Análise da incapacidade ancorada no modelo biopsicossocial e sua relação com determinantes sociais da saúde na pessoa idosa com dor lombar

Abstract

Disability resulting from low back pain (LBP) in older adults reflects the impact on the functioning of this population. Despite this, studies in this area do not explore whether social determinants of health (SDH) influence the protection or increase of disability, and patient-reported outcome measures (PROMs) are unclear in reflecting functioning. This dissertation aims to investigate whether social determinants of health (SDH) influence disability in older adults twelve months after the episode, as well as to identify whether PROMs cover LD-related disability/functioning in the context of aging. In product 1, a systematic review was conducted of disability in older adults with chronic DL, assessing whether the PROMs used to obtain these results are consistent with the ICF structure and the related Geriatric Core Set. A search was conducted in the main health databases, such as PubMed, Embase, Lilacs, and the Virtual Health Library (VHL). Of the 24 studies included, eight PROMs were identified to assess disability in older adults with DL. The main and additional concepts of the PROMs were linked to identify the corresponding International Classification of Functioning, Disability, and Health (ICF) codes, which were then compared with the Geriatric Core Set codes. This product showed that the PROMs that assess disability in older adults with DL do not reflect functioning in the aging scenario. We concluded that further studies are needed to create appropriate PROMs to assess disability in older adults with DL. In product 2, a longitudinal study was conducted using data from the “Back Complaints in the Elders” database in Brazil, BACE-Brasil, to investigate the association between DSS and disability in older adults with acute DL twelve months after the onset of the episode. The independent variables analyzed were DSS and the dependent variable was the Roland-Morris Disability Questionnaire (RMDQ), which assesses disability resulting from LDS at baseline and twelve months after the episode. We revealed, through multivariate logistic regression, these higher income and education levels, as well as darker skin color, were associated with lower disability rates.These findings increased the chance of disability reduction by 1.26, 1.04, 2.1, and 2.4 times, respectively. Health professionals should take these socioeconomic variables into account to better understand the process of recovery from disability in aging. Finally, researchers need to develop PROMs that reflect functioning to cover aspects of aging in disability resulting from DL in older adults, and clinicians must understand that variables such as low income, low education, and skin color influence disability recovery in older adults with DL.