Determinantes da autopercepção de saúde de indivíduos pós acidente vascular cerebral usuários da Atenção Primária à Saúde

Abstract

Stroke is a health condition with high incidence and prevalence, being a great causing of death and disabilities around the world. Self-rated health is a simple measure of how the individual evaluate your own health and it is very informative about this important and complex construct. The aim of this study was to investigate if variables representing functioning and disability, with potential to be modified by rehabilitation, could be determinants of self-rated health in individuals with stroke, patients of the primary health care of Belo Horizonte/Minas Gerais (BH/MG). A cross sectional study was developed with individuals with stroke, patients of the primary health care of four basic health units (UBS) of BH/MG, after approval by the Ethical Commitment of the Universidade Federal de Minas Gerais (UFMG) and of the Secretaria Municipal de Saúde of Belo Horizonte (SMSA-BH) (CAAE:14038313.4.0000.5149). The sample was consisted for all individuals identified by the health professionals as users of the UBS and presenting the following inclusion criterion: history of stroke 6 months, 20 years old, living in the community area of UBS and with UBS registration and that voluntarily accept to participate of the study. The following individuals were excluded: with presence of motor and/or sensitive aphasia (observed for the examiner at the beginning of the contact with the individual), with possible cognitive impairment (Mini Mental State Examination MEEM), or unable to perform the tests of the study. The dependent variable was self-rated health, measured by the first question of the Brazilian version of Short Form Health Survey (SF-36) (In general, would you say your health is) and that has five options of response. This variable was dichotomized into good selfrated health (excellent, very good and good) and poor self-rated health (fair and poor). The independent variables or potential determinants was organized to represent functioning and disability according to the International Classification of Functioning, Disability and Health (ICF): from body structure and function domain, muscle strength (Modified Sphygmomanometer Test TEM) and emotional function (Geriatric Depression Scale short version GDS-15); from activity domain, manual skills (ABILHAND) and locomotion skills (ABILOCO); and from participation domain, total score in the participation itens of the Stroke Specific Quality of Life (SSQOL). Binary logistic regression by the Enter method was used and associations were presented as odds ratio (OR) (á=5%). The sample was composed by 64 individuals, mean age 66±12 years old, 53% women and median of time in months since stroke 45.5±71.7 months. Most of the individuals were into the group good self-rated health (excellent, very good and good): 70.3%. The analysis revealed that selfrated health was significantly associated with emotional function (OR=7.119, 95% CI=1.688-30.031, p=0.008). This important relation between self-rated health and emotional function, commonly reported as depressive symptoms, is still little explored in stroke population. Emotional function is considered a modified variable and so intervention programs that improved emotional function in stroke population has potential to improve self-rated health too. Randomized controlled trials that measure the efficacy of interventions to improve self-rated health of these individuals are scarce. New studies for measure the efficacy of interventions for both outcomes are recommended. Self-rated health and emotional function evaluation are recommended in the primary health care because they are easy to apply and have potential to help in directing actions for the integration health care of stroke population.