Poliomielite, filantropia e fisioterapia: o nascimento da profissão de fisioterapeuta no Rio de Janeiro dos anos 1950

[Workplaces occupied by physiotherapists: less demand for primary care]

In view of the expanded view of health proposed by the Unified Health System (SUS), the approach given to the illness process required a prism focused on the biopsychosocial view and no longer on the biomedical model, which led to a reorganization in the training of health professionals. Thus, the National Curriculum Guidelines were established guiding the pedagogical projects of the courses towards the biopsychosocial model, so that the International Classification of Functionality, Disability and Health contributes to this scenario through its multidimensional and non-reductionist approach. However, physiotherapy has historically been strongly influenced by the biomedical model, distancing it from primary care (PC). This is an exploratory, descriptive and quantitative study, with secondary data source obtained through the National Register of Health Establishments in Brazil, whose objective was to verify, within a 10-year interval, at which level of health care most physiotherapists and their representation in PC are concentrated. The findings indicated that PC represents the minority scenario of jobs occupied by physical therapists, reflecting the hegemony of the biomedical model and reinforcing the rehabilitation character historically given to the profession.

The ICF in the pedagogical projects of Physiotherapy courses in Midwest Brazil

Abstract Introduction: The course pedagogical projects (CPPs) of physical therapy programs in Brazil are based on National Curriculum Guidelines for Physiotherapy (NCGP) and the principles of the National Health System (SUS). The CPPs that guide professional training tend to use a biopsychosocial approach and propose familiarizing undergraduate students with the International Classification of Functionality, Disability and Health (ICF); as such, they should include the use of this instrument. Objective: Assess CPPs by exploratory document analysis and determine whether they propose teaching and using the ICF in student training. Method: Qualitative-quantitative study with document analysis of CPPs for physical therapy courses in Midwest Brazil, from which information related to the ICF was extracted. Results: The biopsychosocial model and NGCP were identified in the 10 CPPs analyzed and the ICF was found in the curriculum outline of 6 of these, indicating the incorporation of this framework in student training. However, the ICF was only identified in the course objectives and literature references of 4 and 2 CPPs, respectively, suggesting possible shortcomings in its application in these documents. Conclusion: The inclusion of the ICF in some CPPs indicates a positive change and favors understanding of functioning, but does not preclude the need for a broader approach to teaching this classification framework in the remaining CPPs in order to provide student training within a biopsychosocial context.

Inserção da fisioterapia na atenção primária à saúde: análise do cadastro nacional de estabelecimentos de saúde em 2010

RESUMO O objetivo deste estudo é descrever a distribuição de fisioterapeutas na atenção primária à saúde (APS) no Brasil, e analisar a relação do número de habitantes por fisioterapeuta na APS, de acordo com o Cadastro Nacional de Estabelecimentos de Saúde (CNES). Foi realizado um estudo transversal descritivo, a partir de dados do CNES e do Censo Demográfico de 2010. A partir disso, foram identificados 6.917 cadastros de fisioterapeutas na APS, com predomínio na região Sudeste (49%), a qual, em junto com a Sul, foram as regiões com melhores relações de habitantes por fisioterapeuta na APS (aproximadamente 23.000/1), enquanto na região Norte foram observados 32.000 habitantes por profissional. Dos municípios do Brasil, 47% possuem fisioterapeuta na APS, e a análise por porte populacional indicou maior percentual de fisioterapeutas na APS em municípios de pequeno porte (39%) e médio porte (34%). A melhor relação entre habitantes por fisioterapeuta ocorreu nos municípios de pequeno porte do Sudeste (6.948/1), e a pior em metrópoles do Centro-Oeste (371.672/1). Observou-se, ainda, que municípios de pequeno porte apresentam fisioterapeutas apenas na APS, ao passo que, por outro lado, a maioria dos municípios de demais portes possui fisioterapeutas em todos os níveis de atenção.

