Censo de deficiências e incapacidades físicas por hanseníase e monitoramento pela escala salsa do plano de autocuidado para prevenção de incapacidades de pacientes atendidos em um centro de referencia nacional do Brasil

Abstract

For a chronic and disabling disease such as leprosy it is necessary to identify and monitor the patient and the proposed actions to prevent disabilities. This study aimed to conduct a census of impairment and disabilities in leprosy patients enrolled in a National Reference Center of Uberlândia and evaluate the effectiveness of guided self-care plan for set up by a physiotherapist/occupational therapist. For the census held a retrospective study of medical records of 506 leprosy patients in the period 2001 to 2010, analyzing the variables: sex, age, occupation, clinical, operational classification, degree of disability (DD), type of impairment/disability by site and affected nerves. In the prospective study were applied a screening of activity limitation and safety awareness (SALSA), including score Salsa (SS) and score safety awareness (SA); Participation Scale (PS) and eyes, hands and feet score (EHF) in 63 patients for monitoring after 3 months. In 506 patients, there were a higher prevalence of males, multibacillary (MB) and borderline-tuberculoid (BT) clinical form. More than 50% had at least one impairment, despite 15% had grade 2 disability (GI=2). The sites most affected were the feet 51.8% and hands 30.4%; and impairments/disabilities were anesthesia and/or hypoesthesia followed by ulcers. The nerve average affected was 3.6 in MB and 2.7 in PB, predominating the ulnar and posterior tibial nerves. In 63 patients, the mean score were: PS=9.1, SS=37.2, SA=1.6 and EHF=1.9. After interventions occurred reduction of the mean scores of SS (31) and EHF (1.5) and increased of SA (3). Stigmatizing and crippling disabilities that are not classified in the table the grading disability and should be included as well as the nose as a body site of disabilities that keeps the stigma of the disease, allowing to plan a specific attention to leprosy with the aim of reintegration and combating social stigma. The SALSA provided a standardized measure of activity limitation and allowed us to outline a plan of self-care oriented and external interventions that helped the patient to perform tasks of daily life. The inclusion of this instruments in the routine associated with the evaluation of grading disability in order to define management protocols, providing screening and referral of patients to sectors specific health units within the network of attention to the condition chronic that is leprosy. Thus, it is expected to promote a rehabilitation of the patient in order to improve health conditions for this specific population.