Efeitos da prática mental na recuperação da mobilidade na fase subaguda precoce após acidente vascular cerebral: ensaio clínico controlado e randomizado

Abstract

Introduction: Stroke is a neurovascular injury that causes motor, sensory and cognitive impairment. Among the main challenges for functional recovery is the recovery of mobility. In the search for therapeutic alternatives that improve motor (re) learning, studies have suggested the use of mental practice (MP), that is, the structured training of the imagination of movements or activities without physically performing them. There are still few studies to evaluate the effects of MP on mobility during the early subacute phase after stroke. Objectives: To evaluate the effects of MP associated with kinesiotherapy on the mobility of individuals in the subacute early post-stroke phase in relation to a control group. Methods: Blind randomized clinical trial with volunteers in subacute early stage after stroke (<3 months). Volunteers were allocated to two groups, the mental practice group (MPG) and the control group (CG) and received the same volume of training, in which they were initially submitted to a MP protocol or performed cognitive exercises, associated with a physical exercise protocol. The interventions were performed three times a week for four weeks, totaling 12 sessions. Mobility was assessed using the Timed Up and Go (TUG) test and the 5-meter walk velocity test (5mWT) at baseline and post-intervention. The maximum isometric muscular strength was also evaluated; the Assessment of Biomechanical Strategies- TUG-ABS; the World Health Organization Instrument to Assess Quality of Life- WHOQOL- Bref and the Depression Anxiety Stress Scales- DASS-21. Results: 18 volunteers were randomly assigned to one of the study groups. With a loss of 11.1% (one in each of the groups), the trial consisted of 16 volunteers (MPG = 8 and CG = 8). At the baseline there were no differences between the groups considering socio-demographic, clinical data and primary measures (TUG, p=0.32, 5MWT, p=0.72) and secondary (p<0.05). After the intervention, the MPG showed an improvement in the mobility measured by the TUG, whose time of 20.5 [19.0; 29.0] was 18.0 [13.25; 26.0] seconds (p=0.01, r=0.59), in the TUG-ABS of 29 [25.5; 32.7] to 37.5 [33.2; 41.7] points (p=0.01, r=0.63) and in the right hip and knee flexion muscle strength (p<0.05). On the other hand, the CG showed no improvement in mobility or muscle strength after the intervention (p>0.05). In the comparison between the post-intervention groups, no statistically significant differences were found for any of the primary and secondary measures of the study (p>0.05). In the deltas (gains of each group with the accomplishment of the protocol), the MPG performed the TUG about 2.5 seconds faster the CG (p=0.27, r=0.29) and obtained a score 4 points higher in the TUG-ABS (p=0.14, r=0.36), but not significantly with a moderate effect size. Conclusion: In this sample of individuals in the early subacute stage post-stroke, no statistically significant differences were observed after MP compared to the CG, considering mobility, muscle strength, mental health and quality of life. Comparing the pre and post intervention results, both groups showed improvement in TUG-ABS, but only the PM group showed improvement in muscle strength and shorter TUG execution time.