doctoralThesis
Implementação do domínio Participação da CIF na prática clínica de fisioterapeutas e terapeutas ocupacionais especializados em saúde da criança: uma abordagem baseada na Tradução do Conhecimento
Fecha
2021-05-07Registro en:
MOURA, Isabelly Cristina Rodrigues Regalado. Implementação do domínio Participação da CIF na prática clínica de fisioterapeutas e terapeutas ocupacionais especializados em saúde da criança: uma abordagem baseada na Tradução do Conhecimento. 2021. 204f. Tese (Doutorado em Fisioterapia) - Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, 2021.
Autor
Moura, Isabelly Cristina Rodrigues Regalado
Resumen
Introduction: The Participation domain of the International Classification of
Functioning, Disability and Health (ICF) is defined as involvement in life situations and
is considered a human right. It covers elements related to the frequency or diversity of
children's participation, involvement, and preferences. These elements work as critical
indicators of quality of life for children with disabilities, but they are little used in the
clinical practice of rehabilitation professionals. Thinking about broadening the look at
aspects related to participation, there is a need to identify barriers and facilitators for
implementation, then develop an intervention strategy through Knowledge Translation
(CT) to train rehabilitation professionals. Objectives: (i) Write a Scoping Review to
identify barriers and enablers for implementing in low-, middle- and upper-middleincome countries; (ii) Identify barriers and enablers to implement the participation
domain; (iii) Train professionals in relation to the participation domain and assess the
propensity level of professionals to change after training; (iv) Assess the perception of
professionals about training in participation. Justification: The implementation of the ICF
Participation domain will provide the identification of barriers and facilitators for the
implementation and the level of propensity to change of rehabilitation professionals,
stimulating the change in the therapeutic dynamics of professionals and better care for
families and children with motor disabilities. Methodology: During this study, a scope
review was carried out for knowledge of implementation strategies in rehabilitation in
low- and middle-income countries, mapping of barriers and facilitators for the
implementation and implementation of the ICF participation domain through a mixedmethods approach. In the scope review, 14 studies were identified, 3 of implementation
and 11 of mapping. During implementation 27 physiotherapists and occupational
therapists participated in four learning sessions facilitated by a knowledge facilitator. Before the intervention, professionals were interviewed through focus groups and through
the Organizational Readiness for Change (ORC) tool and focus groups to analyze the
level of propensity for change and identify barriers and facilitators for change. After the
intervention, professionals were interviewed again through focus groups to assess
possible change in practice. Two researchers performed the thematic analysis of the data
independently. The study design combines elements of a pragmatic essay and mixedmethods model. Results: In the scope review, individual and organizational barriers and
facilitators were observed for implementation in rehabilitation. Individual-level barriers
included lack of skills and knowledge, lack of motivation, decision making; and
knowledge of the English language. Facilitators included positive attitudes and
motivation. Organizational-level barriers included lack of time to access and implement
new practices, lack of financial and personal resources, limited access to scientific
journals, and applicability of research in rural settings. Facilitators included adequate
financial and physical resources, a supportive management environment, continuing
education and telerehabilitation. For the mapping of professionals, focus groups were
carried out where it was possible to identify individual and organizational barriers and
facilitators for implementation in the local context. Before the training, the professionals
demonstrated that they had good knowledge of the ICF, but they had low rates of use of
the classification in clinical practice. Individual and organizational barriers that could
hinder the implementation of participation were identified as negative beliefs of the
family and context, difficulty in broadening the view, and service barriers. As facilitators
for implementation, the standardization of actions, teamwork and encouragement of the
use of the ICF by other categories were mentioned. After the training, the professionals
showed an increase in the levels of propensity to change, and satisfaction with the
training, inserting the participation domain of the ICF into clinical practice. During implementation, professionals faced barriers of time, routine and work overload; and
facilitators related to good team training and personal enhancement. Conclusion: This
strategy was effective in identifying barriers and facilitators for implementation in lowand middle-income contexts, identifying the perception of professionals about training in
the ICF participation domain and redirecting the look of physical therapists and
occupational therapists to the notion of participation in leisure activities for children with
disabilities. This change can potentially facilitate new participation-based
implementations.