Abstract

Introduction

In recent decades, developments in the area of health have had a positive impact on the increase in life expectancy of the Brazilian population¹1. Leal SC, Lopes MJM. Violência como objeto da assistência em um hospital de trauma: o “olhar” da enfermagem. Ciênc Saúde coletiva 2005; 10(2): 419-31.. In truth, this is a worldwide phenomenon, resulting from advances in medicine, vaccinations, drugs manufactured by the pharmaceutical industry and improvement in the quality of life. In contrast, especially since 1980, external causes have become a serious public health problem²2. Gawryszewski VP, Koizumi MS, Mello Jorge MHP. As causas externas no Brasil no ano de 2000: comparando a mortalidade e a morbidade. Cad Saúde Pública 2004; 20(4): 995-1003. ^{, 3}3. Souza ER, Ximenes LF, Alves F, Magalhães C, Bilate D, Szuchmacher AM et al. Avanços do conhecimento sobre as causas externas no Brasil e no mundo: enfoque quantitativo e qualitativo. In: Minayo MCS, Souza ER (org.). Violência sob o olhar da saúde: A infrapolítica da contemporaneidade brasileira. Rio de Janeiro: FIOCRUZ; 2003..

According to the World Health Organization (WHO)⁴4. Organização Mundial da Saúde. Manual de classificação estatística internacional de doenças e problemas relacionados à saúde. 10a Revisão. Volume 1. São Paulo; 1993., external causes are categorized as follows: accidental (falls; poisoning; drowning; transport and work accidents; others) and intentional (assault; self-inflicted injuries; homicides; suicides). Male adolescents are predominantly affected by external causes⁵5. Gawryszewski VP, Scarpelini S, Dib JA, Mello Jorge MHP, Júnior GAP, Morita M. Atendimentos de emergência por lesões decorrentes de causas externas: características das vítimas e local de ocorrência, Estado de São Paulo, Brasil, 2005. Cad Saúde Pública 2008 ; 24(5): 1121-9. ^{, 6}6. Melione LPR, Mello Jorge MHP. Morbidade hospitalar por causas externas no Município de São José dos Campos, Estado de São Paulo, Brasil. Epidemiol Serv Saúde 2008 ; 17(3): 205-16., having a negative effect on the quality of life of victims and their family members. High direct and indirect costs result in a negative impact on society⁷7. São Paulo. Secretaria de Estado da Saúde. Grupo técnico de acidentes e violências. Centro de vigilância epidemiológica “Prof. Alexandre Vranjac”. Coordenadoria de centro de controle de doenças. O impacto dos acidentes e violências nos gastos da saúde. Rev Saúde Pública 2006 ; 40(3): 553-6..

Falls²2. Gawryszewski VP, Koizumi MS, Mello Jorge MHP. As causas externas no Brasil no ano de 2000: comparando a mortalidade e a morbidade. Cad Saúde Pública 2004; 20(4): 995-1003. ^{, 6}6. Melione LPR, Mello Jorge MHP. Morbidade hospitalar por causas externas no Município de São José dos Campos, Estado de São Paulo, Brasil. Epidemiol Serv Saúde 2008 ; 17(3): 205-16.and transport accidents⁶6. Melione LPR, Mello Jorge MHP. Morbidade hospitalar por causas externas no Município de São José dos Campos, Estado de São Paulo, Brasil. Epidemiol Serv Saúde 2008 ; 17(3): 205-16. ^{, 9}9. Oliveira ZC, Mota ELA, Costa MCN. Evolução dos acidentes de trânsito em um grande centro urbano,1991-2000. Cad Saúde Pública 2008; 24(2): 364-72.are the external causes with the highest incidence. In Brazil, data from the DENATRAN's statistical yearbook¹⁰10. Anuário Estatístico do DENATRAN. [S.l], 2005. Disponível em http://www2.cidades.gov.br/ renaest/detalheNoticia.do?noticia.codigo=115 (Acessado em 21 de setembro de 2008).
http://www2.cidades.gov.br/ renaest/deta... reveal significant numbers of victims and injuries that lead to high morbidity¹⁰10. Anuário Estatístico do DENATRAN. [S.l], 2005. Disponível em http://www2.cidades.gov.br/ renaest/detalheNoticia.do?noticia.codigo=115 (Acessado em 21 de setembro de 2008).
http://www2.cidades.gov.br/ renaest/deta... .

