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Prática baseada na evidência em fisioterapia: conceitos e concretizações no acidente vascular cerebral
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Abstract(s)
Introdução: O Acidente Vascular Cerebral (AVC) é uma das principais causas de morbilidade e
mortalidade em todo o mundo, associado a índices elevados de incapacidade a longo prazo. A
Fisioterapia tem um papel preponderante no seu processo de reabilitação, devendo contudo essa
intervenção desenvolver-se numa Prática Baseada na Evidência (PBE).
Objetivos: São objetivos deste trabalho verificar na literatura qual a melhor evidência disponível em Fisioterapia na abordagem do Acidente Vascular Cerebral.
Desenvolvimento: A pesquisa foi realizada em bases de dados eletrónicas: MEDLINE, EMBASE,
CINAHL, Cochrane Library e links relacionados com a Prática Baseada na Evidência, cujos descritores foram “stroke” e “rehabilitation” ou “physiotherapy” ou “physical therapy”. A seleção das intervenções foram classificadas em graus de recomendação segundo o Oxford Centre for Evidence-Based
Medicine.
Conclusões: Encontrámos discrepância entre os autores relativamente às recomendações de
algumas estratégias e alguns procedimentos da prática corrente, não têm qualquer evidência. A
abordagem precoce e a intensidade da intervenção revelaram uma evidência forte, mas ainda a
necessitar de linhas orientadoras mais estruturadas. A maior parte dos estudos são inconclusivos quando comparam duas técnicas diferentes. A Constraint Induced Movement Therapy (CIMT)
e o treino aeróbio revelaram-se os mais consistentes em termos de evidência. A Mirror Therapy
(MT) e o Treino Robótico têm aumentado a sua evidência. Algumas técnicas inovadoras têm
vindo a mostrar-se promissoras, mas também ainda a necessitarem de estudos mais aprofundados.
A Fisioterapia é imprescindível no processo de reabilitação dos doentes com AVC e muitas das
suas intervenções assentam numa Prática Baseada na Evidência. Contudo, continua a ser necessário melhorar essa evidência, aumentando o investimento na qualidade metodológica dos
ensaios clínicos.
Introduction: Stroke is one of the leading causes of morbidity and mortality throughout the world, associated with high levels of long-term disability. Physiotherapy has a leading role in their rehabilitation process, but this intervention should develop in an Evidence-Based Practice. Objectives: The objective of this paper is to verify in the scientific literature the best evidence available in Physiotherapy in the approach to Stroke. Development: The survey was conducted on electronic databases: MEDLINE, EMBASE, CINAHL, Cochrane Library and links related to the Evidence-Based Practice. The descriptors were "stroke" and "rehabilitation" or "physiotherapy" or "physical therapy". The selection of interventions was classified in grades of recommendation according to the Oxford Centre for EvidenceBased Medicine. Conclusions: We have found a discrepancy between the authors with respect to recommendations of some strategies and some procedures of practice do not have any evidence. The early approach and the intensity of the intervention showed strong evidence, but still in need of more structured guidelines. Most of the studies are inconclusive when comparing two different techniques. The Constraint Induced Movement Therapy and aerobic training proved to be the most consistent in terms of evidence. The Mirror Therapy and Robotic Training have increased their evidence. Some innovative techniques are promising, but still need further study. Physiotherapy is very important in the process of rehabilitation of patients with Stroke and many of the interventions are based on an Evidence-Based Practice. However, there is still a need to improve this evidence, by increasing investment in the methodological quality of the clinical trials.
Introduction: Stroke is one of the leading causes of morbidity and mortality throughout the world, associated with high levels of long-term disability. Physiotherapy has a leading role in their rehabilitation process, but this intervention should develop in an Evidence-Based Practice. Objectives: The objective of this paper is to verify in the scientific literature the best evidence available in Physiotherapy in the approach to Stroke. Development: The survey was conducted on electronic databases: MEDLINE, EMBASE, CINAHL, Cochrane Library and links related to the Evidence-Based Practice. The descriptors were "stroke" and "rehabilitation" or "physiotherapy" or "physical therapy". The selection of interventions was classified in grades of recommendation according to the Oxford Centre for EvidenceBased Medicine. Conclusions: We have found a discrepancy between the authors with respect to recommendations of some strategies and some procedures of practice do not have any evidence. The early approach and the intensity of the intervention showed strong evidence, but still in need of more structured guidelines. Most of the studies are inconclusive when comparing two different techniques. The Constraint Induced Movement Therapy and aerobic training proved to be the most consistent in terms of evidence. The Mirror Therapy and Robotic Training have increased their evidence. Some innovative techniques are promising, but still need further study. Physiotherapy is very important in the process of rehabilitation of patients with Stroke and many of the interventions are based on an Evidence-Based Practice. However, there is still a need to improve this evidence, by increasing investment in the methodological quality of the clinical trials.
Description
Keywords
Fisioterapia Acidente Vascular Cerebral
Citation
Publisher
Sociedade Portuguesa de Neurologia