Preditores agudos da autopercepção de saúde de indivíduos acometidos pelo Acidente Vascular Cerebral após três e 12 meses da alta hospitalar

Abstract

Several aspects of individuals affected by stroke’ lives have been investigated, including self-rated health (SRH). SRH is a multidimensional construct and its components are associated with aspects of functionality and human health. Few studies have been published with the objective of investigating SRH predictors and this investigation is important to assist in the process of clinical reasoning and decision making by health professionals. The aim of this study was to determine the acute predictors of general and time comparative SRH of individuals affected by stroke after three and 12 months of hospital discharge, considering the personal, physical, and mental aspects. The sample consisted of all individuals admitted to the stroke unit from September 2019 to February 2021, with diagnosis of primary stroke, age ≥ 20 years, and residents of the metropolitan region of Belo Horizonte. The dependent variable was the general and time comparative SRH, assessed at three and 12 months after hospital discharge, using the first and second questions of the Short Form Health Survey 36. The independent variables, collected during hospital stay, were organized according to the aspects related to SRH: personal aspects (age, sex, presence of comorbidities, socioeconomic level, family arrangement), physical aspects (stroke severity, motor impairment, independence for basic activities of daily living (BADL)), and mental aspects (cognitive function). Four models were developed through binary logistic regression analysis using the Enter method, and the results were presented in Odds Ratio (OR) and 95% confidence interval (95%CI). The sample consisted of 200 individuals evaluated at three months and 121 evaluated at 12 months. For the general SRH assessed at three months, age (OR: 2.1, 95%CI 1.04-4.26 and p=0.04) and independence for BADL (OR: 0.29; 95%CI 0.14-0.58 and p=0.001) were identified as significant predictors. At 12 months, no significant predictors were found. For the time comparative SRH evaluated at three months, motor impairment was identified as a significant predictor (OR: 3.90, 95%CI 2.01-7.60 and p>0.001) and at 12 months, sex (OR: 0.36, 95%CI 0.14-0.93 and p=0.030) and independence for BADL (OR: 0.32, 95%CI 0.13-0.82 and p=0.020) were identified as significant predictors. The results demonstrate that individuals aged 65 years or older were two times more likely to rate their general SRH as poor and individuals independent for BADL in the acute phase of stroke were 0.29 times more likely to rate their general SRH as poor. Individuals with greater motor impairment in the acute phase of stroke were 3 times more likely to rate their time comparative SRH as poor. Men were 0.36 times more likely to rate their time comparative SRH as poor and individuals with greater independence for BADL were 0.32 times more likely to assess their time comparative SRH as poor. Among the predictors identified, independence for BADL and motor impairment, are variables modifiable by rehabilitation professionals, which highlights the importance of these outcomes in the process of elaborating clinical reasoning of these professionals.