Advisor(s)
Abstract(s)
Introdução: A Artroplastia Total do Joelho (ATJ) é um procedimento cirúrgico para restaurar a função e resolver a dor na osteoartrose do joelho. O uso de medidas reportadas pelos doentes (PROM) permite aos fisioterapeutas seguir eficazmente o impacto do tratamento, auxiliando no desenvolvimento de estratégias otimizadas de gestão. Objetivos: Avaliar resultados da ATJ e QV, através dos PROM antes, durante a intervenção da fisioterapia e na alta clínica (T0 a Tn). Medir diferenças mínimas clinicamente importantes (MCIC) e analisá-las no contexto da otimização e gestão adequada do número de sessões a realizar. Métodos: Incluídos indivíduos submetidos a ATJ primária, referenciados para fisioterapia. Foram recolhidos dados sociodemográficos e feita a análise estatística multivariada e correlacional dos PROM EQ-5D-5L (genérico para QV), KOOS (específico para o joelho) e PGIC. Resultados: Analisados 16 indivíduos com média de idade de 70±8,725 anos, 81,25% do género feminino, 68,75% com IMC correspondente a obesidade tipo I e II. A QV variou significativamente entre T0 e Tn (𝑝 = 0,000), nas dimensões Mobilidade e Dor /Malestar, índice de valor para estados de saúde (0,607 e 0,842 (r = 0,506; p < 0,05) 𝑒 na VAS (M𝑑 50; 70,50 e 95; 𝑝 < 0,011). O KOOS TOTAL obteve MCIC estatisticamente significativas (𝑝 < 0,05) de 17,545 ± 11,352 pontos entre T1 e T2 e 8,500 ± 7,314 entre T3 e T4; nas dimensões DOR (22,909 ± 18,463 entre T1 e T2); AVD (27,636 ± 19,495 entre T1 e T2) e QV (22,818 ± 23,012 entre T1 e T2 e 12,333 ± 10,764 entre T3 e T4). As correlações significativas entre variáveis KOOS mostraram uma tendência positiva e forte entre T2 e T3. Na PGIC a média variou entre T1 (𝑥̅ = 4,94 ± 1.526) e T5 (𝑥̅ = 6,50 ± 0,577) e correlacionou-se de forma positiva moderada com a KOOS TOTAL em T3 (𝑟 = 0,734). Conclusão: Os PROM permitiram avaliar melhorias significativas na QV, estado de saúde, mobilidade, dor e AVD nos indivíduos com ATJ entre a 5ª e a 15ª sessões de fisioterapia ambulatória e, contribuir para uma gestão mais adequada do número de sessões de fisioterapia sem perdas na QV e função.
ABSTRACT - Background: Total Knee Arthroplasty (TKA) is a surgical procedure to restore function and resolve pain in osteoarthritis of the knee. The use of patient-reported measures (PROM) allows physiotherapists to effectively track the impact of treatment, assisting in the development of optimal management strategies. Aims: Assess results of TKA and QoL, through PROM before, during the physiotherapy intervention, and at clinical discharge (T0 to Tn). Measure minimal clinically important changes (MCIC) and analyze them in the context of optimization and proper management of the number of sessions to be performed. Methods: Individuals submitted to primary TKA referred for physiotherapy were included. Sociodemographic data were collected and multivariate and correlational statistical analysis was performed on PROM EQ-5D-5L (generic for QoL), KOOS (specific for the knee), and PGIC. Results: 16 individuals with a mean age of 70±8.725 years were analyzed, 81.25% female, 68.75% with BMI corresponding to type I and II obesity. QoL varied significantly between T0 and Tn (p=0.000), in the dimensions Mobility and Pain/Discomfort, in the value index for health states (0.607 and 0.842 (r=0.506; p < 0.05), and in the VAS (Md 50; 70.50 and 95; p < 0.011). KOOS TOTAL obtained statistically significant (p < 0.05) MCIC of 17.545 ± 11.352 points between T1 and T2 and 8.500 ± 7.314 between T3 and T4; in the PAIN dimension (22.909 ± 18.463 between T1 and T2); DLA (27.636 ± 19.495 between T1 and T2) and QOL (22.818 ± 23.012 between T1 and T2 and 12.333 ± 10.764 between T3 and T4). Significant correlations between KOOS variables showed a positive and strong trend between T2 and T3. In the PGIC, the average varied between T1 (𝑥̅=4.94±1.526) and T5 (𝑥̅=6.50±0.577) and correlated in a moderately positive way with the KOOS TOTAL in T3 (r=0.734). Conclusion: PROM allowed the assessment of significant improvements in QoL, health state, mobility, pain, and DLA in individuals with TKA between the 5th and 15th session of outpatient physiotherapy, and contributed to more adequate management of the number of physiotherapy sessions without losses in QoL and function.
