A efetividade do Qigong associado à cinesioterapia no alívio da dor lombar crônica em adultos

Abstract

Low back pain (LBP) is a public health problem. It affects adults of working age and is one of the major causes of absenteeism in the national and world stage. Can be classified into acute (warning sign, nociceptive pain) or chronic (DLC - neuropathic pain or central sensitization) when you have more than three months. Several countries invest millions of dollars in treating patients with this diagnosis. Despite the high costs of investments in several countries for the treatment of DL are many cases of recurrence and unsuccessful treatments. One reason these outcomes according to the literature, is because health professionals disregard the subjective reports of the patient, one of the biomedical model consequences. There is a recommendation to consider the suffering of patients in the treatment of people with chronic low back pain (CLBP), implementing health technologies that consider the patient as a biopsychosocial being. As physical exercise is the most recommended conservative treatment for this disease, we chose to associate Qigong exercise of Traditional Chinese Medicine (TCM) and kinesiotherapy in the treatment of DLC. The aim of this study is to evaluate the effectiveness of Qigong associated with kinesiotherapy in adults with LBP. For this, achieved were prepared two articles. An article, controlled clinical trial randomized, uni-blind in order to evaluate the effectiveness of Qigong associated with kinesiotherapy in pain relief, reduction of disability, depression and muscle activity (in the time domain, root mean square - RMS) the erector muscles of the trunk (multifidus and longissimus trunk) and maximum bilateral gluteus. The second article, qualitative approach, consisting of focus groups aimed to evaluate the patients' perception of the effects of Qigong exercises, exercise and the association between them. The sample consisted of 26 patients of both sexes, aged 49 ± 10 years in Article 1 and 14 participants of both sexes, with the same average age in Article 2; schooling in years 7 ± 4 years, body mass index 27 ± 5 and waist-hip ratio of 0.9 ± 0.6. All patients had a clinical diagnosis of specific DLC caused by uncodiscoartrose, bulging disc, dural sac compression, protusa hernia and extrusa hernia, confirmed by imaging. The participants presented a pain score of Oswestry Index (ODI) between 2 and 4 (on a scale of 0 to 5), total score of ODI between 36% and 61%, Patient Questionnaire Health- 9 (PHQ-9) between 6-27, the normalized RMS trunk longissimus ranging from 0.7 to 1.97, the normalized RMS multifidus ranging from 0.46 to 1.59 and gluteus maximus normalized RMS ranging from 0.7 to 2.86 at baseline. They have been subject to at least 10 and at most 25 physical therapy sessions in groups and reevaluated end. There was a statistically significant reduction considering p values ≤ 0.05 in both groups in the ODI pain score, total score ODI and PHQ -9, and increased muscle activity in the left multifidus muscles and gluteus maximus right in GCQ. It concluded that the association between Qigong and kinesiotherapy (GCQ) is effective in relieving pain, reducing depression, disability and increased electrical activity of the gluteus maximus muscles right and left multifidus in adults with DLC. As for the perception of the exercise by patients, the lines converge on the benefits of kinesiotherapy exercises such as muscle strengthening, the benefits of Qigong, self-control of pain and the importance of the association between both forms of exercise.