Avaliação funcional remota e custos relacionados ao tempo de espera para fisioterapia ambulatorial em idosos no Sistema Único de Saúde

Abstract

The COVID-19 pandemic accelerated the adoption of digital solutions to ensure the continuity in healthcare delivery. Despite increasing use of technology, evidence on the reliability of remote functional assessments remains limited, highlighting the need for targeted research. Simultaneously, delays in initiating physical therapy disrupt cara continuity, imair functional recovery - especially among older adults – and increase healthcare costs. To support the sustainability of Brazil’s Unified Health System (SUS), economic evaluations are crucial to inform resource allocation. This thesis aimed to (1) investigate the measurement properties of the Timed Up and Go (TUG) test and the 30-Second Chair Stand Test (30CST) when administered remotely, and (2) estimate the direct costs associated with waiting period of older adults after hospital discharge for outpatient physical therapy within the SUS. This thesis was conducted in two stages. The first stage comprised a methodological study that evaluated the parallel reliability of remote versus in-person assessments using the TUG and 30CST in older adults with various musculoskeletal conditions. The study also analyzed the test-retest, intra-rater, and inter-rater reliability of the remote assessments. The sample included 50 older adults. Results showed high parallel reliability (ICC > 0.82) and very high test-retest, intra-rater, and inter-rater reliability of the remote assessments (ICC > 0.90). These findings suggest that remote administration of these tests is reliable and can be used when in-person assessments are not feasible. The second stage involved a bottom-up micro-costing study that estimated the direct costs incurred during the waiting period for outpatient physical therapy among recently hospitalized older adults. It also examined clinical and demographic factors associated with the total costs to the SUS. A generalized linear regression model with a gamma distribution and log link was employed. The model included clinical, demographic, and functional variables, as well as interactions between sex and functional performance. The model revealed significant associations between total SUS costs and standardized TUG scores (ZTUG), as well as interactions between sex and functional performance, indicating that poorer TUG performance increased costs in women, while better performance on the 30CST reduced costs in men. The findings of this thesis demonstrate that remote functional assessments are reliable and can expand access to rehabilitation services. Moreover, they reveal the role of functional performance and sex on healthcare costs, reinforcing the importance of implementing screening strategies that optimize resource use and promote greater equity in access to physical therapy within the SUS.