Browsing by Author "Pimenta, C"
Now showing 1 - 10 of 10
Results Per Page
Sort Options
- Análise da Relação Entre Desempenho e Comprometimento em Profissionais de Saúde: Revisão SistemáticaPublication . Pimenta, CIntrodução – O desempenho dos profissionais de saúde refere-se às competências clínicas, conhecimentos e habilidades técnicas, enquanto o seu comprometimento está relacionado com o vínculo psicológico e emocional com o trabalho e a organização. A compreensão da interação entre estes conceitos é importante para otimizar os resultados em saúde. Objetivos – Explorar a extensão e a natureza da relação entre desempenho e comprometimento nos profissionais de saúde, identificando os fatores que influenciam esta relação e quais as metodologias utilizadas para o seu estudo. Métodos – Foi realizada uma revisão sistemática da literatura seguindo o protocolo Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Resultados – Foram identificados 847 artigos, dos quais 14 foram incluídos para análise. Destaca-se a atualidade e universalidade do tema devido à profunda interação entre os constructos estudados. Alguns estudos apontam para correlações positivas diretas, enquanto outros evidenciam relações de influência mútua ou identificam o comprometimento como mediador em várias interações. Além disso, fatores como a satisfação no trabalho, o burnout, a liderança e a motivação também impactam a relação entre desempenho e comprometimento nos profissionais de saúde. Discussão – A relação entre desempenho e comprometimento nos profissionais de saúde é complexa e suscetível a diferentes influências. Conclusão – É pertinente a continuação de investigações para aprofundar o conhecimento nesta área, já que as organizações de saúde enfrentam o desafio contínuo de proporcionar uma assistência de qualidade aos pacientes, ao mesmo tempo que tentam gerir de forma eficiente recursos limitados.
- Assessing the Risk for Falls Among Portuguese Community-Dwelling Stroke Survivors. Are We Using the Better Tools? Observational StudyPublication . Pimenta, C; Correia, A; Alves, M; Virella, DPurpose: This study assesses the estimation of the risk for falls among community-dwelling stroke survivors referred for ambulatory physiotherapy and explores factors that affect the risk. Methods: Observational, cross-sectional with nested case-control study, of individuals, referred to physiotherapy less than 12 months after stroke and able to walk independently. Berg Balance Scale, Timed Up and Go Test, and the Motor Assessment Scale were applied. Berg Balance Scale ≤45 or Timed Up and Go Test > 14 were used to estimate the risk for falls. The discrimination ability of the estimation was assessed. Alternative models were explored by logistic regression analysis. Results: One hundred sixty-seven patients fulfilled the inclusion criteria. Patients were 21 to 87years old (median 66), 98 men (58.7%), and in 133 (79.6%) the stroke occurred in the last 6 months. Falls were reported by 78 (46.7%) of the patients but 139 (83.2% [95%CI 76.84–88.14]) were estimated as having risk for falls. The discrimination ability of the estimation of the actual occurrence of falls by Berg Balance Scale ≤45 or Timed Up and Go Test >14 was 55% (95%CI 47.5–62.4). The actual occurrence of falls was associated only with Motor Assessment Scale, as a protective factor. The discrimination ability of the estimation of the actual occurrence of falls by Motor Assessment Scale alone was area under the curve 0.69 (95%CI 0.60–0.77). Conclusions: Different tools with better performance are needed to identify the risk for falls after stroke.
- Better Balance: a Randomised Controlled Trial of Oculomotor and Gaze Stability Exercises to Reduce Risk of Falling After StrokePublication . Correia, A; Pimenta, C; Alves, M; Virella, DObjective: To assess the effect of a domiciliary program of oculomotor and gaze stability exercises on the incidence of falls and risk of fall in stroke survivors. Design: Two-arm, non-blinded parallel randomized controlled trial. Subjects: Stroke survivors older than 60 years, with positive Romberg test and autonomous gait after the stroke. Setting: Physiotherapy outpatient clinic of a tertiary care hospital. Interventions: Every participant accomplished the current rehabilitation program; the intervention group was randomly allocated into an additional three weeks intervention with a domiciliary program of oculomotor and gaze stability exercises. Main measures: Primary outcome was the incidence of falls through the three weeks after the intervention started; in addition, the variation of the estimated risk for falling assessed by both Berg Balance Scale (four points) and Timed Up and Go Test (four seconds) was the secondary outcome. Results: 79 patients were recruited and 68 completed the protocol (control group 35; intervention group 33). During the follow up, falls were registered in 4/35 participants in the control group and no event occurred in the intervention group (P = 0.064). The estimated risk for falling decreased in 11/35 control group participants and in 28/33 intervention group participants (RR 0.37; 95%CI 0.22-0.62; P < 0.001). Conclusion: After three weeks of a domiciliary program of oculomotor and gaze stability exercises, the estimated risk of falling significantly diminished and no falls occurred among the intervention group. These findings encourage further exploration of this promising intervention.
