ObjectiveInvestigate whether exercise-based telerehabilitation improves pain, physical function and quality of life in adults with physical disabilities.DesignSystematic review of randomised controlled trials.Data sourcesSearches were performed in AMED, MEDLINE, CINAHL, SPORTDiscus, Embase, PEDro, Cochrane Library and PsycINFO.Eligibility criteriaTrials were considered if they evaluated exercise by telerehabilitation. The population included adults with physical disability. Comparisons were control and other interventions. The outcomes were pain, physical function and quality of life. Study selection, data extraction and analysis followed the protocol registered in PROSPERO (CRD42019122824). GRADE determined the strength of evidence.ResultsForty-eight trials were included in the quantitative analysis. When compared with other interventions, there was high-quality evidence that telerehabilitation was not different to other interventions for pain (95% CI: −0.4 to 0.1), physical function (95% CI: −0.2 to 0.2) and quality of life (95% CI: −0.1 to 0.5) at long-term. There was moderate-quality evidence that telerehabilitation was not different to other interventions for physical function (95% CI: −0.1 to 0.5) and quality of life (95% CI: −0.2 to 0.5) at short-term. However, due to the low-quality evidence and the small number of trials comparing exercise protocols offered by telerehabilitation with control groups, it is still not possible to state the efficacy of telerehabilitation on pain, function and quality of life at short-term and long-term.ConclusionsExercise by telerehabilitation may be an alternative to treat pain, physical function and quality of life in adults with physical disabilities when compared with other intervention.

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RF. Atenção domiciliar no âmbito da reabilitação e prática centrada na família: aproximando teorias para potencializar resultados. Rev Ter Ocup Univ São Paulo. 2017 maio-ago.;28(2):206-13. RESUMO:Estudo de revisão narrativa que apresenta e discute os pressupostos da Prática Centrada na Família (PCF) e as influências desta abordagem no contexto da Atenção Domiciliar (AD) no âmbito da reabilitação no Sistema Único de Saúde (SUS). Com base nas informações obtidas, a AD e a PCF foram analisadas, permitindo discutir o potencial impacto dos pressupostos da PCF na AD, do sistema publico de saúde brasileiro. A AD tem importante papel na constituição de redes substitutivas, produzindo novos modos de cuidar. Entretanto, alguns problemas na organização deste serviço geram descontinuidade do cuidado, sobrecarga de todos os níveis de atenção e dificultam o vínculo entre profissionais/usuário/família. A PCF propõe que os programas domiciliares sejam direcionados aos familiares, especialmente aos cuidadores, para que estes desenvolvam as competências necessárias para a prestação do cuidado, possibilitando assim assistência integral, contextualizada e humanizada ao usuário. A utilização da PCF no contexto da AD no SUS, tendo em conta o empoderamento do usuário e sua família, pode favorecer o estabelecimento de vínculos afetivos e de co--responsabilidade entre profissionais/usuário/família, impactando na qualidade da assistência prestada e nos resultados esperados. ABSTRACT: This narrative review presents and discusses the assumptions of Family-Centered Practice (FCP) and the influences of this approach in the context of Home Care (HC) in rehabilitation in the Brazilian Unified Health System (SUS). HC and FCP were analyzed from the information obtained, allowing to discuss the potential impact of the assumptions of the FCP in HC of the Brazilian public health system. HC has an important role in networks, producing new ways of caring. However, some problems in the organization of this service generates discontinuity of care and overload of all levels of attention, hampering the bond between professionals/user/family. FCP proposes that home programs be targeted at family members, especially caregivers, so that they develop the skills required for the provision of care, thus enabling comprehensive, contextualized and humanized assistance to the user. The use of FCP in the context of HC in the Brazilian Unified Health System, considering user empowerment and his family, may favor the establishment of emotional and coresponsibility bonds between professionals/user/family, impacting on the quality of the assistance provided and the results expected. DESCRITORES:

Background Delays in starting physical therapy after hospital discharge worsen deconditioning in older adults. Intervening quickly can minimize the negative effects of deconditioning. Telerehabilitation is a strategy that increases access to rehabilitation, improves clinical outcomes, and reduces costs. This paper presents the protocol for a pragmatic clinical trial that aims to determine the effectiveness and cost-effectiveness of a multi-component intervention offered by telerehabilitation for discharged older adults awaiting physical therapy for any specific medical condition. Methods This is a pragmatic randomized controlled clinical trial with two groups: telerehabilitation and control. Participants (n=230) will be recruited among individuals discharged from hospitals who are in the public healthcare system physical therapy waiting lists. The telerehabilitation group will receive a smartphone app with a personalized program (based on individual’s functional ability) of resistance, balance, and daily activity training exercises. The intervention will be implemented at the individuals’ homes. This group will be monitored weekly by phone and monthly through a face-to-face meeting until they start physical therapy. The control group will adhere to the public healthcare system’s usual flow and will be monitored weekly by telephone until they start physical therapy. The primary outcome will be a physical function (Timed Up and Go and 30-s Chair Stand Test). The measurements will take place in baseline, start, and discharge of outpatient physical therapy. The economic evaluations will be performed from the perspective of society and the Brazilian public healthcare system. Discussion The study will produce evidence on the effectiveness and cost-effectiveness of multi-component telerehabilitation intervention for discharged older adult patients awaiting physical therapy, providing input that can aid the implementation of similar proposals in other patient groups. Trial registration Brazilian Registry of Clinical Trials (ReBEC), RBR-9243v7. Registered on 24 August 2020.

