Literatura académica sobre el tema "Physiotherapy Care"

The provision of physiotherapy via general practitioner (GP) ‘direct access’ arrangements or in primary care itself has become increasingly common in the UK. Evidence on the economics and the cost-effectiveness of alternative methods of organizing access to physiotherapy services is reviewed, and the likely impacts of different organizational models are discussed. GP direct access physiotherapy and primary care provision appear to have a lower average cost than consultant access physiotherapy models, while GP direct access appears to minimize health care resource use per patient. Primary care physiotherapy provision appears to minimize the costs to patients of seeking care, and appears to generate a greater demand for service than other models. The extent to which physiotherapy provision in primary care can substitute for physiotherapy and other resources in the hospital sector is discussed, as is the extent to which patients may benefit from receiving physiotherapy in primary care. It is argued that continued expansion of access to physiotherapy should be critically appraised, and its ability to improve health status compared with that achievable in alternative patient groups who might benefit from physiotherapy in hospital or rehabilitation settings.

There is evidence to suggest that the role of the allied health professional continues to evolve in the delivery of palliative cancer care services. Whilst it appears that there is an increasing need for physiotherapists, there is a lack of understanding about the nature of their role, their educational needs and their place within the rehabilitation team. The aim of my work was to explore a local palliative cancer care physiotherapy service provision in the light of best practice recommendations, using both my own practice development and a research study. For my research a qualitative approach using a single case study design was chosen as it provided a framework to facilitate the inclusion of multiple perspectives in a complex context within an area of healthcare where little research has been undertaken. Multiple methods of data collection were used from numerous perspectives, which included four data sets: interviews (healthcare professionals [10]); interviews (service users [10]); observations (physiotherapists [2] treating service users [5]); and policy document collection (NICE guidelines; white papers [12]). Detailed data analysis was then carried out using a thematic approach within a framework, comparing and contrasting patterns within and across the four data sets. Emergent themes highlighted a number of important aspects relating to physiotherapists including: new ways of working, shift in mindset and treatment planning, emotional adjustment and integration of professional boundaries. My primary research and practice development project combined to evidence the metamorphosis of both the physiotherapist profession and service provision where competencies around mentorship, entrepreneurship, leadership, policy championship, integrated teamwork, humanisation and self-reflection embodied within the psycho-social-cultural-spiritual model of healthcare enabled them to meet key policy recommendations of service quality and innovation. A debate is necessary around the need for profession specific or service specific outcomes in this area, and how physiotherapists ‘prove their worth’ now that they are an integral part of palliative cancer care provision.

Background: Road traffic injuries are the leading cause of death in children and young adults. Children are at increased risk of fatalities and serious injury due to the differences in their body segment proportions affecting their body kinetics in a vehicle accident. Serious injury and death can be reduced by the appropriate use of car restraint systems (CRS). Children with special health care needs (CSHCN), particularly children with poor postural control, may need adaptive seating to improve postural support and sitting ability within the vehicle due to their additional physical needs. Standard CRS might be unsafe or inappropriate for children with physical disabilities. Research Aims: The thesis aimed to understand the current CRS usage as well as the parents' experiences and perspectives of transportation of CSHCN in the Western Cape, and to determine the postural support needs of CSHCN and the suitability of different CRS designs to meet these needs during transportation. This was achieved through a survey study, followed by a cross-sectional study. Assessing the use of car restraint systems in children with special health care needs; a Western Cape based survey study Objectives: To determine the modes of transport and the prevalence of the use of postural support systems by CSHCN. Along with describing the current use of seatbelts, standard or specialised CRS and exploring the challenges faced by parents of CSHCN during transportation. Methods: A