Programa de reabilitação domiciliar orientada por fisioterapeuta em pacientes com esclerose sistêmica: avaliação através da capacidade funcional, função pulmonar e qualidade de vida

Abstract

INTRODUCTION: Systemic sclerosis (SSc) is a rare autoimmune rheumatic disease, predominantly affecting women, that affects multiple organs and systems, resulting in high morbidity and mortality and low health-related quality of life (HRQoL). Due to the variability of rehabilitation programs for SSc, it is urgent to develop viable protocols and tests that measure the response to rehabilitation. In this context, physiotherapist-led home-based rehabilitation programs (PDH) are strategic adjuncts to pharmacological treatment. The Glittre activities of daily living test (TGlittre) is useful for assessing functional capacity, especially due to upper limb impairment. OBJECTIVES: The study aimed to evaluate the functional capacity of women with SSc who underwent a 12-week PGHR program using the TGlittre. Secondarily, the association of TGlittre variables with handgrip strength, hand function, physical disability index, HRQoL, and lung function was investigated, in addition to the impact of LPR on lung ultrasound (LUS) findings. METHODOLOGY: This is a longitudinal, quasi-experimental study including women with SSc in a 12-week PGHR protocol. On the day of enrollment in the protocol, spirometry, lung ultrasound (LUS), TGlittre, handgrip dynamometry, and the Cochin Hand Functional Scale (CHFS), Health Assessment Questionnaire Disability Index (HAQ-DI), and Short-Form 36 Health Survey SF-36 were performed. Subsequently, the patient received the prescription and trained with the PGHR program exercises. A reassessment was performed after 12 weeks. RESULTS: The results showed significant changes in LUS findings in 22 participants, especially in B lines >2. The median of B-lines >2 decreased from 3 (0-7) to 3 (0-6) (p=0.020) and the aeration score from 8 (0-16.5) to 3 (0-16) (p=0.013). In the interstitial lung disease (ILD) group, there was a significant reduction in B-lines >2 (p=0.0004) and in the aeration score (p=0.016). There was also a significant decrease in TGlittre time (p=0.036) and in manual TGlittre time (p=0.001). The HAQ-DI decreased from 1.13 (0.5-1.8) to 1.0 (0.4-1.3) points (p=0.004) and the CHFS from 14 (5-35) to 7 (3-21) points (p=0.0002). Handgrip strength increased significantly (p=0.008). The delta TGlittre time (% predicted) significantly correlated with the delta handgrip strength (rs=-0.360, p=0.039). CONCLUSIONS: The PGHR program is a viable rehabilitation strategy, and the TGlittre is an effective instrument for measuring its impact on the functional capacity of women with SSc. The LUS can be a complementary tool for assessing pre- and post-PGHR changes, especially in association with ILD. PGHR improved hand, physical, and pulmonary function, and HRQoL, suggesting that a 12-week protocol may be a beneficial non-pharmacological therapy, reducing functional limitations and promoting greater independence and quality of life in SSc.