitation Barriers Scale), and patient’s adherence (frequency recorded on the chart). The secondary endpoint was the acute hemodynamic repercussions before, during and after a session through blood pressure (BP), heart rate (HR), HR reserve, respiratory rate (rr), oxygen saturation and rate of perceived exertion (RPE). Statistical analysis: homogeneity of the data had been evaluated (Mauchley sphericity test) followed by the Greenhouse-Geisser correction, if necessary. After this, Anova Two-Way for repeated measures had been analyzed, p <0.05. Results: In both groups, patients had low barriers, high engagement and motivation. The results demonstrate that VRBT promoted an increase in adherence of patients with low adherence to conventional CR, but this increment was not maintained after 12 weeks of protocol interruption. Regarding the analysis of hemodynamic data, VRBT produce physiological acute hemodynamic responses similar to CR. However, there was a greater magnitude during its execution and until 5 minutes of recovery after session for the HR, rr and RPE (p <0.01), observed at rest, up to one, three and five minutes of recovery respectively in relation to VRBT. It was also observed that 74.07% of the patients who underwent VRBT reached HR reserve of training at some point in the session and the HR and RPE responses, suggesting VRBT promoted greater effort intensity. Conclusion: The insertion of VRBT to the conventional CR increased adherence after admission in patients who participated with unsatisfactory frequency, what did not happen with the patients in the conventional CR program, however, adherence returns to basal values after 12 weeks of the program. In addition, VRBT did not stimulated motivation and neither influence patients’ barriers and engagement. Regarding hemodynamic data, VRBT produce physiological acute hemodynamic responses similar to CR, although with greater magnitude for some variables during its execution and up to five minutes after session.
Introduction: there is a concern regarding to the low adherence of patients in cardiovascular rehabilitation (CR), despite their benefits. It may be related to several factors, among them, motivation and engagement to treatment. Alternative therapies can improve motivation, engagement reflecting in better adherence and, in this context, virtual reality based therapy (VRBT) appears as an option for cardiac patients. However, in this population, a greater control of hemodynamic parameters is necessary, once if exceed they can cause a greater risk to health. Objective: to investigate engagement, motivation, barriers and adherence through the application of VRBT in patients with cardiovascular diseases or patients with risk factors who regularly participate in CR. In addition, to evaluate their acute hemodynamic repercussions. Methods: participants of CR program were randomized to CR or CR+ VRBT. The interventions were performed for 12 weeks. The primary endpoint was engagement (User Engagement Scale), motivation (Behavioral Regulation in Exercise Questionnaire 3), barriers (Cardiac Rehabilitation Barriers Scale), and patient’s adherence (frequency recorded on the chart). The secondary endpoint was the acute hemodynamic repercussions before, during and after a session through blood pressure (BP), heart rate (HR), HR reserve, respiratory rate (rr), oxygen saturation and rate of perceived exertion (RPE). Statistical analysis: homogeneity of the data had been evaluated (Mauchley sphericity test) followed by the Greenhouse-Geisser correction, if necessary. After this, Anova Two-Way for repeated measures had been analyzed, p <0.05. Results: In both groups, patients had low barriers, high engagement and motivation. The results demonstrate that VRBT promoted an increase in adherence of patients with low adherence to conventional CR, but this increment was not maintained after 12 weeks of protocol interruption. Regarding the analysis of hemodynamic data, VRBT produce physiological acute hemodynamic responses similar to CR. However, there was a greater magnitude during its execution and until 5 minutes of recovery after session for the HR, rr and RPE (p <0.01), observed at rest, up to one, three and five minutes of recovery respectively in relation to VRBT. It was also observed that 74.07% of the patients who underwent VRBT reached HR reserve of training at some point in the session and the HR and RPE responses, suggesting VRBT promoted greater effort intensity. Conclusion: The insertion of VRBT to the conventional CR increased adherence after admission in patients who participated with unsatisfactory frequency, what did not happen with the patients in the conventional CR program, however, adherence returns to basal values after 12 weeks of the program. In addition, VRBT did not stimulated motivation and neither influence patients’ barriers and engagement. Regarding hemodynamic data, VRBT produce physiological acute hemodynamic responses similar to CR, although with greater magnitude for some variables during its execution and up to five minutes after session.
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Palavras-chave
Terapia de exposição à realidade virtual, Exercício, Frequência cardíaca, Pressão arterial, Virtual reality, Cardiovascular diseases, Motivation, Blood pressure, Heart rate, Exercise