Efetividade de um programa autogerenciável de exercícios, disponibilizado por meio de um aplicativo, para trabalhadores da segurança pública com dor lombar crônica: ensaio clínico controlado aleatorizado

Abstract

Public safety workers (PSW), such as police officers and firefighters, have high rates of chronic low back pain (CLBP). Self-managed exercise interventions via a smartphone app are an alternative for managing CLBP, but the effectiveness of these interventions has not been examined in PSW. This thesis aimed to systematically review findings from randomized controlled trials (RCTs) on conservative interventions for managing CLBP in PSW and military personnel. Furthermore, the objective was to describe the prevalence of CLBP in federal highway police officers (FHPO) from RS. Finally, we aimed to develop and test the effectiveness of a self-managed exercise program, provided through an app, on self-reported and neuromuscular outcomes compared to a health education control group in PSW with CLBP. A systematic review study was conducted in seven databases, as well as a cross-sectional study of the prevalence of CLBP in FHPO from RS, and a parallel, two-arm, superiority RCT. Eligible police officers and firefighters from RS were randomly allocated to one of two groups, which received one of the versions of the app: 1st) self-managed program with 16 sessions of physical exercise to core strengthening (two sessions/week, on non-consecutive days), plus health education (INT); or 2nd) health education program over eight weeks (CON). The primary outcomes included pain intensity (numerical rating scale) and disability (Roland-Morris disability questionnaire) assessed after eight weeks of intervention. Secondary outcomes were pain and disability at 16 weeks follow-up and quality of life, self-efficacy, symptoms of depression, anxiety, and stress, and quality of sleep after 8 and 16 weeks, as well as peak torque, muscular endurance, and muscular activity of trunk extensors and flexors after 8 weeks. All outcomes were analyzed according to the principles of intention to treat, using linear mixed models. The review study found only five RCTs, none of which involved police officers and firefighters. The prevalence study identified a prevalence of CLBP of 67% in FHPO from RS. In the RCT, 47 PSW were allocated to the INT (n=23) and CON (n=24) groups. The INT group showed superior results compared to the CON group regarding pain intensity and disability after eight weeks. Furthermore, the INT group improved quality of life, self-efficacy, and anxiety compared to the CON group after eight weeks. Treatment effects related to disability, quality of life, and anxiety persisted at 16-week follow-up. It is concluded that there is a scientific gap in RCT evaluating the effectiveness of conservative treatments for CLBP in PSW, as well as a high prevalence of CLBP in FHPO from RS and a self-managed, short-term physical exercise program, available through an app, is effective in reducing pain intensity and disability, as well as improving the quality of life and anxiety of PSW from RS with CLBP.