Funcionalidade em indivíduos com doenças cardio e cerebrovasculares crônicas: determinantes e conceitos dos instrumentos de avaliação considerando a classificação internacional de funcionalidade, incapacidade e saúde

Abstract

Disability caused by chronic noncommunicable diseases, such as heart failure (HF) and obstructive sleep apnea (OSA), remains high in developing countries. The first, because it significantly affects the quality of life and is responsible for high morbidity and mortality, and the second, because it is considered an independent risk factor for death from cardiovascular and cerebrovascular diseases. The International Classification of Functioning, Disability and Health (ICF) is a useful tool in clinical guidance, with purposes that extend to health policy scenarios, quality assessments and results, both from the perspective of assisted individuals and health professionals. Considering the set of repercussions caused by OSA in the daily lives of patients, the first study of this dissertation investigated whether the increased risk of OSA could be a determinant of impairment in the functioning of individuals with or without cardio and cerebrovascular comorbidities. The results showed that moderate and high risk of OSA was associated with impaired functioning in individuals with cardiovascular and cerebrovascular diseases, as well as gender, age, depressive symptoms and cognitive impairment. These data allowed us to infer that a range of factors associated with the risk of OSA can impact the individual's health conditions. Likewise, the study revealed that isolated measures used in the assessment of individuals with OSA do not directly impact functioning. In the second study of this dissertation, when considering the importance of several influential factors in the context of a certain health condition, especially heart disease, we sought to verify whether the instruments used to assess the clinical outcomes of individuals with HF in a cardiac rehabilitation program, satisfactorily cover the domains of the International Classification of Functioning, Disability and Health (ICF), namely: Body function; Body structure; Activity; Participation; Environmental factors; and Personal factors.. The results showed that the instruments analyzed do not allow assessment of the individual's functioning because they present gaps in the coverage of the ICF domains, with the body function domain predominating. Among the instruments evaluated, the Minnesota Living with Heart Failure Questionnaire (MLHFQ) stands out as the one with the best coverage of the ICF domains compared to the others. These two studies bring the functioning to the center of the discussion and stimulate a scientific look at health problems that are still little explored from this perspective.