Coronavirus disease 2019 (COVID-19) in Brasil: information to physical therapists

SUMMARY The emergence of the Coronavirus Disease 2019 (COVID-19) pandemic shows a rapid increase in cases and deaths. The World Health Organization (WHO) has shown that more than 200.000 confirmed cases have been identified in more than 166 countries/territories. Public health authorities in Brasil have reported 532 confirmed cases by March 19. Approximately 5% of the patients will require intensive care unit treatment with oxygen therapy and mechanical ventilation. Limited data are available about rehabilitation protocols for severe illness and intensive care treatment of COVID-19 increase. Thus, we aim to show current information about COVID-19, describing symptoms and the respiratory management for critical patients and preventive care. Physical therapists and all health care professionals need to recognize the challenges they will face in the coming months.

RESUMO O surgimento da pandemia do Coronavírus 2019 (COVID-19) tem demonstrado rápido aumento dos casos e das mortes. A Organização Mundial da Saúde (OMS) apontou que mais de 200.000 casos confirmados foram identificados em mais de 166 países/territórios. As autoridades de saúde pública no Brasil relataram 532 casos confirmados até 19 de março. Aproximadamente 5% dos pacientes necessitarão de tratamento em unidade de terapia intensiva com oxigenoterapia e ventilação mecânica. Temos disponíveis dados limitados sobre protocolos de reabilitação para doenças graves e tratamento em unidade de terapia intensiva de pacientes com COVID-19. Assim, nosso objetivo é mostrar informações atuais sobre o COVID-19, descrevendo sintomas e controle respiratório de pacientes críticos e cuidados preventivos. Fisioterapeutas e todos os profissionais de saúde precisam reconhecer os desafios que enfrentaremos nos próximos meses.

Caracterização das intervenções de Fisioterapia em Unidade de Terapia Intensiva adulto: uma proposta de classificação / Characterization of physiotherapy interventions in an adult intensive care unit: a classification proposal

O planejamento de recursos humanos se constitui em uma função estratégica e um processo contínuo e interativo no contexto do gerenciamento das instituições de saúde. Na área da Fisioterapia, estudos orientadores para composição do quadro de trabalhadores são escassos e as publicações dos dispositivos legais evidenciam que os mesmos estão apoiados no julgamento de profissionais, com base em suas experiências e intuições. Para um dimensionamento adequado de fisioterapeutas, particularmente no âmbito da terapia intensiva, faz-se necessária uma revisão de processo de trabalho, para a identificação das atividades específicas desses profissionais. Esta pesquisa teve como objetivo identificar as intervenções/atividades do fisioterapeuta em unidades de tratamento intensivo, como variável do dimensionamento de trabalhadores de Fisioterapia. O método utilizado foi descritivo, exploratório, com abordagem quantitativa. As atividades de Fisioterapia foram levantadas por meio de revisão bibliográfica realizada sem limite para ano de publicação. O resultado identificou 69 atividades consideradas específicas do fisioterapeuta, que foram classificadas por meio da técnica de mapeamento cruzado, em linguagem padronizada proposta pela Classificação das Intervenções de Enfermagem - Nursing Intervention Classification (NIC). As atividades foram mapeadas e resultaram em 4 domínios, 13 classes, 52 intervenções e 458 atividades segundo a NIC, concentradas nos Domínios Fisiológico Básico (46,1%), Fisiológico Complexo (44,2%), Segurança (5,8%) e Sistema de Saúde (3,9%). As atividades que englobaram o domínio Fisiológico Básico, compuseram quatro classes, com destaque para Classe A (controle de atividade e do exercício) que compreendeu 9 intervenções, seguida da Classe E (promoção do conforto físico) com 8 intervenções. As atividades encontradas no Domínio Fisiológico Complexo foram identificadas em cinco classes, com predomínio da classe K, que abrange o controle respiratório e contemplou 13 intervenções (56,5%) e a classe G, controle eletrolítico e acidobásico, com 6 intervenções (26,1%). Do total das atividades elencadas, 47,8%, estão contidas em apenas duas classes, sendo elas A e K, representando as duas grandes áreas de atuação desses profissionais, a Fisioterapia motora e a Fisioterapia respiratória respectivamente. O conjunto de intervenções/atividades identificados permitiu a construção de um instrumento contendo 51 intervenções e 172 atividades identificadas como aquelas com maior representatividade do cotidiano do trabalho do fisioterapeuta no ambiente da UTI. Tal ferramenta representa uma possibilidade concreta de se estudar com profundidade o processo de trabalho do fisioterapeuta nas unidades críticas, com objetivo de resguardar sua prática profissional e direcionando para uma perspectiva de estudos futuros sobre dimensionamento de quadro dessa categoria profissional

