Avaliação de parâmetros clínicos e sociodemográficos como preditores de eficácia do uso de prednisona oral para tratamento da dor ciática aguda
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Data
2023-05-10
Autores
Porceban, Guilherme Henrique [UNIFESP]
Orientadores
Tamaoki, Marcel Jun Sugawara [UNIFESP]
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
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Resumo
Introdução: A dor ciática é prevalente principalmente em uma faixa da população profissionalmente ativa e causa importantes impactos socioeconômicos. Embora a evolução seja predominantemente benigna, indivíduos que apresentam um quadro inicial de maior disfunção ou intensidade da dor podem precisar de intervenção para retomar suas atividades. Apesar de amplamente disponíveis e preconizados por alguns guidelines, os esteroides sistêmicos por via oral apresentam resultados controversos na literatura. Objetivos: Identificar possíveis fatores sociais, demográficos ou clínicos que sejam preditores de respostas favoráveis, em termos de função e/ou dor, em indivíduos com dor ciática aguda severa tratada com prednisona via oral. Métodos: Este é um estudo prospectivo longitudinal com indivíduos com dor ciática grave de início há menos de 3 meses e que foram submetidos ao tratamento com prednisona por via oral em regime decrescente. O desfecho primário avaliado foi o ODI, e a partir de então, as variáveis sociodemográficas e clínicas foram comparadas entre o grupo de participantes de acordo com o desfecho pós-tratamento. Resultados: A amostra foi de 101 participantes, com predomínio do sexo feminino. Houve redução significativa no ODI e VAS pós-tratamento. A regressão logística indicou que história de crise prévia (p=0,02), disfunção inicial pelo ODI (p=0,04) e presença de comorbidades (p=0,048) atuam como fatores preditivos na resposta ao tratamento. O modelo prognóstico apresentou bom poder estatístico (0,81) na curva ROC. Conclusão: A resposta ao tratamento com esteroides está relacionada ao ODI, à presença de comorbidades e à história de dor semelhante previamente.
Introduction: Sciatic pain is predominant primarily in a wide range of the professionally active population and causes significant socioeconomic impacts. Although the evolution is predominantly benign, individuals who present an initial picture of greater dysfunction or increased pain intensity may need intervention to resume their activities. Although widely available and recommended by some guidelines, systemic steroids via oral route have controversial results in the literature. Objectives: Identify possible social, demographic, or clinical factors that are predictors of favourable responses, in terms of function and/or pain, in people with severe acute sciatic pain treated with oral prednisone. Methods: This is a prospective longitudinal study with individuals with severe sciatic pain of onset less than 3 months who underwent oral prednisone treatment in a decreasing regimen. The primary outcome assessed was ODI, and thereafter, sociodemographic and clinical variables were compared between the group of participants according to the post-treatment outcome. Results: The sample consisted of 101 participants, with a predominance of females. There was a significant reduction in ODI and VAS post-treatment. Multivariate logistic regression indicated that prior history of crisis (p=0.02), initial dysfunction according to ODI (p=0.04) and presence of comorbidities (p=0.048) act as predictive factors in treatment response. The prognostic model showed good statistical power (0.81) in the ROC curve. Conclusion: The response to treatment with systemic steroids is related to ODI, presence of comorbidities, and history of similar pain previously.
Introduction: Sciatic pain is predominant primarily in a wide range of the professionally active population and causes significant socioeconomic impacts. Although the evolution is predominantly benign, individuals who present an initial picture of greater dysfunction or increased pain intensity may need intervention to resume their activities. Although widely available and recommended by some guidelines, systemic steroids via oral route have controversial results in the literature. Objectives: Identify possible social, demographic, or clinical factors that are predictors of favourable responses, in terms of function and/or pain, in people with severe acute sciatic pain treated with oral prednisone. Methods: This is a prospective longitudinal study with individuals with severe sciatic pain of onset less than 3 months who underwent oral prednisone treatment in a decreasing regimen. The primary outcome assessed was ODI, and thereafter, sociodemographic and clinical variables were compared between the group of participants according to the post-treatment outcome. Results: The sample consisted of 101 participants, with a predominance of females. There was a significant reduction in ODI and VAS post-treatment. Multivariate logistic regression indicated that prior history of crisis (p=0.02), initial dysfunction according to ODI (p=0.04) and presence of comorbidities (p=0.048) act as predictive factors in treatment response. The prognostic model showed good statistical power (0.81) in the ROC curve. Conclusion: The response to treatment with systemic steroids is related to ODI, presence of comorbidities, and history of similar pain previously.
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Citação
PORCEBAN, Guilherme Henrique. Avaliação de parâmetros clínicos e sociodemográficos como preditores de eficácia do uso de prednisona oral para tratamento da dor ciática aguda. 2023. 86 f. Dissertação (Mestrado em Cirurgia Translacional) – Escola Paulista de Medicina, Universidade Federal de São Paulo, 2023.