descriptive quantitative survey was performed amongst a convenience sample of all parents of CSHCN between the age of 4 – 18 years enrolled at three special needs schools in the Western Cape, South Africa. Parents had to be able to read and understand English or Afrikaans to be eligible for enrolment in the study. Focus group discussions were conducted to validate the self-designed questionnaire. Results: Parents of 268 children were enrolled in the study (median (IQR) age 11.52 (14.63- 8.86) years; 58.96% male). The most common diagnosis was cerebral palsy (CP) (29.10%), and most children were transported to school with public transport, including school bus (73.13%). The mode of transport was linked to the distance travelled and affordability, and each had its own challenges. The main challenges of parents using private transport were transporting the wheelchair (10.82%) and the unavailability of demarcated disability parking bays (7.46%). When using public transport parents identified their child's poor sitting balance (6.34%) and lack of space within the vehicle (5.60%) as the greatest challenges. The majority of children (58.96%) came from low-to-middle income households (< R6500 per month), significantly impacting the use of a CRS, with more children from higher income families being transported in a CRS (X²= 48.14, p< 0.001). Difficulties with sitting balance was reported in 25.75% of the children and was significantly association to the parents understanding of their child's sitting balance (X²= 17.72, p< 0.001). Parents who felt that their child had difficulty with their sitting balance were more likely to use a CRS. Furthermore, a significant association between currently using a CRS and child's weight was observed (X²= 11.54, p=0.021), as children who weighed more were less likely to still be using a CRS. Most parents (54.48%, n=146) did not know South Africa's current legislation on CRS, which was significantly associated with a lower CRS usage (X²= 19.84, p< 0.001). Half of the parents (n= 139, 51.87%) were not willing to spend money on a CRS as they felt that a car seat was not necessary for their child. The amount parents were willing to spend on a CRS was significantly associated with having ever made use of a CRS (X2=43.38, p< 0.001). Conclusions: Parents of CSHCN reported many challenges in transporting their child depending on the mode of transportation. CRS usage was associated with parent perception on the child's sitting abilities, lower weight, knowledge of legislation and a higher household income. Despite these, CRS usage amongst CSHCN is lower than expected as (48.88% – 55.22%) children that are still within the age and weight range to use a CRS as required by law did not report CRS usage. This could link in with the affordability of the CRS and failure to know the legislation on CRS by parents. This study highlights the need for national campaigns to promote and educate citizens on road safety and CRS legislation. Due to the lack of financial resources in low to middle income countries, it is vital that an affordable CRS is made available or is subsidized by the government where families are unable to afford the cost themselves, particularly for use in public transport. Effectiveness of currently available car restraint systems to maintain correct seating position during transportation for children with special health care needs Objectives: To determine the characteristics of CSHCN who require specialised CRS for their postural support needs, through assessment of their sitting ability and whether these needs are met by different CRS. Methods: Participants in the earlier survey study were invited to take part in a crosssectional and pre-post design study. A screening tool for identifying sitting balance problems was developed and found to be reliable for inter- and intra-rater reliability (k>0.700, p0.879). This tool was used to identify CSHCN who had difficulty sitting independently on different types of seats. These participants underwent a standardised sitting balance assessment, using the Level of Sitting Scale (LSS), to identify eligible participants with postural support needs. Participants were excluded if they recently had surgery or had an unstable health condition which could alter their sitting balance. The ability of two standard CRS (Car Seat and Booster seat), two Specialised CRS (one locally and one internationally produced), and Seatbelt only to provide adequate postural support was investigated. Head and trunk postures were analysed and categorised, by deviation from the midline, by photographs taken from different viewpoints. Results: There were 78 CSHCN enrolled in the study (mean (SD) age 11.50 (3.70) years; 65.75% male), the most common diagnosis was CP (63.48%), the majority of participants did not require any support to maintain sitting balance and were categorised as levels 5-8 of the LSS (78.08%). According to the World Health Organisation anthropometric guidelines 