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Doctoral Thesis
DOI
https://doi.org/10.11606/T.25.2019.tde-05102021-072548
Document
Author
Full name
Debora Foger Teixeira
Institute/School/College
Knowledge Area
Date of Defense
Published
Bauru, 2019
Supervisor
Committee
Santos, Paulo Sergio da Silva (President)
Barberio, Gabriel Salles
Bernabé, Daniel Galera
Nelli, Eloisa Aparecida
Title in Portuguese
Protocolo de avaliação para diagnóstico fisioterapêutico no paciente pós-radioterapia de câncer de cabeça e pescoço
Keywords in Portuguese
Fisioterapia
Neoplasias de cabeça e pescoço
Radioterapia
Abstract in Portuguese
Atualmente, para o câncer de cabeça e pescoço (CCP) os tratamentos são cirurgia, radioterapia e quimioterapia, apesar de necessários, causam efeitos colaterais que impactam negativamente a qualidade de vida. As alterações musculoesqueléticas encontradas em sobreviventes de CCP incluem perda ou diminuição de funções musculares causando limitações de mobilidade, trismo e anormalidades posturais. Há a carência de dados científicos sobre esse tema, sendo assim, o objetivo desse estudo foi comparar a postura global dos pacientes pós-tratamento antineoplásico com a população normal e verificar sua relação com a qualidade de vida e problemas bucais. Foram incluídos no estudo pacientes com CCP pós-tratamento antineoplásico, as seguintes variáveis foram avaliadas e comparadas com a população normal: postura corporal, sinais e sintomas de disfunção temporomandibular e dor orofacial (DTM/DOF), trismo, fluxo salivar, saúde bucal relacionada à qualidade de vida (SBQV) e qualidade de vida global. Participaram da pesquisa 90 indivíduos, 60 com CCP (grupo de estudo) e 30 livres de doença. Houve diferenças entre as populações para todas as variáveis avaliadas. A avaliação postural mostrou diferenças significantes entre os grupos, para ângulos que demonstraram assimetria de ombro (p=0,02), alterações entre a cintura pélvica e articulação do joelho (p=0,04) e alterações na coluna cervical (p=0,01). Os pacientes do grupo de estudo que receberam terapia por cobalto e altas doses de radioterapia apresentaram maiores anormalidades posturais, essas anormalidades também demonstraram correlação com os sinais e sintomas de DTM/DOF. A saúde bucal relacionada a qualidade de vida demonstrou diferença entre os grupos para todas as dimensões avaliadas, com impacto negativo maior para o grupo de estudo. Para qualidade de vida houve diferenças entre as populações no que diz respeito a capacidade funcional, limitação por aspectos físicos, e dor. O tratamento antineoplásico causa alterações na postura corporal global dos indivíduos, essas alterações parecem ter relação com o aumento da dose de radioterapia e a terapia realizada com cobalto. Sinais e sintomas de DTM/DOF estão intimamente ligados com as alterações posturais nesses pacientes, incluindo o trismo, que por sua vez dificulta a capacidade de alimentação e higiene bucal causando um impacto negativo na SBQV e na qualidade de vida como um todo, principalmente no que diz respeito a atividades básicas de vida diárias, necessárias para sobrevivência e independência, o que também está relacionado com alterações musculoesqueléticas e posturais.
Title in English
Evaluation protocol for physiotherapeutic diagnosis in head and neck cancer post-radiotherapy patient
Keywords in English
Head and neck neoplasms
Physiotherapy
Radiotherapy
Abstract in English
Currently, for head and neck cancer (HNC) treatments are surgery, radiotherapy and chemotherapy, although necessary, they cause side effects that negatively impact the quality of life. Musculoskeletal changes found in HNC survivors include loss or impairment of muscle function causing limitations of mobility, trismus, and postural abnormalities. There is a lack of scientific data on this topic, so the aim of this study was to compare the overall posture of patients after antineoplastic treatment with the normal population and to verify its relationship with quality of life and oral problems. HNC Patients with post-antineoplastic were included in the study. The following variables were evaluated and compared with the normal population: body posture, signs and symptoms of temporomandibular dysfunction and orofacial pain (TMD / OFP), trismus, salivary flow, oral health-related quality of life (OHQL) and overall quality of life. The study included 90 individuals, 60 with HNC (study group) and 30 disease-free. There were differences between populations for all variables evaluated. Postural evaluation showed significant differences between groups for angles that demonstrated shoulder asymmetry (p = 0.02), changes between the pelvic waist and knee joint (p = 0.04) and changes in the cervical spine (p = 0 .01). Patients in the study group who received cobalt therapy and high doses of radiotherapy had higher postural abnormalities; these abnormalities also demonstrated correlation with TMD / OFP signs and symptoms. Oral health related to quality of life showed differences between the groups for all dimensions evaluated, with a greater negative impact for the study group. For quality of life there were differences between populations regarding functional capacity, limitation by physical aspects, and pain. Antineoplastic treatment causes changes in the overall body posture of individuals, these changes seem to be related to the increase in radiotherapy dose and cobalt therapy. TMD / OFP signs and symptoms are closely linked with postural changes in these patients, including trismus, which in turn hinders the ability to feed and oral hygiene causing a negative impact on OHQL and overall quality of life,, especially with regard to basic daily life activities necessary for survival and independence, which is also related to musculoskeletal and postural changes.
 
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Release Date
2023-10-05
Publishing Date
2021-10-05
 
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