Post-stroke rehabilitation: identification of speech-language disorders signs and symptoms by physicians and nurses in Primary Health Care
Reabilitação pós-AVC: identificação de sinais e sintomas fonoaudiológicos por enfermeiros e médicos da Atenção Primária à Saúde
Paula Anderle; Sheila Petry Rockenbach; Bárbara Niegia Garcia de Goulart
Abstract
Purpose: Stroke is a common disease for people and a global public health concern in terms of mortality, disability, and cost demand. This study aims to assess which groups of comorbidities related to speech-language disorders are identified by physicians and nurses of the Family Health Strategy (FHS) as to be referred to post-stroke speech-language rehabilitation at Primary and Secondary Health Care. Methods: Twenty-two physicians and nurses, from the FHS supported by the Family Health Support Center in southern Brazil, answered a questionnaire developed for this study, exploring socio-demographic variables, education background, professional performance and conduct to post-stroke patients. A descriptive data analysis (absolute and relative frequencies) was performed in SPSS Software 22. Results: Among the participants, 77.3% refer post-stroke patients to physiotherapy and 54.5% to speech-language rehabilitation. None refer to patients to treatment due to cognitive comprehension sequelae; 90.0% refer for significant speech-language disorders. In case of changes in the stomatognathic system, 80.0% of physicians do not refer to speech-language pathologists, and 83.3% of nurses usually do. Conclusion: The professionals showed difficulty in identifying speech-language pathological signs and symptoms related to cognition and the stomatognathic system, not referring to speech-language rehabilitation at primary or secondary health care. The results highlight the importance of continuing education and improvement of the knowledge of the primary health care teams, so that speech-language sequelae are properly identified and sent for rehabilitation.
Keywords
Resumo
Objetivo: O Acidente Vascular Cerebral (AVC) é um agravo comum para a população e um problema para a saúde pública global em termos de mortalidade, deficiência e demanda de custos. O objetivo deste estudo é verificar quais grupos de comorbidades ligados aos distúrbios fonoaudiológicos são identificados por médicos e enfermeiros das equipes de Estratégia de Saúde da Família (ESF) para encaminhamento à reabilitação fonoaudiológica e continuidade do cuidado de pacientes pós-AVC nas Atenções Primária e Secundária à Saúde (APS). Método: Participaram 22 médicos e enfermeiros das equipes de ESF apoiadas pelo Núcleo de Apoio à Saúde da Família, no sul do Brasil. Um questionário desenvolvido para este estudo foi respondido, explorando variáveis sociodemográficas, histórico de formação, atuação profissional e condutas ao paciente com AVC. Análise descritiva dos dados (frequências absoluta e relativa) foi realizada no Software SPSS 22. Resultados: Dos entrevistados, 77,3% encaminham pacientes pós-AVC para fisioterapia e 54,5%, para reabilitação fonoaudiológica. Nenhum profissional realiza encaminhamento por sequelas cognitivas de compreensão; 90,0% encaminham por distúrbios de linguagem expressiva na fala. Para alterações do sistema estomatognático, 80,0% dos médicos não encaminham para fonoaudiólogo e 83,3% dos enfermeiros o fazem. Conclusão: Os profissionais demonstraram dificuldade em identificar distúrbios fonoaudiológicos ligados à cognição e ao sistema estomatognático, não encaminhando para reabilitação fonoaudiológica nas Atenções Primária e Secundária à Saúde. Os resultados apontam para a necessidade de ações que auxiliem no processo de educação permanente e melhorem o conhecimento das equipes de APS, para que as sequelas fonoaudiológicas sejam devidamente identificadas e encaminhadas para reabilitação.
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Referências
1. GBD: Global Burden of Disease. IHME: Institute for Health Metrics and Evaluation. GBD compare data visualization [Internet]. Seattle: University of Washington, 2016 [cited 2017 Dec 7]. Available from: http://vizhub. healthdata.org/gbd-compare/
2. Carvalho-Pinto BPB, Faria CDCM. Health, function and disability in stroke patients in the community. Braz J Phys Ther. 2016;20(4):355-66. http://dx.doi.org/10.1590/bjpt-rbf.2014.0171. PMid:27556392.
