O acesso e o fazer da reabilitação na Atenção Primária à Saúde

The rehabilitation workforce in Brazil

BACKGROUND

The surge in individuals facing functional impairments has heightened the demand for rehabilitation services. Understanding the distribution of the rehabilitation workforce is pivotal for effective health system planning to address the population's health needs.

OBJECTIVE

To investigate the spatial and temporal dispersion of physical therapists, speech therapists, psychologists and occupational therapists across various tiers of care within Brazil's Unified Health System and its regions.

METHOD

This is an ecological time series study on the supply of rehabilitation professionals. Data were obtained from the National Register of Health Establishments from 2007 to 2020. The density of professionals was calculated per 10,000 inhabitants annually for Brazil and its five regions. The Joinpoint regression model was used to analyze the temporal trends of the density of professionals, considering a 95% confidence interval.

RESULTS

In 2020, the most notable concentrations of psychologists, speech therapists, and occupational therapists in Brazil were observed in the domain of Specialized Health Care, with densities of 0.60, 0.20, and 0.16 professionals per 10,000 inhabitants, respectively. Conversely, the highest density of physical therapists was found within Hospital Health Care, with a density of 1.19 professionals per 10,000 inhabitants. Notably, variations in professional dispersion across different regions were apparent. Primary Health Care exhibited the highest density of professionals in the Northeast region, while the Southern region accounted for the highest densities in all professional categories within Specialized Health Care. The southeast region exhibited the largest workforce within Hospital Health Care. A marked upsurge in professional availability was noted across all categories, notably in the occupational therapy sector within hospital care (AAPC: 30.8), despite its initial low density.

CONCLUSION

The implementation of public health policies played a significant role in the expansion of the rehabilitation workforce at all three levels of care in Brazil and its various regions from 2007 to 2020. Consequently, regional disparities and densities of professionals have emerged, mirroring patterns observed in low-income countries.

Telehealth for Parkinson disease patients during the COVID-19 pandemic: the TeleParkinson study

BACKGROUND

Telemedicine allows Parkinson disease (PD) patients to overcome physical barriers to access health care services and increases accessibility for people with mobility impairments.

OBJECTIVE

To investigate the feasibility indicators of a telehealth intervention for PD patients, including patient recruitment, attendance, technical issues, satisfaction, and benefits on levels of physical activity and sleep.

METHODS

We conducted a single-center, single-arm study of telehealth video consultations using WhatsApp (Meta Platforms, Inc., Menlo Park, CA, USA). Also, we collected the feasibility indicators as the primary endpoints. All the patients in the study were previously evaluated in person by the same team.

RESULTS

Patient recruitment, attendance, and technical issues rates were 61.3%, 90.5%, and 13.3%, respectively, with good scores of patient acceptance and satisfaction with the study intervention. The telehealth intervention improved physical activity, including the number of walks for at least 10 continuous minutes (p = 0.009) and the number of moderate-intensity activities lasting at least 10 continuous minutes (p = 0.001). The Pittsburgh sleep quality index (PSQI) scores also improved for one of its components: perceived sleep duration (p < 0.001) and for total Pittsburgh score (p < 0,001). The average travel time saving was 289.6 minutes, and money-saving was R$106.67 (around USD 18; almost 10% of the current minimum wage in Brazil).

CONCLUSIONS

Direct-to-patient telehealth video consultations proved to be feasible and effective and had a positive impact on physical activity levels and sleep in PD patients.

Describing the Rehabilitation Workforce Capacity in the Public Sector of Three Rural Provinces in South Africa: A Cross-Sectional Study

The World Health Organisation emphasises the importance of addressing gaps in health systems where rehabilitation services are poorly integrated. In South Africa, regions with the largest disability rates are usually the areas where rehabilitation is least accessible, due to inadequate workforce capacity. The first step towards addressing workforce capacity is to determine current capacity. This paper presents a cross-sectional study to describe rehabilitation workforce data in the public sector of three rural South African provinces. A web-based therapist survey and a telephonic facility survey was conducted. Data were collected regarding total number of therapists per province, age, years employed, qualifications, salary level, profession type, level of care, and rural/urban distribution. Descriptive statistics were conducted, while Chi-squared tests compared professions regarding highest qualification and salary level. Population-adjusted ratios were calculated using national uninsured population statistics. The web-based survey had 639 responses while the telephonic survey reported on 1166 therapists. Results indicated that the mean age of therapists across the respective provinces was 28, 35 and 31 years of age, and the mean employment years in the respective provinces were three, eight and five years. Most of the workforce (n = 574) had a bachelor's degree as their highest qualification. A total of 27% of the workforce were community service therapists and 61% of therapists earned a production-level salary. Occupational therapy was best (40%) and speech and audiology therapy least (7%) represented. Three percent of therapists worked at primary level, versus eighty percent at secondary level. Forty percent of therapists worked in rural areas. Workforce density per province ranged from 0.71-0.98 per 10,000 population. Overall, results show that the rehabilitation workforce density is low, and that the distribution of therapists between rural and urban settings, and levels of care, is inequitable. Considering the rise in rehabilitation need, prioritisation and strengthening of the rehabilitation workforce capacity is vital to ensure integration across all levels of care and service.

