Doença de chagas e acidente vascular encefálico: impacto sobre a funcionalidade, qualidade de vida e efeitos da reabilitação

Abstract

Chagas disease (CD) is a neglected chronic systemic infection. The leading causes of morbidity in patients with CD result from cardiac involvement, with one of the main clinical manifestations being the stroke. Disabling diseases such as CD and stroke often give rise to secondary complications and contribute to a sedentary lifestyle. Moreover, psychological aspects associated with the incidence of chronic and stigmatizing diseases may have an even greater negative impact on the lives of these individuals. Therefore, it is important to implement effective multidimensional rehabilitation programs, which include adopting healthier and more active lifestyles. This study is part of a comprehensive line of research on the topic and had the following objectives: a) to explore aspects related to physical disability, depressive symptoms, quality of life (QoL) and functioning of patients with CD associated with stroke, and establish possible correlations between them (article I); b) to investigate the functional performance and physical activity (PA) level of these patients and compare qualifiers of functioning with different population groups (article II), and c) to investigate the impact of aerobic training on the QoL and functional capacity of these individuals (article III). Two cross-sectional studies and one quasi-experimental study were conducted to meet the proposed objectives. Considering the specificity of each of the study questions, the participant details, the description of inclusion and exclusion criteria, and the statistical analyses used were provided in each article for better understanding. The first article included 21 patients with CD and stroke. Data showed that secondary physical stroke sequelae had a significant impact on functioning (r = -0.663, p = 0.003), but did not influence any domain of patient QoL (physical aspects, r = 0.207, p = 0.410; psychological aspects, r = 0.017, p = 0.946; social aspects, r = 0.511, p = 0.530; environmental aspects, r = 0.229, p = 0.560). On the other hand, the presence of depressive symptoms was correlated with QoL (physical aspects, r = -0.733, p = 0.001; psychological aspects, r = -0.581, p = 0.012; social aspects, r = -0.713, p = 0001; environmental aspects, r = -0.659, p = 0.003), but not with functional performance (r = 0.279, p = 0.262). In the second article, PA levels and functional performance were compared between patients with CD associated with stroke (n = 31), individuals diagnosed with either CD (n = 36) or stroke (n = 48), and a healthy control group (n = 95), revealing that patients with CD and stroke had worse functional levels and PA classification than individuals diagnosed with either CD or stroke. There was no difference between these last two groups, with the exception of the greater ability to achieve maximum exertion in patients with CD but without stroke. The functional performance and PA pattern of the control group surpassed all the others. In the third article, 11 patients with CD associated with stroke underwent an aerobic conditioning program and were compared with 17 individuals diagnosed only with CD who received the same training. The outcomes assessed were functional capacity and QoL, assessed using Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and six-minute walk test (6MWT), respectively. Although both groups benefitted from training, improvements were observed in all domains of QoL in individuals with the two coexisting conditions, but in only two domains of SF-36 (functional capacity and vitality) in patients solely with CD. There were no differences with respect to improvements in the distance walked during 6MWT between groups (-9.5 ± 20.2, p < 0.65).