3. Pontes-Neto OM, Silva GS, Feitosa MR, De Figueiredo NL, Fiorot JA Jr, Rocha TN, et al. Stroke awareness in Brazil: Alarming results in a community-based study. Stroke. 2008;39(2):292-6. http://dx.doi.org/10.1161/ STROKEAHA.107.493908. PMid:18162624.
4. Byeon H, Koh HW. The relationship between communication activities of daily living and quality of life among the elderly suffering from stroke. J Phys Ther Sci. 2016;28(5):1450-3. http://dx.doi.org/10.1589/jpts.28.1450. PMid:27313349.
5. Abdul Aziz AF, Mohd Nordin NA, Ali MF, Abd Aziz NA, Sulong S, Aljunid SM. The integrated care pathway for post stroke patients (iCaPPS): a shared care approach between stakeholders in areas with limited access to specialist stroke care services. BMC Health Serv Res. 2017;17(1):35. http://dx.doi.org/10.1186/s12913-016-1963-8. PMid:28086871.
6. GBD 2015 Neurological Disorders Collaborator Group. Global, regional, and national burden of neurological disorders during 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Neurol. 2017;16(11):877-97. http://dx.doi.org/10.1016/S1474-4422(17)30299-5. PMid:28931491.
7. Aziz NA, Pindus DM, Mullis R, Walter FM, Mant J. Understanding stroke survivors’ and informal carers’ experiences of and need for primary care and community health services — a systematic review of the qualitative literature: protocol: Table 1. BMJ Open. 2016;6(1):e009244. http://dx.doi. org/10.1136/bmjopen-2015-009244. PMid:26739728.
8. Fountouki A, Theofanidis D. Service provision for stroke: the greek paradox. J Vasc Nurs. 2017;35(3):136-40. http://dx.doi.org/10.1016/j. jvn.2017.03.003. PMid:28838588.
9. Man S, Schold JD, Uchino K. Impact of stroke center certification on mortality after ischemic stroke: the medicare cohort from 2009 to 2013. Stroke. 2017;48(9):2527-33. http://dx.doi.org/10.1161/STROKEAHA.116.016473. PMid:28747463.
10. Brasil. Ministério da Saúde. Portaria GM/MS no 665, de 12 de abril de 2012. Diário Oficial da União; Brasília; 12 abril 2012.
11. Abdul Aziz AF, Mohd Nordin NA, Abd Aziz N, Abdullah S, Sulong S, Aljunid SM. Care for post-stroke patients at Malaysian public health centres: self-reported practices of family medicine specialists. BMC Fam Pract. 2014;15(1):40. http://dx.doi.org/10.1186/1471-2296-15-40. PMid:24580779.
12. Brasil. Diretrizes do NASF: Núcleo de Apoio a Saúde da Família [Internet]. Brasília: Ministério da Saúde; 2009 [cited 2017 Dec 7]. (Caderno de Atenção Básica; no. 27). Available from: www.saude.gov.br/bvs
13. Wissel J, Olver J, Sunnerhagen KS. Navigating the poststroke continuum of care. J Stroke Cerebrovasc Dis. 2013;22(1):1-8. http://dx.doi.org/10.1016/j. jstrokecerebrovasdis.2011.05.021. PMid:21733720.
14. Langstaff C, Martin C, Brown G, McGuinness D, Mather J, Loshaw J, et al. Enhancing Community-Based Rehabilitation for Stroke Survivors: Creating a Discharge Link. Top Stroke Rehabil. 2014;21(6):510-9. http:// dx.doi.org/10.1310/tsr2106-510. PMid:25467399.
15. Huang K, Khan N, Kwan A, Fang J, Yun L, Kapral MK. Socioeconomic status and care after stroke: Results from the registry of the Canadian stroke network. Stroke. 2013;44(2):477-82. http://dx.doi.org/10.1161/ STROKEAHA.112.672121. PMid:23321439.
