Lombalgia durante a gestação: eficácia do tratamento com Reeducação Postural Global (RPG)

Abstract

Realizou-se um estudo clínico comparativo com o objetivo de avaliar o efeito da Reeducação Postural Global (RPG) no tratamento da lombalgia durante a gravidez e sua relação com limitações funcionais das gestantes. Os sujeitos foram 34 gestantes nulíparas atendidas em três centros de saúde e um hospital privado de Campinas, com idade gestacional entre 20 e 25 semanas e queixa de dor lombar. Dezessete gestantes foram submetidas a sessões de RPG durante oito semanas consecutivas, e as demais seguiram orientações de rotina para controle da dor lombar. Em cada sessão de RPG avaliou-se a intensidade da dor percebida pela mulher, antes e após os procedimentos. O grupo controle foi avaliado quanto à intensidade da dor na admissão, às quatro e oito semanas do estudo. Aplicou-se o questionário Roland-Morris para avaliar limitações funcionais, ao início e final do acompanhamento. O grupo de RPG apresentou decréscimo estatisticamente significativo na intensidade da dor antes e depois das sessões. Ao longo do estudo, as mulheres submetidas a RPG tiveram medianas de intensidade da dor e médias do escore de limitações funcionais significativamente menores que as do grupo controle. Análise de covariância indicou que o tratamento com RPG estava associado à menor intensidade da dor percebida ao final do estudo. Conclui-se que a RPG pode dar importante contribuição no tratamento da dor lombar durante a gestação, reduzindo, ao mesmo tempo, as limitações funcionais.

Therapeutic exercise for pregnancy low back and pelvic pain: a systematic review

“…After assessing the complete articles, 16 were excluded because they did not report interventions that were supervised or guided by physical therapists (9-11, 24-28); because they associated the exercises to manual therapy (29,30); because they were unpublished (theses and dissertations) (31)(32)(33); for lack of data (34); or because they did not relate the outcomes or interventions of interest (8,35). Thus, eight studies (36)(37)(38)(39)(40)(41)(42)(43), published between the years of 2005 and 2014, were included in this systematic review (Tables 2, 3 Eight RCT (36 -43) were included; one about low back pain (36), two about pelvic pain (37,38) and five about low back and/or pelvic pain (39 -43) . The size of the sample of the studies included in the review varied from 34 to 855 participants, with a total of 1781 pregnant women.…”

“…As to the methodological quality of the studies, assessed with the PEDro Scale, seven studies (36)(37)(38)(39)(41)(42)(43) were considered to have high quality, with scores varying from six to eight points. Only one study (40) had low methodological quality.…”

“…Pain intensity was assessed by most studies (36-40, 42, 43), and the Visual Analogue Scale (VAS) was the most commonly used instrument for the assessment (36,38,40,42,43). Another outcome that was highly emphasized in the assessments was functionality (36-39, 41, 42), especially using the RolandMorris Questionnaire (36,37,39) and the Disability Rating Index (DRI) (38,41,42).…”

“…Another outcome that was highly emphasized in the assessments was functionality (36-39, 41, 42), especially using the RolandMorris Questionnaire (36,37,39) and the Disability Rating Index (DRI) (38,41,42). Two studies (41,42) assessed medical leaves for time off work and three studies (38, 41, 42) used self-reports and pain design.…”

“…Only the study by Gil et al (36) assessed the efficacy of therapeutic exercises for pregnancy low back pain (Table 2). A total of 34 pregnant women was randomized and divided into an intervention and a control group.…”