Variáveis psicológicas relacionadas ao processo de adesão ao tratamento fisioterapêutico / Motivation and attachment behavior related to patient's compliance with physiotherapeutic treatment

Estuda variáveis psicológicas na cooperação do paciente ao tratamento fisioterapêutico pós-operatório de cirurgias abdominais em seis pacientes, de um hospital de São Paulo. Nos três meses de investigação clínica-qualitativa, os pacientes foram atendidos na internação e treinados os exercícios domiciliares. Utilizou–se um roteiro de treino em fisioterapia na internação e nas entrevistas de retorno ambulatorial. Na análise do conteúdo as variáveis foram explicadas pelo modelo de “fatores de motivação humana”. A categoria comportamento de apego “medo da doença e da morte” foi fator mobilizador para a adesão; mas também foi a emoção responsável pela paralisação, pela não adesão de pacientes, na medida em que a condição ameaçadora incapacitou-lhes o enfrentamento. Observam-se, na não adesão, dificuldades quanto à suscetibilidade no contato com a doença, em função de experiências subjetivas de mudanças físicas e emocionais; aspectos que podem ser amenizados com a capacidade do terapeuta em funcionar como um instrumento de facilitação da cooperação do paciente ao tratamento fisioterapêutico, com diminuição da angústia e ampliação do uso de diferentes estilos para lidar efetivamente com a doença.

This paper studies psychological aspects involved in the adherence process to the physiotherapeutic treatment after abdominal surgeries in six patients, in a hospital ofSão Paulo city. During the three months of the clinical-qualitative investigation, the patients were submitted to consultation within the hospitalization period and trained in doing home exercises. A routine of physiotherapy training was used during the hospitalization period; a clinical interview based on the health conviction model was used by the occasion of outpatient consulting. The content analysis of interviews was based on the model of “human motivation factors”. The emotion “fear of dying”, common to patient’s disease, was a motivating factor to compliance, responsible to two adherent patients taken away from dangerous situations and therefore more committed to their treatment. Emotion was also responsible for the non-compliance – a threatening condition that prevents the patients to cope with her disease. It is observed that in non-adherence situation there were many difficulties concerning susceptibility to health condition, to stay in contact with the disease, and considering subjective experience of physical and emotional chance. It was concluded that some psychological aspects may be soften by therapist facilitating as a compliance tool, and aiding patients in diminishing anxiety and increasing his best coping styles.

Motivation et comportment d’attachement relationnés avec l’adhésion au traitement physio-thérapeutiqueRésuméOn a étudié des variables psychologiques dans l’adhésion au traitement physio thérapeutique postopératoire de chirurgies abdominales dans six patients d’un hôpital de São Paulo. Pendant les trois mois de recherche clinique et qualitative, les patients ont été reçus en interne et entraînés à des exercices à domicile. On a utilisé une routine d’entraînement en physiothérapie en internement et un en retour ambulatoire d’entrevues cliniques. Dans l’analyse du contenu les variables ont été expliquées par le modèle de ® facteurs de motivation humaine ¼. L’émotion peur - de la maladie et de la mort - a été facteur mobilisateur pour l’adhésion ; mais elle a été aussi l’émotion responsable de l’interruption, la non-adhésion de patients, dans la mesure où la condition menaçante leur empêchait la confrontation. On observe, dans la non-adhésion, des difficultés quant à la susceptibilité - dans le contact avec la maladie- dues aux expériences subjectives de changements physiques et émotionnels, aspects qui peuvent être adoucis par la capacité du thérapeute à fonctionner comme un instrument dans l’adhésion, en facilitant la diminution de l’angoisse et élevant la capacité de confrontation du patient.