16. National Audit Office. Progress in improving stroke care [Internet]. London: Department of Health National Audit Office; 2010 [cited 2017 Dec 7]. Available from: http://www.nao.org.uk/wp-content/uploads/2010/02/0910291. pdf
17. McKevitt C, Fudge N, Redfern J, Sheldenkar A, Crichton S, Rudd AR, et al. Self-reported long-term needs after stroke. Stroke. 2011;42(5):1398-403. http://dx.doi.org/10.1161/STROKEAHA.110.598839. PMid:21441153.
18. Goulart BNG, Podalirio CB A, Silva MW, Oenning NSX, Lagni VB. Characterization of stroke with a focus on oral communication disorders in inpatients of a regional hospital. Audiol Commun Res. 2016;21:e1603. http://dx.doi.org/10.1590/2317-6431-2015-1603.
19. Johansen I, Lindbak M, Stanghelle JK, Brekke M. Independence, institutionalization, death and treatment costs 18 months after rehabilitation of older people in two different primary health care settings. BMC Health Serv Res. 2012;12(1):400. http://dx.doi.org/10.1186/1472-6963-12-400. PMid:23150906.
20. Hofstad H, Naess H, Moe-Nilssen R, Skouen JS. Early supported discharge after stroke in Bergen (ESD Stroke Bergen): A randomized controlled trial comparing rehabilitation in a day unit or in the patients’ homes with conventional treatment. Int J Stroke. 2013;8(7):582-7. http://dx.doi. org/10.1111/j.1747-4949.2012.00825.x. PMid:22594689.
21. Dragga A. The role of speech-language pathologists in stroke rehabilitation. R I Med J. 2015;98(12):20-2.
22. Jones O, Cartwright J, Whitworth A, Cocks N. Dysphagia therapy post stroke: an exploration of the practices and clinical decision-making of speech-language pathologists in Australia. Int J Speech Lang Pathol. 2018;20(2):226-37. PMid:28079400.
23. Falsetti P, Acciai C, Palilla R, Bosi M, Carpinteri F, Zingarelli A, et al. Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit. J Stroke Cerebrovasc Dis. 2009;18(5):329-35. http://dx.doi.org/10.1016/j. jstrokecerebrovasdis.2009.01.009. PMid:19717014.
24. Forster A, Dickerson J, Young J, Patel A, Kalra L, Nixon J, et al. A cluster randomised controlled trial and economic evaluation of a structured training programme for caregivers of inpatients after stroke: the TRACS trial. Health Technol Assess. 2013;17(46):1-216. http://dx.doi.org/10.3310/hta17460. PMid:24153026.
25. Liu N, Cadilhac DA, Andrew NE, Zeng L, Li Z, Li J, et al. Randomized controlled trial of early rehabilitation after intracerebral hemorrhage stroke: Difference in outcomes within 6 months of stroke. Stroke. 2014;45(12):3502- 7. http://dx.doi.org/10.1161/STROKEAHA.114.005661. PMid:25336514.
26. Luft AR, Kesselring J. Critique of A Very Early Rehabilitation Trial (AVERT). Stroke. 2016;47(1):291-2. http://dx.doi.org/10.1161/STROKEAHA.115.010483. PMid:26658440.
27. Li Y, Padrón NA, Mangla AT, Russo PG, Schlenker T, Pagán JA. Using systems science to inform population health strategies in local health departments: a case study in San Antonio, Texas. Public Health Rep. 2017;132(5):549. http://dx.doi.org/10.1177/0033354917722149. PMid:28813636.
28. Brasil. Ministério da Saúde. Manual instrutivo do melhor em casa [Internet]. Brasilia; 2012. 30 p. Available from: http://189.28.128.100/dab/docs/geral/ cartilha_melhor_em_casa.pdf
29. Bland MD, Sturmoski A, Whitson M, Harris H, Connor LT, Fucetola R, et al. Clinician Adherence to a Standardized Assessment Battery Across Settings and Disciplines in a Poststroke Rehabilitation Population. Arch Phys Med Rehabil. 2013;94(6):53.e1. http://dx.doi.org/10.1016/j.apmr.2013.02.004. PMid:23415809.
30. Norrving B, Kissela B. The global burden of stroke and need for a continuum of care. Neurology. 2013;80(3, Suppl 2):5-12. PMid:23319486.
Submetido em:
07/02/2018
Aceito em:
03/10/2018
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