Efeitos do programa de promoção da saúde baseado em Mindfulness – MBHP na qualidade de vida de idosos: um estudo de intervenção controlado e randomizado
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Data
2020-03-10
Autores
Mapurunga, Marcelo Vasconcelos [UNIFESP]
Orientadores
Demarzo, Marcelo Marcos Piva [UNIFESP]
Tipo
Dissertação de mestrado
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Objetivo: Investigar os efeitos do Programa de Promoção da Saúde Baseado em Mindfulness na qualidade de vida de idosos assistidos pela Atenção Primária à Saúde.
Métodos: Foi realizado um estudo de intervenção controlado e randomizado aninhado a um estudo de coorte prospectivo cujos participantes foram idosos a partir de 60 anos de idade residentes de um bairro de classe média no município de São Paulo – SP. Os participantes foram randomizados em dois grupos: um de intervenção, no qual foram submetidos ao protocolo Mindfulness-Based Health Promotion (MBHP),
programa psicoeducativo formatado para ensinar técnicas de meditação e desenvolver a consciência nas atividades diárias, e um outro grupo controle ativo de estimulação cognitiva, por meio de uma oficina de informática direcionada à idosos que utilizava a metodologia do estadiamento. Os grupos aconteceram de forma simultânea durante quatro meses e tiveram coleta antes e após as intervenções. Para
a coleta de dados, utilizaram-se métodos quantitativos (por meio de instrumentos psicométricos e um teste neuropsicológico) e qualitativos (grupo focal e técnica de associação livre de palavras). O desfecho primário avaliado neste estudo foi a qualidade de vida medida por meio do WHOQOL-bref e WHOQOL-old e os desfechos secundários foram a melhora da função cognitiva e medidas de bem-estar (nível de mindfulness, qualidade do sono, ansiedade, depressão, stress e religiosidade).
Resultados: Iniciou-se o estudo com o N=96, no qual N=50 estavam alocados para o grupo intervenção, e N=46 para o controle. Da amostra total, 84,4% (N=81) eram mulheres e 40,63% (N=39) tinham nível superior completo, a média de idade dos participantes foi de 74,58 (DP±5,77) anos. Foram realizadas análises por protocolo e por intenção de tratar. Concluiu-se o estudo com N=37 para o grupo intervenção e
N=43 no grupo controle ativo. Observou-se que o grupo controle ativo foi mais eficaz na melhora dos escores psicométricos da qualidade de vida e na função cognitiva. A análise delta, no comparativo de diferenças médias, demonstrou que o programa MBHP obteve resultados positivos nos sintomas de estresse e qualidade de sono, confirmados pelo Número Necessário para Tratar. As análises qualitativas sugerem
melhoras dos relacionamentos e suporte social dos participantes submetidos ao programa de mindfulness. Conclusão: Os resultados desta pesquisa diferem de outros estudos previamente realizados, o que nos faz acreditar que a proporção dos efeitos das Intervenções Baseadas em Mindfulness em idosos vão depender das particularidades e condições do grau de severidade no qual se encontra o universo
amostral antes de ser submetido à intervenção. O programa MBHP não apresentou efeitos estatisticamente significantes nas medidas psicométricas de qualidade de vida, porém foram observadas melhoras nos sintomas de estresse, ansiedade, na qualidade do sono, religiosidade intrínseca e no suporte social. Novos estudos devem ser realizados com diferentes contextos sociodemográficos para confirmar os resultados na população geral de idosos.