Lianza points out that, according to WHO estimates¹²12. Organização Mundial da Saúde. Relatório mundial sobre violência e saúde . Genebra; 2002., 10% of the population of any country in peace have several levels of disability. Thus, for these individuals to recover their role in their family and society, adequate therapeutic interventions must be performed in due course¹¹11. Lianza S. Medicina de reabilitação . 4aedição. Rio de Janeiro: Guanabara Koogan; 2007..

In Brazil, studies and research projects on external causes emphasize mortality^2,5,10and/or hospital care services⁷7. São Paulo. Secretaria de Estado da Saúde. Grupo técnico de acidentes e violências. Centro de vigilância epidemiológica “Prof. Alexandre Vranjac”. Coordenadoria de centro de controle de doenças. O impacto dos acidentes e violências nos gastos da saúde. Rev Saúde Pública 2006 ; 40(3): 553-6. ^{, 8}8. Anjos KC, Evangelista MRB, Silva JS, Zumiotti AV. Paciente vítima de violência no trânsito: análise do perfil socioeconômico, características do acidente e intervenção do Serviço Social na emergência. Acta Ortop Bras 2007: 15(5): 262-6.. According to certain studies, physiotherapy services are mainly sought by patients with back problems and external cause victims¹³13. Moretto LC, Longo GZ, Boing AF, Arruda MO. Prevalência da utilização de serviços de fisioterapia entre a população adulta urbana de Lages, Santa Catarina. Rev Bras Fisioter , São 2009; 13(2): 130-5. ^{, 14}14. Siqueira FV, Facchini LA, Hallal PC. Epidemiologia da utilização da fisioterapia em adultos e idosos. Rev Saúde Pública 2005; 39(4): 662-8..

The present study aimed to understand the profile of victims and characteristics of external cause injuries, the physiotherapeutic treatment and the functional evolution of patients cared for in the Centro de Reabilitação Municipal de Uberlândia (CEREM – City of Uberlândia Rehabilitation Center), a public rehabilitation center that provides care on a regional level.

Methods

The city of Uberlândia is situated in the Triângulo Mineiro and Alto Paranaíba region, in the state of Minas Gerais, Southeastern Brazil. It has more than 600,000 inhabitants and holds a privileged position in terms of economy and geographical location, including referral health services for several neighboring cities.

The CEREM is a medium-complexity regional referral center for the 59 cities registered with the Inter-City Agreement Program (a device for planning, programming and regulating the SUS – Unified Health System, aimed at enabling population access to all health care levels), caring for patients who have suffered different types of injuries, with sequelae that raise the need for rehabilitation. During the study period, this center had a team comprised of one orthopedist, 17 physiotherapists, one social worker and one psychologist, among other professionals. It was structured in accordance with Decree 818/GM from June 5^th2001, which provides for mechanisms to organize and implement State Networks of Care for the Physically Disabled¹⁵15. Brasil. Ministério da Saúde. Portaria 818 de 05 de junho de 2001 . Brasília; 2001. Disponível em http://senado.gov.br/senadores/senador/FlavioArns/docs/Portarias%20da%20saude/ anexo2.doc (Acessado em 25 de julho de 2009).
http://senado.gov.br/senadores/senador/F... .

Appointments are usually set up by telephone through the Appointment Booking Center of the City of Uberlândia Department of Health. According to the CEREM norms, patients initially undergo multi-professional triage, where they are referred to different types of health care services and where possible inadequate referrals are evaluated as well.

The following individuals were included in the present study: patients who sought the CEREM between January and July 2005 to begin treatment for an external cause injury, regardless of its being recent or not and having occurred in the city of Uberlândia or some other location. Even patients who had previously attempted injury rehabilitation in other places were included in this study. In contrast, patients who did not undergo the CEREM's multi-professional triage were excluded.

