Efeitos do programa de reabilitação pulmonar domiciliar em pacientes com DPOC - adaptação à vida real do paciente
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Data
2013-02-27
Autores
Pradella, Cristiane Oliveira [UNIFESP]
Orientadores
Jardim, Jose Roberto de Brito [UNIFESP]
Tipo
Dissertação de mestrado
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Introdução: Reabilitação pulmonar é parte obrigatória do tratamento integral dos pacientes com DPOC. No entanto, não há centros de reabilitação pulmonar em número suficiente para que todos os pacientes com DPOC que tenham necessidade de reabilitação possam realizá-la. A realização de exercícios em um programa de reabilitação pulmonar domiciliar com supervisão
parcial poderia abranger um maior número de pacientes. Objetivo: Avaliar o impacto de um programa de reabilitação domiciliar (PRPD) na qualidade de vida e na capacidade de exercício em comparação com grupo controle, sob supervisão parcial, em pacientes com DPOC. Métodos: Estudo prospectivo e randomizado com a participação de 50 pacientes com DPOC, sendo 29 pacientes incluídos no PRPD (VEF1: 62,4 + 10,7%; 62,4 + 10,7anos) e 15 pacientes controles (VEF1: 54+ 26,2%; 65,3 ± 8 anos). Todos os pacientes foram avaliados pré e pós-intervenção: TC6M, SGRQ, SF-36, teste de endurance na esteira com 80% da carga máxima alcançada em teste máximo, espirometria e HDAS. O programa de reabilitação
domiciliar com 24 sessões, com 3 a 5 sessões semanais, incluiu: subir escada por 15 minutos, andar por 30 minutos, e exercícios com membros superiores com uma lata de óleo (1 kg) com a técnica de movimentos em diagonal por 15
minutos. Semanalmente: um telefonema foi feito para estimular e verificar a aderência: O grupo controle recebeu tratamento usual, sem orientação sobre exercício ou telefonema. Resultados: Pacientes no PRPD caminharam no TC6M 65 metros a mais no pós-reabilitação (485m para 550m) (p<0,05) enquanto que os controles caminharam 6m a mais (456m para 462m) (NS). Encontramos no teste de endurance pós-experimento aumento no grupo reabilitação na
distância caminhada (controle= 31,2m ± 419,7, pós-PRPD= 316,6m ± 81,8 (p<0,05) e no tempo (controle= 82,8seg ± 479,1 e pós-PRPD= 347,6seg ±87,4) (p<0,05). Os pacientes do PRPD apresentaram melhora significativa na qualidade de vida em relação ao basal (Escore total do GGRQ no controle aumentou 2,2 unidades e no PRPD reduziu 6,7 unidades). Não foi observada diferença no HADS e SF-36 após o programa em ambos os grupos. Conclusão: Concluímos que um programa de reabilitação pulmonar no domicílio, simples, de baixo custo e adaptado à vida real em pacientes com DPOC é um instrumento útil e que melhora a qualidade de vida e capacidade de exercício dos pacientes. Este programa permite que um número maior de pacientes com DPOC possam se beneficiar de exercícios programados realizados em sua própria casa. Seria interessante que um estudo com programa semelhante com supervisão parcial avaliasse a aderência com espaço maior de tempo.
