Pensando na dor crônica do ombro através de uma abordagem biopsicossocial

Abstract

Introduction: Chronic shoulder pain is a common complaint in the world's population. It has a multifactorial characteristic and is associated with behavioral and psychological changes that influence shoulder pain and disability outcomes. However, it is not yet clear in the literature how these behavioral and psychological aspects are related to the social participation and interpersonal relationships of individuals with chronic shoulder pain. It is also unclear whether any intervention proposed by a physiotherapist is capable of modifying behavioral and psychological aspects. The assessment and management of chronic shoulder pain based on biopsychosocial instruments and strategies can facilitate clinical decision-making. This thesis is composed of three studies: Study 1: Objective: To understand the contribution of behavioral and psychological in the outcomes such as social participation, interpersonal relationships, sensory function, physical function and activity of individuals with chronic shoulder pain. Methods: Individuals aged between 18 and 65 years were included. The Disability Assessment Schedule (WHODAS), Shoulder Pain Disability Index (SPADI), Disability Arm, Shoulder and Hand Questionnaire (DASH), TAMPA Kinesiophobia Scale (TSK), Fear-Avoidance Beliefs Questionnaire (FABQ), Pain Catastrophizing Scale (PCS) and the Hospital Anxiety and Depression Scale (HADS) were used to assess the International Classification of Functioning, Disability and Health (ICF) domains and behavioral characteristics and psychological. Results and conclusion: Pain catastrophizing was the only behavioral aspect able to explain the variability of the ICF domains in individuals with chronic shoulder pain. Anxiety and depressive symptoms explained changes in social participation. Depressive symptoms seems to be relevant to understanding changes in interpersonal relationships and activities of individuals with chronic shoulder pain, and anxiety explained changes in sensory and physical function. Study 2: Objective: To link shoulder-specific questionnaire items to the International Classification of Functioning, Disability and Health (ICF) domains and categories and to determine whether the items fit within the ICF framework. Methods: The Brazilian versions of the Oxford Shoulder Score (OSS), Shoulder Pain and Disability Index (SPADI), Simple Shoulder Test (SST) and Western Ontario Rotator Cuff Index (WORC) were independently linked to the ICF by two researchers. Agreement between raters was determined by calculating the Kappa index. Results and conclusion: The shoulder-specific questionnaire items covered components of body functions, activities, and participation. Body structure components and environmental factors were not covered by any of the items present in the questionnaires. There was substantial agreement between researchers. when linking OSS (Kappa index=0.66), SPADI (Kappa index=0.92), SST (Kappa index=0.72) and WORC (Kappa index=0.71). WORC and SST were the questionnaires that covered the greatest number of ICF domains. Study 3: Objective: To identify whether interventions performed by physiotherapists are effective in improving behavioral and psychological aspects in individuals with Chronic Shoulder Pain. Methods: Databases (CINAHL, PubMed, MEDLINE, Scielo, Scopus, Web of Science, Embase, PEDro and PsycINFO) were searched from inception to July 2022. Randomized clinical trials that investigated the effects of interventions performed by physiotherapists on behavioral and psychological aspects of individuals with chronic shoulder pain. Results and conclusion: Seven randomized controlled trials were included. Very low evidence shows no additional benefit of electrophysical agents or manual therapy to improve symptoms of depression and anxiety. Low to moderate evidence suggests that there is no difference between the effectiveness of graded exercise therapy and exercise plus behavioral strategy to improve kinesiophobia, coping, and fear avoidance beliefs. On the other hand, the evidence suggests the effect of graded exercise to improve catastrophizing and the low evidence shows the effect of exercise associated with the behavioral strategy in improving self-efficacy.