Physiotherapy work process in primary health care in a Brazilian municipality: qualitative study.

OBJECTIVE: The aim of this study was to analyze the work process of physiotherapists in primary health care (PHC) and the repercussions of work management practices. METHODS: A qualitative study that used semi-structured interviews with nineteen physiotherapists, two management physiotherapists and a coordinator of PHC in municipality in Southern Brazil. Data were analyzed using the methodological framework of discourse analysis. RESULTS: Through the analyzed speeches, the work routine of physiotherapists working in basic health units in the municipality studied mainly involves individual care, group activities and home visits. The diversity of this routine is influenced by management, work teams, the characteristics of the assisted population and the professional profile of the physiotherapist. Measures that enhanced work effectiveness were the increase in the number of physiotherapists in the city over the years, effective interprofessional relationships, the possibility of working in a single health unit, and monthly meetings for continuing education. Among the weaknesses presented were the low effectiveness of the orthopedics protocol adopted in the municipality, poor access to secondary care, lack of knowledge about the physiotherapist's functions in PHC and limitations in infrastructure and financial resources. CONCLUSION: Physiotherapy in primary care has been consolidated in the studied city, with effective management actions and increased access to professional, having a positive impact on resolving health conditions sensitive to this level of care.

Perfil epidemiológico de crianças e adolescentes vítimas de queimaduras admitidos em centro de tratamento de queimados / Epidemiological profile of children and adolescents burn victims admitted to the burned treatment center / Perfil epidemiológico de niños y adolescentes víctimas de quemaduras admitidas en centro de tratamiento de quemados

Objetivo: Estabelecer o perfil epidemiológico de crianças e adolescentes atendidas em Centro de Tratamento de Queimados (CTQ). Método: Estudo transversal realizado por meio da análise dos prontuários de crianças e adolescentes (0 a 17 anos), internadas no CTQ, no período entre maio de 2011 e fevereiro de 2014. Aspectos investigados: sexo; idade; agente causal; motivo da queimadura; superfície corpórea queimada (SCQ), regiões acometidas; procedimentos; necessidade de Unidade de Terapia Intensiva (UTI), ventilação assistida; tempo de internação; fisioterapia e desfecho. Resultados: Foram analisados 177 prontuários, a mediana da idade foi de 4 [2-10] anos, maior prevalência no sexo masculino (n=118; 67%) e fase pré-escolar (n=66; 37%). O principal agente causal foi escaldo (53%) e o motivo com maior prevalência foi acidente doméstico (86%). O percentual da SCQ foi de 8,5% [4-15], com mediana do tempo de internação de 12 [5-15] dias, 23% necessitaram de atendimento em UTI, 6% foram a óbito. O desbridamento foi o procedimento mais realizado e a fisioterapia acompanhou todos os pacientes. Conclusão: Os resultados apontam que a fase mais suscetível à queimadura é a pré-escolar, com predominância no sexo masculino, sendo que os acidentes ocorrem no âmbito domiciliar por escaldaduras, acometem várias regiões do corpo e demandam internação e vários procedimentos terapêuticos. Programas preventivos devem dar atenção especial à população pediátrica na faixa etária entre os 2 e 6 anos, com ênfase nos cuidados no domicílio.

Objective: To analyze the epidemiological profile of children and adolescents burn victim admitted to the Burn Treatment Center (BTC). Methods: A crosssectional study was conducted through the analysis of records of children and adolescents (0-17 years) who were burn victims hospitalized in BTC, between May 2011 and February 2014. It was analyzed: sex; age; causal agent; burns reason; body surface area burned (BSAB) and affected regions; procedures; intensive care unit (ICU); mechanical ventilation and tracheostomy; length of stay; physiotherapy and outcome. Results: A total of 177 subjects were analyzed, the average age was 4 [2-10] years, with a higher prevalence in males (n=118; 67%) and preschool children (n=66; 37%). The main etiologic agent was scald (53%) and the most prevalent reason was domestic accident (86%). The percentage of BSAB was 8.5% [4-15] and average length of stay was 12 [5-15] days, while 23% required ICU care and 6% patients died. Debridement was the most performed procedure and physiotherapists assisted all study patients. Conclusions: These results indicate that preschools are more susceptible to burning with predominance in males, and those accidents occur in the home environment by scalds, affecting multiple body regions and requiring hospitalization and several therapeutic procedures. Prevention programs should give special attention to pediatric population aged between two and six years, with emphasis on care in the home environment.

Objetivo: Establecer el perfil epidemiológico de los niños y adolescentes atendidos en el Centro de Tratamiento de Quemaduras. Métodos: Estudio transversal de análisis de las historias clínicas de los niños y adolescentes (0-17 años) ingresados entre mayo de 2011 y febrero de 2014. Aspectos investigados: sexo; edad; agente causal; razón de laquema; superficie corporal quemada (SCQ); regiones afectadas; procedimientos; necesidad de cuidados intensivos, ventilación asistida; duración de la estancia; terapia física y resultado. Resultados: Se analizaron 177 registros, la mediana de edad fue de 4 [2-10] años, siendo mayor entre los hombres (n=118; 67%) y pre-escolares (n=66; 37%). El principal agente causal fue escaldadura (53%) y la razón fue accidente doméstico (86%). La media de la SCQ fue de 8,5% [4-15] con una mediana de la estancia hospitalaria 12 [5-15] días, 23% necesitaban de cuidados en UTI, 6% murieron. El desbridamiento y la terapia física fueron los procedimientos más comunes en todos los pacientes. Conclusión: Los resultados muestran los pre-escolares como más susceptibles, especialmente los hombres, y ocurren con mayor frecuencia en ambiente doméstico por escaldaduras; afectan a varias regiones del cuerpo, requieren hospitalización y varios procedimientos terapéuticos. Programas de prevención deben prestar especial atención a lapoblación infantil de entre dos y seis años, con énfasis en la atención domiciliaria.

