Primary Care Rehabilitation Research Articles

Abstract TP80: Innovative Use Of A Large Real-world Database For Identifying Stroke Survivors And Access To Rehabilitation In Primary Care In Brazil

Background: As the impact of stroke continues, the number of people who require rehabilitation close to their homes will also increase. Primary health care will continue to be a critical platform for the identification and referral of stroke survivors who need long-term rehabilitation Purpose: We aimed at identifying stroke survivors assisted by community health workers (CHW) in Brazil as they relate to rehabilitation facilities locations. Methods: We used de-identified data from a real-world database generated by a free data collection app used by CHW from May 2015 to January 2021 in Brazil to identify stroke survivors, and to assess demographics and clinical characteristics. We used data from a public database, Cadastro Nacional de Estabelecimentos de Saúde (CNES), for identifying rehabilitation facilities. Locations were obtained by a Geocoding API (Google Maps Platform), distances were measured in kilometers (km) and travel time in minutes (min). Continuous variables were measured by mean (SD) and, categorical data in frequencies and percentages. Results: Among 2,397,764 individuals assisted by CHW that used the free app, 21,785 were stroke survivors, representing a 0.9% prevalence. Among this subgroup, the majority were from the Northeast region (50.3%), and 77.7% in urban areas. Most individuals (52.8%) were women, the mean age was 66.5 years (SD 14.7) and 4313 reported physical disability. A total of 348 re-habilitation facilities were identified, mostly located in the Southeast region (40.8%). The mean distance from stroke survivor to facility was 79.13 km and, mean travel time 81.16 min. The southern region has the largest mean distance (175.58 km) and travel time (144.48 min). Among patients that reported physical disability, the mean distance from stroke survivor to facility was 83.26 km and, mean travel time 85.29 min. Conclusions: We observed that stroke survivors’ distributions as they relate to rehabilitation facilities varies widely in Brazil. As a means of evaluating improvement of the clinical pathway and resources allocation for long term care, the use of large real-world databases and adequate analysis may assist in real needs assessments and policy changes.

Musculoskeletal injuries in UK Service Personnel and the impact of in-theatre rehabilitation during Cold Weather Warfare training: Exercise CETUS 2020

IntroductionThe Royal Marines provide the lead Service for UK Defence Mountain and Cold Weather Warfare capability. This is the first prospective study addressing musculoskeletal injury rates sustained during Cold Weather...

THE FRIDA PILOT STUDY (FEMALE RISK FACTORS FOR POST-INFARCTION DEPRESSION AND ANXIETY)

<h3>BACKGROUND</h3> Cardiovascular disease (CVD) is the leading global cause of mortality, with ischemic heart disease causing the most cardiovascular deaths. CVD is traditionally considered to be more prominent in men, however, it accounts for a slightly higher percentage of mortality in women. Within a year of an acute myocardial infarction (AMI), women have a higher mortality rate than men, which is sustained at the five-year mark. Several studies have demonstrated that women are significantly more likely to experience depression and anxiety following AMI and may be in part contributing to the observed higher rates of morbidity, mortality, and re-hospitalization. There is a clinical gap as to how mental health screening and support should be approached in women following AMI. The objective of the present study was to investigate the association between anxiety, depression, and sex while identifying the influence of psychosocial factors. <h3>METHODS AND RESULTS</h3> A total of 118 participants (83 male; 34 female) with AMI diagnosis were prospectively recruited from Kingston General Hospital within 72 hours of admission for AMI. Participants received a demographic questionnaire consisting of age, sex, socioeconomic status, marital status, race, history of smoking, history of drug/alcohol use, living situation, cardiac risk factors, and attitudes toward COVID-19. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS) with Anxiety (HADS-A) or Depression (HADS-D) subscale score >7 indicating significant depression or anxiety, respectively. Anxious participants (HADS-A>7) were more likely to be female (OR 7.01; p=0.0001), unemployed (OR 6.72; p=0.0061), report increased loneliness during COVID-19 (OR 3.74; p=0.0054), and report a household income of less than $20,000 CAD (OR 5.31; p=0.0110) while depressed participants were more likely to be female (OR 3.21; p=0.0313). Within the group of female participants, those who were unemployed were more likely to be depressed (OR 15.00; p=0.0309). <h3>CONCLUSION</h3> The present pilot study demonstrated the impact of CVD risk factors and sociodemographic variables on post-AMI depression and anxiety, with a focus on sex differences. Participants who were female, unemployed, lonely during COVID-19, and who had a household < $20,000 were at high risk for anxiety. Female participants were at higher risk for depression, particularly if they were unemployed. The emerging trends in this pilot study highlight the need for continued data collection. This will inform interventions following AMI in the primary care and cardiac rehabilitation settings as well as prevention strategies at the public health level in order to reduce associated morbidity and mortality.

