Reabilitação e qualidade de vida em pessoas com amputação de membros inferiores

Tese (doutorado)—Universidade de Brasília, Instituto de Psicologia, Programa de Pós-graduação em Psicologia Clínica e Cultura, 2019.É necessário compreender o indivíduo que sofreu a perda de membros em todos os seus aspectos, nas dificuldades encontradas na adaptação à amputação, no uso de próteses e na percepção da sua condição física, sendo a avaliação de qualidade de vida, através de suas características de multidimensionalidade e subjetividade, uma ferramenta eficaz para promover essa compreensão. Dessa forma, realizou-se pesquisa com objetivo de avaliar a qualidade de vida de pacientes com amputação de membros inferiores e em uso de próteses, em contexto de um hospital de reabilitação (Rede Sarah de Hospitais). Participaram do estudo 116 pacientes com idade igual ou superior a 18 anos, com tempo de amputação acima de seis meses, em uso de próteses. Para avaliar a qualidade de vida, utilizou-se o questionário de avaliação de qualidade de vida geral – SF-36; para mensurar a atividade do participante com a prótese, o questionário de Medida Funcional para Amputados (FMA); e, para avaliar a adaptação à amputação e à prótese, além de permitir uma avaliação de qualidade de vida específica, a escala Trinity Amputation and Prosthetic Experiences Scales-revised (TAPES-R). Dados sociodemográficos e relativos ao procedimento cirúrgico foram coletados em prontuário eletrônico. Para aplicação nessa pesquisa, realizou-se a adaptação transcultural da escala TAPES-R, que foi nomeada de Escala Trinity sobre a experiência da amputação e uso de prótese - versão revisada. Na segunda fase desse estudo, realizou-se uma entrevista semiestruturada com 10 participantes da amostra. Dentre as características descritivas da amostra, verificou-se uma idade média de 35,9 anos (DP = 12), 58,6% são do sexo masculino, 51,7% são solteiros. As amputações acima do joelho representaram 68% da amostra, as causas traumáticas e por tumores somaram 68,1% e as amputações em membro inferior esquerdo, 57,7%. O tempo médio de amputação foi de 18 anos (DP = 12,6) e de uso de prótese, 13,1 h/dia. Os resultados do SF-36 mostraram que os domínios mais afetados foram a capacidade funcional e a vitalidade, sendo o aspecto social a média mais alta. Há uma pior percepção de qualidade de vida entre as mulheres, em pacientes com amputações acima do joelho e por causas traumáticas. Com relação ao FMA, observou-se que os participantes eram independentes para colocar e retirar a prótese, mas relataram dificuldade nas atividades funcionais realizadas com ela; apesar disso, 45,7% retornaram às atividades que realizavam antes da amputação e a maioria consegue deambular o necessário para as suas atividades diárias. Com a escala TAPES-R, evidenciou-se pior ajustamento, maior dificuldade funcional e menor satisfação com a prótese em pacientes com amputações acima do joelho. Usuários que permanecem com a prótese por um período inferior a 10h/dia apresentaram pior ajustamento à limitação, maior limitação nas atividades, assim como insatisfação com o dispositivo protético. Há uma correlação entre os instrumentos TAPES-R e SF-36, que evidencia a coerência entre eles e seus domínios, denotando seu caráter avaliador. A análise das entrevistas foi realizada com o software Iramuteq®, empregando-se o método de Classificação Hierárquica Descendente, o que resultou em cinco classes: tornar-se um amputado, percepção de dor, preconceito e barreiras, superação e recomeço e sentido no uso da prótese. Tempo desde a amputação, sexo masculino e amputações abaixo do joelho parecem ser fatores preditores de uma melhor percepção de qualidade de vida e de um melhor ajustamento na amostra estudada. Avaliação e orientação pré-operatória e integração precoce em um programa de reabilitação composto por uma equipe interdisciplinar são condutas adequadas para minimizar o impacto da incapacidade e melhorar o prognóstico funcional e a qualidade de vida desta população. Recomenda-se que futuras pesquisas adotem delineamento longitudinal, inclusive com pacientes que não façam uso de prótese.It is necessary to understand the individual who suffered loss of limbs in all their aspects, in the difficulties encountered in adapting to amputation, in the use of prostheses and in the perception of their physical condition. The quality of life assessment, through its multidimensionality and subjectivity, is an effective tool to promote this understanding. Thus, this study was carried out to evaluate the quality of life in patients with lower limb amputation and in the use of prostheses, in the context of a rehabilitation hospital (Sarah Network of Hospitals). A total of 116 patients aged 18 years and over, with amputation time of more than six months, using prosthesis, participated in the study. The general quality of life evaluation questionnaire – SF-36, was used to evaluate the quality of life; the Functional Measure for Amputees questionnaire – FMA, was used to measure the activity of the participant with the prosthesis; and the TAPES-R scale was used to assess the adaptation to amputation and prosthesis, besides allowing a specific quality of life assessment. Sociodemographic and surgical data were collected in electronic medical records. For application in this research, the transcultural adaptation of the Trinity Amputation and Prosthetic Experiences Scalesrevised (TAPES-R) was carried out. In the second phase of this study, a semi-structured interview was conducted in 10 participants of the sample. Among the descriptive characteristics of the sample, there was an average age of 35.9 years (SD = 12), 58.6% were males, 51.7% were single. The amputations above the knee represented 68% of the sample, the traumatic causes and tumors totaled 68.1%, and the amputations in the lower left limb, 57.7%. The mean amputation time was 18 years (SD = 12.6), and prosthesis use, 13.1 h/day. The SF36 results showed that the most affected domains were functional capacity and vitality, with the social aspect having the highest average. There is a worse perception of quality of life among women, in patients with above knee and traumatic causes amputations. Regarding the FMA, the participants were independent to place and remove the prosthesis, but reported difficulty in the functional activities performed with it; nevertheless, 45.7% returned to their pre-amputation activities, and most are able to walk around what is necessary for their daily activities. With the TAPES-R scale, there was worse adjustment, greater functional difficulty and less satisfaction with the prosthesis in patients with above knee amputations. Prosthesis users who stayed with it for less than 10 hours per day presented worse adjustment to the limitation, greater limitation in the activities, as well as dissatisfaction with the prosthetic device. There is a correlation between the TAPES-R and SF-36 instruments, which shows the coherence between them and their domains, denoting their evaluating character. The analysis of the interviews was carried out using the Iramuteq® software, with the descending hierarchical classification method, which resulted in five classes: becoming an amputee, pain sensation, prejudice and barriers, overcoming and restarting, and sense of use of the prosthesis. Time since amputation, male gender and below knee amputations appear to be predictors of better perception of quality of life and better adjustment in this sample. Preoperative assessment and orientation, and early integration into a rehabilitation program composed of an interdisciplinary team is an adequate conduct to minimize the impact of disability and improve the functional prognosis and quality of life of this population. It is recommended that future researches adopt a longitudinal design, even with patients who do not use a prosthesis