Translation, cultural adaptation and evaluation of the psychometric properties of the Falls Risk Awareness Questionnaire (FRAQ): FRAQ-Brazil.

OBJECTIVE: This study aimed to translate and culturally adapt the Falls Risk Awareness Questionnaire (FRAQ) for the elderly Brazilian population as well as to evaluate the internal consistency and reliability of this instrument. METHOD: The study used internationally accepted guidelines for the cross-cultural adaptation process. The questionnaire in its final Portuguese version was then applied to 120 elderly people to assess the measurement properties. The participants were interviewed twice in the first assessment (examiners 1 and 2 at an interval of 30 to 60 minutes) and again after 2 to 7 days by examiner 1. The internal consistency was assessed with Cronbach' s alpha coefficient. To evaluate the reliability of the intra- and inter-evaluators, the Kappa coefficient for categorical variables was used; for numeric variables, the intra-class correlation coefficient (2-way mixed model) and the respective 95% confidence intervals were used in addition to the concordance test of Bland and Altman. RESULTS: The Brazilian version of the FRAQ was obtained while maintaining a semantic, idiomatic, cultural and conceptual equivalence. The internal consistency was α=0.95, while for intra-examiner reliability, an intrarater correlation coefficient (ICC-3,1) of 0.91 was obtained with an intra-class correlation Kappa coefficient of 0.89 and a Bland and Altman mean difference (bias) of -0.52. Regarding the inter-examiner reliability, the ICC=0.78, Kappa=0.76 and bias=0.12. CONCLUSIONS: The translation and cultural adaptation of the FRAQ for the elderly Brazilian population was successfully performed. The instrument demonstrated excellent reliability and internal consistency, thus making it useful for assessing the perception of the risk of a fall among elderly Brazilians.

Translation, cultural adaptation and evaluation of the psychometric properties of the Falls Risk Awareness Questionnaire (FRAQ): FRAQ-Brazil / Tradução, adaptação cultural e avaliação das propriedades psicométricas do Falls Risk Awareness Questionnaire (FRAQ): FRAQ-Brasil

OBJECTIVE: This study aimed to translate and culturally adapt the Falls Risk Awareness Questionnaire (FRAQ) for the elderly Brazilian population as well as to evaluate the internal consistency and reliability of this instrument. METHOD: The study used internationally accepted guidelines for the cross-cultural adaptation process. The questionnaire in its final Portuguese version was then applied to 120 elderly people to assess the measurement properties. The participants were interviewed twice in the first assessment (examiners 1 and 2 at an interval of 30to60minutes) and again after 2 to 7 days by examiner 1. The internal consistency was assessed with Cronbach' s alpha coefficient. To evaluate the reliability of the intra- and inter-evaluators, the Kappa coefficient for categorical variables was used; for numeric variables, the intra-class correlation coefficient (2-way mixed model) and the respective 95% confidence intervals were used in addition to the concordance test of Bland and Altman. RESULTS: The Brazilian version of the FRAQ was obtained while maintaining a semantic, idiomatic, cultural and conceptual equivalence. The internal consistency was α=0.95, while for intra-examiner reliability, an intrarater correlation coefficient (ICC-3,1) of 0.91 was obtained with an intra-class correlation Kappa coefficient of 0.89 and a Bland and Altman mean difference (bias) of -0.52. Regarding the inter-examiner reliability, the ICC=0.78, Kappa=0.76 and bias=0.12. CONCLUSIONS: The translation and cultural adaptation of the FRAQ for the elderly Brazilian population was successfully performed. The instrument demonstrated excellent reliability and internal consistency, thus making it useful for assessing the perception of the risk of a fall among elderly Brazilians. .

OBJETIVO: Traduzir e adaptar culturalmente o Falls Risk Awareness Questionnaire (FRAQ) para a população idosa brasileira e avaliar a consistência interna e a confiabilidade desse instrumento. MÉTODO: O estudo utilizou as diretrizes internacionais para adaptação transcultural. Em seguida, o questionário em sua versão final em português foi aplicado em 120 idosos, a fim de se avaliarem as propriedades de medida. Os participantes foram entrevistados duas vezes na primeira avaliação (examinadores 1 e 2, com intervalo de tempo de 30 a 60 minutos) e novamente entre 2 e 7 dias pelo examinador 1. A consistência interna foi estimada pelo coeficiente alfa de Cronbach. Para avaliar a confiabilidade intra e interavaliadores, utilizou-se o coeficiente Kappa para as variáveis categóricas. Já para as variáveis numéricas, utilizou-se o Coeficiente de Correlação Intraclasse(CCI) (modelo 2-way mixed) e seus respectivos intervalos de confiança de 95%, além do teste de concordância de Bland e Altman. RESULTADOS: A versão brasileira do FRAQ foi adquirida mantendo-se as equivalências semântica, idiomática, cultural e conceitual. A consistência interna foi de α=0,95, já a confiabilidade intraexaminador obteve CCI (3,1)=0,91, Kappa de 0,89 e Bland e Altman, por meio da diferença da média (viés)=-0,52. Quanto à confiabilidade interexaminador, CCI=0,78, Kappa=0,76 e viés=0,12. CONCLUSÕES: A tradução e a adaptação cultural do FRAQ para a população idosa brasileira foi realizada com sucesso. O instrumento demonstrou excelente confiabilidade e consistência interna, tornando assim útil para avaliação da percepção do risco de queda entre os idosos brasileiros. .