Desde as últimas décadas o Brasil vivencia o aumento das doenças crônicas e da expectativa de vida que, associadas à crescente urbanização e industrialização, modificam o perfil de adoecimento da população, marcado por incapacidades transitórias/permanentes. Tais mudanças aumentam a demanda por serviços públicos de reabilitação e geram a necessidade de ampliar e diversificar tais serviços e constituí-los em rede integrada e efetiva. O adequado funcionamento e planejamento da rede de reabilitação dependem de dados que reflitam as condições funcionais dos usuários. Assim, um protocolo sistematizado, que possibilite o levantamento e qualificação das demandas funcionais desde o acolhimento do usuário, tem grande potencial para melhorar o direcionamento do caso entre os diversos profissionais e serviços da rede – Atenção Básica e Especializada. O objetivo deste estudo foi, através deste protocolo único, traçar o perfil dos usuários da rede pública de reabilitação de Belo Horizonte – MG. O protocolo foi aplicado no acolhimento de usuários da rede pública de reabilitação da cidade. No protocolo há questões que representam componentes da Classificação Internacional de Funcionalidade, Incapacidade e Saúde, para caracterização social, da saúde e funcional dos usuários. Para descrição funcional há 25 questões alocadas em 10 domínios: Mobilidade, Comunicação, Eutrofia, Auto-cuidado, Dor, Atividade Interpessoal, Energia e Sono, Afeto, Tarefas e Demandas Gerais, Trabalho Remunerado. Foram avaliados 516 usuários, média de idade 57 anos, 75% mulheres, 47% casados/união estável, média de 3 filhos. Quanto à escolaridade, 65% concluíram até o ensino fundamental. Menos da metade trabalhava (41%) e 35% eram aposentados. Sedentarismo (65%) e sobrepeso (31%) foram os principais fatores de risco. Na auto-avaliação de saúde, 34% avaliaram como boa/muito boa a saúde física e 43% a emocional; 32% precisavam de ajuda nas atividades diárias e 75% realizavam algum tratamento de saúde. Na descrição funcional, 87% relataram dificuldade grave/completa em pelo menos um domínio, sendo Dor o mais frequente (58%). A mediana do escore funcional foi 23,89 (escala de 0 a 100). A maioria iniciou a reabilitação na atenção básica (n=398) e em média apresentava dificuldade grave/completa em 5 itens da descrição funcional comparado com média de 8 itens para os que iniciaram na atenção especializada (n=109). Nove usuários receberam apenas orientações. Espera-se que o uso do protocolo contribua para a redução da fila de espera para atendimento de reabilitação, assim como redução dos encaminhamentos inadequados entre os serviços.

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Background: Delays in starting physical therapy after hospital discharge worsen deconditioning in older adults. Intervening quickly can minimize the negative effects of deconditioning. Telerehabilitation is a strategy that increases access to rehabilitation, improves clinical outcomes, and reduces costs. This paper presents the protocol for a pragmatic clinical trial that aims to determine the effectiveness and cost-effectiveness of a multi-component intervention offered by telerehabilitation for discharged older adults awaiting physical therapy for any specific medical condition.Methods: This is a pragmatic randomized controlled clinical trial with two groups: telerehabilitation and control. Participants (n=230) will be recruited among individuals discharged from hospitals who are in the public healthcare system physical therapy waiting lists. The telerehabilitation group will receive a smartphone app with a personalized program (based on individual’s functional ability) of resistance, balance, and daily activity training exercises. The intervention will be implemented at the individuals’ homes. This group will be monitored weekly by phone and monthly through a face-to-face meeting until they start physical therapy. The control group will adhere to the public healthcare system usual flow and will be monitored weekly by telephone until they start physical therapy. The primary outcome will be physical function (Timed Up and Go and 30-second Chair Stand Test). The measurements will take place in baseline, start, and discharge of outpatient physical therapy. The economic evaluations will be performed from the perspective of society and the Brazilian public healthcare system.Discussion: The study will produce evidence on the effectiveness and cost-effectiveness of multi-component telerehabilitation intervention for discharged older adult patients awaiting physical therapy, providing input that can aid implementation of similar proposals in other patient groups. Trial registration: Brazilian Clinical Trials Registry, RBR-9243v7. Registered on 24 August 2020.

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