- Concordância entre Instrumentos de Avaliação do Equilíbrio após Acidente Vascular CerebralPublication . Correia, A; Pimenta, C; Alves, M; Virella, DIntrodução – A perturbação do equilíbrio após acidente vascular cerebral (AVC) é importante pela sua frequência e repercussões. Instrumentos de avaliação do equilíbrio validados e de fácil aplicação são necessários para identificar risco de queda e para adequar estratégias de intervenção. Objetivos – Verificar a concordância entre as avaliações do equilíbrio estático, dinâmico e mobilidade funcional após AVC e verificar se a concordância varia com o grau de dependência. Metodologia – Estudo transversal de amostra sequencial de adultos com marcha autónoma, até dois anos após AVC, referenciados para fisioterapia em ambulatório. O equilíbrio estático foi avaliado pelo teste de Romberg, o equilíbrio dinâmico pela Escala de Equilíbrio de Berg (EEB), a mobilidade funcional pelo Timed Up and Go test (TUG) e o grau de dependência pela Motor Assessment Scale (MAS). A concordância foi avaliada pelo coeficiente de correlação interclasse e pelo teste k de Cohen. Resultados – Foram incluídos 52 indivíduos, 26 com dependência leve, 20 moderada e seis grave. Tinham Romberg positivo 48/52; 39/52 tinham EEB<45 e o TUG>14 foi observado em 42/52. A concordância global entre as três variáveis avaliadas obteve ICC=0,63. Verificou-se uma concordância global k=0,61 entre EEB e TUG, nos indivíduos com dependência leve k=0,52 e naqueles com dependência moderada k=0,64. A concordância entre Romberg e EEB obteve globalmente k=0,27 e entre Romberg e TUG k=0,04. Conclusões – A concordância entre as avaliações do equilíbrio estático, dinâmico e mobilidade funcional após AVC é total nos casos de dependência grave e elevada nos casos de dependência moderada. Estes resultados reforçam a necessidade da utilização destes três instrumentos, particularmente nos casos de dependência leve.
- Domiciliary Gaze Stability and Oculomotor Exercises Improves Balance After Stroke. Better Balance, a Randomized Controlled TrialPublication . Correia, A; Pimenta, C; Alves, M; Virella, DAbstract Title: Domiciliary gaze stability and oculomotor exercises improves balance after stroke. BetterBalance, a randomized controlled trial Authors: Anabela Correia1,2, Carla Pimenta1,2, Marta Alves3, Daniel Virella3 1. Physiotherapy Department, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Portugal. 2. Department of Rehabilitation Science and Technology, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, 3. Epidemiology and Statistics Office of the Research Unit, Centro Hospitalar Universitário Lisboa Central, Portugal. Background: Visual stabilization and the vestibulo-ocular reflex as mechanisms of gaze stability are needed to coordinate the movements of the head, trunk and pelvis during walking. Balance impairment after stroke is strongly associated with more severely impaired motor function, a decrease in recovery potential and an increase of the number of falls. Purpose: To verify the efficacy of a domiciliary training program for balance impairment after stroke in senior patients. Methods: Patients older than 60 years, discharged after stroke to the physiotherapy department, were recruited to a randomized controlled trial for improving orthostatic balance (ClinicalTrials.gov: NCT02280980). Eligible patients had stroke 3-15 months earlier, positive Romberg test and autonomous walk for ³3m. Participants were allocated (block randomization by age, balance and functionality) into the current rehabilitation program (observational group - OG) or into a supplemental intervention focused on a domiciliary program of oculomotor and gaze stability exercises (intervention group - IG) for three weeks. Primary outcome was the incidence of falls; the variation of the estimated risk for falls by Berg Balance Scale (BBS) and Timed Up and Go Test (TUG) were surrogate outcomes: minimum difference of 4 seconds in TUG and 4 points in BBS. Data were analyzed by per protocol. Relative Risk (RR) for the outcome was estimated with 95% confidence interval (95%CI). Multivariable logistic regression was applied to model for the decrease of the risk for falls. Results: From the 217 referred patients, 71 were recruited and completed the protocol 61 patients (OG 32; IG 29), aged 60-87 years old (median OG 73; IG 74), similarly distributed by