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CRITÉRIOS DE AVALIAÇÃO E MÉTODOS DE INTERVENÇÃO DE FISIOTERAPIA EM CRIANÇAS COM BRONQUIOLITE: UM INQUÉRITO EM PORTUGAL
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Abstract(s)
Introdução e objetivos: As orientações nacionais, Direção Geral da Saúde (DGS), e internacionais, American Academy of Pediatrics (APP), não recomendam a fisioterapia respiratória em crianças com bronquiolite viral aguda (BVA); no entanto, estas orientações baseiam-se, na sua maioria, em técnicas desatualizadas (percussão e vibração). Estudos recentes sugerem a necessidade de critérios de avaliação específicos, como o score de Wang, para suportar a intervenção do fisioterapeuta e demonstram que técnicas de intervenção baseadas na modulação de fluxos têm efeitos positivos na redução de sibilâncias, normalização do score de Wang, da frequência respiratória e aumento da saturação periférica de oxigénio (SpO2). Apesar de em Portugal existir um grande número de profissionais a trabalhar nesta área, desconhece-se que critérios de avaliação e técnicas de intervenção utilizam. Este estudo teve como objetivo identificar os critérios e métodos utilizados pelos fisioterapeutas que tratam crianças com BVA. Como objetivo secundário, o estudo pretendeu verificar se há associação entre os critérios e as técnicas utilizados com fatores como a idade, anos de experiência profissional, formação especializada, prática baseada na evidência, bem como a idade das crianças e a gravidade da BVA.
Metodologia: Foi realizado um inquérito online em Portugal, divulgado através de instituições de ensino, redes sociais e emails direcionados a fisioterapeutas que se encontravam a trabalhar nesta área, identificados através da rede de contactos da equipa. Foi realizada estatística descritiva dos dados recolhidos e testes de qui-quarado e Fisher para avaliar associações entre as variáveis sociodemográficas, de formação, gravidade da BVA, critérios de avaliação e técnicas de intervenção.
Resultados: Foram incluídos 60 participantes (90% mulheres, 65% com idade igual ou inferior a 39 anos, 83,3% com formação específica na área). Os critérios de avaliação que os fisioterapeutas mais utilizam foram sinais de dificuldade respiratória (98,3%), auscultação pulmonar (96,7%), condição geral da criança (95%), frequência respiratória (70%) e SpO2 (58,3%). Relativamente à intervenção, 80% dos fisioterapeutas utilizavam a técnica expiração lenta prolongada e 68,3% aumento do fluxo expiratório. A maioria (70%) reportou utilizar evidências científicas para suportar a prática. Houve associações significativas entre a prática baseada na evidência e a condição geral da criança (p=0,024) bem como a menor utilização de técnicas como vibração (p=0,034) e glossopulsão retrógrada (p=0,044), especialmente entre fisioterapeutas com menos experiência. A desobstrução rinofaríngea retrógrada (p=0,007) foi mais usada por profissionais com formação específica e em casos de BVA moderada, enquanto o uso de broncodilatadores (p=0,037) foi menos frequente entre fisioterapeutas com menos de cinco anos de experiência.
Conclusão: O estudo revelou que grande parte dos fisioterapeutas em Portugal apresenta uma prática baseada na evidência. No entanto, os critérios de avaliação e de intervenção ainda não são consensuais na prática de fisioterapia respiratória em crianças com BVA.
