Use este identificador para citar ou linkar para este item: https://repositorio.ufba.br/handle/ri/34669
Tipo: Tese
Título: Mobility, functional balance and dependence on functionality in hospital discharge as predictors of social participation in the community after cerebrovascular accident.
Título(s) alternativo(s): Mobilidade, equilíbrio funcional e a dependência de funcionalidade na alta hospitalar como preditores de participação social na comunidade após acidente vascular cerebral
Autor(es): Souza, Flaviane
Primeiro Orientador: Ribeiro, Nildo
metadata.dc.contributor.referee1: Ribeiro, Nildo
metadata.dc.contributor.referee2: Ferraz, Daniel
metadata.dc.contributor.referee3: Trippo, Karen
metadata.dc.contributor.referee4: Pinheiro, Igor
metadata.dc.contributor.referee5: Assis, Silvana
Resumo: Introdução: O acidente vascular cerebral (AVC) representa a primeira causa de morte e incapacidade no Brasil, e seus indicadores prognósticos de reinserção social ainda não são bem estabelecidos. Mapear possíveis preditores de restrições na participação social após AVC na comunidade pode ser uma importante ferramenta para subsidiar o desenvolvimento de estratégias de reabilitação mesmo em ambiente hospitalar. Objetivo: Identificar deficiências na estrutura e função e limitações em atividade que predizem restrições na participação social pós-AVC na comunidade (artigo 1). Identificar se a mobilidade, o equilíbrio funcional e a dependência da funcionalidade na alta hospitalar são capazes de predizer restrições à participação social um ano após AVC na comunidade (artigo 2). Método: O presente estudo teve como proposta investigar a temática através de dois desenhos metodológicos. Inicialmente foi realizada revisão sistemática (artigo 1), selecionando estudos de coorte prospectiva e/ou retrospectiva que investigassem déficits de estrutura e função e/ou limitações de atividade, como preditores de participação social, em indivíduos pós-AVC na comunidade. Nesta revisão, foram excluídos estudos envolvendo hemorragia subaracnoidea, assim como outras doenças neurológicas, e participantes em instituições de longa permanência. A Newcastle-Ottawa quality assessment scale foi utilizada para avaliar a qualidade metodológica, e seus resultados foram sintetizados de acordo com exposições encontradas, considerando os modelos estatísticos empregados (artigo 1). Posteriormente, foi conduzido estudo de coorte concorrente dinâmica de base hospitalar (artigo 2). Foram incluídos indivíduos maiores de 18 anos, com diagnóstico de AVC agudo. Portadores de demência, limitações funcionais prévias e pacientes oncológicos não foram incluídos. Mobilidade, equilíbrio e independência funcional foram as variáveis preditoras na alta hospitalar, e o desfecho de interesse foi participação social avaliada um ano após AVC na comunidade (artigo 2). Resultados: Artigo 1, incluídos 11 artigos, total 2.412 indivíduos, 58,4% homens, 83,7% AVC I. Sete exposições foram avaliadas entre os estudos. 10 estudos avaliaram exposições de estrutura e função corporal (gravidade do AVC, função cognitiva, executiva, emocional e motora), e 8 estudos avaliaram exposições de atividade (atividade de vida diária e capacidade de andar). Artigo 2, 48 pacientes incluídos na análise após acompanhamento de um ano. O grau de independência funcional na alta hospitalar (b = 0,813; p <0,01) foi preditor independente de participação social, especificamente locomoção (B = 0,452; p <0,001) e cognição social (B = 0,462; p <0,001), relacionada à independência funcional. Mobilidade (b = 0,040; p 0,777) e equilíbrio funcional (b = 0,060; p 0,652) não apresentaram associação independente. Independência funcional cognitiva foi preditora das atividades diárias (B = 0,786; p <0,001), dos papéis sociais (B = 0,390; p = 0,014) e da satisfação (B = 0,564; p <0,001) da participação social. Conclusão: Há alguma evidência de que gravidade do AVC, dos déficits mentais e motores, das limitações nas atividades da vida diária e a capacidade de andar após AVC podem predizer a participação social na comunidade. Especificamente, o grau de independência funcional após AVC na alta hospitalar foi capaz de predizer a participação social na comunidade um ano após o AVC.
Abstract: Introduction: Cerebrovascular accident (CVA) is the leading cause of death and disability in Brazil, and its prognostic indicators of social reintegration are not well established yet. Mapping possible predictors of restrictions on social participation after stroke in the community can be an important tool to support the development of rehabilitation strategies even in a hospital environment. Objective: To identify deficiencies in structure and function and limitations in activity that predict restrictions on post-stroke social participation in the community (Article 1). Identify whether mobility, functional balance and the dependence on functionality at hospital discharge are capable of predicting restrictions on social participation one year after a stroke in the community (article 2). Method: This study aimed to investigate the theme through two methodological designs. Initially, a systematic review was carried out (article 1), selecting prospective and/or retrospective cohort studies that investigated deficits in structure and function and/or activity limitations, as predictors of social participation, in post-stroke individuals in the community. In this review, we excluded studies involving subarachnoid hemorrhage, as well as other neurological diseases, and participants in long-term care facilities. The Newcastle-Ottawa quality assessment scale was used to assess methodological quality, and the results were synthesized according to the exposures found, considering the statistical models used (article 1). Subsequently, a hospital-based dynamic concurrent cohort study was conducted (article 2). Individuals over 18 years of age with a diagnosis of acute stroke were included. Patients with dementia, previous functional limitations and cancer patients were not included. Mobility, balance and functional independence were the predictor variables at hospital discharge, and the outcome of interest was social participation assessed one year after stroke in the community (article 2). Results: Article 1, included 11 articles, total 2,412 subjects, 58.4% men, 83.7% Stroke I. Seven exposures were evaluated across studies. 10 studies assessed body structure and function exposures (stroke severity, cognitive, executive, emotional and motor function) and 8 studies assessed activity exposures (activity of daily living and ability to walk). Article 2, 48 patients included in the analysis after a one-year follow-up. The degree of functional independence at hospital discharge (b = 0.813; p <0.01) was an independent predictor of social participation, specifically locomotion (B = 0.452; p <0.001) and related social cognition (B = 0.462; p <0.001) to functional independence. Mobility (b = 0.040; p 0.777) and functional balance (b = 0.060; p 0.652) did not show an independent association. Cognitive functional independence was a predictor of daily activities (B = 0.786; p <0.001), social roles (B = 0.390; p = 0.014) and satisfaction (B = 0.564; p <0.001) of social participation. Conclusion: There is some evidence that stroke severity, mental and motor deficits, activities of daily life limitations and post-stroke walking ability can predict social participation in the community. Specifically, the degree of functional independence after stroke at hospital discharge was able to predict social participation in the community one year after the stroke.
Palavras-chave: Acidente cerebrovascular
Cerebrovascular accident
Predição
Prediction
Prognóstico
Prognosis
Atividades da vida diária
Activities of daily life
CNPq: CNPQ::CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONAL
Idioma: por
País: Brasil
Editora / Evento / Instituição: Universidade Federal da Bahia
Sigla da Instituição: UFBA
metadata.dc.publisher.department: Instituto de Ciências da Saúde - ICS
metadata.dc.publisher.program: Programa de Pós-Graduação em Processos Interativos dos Órgãos e Sistemas (PPGORGSISTEM) 
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Tipo de Acesso: Acesso Aberto
URI: https://repositorio.ufba.br/handle/ri/34669
Data do documento: 15-Dez-2021
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