Recovery after Critical Illness and Acute Kidney Injury.

AKI is a common complication in hospitalized and critically ill patients. Its incidence has steadily increased over the past decade. Whether transient or prolonged, AKI is an independent risk factor associated with poor short- and long-term outcomes, even if patients do not require KRT. Most patients with early AKI improve with conservative management; however, some will require dialysis for a few days, a few weeks, or even months. Approximately 10%-30% of AKI survivors may still need dialysis after hospital discharge. These patients have a higher associated risk of death, rehospitalization, recurrent AKI, and CKD, and a lower quality of life. Survivors of critical illness may also suffer from cognitive dysfunction, muscle weakness, prolonged ventilator dependence, malnutrition, infections, chronic pain, and poor wound healing. Collaboration and communication among nephrologists, primary care physicians, rehabilitation providers, physical therapists, nutritionists, nurses, pharmacists, and other members of the health care team are essential to create a holistic and patient-centric care plan for overall recovery. Integration of the patient and family members in health care decisions, and ongoing education throughout the process, are vital to improve patient well-being. From the nephrologist standpoint, assessing and promoting recovery of kidney function, and providing appropriate short- and long-term follow-up, are crucial to prevent rehospitalizations and to reduce complications. Return to baseline functional status is the ultimate goal for most patients, and dialysis independence is an important part of that goal. In this review, we seek to highlight the varying aspects and stages of recovery from AKI complicating critical illness, and propose viable strategies to promote recovery of kidney function and dialysis independence. We also emphasize the need for ongoing research and multidisciplinary collaboration to improve outcomes in this vulnerable population.

Exploration of current challenges in rehabilitation from the perspective of healthcare professionals: Switzerland as a case in point

Rehabilitation is a health strategy with the potential to mitigate the negative health consequences of population ageing and the rise of noncommunicable diseases. Literature indicates that even in high-income countries rehabilitation services can be improved. The purpose of this study is to engage rehabilitation professionals in Switzerland in identifying and prioritizing current challenges in the development and delivery of rehabilitation services.We conducted a qualitative study consisting of interviews with key informants and a stakeholder consultation. Thirteen interviews were conducted and analysed using inductive thematic analysis. Identified challenges were refined, extended, and prioritized through multi-voting in a workshop attended by a wide range of rehabilitation professional organizations. Final results were subject to further analysis and member checking.We identified nineteen challenges, of which eight were viewed as highly important. Results suggest the need to revise the financing system for rehabilitation services, highlighted a poor integration of rehabilitation in primary care, a lack of academic rehabilitation training, and insufficient funding for research. Finally, we identified a perceived lack of awareness for rehabilitation among policy-makers and the public.This study provides a unique perspective on challenges in rehabilitation practice and policy and offers an opportunity for professionals, policy-makers, and other stakeholders, to influence and guide the rehabilitation service agenda both in Switzerland and in terms of mutual learning also in other countries.

Clinical assessment of pelvic floor and abdominal muscles 3 months post partum: an inter-rater reliability study

ObjectivesEvaluation of the inter-rater reliability of clinical assessment methods for pelvic floor muscles and diastasis recti abdominis post partum.DesignA multicentre inter-rater reliability study.SettingThree primary care rehabilitation centres in Sweden.ParticipantsA total...