Overview of physical therapy graduation courses in Brazil: current scenario

Abstract Introduction: After the regulation of Physical Therapy (PT) in 1969, there were only six undergraduate courses in Brazil. In the 90s, higher education underwent major expansion in all professions and the same occurred to PT, with consequent increase in the number of professionals in the labor market and privatization of education. Objective: To describe the current situation of PT courses in Brazil offered by Higher Education Institutions (IES). Methods: The data for the region, academic organization, situation, period, school system, administrative category, vacancies, course hours and duration were obtained from the website of the Ministry of Education (MEC) and refer to the year of 2013. The descriptive analyzes of central tendency, dispersion and percentage were performed in Stata 9®. Results: From the total of 550 IES registered in the MEC, 281 (51%) were in the Southeast. Regarding the academic organization, 341 (62%) corresponded to universities and 483 (87.9%) of the IES were private. Of the courses, 521 (94.7%) are active, the predominant school system was the semiannual (91.5%) and 438 were part-time. The average vacancies authorized by the IES were 129 ± 102, with at least 44,900 vacancies available in the country. Of the courses, 75% had 4,000 hours of duration with the minimum of seven semesters and a maximum of fourteen. Conclusion: The data show a higher offer of PT courses in the private sector compared to the public. There was a progressive concentration of courses and vacancies in the Southeast, especially in São Paulo.

Physiotherapy: a historical analysis of the transformation from an occupation to a profession in Brazil

Background:

Analyzing the historical and social path of an occupation using the sociology of professions and the perspective of scientific knowledge promotes an understanding of the origin of physical therapy in Brazil and of discussions of the profession in its contemporary context.

Objective:

The aim of this paper was to discuss the professionalization process of physical therapy in São Paulo. The authors tried to analyze bath therapy, massage therapy, and physical therapy as occupations involving distinct expertise and as part of the group of occupations that evolved into the profession of physiotherapy in the first half of the twentieth century.

Method:

The analysis undertaken was a qualitative study based on an analysis of historical documents. Eighty-six professional records from the Service of Inspection of Professional Practice in the state of São Paulo and healthcare legislation from the 1930s and 1940s were analyzed.

Results:

The distinction between physical therapy practitioner and profession of physiotherapy can be seen by examining registration requirements for rank-and-file nurses with expertise in interactions; this distinction suggests the emergence of specialized expertise that was clearly a part of neither medicine nor nursing and contributed to expertise in physical therapy since the 1950s.

Conclusion:

The regulation of physiotherapy practices, the recognition of expertise, the accreditation of practical nurses by the State, and the institutionalization of a course for physical therapy practitioners in 1951 are key elements of the professionalization process for the physical therapy profession in Brazil.

Local health policies under the microscope: consultants, experts, international missions and poliomyelitis in Spain, 1950-1975

One of the main focuses of analysis of this paper concerns the missions of international health agency experts to Spain to report on the situation, the activities in the fight against physical disabilities in children and on the actions taken to cope with the problem. The Spain-23 Plan was the instrument used by WHO and other agencies to start the process of change in a country undergoing a period of transformation under the enduring Franco dictatorship. As key sources, the paper uses unpublished reports of WHO experts on the subject, which resulted from visits to the country between 1950 and 1975. The methodological approach consists of an analysis of discourses from primary sources within the historiographical framework.

[Curing by doing: poliomyelitis and the rise of occupational therapy in Argentina, 1956-1959]

Analiza la creación de la carrera de terapia ocupacional en Argentina. Privilegiando la construcción histórico social, se recuperan aspectos del proceso de profesionalización estableciendo relaciones entre el contexto provocado por la epidemia de poliomielitis de 1956 y la influencia de las concepciones de género sobre la conformación de la profesión del terapista ocupacional. La llegada al país de esta profesión introdujo la idea de curing by doing , una terapéutica lograda a través del hacer y una forma de atenuar las consecuencias de la crítica epidemia. Finalmente, se sugiere un proceso inacabado de pujas y tensiones que necesita aún superar obstáculos para adquirir la autonomía profesional y el monopolio de la práctica.

[Healthcare professions: a critical analysis of care]

The article focuses on the activities of nurses and physical therapists within Brazil's Unified Health System (Sistema Único de Saúde), especially the Family Health Program. With the appearance of new professions and redefinitions in the practices of traditional healthcare professions, the subsequent multi-professional, interdisciplinary type of work has presented challenges when it comes to training new generations of healthcare providers, all part of an endeavor to humanize care and provide universalist, integrated, high-quality services. Collective health has contributed to this effort by networking with other fields of knowledge and human sciences. Healthcare fields have also sometimes tended to disregard any type of exchange with the human sciences, preferring to limit interactions to biomedical fields.