Avaliação da qualidade de serviços de fisioterapia neuropediátrica ofertados em centros especializados em reabilitação na Paraíba

Abstract

OBJECTIVE: to analyze the caregivers' perspective on the quality of neuropediatric physiotherapy services offered in Specialized Rehabilitation Centers (SRC) in Paraíba, Brazil. MATERIALS AND METHODS: this is a cross-sectional and evaluative study, which took place in two methodological stages: 1- development and validation of an instrument to assess the quality of neuropediatric physiotherapy services; 2- evaluation of the quality of these services in the SRC. The first stage took place according to the following phases: conceptual definition and selection of dimensions and items, through literature review and content validation; determination of the sampling process; and evaluation of psychometric properties, through reliability analysis, using Cronbach's alpha (α), and validity, through Factor Exploratory (EFA) and Confirmatory (CFA) Analysis. The second stage was conducted from a quantitative approach, whose target population was represented by caregivers of children in rehabilitation. In the second stage, for data collection, the instrument developed and validated was used, AQSF-Neuroped, to assess the quality of neuropediatric physiotherapy services offered at three SRC in Paraíba, based on the perspective of caregivers, as well as an instrument to trace the sociodemographic and clinical profile. 320 caregivers were interviewed. For the assessment of quality, the proportions test was used to designate the quality of services from the perspective of caregivers. In this context, a positive quality perspective was adopted as a parameter. Therefore, a proportion of respondents equal to or greater than 80% was accepted as acceptable. To analyze the quality results based on the influence of the variables ―child's age‖, ―education of the caregiver‖ and ―evaluated service‖, the following methods were selected: Weight of Evidence (WoE) and Latent Class Analysis (LCA). RESULTS: The Kaiser-Meyer-Olkin test obtained an index of 0.917 and Bartlett's sphericity index of ꭓ2 = 4540.178 (p <0.001). EFA defined four factors, with total variance of 52.29% and internal consistency greater than 0.70 for each factor. The structure obtained was confirmed by CFA, indicating a good model fit (ꭓ2/gl = 1.534; RMSEA = 0.046; TLI = 0.927; CFI = 0.936). The final version of AQSF-Neuroped consisted of 33 items distributed in four dimensions of quality: technical, interpersonal and organizational I and II. The services were evaluated with a ―positive quality perspective‖, however, a score was obtained that was very close to regular quality. The aspects evaluated with the worst perspective of quality were those related to the interpersonal dimension, therefore, associated with the structure and supply of resources. The organizational dimension II, linked to access, was also negatively assessed, implying the need for improvements in view of its aspects. However, the technical dimension was well evaluated. In WoE, the ―service‖ variable strongly influenced the positive quality perspective, with the service offered at CER B being the best rated. The LCA made it possible to identify, through the formation of a group, which characteristics of the caregiver determined a positive or negative quality perspective. CONCLUSION: the instrument's psychometric properties showed evidence of validity and reliability, suggesting that it could be used in health contexts similar to the study. It is hoped that the results can support decision making by managers, in order to improve the quality of aspects related to physical therapy assistance, the structure and organization of these services.