A semi-structured questionnaire designed by the authors themselves was used as the guidelines for questions. Data were collected prospectively and those provided by patients were personally obtained by the physiotherapist/professor and two physiotherapy students in their third year. Interviews with patients were conducted during the multi-professional triage, where information about the victims and characteristics of injuries and causing event was obtained. As patients were discharged from physiotherapy, they were contacted again to provide information about their clinical evolution. When two consecutive sessions were missed, resulting in disconnection from the CEREM's treatment program, the physiotherapist/researcher would call the patient in this case within one week and obtain information about their evolution from them. Data on the treatment performed, in their turn, were obtained from medical records and interviews conducted by the physiotherapists who provided the services.

External causes were categorized as work accidents, transport accidents, assault, falls, domestic accidents and others, according to this sequence and only one time. Thus, if a certain external cause was categorized as a fall, for example, this fall could not have resulted from a work accident, transport accident or assault, otherwise it would have been categorized as such; likewise, it would not be subsequently categorized as a domestic accident, even if it had occurred at home.

A pilot test was performed with 50 patients who had been cared for prior to the study period. It aimed to enable physiotherapy students to collect data from patients, and to test the questionnaire applicability and form of application. This resulted in certain changes in the questions for higher data reliability.

A database was constructed in the ACCESS 2000 software, where data were processed and information was obtained for the present study. Data were explored with descriptive statistical techniques (trend measures and proportions) and the chi-square test was exclusively used to show differences in sex and age group.

The present research project was approved by the Federal University of Uberlândia Research Ethics Committee (Official Opinion 252/04) and performed in accordance with the regulatory norms of Resolution 196/96. This project was used as the Master's thesis of the author and funding was not required. Authors declared there were no conflicts of interest.

Results

In the CEREM, during the period studied, 345 patients began treatment of injuries from external causes; 285 (82.6%) were contacted and, as none refused to respond to the questionnaire, all were interviewed and included in the present study. The remaining 60 patients (17.4%) were excluded because they did not undergo triage, in accordance with the institution's usual process.

Of all 285 patients, 238 (83.5%) had not had previous physiotherapeutic treatment and 47 (16.5%) had had at least one type of treatment, due to the injury in question; 198 (69.5%) had completed their treatments and been personally contacted again; 79 (27.7%) patients did not complete the treatment and the second contact was made by telephone exclusively. Additionally, 8 (2.8%) did not require treatment or reassessment, as they were considered to be functionally normal in the triage.

The majority of patients were males. They had a median age of 36.5 years and were mainly concentrated in the 20-to-29-year age group; female patients had a median age of 49 years and, unlike men, were concentrated in the 60-and-older age group (p < 0.01) ( Table 1 ).

Data on place of origin, marital status, employment status, level of education, health insurance, profession/occupation and monthly income of patients are shown in Table 2 .

Of all 185 patients who had a formal employment status, 129 (69.7%) had been on a leave of absence for 66 days on average.

The majority of injuries were caused by accidents and fractures predominated ( Table 3 ). The body parts most frequently affected were the upper limbs ( Table 4 ).

Almost half of the events (135; 47.3%) occurred on public roads (especially transport accidents); out of the remaining events, 71 (24.9%) occurred at home, 30 (10.5%) in the workplace, 26 (9.1%) in areas for the practice of sports and track and field, 13 (4.5%) in service and business areas, and 5 (1.7%) on farms.

Almost all referrals (281; 98.6%) originated from the public network. The period between the request for physiotherapy and the beginning of treatment lasted 48.4 days on average (median of 14 days).

Kinesiotherapy (228; 80%), electrotherapy (211; 74%) and thermotherapy (200; 70.1%) were the most frequent types of therapy, usually combined with each other. The number of sessions varied from 10 to 148 per patient (mean of 17 and median of 20 sessions per patient).

Pain, restriction in movements and dependence on a certain type of assistance were frequent when patients arrived at the service. They progressed well, regardless of having completed the entire treatment proposed ( Table 5 ).

