Avaliaçao funcional em pacientes portadores de AIDS.

Abstract

Resumo: Atualmente, com o avanco nos tratamentos e aumento da sobrevida, a aids tem sido considerada como uma doenca cronica progressiva. O aumento da sobrevida muitas vezes esta associado a debilidade fisica que ocorre em consequencia da doenca, debilidade esta que pode comprometer a independencia funcional dos pacientes. A incapacidade funcional e a chave para se entender as consequencias da doenca e para definir a necessidade de assistencia por parte dos servicos de saude. Os objetivos deste estudo foram documentar e descrever os graus e os tipos de incapacidades funcionais encontradas em pessoas com aids e associar a incapacidade a fatores clinicos e imunologicos relacionados a doenca. Foram avaliados 120 pacientes internados com diagnostico de aids, no Hospital de Clinicas da Universidade Federal do Parana, no periodo de maio/2000 a julho/2001. Cada paciente foi avaliado apenas uma vez; a avaliacao funcional consistiu em entrevista com o paciente, exame retrospectivo do prontuario, exame fisico direcionado, e aplicacao das escalas de capacidade fisica e capacidade funcional: Medicao da Independencia Funcional (MIF), indice de Barthel, escala de Rankin modificada e a escala de Kamofsky. Na entrevista os pacientes foram questionados quanto a existencia de dificuldades fisicas, seu inicio e relacao com outros fatores. No exame fisico foi avaliada a forca de grupos musculares ou musculos especificos. Oitenta e cinco por cento dos pacientes referiram ter dificuldade na atividade fisica e 70% referiam diferentes graus de fraqueza; metade da populacao referiu fazer suas atividades normais com esforco; 67% nao trabalhavam sendo que 44% deixaram o trabalho devido a doenca; a forca muscular estava alterada em 43% e 46% apresentavam queixas relacionadas ao sistema nervoso. Pela escala de Kamofsky a media foi de 70% ( } 0,19), mediana de 80% e o indice mais frequente foi 80% em 63 (52%) pacientes. Pela escala de Rankin modificada 33 (28%) pacientes foram considerados independentes, 72 (60%) considerados parcialmente dependentes e 15 (12%) considerados dependentes. Pelo indice de Barthel 67 (56%) foram considerados independentes, 41 (34%) parcialmente dependentes 12 (10%) dependentes. Pela escala MIF 49 (58%) foram considerados independentes e 36 (42%) dependentes. As areas de maior dificuldade foram as que exigiam maior esforco fisico e equilibrio: uso de escadas, andar e as transferencias. Houve relacao estatisticamente significativa entre a incapacidade medida por estas escalas e os valores de log. carga virai c/ml elevados, valores menores do CD4+/fj,l e da relacao CD4+/CD8+. Houve tambem diferenca significativa entre a incapacidade e o maior numero de meses com diagnostico de aids, envolvimento de mais de um sistema na abertura do quadro de aids, envolvimento do sistema nervoso como causa do internamento, presenca de alteracao na forca muscular, queixa de envolvimento neurologico, queixa de fraqueza e com o trabalho. Verificou-se por este estudo a presenca de um grau significativo de incapacidades em pacientes internados com aids, o que sugere a indicacao de medidas preventivas e/ou tratamento visando manter a independencia pelo maior tempo possivel e melhorar a qualidade de vida nesta populacao.

Abstract: Currently, with the advance achieved in the treatment of AIDS and an increase in survival rates, this illness is seen as chronic. The increase in survival rates is associated with the physical disability that occurs as a result of the illness, and can compromise the functional independence of the patients. Functional disability is a key to understanding the consequences of the disease and to defining the need for providing services. The purpose of this study is to register and to describe the degree and types of disability seen in persons affected by AIDS, as well as to associate the inability with immunological and clinical data. The study took place at Hospital de Clinicas of the Federal University of Parana, where 120 inpatients diagnosed to be with AIDS were evaluated in the period of may/2000 july/2002. Each patient was evaluated only once. The functional evaluation consisted of an interview with the patient, a retrospective analysis of the hospital records, of a physical examination, and the application of scales that measures physical ability - Kamofsky and modified Rankin Scale - and functional ability, Functional Independence Measure (FTM) and Barthel Index. During the interview, the patients were questioned about the existence of disabilities, their beginning and relationship with other factors. The physical examination consists of the evaluation of muscular strength. One hundred and two patients (85%) reported impaired physical activity and 70% complained of various degrees of weakness. Half of the population referred to the physical effort required for the performance of all their activities; 67% don't work and 44% gave up their jobs for reasons related to the infection; the muscle strength was altered in 43% and 46% complained about disabling neurological involvement. Based on Kamofsky's scale, the average was 70% ( } 0,19), median of 80%. Eighty percent (80%) was the most frequent ranking, which was found in 63 (52%) of them. According with Rankin's modified scale, 33 (28%) patients were considered independent, 72 (60%) partially dependents and 15 (12%) dependents. In accordance with the Barthel index, 67 (56%) were considered independent, 41 (34%) partially dependent 12 (10%) were dependent. According with the F1M scale, 49 (58%) were considered independent and 36 (42%) dependents. The items most often requiring assistance were stair climbing, walking and transfers, which were the items that called for a greater effort to be performed. There was a statistical correlation between the inability measured by the scales and the higher rates of viral load (log) c/ml, lower rates of CD4+4il counts and CD4+/CD8+. There was also a significant difference between inability and the greater number of months since AIDS had been diagnosed, the involvement of more than one set of systems in the definition of AIDS, involvement of the nervous system in the cause of hospitalization, muscle strength alteration, complaints of neurological involvement, complaints of weakness and with being unemployed. We found a significant degree of inability in patients hospitalized with AIDS, which means that it is important to focus attention on preventin and/or treating in order to keep the patients at the independence level for as long as possible, thus ensuring for them a better quality of life.