Programa domiciliar individualizado remoto durante a pandemia da COVID-19: análise dos efeitos da intervenção na funcionalidade diária de crianças com deficiência e percepção dos cuidadores e profissionais de reabilitação

Abstract

Governments and health sectors in several countries have adopted significant changes in the regulation of health services in the context of the COVID-19 pandemic. At that moment, there was an urgency in decision-making strategies to monitor families and continue providing pediatric rehabilitation services. Family-centered intervention models, such as home-based programs, can be an alternative to support families during the period of social isolation. Home programs are defined as therapeutic activities that the child performs with the assistance of parents and support from therapists, at the home environment, with the aim of achieving better functional performance in daily activities. However, little is known about the effects of an individualized remote home program implemented with children with disabilities with the addition of the context of social isolation due to COVID-19 pandemic in Brazil and about the perceptions of families and professionals regarding the implementation of this type of program. Such information can contribute to the development of future child and youth rehabilitation actions. Objectives: 1) To analyze the effects of the individualized home program through an online platform on the performance and satisfaction with the performance of functional goals of children and adolescents with cerebral palsy (CP); 2) To investigate the influence of factors such as age, sex, functional abilities, type of functional objectives, parental education level and perception of the care process, on the performance and satisfaction with the performance of functional goals of children and adolescents with CP; 3) To understand the benefits and challenges, from the perspective of the family and therapists, of an individualized remote home program in a pediatric rehabilitation institution during the period of the COVID-19 pandemic. Methods: Families of children and adolescents with CP treated in a remote home program implemented at the Associação Mineira de Reabilitação (AMR), in partnership with Universidade Federal de Minas Gerais (UFMG), for 4 months. Teleservices took place weekly on the Google Meet platform and lasted approximately 40 minutes. Functional goals were established by the family through the application of the Canadian Occupational Performance Measure (COPM). The performance and satisfaction scores with performance on the COPM before (T1), after (T2) and follow-up (T3) (3 months after the intervention), were used for inferential analysis. Results: Significant changes were observed in the performance and satisfaction with the performance of daily activities of children and adolescents with CP. Reports of the, benefits and challenges of the intervention were explicitly mentioned by the families and professionals. Conclusion: The implementation of the remote individualized home program had positive functional outcomes for children and adolescents with disabilities. The active participation of families can foster their involvement with the rehabilitation and the achievement of functional goals. Families should be part of their children's rehabilitation team.