{"id":946,"date":"2017-09-19T18:53:51","date_gmt":"2017-09-19T18:53:51","guid":{"rendered":"http:\/\/pesquisaemdor.com.br\/?p=946"},"modified":"2017-09-19T18:53:51","modified_gmt":"2017-09-19T18:53:51","slug":"o-programa-positive-learning-a-relacao-terapeutica-e-seu-efeito-na-dor","status":"publish","type":"post","link":"http:\/\/pesquisaemdor.com.br\/?p=946","title":{"rendered":"O PROGRAMA POSITIVE LEARNING, A RELA\u00c7\u00c3O TERAP\u00caUTICA E SEU EFEITO NA DOR"},"content":{"rendered":"

Um dos sintomas mais prevalentes em pessoas que vivem com HIV \/ AIDS \u00e9 a dor (1-12). Na \u00c1frica do Sul, onde mais de dez por cento da popula\u00e7\u00e3o vivem com HIV \/ AIDS (13), h\u00e1 necessidade de um tratamento efetivo da dor (14). Em particular, \u00e9 necess\u00e1rio encontrar interven\u00e7\u00f5es eficazes para a gest\u00e3o da dor para as pessoas que vivem nas zonas rurais, as \u00e1reas pobres em recursos, e em especial para as mulheres, uma vez que as mulheres experimentam um manejo da dor mais prec\u00e1rio quando comparado aos homens (4,15-20). Al\u00e9m disso, as mulheres geralmente carregam o \u00f4nus de ser \u201cchefes da casa\u201d nessas comunidades rurais uma vez que os homens, que tradicionalmente desempenhavam esse papel, muitas vezes se afastam para \u00e1reas urbanas (21,22).<\/p>\n

As evid\u00eancias atuais indicam efic\u00e1cia limitada da administra\u00e7\u00e3o farmacol\u00f3gica de dor em pessoas com HIV (23). Al\u00e9m da terapia farmacol\u00f3gica (6,23,24), as interven\u00e7\u00f5es existentes para o manejo da dor incluem educa\u00e7\u00e3o (25-28), interven\u00e7\u00f5es de auto-manejo (29-31), terapia cognitivo-comportamental (TCC) (32,33), exerc\u00edcios f\u00edsicos (34-37). O programa ‘Positive Living’ (PL ) (38,39) \u00e9 baseado na teoria da auto-efic\u00e1cia e na terapia cognitivo comportamental (TCC) (40). Esse programa foi desenvolvido e testado para uso em mulheres amaXhosa que vivem em um ambiente urbano (39). Considerando os recursos limitados dispon\u00edveis na \u00c1frica do Sul (6,23-39), desenvolvemos um estudo para mulheres amaXhosa que vivem em \u00e1reas urbanas e tem diagn\u00f3stico de HIV \/ AIDS com objetivo de se verificar o efeito do programa PL.<\/p>\n

Pesquisas anteriores sobre o programa PL sugeriram que a rela\u00e7\u00e3o terap\u00eautica que se desenvolveu entre os participantes do estudo e os pesquisadores pode ter um efeito positivo sobre a dor (39). O desenvolvimento da rela\u00e7\u00e3o terap\u00eautica parece ser importante para os resultados de sa\u00fade, incluindo a redu\u00e7\u00e3o da dor (41,42). Essas melhorias nos sintomas foram anteriormente consideradas como efeito placebo, mas agora o efeito significativo \u00e9 reconhecido como sendo devido \u00e0 percep\u00e7\u00e3o do paciente sobre o cuidado (43). Os efeitos podem resultar em altera\u00e7\u00f5es fisiol\u00f3gicas, como a libera\u00e7\u00e3o de opi\u00f3ides end\u00f3genos e altera\u00e7\u00f5es neurofisiol\u00f3gicas , mesmo na aus\u00eancia de medica\u00e7\u00e3o analg\u00e9sica (44-46).<\/p>\n