Surgeons and Administrators Co-creating Value.

Surgeons and Administrators Co-creating Value.

STRONGER 60+ Adaption of the multimodal FINGER model to prevent cognitive decline in a Swedish primary care rehabilitation unit: An effectiveness‐implementation hybrid design

AbstractBackgroundPreventing cognitive and physical decline in people &gt;60 is a major public health priority. Evidence‐based programs for promoting healthy lifestyle in people 60+ are sparse. WHO has launched risk reduction guidelines for cognitive decline and dementia focusing on several lifestyle and cardiovascular risk factors. The FINGER trial is the first large RCT indicating that targeting several risk factors simultaneously can reduce cognitive and functional decline among at risk elderly persons. To develop and implement personalized, effective and feasible lifestyle interventions for real life settings, the multimodal FINGER model needs to be adopted and new evidence from recent studies implemented (e.g. importance of psychosocial factors). The aim of STRONGER 60+ is to adapt the FINGER‐model and investigate intervention effectiveness on lifestyle factors in association with cognitive‐ and physical function. By adopting a hybrid‐design, the implementation process will be followed in a real‐world setting.MethodSTRONGER 60+ will include an adapted version of the FINGER‐model, with the components of a brain‐healthy diet, exercise, cognitive training, and stimulating social activity, in addition with careful monitoring of cardiovascular risks. A co‐production design including clinicians and participants will be used. It is a 6‐monh (with 12 month follow‐up) randomized controlled, single blind parallel‐group clinical effectiveness study. Up to 160 persons will be recruited. Participants will receive either the adapted multimodal healthy lifestyle intervention or regular health advice. A measure of psychosocial states will be included to highlight the importance of tailormade interventions in the study. The intervention is designed for community‐dwelling persons ≥ 60 years, with elevated risk for dementia according to the Dementia Risk Tool risk score, MMSE ≥ 24.ResultWe are currently finalizing the resource planning, recruitment start in September 2020. With the hybrid‐design outcome evaluation we will be able to explore the process by examining; facilitators and barriers for the adaption process, the recruitment process of participants, the extent to which the target audience encounter the program, retention rate, fidelity to the FINGER‐model, dose received/delivered.ConclusionFor people at‐risk of cognitive‐ and physical decline to benefit from multimodal lifestyle intervention research, interventions tested in research settings require adaption and assessment in real‐world clinical practice.

Prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal pain (PREVSAM): a randomised controlled trial protocol

BackgroundMusculoskeletal pain is globally a leading cause of physical disability. Many musculoskeletal-related pain conditions, such as low back pain, often resolve spontaneously. In some individuals, pain may recur or persist, leading to ong-term physical disability, reduced work capacity, and sickness absence. Early identification of individuals in which this may occur, is essential for preventing or reducing the risk of developing persistent musculoskeletal pain and long-term sickness absence. The aim of the trial described in this protocol is to evaluate effects of an early intervention, the PREVSAM model, on the prevention of sickness absence and development of persistent pain in at-risk patients with musculoskeletal pain.MethodsEligible participants are adults who seek health care for musculoskeletal pain and who are at risk of developing persistent pain, physical disability, and sickness absence. Participants may be recruited from primary care rehabilitation centres or primary care healthcare centres in Region Västra Götaland. Participants will be randomised to treatment according to the PREVSAM model (intervention group) or treatment as usual (control group). The PREVSAM model comprises an interdisciplinary, person-centred rehabilitation programme, including coordinated measures within primary health care, and may include collaboration with participants’ employers. The primary outcome sickness absence is operationalised as the number and proportion of individuals who remain in full- or part-time work, the number of gross and net days of sickness absence during the intervention and follow-up period, and time to first sickness absence spell. Secondary outcomes are patient-reported short-term sickness absence, work ability, pain, self-efficacy, health-related quality of life, risk for sickness absence, anxiety and depression symptoms and physical disability at 1 and 3 months after inclusion (short-term follow-up), and at 6 and 12 months (long-term follow-up). A cost-effectiveness analysis is planned and drug consumption will be investigated.DiscussionThe study is expected to provide new knowledge on the effectiveness of a comprehensive rehabilitation model that incorporates early identification of patients with musculoskeletal pain at risk for development of sickness absence and persistent pain. The study findings may contribute to more effective rehabilitation processes of this large patient population, and potentially reduce sickness absence and costs.Trial registrationClinicalTrials.gov Protocol ID: NCT03913325, Registered April 12, 2019.Version 2, 10 July 2020.Version 2 changes: Clarifications regarding trial aim and inclusion process.