Rehabilitation workforce descriptors: a scoping review

Background

A comprehensive, accurate description of workforce capacity is important for health service planning, to ensure that health services meet local needs. In many low- to middle-income countries, the government’s service planning ability is barred by the lack of accurate and/or comprehensively-described workforce data. In these low-resource settings, lack of appropriate planning leads to limited or no access to rehabilitation services. Variability in the definitions and scope of rehabilitation professionals further complicates the understanding of rehabilitation services and how it should be planned and delivered. Another challenge to describing the primary rehabilitation workforce capacity, is the lack of standardised and agreed-upon global metrics. These inconsistencies highlight the need for a comprehensive understanding of current practices, which can offer guidance to countries wishing to describe their rehabilitation workforce. This study aimed to scope the range of descriptors and metrics used to describe the rehabilitation workforce and to compare the workforce across countries that used similar descriptors in published reports.

Methods

A scoping review was conducted according to the five-step framework first developed by Arksey and O’Malley. The review included a broad search of literature regarding the rehabilitation workforce and how countries quantify and describe the rehabilitation workforce.

Results

Nineteen studies on rehabilitation workforce capacity were identified. All but one (a cross-sectional study) were database reviews. The main descriptors and indicators used to describe the rehabilitation workforce capacity were profession type, age, gender, distributions between urban/rural, level of care, and private/public sectors, absolute count totals, and population-adjusted ratios.

Conclusion

This scoping review provided an overview of descriptors and indicators used to describe the rehabilitation workforce capacity internationally. The study is a first step towards developing standardised descriptors and metrics to quantify the rehabilitation workforce capacity, that will allow for comparison between different settings.

Trial registration

This scoping review protocol has been registered with the Open Science Framework (http://osf.10/7h6xz).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08531-z.

Characterization of the procedures and professional practices of primary care physiotherapists in Brazil

BACKGROUND: Physiotherapy interventions are well known and established in secondary and tertiary care. However, within the Brazilian primary health care (PHC), the role of physiotherapists is still under development, and there is a lack of representative data showing how and what is being implemented by these professionals. OBJECTIVE: The aim was to characterize the professional practices of physiotherapists working at PHC in Brazil. METHODS: This is an exploratory study that adopted a descriptive analysis based on the records of physiotherapists, considering assistance and sociodemographic aspects, in the period from 2016 to 2017. The following variables were extracted: region, federative unit and municipality, age group and sex of the attended user, condition/problem, procedure and place of attendance. RESULTS: A total of 318,780 procedures were recorded, concentrated in the South and southeast regions, with a predominance of clinical-assistance procedures and a higher frequency of attendance in Basic Health Units. Among the assisted users, the female gender prevailed in the age group of 20 to 59 years. Low back pain was the most frequently treated condition. CONCLUSION: The professional practices of physiotherapists working at PHC in Brazil were characterized by healthcare, clinical-assistance, preventive and health promotion activities, with emphasis on clinical-assistance practices focused on musculoskeletal conditions, especially low back pain.

Organization and offer of physical therapy care in response to the COVID-19 pandemic in Brazil

The recovery of people affected by COVID-19 is a process that continues beyond the acute condition of infection by Sars-CoV-2. The impairment of several body systems can cause functional impacts and demand continuous physical therapy assistance both in outpatient care and in Primary Health Care (PHC). In this essay, we seek to discuss the challenges of organizing and offering Physical Therapy assistance in response to the COVID-19 pandemic in Brazil. The analysis was summarized in three dimensions: offering physical therapy assistance in PHC, outpatient care, via telehealth. It is concluded that functional rehabilitation depends on the PHC's response capacity; there is a shortage of rehabilitation services that precedes the pandemic, and may not respond satisfactorily to the demands of the current epidemiological context; it is necessary to articulate the outpatient physiotherapy and PHC teams; although telehealth is a resource and an opportunity to increase the population's access to functional rehabilitation, its use requires caution; the physiotherapist plays a crucial role in the entire COVID-19 care continuum.

The physiotherapy workforce in the Brazilian Unified Health Care System

BACKGROUND

Maintaining sufficient health care workforce is a global priority to achieve universal health coverage. Therefore this study addresses the availability of physiotherapists in Brazil.