Human resource planning is a strategic function and a continuous and interactive process in the context of the management of health institutions. In the area of Physiotherapy, guidelines for the composition of the workers staff are scarce, and the publications of legal devices show that they are based on the judgment of professionals, based on their experiences and intuitions. For an adequate design of physiotherapists, particularly in the context of intensive care, it is necessary to review the work process to identify the specific activities of these professionals. The aim of this research was to identify the interventions/activities of the physiotherapist in intensive care units as a variable for the design of physiotherapy workers. The method used was descriptive, exploratory, with a quantitative approach. The physiotherapy activities were performed through a bibliographic review carried out without limit for the year of publication. The result identified 69 activities considered specific to the physiotherapist, which were classified using the cross-mapping technique, in a standardized language proposed by the Nursing Intervention Classification (NIC). The activities were mapped and resulted in 4 domains, 13 classes, 52 interventions and 458 activities, according to NIC, concentrated in the areas Basic Physiological (46.1%), Complex Physiological (44.2%), Safety (5.8%) and Health System (3.9%). The activities encompassing Basic Physiological domains comprised four classes, with emphasis on class A (activity and exercise control), which comprised 9 interventions, followed by class E (promotion of physical comfort), with 8 interventions. The activities found in the Complex Physiological domain were identified in five classes, with predominance of class K, which encompasses respiratory control and contemplated 13 interventions (56.5%), and class G, regarding electrolytic and acid-base control, with 6 interventions (26.1%). Of the total activities listed, 47.8% are contained in only two classes, A and K, representing the two major areas of activity of these professionals: motor physiotherapy and respiratory physiotherapy, respectively. The set of interventions/activities identified allowed the construction of an instrument containing 51 interventions and 172 activities identified as those with greater representation of the daily work of the physiotherapist in the ICU environment. Such tool represents a concrete possibility to study in depth the work process of the physical therapist in the critical units, with the purpose of safeguarding their professional practice and directing to a perspective of future studies on the dimensioning of the professional category

Evidence-Based Practice: a survey regarding behavior, knowledge, skills, resources, opinions and perceived barriers of Brazilian physical therapists from São Paulo state

BACKGROUND: Evidence-Based Practice (EBP) has been widely used by health professionals. However, no study in Brazil has investigated the data regarding the knowledge and difficulties related to EBP from a representative sample of physical therapists.OBJECTIVE: To identify behavior, knowledge, skills, resources, opinions and perceived barriers of Brazilian physical therapists from the state of São Paulo regarding EBP.METHOD: A customized questionnaire about behavior, knowledge, skills, resources, opinions and perceived barriers regarding EBP was sent by email to a sample of 490 physical therapists registered by the Registration Board of São Paulo, Brazil. Physical therapists who did not respond to the questionnaire were contacted by telephone and/or letter. The data were analyzed descriptively.RESULTS: The final response rate was 64.4% (316/490). Because 60 physical therapists were no longer practicing, 256 answers were analyzed. The physical therapists reported that they routinely read scientific papers (89.5%) as a resource for professional development, followed by continuing education courses (88.3%) and books (86.3%). Approximately 35% of the respondents reported a clear understanding of the implementation of research findings in their practice; approximately 37% reported no difficulties in critically appraising scientific papers; and 67.2% strongly agreed that EBP is important for their practice. The most commonly reported barriers were related to difficulties in obtaining full-text papers (80.1%), using EBP may represent higher cost (80.1%) and the language of publication of the papers (70.3%).CONCLUSION: Physical therapists from São Paulo state believe that they have knowledge and skills to use EBP. Although they have favorable opinions regarding its implementation, they still encounter difficulties in implementing EBP successfully.

Evidence-based practice: beliefs, attitudes, knowledge, and skills among Colombian physical therapists / Práctica basada en la evidencia: creencias, actitudes, conocimientos y habilidades entre fisioterapeutas colombianos

Objective: The main purpose of this study was to describe a group of Colombian physical therapists' beliefs and attitudes towards Evidence-Based Practice (EBP), their education, knowledge and skills for implementing EBP, the use of relevant literature in clinical practice, access to and availability of scientific information and perceived barriers to including EBP in practice. Methods: This was a cross-sectional study which involved 1,064 Colombian physical therapists. The study used a 50-item screening questionnaire EBP developed to estimate attitudes, beliefs, knowledge and skills regarding. This instrument has been adapted and was validated previously in Colombia by Flórez-López et al. Results: The population mostly consisted of young females (77.2%) aged 22 to 29 years old (79.4%). Most respondents had an undergraduate degree (87.7%). The physical therapists stated that they had positive attitudes and beliefs regarding EBP, most of them answering that they agreed or strongly agreed that EBP is necessary (71.6%), the relevant literature is useful for practice (61.3%), EBP improves the quality of patient care (64.1%) and evidence helps in decision-making (44.5%). Forty-one percent of the respondents indicated that a lack of research skills was the most important barrier to the use of evidence in practice. Conclusion: The physical therapists reported that they had a positive attitude to EBP and were interested in learning about or improving the skills necessary to adopt EBP in their clinical practice.

