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Master's Dissertation
DOI
https://doi.org/10.11606/D.5.2020.tde-02072020-163034
Document
Author
Full name
Antonia Lilian de Lima Rodrigues
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2019
Supervisor
Committee
Paiva, Wellingson Silva (President)
Dale, Camila Squarzoni
Grando, Lucia Helena
Toniolo, Elaine Flamia
Title in Portuguese
Qualidade de vida dos doentes após acidente vascular cerebral: avaliação da dor, déficit motor e declínio cognitivo como fatores incapacitantes
Keywords in Portuguese
Acidente vascular cerebral
Cognição
Dor
Dor neuropática
Incapacidade
Qualidade de vida
Abstract in Portuguese
Introdução: A dor neuropática central é descrita como dor iniciada ou causada por lesão de vias somatossensitivas centrais decorrentes de lesão vascular no sistema nervoso central. Acomete cerca de 1 a 12% das pessoas após um AVC, sendo esta, uma incapacidade relevante podendo ter grande impacto negativo na qualidade de vida dos doentes. Objetivo: comparar o impacto funcional negativo das diferentes síndromes: dor neuropática central, incapacidade física e cognição decorrentes do AVC na qualidade de vida dos doentes. Métodos: Foram avaliados 39 doentes com dor central após acidente vascular cerebral e dois grupos controle: o primeiro com 32 doentes com dor não neuropática e o segundo com 31 sem dor crônica. Os participantes responderam os questionários propostos pelo estudo. Resultados: O questionário SF 12, versão breve, a soma do componente físico e mental no grupo total evidenciou, (83,38±19,70) p =< 0,001. O grupo de doentes com dor central apresentaram maior frequência, (79,5%) p=0,001, e intensidade (6,62±1,78) p = < 0,001 da dor comparado ao grupo com dor não neuropática. Os escores dos questionários de dor, Dor Neuropática 4, (7,60±1,74), p = < 0,001, Inventário de Sintomas de Dor Neuropática, escore total, (41,33±20,67) p = < 0,001, questionário de dor McGill breve, (11,16±2,76) p = < 0,001, e Inventário Breve de Dor, dor no momento, (7,51±1,71) p = < 0,001 foram superiores aos do grupo com dor não neuropática. Nas avaliações de déficit motor, a Escala de Rankin Modificada apresentou incapacidade moderada a grave, (17,9%) p=0,013, o índice de Barthel, (87,05±20,57) p = < 0,013, grau de força motora (0,94±0,85) p= 0,040 e a avaliação de Ashworth, (1,25±2,48) p = < 0,001 no grupo total. O Mini Exame do Estado Mental não apresentou diferença significativa entre os três grupos. Realizou-se teste de correlação de Spearman para verificar forca de correlação entre o SF 12, questionário breve e as demais avaliações e análise de regressão linear múltipla resultou em um modelo estatístico significante mostrando que em doentes com DCAVC, humor e sintomas neuropáticos explicam em grande proporção a baixa qualidade de vida dos doentes. Conclusão: Estratégias visando controle de sintomas neuropáticos, principalmente ansiedade e depressão podem ter maior impacto na qualidade de vida de doentes com DCAVC. Declínio cognitivo não demonstrou ser um fator incapacitante nesta amostra
Title in English
Quality of life after stroke: pain assessment, motor deficit and cognitive decline as disabling factors
Keywords in English
Cognition
Disability
Neuropathic pain
Pain
Quality of life
Stroke
Abstract in English
Introduction: Central Post-Stroke Pain is described as pain initiated or caused by a primary injury or central nervous system dysfunction. It affects about 1 to 12% of people after stroke, which is a relevant disability and can have a major negative impact in QOL. Objective: To describe the disability profile and negative functional impact of neuropathic pain, motor deficit and cognitive decline in the quality of life patients after stroke. Methods: Thirty-nine patients with Central Post-Stroke Pain, 32 with non-neuropathic pain and 31 without chronic pain were evaluated. Patients answered the proposed questionnaires for pain assessment. Results: The SF 12 short form questionnaire, SF12 total sum of the physical and mental component in total group showed (83.38 ± 19.70) p = < 0.001. The group of patients with central pain had a higher frequency (79.5%) p = 0.001, and pain intensity (6.62 ± 1.78) p = < 0.001 compared to the group with non-neuropathic pain. Pain questionnaires scores, Neuropathic Pain 4, (7.60 ± 1.74), p = < 0.001, Neuropathic Pain Symptom Inventory total score, (41.33 ± 20.67) p = < 0.001, McGill Pain Questionnaire, (11.16 ± 2.76) p = < 0.001, and Brief Pain Inventory, pain at the moment, (7.51 ± 1.71) p = < 0.001 were higher than in the non-pain group neuropathic. In motor deficit assessments, the Modified Rankin Scale presented moderate to severe disability (17.9%) p = 0.013, Barthel index, (87.05 ± 20.57) p = < 0.013, degree of strength (0.94 ± 0.85) p = 0.040 and Ashworth's assessment (1.25 ± 2.48) p = < 0.001 in the total group. The Mini Mental State Examination showed no significant difference between the three groups. Spearman's correlation test was performed to verify the strength of correlation between the Short Form 12 questionnaire and the other evaluations. Multiple linear regression analysis showed a significant statistic showing that in patients with stroke, mood and neuropathic symptoms largely explain the poor quality of life of patients. Conclusion: These findings evidence that the presence of neuropathic pain could be an important component responsible for low QQL in patients after stroke. Strategies to control neuropathic pain symptoms could help to improve QQL in CPSP patients. Cognitive decline has not been shown to be a disabling factor
 
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Publishing Date
2020-07-02
 
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