gender, type of stroke and reported falls before recruitment (OG 21/32; IG 15/29). No falls were registered in the IG and 4 patients fell in the OG. The surrogate outcome occurred in 11/32 OG patients and in 26/29 IG patients (RR 2.61; 95%CI 1.59 - 4.28; p<0.001); all the IG females reached the surrogate outcome. The increase of BBS was larger (p<0.001) in the IG (median difference 7 vs. 2); a weak evidence of difference on TUG was observed (median difference OG=-0.72 sec. and IG=-1.28 sec.; p=0.059). The model for decrease of the estimated risk for falls revealed that the intervention lead to a 21.4 fold increase on the odds (aOR 21.43; 95%CI 4.75 – 96.66; p<0.001) and that females had 4.75 fold higher odds for decrease than males (aOR 4.75; 95%CI 1.11 – 20.25; p=0.035). Conclusions: The trial did not reach power to assess the efficacy of the intervention as actually preventing falls, although evidence was obtained that complementary oculomotor and gaze stability exercises decrease the estimated risk for falls and that this decrease is larger in females. Implications: Domiciliary oculomotor and gaze stability exercises are a promising approach as a complement in the physiotherapy intervention after stroke, whenever balance impairment is present. Given the high incidence of falls in these patients and their social and economic impact, this can be an efficient strategy to improve balance and reduce the risk for falls. Keywords: risk for falls, stroke, clinical trial Funding acknowledgements: No external funding was granted to this study. Brief biography of presenting author: Anabela Correia (presenting author) is a Portuguese Physiotherapist, with a graduation from the Escola Superior de Tecnologia da Saúde de Lisboa (ESTESL) and a MSc degree Physiotherapy from ESTESL. Works as a physiotherapist as part of a multidisciplinary team in a Rehabilitation Department in a central hospital in Lisbon (Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central) for more than 20 years and as an invited assistant, teaching at ESTESL since 2012. The mainly interest and current work is focus in vestibular and balance disorders in patients with vestibular, neurologic pathology and in patients with a high risk of falls. Information concerning any presentations or publications of the work made prior to congress This trial is registered (ClinicalTrials.gov NCT02280980) and the study protocol was published [Pimenta C, Correia A, Alves M, Virella D (2017) Effects of oculomotor and gaze stability exercises on balance after stroke: Clinical trial protocol. Porto Biomedical Journal. 2(3):76–80]. In this presentation will be released the preliminary results.
- Effects of Oculomotor and Gaze Stability Exercises on Balance after Stroke: Clinical Trial ProtocolPublication . Pimenta, C; Correia, A; Alves, M; Virella, DBackground: The inability to maintain balance after stroke is an important risk factor for falling and relatesto decreased potential for recovery. The vestibular system and gaze stability contribute respectively topostural stability and to maintain balance. Rehabilitation may be more effective with domiciliary training.Objective: This trial aims to verify if balance impairment after stroke improves with a domiciliary oculo-motor and gaze stability training program.Methods: Individuals older than 60 years, discharged after suffering brain stroke with referral to thephysiotherapy department, will be assessed for orthostatic balance. Patients with stroke diagnosis 3–15months before recruitment, positive Romberg test and able to walk 3 m alone are invited to participate inthis randomized controlled trial. Participants will be allocated in two intervention groups through blockrandomization, either the current rehabilitation program or to a supplemental intervention focused onoculomotor and gaze stability exercises to be applied at home twice a day for three weeks. Primaryoutcome measures are the Motor Assessment Scale, Berg Balance Scale and Timed Up and Go Test. Trialregistration: ClinicalTrials.gov (NCT02280980).Results: A minimum difference of four seconds in the TUG and a minimum difference of four points inBBS will be considered positive outcomes.Conclusions: Oculomotor and gaze stability exercises may be a promising complement to conventionalphysiotherapy intervention after brain stroke, improving the balance impairment.