ABSTRACT - Background: Total Knee Arthroplasty (TKA) is a surgical procedure to restore function and resolve pain in osteoarthritis of the knee. The use of patient-reported measures (PROM) allows physiotherapists to effectively track the impact of treatment, assisting in the development of optimal management strategies. Aims: Assess results of TKA and QoL, through PROM before, during the physiotherapy intervention, and at clinical discharge (T0 to Tn). Measure minimal clinically important changes (MCIC) and analyze them in the context of optimization and proper management of the number of sessions to be performed. Methods: Individuals submitted to primary TKA referred for physiotherapy were included. Sociodemographic data were collected and multivariate and correlational statistical analysis was performed on PROM EQ-5D-5L (generic for QoL), KOOS (specific for the knee), and PGIC. Results: 16 individuals with a mean age of 70±8.725 years were analyzed, 81.25% female, 68.75% with BMI corresponding to type I and II obesity. QoL varied significantly between T0 and Tn (p=0.000), in the dimensions Mobility and Pain/Discomfort, in the value index for health states (0.607 and 0.842 (r=0.506; p < 0.05), and in the VAS (Md 50; 70.50 and 95; p < 0.011). KOOS TOTAL obtained statistically significant (p < 0.05) MCIC of 17.545 ± 11.352 points between T1 and T2 and 8.500 ± 7.314 between T3 and T4; in the PAIN dimension (22.909 ± 18.463 between T1 and T2); DLA (27.636 ± 19.495 between T1 and T2) and QOL (22.818 ± 23.012 between T1 and T2 and 12.333 ± 10.764 between T3 and T4). Significant correlations between KOOS variables showed a positive and strong trend between T2 and T3. In the PGIC, the average varied between T1 (𝑥̅=4.94±1.526) and T5 (𝑥̅=6.50±0.577) and correlated in a moderately positive way with the KOOS TOTAL in T3 (r=0.734). Conclusion: PROM allowed the assessment of significant improvements in QoL, health state, mobility, pain, and DLA in individuals with TKA between the 5th and 15th session of outpatient physiotherapy, and contributed to more adequate management of the number of physiotherapy sessions without losses in QoL and function.
Description
Mestrado em Gestão e Avaliação de Tecnologias em Saúde
Keywords
Fisioterapia Artroplastia total do joelho Medidas reportadas pelos doentes PROM Eficiência em saúde Total knee arthroplasty Patient-reported measures Physiotherapy Health efficiency
Citation
Pinto AM. Avaliação de resultados da condição e qualidade de vida em saúde de indivíduos submetidos a artroplastia total do joelho na perspetiva do doente (PROM): contributo para uma gestão eficiente da intervenção do fisioterapeuta [dissertation]. Lisboa: Escola Superior de Tecnologia da Saúde de Lisboa/Instituto Politécnico de Lisboa; Escola Superior de Saúde da Universidade do Algarve; 2023.
Publisher
Instituto Politécnico de Lisboa, Escola Superior de Tecnologia da Saúde de Lisboa