54.79% (n=40) of the participants should still use a CRS, either a Booster Seat (42.47%, n=31) or a Car Seat (12.33%, n=9). The head or torso fully supported and between the side supports of the CRS was the most common posture in all the viewpoints of the different CRS except for the lateral head viewpoint of the CRS Car Seat (50.00%; n=4), the Booster Seat (60.00%; n=18), and the International Specialised CRS (60.61%; n=20), as well as the anterior torso viewpoint of the Seatbelt only (50.75%; n=34). The CRS that resulted in the largest proportion of unacceptable posture deviations from the standard position were the Seatbelt only (20.90%, n=56) and the Booster Seat (18.33%, n=22). Out of position (OOP) postures were observed in all the devices for the anterior and lateral head positions (3.03% - 20.00%). The Booster Seat, the Local Specialised CRS and the Seatbelt only devices had participants with OOP postures in all four viewpoints. A key observation in the current study is the lack of torso support for the majority of CSHCN in the anterior torso viewpoint of the Seatbelt Only CRS (55.22%, n=37), indicating that the use of a Seatbelt only does not provide adequate postural support for all CSHCN despite them meeting WHO anthropometric requirements. No significant association was found between the pre- and post-test postural analysis scores of the Seatbelt only (X2=2.14, p=0.144) which could be as a result of the large postural deviations pre-testing (41.79%, n=28) remained post-testing. However, there was a significant association between the preand post-test scores of the anterior head viewpoint of the Booster seat (X2= 7.94, p=0.005), indicating lateral head deviation. The post-test postural analysis score of the Booster Seat anterior head viewpoint was significantly associated with a deviated posture (X2= 7.94, p=0.005). Other OOP observations included postures that could not be categorised by head and trunk deviation from the midline including head or torso rotation, abnormal limb placement, body extension and slouching. Overall performance scores are a sum of the number of viewpoints where the CSHCN posture worsens post-test. an indication of the number of CSHCN whose posture worsened post-test in each of the viewpoints of the CRS. Although there was no correlation between the LSS score and the overall performance score of any CRS device which would indicate if the CSHCN balance influences CRS performance, the Booster Seat (80.00%, n=24) and the Seatbelt only (55.23%, n=37) devices had the greatest number of participants with a poor overall performance. The viewpoints which had the worst performance scores were the anterior and lateral head of the Booster Seat (46.67%, n=14 and 43.33%, n=13 respectively) and both viewpoints had majority of participants worsen their scores. All CRS performed adequately in the lateral torso viewpoint, indicating sufficient support of the torso in the sagittal plane. Conclusions: The postural support needs of CHSCN are unique and depend on the child's anthropometry and the severity of their disability. The currently available CRS designs may not provide the postural support needed for many CSHCN. Postural deviations of the head, torso and limbs were observed which could be dangerous in the event of an accident. This study was not able to determine specific characteristics of CSHCN that require specialised CRS, as there was no association between the LSS and the overall performance score for any of the CRS devices. However, devices that offer less head and torso lateral support, or do not offer additional harness support such as the Seatbelt Only and the Booster Seat showed the largest proportion of OOP postures in CSHCN. Thesis Conclusion: This thesis highlights the complex transportation needs of CSHCN in South Africa and how the different CRS can influence posture. Additional observational research is required to determine the CRS usage in the CSHCN population to compare to the prevalence of CRS usage found in this survey study. Future research could incorporate other specialised CRS designs, particularly ones that are suitable for CSHCN beyond standard CRS weight and height limits or those with severe physical limitations that could not be tested during this study's simulated course. Practitioners prescribing and advising parents on CRS devices for the safe transportation of CSHCN should integrate thorough patient assessment and knowledge of manufacturer CRS design specifications to promote CRS usage. Policies should consider and accommodate for the challenges faced by CSHCN and their families in accessing, affording and utilising transport services. Advocacy and education programs should be combined with legislation enforcement to support improved implementation of CRS usage amongst all children, regardless of their disability status. For effective implementation for CSHCN, CRS should be affordable, accessible, functional and accommodate growth and postural support needs.

