Factors associated with access to physical rehabilitation for victims of traffic accidents.

OBJECTIVE: Evaluate the level of access to physical rehabilitation for survivors of traffic accidents and the associated factors. METHODS: A cross-sectional study performed in Natal, Northeastern Brazil, through a telephone survey of 155 victims of traffic accidents admitted to an emergency hospital between January and August of 2013, with a diagnosis of fracture, traumatic brain injury or amputation. Participants were identified in the database of the reference hospital for care of traffic accident victims. We calculated point estimates and confidence interval (95%CI) for the frequency of subjects who had access, in addition to multivariate analysis (logistic regression) between access (dependent variable) and sociodemographic, clinical, and assistance variables. RESULTS: Among the 155 respondents, the majority were adolescents and adults between 15-29 years of age (47.7%), men (82.6%), education up to high school (92.3%), income of up to two minimum wages (78.0%) and bikers (75.5%). Although 85.8% of traffic accident survivors reported the need for physical rehabilitation, there was little access (51.6%; 95%CI 43.7-59.4) and a delay to start the physical rehabilitation (average = 67 days). We classified factors associated with access to physical rehabilitation as: (i) unmodifiable individuals in the short term - family income greater than two minimum wages (OR = 3.7), informal worker (OR = 0.11) or unemployed (OR = 0.15) and possession of a private health care plan (OR = 0.07); and (ii) assistance modifiable by service management - written referral for physical rehabilitation (OR = 27.5) and perceived need of physical rehabilitation (OR = 10). CONCLUSIONS: This study found a low and slow access to physical rehabilitation for individuals potentially in need. The associated factors were the organizational processes of health care (health information and referral) and social determinants (income, occupation and private health care plan). OBJETIVO: Avaliar o nível de acesso à reabilitação física para sobreviventes de acidentes de trânsito e seus fatores associados. MÉTODOS: Estudo transversal realizado em Natal, Nordeste do Brasil, com inquérito telefônico a 155 vítimas de acidentes de trânsito atendidos no hospital de emergência, entre janeiro e agosto de 2013, com diagnóstico de fratura, traumatismo cranioencefálico ou amputação. Os participantes foram identificados no banco de dados do hospital referência para atendimentos de acidentes de trânsito. Calculou-se a estimativa pontual e o intervalo de confiança (IC95%) da porcentagem de acesso e tempo para acesso, além de análise multivariada (regressão logística) entre o acesso (variável dependente) e as variáveis sociodemográficas, clínicas e assistenciais. RESULTADOS: Entre os 155 entrevistados, predominaram jovens e adultos de 15-29 anos (47,7%), sexo masculino (82,6%), escolaridade até o ensino médio (92,3%), renda de até dois salários mínimos (78,0%) e motociclistas (75,5%). Embora 85,8% dos sobreviventes de acidentes de trânsito tivessem relatado a necessidade de reabilitação física, houve baixo acesso geral (51,6%; IC95% 43,7-59,4) e demora para início da reabilitação física (média = 67 dias). Os fatores associados ao acesso à reabilitação física classificaram-se em: (i) individuais não modificáveis em curto prazo - renda familiar maior que dois salários mínimos (OR = 3,7), ser trabalhador informal (OR = 0,11) ou desempregado (OR = 0,15) e ter plano privado de saúde (OR = 0,07); e (ii) assistenciais modificáveis pela gestão do serviço - encaminhamento escrito para reabilitação física (OR = 27,5) e necessidade percebida de reabilitação física (OR = 10). CONCLUSÕES: Este estudo encontrou um baixo e demorado acesso à reabilitação física para indivíduos potencialmente necessitados. Os fatores associados foram os processos organizativos dos cuidados em saúde (encaminhamento e informação em saúde) e os determinantes sociais (renda, ocupação e plano privado de saúde).

A qualitative study analyzing access to physical rehabilitation for traffic accident victims with severe disability in Brazil.

