Editorialblog

HANDI Project

Carlos Martins - Wednesday, January 08, 2020



Nas últimas décadas, tem vindo a aumentar a evidência científica de boa qualidade que demonstra a eficácia de algumas medidas terapêuticas não farmacológicas em várias áreas da Medicina. Contudo, os manuais de intervenção terapêutica, também designados por formulários terapêuticos ou farmacopeias, normalmente só encontramos as medidas farmacológicas. Neste contexto, um conjunto de médicos de família australianos, coordenados por Paul Glasziou, iniciou o projeto HANDI - Handbook of Non-Drug Interventions.

Com base na ideia das farmacopeias modernas, cada entrada do HANDI inclui a descrição da intervenção, as suas indicações, contraindicações e efeitos adversos, entre outros. Segundo os autores, o objetivo é tornar a "prescrição" de uma terapia não farmacológica tão fácil quanto a prescrição de um medicamento. A metodologia de construção deste manual é rigorosa e transparente. Por exemplo, um dos critérios para que uma intervenção seja incluída no formulário HANDI passa pela existência de pelo menos dois ensaios clínicos randomizados de boa qualidade e com marcadores de resultado orientados para o paciente.

No seu formato atual, o Manual HANDI dispõe de intervenções agrupadas em 6 secções: cardiovascular, Pediatria, Saúde Mental. Músculo-esquelética, Nutrição e “Outras”. Uma ferramenta muito útil!



Cardiovascular

Exercise based rehabilitation for Coronary heart disease

Exercise based rehabilitation for heart failure

Exercise for cancer fatigue

Exercise: Intermittent claudication and peripheral arterial disease

Exercise: type 2 diabetes

Modified Valsalva manoeuvre for supraventricular tachycardia

Mediterranean diet for reducing cardiovascular disease risk

Physical fitness training following a stroke

Inspiratory muscle training for surgical pre-rehabilitation

Children

Autoinflation for glue ear in children

Behavioural intervention: infant sleep problems and maternal mood

Behavioural interventions including alarms: bedwetting (enuresis)

Dilute apple juice for children rehydration

Egg allergy prevention

Feed thickener for infant reflux

Honey and cough in children with URTI

Manipulation and subluxation of radial head (pulled elbow)

Moisturiser: infant atopic dermatitis prevention

Mother’s kiss: nasal foreign bodies

Pain management strategies for childhood immunisation

Peanut allergy prevention

Probiotics in pregnancy for infant atopic eczema

Sweet solutions: procedural pain in infants (up to 12 months of age)

Wet combing: head lice

Mental Health

Behavioural intervention: infant sleep problems and maternal mood

Bibliotherapy: depression

Brief behavioural therapy: insomnia in adults

CBT for panic disorder

Cognitive behavioural therapy for chronic insomnia

Exercise: depression

Internet based or computerised CBT (iCBT or CCBT): depression and anxiety

Mindfulness and CBT for chronic low back pain

Music for insomnia in adults

Psychological treatments for postnatal depression

Musculoskeletal

Advice to stay active for people with acute low back pain

Antenatal perineal massage: reduce perineal injury during childbirth

Aquatic exercise for knee and hip osteoarthritis

Education about joint protection strategies: hand osteoarthritis

Exercise for acute lower back pain

Exercise for chronic low back pain

Exercise for preventing bone loss and reducing fracture risk

Exercise for preventing recurrent ankle sprain

Exercises for falls prevention

Pelvic floor muscle training: pelvic organ prolapse

Pelvic floor muscle training: urinary incontinence

Physiotherapy for tennis elbow

Pulmonary rehabilitation for COPD

Splints for the reduction of pain from hand osteoarthritis

Knee taping for osteoarthritis

Walking cane for knee osteoarthritis

Exercise for knee osteoarthritis

Mandibular devices for obstructive sleep apnoea

Mindfulness and CBT for chronic low back pain


Nutrition

DASH (Dietary Approaches to Stop Hypertension) diet to prevent and control hypertension

Low-FODMAP diets for irritable bowel syndrome (IBS)

Peanut allergy prevention

Mediterranean diet for reducing cardiovascular disease risk

Pre-meal water consumption for weight loss

Probiotics for acute infectious diarrhea

Probiotics in pregnancy for infant atopic eczema

Probiotics for the prevention of antibiotic-associated diarrhoea in adults and children

Ten top tips for weight control

Other

Exercise for cancer fatigue

Citrate salts for preventing kidney stones

Compression for venous leg ulcers

Graded exercise therapy: chronic fatigue syndrome

Mandibular devices for obstructive sleep apnoea

Moisturiser for prevention of skin tears

Partial nail avulsion and matricectomy for ingrown toenails

Pedometers for increasing physical activity

Smartphone apps for smoking cessation

Stretching exercises for plantar fasciitis

Sunscreen for skin cancer prevention

The Epley manoeuvre: vertigo

Topical heat for bluebottle stings







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