Objective: Investigating the effects of the Mindfulness-Based Health Promotion Program on the quality of life of elderly people assisted by Primary Health Care. Methods: A controlled and randomized intervention study was carried out, nested in a prospective cohort study whose participants were elderly above 60 years old living in a middle class neighborhood in the city of São Paulo – Brazil. Participants were randomized into two groups: an intervention group in which they were submitted to the Mindfulness-Based Health Promotion (MBHP) protocol, a psychoeducational program designed to teach meditation techniques and develop awareness in daily activities, and another active control group of a computer-based cognitive stimulation aimed at elderly that used the staging methodology. Both groups took place simultaneously over four months and data were collected before and after the interventions. For data collection, quantitative methods (psychometric instruments and a neuropsychological test) and qualitative methods (a focus group and free word association technique) were performed. The primary outcome was the quality of life measured by WHOQOL-bref and WHOQOL-old and secondary outcomes were the improvement of cognitive function and measures of well-being (level of mindfulness, quality of sleep, anxiety, depression, stress and religiosity). Results: The study started with N=96 in which N=50 were allocated to the intervention group and N=46 to the control group. Overall, 84.4% (N=81) were women and 40.63% (N=39) had completed higher education, the mean age of the participants was 74.58(SD±5.77) years old. Analyzes were performed by intention-to-treat and per protocol. The study were concluded with N=37 for the intervention group and N=43 in the active control group. It was noticed that the active control group was more effective in improving psychometric scores for quality of life and cognitive function. The delta analysis, in the comparison of mean differences, showed that the MBHP program had positive outcomes in the symptoms of stress and quality of sleep, confirmed by Number Needed to Treat. Qualitative analyzes suggest improvements in the relationships and social support of participants submitted to the mindfulness program. Conclusion: The results of this research differ from other studies previously carried out, which make us believe that the proportion of the effects of Mindfulness-Based Intervention on older adults depends on the particularities and conditions of severity in which the sample is found before submitted to the intervention. The MBHP program did not have statistically significant effects on psychometric measures of quality of life, but improvements were observed in the symptoms of stress, anxiety, quality of sleep, intrinsic religiosity and social support. New studies should be carried out with different sociodemographic contexts to confirm the results in the general elderly population.
Objective: Investigating the effects of the Mindfulness-Based Health Promotion Program on the quality of life of elderly people assisted by Primary Health Care. Methods: A controlled and randomized intervention study was carried out, nested in a prospective cohort study whose participants were elderly above 60 years old living in a middle class neighborhood in the city of São Paulo – Brazil. Participants were randomized into two groups: an intervention group in which they were submitted to the Mindfulness-Based Health Promotion (MBHP) protocol, a psychoeducational program designed to teach meditation techniques and develop awareness in daily activities, and another active control group of a computer-based cognitive stimulation aimed at elderly that used the staging methodology. Both groups took place simultaneously over four months and data were collected before and after the interventions. For data collection, quantitative methods (psychometric instruments and a neuropsychological test) and qualitative methods (a focus group and free word association technique) were performed. The primary outcome was the quality of life measured by WHOQOL-bref and WHOQOL-old and secondary outcomes were the improvement of cognitive function and measures of well-being (level of mindfulness, quality of sleep, anxiety, depression, stress and religiosity). Results: The study started with N=96 in which N=50 were allocated to the intervention group and N=46 to the control group. Overall, 84.4% (N=81) were women and 40.63% (N=39) had completed higher education, the mean age of the participants was 74.58(SD±5.77) years old. Analyzes were performed by intention-to-treat and per protocol. The study were concluded with N=37 for the intervention group and N=43 in the active control group. It was noticed that the active control group was more effective in improving psychometric scores for quality of life and cognitive function. The delta analysis, in the comparison of mean differences, showed that the MBHP program had positive outcomes in the symptoms of stress and quality of sleep, confirmed by Number Needed to Treat. Qualitative analyzes suggest improvements in the relationships and social support of participants submitted to the mindfulness program. Conclusion: The results of this research differ from other studies previously carried out, which make us believe that the proportion of the effects of Mindfulness-Based Intervention on older adults depends on the particularities and conditions of severity in which the sample is found before submitted to the intervention. The MBHP program did not have statistically significant effects on psychometric measures of quality of life, but improvements were observed in the symptoms of stress, anxiety, quality of sleep, intrinsic religiosity and social support. New studies should be carried out with different sociodemographic contexts to confirm the results in the general elderly population.
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Citação
MAPURUNGA, M. V. Efeitos do programa de promoção da saúde baseado em Mindfulness – MBHP na qualidade de vida de idosos: um estudo de intervenção controlado e randomizado. São Paulo, 2020. 181 p. Dissertação (Mestrado em Saúde Coletiva) - Universidade Federal de São Paulo - UNIFESP, São Paulo, 2020.