Discussion

It is difficult to know whether certain conditions such as professions and occupations, employment status, length of absence from work, type of service requesting physiotherapy, ownership of health insurance and time required for patients to receive physiotherapeutic treatment for injuries from external causes are similar to those found in other locations in Brazil, as they have not been assessed by other studies. Additionally, no special reasons were found to believe that patients referred to CEREM in the first semester of the year had significantly different characteristics than those referred to such center in the second semester, although this cannot be entirely disregarded.

The higher frequency of male adolescents, low level of education of patients and high percentage of falls and accidents on public roads, according to data from the present study, appear to simply reflect the most common situations involved in the occurrence of injuries from external causes²2. Gawryszewski VP, Koizumi MS, Mello Jorge MHP. As causas externas no Brasil no ano de 2000: comparando a mortalidade e a morbidade. Cad Saúde Pública 2004; 20(4): 995-1003. ^{, 5}5. Gawryszewski VP, Scarpelini S, Dib JA, Mello Jorge MHP, Júnior GAP, Morita M. Atendimentos de emergência por lesões decorrentes de causas externas: características das vítimas e local de ocorrência, Estado de São Paulo, Brasil, 2005. Cad Saúde Pública 2008 ; 24(5): 1121-9. ^{, 16}16. Marin-Leon L, Queiroz MS. Atualidade dos acidentes de trânsito na era da velocidade: uma visão geral. Cad Saúde Pública 2000; 16(1): 7-21.

17. Marin-Leon L, Vizzotto MM. Comportamento no trânsito: um estudo epidemiológico com estudantes universitários. Cad Saúde Pública 2003; 19(5): 515-23.

18. Veronese AM, Oliveira DLLC, Shimitz TSD. Caracterização de motociclistas internados no hospital de Pronto Socorro de Porto Alegre. Rev Gaúcha Enferm 2006; 27 (3): 379-85. ^{- 19}19. Santos JLG, Garlet ER, Figueira RB, Lima SBS, Prochonow AG. Acidentes e violências: caracterização dos atendimentos no pronto-socorro de um hospital universitário. Saúde & Sociedade 2008; 17(3): 211-8.. A study conducted in the University of Cuiabá physiotherapy clinic showed similar results²⁰20. Silva Filho CAR, Reis ES dos, Barros IGP. Perfil dos pacientes vítimas de acidentes de trânsito atendidos na clínica de fisioterapia da UNIC no ano de 2005 a 2008. UNIciências 2010; 14(1): 83-94.. Unlike the present study, a predominance of single individuals cared for in public emergency services and hospitalized due to external causes has been reported²2. Gawryszewski VP, Koizumi MS, Mello Jorge MHP. As causas externas no Brasil no ano de 2000: comparando a mortalidade e a morbidade. Cad Saúde Pública 2004; 20(4): 995-1003. ^{, 5}5. Gawryszewski VP, Scarpelini S, Dib JA, Mello Jorge MHP, Júnior GAP, Morita M. Atendimentos de emergência por lesões decorrentes de causas externas: características das vítimas e local de ocorrência, Estado de São Paulo, Brasil, 2005. Cad Saúde Pública 2008 ; 24(5): 1121-9. ^{, 8}8. Anjos KC, Evangelista MRB, Silva JS, Zumiotti AV. Paciente vítima de violência no trânsito: análise do perfil socioeconômico, características do acidente e intervenção do Serviço Social na emergência. Acta Ortop Bras 2007: 15(5): 262-6.. It is probable that the samples assessed in these studies better reflect the profile of victims as a whole, because they evaluate patients upon their arrival at the health services, whereas only a portion of them have specific characteristics and needs and thus seek physiotherapeutic care.