- Estimated Risk for Falls Among Community-Dwelling Stroke Survivors Referred to Outpatient PhysiotherapyPublication . Pimenta, C; Correia, A; Alves, M; Virella, DTitle: Estimated risk for falls among community-dwelling stroke survivors referred to outpatient physiotherapy Authors: Carla Pimenta1,2, Anabela Correia1,2, Marta Alves3, Daniel Virella3 1. Physiotherapy Department, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Portugal. 2. Department of Rehabilitation Science and Technology, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Portugal. 3. Epidemiology and Statistics Office of the Research Unit, Centro Hospitalar Universitário Lisboa Central, Portugal. Background: In the sub-acute phase of stroke, most of the patients with moderate or severe impairments typically attend in-patient rehabilitation. Functional recovery continues after discharge and patients can benefit of outpatient physiotherapy. Homecoming may lead to an increased risk for falls, as the patient is no longer in a protected environment. The physiotherapy assessment should identify the risk of falling, in order to minimize it. Purpose: To estimate the risk for falls among community-dwelling stroke survivors referred to the outpatient physiotherapy in a tertiary care hospital and to explore factors associated with increased risk for falls. Methods: Observational, cross-sectional study with nested case-control study, of individuals referred to the physiotherapy department less than 12 months after stroke and able to walk independently. A referral period of 4 years was considered. Three functional tools were applied: Berg Balance Scale (BBS), Timed Up and Go Test (TUG) and the Motor Assessment Scale (MAS); demographic and clinical data were collected. Risk for falls was defined as BBS≤45 or TUG³14. Independent variables to include in the multivariable logistic regression model were identified by Chi- Square test and Mann-Whitney test. Results: Of 217 individuals referred for ambulatory treatment, 140 fulfilled the inclusion criteria. Patients were 21 to 87 years old (median 66), 80 males, in 109 the stroke occurred in the lasts 6 months, 117 had ischemic stroke and in 29 it was a recurrent stroke. Risk for falls was identified in 117 individuals (83.6% [95%CI 76.6 - 88.8]); 95 cases were identified by both BBS and TUG, 12 only by BBS and 10 by TUG alone. The model for risk for falls included age, gender and MAS shows that for each increase in one year of age, the odds for falls increased 10% (adjusted OR 1.10; 95%CI 1.04 – 1.17; p=0.002), odds for falls was 14 fold higher in females (adjusted OR 14.43; 95%CI 1.89 – 110.12; p=0.010) and for each increase in MAS units, the odds for falls decreased 23% (adjusted OR 0.77; 95%CI 0.66 – 0.88; p<0.001). Conclusions: Estimated risk for falls is very frequent after stroke (75-90%), especially in the elder and in females; it is associated with lower autonomous functionality. Evidence is needed for the adequate physiotherapy interventions to prevent falls after stroke, customized by standardized risk assessment. Implications: The identification of the risk for falls and its causes, such as the balance disorders should be translated into physical therapy practice. Keywords: Fall, stroke, balance disorder, functionality, risk assessment. Funding acknowledgements: No external funding was granted to this study. Brief biography of presenting author: Carla Pimenta (presenting author) is a Physiotherapist with a graduation from the Escola Superior de Tecnologia da Saúde de Lisboa (ESTESL) and a MSc degree in Social and Organizational Intervention in Health from the Universidade de Évora / ESTESL. Presently, works as a physiotherapist, in a multidisciplinary team at the Rehabilitation Department in a tertiary hospital in Lisbon (Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central) and as an invited assistant, teaching at ESTESL. In more than 20 years of hospital practice has already worked in several departments that request physiotherapy interventions, with in and outpatients. Since 2001, is mainly dedicated to the area of neuromuscular therapy, with patients with neurological disorders in sub-acute phase, admitted to the rehabilitation department and follow up immediately after hospital discharge (essentially strokes, traumatic head injuries and neurosurgery patients). Information concerning any presentations or publications of the work made prior to congress: No presentation or publication of this work was done before the congress; however, the authors are writing a manuscript and intend to publish. Pimenta C, Correia A, Alves M, Virella D. (2009) Estimated risk for falls among community-dwelling stroke survivors referred to outpatient physiotherapy (Postrer). Geneve: World Conference for Physical Therapy
- Liderança e Motivação para o Serviço Público: Revisão SistemáticaPublication . Pimenta, CA liderança é entendida como um processo de influência em que um líder orienta um grupo em direção a um objetivo comum. A Motivação para o Serviço Público (MSP) envolve o desejo de contribuir para o bem-estar da sociedade e o compromisso em oferecer um serviço público de qualidade. Compreender a relação entre liderança e MSP é fundamental para o desenvolvimento de estratégias de gestão de recursos humanos, nomeadamente na Administração Pública, visando melhorar a eficácia e eficiência do serviço público. Foi realizada uma revisão sistemática da literatura para analisar os estilos, características e práticas de liderança que mais influenciam a MSP, bem como para identificar outros fatores determinantes considerados relevantes nesta relação. Seguindo o protocolo Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), foram identificados 309 documentos, dos quais 39 foram incluídos para análise. Os resultados mostram que este é um tema atual e universal. A liderança transformacional e a liderança servidora são destacadas como promotoras da MSP. Além disso, identificaram-se outros fatores determinantes, na relação entre liderança e MSP, como as questões organizacionais, o desempenho, as atitudes e aspetos comportamentais, a satisfação e bem-estar e o comprometimento. A relação entre liderança e MSP é complexa e influenciada por vários fatores. É pertinente que se continuem a realizar estudos empíricos, para ampliar o conhecimento nesta área.
