Exercícios terapêuticos para tratamento de dor lombar crônica em pacientes atendidos na atenção primária à saúde: uma scoping review e proposta de utilização de vídeo educativo

Abstract

Introduction: Low Back Pain (LBP) is one of the most frequently treated complaints in Primary Health Care (PHC), and non-specific Chronic Low Back Pain (CLBP) presents itself, in this context, as a relevant pathology, potentially capable of affecting the quality of life of individuals and disabling them for work and their daily activities. This topic is highly relevant in the daily practice of health professionals who face difficulties with the management of CLBP in PHC. Scientific evidence supports the use of Therapeutic Exercises (ET) in the approach to non-specific CLBP, but the type, form and appropriate frequency of physical exercises to treat non-specific CLBP at this level of user access to the health system is still unclear. This work is aligned with the line of research on Quality in Adult Health Care of the Professional Master's Degree in Health Sciences of the Health Sciences Teaching and Research Foundation (FEPECS). Objective: To identify and map, through a Scoping Review, the scientific evidence available on ET provided by physiotherapists for treatments of patients with CLBP in PHC. Furthermore, compile information from the studies analyzed to develop the content of the educational video, ensuring that it is understandable and accessible to the general population. Method: This is an original work of the Scoping Review type, which contributes by compiling and analyzing data on ET for DLC performed by professional physiotherapists in the PHC setting, providing a solid basis to support ET protocol in the area and guide future studies. The present study followed the method proposed by the Joanna Briggs Institute (JBI) and the PRISMA-ScR checklist (The Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews). The acronym PCC (population, concept and context) was used to prepare the question: Which therapeutic exercises (concept) are most effective for treating chronic low back pain (population) used by physiotherapists in patients treated in primary health care (context)? The databases were consulted: MEDLINE (Medical Literature Analysis and Retrieval System Online) via PUBMED (National Library of Medicine), The Cochrane Library (Cochrane Central Register of Controlled Trials), EMBASE from Elsevier, LILACS (Latin American and Caribbean Literature in Health Sciences) via VHL (Virtual Health Library), Scopus, Scielo, PEDro and gray literature such as Google Scholar and ProQuest, using the following key words: primary health care, pain chronic low back pain and therapeutic exercise; and their respective counterparts in English: primary health care, low back pain, exercise therapy. Duplicates were removed and article titles and abstracts were read and analyzed by two reviewers independently, with conflicts resolved by a third reviewer. The included studies were read in full and the data extracted, according to the acronym PCC. The results were presented in a flowchart and narrative summary, following the PRISMA-ScR guidelines, aiming to achieve the review objective. Results: The present study initially identified 1,999 studies, with 375 duplicate studies detected and resolved. After duplication analysis, 1,624 studies were analyzed based on title and abstract. However, a total of 12 studies were included, all using quantitative methodology. The studies were published in 8 countries, with Spain presenting 4 articles (33.33%), Brazil with 02 articles (16.66%), and the other countries presenting only one (01) article each, totaling (50%) of the remaining studies. The type of study found was entirely type randomized (100%) and with a predominance of the English language (91.66%), only one (01) study in Portuguese. The studies varied in relation to interventions with therapeutic exercises, with interventions involving strengthening, stretching, high and low intensity aerobics, mobilization and spinal flexibility exercises. Still part of ET was based on relaxation and deep breathing. The review shows that different types of therapeutic exercises are used in the treatment of chronic non-specific low back pain in primary health care with good results. Products developed: two products were developed: a Scoping Review and an animated educational video. The Scoping Review mapped therapeutic exercises for treating chronic low back pain in primary health care and identified in the literature the challenges for implementation in PHC clinical practice. The educational video aimed to disseminate adequate and updated information, in an accessible and innovative way for the population, highlighting the pathophysiology, recognition of symptoms, appropriate postures and guidance on therapeutic exercises to perform at home. The educational video was titled “Therapeutic exercises to alleviate chronic low back pain in Primary Health Care”. The educational video was sent to the Brazilian Book Chamber (CBL) for copyright registration. The two products aim to improve the approach and results in treating this condition in the public health service. The educational video is available on the official You Tube channel of the Postgraduate Program in Health Sciences at the School of Public Health of the Federal District (ESPDF) maintained by FEPECS, follow the access link: https://youtu.be/iEvTotVNCxQ. Conclusion: It is expected that the scope review to be generated through this Scoping Review study will present the general state of research on the topic, with appropriate exercises for relief and treatment of CLBP, and also identify the gaps in the evidence base that need to be studied on the topic investigated. This study has the potential to generate impact and be applied in health units and can also guide future research. By combining theory with practice and developing the technical product, significant advances are expected to be made in the approach to low back pain. This includes achieving better treatment outcomes, reducing complications and increasing patient satisfaction. The technical product will be made available for access by patients and professionals from the Health Department of the Federal District (SES-DF). The scoping review protocol was registered in the Open Science Framework - OSF database under code DOI 10.17605/OSF.IO/3ERBH. Access link: https://osf.io/3erbh/?view_only= c75a2dbbba6e49019e0c0b18ab7b2d6a.