Protocolo fisioterapêutico de atendimento à pessoa idosa em situação de violência

Abstract

Violence against the old person develops in the context of the vulnerability of interpersonal relationships, and health professionals are able to trigger effective prevention and protection mechanisms. The physiotherapist has the potential to intervene in the entire dynamics of the situation, because it acts in health promotion, disease prevention and rehabilitation of the old person, besides establishing an intimate and prolonged bond with these people. However, no care therapy protocol has been identified in the literature. Objectives: To identify physical therapy interventions aimed at the old person in situations of violence; propose a physiotherapeutic protocol directed to these people; and validate the contents of the protocol. Method: This is a study conducted in three stages: scope review, elaboration and validation of a protocol (methodological study). The scope review involved research in databases, libraries, search engines and gray literature on physical therapy interventions aimed at the old person in situations of violence. For the preparation of the document, the results obtained in the scope review were considered; recommendations of guides for the development of protocols; government publications and professional associations; and scientific studies in common with the subject. The validation comprised the evaluation of the protocol by 6 expert judges, through 23 items distributed in 6 domains, and two general classification items, described in the Appraisal of Guidelines for Research and Evaluation II instrument (AGREE II). For each domain, a percentage of quality was calculated according to the formula established in the tool. Results: The approaches included in the protocol involved: prevention (health education; evaluation and interventions in caregiver stress; social bonds and community resources, maintenance of functional independence and screening/triage); diagnosis (identification, evaluation and notification of cases); therapeutic plan and rehabilitation; and follow-up. In the validation stage, the percentages obtained were: 97.2% for Domain 1 (scope and purpose); 88.9% for Domain 2 (stakeholder involvement); 94.1% for Domain 3 (development rigour); 97.2% for Domain 4 (clarity of presentation); 93.1% equivalent to Domain 5 (applicability); and 93.1% related to Domain 6 (editorial independence). In the overall evaluation, 83.3% of the experts judged it with a maximum score, recommending the use of this guideline. Discussion: In order to meet the considerations of all judges and improve the quality of the guidelines, adjustments and complements were made in the protocol elaborated, regarding the following items: development team (item 4); knowledge of the opinions and preferences of the target population (item 5); target users (item 6); benefits, side effects and health risks (item 11); external review (item 13); description of facilitating factors and barriers to protocol application (item 18). Final Considerations: It is expected that this protocol can contribute to physiotherapy services regarding the organization and standardization of their conducts, in addition to supporting the practice of professionals who work with the old people in situations of violence, making it possible to reduce the impacts caused by this problem.