Objetivo: Describir en un grupo colombiano de fisioterapeutas las i) creencias y actitudes hacia la practica basada en la evidencia (PBE), ii) la educación, el conocimiento y las habilidades para implementar la PBE; iii) el uso de la literatura relevante en la práctica clínica; iv) el acceso y la disponibilidad de información científica; y v) la percepción de las barreras para la inclusión de la PBE. Métodos: Se realizó un estudio transversal en 1,064 fisioterapeutas colombianos. El estudio usó el cuestionario que consta de 50-ítems para estimar las actitudes, creencias, conocimientos y habilidades hacia la PBE. Dicho instrumento fue adaptado y validado en Colombia por Flórez-López et al. Resultados: La mayoría de la población participante fueron mujeres (77.2%) en edades comprendidas entre 22 y 29 años (79.4%). El 87.7% de los encuestados eran titulados en fisioterapia. Los fisioterapeutas manifestaron tener actitudes y creencias positivas hacia la PBE. Una mayoría respondió que estaba de acuerdo o muy de acuerdo en que es necesaria la PBE (71.6%), en que la literatura es útil para la práctica clínica (61.3%), que la PBE mejora la calidad de la atención a los pacientes (64.1%), y en que la evidencia ayuda en la toma de decisiones clínicas (44.5%). El 41.0% de los encuestados indicaron que la falta de habilidades de investigación era la barrera más importante para el uso de la evidencia científica en la práctica clínica. Conclusiones: Los fisioterapeutas manifestaron una actitud positiva acerca la PBE y estaban interesados en aprender o mejorar las habilidades necesarias para adoptar la PBE en la práctica clínica.

Validity and reliability of the clinical competency evaluation instrument for use among physiotherapy students pilot study

The aim of this study was to determine the content validity, internal consistency, test retest reliability and inter-rater reliability of the Clinical Competency Evaluation Instrument [CCEVI] in assessing the clinical performance of physiotherapy students. This study was carried out between June and September 2013 at University Kebangsaan Malaysia [UKM], Kuala Lumpur, Malaysia. A panel of 10 experts were identified to establish content validity by evaluating and rating each of the items used in the CCEVI with regards to their relevance in measuring students' clinical competency. A total of 50 UKM undergraduate physiotherapy students were assessed throughout their clinical placement to determine the construct validity of these items. The instrument's reliability was determined through a cross-sectional study involving a clinical performance assessment of 14 final-year undergraduate physiotherapy students. The content validity index of the entire CCEVI was 0.91, while the proportion of agreement on the content validity indices ranged from 0.83-1.00. The CCEVI construct validity was established with factor loading of >/=0.6, while internal consistency [Cronbach's alpha] overall was 0.97. Test-retest reliability of the CCEVI was confirmed with a Pearson's correlation range of 0.91-0.97 and an intraclass coefficient correlation range of 0.95-0.98. Inter-rater reliability of the CCEVI domains ranged from 0.59 to 0.97 on initial and subsequent assessments. This pilot study confirmed the content validity of the CCEVI. It showed high internal consistency, thereby providing evidence that the CCEVI has moderate to excellent inter-rater reliability. However, additional refinement in the wording of the CCEVI items, particularly in the domains of safety and documentation, is recommended to further improve the validity and reliability of the instrument

Fisioterapia e núcleo de apoio à saúde da família: conhecimento, ferramentas e desafios / Physiotherapy and support center for family health: knowledge, tools and challenges

Este artigo teve como objetivo entender os desafios da práxis do fisioterapeuta no Núcleo de Apoio à Saúde da Família(NASF). Apresenta uma abordagem qualitativa numa perspectiva histórico-social. Foram entrevistados 14 indivíduos por meio de entrevista semiestruturada. Os entrevistados foram divididos em três grupos: o grupo I foi composto por Gestores,grupo II por Profissionais de Saúde e grupo III por Usuários. A análise dos dados foi realizada a partir da análise de conteúdo. Assim, foram construídas três categorias, sendo denominadas de tratamento fisioterapêutico e o cuidador,conhecimento e NASF e acesso e trabalho em equipe. O fisioterapeuta, quando inserido no Núcleo de Apoio à Saúde da Família, precisa enfrentar os problemas que aportam ao serviço de saúde, deve promover educação permanente em saúde em seu processo de trabalho juntamente com os usuários e a equipe do programa saúde da família. Há porém, uma escassez de recursos no NASF, assim como a dificuldade de acesso e formação de vínculo entre profissionais e usuários, o que dificulta a produção de um cuidado integral com uma ação compartilhada com a equipe do NASF e da saúde da família.Dessa forma, deve-se fazer uma reflexão sobre a formação desse profissional para atender às necessidades da população.

This article aims to understand the Challenges to the practice of physiotherapist in NASF. It presents a qualitative approachin a historical-social perspective. Were interviewed 14 individuals, using a semi-structured interview. Respondents weredivided into three groups: group I was composed by managers, group II by Health Professionals and group III by users.Data analysis was performed based on content analysis. Thus, we constructed three categories, namely physical therapyand caregiver, knowledge and access and NASF and teamwork. Physiotherapist inserted into the Support Center for Family Health must face the problems that contribute to the health service, in their work process, must promote continuing health education along with users and staff of the family health strategy, but there is a shortage of resources in NASF, as there is a difficult access and formation bonds between professionals and users, which hinders the producing an integral care witha shared action with the team NASF and family health. Thus it should be a reflection on the formation of this professional to meet the needs of the population.