People with dizziness commonly seek medical solutions through primary contact medical practitioners and Ear Nose and Throat (ENT) outpatient services. Physiotherapists trained in vestibular rehabilitation may independently and safely assess and manage these people. This thesis presents a programme of research undertaken to investigate a standalone physiotherapy-led vestibular rehabilitation service and its management of people with dizziness screened from the wait lists of ENT outpatient services. A systematic review and two clinical studies support the main service investigation. The published systematic review, Study 1, synthesised vestibular diagnostic proportions reported by the specialties of ENT/Otology, Neurology, Emergency, General Practice and Physiotherapy, enabling comparison with the findings of the clinical studies in this programme of research. A 2020 update found increased awareness for setting-specific differences in diagnostic proportions and for benign paroxysmal positional vertigo (BPPV) diagnostic procedures; however, awareness of correct BPPV management was still deficient. The Study 2 pilot demonstrated the feasibility of the model of care and informed the extension of the trial into a major study. Sixty-seven participants from an ENT wait list included a 44:23 female to male ratio, a mean age of 55.2 years (SD 17.57) and a diagnostic profile of common diagnoses including BPPV (22%), unilateral vestibular hypofunction (40%), vestibular migraine (10%) and cervicogenic dizziness (6%). Service outcomes included a mean wait of 382.6 days (SD 246.3) with 31(46%) participants receiving one occasion of service. Nine percent of people assessed were returned to ENT for consultant review and no adverse events were recorded. Patient management led to the resolution of BPPV and unilateral vestibular hypofunction clinical signs and significant improvements in the Dizziness Handicap Inventory (34.9/100 to 11.1/100, p< 0.001) and the Activities-specific Balance Confidence scale (78.3/100 to 87.9/100, p= 0.009). Study 3, an interrater reliability trial between a vestibular audiologist and physiotherapist for diagnostic accuracy and referrals for vestibular rehabilitation included 22 people (82% female) with dizziness from ENT wait lists with a mean age of 54.9 years (SD 19.44). Clinician diagnoses compared closely for the common forms of vestibular dysfunction: BPPV 100% agreement (Kappa 1.0), unilateral vestibular hypofunction 77.3% (Kappa 0.54), vestibular migraine 95.5% (Kappa 0.78), and cervicogenic dizziness 86.4% (Kappa 0.65). Percentage agreement for referral to vestibular rehabilitation was 95.5% (Kappa 0.89). Study 4 investigated a cohort of 301 people with dizziness (191 (63%) females) from ENT wait lists averaging 55.5 years (SD 17.23) in age and with a diagnostic profile of BPPV (20%), unilateral vestibular hypofunction (36%), vestibular migraine (15%) and cervicogenic dizziness (8%). Wait times reduced significantly from 390.2 days (SD 243.5) in 2013 to 93.0 days (SD 219.4) (p= 0.004) in 2017, and occasions of service and duration of treatment were skewed positively towards medians of one. Consumer engagement using visual analogue scales showed consistently high median levels of satisfaction for wait time (9.3/10 cm) and service quality (10/10 cm). Clinical effectiveness of the model of care was demonstrated through its treatment of BPPV leading to resolution in 48 out of 50 people (p< 0.001) and its treatment of unilateral vestibular hypofunction leading to compensation in 47 out of 54 people presenting with uncompensated DVA (p< 0.001). Whole cohort Dizziness Handicap Inventory scores improved from 38.1/100 (SD 22.1) to 24.6/100 (SD 21.6) (p< 0.001) and Activities-specific Balance Confidence scale scores from 73.2/100 (SD 21.89) to 81.0/100 (SD 18.94) (p< 0.001). Investigating the burden of dizziness, initial assessment utility scores calculated from the Assessment of Quality-of-Life 8 Dimensions questionnaire averaged 0.58 (SE 0.01), representing a 30% reduction in quality of life compared with published normal population scores. Treatment saw a significant improvement in the utility by 0.08 (95% CI 0.06, 0.10) (p< 0.001). Using the Work Productivity and Activity Impairment (Dizziness) questionnaire, absenteeism in 2013 participants amounted to potential annualised lost wages of AUD $16380 per person: reducing to AUD $4185 by 2017. Presenteeism by people with dizziness at a mean of 30%, represented a considerable potential cost in lost productivity to employers in 2013 at AUD $20998, reducing with wait reduction by 2017 to AUD $5308. Cost consequences analysis using decision tree modelling of two models of care, physiotherapy-led and ENT-led, showed dominance in cost by the physiotherapy-led model. In conclusion, the physiotherapy-led vestibular rehabilitation model of care was shown to be one of high value care; being clinically, service, and cost effective, and safe and satisfactory for people with dizziness referred to an ENT waitlist. Research into the burden of dizziness considering quality of life, absenteeism and presenteeism indicated considerable consequences for people with dizziness and found the physiotherapy-led model improved this burden significantly. In the Australian public hospital setting, independent, primary contact, physiotherapy-led vestibular rehabilitation services provide a safe, effective, efficient and cost-effective pathway for people with dizziness referred to ENT.