The great number of motorcyclists among victims of transport accidents is probably due to the incidence of this type of accident as well⁵5. Gawryszewski VP, Scarpelini S, Dib JA, Mello Jorge MHP, Júnior GAP, Morita M. Atendimentos de emergência por lesões decorrentes de causas externas: características das vítimas e local de ocorrência, Estado de São Paulo, Brasil, 2005. Cad Saúde Pública 2008 ; 24(5): 1121-9. ^{, 6}6. Melione LPR, Mello Jorge MHP. Morbidade hospitalar por causas externas no Município de São José dos Campos, Estado de São Paulo, Brasil. Epidemiol Serv Saúde 2008 ; 17(3): 205-16. ^{, 8}8. Anjos KC, Evangelista MRB, Silva JS, Zumiotti AV. Paciente vítima de violência no trânsito: análise do perfil socioeconômico, características do acidente e intervenção do Serviço Social na emergência. Acta Ortop Bras 2007: 15(5): 262-6..

The high frequency of injuries on public roads and at home may simply reflect where these events resulting from external causes usually occur⁵5. Gawryszewski VP, Scarpelini S, Dib JA, Mello Jorge MHP, Júnior GAP, Morita M. Atendimentos de emergência por lesões decorrentes de causas externas: características das vítimas e local de ocorrência, Estado de São Paulo, Brasil, 2005. Cad Saúde Pública 2008 ; 24(5): 1121-9. ^{, 21}21. Mello Jorge MHP, Koizumi MS, Tono VL. Causas externas: o que são, como afetam o setor saúde, sua medida e alguns subsídios para a sua prevenção. Cad Saúde Pública 2007 ; 1(1): 37-47..

The small percentage of assaults among victims of external causes, which has also been observed in broader studies⁶6. Melione LPR, Mello Jorge MHP. Morbidade hospitalar por causas externas no Município de São José dos Campos, Estado de São Paulo, Brasil. Epidemiol Serv Saúde 2008 ; 17(3): 205-16. ^{, 7}7. São Paulo. Secretaria de Estado da Saúde. Grupo técnico de acidentes e violências. Centro de vigilância epidemiológica “Prof. Alexandre Vranjac”. Coordenadoria de centro de controle de doenças. O impacto dos acidentes e violências nos gastos da saúde. Rev Saúde Pública 2006 ; 40(3): 553-6., could be partly due to the fact that violence and assaults, especially in the domestic context, are not often explicitly revealed to health services¹1. Leal SC, Lopes MJM. Violência como objeto da assistência em um hospital de trauma: o “olhar” da enfermagem. Ciênc Saúde coletiva 2005; 10(2): 419-31. ^{, 19}19. Santos JLG, Garlet ER, Figueira RB, Lima SBS, Prochonow AG. Acidentes e violências: caracterização dos atendimentos no pronto-socorro de um hospital universitário. Saúde & Sociedade 2008; 17(3): 211-8..

Upper limbs were predominantly affected, partly due to the fact that they are often involved in external causes in general²2. Gawryszewski VP, Koizumi MS, Mello Jorge MHP. As causas externas no Brasil no ano de 2000: comparando a mortalidade e a morbidade. Cad Saúde Pública 2004; 20(4): 995-1003. ^{, 11}11. Lianza S. Medicina de reabilitação . 4aedição. Rio de Janeiro: Guanabara Koogan; 2007. ^{, 22}22. Sá VWB. Distúrbios ortopédicos e traumatológicos: análise prospectiva de 732 casos em enfermaria de ortopedia. Fisioter Brasil 2003; 4(4): 238-42.. It has been suggested that this happens as a result of the upper limbs being the most frequently used body parts in the activities of daily living, in the workplace and in leisure activities, thus being more exposed to injuries²²22. Sá VWB. Distúrbios ortopédicos e traumatológicos: análise prospectiva de 732 casos em enfermaria de ortopedia. Fisioter Brasil 2003; 4(4): 238-42.. However, it is also likely that injuries in these body parts lead to more recommendations for rehabilitation than others.