- Nova Gestão Pública e Novo Serviço Público: uma Análise ComparativaPublication . Pimenta, CA Administração Pública (AP) desempenha um papel vital na história humana, as suas práticas evoluíram ao longo do tempo, refletindo valores em constante mudança. Existem três categorias principais de modelos de governação pública: os modelos tradicionais, os gestionários e os pós-gestionários. Este estudo descritivo tem como objetivo realizar uma análise comparativa entre um modelo gestionário - a Nova Gestão Pública (NGP) e um modelo pós-gestionário - o Novo Serviço Público (NSP). A NGP ao defender a aplicação de práticas de negócios no setor público, visando maior eficiência e responsabilização, enfrentou críticas de falta de substância, efeitos negativos na qualidade do serviço público e concentração de poder. Em contrapartida, o NSP valoriza a democracia, a responsabilidade pública e a ética na AP, promovendo uma abordagem centrada no cidadão. A comparação entre a NGP e o NSP destaca a importância dada a diferentes valores na AP, com a NGP enfatizando a eficiência e o NSP promovendo valores democráticos e de cidadania. No entanto, a tendência atual é para uma abordagem híbrida que combina eficiência com a responsabilidade pública e a participação cívica. O estudo comparativo entre a NGP e o NSP é relevante, pois oferece uma compreensão da evolução da gestão na AP, destacando como esses modelos aparentemente opostos podem coexistir e complementar-se para promover uma governança pública mais eficaz e centrada no cidadão. Isso é essencial para os gestores e decisores atuais enfrentarem os desafios contemporâneos da AP.
- Transição Digital e Transformação Organizacional na Saúde: Políticas Públicas, Desafios e OportunidadesPublication . Pimenta, CA transição digital na saúde desencadeou uma transformação profunda na organização do setor, apresentando novos desafios para os decisores políticos e exacerbando a complexidade das escolhas necessárias para garantir uma prestação de cuidados eficiente e a sustentabilidade dos sistemas de saúde. Este estudo descritivo pretende analisar as perspetivas apresentadas na literatura, tendo como objetivo geral enquadrar a transição digital na saúde como uma política pública e refletir sobre como influencia a transformação organizacional. Especificamente visa identificar desafios e oportunidades inerentes às políticas públicas que promovem a transição digital e que contribuem para a transformação organizacional na área da saúde. A transição digital na saúde, com a consequente transformação organizacional, melhora a acessibilidade e a qualidade dos cuidados. Abordagens inovadoras superam as limitações dos modelos tradicionais de prestação de cuidados, promovendo a melhoria da eficiência operacional global. A proteção dos dados de saúde e a segurança dos sistemas contra ameaças digitais são pré-requisitos essenciais para assegurar a integridade e a confidencialidade da informação. Este panorama reflete a visão de um sistema de saúde mais ágil, personalizado e resiliente, alinhado com os desafios e as oportunidades do mundo digital contemporâneo. Sugere-se a realização de futuras pesquisas que avaliem o impacto da transição digital na experiência do utente, identifiquem os desafios específicos de cibersegurança e ética na saúde digital e também a realização de estudos comparativos ou análises sistemáticas de abordagens específicas que são essenciais para orientar as decisões estratégicas neste contexto.