Why do challenges still exist in primary care for patients with spinal cord injury?

&#x0D; &#x0D; &#x0D; Despite having high healthcare needs, individuals with spinal cord injury (SCI) receive suboptimal primary care; they are less likely than able-bodied persons to receive preventive care and more likely to have unmet health care needs. The aim of this mixed quantitative (surveys) and qualitative (interviews) study was to gather primary care health provider and rehabilitation specialists’ perspectives on why these challenges persist despite the increasing body of evidence identifying delivery service gaps. Surveys were completed by 12 family physicians who referred individuals with SCI to an interprofessional primary care mobility clinic. Interviews were completed with eight SCI rehabilitation providers. Questions in both the survey and interviews were asked related to the barriers to the provision of optimal care for SCI, potential solutions, and preferred methods for knowledge dissemination. Skill and attitudinal reasons were offered for the lack of evidence to practice transfer including: the absence of patient self-management, poor access to specialists, lack of education for family practice physicians, fragmentation of community resources and co-ordination upon hospital discharge. Solutions offered included greater patient self-management, better access to specialists, specialized primary care services and provision of SCI guidelines and protocols. Participant explanations and solutions were then analyzed through a social disability lens to see if new understandings could be identified to explain the lack of uptake from research findings to clinical practice for this underserviced vulnerable population.&#x0D; &#x0D; &#x0D;

F@ce: a team-based, person-centred intervention for rehabilitation after stroke supported by information and communication technology \u2013 a feasibility study

BackgroundGlobally, there is a growing use of Information and Communication Technology (ICT), including mobile phones, tablets and computers, which are being integrated into people’s daily activities. An ICT-based intervention called F@ce was developed in order to provide a structure for the process in stroke rehabilitation and facilitate change by integrating a global problem-solving strategy using SMS alerts. The aim of the study was to evaluate the feasibility of i) F@ce within in-patient and primary care rehabilitation after stroke, ii) the study design and outcome measures used, and iii) the fidelity, adherence and acceptability of the intervention.MethodsThree teams comprising occupational therapists and physiotherapists who work in neurological rehabilitation participated in a preparatory workshop on F@ce and then enrolled 10 persons with stroke to participate in the intervention. Goals were set using the Canadian Occupational Performance Measure (COPM) and the participants with stroke rated their performance and satisfaction with the activities associated with the three goals every day for 8 weeks. Data were collected at inclusion, at four and 8 weeks, using the COPM, Stroke Impact Scale, Frenchay Activities Index, Life Satisfaction Checklist, Self-Efficacy Scale, Hospital Anxiety and Depression Scale, Fatigue Severity Scale, follow-up survey, daily ratings on the web platform and logbooks.ResultsAll of the participants showed increased scores in the primary outcome (COPM) and a clinically meaningful improvement of ≥2 points was found in four participants regarding performance and in six participants regarding satisfaction. Overall fidelity to the components of F@ce was good. The response rates to the F@ce web platform were 44–100% (mean 78%). All of the participants stated that F@ce had supported their rehabilitation.ConclusionThe results indicate that the most beneficial part of F@ce was the person-centred, goal-setting process and SMS alerts. All participants were satisfied with F@ce and highlighted the benefits of receiving daily alerts about their goals. This encouraged them to be more active. The only downside mentioned was that they felt under an obligation to practice, although this was described as “a positive obligation”.

