Rodrigues-de-Paula Fátima, Lana Raquel de Carvalho, Lopes Larissa Karlla Rodrigues, Cardoso Francisco, Lindquist Ana Raquel Rodrigues, Piemonte Maria Elisa Pimentel, Correa Clynton Lourenço, Israel Vera Lúcia, Mendes Felipe, Lima Lidiane Oliveira
Universidade Federal de Minas Gerais, Departamento de Fisioterapia, Belo Horizonte MG, Brasil.
Universidade Federal de Minas Gerais, Departamento de Clínica Médica, Belo Horizonte MG, Brasil.
Arq Neuropsiquiatr. 2018 Sep;76(9):592-598. doi: 10.1590/0004-282X20180087.
To identify the factors affecting the use of physiotherapy services among individuals with Parkinson's disease (PD) living in Brazil.
Overall, 479 individuals with idiopathic PD, of both sexes, at any stage of the Hoehn & Yahr (HY) scale, and from seven capital cities in Brazil were recruited from 2014 to 2016. Multivariate logistic regression was the main statistical tool. For the construction of the logistic model, the association of the dependent variable "physiotherapy" with the independent sociodemographic/economic and clinical variables: age, education, family income, time of PD since onset, HY, the activities of daily living and motor subscales of the Unified Parkinson's Disease Rating Scale, cognitive aspects, depressive symptoms, fear of falling, freezing gait, history of falls, physical activity level, gait speed, walking performance and balance, were verified.
The 479 individuals had an average age of 65.2 ± 11.0 years, 88% were in the HY I-III stages and 43.4% were under physiotherapy treatment. The analysis identified two determinant variables related to the use of the physiotherapy service: level of education (OR = 1.24) and walking performance (OR = 0.82). Decreased walking performance and a higher educational level increased the use of a physiotherapy service in individuals with PD living in Brazil.
The present study shows that individuals with PD, residents from different regions of Brazil, have limited access to physiotherapy services. In addition, the Brazilian Public Health Care System, as well as local programs, need to target PD individuals with a low educational level to improve their access to physiotherapy services. Goals should aim towards the development of physical exercise programs to improve the patients' functional performance for a longer period.
确定影响巴西帕金森病（PD）患者理疗服务使用情况的因素。
2014年至2016年期间，从巴西七个首府城市招募了479名特发性PD患者，涵盖各个性别、处于 Hoehn & Yahr（HY）量表的任何阶段。多因素逻辑回归是主要的统计工具。为构建逻辑模型，验证了因变量“理疗”与独立的社会人口统计学/经济和临床变量之间的关联：年龄、教育程度、家庭收入、PD发病以来的时间、HY、统一帕金森病评定量表的日常生活活动和运动子量表、认知方面、抑郁症状、跌倒恐惧、冻结步态、跌倒史、身体活动水平、步态速度、步行表现和平衡。
479名患者的平均年龄为65.2±11.0岁，88%处于HY I - III期，43.4%正在接受理疗治疗。分析确定了与理疗服务使用相关的两个决定因素变量：教育程度（OR = 1.24）和步行表现（OR = 0.82）。步行表现下降和较高的教育水平增加了巴西PD患者对理疗服务的使用。
本研究表明，来自巴西不同地区的PD患者获得理疗服务的机会有限。此外，巴西公共卫生保健系统以及地方项目需要针对低教育水平的PD患者，以改善他们获得理疗服务的机会。目标应朝着制定体育锻炼计划，以长期改善患者的功能表现。
