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Barreiras e Facilitadores para a Promoção de Atividade Física em pessoas com Osteoartrose: um estudo qualitativo com Fisioterapeutas Portugueses
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Advisor(s)
Abstract(s)
Introdução: A evidência atual sugere que intervenções focadas no exercício físico e/ou
promoção de atividade física regular podem reduzir a dor, melhorar a funcionalidade e a
qualidade de vida das pessoas com Osteoartrose (OA), se continuadas no tempo. Apesar
destas intervenções serem amplamente recomendadas, existe uma baixa adesão das pessoas
com OA ao exercício físico ou aos níveis recomendados de atividade física, fora do contexto
clínico. Adicionalmente, a literatura sugere uma ineficaz promoção de atividade física em
vários países, incluindo Portugal. Desta forma, torna-se essencial estudar o comportamento
dos principais envolvidos, tais como os fisioterapeutas. Assim, este estudo teve como
objetivo identificar e explorar e as barreiras e facilitadores dos fisioterapeutas para a
promoção de atividade física no quotidiano das pessoas com OA, fora do contexto clínico.
Metodologia: Este foi um estudo qualitativo com abordagem descritiva. Foram realizados 4
grupos focais, com um total de 20 fisioterapeutas portugueses, com base num guião de
entrevista semiestruturado e informado pelo modelo Capacidade, Oportunidade, Motivação
– Comportamento (COM-B) e pelo Theoretical Domains Framework (TDF). Os grupos
focais foram realizados através de videoconferência, gravados em formato áudio e vídeo,
sendo posteriormente transcritos verbatim. Foi realizada uma análise de conteúdo dedutiva
informada pelo COM-B e TDF. Esta análise foi inicialmente realizada de forma
independente pela investigadora principal. Posteriormente, outros dois membros da equipa
de investigação reviram toda a codificação e discutiram potenciais alterações relativamente
aos códigos, subtemas e domínios identificados.
Resultados: A análise revelou a existência de 14 barreiras (5 componentes COM-B; 8
domínios TDF) e 25 facilitadores (5 componentes COM-B; 14 domínios TDF) à
recomendação para a adesão à prática de atividade física fora do contexto clínico, como
componente da promoção da atividade física. Foram identificadas barreiras como a falta de
confiança nos serviços de atividade física na comunidade, a resistência de outros
profissionais de saúde à promoção de atividade física, as crenças e comportamentos das
pessoas com OA sobre a adequabilidade da atividade física e a organização atual dos
cuidados de saúde. Como facilitadores, destacou-se o conhecimento sobre estratégias de
promoção de atividade física, a promoção regular de atividade física fora do contexto clínico,
a adaptação de estratégias de promoção de atividade física às pessoas com OA, o apoio da
equipa multidisciplinar, a existência de serviços da comunidade e condições para a prática
de atividade física e recursos para a promoção de atividade física.
Conclusões: Através deste estudo foi possível identificar e explorar, a nível dos
fisioterapeutas, barreiras e facilitadores para a promoção de atividade física no quotidiano
das pessoas com OA. Estes resultados poderão vir a informar o desenvolvimento de
intervenções que promovam a integração da promoção de atividade física nos serviços da
comunidade. Assim, poderá ter um elevado impacto a nível das pessoas com OA e
socioeconómico, potenciando uma série de outcomes de saúde, participação social e o
consumo desnecessário de cuidados de saúde.