Magister Artium - MA
Background: Physiotherapists are involved in the management of patients in the cardiothoracic Intensive Care Unit (ICU). Patient and family perception of care has become an important measure in evaluating the quality of care, including care in the intensive care setting. Overall Aim: To explore and describe the family and patient perception of physiotherapy care rendered in a public sector cardiothoracic ICU in the Western Cape, South Africa. Method: This study was conducted in two phases. Phase 1 (scoping review) identified and described available outcomes for measuring family perception of ICU care by searching six databases from inception to the 20th June 2018. Results from the scoping review informed the discussion schedule for the first primary study of Phase 2. Phase 2 (two exploratory descriptive qualitative primary studies) explored and described i) family perception and ii) patient perception of physiotherapy care in a cardiothoracic ICU. Audio-taped, individual face to face semi-structured interviews were conducted with family and patient participants that met the inclusion and exclusion sampling criteria (purposive sampling). Data was transcribed verbatim and analysed using deductive-inductive thematic content analysis. The data was coded, categorised and themes were generated. Trustworthiness of the data was ensured through methods addressing credibility, dependability, confirmability and transferability. Results: A total of ten full text studies were included in the scoping review. Included studies were published between 2006 and 2017, were conducted in both developed and developing countries, in different ICUs (except cardiothoracic ICU)and all used different quantitative outcome measures to measure family perception of ICU care. Thirteen cardiothoracic ICU patients and their respective family members partook in the studies describing patient and family perception of cardiothoracic ICU physiotherapy care. The median patient age was 62 years; the mean ICU length of stay 6 days and the median family age was 55. Themes arising from the family perception of care data analysed included: i) understanding of physiotherapy care (the role of the physiotherapist, perceived benefit of physiotherapy and communication), family involvement in physiotherapy care (physical presence during physiotherapy sessions and decision-making), and satisfaction of physiotherapy ICU care. Themes arising from patient perception of care data analysed included: i) Physiotherapy management of patients, ii) The Physiotherapists – skill, iii) knowledge and professionalism, iv) Continuity of Care, v) Tangibility, vi) Physiotherapy benefits, vii) Decision-Making, viii) Communication, ix) Satisfaction of Physiotherapy ICU care. Overall, family and patients were satisfied with the physiotherapy care in the cardiothoracic ICU. However, there were areas of improvement such as the understanding of physiotherapy care, communication, family involvement in the physiotherapy care and decision-making. Conclusion: While there are multiple quantitative measures for measuring family perception of ICU care there is no “gold” standard measure that has been identified. A qualitative measure and research design would allow richer in-depth information on family perception of ICU care. The findings from the family and patient perception of cardiothoracic ICU physiotherapy care are influenced by many factors. While family and patients perceive cardiothoracic ICU physiotherapy care both positively and negatively, the majority of patient and family were satisfied overall with the care the patient received. Family perception of ICU physiotherapy care should be evaluated in order to identify areas for improvement in quality of care and could add to the body of evidence in ICU physiotherapy practice.

The ability of a patient to access physiotherapy directly (patient self-referral), although used widely in the private sector, is not the mechanism in use within the NHS where there exists a system of open access controlled by doctors. This study aimed to develop, implement and investigate a direct access physiotherapy service within a primary care setting in a health district of Scotland. The service was introduced and compared to the existing system of open access over a twelve-month period (1997-1998). Demographic and clinical data was collected relating to two samples: Control Year Group: All GP referrals for a year prior to the study year collected retrospectively. Study Year Group: General practitioner (GP) and direct access (DA) referrals. All patients were followed up one-month after discharge, and the number of associated GP consultations collated together with patient, physiotherapist, general practitioner and service non-user views of physiotherapy generally and direct access specifically. There were similar numbers of referrals (339 vs. 340) with no significant differences with regard to patient age or gender between the Control and Study Year Groups. The Study Year Group however revealed significant differences between DA and GP referrals. DA referrals, all of which were appropriate, accounted for 22.4% of total referrals in comparison to 77.6% GP referrals. DA patients were more likely to have been: male, younger, suffering from conditions of a shorter duration, in paid employment with less work absence, who were more compliant with attendance, had fewer physiotherapy contacts, lower reporting of symptom severity at discharge and were more highly satisfied with their physiotherapy care. This group also demonstrated a greater confidence in knowing when to access physiotherapy and were highly supportive of the effectiveness of physiotherapy. DA patients also consulted their general practitioner significantly less often than GP referrals (p = 0.001). Support for direct access was strongly expressed by service users and nonusers, physiotherapists and general practitioners. Direct access to physiotherapy is an example of an innovative, flexible approach to primary care service provision encouraged by current health policy.