Realizamos um estudo para determinar a efic\u00e1cia do programa PL combinado com a rela\u00e7\u00e3o terap\u00eautica em compara\u00e7\u00e3o com a rela\u00e7\u00e3o terap\u00eautica sozinha em mulheres amaXhosa de zonas rurais. O grupo de interven\u00e7\u00e3o recebeu o programa PL (por 6 semanas) combinado com uma rela\u00e7\u00e3o terap\u00eautica, enquanto o grupo de relacionamento terap\u00eautico recebeu apenas a rela\u00e7\u00e3o terap\u00eautica. O assistente de pesquisa conduziu a coleta de dados, foi cegado quanto \u00e0 aloca\u00e7\u00e3o de grupo e foi treinado para desenvolver uma rela\u00e7\u00e3o terap\u00eautica com todos os participantes atrav\u00e9s de estrat\u00e9gias de comunica\u00e7\u00e3o (47-51). Nossos resultados indicaram que a intensidade e a interfer\u00eancia da dor foram significativamente reduzidas em todos os participantes ao longo das 24 semanas do estudo e n\u00e3o houve diferen\u00e7as significativas entre os grupos para esses desfechos prim\u00e1rios.<\/p>\n

Esta pesquisa destaca que a rela\u00e7\u00e3o terap\u00eautica \u00e9 uma interven\u00e7\u00e3o ativa. Os profissionais de sa\u00fade precisam reconhec\u00ea-la como parte do tratamento. Isso significa que a forma\u00e7\u00e3o de profissionais de sa\u00fade em estrat\u00e9gias de comunica\u00e7\u00e3o conhecidas por melhorar a rela\u00e7\u00e3o terap\u00eautica deve ocorrer para proporcionar um tratamento de dor eficaz e adequado entre as mulheres amaXhosa de zonas rurais que vivem com HIV \/ AIDS (47-51). Embora nossos resultados n\u00e3o sejam generaliz\u00e1veis para al\u00e9m das mulheres amaXhosa de zonas rurais, eles aumentam a necessidade de novas pesquisas sobre a rela\u00e7\u00e3o terap\u00eautica e seu efeito na dor em outros grupos de pessoas vivendo com HIV \/ AIDS e pessoas com outras s\u00edndromes dolorosas.<\/p>\n

Texto escrito como parte de um estudo maior realizado por pesquisadores da University of Cape Town sob orienta\u00e7\u00e3o das professoras Romy Parker e Antonia Wadley, e em colabora\u00e7\u00e3o com Cameron Reardon, Sarah Cameron e Dershnee Devan. A Funda\u00e7\u00e3o Nacional de Pesquisa Thuthuka Grant e uma Sociedade Sul-Africana de Fisioterapia promoveram financeiramente esse estudo.<\/strong><\/p>\n

 <\/p>\n

ENGLISH VERSION<\/h2>\n

Handle with care: the therapeutic relationship and its effect on pain<\/u><\/h2>\n

One of the most prevalent symptoms in people living with HIV\/AIDS (PLWHA) is pain and yet, it is largely undermanaged1\u20139<\/sup> 1,10\u201312<\/sup>. In the Eastern Cape of South Africa, where over ten percent of the population are living with HIV\/AIDS13<\/sup>, there is a need for effective pain management14<\/sup>. In particular finding effective pain management interventions for people living in the rural, resource poor areas of the Eastern Cape is pressing and even more so for women as women experience poorer management of pain than men4,15\u201320<\/sup>. Additionally, women commonly carry the burden of being heads of the home in these rural communities, as men, who traditionally performed this role, often move away to the urban areas21,22<\/sup>.<\/p>\n

Current evidence indicates limited efficacy of pharmacological management for pain in PLWHA6,23<\/sup>. Apart from pharmacological therapy6,23,24<\/sup>, existing interventions for managing pain include education25\u201328<\/sup>, self-management interventions29\u201331<\/sup>, cognitive behavioural therapy (CBT)32,33<\/sup>, physical exercise34\u201337<\/sup>, and a peer-led exercise and education group intervention, the \u2018Positive Living\u2019 (PL) programme38,39<\/sup>. The PL programme, based on the self-efficacy theory and CBT40<\/sup>, was developed and tested for use in amaXhosa women living in an urban setting39<\/sup>. Considering the efficacy and acceptability for urban amaXhosa women living with HIV\/AIDS and the limited resources available in the Eastern Cape of South Africa6,23\u201339<\/sup>, we set out to study the effect of the PL programme in the Eastern Cape in rural amaXhosa women.<\/p>\n