As in the present study, in a municipal health service of the city of Santa Maria, RS, that provides physiotherapy care, the majority of services resulted from fractures²³23. Peraça DVL, Vendrusculo AP. Perfil da população atendida pelos acadêmicos de fisioterapia do Centro Universitário Franciscano no Centro de diagnóstico e atenção secundária. Disciplinarun Scientia 2006. Série: Ciências da Saúde; 7(1): 41-9.. This high frequency, although also found in studies with patients cared for in emergency rooms and hospitals¹⁹19. Santos JLG, Garlet ER, Figueira RB, Lima SBS, Prochonow AG. Acidentes e violências: caracterização dos atendimentos no pronto-socorro de um hospital universitário. Saúde & Sociedade 2008; 17(3): 211-8. ^{, 24}24. Bhalla K, Shahraz S, Naghavi M, Lozano R, Murray C. Estimating the distribution of external causes in hospital data from injury diagnosis. Accid Anal Prev 2008; 40(6): 1822-9., may be partly due to this type of injury resulting in a significant number of rehabilitation services.

Traumatic injuries affecting the musculoskeletal system usually require care and therapeutic measures in due time, as the lack or inadequacy of treatment can lead to temporary or even permanent functional impairment, being directly reflected in the victim's activities of daily living and in the workplace¹¹11. Lianza S. Medicina de reabilitação . 4aedição. Rio de Janeiro: Guanabara Koogan; 2007.. The contributions of physiotherapy to the treatment of injuries from external causes have been discussed in the literature and there have been more opportunities for professionals to work in public and private hospitals, clinics and other health units¹¹11. Lianza S. Medicina de reabilitação . 4aedição. Rio de Janeiro: Guanabara Koogan; 2007..

Physiotherapy services provided in a municipal clinic in the state of Rio Grande do Sul, Southern Brazil, revealed an average of seven services per patient and, among the physiotherapeutic treatments provided, kinesiotherapy (72.5%), electrotherapy (72%) and massage therapy (72%) were those most frequently used²³23. Peraça DVL, Vendrusculo AP. Perfil da população atendida pelos acadêmicos de fisioterapia do Centro Universitário Franciscano no Centro de diagnóstico e atenção secundária. Disciplinarun Scientia 2006. Série: Ciências da Saúde; 7(1): 41-9.. Unlike the present study, there was a significant frequency of massage therapy and lack of references to the use of thermotherapy among the most often used resources. No reasons could be found for this difference, as the types of injuries appear to be the same and thermotherapy, based on its effects and recommendations, is more frequently used in the rehabilitation of musculoskeletal system injuries than massage therapy¹¹11. Lianza S. Medicina de reabilitação . 4aedição. Rio de Janeiro: Guanabara Koogan; 2007. ^{, 25}25. Prentice WE. Modalidades terapêuticas para fisioterapeutas . 2aedição. Porto Alegre: Artmed; 2004. ^{, 26}26. Prentice WE, Voight ML. Técnicas em reabilitação musculoesquelética . Porto Alegre: Artmed; 2003..

It is known that accurate interventions performed in due course are key in the recovery process of patients²⁵25. Prentice WE. Modalidades terapêuticas para fisioterapeutas . 2aedição. Porto Alegre: Artmed; 2004. ^{, 26}26. Prentice WE, Voight ML. Técnicas em reabilitação musculoesquelética . Porto Alegre: Artmed; 2003.. Among the advantages of physiotherapy, Lianza¹¹11. Lianza S. Medicina de reabilitação . 4aedição. Rio de Janeiro: Guanabara Koogan; 2007.points out the efficiency in functional rehabilitation and localized treatment with a low incidence of adverse effects. Starkey²⁷27. Starkey C. Recursos terapêuticos em fisioterapia . 2aedição. São Paulo: Manole; 2001.complements this by stating the capacity of this type of treatment to create a favorable environment for injured tissue recovery.

Physiotherapists determine the most adequate resources for the patients' physical and mental conditions²⁵25. Prentice WE. Modalidades terapêuticas para fisioterapeutas . 2aedição. Porto Alegre: Artmed; 2004. ^{, 26}26. Prentice WE, Voight ML. Técnicas em reabilitação musculoesquelética . Porto Alegre: Artmed; 2003.. Kinesiotherapy, electrotherapy and thermotherapy are key resources for rehabilitation, especially when injuries result from traumas. Lianza¹¹emphasizes kinesiotherapy as the most frequently used type of therapy in the field of rehabilitation and it is prescribed for the majority of disabilities. Additionally, Kisner and Colby emphasize the effectiveness of this resource to prevent the development of adherences, contractures and stiffness and its capacity to promote the tissue regeneration process and increase lubrication through the synovial fluid, thus preventing the harmful effects of immobilization²⁸28. Kisner C, Colby LA. Exercícios terapêuticos: Fundamentos e técnicas . 4aed. Barueri: Manole 2003..