Purpose To identify access barriers to physical rehabilitation for traffic accident (TA) victims with severe disability and build a theoretical model to provide guidance towards the improvement of these services. Methods Qualitative research carried out in the city of Natal (Northeast Brazil), with semi-structured interviews with 120 subjects (19 key informer health professionals and 101 TA victims) identified in a database made available by the emergency hospital. The interviews were analyzed using Alceste software, version 4.9. Results The main barriers present in the interviews were: (1) related to services: bureaucratic administrative practises, low offer of rehabilitation services, insufficient information on rehabilitation, lack of guidelines that integrate hospital and ambulatory care and (2) related to patients: financial difficulties, functional limitations, geographic distance, little information on health, association with low education levels and disbelief in the system and in rehabilitation. Conclusion The numerous access barriers were presented in a theoretical model with causes related to organizational structure, processes of care, professionals and patients. This model must be tested by health policy-makers and managers to improve the quality of physical rehabilitation and avoid unnecessary prolongation of the suffering and disability experienced by TA survivors. Implications for rehabilitation Traffic accidents (TAs) are a global health dilemma that demands integrality of preventive actions, pre-hospital and hospital care and physical rehabilitation (PR). This study lays the foundation for improving access to PR for TA survivors, an issue of quality of care that results in preventable disabilities. The words of the patients interviewed reveal the suffering of victims, which is often invisible to society and given low priority by health policies that relegate PR to a second plan ahead of prevention and urgent care. A theoretical model of the causes of the problem of access to PR was built. The identified barriers are potentially preventable through the intervention of health policy-makers, managers, regulators and rehabilitation professionals, and by encouraging the participation of patients. Addressing timely access barriers involves the expansion of the supply of services and rehabilitation professionals, regulation and standardization of referencing practises and encouraging the provision of information to patients about continuity of care and their health needs.

Factors associated with access to physical rehabilitation for victims of traffic accidents / Fatores associados ao acesso à reabilitação física para vítimas de acidentes de trânsito

ABSTRACT OBJECTIVE Evaluate the level of access to physical rehabilitation for survivors of traffic accidents and the associated factors. METHODS A cross-sectional study performed in Natal, Northeastern Brazil, through a telephone survey of 155 victims of traffic accidents admitted to an emergency hospital between January and August of 2013, with a diagnosis of fracture, traumatic brain injury or amputation. Participants were identified in the database of the reference hospital for care of traffic accident victims. We calculated point estimates and confidence interval (95%CI) for the frequency of subjects who had access, in addition to multivariate analysis (logistic regression) between access (dependent variable) and sociodemographic, clinical, and assistance variables. RESULTS Among the 155 respondents, the majority were adolescents and adults between 15–29 years of age (47.7%), men (82.6%), education up to high school (92.3%), income of up to two minimum wages (78.0%) and bikers (75.5%). Although 85.8% of traffic accident survivors reported the need for physical rehabilitation, there was little access (51.6%; 95%CI 43.7–59.4) and a delay to start the physical rehabilitation (average = 67 days). We classified factors associated with access to physical rehabilitation as: (i) unmodifiable individuals in the short term – family income greater than two minimum wages (OR = 3.7), informal worker (OR = 0.11) or unemployed (OR = 0.15) and possession of a private health care plan (OR = 0.07); and (ii) assistance modifiable by service management – written referral for physical rehabilitation (OR = 27.5) and perceived need of physical rehabilitation (OR = 10). CONCLUSIONS This study found a low and slow access to physical rehabilitation for individuals potentially in need. The associated factors were the organizational processes of health care (health information and referral) and social determinants (income, occupation and private health care plan).

RESUMO OBJETIVO Avaliar o nível de acesso à reabilitação física para sobreviventes de acidentes de trânsito e seus fatores associados. MÉTODOS Estudo transversal realizado em Natal, Nordeste do Brasil, com inquérito telefônico a 155 vítimas de acidentes de trânsito atendidos no hospital de emergência, entre janeiro e agosto de 2013, com diagnóstico de fratura, traumatismo cranioencefálico ou amputação. Os participantes foram identificados no banco de dados do hospital referência para atendimentos de acidentes de trânsito. Calculou-se a estimativa pontual e o intervalo de confiança (IC95%) da porcentagem de acesso e tempo para acesso, além de análise multivariada (regressão logística) entre o acesso (variável dependente) e as variáveis sociodemográficas, clínicas e assistenciais. RESULTADOS Entre os 155 entrevistados, predominaram jovens e adultos de 15–29 anos (47,7%), sexo masculino (82,6%), escolaridade até o ensino médio (92,3%), renda de até dois salários mínimos (78,0%) e motociclistas (75,5%). Embora 85,8% dos sobreviventes de acidentes de trânsito tivessem relatado a necessidade de reabilitação física, houve baixo acesso geral (51,6%; IC95% 43,7–59,4) e demora para início da reabilitação física (média = 67 dias). Os fatores associados ao acesso à reabilitação física classificaram-se em: (i) individuais não modificáveis em curto prazo – renda familiar maior que dois salários mínimos (OR = 3,7), ser trabalhador informal (OR = 0,11) ou desempregado (OR = 0,15) e ter plano privado de saúde (OR = 0,07); e (ii) assistenciais modificáveis pela gestão do serviço – encaminhamento escrito para reabilitação física (OR = 27,5) e necessidade percebida de reabilitação física (OR = 10). CONCLUSÕES Este estudo encontrou um baixo e demorado acesso à reabilitação física para indivíduos potencialmente necessitados. Os fatores associados foram os processos organizativos dos cuidados em saúde (encaminhamento e informação em saúde) e os determinantes sociais (renda, ocupação e plano privado de saúde).

