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: Intermittent claudication and peripheral arterial disease
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
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
Probiotics in pregnancy for infant atopic eczema
Sweet solutions: procedural pain in infants (up to 12 months of age)
Mental Health
Behavioural intervention: infant sleep problems and maternal mood
Brief behavioural therapy: insomnia in adults
Cognitive behavioural therapy for chronic insomnia
Internet based or computerised CBT (iCBT or CCBT): depression and anxiety
Mindfulness and CBT for chronic low back pain
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)
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
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
Topical heat for bluebottle stings