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Avaliação do grau de incapacidade em doentes pós-AVC : correlação entre o Exame geronto psicomotor e outras escalas de avaliação de incapacidade funcional
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INTRODUÇÃO: O Acidente Vascular Cerebral (AVC) constitui uma das principais causas de incapacidade em Portugal, sendo de extrema importância aplicar instrumentos de avaliação válidos para medir a gravidade dessas incapacidades. Os psicomotricistas são confrontados com uma escassez de instrumentos de avaliação psicomotora para a população pós-AVC. Este estudo teve como objetivo avaliar se o Exame Geronto Psicomotor (EGP), aplicado na fase aguda do AVC, é um melhor preditor de independência funcional e qualidade de vida aos 3 meses, quando comparado com outras escalas atualmente utilizadas, como a National Institute of Health Stroke Scale (NIHSS), o Índice de Barthel (IB) e a Medida de Independência Funcional (MIF). METODOLOGIA: Este é um estudo de caráter observacional, prospetivo e exploratório, com uma amostra de doentes com diagnóstico clínico de AVC de tipo isquémico ou hemorrágico admitidos na Unidade de Acidentes Vasculares Cerebrais do Serviço de Neurologia do Hospital de Santa Maria. Na alta hospitalar os doentes foram avaliados com a Escala de Rankin modificada (mRS), a NIHSS, o IB, a MIF e o EGP. Nas consultas de seguimento foram reavaliados com a mRS e avaliados com a Escala de Qualidade de Vida Específica para utentes que sofreram um AVC (EQVE-AVC). Através do coeficiente de Spearman analisou-se o nível de correlação entre o EGP, a NIHSS, o IB e a MIF. Determinaram-se curvas “receiver operating characteristic” (ROC) para definir o melhor preditor de independência funcional e qualidade de vida aos 3 meses e para determinar o ponto de corte do EGP com maior acuidade para predição de independência funcional aos 3 meses. RESULTADOS: Foram incluídos 29 doentes com uma média de idades de 75,28±8,70 anos. A grande maioria sofreu um AVC isquémico no território da artéria cerebral média direita de etiologia indeterminada. Dos 29 doentes, apenas 21 concluíram o estudo com as avaliações das consultas de seguimento. Verificaram-se correlações fortes e significativas entre os resultados do EGP e os resultados da NIHSS, do IB e da MIF. Na determinação do melhor preditor de independência funcional e qualidade de vida aos 3 meses, obtiveram-se valores de área abaixo da curva mais elevados com o EGP, 0,91±0,08 e 0,97±0,04, respetivamente. O ponto de corte com a maior especificidade (87,5%) e sensibilidade (92,9%) foi estabelecido em 57. CONCLUSÃO: Os resultados deste estudo sugerem que um melhor desempenho psicomotor na alta hospitalar está relacionado com um melhor nível de funcionalidade dos doentes pós-AVC aos 3 meses, isto porque, quando aplicados na fase aguda do AVC, o EGP é melhor preditor de incapacidade funcional e qualidade de vida aos 3 meses comparativamente com a NIHSS, o IB e a MIF.
BACKGROUND: Stroke is one of the main causes of disability in Portugal, and it is extremely important to apply valid assessment instruments to measure the severity of this disability. Psychomotricists are facing an insufficiency of psychomotor evaluation instruments for post-stroke population. This study aimed to assess if EGP, applied in the acute phase of stroke, is a better predictor of functional independence and quality of life at 3 months, compared with other scales currently used (NIHSS, BI, FIM). METHODS: This is an observational, prospective and exploratory study, with a sample of patients with a clinical diagnosis of ischemic or hemorrhagic stroke admitted to the Stroke Unit of the Neurology Service of Hospital de Santa Maria. At hospital discharge, patients were evaluated using mRS, NIHSS, BI, FIM and EGP. At follow-up, they were re-evaluated with the mRS and evaluated with the SS-QoL. Through the Spearman coefficient, the level of correlation between EGP, NIHSS, BI and FIM was analyzed. ROC curves were determined to define the best predictor of functional independence and quality of life at 3 months and to determine the most accurate cut-off point of EGP to predicting functional independence at 3 months. RESULTS: 29 patients with a mean age of 75.28 ± 8.70 years were included. Most of them suffered an ischemic stroke in the territory of the right middle cerebral artery and with undetermined etiology. Only 21 of the 29 patients completed the study with evaluations of follow-up. There were strong and significant correlations between the EGP results and the NIHSS, BI and FIM results. In determining the best predictor of functional independence and quality of life at 3 months, higher values of area under the curve (AUC) were obtained with the EGP, 0.91±0.08 and 0.97±0.04, respectively. The cut-off point with the highest specificity (87.5%) and sensitivity (92.9%) was established at 57. CONCLUSION: The results of this study suggest that better psychomotor performance at hospital discharge is related to a better level of functionality in post-stroke patients at 3 months, because, when applied in the acute phase of stroke, EGP is a better predictor of functional disability and quality of life at 3 months compared to NIHSS, IB and MIF.
BACKGROUND: Stroke is one of the main causes of disability in Portugal, and it is extremely important to apply valid assessment instruments to measure the severity of this disability. Psychomotricists are facing an insufficiency of psychomotor evaluation instruments for post-stroke population. This study aimed to assess if EGP, applied in the acute phase of stroke, is a better predictor of functional independence and quality of life at 3 months, compared with other scales currently used (NIHSS, BI, FIM). METHODS: This is an observational, prospective and exploratory study, with a sample of patients with a clinical diagnosis of ischemic or hemorrhagic stroke admitted to the Stroke Unit of the Neurology Service of Hospital de Santa Maria. At hospital discharge, patients were evaluated using mRS, NIHSS, BI, FIM and EGP. At follow-up, they were re-evaluated with the mRS and evaluated with the SS-QoL. Through the Spearman coefficient, the level of correlation between EGP, NIHSS, BI and FIM was analyzed. ROC curves were determined to define the best predictor of functional independence and quality of life at 3 months and to determine the most accurate cut-off point of EGP to predicting functional independence at 3 months. RESULTS: 29 patients with a mean age of 75.28 ± 8.70 years were included. Most of them suffered an ischemic stroke in the territory of the right middle cerebral artery and with undetermined etiology. Only 21 of the 29 patients completed the study with evaluations of follow-up. There were strong and significant correlations between the EGP results and the NIHSS, BI and FIM results. In determining the best predictor of functional independence and quality of life at 3 months, higher values of area under the curve (AUC) were obtained with the EGP, 0.91±0.08 and 0.97±0.04, respectively. The cut-off point with the highest specificity (87.5%) and sensitivity (92.9%) was established at 57. CONCLUSION: The results of this study suggest that better psychomotor performance at hospital discharge is related to a better level of functionality in post-stroke patients at 3 months, because, when applied in the acute phase of stroke, EGP is a better predictor of functional disability and quality of life at 3 months compared to NIHSS, IB and MIF.
Descrição
Tese de mestrado, Neurociências, Universidade de Lisboa, Faculdade de Medicina, 2021
Palavras-chave
Acidente vascular cerebral (AVC) Exame Geronto Psicomotor (EGP) Incapacidade funcional Qualidade de vida Neurociências