Percepção subjetiva do esforço, resposta afetiva e hipotensão pós-exercício em sessão de Tai Chi Chuan / Rating of perceived exertion, affective response and post-exercise hypotension in Tai Chi Chuan session

O objetivo do estudo foi analisar a percepção subjetiva do esforço (PSE), resposta afetiva (RA) e pressão arterial pós-exercício em sessão aguda de Tai Chi Chuan (TCC). Vinte e quatro mulheres (47-79 anos; 9 normotensas e 15 hipertensas) foram submetidas a uma sessão de TCC e uma sessão controle (delineamento cruzado). A PSE foi avaliada pela escala de Borg (CR10), a RA pela escala de valência afetiva (+5/-5) e a pressão arterial (PA) pelo método oscilométrico (5, 10, 25, 20, 25 e 30 min pós-sessão). Redução significante da PA sistólica foi identificada aos 20 e 25 min após a sessão de TCC somente nas hipertensas. Os valores de RA e PSE foram +2,8 ± 1,9 e 3,5 ± 1,2, respectivamente. Os resultados sugerem que uma sessão de TCC de intensidade moderada foi prazerosa para as voluntárias (hipertensas e normotensas), embora tenha induzido discreto efeito hipotensor agudo na PA sistólica somente das hipertensas.

The aim of the study was to analyze the rating of perceived exertion (RPE), affective response (AR), and blood pressure (BP) post-exercise in acute Tai Chi Chuan (TCC) session. Twenty-four women (47-79 years; 9 normotensive and 15 hypertensive) performed one TCC and one control session (cross-over design). The RPE was assessed using the Borg's scale (CR10), the AR was assessed by the Feeling Scale (+5/-5) and the BP by the oscillometric method (5, 10, 15, 20, 25, and 30min post-TCC session). A significant systolic BP reduction was observed in the 20 and 25min post-TCC session only in the hypertensive women. The AR and RPE values were +2.8 ± 1.9 e 3.5 ± 1.2, respectively. The results suggest that a moderate TCC exercise bout was pleasurable for the volunteers (normotensive and hypertensive), although it has induced a slight acute hypotensive effect on the systolic BP only in the hypertensive women.

Efeito da prática do Tai Chi Chuan sobre a resistência aeróbia de idosas sedentárias / Effect of Tai Chi Chuan practice on aerobic resistance of sedentary elderly women

OBJETIVO: Investigar o efeito da prática do Tai Chi Chuan (TCC) sobre a resistência aeróbia de idosas sedentárias. Métodos: Fizeram parte do estudo 11 idosas sedentárias (67,9 ± 6,8 anos; 25,9 ± 2,8 kg/m²), as quais foram submetidas aos testes de marcha estacionária de dois minutos e teste de caminhada de seis minutos pré e pós-intervenção de 12 semanas de TCC. RESULTADOS: Houve aumento da resistência aeróbia das idosas analisadas após 12 semanas de prática de TCC, demonstrado tanto por meio do teste de caminhada de seis minutos (510 ± 64 vs. 536 ± 63 metros; p = 0,006) quanto no teste de marcha estacionária de dois minutos (83 ± 20 vs. 110 ± 19 execuções; p = 0,001). CONCLUSÃO: De acordo com os resultados obtidos, é possível concluir que a prática do TCC é capaz de promover aumento da resistência aeróbia de idosas sedentárias.

OBJECTIVE: To investigate the effect of Tai Chi Chuan(TCC) practice on cardiorespiratory fitness of sedentary elderly women. Methods:A total of 11 sedentary elderly women (67.9 ± 6.8 years; 25.9 ± 2.8 kg·m-2)were submitted to six-minute walk test and two-minute step testbefore and after a 12-week TCC training program. RESULTS: Improvements were observed on cardiorespiratory fitness of elderly women analyzed after a 12-week TCC training program, through six-minute walk test (510 ± 64 vs. 536 ± 63 meters; p= 0.006)and two-minute step test(83 ± 20 vs. 110 ± 19 executions; p= 0.001). CONCLUSION: According with obtained results, itis possible to conclude that the TCC practice may promote an increase in cardiorespiratory fitness in sedentary elderly women.