Ajustamento psicossocial de pessoas com amputação: ponto de vista

Anualmente, no Brasil, milhares de pessoas são submetidas a procedimento de amputação. Nesse cenário, as instituições que prestam cuidados – desde a etapa cirúrgica ao processo de reabilitação – necessitam planejar e avaliar seus programas assistenciais tendo por base evidências divulgadas pela literatura especializada nacional e internacional. Visando, portanto, propiciar a problematização da temática e gerar reflexões para a intervenção da equipe de reabilitação, este artigo discute fatores clínicos, sociodemográficos e psicossociais associados ao processo de ajustamento à prótese. Sugere-se que, no cenário brasileiro, futuras investigações focalizem variáveis de natureza psicossocial, a exemplo dos estudos internacionais mais recentes.Every year in Brazil, thousands of people undergo an amputation procedure. In this scenario, institutions that provide care – from surgery to rehabilitation – need to plan and evaluate their care programs based on evidence published in national and international specialized literature. Therefore, aiming to discuss this issue and generate reflections for interventions of the rehabilitation team, this study discusses clinical, sociodemographic and psychosocial factors associated with the process of adjustment to the prosthesis. This study suggests that, in the Brazilian scenario, future investigations should focus on variables of a psychosocial nature, such as the most recent international studies

Práticas Educomunicativas

Esta publicação pretende divulgar as práticas educomunicativas realizadas em diferentes regiões do país e que estão sendo implantadas por nossos associados. O e-book Práticas Educomunicativas, que visa oferecer um material de uso prático que possa servir de apoio pedagógico em diferentes contextos, escolar ou de ações junto a instituições, apresenta 20 artigos de profissionais e pesquisadores que implementam ações que inter-relacionam comunicação e educação no contexto da educação apontando as experiências e processos de educomunicação e valorizando desta forma, o trabalho realizado por cada educomunicador oferecendo, ao leitor, um material de uso prático que possa servir de apoio pedagógico em diferentes contextos

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