Musculoskeletal injury outcomes: 2-year retrospective service evaluation of a UK defence primary care rehabilitation facility (PCRF)

IntroductionMusculoskeletal injury represents the leading cause of medical discharge from the UK Armed Forces. This study evaluates effectiveness of care provision within a large primary care rehabilitation facility (PCRF) against...

Cross-cultural adaptation and validity of the Spanish fear-avoidance components scale and clinical implications in primary care

BackgroundPain-related fear-avoidance (FA) is a common problem affecting many patients with painful medical conditions. As there is great interest in the clinical importance of the relationship between FA and disability, several questionnaires have been developed to measure FA. The Fear-Avoidance Components Scale (FACS) is a recently developed patient-reported instrument that addresses critical issues not previously considered in previous FA-related questionnaires. The original English version of the FACS demonstrated good reliability, internal consistency, and construct, criterion, and predictive validity. Two factors were determined: General Fear Avoidance and Types of Activities That are Avoided. The aim of this study was to to translate the FACS into European-style Spanish (FACS-Sp), and validate its psychometric properties.MethodsThis two-stage psychometric study included 330 subjects with various chronic musculoskeletal pain disorders. An initial translation and cross-cultural adaptation of the FACS, from English to Spanish, was performed. Then, critical psychometric properties were analysed, including internal consistency by Cronbach’s α coefficients, structural validity from the Maximum Likelihood Extraction (MLE), and convergent validity by Pearson correlation with the Central Sensitization Inventory (CSI).ResultsThis study reports for the first time the psychometric properties of the Spanish version of the FACS. Total scores ranged from 0 to 88 points, with a mean of 30.49 (±17.18). The FACS-Sp showed a high internal consistency for factor 1 (α = 0.902) and factor 2 (α = 0.88). Factor structure was two-dimensional and supported structural validity, accounting for 48.75% of the total variance. Convergent validity analysis found a significant Pearson correlation r = 0.414.ConclusionThis study reports for the first time the psychometric properties of the Spanish version of the FACS-Sp. Psychometric properties supported the validation of FACS-Sp and ensured the conceptual equivalence with the original English version. In primary care and chronic pain rehabilitation, FA assessment is crucial for clinical decision-making and treatment guidance. The FACS-Sp offers a new measure of FA in Spanish speaking populations. Future research on the FACS-Sp should evaluate test-retest reliability, treatment responsiveness and psychometric comparisons with other translated versions.

Preparedness to Implement Physical Activity and Rehabilitation Guidelines in Routine Primary Care Cancer Rehabilitation: Focus Group Interviews Exploring Rehabilitation Professionals\u2019 Perceptions

To explore primary care professionals’ perceptions of physical activity and other cancer rehabilitation practice in cancer survivors, investigating the preparedness to implement guidelines regarding cancer rehabilitation. We collected qualitative data through seven semi-structured focus group interviews with 48 rehabilitation professionals, with mean 9 years of experience in primary care rehabilitation (32 physiotherapists, 15 occupational therapists, and 1 rehabilitation assistant) in a primary care setting. Data was analyzed using content analysis. Primary care rehabilitation professionals expressed limited experience of cancer survivors, experienced lack of knowledge of cancer-related disability, and had doubts concerning how to treat cancer survivors. They also experienced uncertainty about where to find collaboration and support in the healthcare system outside their own rehabilitation clinic. There is a need to combine different implementation strategies to tackle multiple barriers for effective cancer survivor rehabilitation in primary care, to boost individual rehabilitation professionals’ knowledge and self-efficacy, to clarify roles and responsibilities for cancer rehabilitation across levels of care, and to develop and strengthen organizational bridges to provide adequate access to rehabilitation for cancer survivors.

How is it to Work With JEMS: Physiotherapists' Experiences in Working With JEMS, in Primary Care Rehabilitation

How is it to Work With JEMS: Physiotherapists' Experiences in Working With JEMS, in Primary Care Rehabilitation

Long-term outcomes of multimodal rehabilitation in primary care for patients with chronic pain.