OBJECTIVE

To describe secular trends of the physiotherapy workforce-to-population ratio in the Unified Health System, considering public and private sector and care level (primary, secondary, tertiary) in Brazil and its regions.

METHOD

Descriptive exploratory quantitative study based on secondary sources. All data related to the distribution of physiotherapists between August 2007 and September 2016 regarding facilities types, location and public and private sectors was obtained from the Brazilian National Registry of Health Care Facilities. Data related to the population of Brazil was extracted from Brazilian Institute of Geography and Statistics. The physiotherapy workforce-to-population ratio was calculated by the number of physiotherapists per 1000 population (public and private sector and care level) by ANOVA test. The distribution trends are represented on maps. Annual growth rates were estimated with Prais-Winsten linear regression models, with a significance level of 0.05, autocorrelation was checked by the Durbin-Watson test.

RESULTS

The physiotherapists ratio in Brazil was 0.22/1000 population in 2007 and 0.41 in 2016, showing growth of 86%, with an increasing trend of 0.5% on an annual average. The public sector had the biggest physiotherapy workforce in the country in 2007 and 2016. The primary health care had the smallest physiotherapy workforce-to-population ratio (2007: p > 0.001 and 2016: p = 0.003), even though it had the largest growth trend in annual average (0.9% p > 0.001), followed by public and private tertiary health care sectors (0.8% p > 0.001). The workforce in secondary health care was bigger in the private sector than in the public sector (0.6% p > 0.001 vs. 0.2% p = 0.004). Overall, all regions had greater growth of physiotherapy workforce-to-population ratio in public primary and tertiary health care sectors, and private secondary health care sector, mainly the Southeast, South and Central-West regions.

CONCLUSION

Although the physiotherapy workforce in Brazil is relatively small, there was a trend towards growth with differences among care levels, and public and private sectors. The physiotherapy workforce-to-population ratio is bigger in the private secondary health care sector, followed by public tertiary, secondary and primary health care sectors. Sub-national regions show similar trends to the national estimates, with minor variations by region.

Current physical therapy care of patients undergoing breast reconstruction for breast cancer: a survey of practice in the United Kingdom and Brazil

BACKGROUND

In both the United Kingdom (UK) and Brazil, women undergoing mastectomy should be offered breast reconstruction. Patients may benefit from physical therapy to prevent and treat muscular deficits. However, there are uncertainties regarding which physical therapy program to recommend.

OBJECTIVE

The aim was to investigate the clinical practice of physical therapists for patients undergoing breast reconstruction for breast cancer. A secondary aim was to compare physical therapy practice between UK and Brazil.

METHODS

Online survey with physical therapists in both countries. We asked about physical therapists' clinical practice.

RESULTS

181 physical therapists completed the survey, the majority were from Brazil (77%). Respondents reported that only half of women having breast reconstruction were routinely referred to physical therapy postoperatively. Contact with patients varied widely between countries, the mean number of postoperative sessions was 5.7 in the UK and 15.1 in Brazil. The exercise programs were similar for different reconstruction operations. Therapists described a progressive loading structure over time: range of motion (ROM) was restricted to 90° of arm elevation in the first two postoperative weeks; by 2-4 weeks ROM was unrestricted; at 1-3 months muscle strengthening was initiated, and after three months the focus was on sports-specific activities.

CONCLUSION

Only half of patients having a breast reconstruction are routinely referred to physical therapy. Patients in Brazil have more intensive follow-up, with up to three times more face-to-face contact with a physical therapist than in the UK. Current practice broadly follows programs for mastectomy care rather than being specific to reconstruction surgery.

Changes and predictors of psychological stress among elderly stroke survivors 6 months after hospital discharge

The aim of this study was to analyse the changes in psychological stress and identify its basal predictors among elderly stroke survivors after 6 months following discharge from hospital to home directly, rather than to a rehabilitation facility. The sample comprised 50 elderly stroke survivors. Data were collected at 2 weeks (T1), at 3 months (T2), and at 6 months (T3) after hospital discharge. The following instruments were applied: Perceived Stress Scale-10 items (PSS-10), National Institute of Health Stroke Scale, Functional Independence Measure, and Geriatric Depression Scale-15 items. Study records indicated that the age of the study participants ranged from 60 to 87 years old (mean = 70.3; standard deviation = 7.6). The number of male and female participants was similar. The PSS-10 score decreased almost 6 points between T1 (mean = 15.1) and T3 (mean = 9.7; p < .001). Both Functional Independence Measure (p = .025) and Geriatric Depression Scale-15 (p = .017) scores at T1 predicted the PSS-10 score at T3. The study thus demonstrated that elderly stroke survivors experienced significant stress after hospital discharge, which tended to improve over the next 6 months. Depression and lower functional independence 2 weeks after discharge were predictors of a greater level of psychological stress at 6 months following discharge.