Efetividade da cartilha "Cirurgia bariátrica: cuidados para uma vida saudável" no preparo pré- operatório : ensaio clínico randomizado pragmático

Abstract

Introduction: The preoperative preparation of bariatric surgery involves the education of the patient in which the candidate has the opportunity to clarify their doubts regarding the procedure and to understand the necessary care in the perioperative period. The use of educational technologies, specially booklets, as tools to aid in this process is important for the promotion of health. Objective: To evaluate the effectiveness of educational intervention mediated by the booklet "Bariatric surgery: care for a healthy life" in the preoperative preparation. Method: this is a randomized controlled clinical trial developed from May to July of 2017 at a reference institution in bariatric surgeries performed by the Brazilian National Health System. The sample consisted initially of 60 patients on the waiting list for the surgery, which were also randomized in the Control Group (CG - n = 30) and Intervention Group (IG - n = 30), with a lenght of seven weeks. The CG received only the routine care from the institution and the IG participated in an educational intervention with the booklet. At baseline moment (M0), instruments were applied for clinical-epidemiological characterization; Self-concept by the Clinical Inventory of Self-concept; Levels of anxiety and depression by the Anxiety Hospital Depression Scale and Trait-State Anxiety Inventory; Quality of life by WHOQOL-bref (general assessment) and Moorehead-Oria II questionnaire (specific for bariatric surgery); And CAP survey on bariatric surgery and perioperative care, which were reapplied with three (M1 - only for IG) and seven weeks (M2). Results: The variation between the medians of initial and final weight was Δ=+4.3kg in the CG (p=0.211) and Δ=-1.8kg in the GI (p=0.000) and the Body Mass Index, during moments M0-M2, was 48.7 vs. 48.9 kg/m2 in the GC (p=0.227) and 49.5 vs. 49 kg/m2 in the GI, p=0.000. In M2, the medians of the scores between GI and GC were 40 vs. 33.5, p=0.000 for state-anxiety and 44 vs. 41, p=0.001 for anxiety-trait. The median HADS-A score ranged from 7 to 5 points (p=0.000) and HADS-D ranged from 6 to 4 points (p=0.001), demonstrating improvement in anxiety and depression between GI. There was an improvement in the self-concept of GI (M2: 80.68 ± 11.37, M1: 72.3 ± 14.28) when compared to CG (M2: 69.61 ± 12.7, M1: 72.47 ± 12, 43), p=0.003. In the WHOQOL-bref evaluation, the mean scores between GC and GI in M0 were 11.65 ± 2.52 vs. 11.42 ± 2.21 (p=0.929). In M2, the mean in the GC was 11.22 ± 2.3 and in the GI 13.43 ± 1.87, p = 0.000. In knowledge, the average accuracy of GI increased from 21.07 (± 5.82) to 31.1 (± 2.96). The GC did not present statistical significance (p=0.433) in the M0-M2 comparison. Conclusion: the booklet can be considered technology that allows the obtainment of health information in an innovative and reliable way among patients of the obesity program treated in SUS, guaranteeing to the obese patient the integrality of the care through an educational intervention aligned to the Principles of health promotion as autonomy and self-care.