To investigate the outcomes 1 year after multimodal rehabilitation programmes in primary care for patients with chronic pain, both as a whole and for men and women separately. A second aim was to identify predictive factors for not being on sickness absence at follow-up after 1 year. A prospective longitudinal cohort study of 234 patients, 34 men and 200 women, age range 18-65 years, who participated in multimodal rehabilitation programmes in primary care in 2 Swedish county councils. Pain, physical and emotional functioning, coping, health-related quality of life, work-related factors, sickness absence (sick leave, sickness compensation/disability pension) were evaluated prior to and 1 year after multimodal rehabilitation programmes. Patients showed significant improvements at 1-year follow-up for all measures (all p ≤ 0.004) except satisfaction with vocation (p = 0.060). The proportion of patients on sick leave decreased significantly at follow-up (p = 0.027), while there was no significant difference regarding the proportion of patients on sickness compensation/disability pension (p = 0.087). Higher self-rated work ability was associated with not being on sickness absence at 1-year follow-up (odds ratio (OR) 1.19, confidence interval (CI) 1.21-1.06, p = 0.005). This study indicates that multimodal rehabilitation programmes in primary care could be beneficial for patients with chronic pain, since the outcomes at 1-year follow-up for pain, physical and emotional functioning, coping, and health-related quality of life were positive. However, the effect sizes were small and thus further development of multimodal rehabilitation programmes is warranted in order to improve the outcomes.

A pilot study of rehabilitation at home after stroke: a health-economic appraisal

This study aimed at describing the health-economic implications and organisational issues of rehabilitation at home in south-west Stockholm of 15 acute stroke patients, mean age 68.2, male:female ratio 9:6, independent in feeding and continent one week after their stroke. Average patient satisfaction with different dimensions of care was 92%. Perceived dysfunction, by means of the Sickness Impact Profile, 3 months after stroke was highest for Recreation-and-Pastime, Home Management and Ambulation. Between 3-12 months after stroke, functional improvement was particularly seen in Home Management, Recreation-and-Pastime and Emotional Behaviour. Three fourths of the patients received help with different ADL tasks from a family caregiver and 1/5 from home service assistants. According to the scores for subjective health of the spouses and time used to help the patient, the burden that the programme put on the patient's family was modest, temporary and in accordance with preferences reported by the elderly in Sweden. The mean duration of hospital stay for patients under rehabilitation at home was 14 days and for a selected comparison group with similar ADL-grade, 27 days. The mean number of therapy sessions at home was 11. Each home visit took 3.2 hours, 60% of which were direct patient time. In the selected comparison group, 1/3 was referred to other departments for rehabilitation and care, and 40% had contacts with day-care and paramedical professionals after discharge from the hospital. During the first year after stroke, the average, direct, per capita cost for rehabilitation at home amounted to SEK 127,730 divided between hospital care (50%), followed by contribution by family caregivers (18%), rehabilitation at home (10%), out-patient visits to physicians and nurses (8.8%), home-help service (7%), auxiliary equipment (2%), medication (1.5%), home adaptation (1%) and transportation service (0.3%). This organisational model of home-based rehabilitation of stroke patients constitutes a feasible, possibly less expensive alternative and complement to current rehabilitation in hospital and primary care, which could be further developed and evaluated.

Cardiac Rehabilitation in Primary Care. Impact of an Intervention on Perceived Self-Efficacy.

Cardiac rehabilitation is cost-effective and should be considered a part of the care system provided to patients who have suffered a myocardial infarction or another heart disease. The main variable to study was the scoring, prior to and after the intervention in the General Scale of Self-Efficacy by Baessler & Schwarzer. A clinical community trial that was open controlled and randomised was used. All adult subjects of both sexes who had completed a cardiac rehabilitation program for 12 months at the reference hospital were selected and offered to participate. The psychometric variables registered were the Salamanca screening questionnaire, the Hamilton Anxiety Rating Scale, and the Beck Depression Inventory. Eighty-nine subjects accepted to participate in the study (93.89% response rate), with an average age of 63.01 years (SD 8.75). Once the study was concluded, the main outcome was a difference in means of 6.09 points in the General Scale of Self-Efficacy (p < 0.0053, 96% confidence interval—4.1950–10.29), showing that the group exposed to the intervention reached a higher score in the above-mentioned scale. However, there were no significant differences (t-student 0.1211; p = 0.943) after the estimation and contrast of population means for score differences between the groups regarding the Hamilton scale. Similarly, there were no significant differences between the groups regarding the means obtained in the variable score difference in the Beck Depression Inventory (t-student −0.1281; p = 0.8987). The results showed an increase in those scores related to general self-efficacy among the population that completed the intervention program, as compared to the control group.