Moreover, the literature points out the benefits of electrotherapy for local tissues. In this sense, the promotion of the normalization of local blood flow and production of an anti-irritating effect result in pain suppression, which in its turn facilitates the maintenance of the therapeutic process¹¹11. Lianza S. Medicina de reabilitação . 4aedição. Rio de Janeiro: Guanabara Koogan; 2007.,²⁹29. Kitchen S, Bazin S. Eletroterapia: prática baseada em evidências . 11aedição. Barueri, São Paulo: Manole; 2003..

The effects of thermotherapy, such as the gain in amplitude of movement resulting from the increase in soft tissue elasticity and reduction in joint stiffness, in their turn, have been widely observed in practice¹¹11. Lianza S. Medicina de reabilitação . 4aedição. Rio de Janeiro: Guanabara Koogan; 2007. ^{, 25}25. Prentice WE. Modalidades terapêuticas para fisioterapeutas . 2aedição. Porto Alegre: Artmed; 2004. ^{, 25}25. Prentice WE. Modalidades terapêuticas para fisioterapeutas . 2aedição. Porto Alegre: Artmed; 2004.. In this context, the therapeutic ultrasound is a resource frequently used both in the treatment of musculoskeletal system disorders and in the speeding up of tissue repair of muscular injuries³⁰30. Dyson M. Mechanisms involved in therapeutic ultrasound. Physiotherapy. 1987; 73(3): 116-20..

The need for a higher or lower number of physiotherapy sessions to be fully recovered depends on the severity and type of injury and response to the treatment²⁶26. Prentice WE, Voight ML. Técnicas em reabilitação musculoesquelética . Porto Alegre: Artmed; 2003.. More serious injuries require a greater number of sessions and, in these cases, full recovery may not be achieved.

Patients who did not complete the treatment also had good recovery, which could suggest that this is a natural evolution, independent from the treatment. However, some of them may have abandoned the treatment precisely due to pain relief and return to their regular activities.

The qualification and practice of physiotherapists are currently aimed at outpatient and hospital care. Studies on physiotherapy, in their turn, tend to value individual therapy and the search for sophisticated methods and techniques³¹31. Rezende M. Avaliação da inserção do fisioterapeuta na saúde da família de Macaé/RJ: A contribuição deste profissional para a acessibilidade da população idosa às ações de saúde da equipe. Um estudo de caso (dissertação de mestrado). Escola Nacional de Saúde Pública Sérgio Arouca da Fundação Osvaldo Cruz: Rio de Janeiro; 2007.. The evolution of patients cared for in rehabilitation services, which could enable comparisons to be made, has not been reported.

Conclusion

The profile of patients seeking rehabilitation due to external causes at the CEREM in the city of Uberlândia seem to reflect, above all, the characteristics of individuals who are usually exposed this type of health problem, which can be observed through the predominance of male adolescents, individuals with a low income and level of education, and victims of falls or transport accidents. In the universe of this study, the great occurrence of fractures, especially in the upper limbs, appears to be associated not only with the high frequency of this type of injury among victims of external causes, but also with the fact that they raise the need for rehabilitation.

It could be observed that relatively simple resources such as kinesiotherapy, electrotherapy and thermotherapy, frequently used in physiotherapeutic treatment, are sufficient for the good evolution of patients who complete the treatment. Additionally, researchers found that even those who did not complete it usually showed satisfactory progress, which could be due to the natural history of the health problem and to the treatment, although incomplete.

The data point to a positive view of health service organization with Rehabilitation Centers operating in accordance with the Ministry of Health requirements. Moreover, the construction of a centralized database, which enables information to be obtained from the services offered in similar centers in other Brazilian regions, could provide useful information to health service managers.

References

Publication Dates

History