Características do ritmo biológico social e associação com a capacidade funcional em pacientes após acidente vascular cerebral

Abstract

Introduction: After a Stroke (AVC), patients often exhibit various sensorimotor impairments that are frequently assessed during the rehabilitation process. However, changes in social biological rhythm are rarely investigated in patients with neurological disorders, as well as the impact these changes may have on the patients' functional capacity. Objective: To investigate the characteristics of social biological rhythm and associate it with functional capacity in poststroke patients. Methodology: Initially, a scoping review was conducted to identify alterations in social biological rhythm that might occur in individuals with mental and neurological disorders, serving as a basis for the subsequent cross-sectional analytical observational study. The scoping review was performed using electronic databases, including articles in all languages and without publication date restrictions, following the PRISMA guidelines. The descriptors used were: social rhythm measurement, SRM, and disruption of social rhythm. Studies involving mental and neurological disorders were analyzed. In the observational study, the sample comprised 73 patients (41 men and 32 women), with a mean age of 60 years (±10) and an average time since sequelae of 19 months (±22). The characteristics of social biological rhythm were assessed using the Social Rhythm Metric (SRM), and its association with functional capacity was evaluated through the International Classification of Functioning, Disability, and Health (ICF). Over seven consecutive days, patients recorded the time at which they performed 17 SRM activities: getting out of bed, first contact with a person, having a morning drink, having breakfast, leaving home, starting work, having lunch, napping, having dinner, doing physical exercises, having a snack, watching evening news, watching other television programs, returning home, going to bed, and two additional activities chosen by the patients. The characteristics of social biological rhythm analyzed included: regularity, intensity, frequency, and period of activities. Subsequently, SRM activities were associated with ICF domains and categories. Data were analyzed using the Student's t-test, ANOVA, and Chi-square tests. Results: In the scoping review, 696 articles were identified. Of these, 15 articles were included in the final listing, with a sample size of 10,374 individuals with mental and neurological disorders, with a mean age of 38 years. Lower scores on the Social Rhythm Metric (SRM), indicating reduced social rhythm regularity, were directly associated with depression, anxiety, increased vulnerability to bipolar disorder, and neurological impairment following Parkinson's disease and stroke. Higher scores on the SRM were associated with normal health conditions or a reduction in the frequency, intervals, and intensity of clinical disruptions. In the observational study, the mean SRM score was 5.1 ± 0.9 and the mean International Classification of Functioning (ICF) score was 58.3 ± 14.9. In the studied sample, 40% of patients exhibited low regularity and low intensity of activities. Five SRM activities were performed infrequently: working, exercising, having a snack, watching other television programs, and returning home, which tended to have longer or shorter periods than 24 hours. The ICF domains most associated with the SRM were: “General tasks and demands,” “Communication,” “Mobility,” “Self-care,” “Major life areas,” and “Community, social, and civic life.”. Conclusion: The review provided important evidence of disruptions in social rhythm associated with mental and neurological disorders. Similarly, the observational study highlighted changes in social biological rhythm that have implications for patients' functional capacity. Identifying disruptions in social rhythm could be an integral part of the clinical assessment during the rehabilitation process for post-stroke patients.