Introduction: Pulmonary rehabilitation is a mandatory part of a comprehensive treatment for patients with COPD. However, there is no enough pulmonary rehabilitation centers that could fit all COPD patients needing rehabilitation. The performance of exercises in a pulmonary rehabilitation program at home with partial supervision could cover a larger number of patients. Objective: To evaluate the impact of a home-based rehabilitation (HBR) program in COPD patients on quality of life and exercise capacity compared to a control group, under partial supervision. Methods: Prospective and randomized trial involving 50 patients with 29 COPD patients included in the PRPD (FEV1: 62.4 + 10.7%, 62.4 + 10.7 years) and 15 control patients (FEV1: 54 + 26.2%; 65.3 ± 8 years). All patients were evaluated pre-and post-intervention: TC6M, SGRQ, SF-36, test of endurance on the treadmill with 80% of the maximum load reached in the maximal test and spirometry and HADS. A home rehabilitation program with 24 sessions, 3 to 5 session a week included: climbing stairs for 15 minutes, walking for 30 minutes, and exercises with upper limbs using a can of oil (1 kg) with the technique of diagonal movements for 15 minutes. A call was given weekly to the patient in order to stimulate the exercise and verify adherence: The control group received usual treatment without guidance on exercise or phone call. Results: Patients in the PRPD walked in the 6MWT 65 meters more on the post-rehabilitation (485m to 550m) (p <0.05) while controls walked over 6m to 456M to 462M) (NS).We found in the post-experiment endurance test an increase in the PRPD in the walked distance (control= 419.7m ± 31.2, PRPD = 316.6m ± 81.8 (p <0.05) and time (control = 479.1sec ± 82.8, PRPD = 347.6sec ± 87.4) (p<0.05). Patients in the PPRD showed a better quality of life after the program (Total score SGRQ control increased 2.2 units and PPRD decreased 6.7 units). No difference was found in the HADS and SF-36 after the program in both groups. Conclusions: We conclude that a pulmonary rehabilitation program performed at home, simple, with low cost and adapted to real life in patients with COPD is a useful tool that improves quality of life and exercise capacity of patients. This program allows that a greater number of patients with COPD may benefit from a exercise program performed at home. It would be interesting to have a study with a similar program that would evaluate the patient long term adherence under partial supervision.
Introduction: Pulmonary rehabilitation is a mandatory part of a comprehensive treatment for patients with COPD. However, there is no enough pulmonary rehabilitation centers that could fit all COPD patients needing rehabilitation. The performance of exercises in a pulmonary rehabilitation program at home with partial supervision could cover a larger number of patients. Objective: To evaluate the impact of a home-based rehabilitation (HBR) program in COPD patients on quality of life and exercise capacity compared to a control group, under partial supervision. Methods: Prospective and randomized trial involving 50 patients with 29 COPD patients included in the PRPD (FEV1: 62.4 + 10.7%, 62.4 + 10.7 years) and 15 control patients (FEV1: 54 + 26.2%; 65.3 ± 8 years). All patients were evaluated pre-and post-intervention: TC6M, SGRQ, SF-36, test of endurance on the treadmill with 80% of the maximum load reached in the maximal test and spirometry and HADS. A home rehabilitation program with 24 sessions, 3 to 5 session a week included: climbing stairs for 15 minutes, walking for 30 minutes, and exercises with upper limbs using a can of oil (1 kg) with the technique of diagonal movements for 15 minutes. A call was given weekly to the patient in order to stimulate the exercise and verify adherence: The control group received usual treatment without guidance on exercise or phone call. Results: Patients in the PRPD walked in the 6MWT 65 meters more on the post-rehabilitation (485m to 550m) (p <0.05) while controls walked over 6m to 456M to 462M) (NS).We found in the post-experiment endurance test an increase in the PRPD in the walked distance (control= 419.7m ± 31.2, PRPD = 316.6m ± 81.8 (p <0.05) and time (control = 479.1sec ± 82.8, PRPD = 347.6sec ± 87.4) (p<0.05). Patients in the PPRD showed a better quality of life after the program (Total score SGRQ control increased 2.2 units and PPRD decreased 6.7 units). No difference was found in the HADS and SF-36 after the program in both groups. Conclusions: We conclude that a pulmonary rehabilitation program performed at home, simple, with low cost and adapted to real life in patients with COPD is a useful tool that improves quality of life and exercise capacity of patients. This program allows that a greater number of patients with COPD may benefit from a exercise program performed at home. It would be interesting to have a study with a similar program that would evaluate the patient long term adherence under partial supervision.
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Citação
PRADELLA, Cristiane Oliveira. Efeitos do programa de reabilitação pulmonar domiciliar em pacientes com dpoc - adaptação à vida real do paciente. 2013. Dissertação (Mestrado) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2013.