Teste de velocidade da marcha de seis metros em pacientes submetidos à revascularização miocárdica e troca valvar : repercussões na qualidade de vida e avaliação da confiabilidade.

Abstract

Due to the progressive aging of the population, cardiovascular diseases are among the main causes of death that lead to an increase in health resources and surgical specialties. Aging impacts the individual's way of life, as age brings with it several comorbidities, making the individual more fragile. Although cardiac surgery (CS) is considered a safe measure, several complications can occur due to the patient's anatomy, vascular and clinical condition. This research aimed to characterize the profile of patients undergoing CS, to assess physical performance and quality of life in the preoperative, postoperative (PO) and outpatient clinic. Abstract of manuscript I: Clinical and quality of life factors associated with gait speed performance in patients undergoing cardiac surgery: A longitudinal study. Objective: To identify which clinical and quality of life variables are associated with the performance of the 6-Meter Walk Test (6MWT) of patients undergoing CS. Methods: A prospective longitudinal study which evaluated gait speed and quality of life in the preoperative and PO periods, and in academic outpatient settings after hospital discharge. Age, ejection fraction (EF), clinical severity, time of cardiopulmonary bypass, perception of fatigue and dyspnea, pain, handgrip strength (HS), dimensions assessed by the Quality of Life Instrument - EQ - 5D-3L and the value of years of life adjusted for quality based on the Brazilian population (QALYs) were included in the multiple linear regression analysis when significant (p<0.05). Results: There were 63 patients evaluated with a mean age of 62.92 ± 8.48 years, with PO evaluation being performed 5.06 ± 1.70 days after CS and outpatient assessment 17.33 ± 5.36 days after hospital discharge. It was observed that the HS and the preoperative mobility of the EQ-5D-3L, as well as the EF were responsible for 45% (R2 = 0.454; p<0.001) of the variation in the gait speed in the preoperative period. In the PO, age, HS and QALYs PO were responsible for 60% (R2 = 0.602; p<0.001) in gait speed variation, while age, postoperative HS and self-care of EQ- 5D-3L in the outpatient clinic for 55% (R2 = 0.554; p<0.001) in the ambulatory gait speed variation. Conclusion: The variables HS, age, EF, mobility, self-care and QALYs influenced the gait speed of patients after cardiac surgery. Abstract of Manuscript II: Reliability of the practice test and retest in the evaluation of gait speed in patients undergoing cardiac surgery. Objective: To evaluate the reliability of the practice test and retest in the assessment of gait speed in patients undergoing CS. Methods: Prospective longitudinal study that evaluated the gait speed of patients undergoing CS, between eptember 2018 and October 2019, using the 6MWT in the preoperative period, PO and ambulatory of a eaching hospital. Results: The sample consisted of 82 patients aged 62.51 ± 8.88 years. The intra-class orrelation coefficient showed excellent reliability between the practice test and the 6MWT retest in the preoperative period (ICC= 0.98; IC 95%: 0.97-0.99; p<0.001), in the PO (ICC= 0.97; IC 95%: 0.94-0.99; p<0.001) and in the outpatient clinic (ICC= 0.97; IC 95%: 0.94-0.99; p<0.001). A significant increase in gait speed was observed between the practice test and the retest in the PO and the outpatient clinic, with an average learning effect of 0.06 m/s (IC 95%: 0.17-0.29 m/s; p<0.001). Conclusion: 6MWT has proved to be a safe and reliable evaluation measure of the physical performance of patients undergoing CS. There was a learning effect between the practice test and the retest, demonstrating the importance of the 6MWT replication in patients undergoing CS.