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Ganhos Funcionais dos Clientes Alvo de Cuidados de Reabilitação na RAM: Um Estudo de Caracterização
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Abstract(s)
Enquadramento: Outcomes advindos da reabilitação são usados como indicadores da qualidade dos cuidados. É limitada a evidência sobre outcomes decorrentes dos cuidados de reabilitação (CR) e que avalie sua efetividade ou eficiência.
Objetivos: Caracterizar nível de dependência funcional dos clientes alvo de CR e avaliar ganhos funcionais e a eficácia e eficiência dos Programas de Reabilitação (PR) na RAM. Analisar relação entre a idade e os ganhos funcionais entre dois momentos distintos de avaliação.
Metodologia: Estudo observacional retrospetivo, descritivo e correlacional. Mensuração das variáveis com recurso ao Índice de Barthel (IB), aplicado em dois momentos díspares (IBm1 e IBm2) (n=207) e ao cálculo de três índices de impacto da reabilitação (AFG, RFG e REI) na amostra com ≥ sete sessões de reabilitação (n=160).
Resultados: 44% dos utentes encontravam-se em contexto de Cuidados de Saúde Primários (CSP), 24,2% Cuidados Hospitalares (CH), 16,4% Unidade de Internamento de Longa Duração (UILD) e 15,5% RRCCI. CSP registou menor nível de dependência funcional no IBm1. No IBm2, a RRCCI foi contexto com evolução funcional mais favorável, sendo a maioria da amostra independente. Ganhos funcionais: AFG médio de 30,83 na RRCCI; 18,95 CSP; 10,97 CH e -6,09 nas UILD. RFG médio de 63,14% nas RRCCI, 18,94% CH, 10,42% CSP e -27,09% nas UILD. REI médio de 0,97 nos CSP, 0,78 RRCCI, 0,4 nos CH e -0,15 nas UILD. Nas RRCCI 56,7% dos CR são eficientes e com eficácia elevada, restantes contextos maioritariamente sem eficácia e eficiência. Relação estatisticamente significativa entre o IBm1 e IBm2, nas RRCCI (efeito grande. r=. nos CSP (efeito médio, r=0.30) e nos CH (efeito pequeno, r=0.03). Ausência de relação estatisticamente significativa entre idade e aquisição de ganhos funcionais.
Conclusão: A comparação dos outcomes dos diferentes contextos da prática permite, aos administradores e gestores, orientar mudanças futuras, e criar sistemas de reabilitação mais fortes e capazes. São necessários mais estudos com rigor científico que permitam comparar resultados, fortalecendo a evidência de suporte à prática da Enfermagem de Reabilitação.
Background: Disability prevalence demands rehabilitation care (RC). Rehabilitation Outcomes are used as indicators of quality of care. The evidence that compares RC with outcomes, and assesses its effectiveness or efficiency is severely limited. Aims: Characterize level of functional dependence and Functional Outcomes obtained by the clients who have rehabilitation care in the Autonomous Region of Madeira. Analyze effectiveness and efficiency of rehabilitation programs. Describe a correlation between age and functional gain acquisition and the functional evolution between two different moments of functional evaluation (BIm1 and BIm2). Methodology: Observacional retrospective, descriptive and correlational study. Measurement of variables using Barthel Index (BI), applied at two different times and calculation of the three rehabilitation Impact Indices: Absolute Functional Gain (AFG), Relative Functional Gain (RFG) and Rehabilitation efficiency index (REI) in the sample with ≥ seven rehabilitation sessions (n=160). Interpretation of results: 44% of the sample was in context of Home Based Care (HBC), 24,2% in Hospital care (HC), 16,4% in Long term inpatient units (LTIU) and 15,5% in inpatient rehabilitation facilities (IRF). HBCs registered lowest level of functional dependency in BIm1, being the majority of the sample (47.3%), independent in BADL. In BIm2, IRF was the context with the most favorable functional evolution, being the majority of the sample (44.1%) independent. Functional Outcomes of the sample: Average AFG of 30,83 in IRF, 18,95 in HBC, 10,97 in HC and -6,09 in LTIU. Average RFG of 63,14% in IRF, 18,94% in HC, 10,42% in HBC and -27,09% in LTIU. Average REI of 0,97 in HBC, 0,78 in IRF, 0,4 in HC and -0,15 in LTIU. In IRF most rehabilitation care (56.7%) is efficient and highly effective, mostly inefficient and inefficient in other contexts. There was a statistically significant relationship between BIm1 and BIm2 in all contexts, except for the LTIU. In IRF the effect was big (r=.60). Absence of statistically significant relationship between age and the acquisition of functional outcomes was found. Conclusion: Comparing the outcomes of different contexts of practice allows administrators and managers to guide future changes, and to create stronger and more capable rehabilitation systems. More studies with scientific rigor are needed to compare results, strengthening the evidence to support the practice of Rehabilitation Nursing.
Background: Disability prevalence demands rehabilitation care (RC). Rehabilitation Outcomes are used as indicators of quality of care. The evidence that compares RC with outcomes, and assesses its effectiveness or efficiency is severely limited. Aims: Characterize level of functional dependence and Functional Outcomes obtained by the clients who have rehabilitation care in the Autonomous Region of Madeira. Analyze effectiveness and efficiency of rehabilitation programs. Describe a correlation between age and functional gain acquisition and the functional evolution between two different moments of functional evaluation (BIm1 and BIm2). Methodology: Observacional retrospective, descriptive and correlational study. Measurement of variables using Barthel Index (BI), applied at two different times and calculation of the three rehabilitation Impact Indices: Absolute Functional Gain (AFG), Relative Functional Gain (RFG) and Rehabilitation efficiency index (REI) in the sample with ≥ seven rehabilitation sessions (n=160). Interpretation of results: 44% of the sample was in context of Home Based Care (HBC), 24,2% in Hospital care (HC), 16,4% in Long term inpatient units (LTIU) and 15,5% in inpatient rehabilitation facilities (IRF). HBCs registered lowest level of functional dependency in BIm1, being the majority of the sample (47.3%), independent in BADL. In BIm2, IRF was the context with the most favorable functional evolution, being the majority of the sample (44.1%) independent. Functional Outcomes of the sample: Average AFG of 30,83 in IRF, 18,95 in HBC, 10,97 in HC and -6,09 in LTIU. Average RFG of 63,14% in IRF, 18,94% in HC, 10,42% in HBC and -27,09% in LTIU. Average REI of 0,97 in HBC, 0,78 in IRF, 0,4 in HC and -0,15 in LTIU. In IRF most rehabilitation care (56.7%) is efficient and highly effective, mostly inefficient and inefficient in other contexts. There was a statistically significant relationship between BIm1 and BIm2 in all contexts, except for the LTIU. In IRF the effect was big (r=.60). Absence of statistically significant relationship between age and the acquisition of functional outcomes was found. Conclusion: Comparing the outcomes of different contexts of practice allows administrators and managers to guide future changes, and to create stronger and more capable rehabilitation systems. More studies with scientific rigor are needed to compare results, strengthening the evidence to support the practice of Rehabilitation Nursing.
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Keywords
Capacidade Funcional Qualidade Cuidados de Saúde Resultados de Reabilitação Ganhos Funcionais