Introduction: Current evidence suggests that interventions focused on physical exercise and/or promoting regular physical activity can reduce pain, improve function and quality of life of people with Osteoarthritis (OA), if continued over time. Although these interventions are widely recommended, there seems to be a low adherence among people with OA to physical exercise or recommended levels of physical activity, outside the clinical context. Additionally, the literature suggests an ineffective promotion of physical activity in several countries, including Portugal. Therefore, it is essential to study the behavior of the main stakeholders, such as physiotherapists. Therefore, this study aimed to identify and explore physiotherapists’ barriers and facilitators to the promotion of physical activity in the daily lives of people with OA, outside the clinical context. Methodology: This was a qualitative study with a descriptive approach. Four focus groups were conducted, with a total of 20 portuguese physiotherapists, based on a semi-structured interview guide informed by the Capability, Opportunity, Motivation – Behavior (COM-B) model and the Theoretical Domains Framework (TDF). The focus groups were carried out via videoconference, recorded in audio and video format, and later transcribed verbatim. A deductive content analysis informed by COM-B and TDF was performed. This analysis was carried out independently by the main researcher. Subsequently, two other members of the research team reviewed the entire coding and discussed potential changes regarding the codes, subthemes, and domains identified. Results: The analysis revealed the existence of 14 barriers (5 COM-B components; 8 TDF domains) and 25 facilitators (5 COM-B components; 14 TDF domains) to the recommendation for adherence to physical activity practice outside the clinical context, as a component of physical activity promotion. Barriers, such as a lack of trust in physical activity services in the community, resistance from other health professionals to promoting physical activity, the beliefs and behaviors of people with OA about the suitability of physical activity and the current organization of health care, were identified. On the other hand, some of the main identified facilitators were knowledge about strategies to promote physical activity, the regular promotion of physical activity outside the clinical context, the adaptation of strategies to promote physical activity for people with OA, the support of the multidisciplinary team, the existence of community services and conditions for practicing physical activity and resources for promoting physical activity. Conclusions: Through this study, it was possible to identify and explore, at the physiotherapist level, barriers and facilitators for promoting physical activity in the daily lives of people with OA. These findings may inform the development of interventions that promote the integration of physical activity promotion within community services. Thus, it could have a significant impact on individuals with OA and socioeconomic outcomes, enhancing a range of health outcomes, social participation, and the reduction of unnecessary healthcare consumption
Introduction: Current evidence suggests that interventions focused on physical exercise and/or promoting regular physical activity can reduce pain, improve function and quality of life of people with Osteoarthritis (OA), if continued over time. Although these interventions are widely recommended, there seems to be a low adherence among people with OA to physical exercise or recommended levels of physical activity, outside the clinical context. Additionally, the literature suggests an ineffective promotion of physical activity in several countries, including Portugal. Therefore, it is essential to study the behavior of the main stakeholders, such as physiotherapists. Therefore, this study aimed to identify and explore physiotherapists’ barriers and facilitators to the promotion of physical activity in the daily lives of people with OA, outside the clinical context. Methodology: This was a qualitative study with a descriptive approach. Four focus groups were conducted, with a total of 20 portuguese physiotherapists, based on a semi-structured interview guide informed by the Capability, Opportunity, Motivation – Behavior (COM-B) model and the Theoretical Domains Framework (TDF). The focus groups were carried out via videoconference, recorded in audio and video format, and later transcribed verbatim. A deductive content analysis informed by COM-B and TDF was performed. This analysis was carried out independently by the main researcher. Subsequently, two other members of the research team reviewed the entire coding and discussed potential changes regarding the codes, subthemes, and domains identified. Results: The analysis revealed the existence of 14 barriers (5 COM-B components; 8 TDF domains) and 25 facilitators (5 COM-B components; 14 TDF domains) to the recommendation for adherence to physical activity practice outside the clinical context, as a component of physical activity promotion. Barriers, such as a lack of trust in physical activity services in the community, resistance from other health professionals to promoting physical activity, the beliefs and behaviors of people with OA about the suitability of physical activity and the current organization of health care, were identified. On the other hand, some of the main identified facilitators were knowledge about strategies to promote physical activity, the regular promotion of physical activity outside the clinical context, the adaptation of strategies to promote physical activity for people with OA, the support of the multidisciplinary team, the existence of community services and conditions for practicing physical activity and resources for promoting physical activity. Conclusions: Through this study, it was possible to identify and explore, at the physiotherapist level, barriers and facilitators for promoting physical activity in the daily lives of people with OA. These findings may inform the development of interventions that promote the integration of physical activity promotion within community services. Thus, it could have a significant impact on individuals with OA and socioeconomic outcomes, enhancing a range of health outcomes, social participation, and the reduction of unnecessary healthcare consumption
Description
Keywords
Osteoartrose Atividade física Fisioterapia Comunidade Investigação qualitativa Osteoarthritis Physical activity Physiotherapy Community Qualitative research