Incidência e preditores de contratura de membro superior em indivíduos após acidente vascular encefálico

Abstract

Introduction: After Stroke several deficits can impact the function of the upper limb. Contracture is one of the major factors of disability, resulting in limitations in dressing, bathing or eating. Although the contracture is reported as a common alteration after stroke, there is little data on its incidence in this population. Objectives: To determine the incidence of upper limb contractures after three months of stroke, as well as to identify which factors measured within the first four weeks after stroke can predict the development of shoulder, elbow and wrist contractures after three months of the lesion. Design: Prospective cohort study. Participants: A sample composed of individuals consecutively admitted to a stroke at a Hospital in Belo Horizonte, Brazil. Measurements: Passive joint and lateral rotational amplitudes of shoulder, flexion and elbow and wrist extension were measured using torque-controlled measure (gravity) and gravity inclinometer. Potential predictors of contracture were muscle strength, spasticity, upper limb function, dexterity, and pain, which were assessed using the Manual Muscle Test, Tardieu Scale, Motor Assessment Scale, Nine Hole Peg Test and Vertical Numerical Pain Scale, respectively. Measurements were performed within the first four weeks after stroke and after three months of injury. Results: Seventy-six individuals participated in the study. The sample had a median age of 66 years (IQR 54,5-76), 51% of whom were women and 96% had ischemic stroke. 28% of the participants developed at least one contracture. The incidence varied from 6% to 16% in the joints, and the wrist to the joint was more frequently affected. Individuals with moderate AVE had a higher incidence of contracture in comparison with mild AVE. Deficiency (OR 0.009, 95% CI 0.000-0.193) and pain (OR 6.417, 95% CI, 1,217-33,831) were significant predictors of shoulder, elbow, and wrist contracture and, together, explained 77% of the variance in the measure of joint range of motion. Conclusion: Individuals after three months of stroke, with mild to moderate severity, presented a rapid development of contracture in the upper limb, with an incidence rate of 28%. The predictors for contracture were the presence of pain and loss of dexterity. Measures for the prevention of contracture should be initiated early, aiming at the control of pain and the improvement of upper limb dexterity, in order to avoid its development, which occurs in a short period of time.