Efeitos da auriculoterapia na dor e limitação da mobilidade de indivíduos com febre chikungunya

Abstract

Chikungunya Fever is an acute viral disease transmitted by the mosquitos Aedes aegypti and Aedes albopictus that triggers pain and disabling rheumatic manifestations. There is no cure for this disease, and the usual treatment is directed at relieving symptoms through the use of use of analgesic and anti-inflammatory drugs. Due to the risk of adverse effects triggered by prolonged use of these drugs, the use of complementary therapies, such as auriculotherapy, might be a safe and effective non-pharmacological treatment for the management of Chikungunya symptomatic cases. Thus, the main objective of this doctoral thesis was to evaluate the effectiveness of auriculotherapy, complementary to the standard drug treatment, in the improvement of pain and mobility of symptomatic individuals after Chikungunya Fever, as well as the predictive factors for disability in the different phases of the disease. The first article presents the detailed description of the intervention protocol developed in the second study. 50 individuals with Chikungunya Fever were divided into two intervention groups: auriculotherapy on specific acupuncture points and sham auriculotherapy on non-specific points. Both groups received five treatment sessions performed once a week over five weeks. Participants were assessed at the baseline, immediately after the fifth care, and one-month post-intervention. The primary outcome of the study was pain, assessed by the Numeric Pain Rating Scale (NPRS), and mobility limitation assessed by the Timed Up and Go (TUG) test. The lower limb function was the secondary outcome and was assessed using the Short Physical Performance Battery (SPPB) tests. Groups comparison were analyzed using ANOVA with two factors for repeated measures and Cohens d for effect size. The results of the randomized controlled clinical trial were presented in the second article. Between groups comparison showed significantly improvement of the auriculotherapy group in performing the TUG test (p < .001), the SPPB balance (p = .003) and SPPB chair stand (p = .003) at post intervention and follow up, with moderate effect size. There was no difference between groups for the pain score (p = .088), and both groups decreased their pain scores at post intervention. The aim of the third article was to identify the most disable phase and the predictive factors in individuals with Chikungunya Fever. The sample was stratified into two groups according to the duration of symptoms, and the data analyzed by comparison, logistic and linear regression tests. The acute/subacute phase was the most disabling phase and different in relation to mobility limitation, gait speed, self-perception of incapacity for mobility, domestic life activities, social participation and self-care compared to the chronic phase. Mobility limitation was the main predictor for disability (r = .417, p < .001), accounting for 17.4% of self-perceived disability assessed by the World Health Organization Disability Assessment Schedule (WHODAS). The results of this thesis showed that auriculotherapy is effective in improving the mobility limitation after Chikungungunya fever, and that individuals in the acute / subacute phase of the disease present greater disability, with mobility limitation the main predictor.