Introduction and aims: National guidelines from the Direção Geral da Saúde (DGS) and international guidelines from the American Academy of Pediatrics (AAP) do not recommend respiratory physiotherapy for children with acute viral bronchiolitis (AVB); however, these guidelines are mostly based on outdated techniques (percussion and vibration). Recent studies suggest the need for specific assessment criteria, such as the Wang score, to support the physiotherapist's practice and demonstrate that flow modulation-based techniques have positive effects on reducing wheezing, normalizing the Wang score, normalizing respiratory rate, and increasing peripheral oxygen saturation (SpO2). Although many professionals work in this field in Portugal, the assessment criteria and intervention techniques they use are not well known. This study aimed to identify the assessment criteria and methods used by physiotherapists treating children with AVB. As a secondary objective, the study sought to determine whether there is an association between the criteria and techniques used and factors such as age, years of professional experience, specialized training, evidence-based practice, as well as the age of the children and the severity of AVB. Methodology: An online survey was conducted in Portugal, distributed through educational institutions, social networks, and emails sent to physiotherapists working in this area, identified through the team’s contact network. Descriptive statistics of the collected data were performed, as well as chi-square and Fisher’s exact tests to assess associations between sociodemographic variable, training, AVB severity, assessment criteria, and intervention techniques. Results: A total of 60 participants were included (90% women, 65% aged 39 years or younger, 83.3% with specific training in the field). The most commonly used evaluation criteria by physiotherapists were the assessment of signs of respiratory distress (98.3%), lung auscultation (96.7%), the child's general condition (95%), respiratory rate (70%), and SpO2 (58.3%). Regarding the intervention techniques, 80% of physiotherapists used the prolonged slow expiration technique, and 68.3% used the increased expiratory flow technique. The majority of physiotherapists (70%) reported using current scientific resources to support their clinical practice. The evidence-based practice is associated with the evolution of the child (p=0,024) and the lesser use of techniques such as vibration (p=0,034) and retrograde glossopulsion (p=0,044) specially between physiotherapists with less experience. Retrograde rhinopharyngeal clearance (p=0,007) was the most used by professionals with specific formation and in cases of moderate bronchitis; while using bronchodilators (p=0,037) was less frequent between physiotherapists with less than five years of experience. Conclusion: The study revealed that a large proportion of physiotherapists in Portugal demonstrate evidence-based practice. However, the assessment criteria and intervention techniques are not yet fully consensual in the practice of respiratory physiotherapy in children with AVB.
Introduction and aims: National guidelines from the Direção Geral da Saúde (DGS) and international guidelines from the American Academy of Pediatrics (AAP) do not recommend respiratory physiotherapy for children with acute viral bronchiolitis (AVB); however, these guidelines are mostly based on outdated techniques (percussion and vibration). Recent studies suggest the need for specific assessment criteria, such as the Wang score, to support the physiotherapist's practice and demonstrate that flow modulation-based techniques have positive effects on reducing wheezing, normalizing the Wang score, normalizing respiratory rate, and increasing peripheral oxygen saturation (SpO2). Although many professionals work in this field in Portugal, the assessment criteria and intervention techniques they use are not well known. This study aimed to identify the assessment criteria and methods used by physiotherapists treating children with AVB. As a secondary objective, the study sought to determine whether there is an association between the criteria and techniques used and factors such as age, years of professional experience, specialized training, evidence-based practice, as well as the age of the children and the severity of AVB. Methodology: An online survey was conducted in Portugal, distributed through educational institutions, social networks, and emails sent to physiotherapists working in this area, identified through the team’s contact network. Descriptive statistics of the collected data were performed, as well as chi-square and Fisher’s exact tests to assess associations between sociodemographic variable, training, AVB severity, assessment criteria, and intervention techniques. Results: A total of 60 participants were included (90% women, 65% aged 39 years or younger, 83.3% with specific training in the field). The most commonly used evaluation criteria by physiotherapists were the assessment of signs of respiratory distress (98.3%), lung auscultation (96.7%), the child's general condition (95%), respiratory rate (70%), and SpO2 (58.3%). Regarding the intervention techniques, 80% of physiotherapists used the prolonged slow expiration technique, and 68.3% used the increased expiratory flow technique. The majority of physiotherapists (70%) reported using current scientific resources to support their clinical practice. The evidence-based practice is associated with the evolution of the child (p=0,024) and the lesser use of techniques such as vibration (p=0,034) and retrograde glossopulsion (p=0,044) specially between physiotherapists with less experience. Retrograde rhinopharyngeal clearance (p=0,007) was the most used by professionals with specific formation and in cases of moderate bronchitis; while using bronchodilators (p=0,037) was less frequent between physiotherapists with less than five years of experience. Conclusion: The study revealed that a large proportion of physiotherapists in Portugal demonstrate evidence-based practice. However, the assessment criteria and intervention techniques are not yet fully consensual in the practice of respiratory physiotherapy in children with AVB.
Description
Keywords
Bronquiolite Viral Aguda Fisioterapeutas portugueses Fisioterapia Respiratória Pediátrica Score de Wang