does it matter which exercise? a randomized control trial of exercise for low back pain audrey long,...
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Does it Matter Which Exercise?
A Randomized Control Trial of Exercise for Low Back Pain
Audrey Long, BScPT,* Ron Donelson, MD,† Tak Fung, PhD‡
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Does it Matter Which Exercise?
Eduardo da Silva RibeiroDanyelle LemosDaniele Ayala
ElaineJoyce
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Objetivos
Determinar como subgrupos reagem a diferentes formas de prescrição de exercícios para
contrastar com os estudos já validados sobre dor nas costas.
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Métodos fisioterapeutas voluntários de 11 clínicas diferentes.Total de 312 pacientes.
Dor aguda;Dor subaguda;Crônica;Dor somente e de origem ciática.
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MétodosFormulário de consentimento:
“Estudos anteriores mostraram que o exercício ajuda a promover a cura, pode ajudar a controlar a dor e melhorar a função. No entanto, há uma variedade de opiniões a respeito de quais exercícios são melhores.”
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Métodos
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Métodos
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Métodos
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Tratamento
Exercícios
1. Direção correspondente: DP descrita na avaliação
2. Direção oposta: Ao descrito na Avaliação
3. Baseado em evidências: Multidirecionais: exercícios
lombares, quadril e quadríceps.
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Tratamento
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Protocolo tratamentoMínimo de 3 e máximo de 6 consultas durante 2 semanas.
Consequências:Abandono: Não alívio da dor;Adesão: Alívio da dor
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Segurança
Indivíduos que não apresentaram melhora da dor, teria tratamento interrompido e resultados incluídos na análise.
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Terapeutas e tratamento
12 Fisioterapeutas com experiência de 12 anos e credenciados no método Mackenzie a pelo menos 3 anos.
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Medidas e resultados
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Medidas e resultadosMonitoramento na própria residência
EscoreSessões:• 0= pobre• 1-2= razoável• 3-4= boa• 5= excelente
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Resultados Diferença direcional atingida em 230 pacientes (74%).Restante, 82 (26%) – excluídosPreferências:
191 (83%) – extensão;16 (7%) – flexão;23 (10%) – correspondem lateral.
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Resultados
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Todos os três grupos de tratamento melhoraram em todos os resultados em 2 semanas. Grupos de exercícios combinados tiveram melhora estatisticamente maiores do que os outros dois grupos em todos os sentidos: regresso ao trabalho, lazer, repouso.
Resultados
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Resultados O grupo de exercícios opostos são os mais pobres em benefícios, tendo na verdade, relatado piora do quadro, mesmo tendo bom prognóstico para melhora.
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Resultados
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Discussão Embora poucas tenham sido as visitas, o resultado foi satisfatório;Exercícios de DP tem foco específico: controle e / ou eliminação da dor.Se com poucas visitas se observa melhora, com uma investigação mais profunda aumentria este resultado.
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Discussão A MDT embora forneça aconselhamento a educação do paciente, não foi utilizado seus protocolos neste estudo.MDT – “tanto uma ferramenta de diagnóstico e de um indicador de prognóstico”.DP – primeiro estudo realizado com a prescrição somente da técnica.
Bons resultados
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Discussão
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Pontos fortesEnsinar o indivíduo a ter precaução;Fisioterapeutas treinados e confiantes na técnica;Exercícios executados em DP.
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Conclusão Exercícios realizados em DP e com aconselhamento demonstrou eficácia no controle / eliminação da dor.A literatura de prognóstico prévio existente interferiu um pouco na tese DP.