Previous research on the PL programme suggested that the therapeutic relationship which developed between study participants and the researchers may have had a positive effect on their pain39<\/sup>. Fostering the therapeutic relationship appears to be important for health outcomes, including pain reduction41,42<\/sup>. These improvements in symptoms were previously dismissed as a placebo effect but it is now acknowledged to be due to the patient\u2019s perception of care, or meaning effect 43<\/sup>. The meaning effect may result in physiological changes, such as a release of endogenous opioids and neurophysiological changes, even in the absence of analgesic medication44\u201346<\/sup>.<\/p>\n

We conducted a study to determine the efficacy of the PL programme combined with a therapeutic relationship in comparison to the therapeutic relationship alone in rural amaXhosa women LWHA. The Positive Living group received the PL programme (which ran for 6 weeks) combined with a therapeutic relationship whilst the therapeutic relationship group received the therapeutic relationship only. The research assistant conducted the data collection, was blinded as to group allocation and was trained to develop a therapeutic relationship with all the participants through communication strategies47\u201351<\/sup>. Our results indicated that pain severity and pain interference were significantly reduced in all the participants over the 24 weeks of the study and there were no significant differences between groups for these primary outcomes.<\/p>\n

This research highlights that the therapeutic relationship is an active intervention. Health care professionals need to recognise it – as a treatment. This means that training health care professionals in communication strategies known to enhance the therapeutic relationship should take place to provide effective and adequate pain management amongst rural amaXhosa women living with HIV\/AIDS47\u201351<\/sup>. While our results are not generalisable beyond rural amaXhosa women in the Eastern Cape, they raise the need for further research into the therapeutic relationship and its effect on pain in other groups of people living with HIV\/AIDS and people with other pain syndromes.<\/p>\n

*This was done as part of a larger study by researchers at the University of Cape Town with principal investigators, Associate Professor Romy Parker and Dr Antonia Wadley, and in collaboration with Cameron Reardon, Sarah Cameron and Dershnee Devan. The National Research Foundation Thuthuka Grant and a South African Society of Physiotherapy education grant financially supported this study.<\/p>\n

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       <\/p>\n

      \"\"<\/a>Kirsty Jackson
      \n<\/a><\/h3>\n

      Fisioterapeuta – University of Cape Town<\/h3>\n","protected":false},"excerpt":{"rendered":"

      Um dos sintomas mais prevalentes em pessoas que vivem com HIV \/ AIDS \u00e9 a dor (1-12). Na \u00c1frica do Sul, onde mais de dez<\/p>\n

      Read more<\/span><\/a><\/div>\n","protected":false},"author":1,"featured_media":947,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"_links":{"self":[{"href":"http:\/\/pesquisaemdor.com.br\/index.php?rest_route=\/wp\/v2\/posts\/946"}],"collection":[{"href":"http:\/\/pesquisaemdor.com.br\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/pesquisaemdor.com.br\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/pesquisaemdor.com.br\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/pesquisaemdor.com.br\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=946"}],"version-history":[{"count":4,"href":"http:\/\/pesquisaemdor.com.br\/index.php?rest_route=\/wp\/v2\/posts\/946\/revisions"}],"predecessor-version":[{"id":954,"href":"http:\/\/pesquisaemdor.com.br\/index.php?rest_route=\/wp\/v2\/posts\/946\/revisions\/954"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/pesquisaemdor.com.br\/index.php?rest_route=\/wp\/v2\/media\/947"}],"wp:attachment":[{"href":"http:\/\/pesquisaemdor.com.br\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=946"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/pesquisaemdor.com.br\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=946"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/pesquisaemdor.com.br\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=946"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}