Intervenção colaborativa família-profissional na reabilitação pediátrica via telessaúde: percepção das famílias

Abstract

Introduction: The offer of services via telehealth makes it possible to know the child's natural environment and allows the physiotherapist to identify factors in the family context that can be modified to increase the performance in activities and the participation of the child. Collaborative models, which integrate the principles of family-centered practice, have been studied in the face-to-face rehabilitation of children with disabilities. However, there are no studies on the feasibility of a collaborative family-professional intervention offered via telehealth. Objectives: The primary objectives of this study were to verify the adherence rate, daily commitment time, and parents' perception regarding the feasibility and centrality in the family of a collaborative family-professional physical therapy intervention via telehealth for children with disabilities. The secondary objectives were to verify the achievement of goals and changes in the performance of the participating children, and their satisfaction with their performance based on the family's perception. Methods: This is a mixed methods feasibility study, with 15 families responsible for 17 children with disabilities who participated in a collaborative family-professional intervention, in four stages, for eight weeks. In Step 1, an interview was conducted with the adaptation of the Canadian Occupational Performance Measure (COPM) and, the Pediatric Assessment of Disability Inventory – Adaptive Computerized Testing (PEDI-CAT) was applied. Step 2 consisted of shared planning of the intervention, with the elaboration of the Goal Attainment Scaling (GAS) and the matrix of activities and family routine. In Step 3, the family-professional collaborative intervention was implemented, considering the principles of goal-oriented training. In Step 4, the entire process was evaluated, with reapplication of the COPM, PEDI-CAT and GAS. In the end, families were invited to respond to the Measure of Processes of Care - 20 (MPOC) and participated in a semi-structured interview. In-depth interviews were analyzed using thematic analysis. To compare the pre-and post-intervention scores, the paired t-test was performed, and the effect size (d) was calculated. Results: The study included 15 families, responsible for 17 children, with a mean age of 22.41 (±25.37) months, 12 of which were boys (70.6%). The adherence rate to the telehealth sessions ranged from 66.7% to 100%, and the average daily commitment time reported by the family to carry out the proposed activities was 1.32 hours (±0.58). The main facilitators, barriers, and benefits of participating in this intervention modality were explored by parents who perceived the service as “to a fair extent” family-centered, according to the MPOC-20. Through the thematic analysis method, four sub-themes for “facilitators”, three sub-themes for “barriers” and four sub-themes for “benefits” emerged from the qualitative data. More than half (58.92%) of the established goals were achieved and there was a statistically significant increase in performance (p<0.0001) and satisfaction with performance in the COPM (p=0.001), with a large effect size. A significant improvement was verified for the performance of daily activities (p=0.02) and for the mobility performance (p=0.001) in the PEDI-CAT, with a small effect size. Conclusion: The family-professional physiotherapeutic intervention via telehealth was considered feasible to be used with children with disabilities. Participating families showed satisfaction and involvement with the intervention process, with a high rate of adherence and daily commitment.