article
Práctica clínica cotidiana frente a la evidencia científica en el manejo fisioterapéutico del dolor lumbar crónico inespecífico
Autor
Trillos-Chacon, Maria-Constanza
Hernandez-Jaramillo, Janeth
Osorio Camacho, Ana María
Pulido Forero, Ángela María
Rodríguez Muñoz, Maritza Angélica
Rojas Ramos, Ana María
Torres Cuartas, Andrea
Institución
Resumen
Introduction: 80 % of adults experience back pain at least once in their life. Back pain is the third leading cause of consultation in the emergency room, the fourth in general practice, the second of disability pension and the first job relocation. Objective: To compare the criteria that guide decision making of a group of physiotherapists in Bogota Colombia for the management of chronic nonspecific low back pain management criteria contained in the guide COST B13 (European Guidelines For The Management Of Chronic Non- specific Low Back Pain, 2004). Material and methods: This was a descriptive study, for which clinical practice guideline COST B13 for the management of chronic nonspecific low back pain through the AGREE tool is selected anda survey was applied to 50 physiotherapists through a convenience sample with to compare the clinical practices that are performed with the recommendations given guidance. Results: 56 % of respondents had some type of training for the management of chronic nonspecific low back pain (DLCI). 94 % of patients with DLCI served range in age from 40 to 59, with female predominance. In 80 % of respondents stated that physiotherapists diagnostic help with counting for the management of patients is the radiological image. 80 % of physiotherapists evaluated variable lumbar pain experienced by the patient and 54 % stance. Other aspects were reported in lower percentage. In the treatment of DLCI, physiotherapists reported use of stretching in 80 %of cases, the superficial thermotherapy in 70 % and isometric muscle strength in 70 %, all with favorable results. Conclusion: There are differences between clinical practice of physiotherapists and guidelines contained in the recommendations of the guide in the cost DLCI B13. Mainly in the processes of physiotherapy assessment of the surveyed population as they are often focusedon observation and not always in the rigorous measurement, which makes it difficult to establish indicators of process and outcome in the diagnosis and treatment of patients with DLCI. Introducao: o 80% dos adultos experimenta dor lombar pelo menos uma vez em sua vida; a dor lombar e a terceira causa de consulta em emergencias, a quarta em medicina geral, a segunda de pensao por invalidez e a primeira de deslocalizacao laboral. Objetivo: Comparar os criterios que orientam a tomada de decisoes de um grupo de fisioterapeutas em Bogota, Colombia, para o manejo da dor lombar cronica inespecifico com os criterios de manejo conteudos na guia COST B13 (European Guidelines For The Management Of Chronic Non-Specific Low Back Pain, 2004). Materiais e metodos: tratou-se de um estudo descritivo, no qual se selecionou a guia de pratica clinica COSTB13 para o manejo de dor lombar cronico inespecifico atraves da ferramenta AGREE e se aplicou uma enquete a 50 fisioterapeutas atraves de uma amostragem por conveniencia como fim de comparar as praticas clinicas que se realizam frente as recomendacoes dadas na guia. Resultados: o 56% dos questionados contavam com algum tipo de treinamento para o manejo da dor lombar cronico inespecifico (DLCI). O 94% dos pacientes com DLCI atendidos oscilam em idades de 40 a 59 anos, com predominio do sexo feminino. O 80% dos fisioterapeutas avalia a variavel de dor lombar experimentado pelo paciente e o 54% a postura. Outros aspectos foram reportados em menor porcentagem como teste neurais, rasgos de movimentos, e provas de flexibilidade muscular. No tratamento da DLCI, os fisioterapeutas reportam fazer uso dos estiramentos no 80% dos casos, a termoterapia superficial no 70% e o fortalecimento muscular isometrico no 70%, todos com resultados favoraveis. Conclusoes: Existem diferencas entre a pratica clinica e os lineamentos conteudos nas recomendacoes dadas pela guia COST B12 para DLCI principalmente nos processos de avaliacao clinica devido a que costumam estar centrados na observacao e nao sempre na medicao rigorosa o que dificulta a possibilidade de estabelecer indicadores de proceso e desenlace no diagnostico e tratamento dos pacientes com DLCI.