Aim: The study aimed to record the recovery patterns of gross motor function following acquired brain injury (ABI) in 17 participants, aged two to 14 years, receiving physiotherapy intervention at a paediatric intermediate care facility in the Western Cape, South Africa. Objectives of the study were to explore if factors such as age at injury, time since injury, intervention type, injury severity, gender, and the health- related quality of life of the child and caregiver were predictive of improvement of motor function and participation. Methods: A quantitative, longitudinal, prospective cohort design with repeated measures was employed. The children received physiotherapy either intensively or intermittently within eight months post brain insult. The Gross Motor Function Classification System (GMFCS) was used to classify the children according to their functional abilities. The Gross Motor Function Measure 88 (GMFM88) was used to assess changes in the child’s gross motor function. The Paediatric Evaluation of Disability Inventory (PEDI) evaluated functional performance in daily life activities (participation). The EQ-5D-Y proxy version and the Caregiver Strain Index (CSI) evaluated the health-related quality of life of the children and caregivers respectively. Assessments were performed at Baseline, Week 3, 7, 9 and 13 after admission to the study. Analysis: Descriptive statistics were used to describe the demographic data of the participants. Non-parametric analysis was performed to determine the time points at which the greatest improvement occurred because the sample was relatively small to support an adequately powered randomized intermittent trial. The GMFM88 was the primary outcome measure and the changes in score over the 13-week study period were plotted graphically in an attempt to identify patterns of improvement. The change in score from Baseline to Week 3 was also used as the dependent variable in investigating the determinants of short term improvement between the five measurement time points. Scatterplots and Spearman’s rho were used to investigate the relationship between changes in GMFM88 score from Baseline to Week 3 and the age of the child at injury, time from injury and Baseline GMFM88 score. The Kruskal Wallis ANOVA for ordinal data was used to establish whether there were differences in all the outcome measures at the different time points: between Baseline and Week 3, between Week 3 and Week 7 and between Week 7 and Week 9 and, if significant, a post-hoc Sign test was done to see where the differences lay. The effect size was calculated by dividing the z value by the square root of the total number of observations at both time points. Simple regression analysis was used to determine the variance in Week 9 GMFM88% score accounted for by the Baseline score. Results: Seventeen participants met the inclusion criteria and were recruited. There were more boys (n=14) than girls (n=3) admitted with brain injury and the majority of the total sample (n=14) were drawn from families with minimal financial resources. Although no differences were found between the two intervention groups, the greatest improvement in GMFM88 scores was observed within the first three weeks of intervention, regardless of the time since injury. Three patterns of recovery were identified through plotting the GMFM88 scores: Group A, included participants with a high baseline score who showed sustained but small improvement until reaching the ceiling score; Group B, participants who started with lower scores and then improved considerably; and Group C, participants who started with low scores and showed slower and smaller improvement. Most participants (n=13) returned to near normal motor function after Week 9 (over 90% on the GMFM). Four participants did not show the same improvement: The Week 9 GMFM88 score was less than 60% in one participant and less than 30% for the other three. In this study, participants who showed the greatest improvement were those children on GMFCS levels three and four. The Baseline GMFM88 scores were significantly correlated with other time points (rho=0.886 at Week 9 and 0.748 at Week 13), but not with the change in scores. The effect size of the change in GMFM88 scores from one time point to the other were all measured as medium (effect size of 0.5 but less than 1.3) and the largest effect size was seen between Baseline and Week 7 (effect size=.660). Change in score from Baseline to Week 3 was not predicted by gender, cause of injury or method of intervention delivered (intensive or intermittent). The Baseline motor score accounted for 86% of the variance of the Week 9 GMFM88% score and each point in the baseline score increased the Week 9 score by .94. The PEDI Mobility Score demonstrated a similar pattern of improvement to the GMFM88, but the pattern in progression of the PEDI Self-care domain was less clear. The EQ-5D-Y Proxies indicated that at Week 13, at least five children still had problems in one or more of the dimensions, with the greatest number (n=-8) having problems with the Usual Activities and Worried, Sad, or Unhappy domains. The older (above age nine years), higher functioning children made less gains in their functional abilities. The greatest cumulative cause of strain reported by the thirteen respondents, was a change in the former self of the child, followed closely by financial strain and work adjustments. The caregivers of the children in Group C, the most disabled group, experienced double the strain at Week 13 than caregivers of children with mild and moderate brain injury. Although not correlated at Baseline, the CSI was negatively correlated with the proxy EQ-5D-Y reported visual analogue general health scale at Week 13 (n=10, rho=-724, p=.018) .655, p=.021). Conclusions: Although, most participants in the study regained physical functioning, approximately 25% admitted for rehabilitation with ABI might have significant residual motor damage and require on-going rehabilitative support. Although there were no other factors identified which predicted the outcome, these children could be identified based on poor GMFM88 scores on admission to rehabilitation. The EQ-5D-Y indicated that at Week 13, eight of the 12 proxies reported that participants had problems with anxiety and depression. Rehabilitation might therefore need to include a greater emphasis on self-care and mental health of the child, even when motor control has been established. Planning of long-term support should start early to maximise recovery and reduce the stress on caregivers. The study findings cannot be generalised due to the small sample size, but the results should alert therapists at the Facility to the possible long-term outcomes of children admitted with ABI. The study findings can assist with the formulation of patient specific and family centred rehabilitation care plans for children admitted with ABI at the Facility.

Objective: The aim of this study was to verify whether the primary care strategies carried out by physiotherapy in the immediate postoperative period of breast cancer are effective. Methodology: This is a retrospective study of consultations carried out in the breast ward by the physiotherapy service, including screening of consultations from February 2019 to February 2023. The data analyzed were age, education, marital status, parity, hormonal status, diagnosis, dominant limb, type of surgery, condition of the scar, need for referral to physiotherapeutic care, and the physiotherapeutic strategies adopted at that time. The study was approved by the Brazil Platform (CAAE 56561222.9.0000.0084). Results: A total of 122 files were analyzed, and 12 (9.8%) were excluded due to missing data; the mean age was 51.66±16.2 years, 31 (28%) had completed high school, 43 (39%) were married, 26 (23%) were nulliparous, and 58 (51%) underwent menopause. As for the diagnosis, 78 (70%) discovered it through self-examination and only 28 (25%) through mammography, 45 (40%) had cancer on the dominant side. Quandrantectomy was the most common surgical type in 40 (36%), followed by sectorectomy in 21 (19%), and lymph node dissection was present in 11 (10%). Inflammatory signs were not identified in 58 (52.7%), and 69 (62.7%) were referred for physiotherapy. All women were instructed to freely maintain upper limb movements and taught to perform simple free active movements at home for the prevention of lymphedema, being reinforced by the delivery of educational material. After a week, it was observed that all of them had no signs of lymphedema and or upper limb movement loss. Conclusion: The performance of physiotherapy in the immediate postoperative period is extremely relevant in caring for the scar/hydration of the skin and in stimulating free active exercise that may prevent the development of lymphedema or even functional limitation due to kinesiophobia. Delivery of educational material, as well as physiotherapeutic follow-up at the time of chemotherapy/radiotherapy, enhances the positive results.

Review question / Objective: The objective of this systematic review is to summarise different approaches reported in studies to evaluate guideline adherence in physiotherapy care. Further, we aim to identify clinical and methodological factors that may explain the assumed heterogeneity of guideline adherence among physiotherapists. Condition being studied: Clinical practice guidelines are systematically developed statements that summarise the current state of knowledge from research and practice. They are intended to support clinicians and patients to make decisions about appropriate health care for specific clinical circumstances (2). Various studies show that evidence-based physiotherapy care can lead to improved patient outcomes (e.g. pain, function, quality of life) and at the same time contribute to a lower utilisation of medical services and a reduction in health care costs. The degree of agreement between medical or therapeutic care and the recommendations made in guidelines is often described in studies with the term "guideline adherence". However, the heterogeneous use of the term guideline adherence and the lack of a standardised research methods or operationalisation lead to limited comparability of the study results.