Georreferenciamento e políticas públicas de acesso à fisioterapia na atenção primária na cidade de Parnaíba-PI

INTRODUÇÃO: O Sistema Único de Saúde (SUS) é uma política pública construída em um contexto de dimensões políticas, tecnológicas e sociais. Embora muito se tenha avançado no SUS, a ampliação do acesso à fisioterapia na atenção primária ainda é um dos seus grandes desafios. A distribuição espacial dos usuários pode fornecer importantes informações sobre políticas públicas voltadas para atenção primária á saúde. OBJETIVO: Analisar a distribuição espacial de usuários do SUS em busca de tratamento no Serviço Escola de Fisioterapia da Universidade Federal do Piauí (SEF-UFPI). MATERIAIS E MÉTODOS: Trata-se de uma pesquisa descritiva documental, quantitativa e retrospectiva. Pacientes com queixas musculoesqueléticas que buscaram tratamento fisioterapêutico no SEF-UFPI nos anos de 2010 a 2017 foram mapeados por meio de georreferenciamento espacial. RESULTADOS: 1476 prontuários foram identificados em 32 bairros distintos. 63% dos pacientes atendidos foram provenientes dos sete bairros mais próximos do SEF-UFPI. A maioria (n=924) dos pacientes era do sexo feminino, com queixas de dores crônicas nos membros inferiores. A cidade de Parnaíba-PI possui aproximadamente 155.000 habitantes e apenas quatro fisioterapeutas cadastrados como membros do NASF. CONCLUSÃO: O elevado fluxo de pacientes que buscaram atendimento fisioterapêutico é proveniente de áreas cobertas pela estratégia de saúde da família. A ausência de fisioterapeutas nestas equipes indica a necessidade urgente de reformulação das políticas públicas de acesso à reabilitação física na atenção primária.

A quality indicator set for use in rehabilitation team care of people with rheumatic and musculoskeletal diseases; development and pilot testing

BackgroundSystems for monitoring effectiveness and quality of rehabilitation services across health care levels are needed. The purpose of this study was to develop and pilot test a quality indicator set for rehabilitation of rheumatic and musculoskeletal diseases.MethodsThe set was developed according to the Rand/UCLA Appropriateness Method, which integrates evidence review, in-person multidisciplinary expert panel meetings and repeated anonymous ratings for consensus building. The quality indicators were pilot-tested for overall face validity and feasibility in 15 specialist and 14 primary care rehabilitation units. Pass rates (percentages of “yes”) of the indicators were recorded in telephone interviews with 29 unit managers (structure indicators), and 164 patients (process and outcome indicators). Time use and participants’ numeric rating of face validity (0–10, 10 = high validity) were recorded.ResultsNineteen structure, 12 process and five outcome indicators were developed and piloted. Mean (range) sum pass rates for the structure, process and outcome indicators were 59%(84%), 66%(100%) and 84%(100%), respectively. Mean (range) face validity score for managers/patients was 8.3 (8)/7.9 (9), and mean answering time was 6.0/5.5 min. The final indicator set consists of 19 structure, 11 process and three outcome indicators.ConclusionTo our knowledge this is the first quality indicator set developed for rehabilitation of rheumatic and musculoskeletal diseases. Good overall face validity and a feasible format indicate a set suitable for monitoring quality in rehabilitation. The variation in pass rates between centers indicates a potential for quality improvement in rheumatic and musculoskeletal rehabilitation in Norway.