Effectiveness of the physiotherapist's matrix support for community health agents: a quasi-experimental study

Barbosa, Samara Maria Neves; Silva, Gabriel Brighenti Menezes; Costa, Henrique Silveira; Bastone, Alessandra de Carvalho; Vitorino, Débora Fernandes de Melo; Santos, Juliana Nunes

doi:10.1590/fm.2024.37127

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Original Article • Fisioter. Mov. 37 • 2024 • https://doi.org/10.1590/fm.2024.37127 copy

Effectiveness of the physiotherapist's matrix support for community health agents: a quasi-experimental study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

Primary health care (PHC) represents the first step of a network of health care processes that have the Family Health Strategy as their foundation for reorganization, expansion and consolidation.

Objective:

To investigate the effectiveness of the matrix support provided by the physical therapist to the community health agents (CHAs) regarding the level of knowledge about health conditions responsive to the performance of physiotherapy in PHC.

Methods:

We conducted a quasi-experimental study with two groups of CHAs, divided into control (n = 6) and intervention (n = 7), totaling 13 professionals belonging to a small municipality. Matrix support took place through educational workshops, addressing the axes of maternal and child health, adult health, health of older people and musculoskeletal disorders. For the initial assessment, a semi-open questionnaire was administered with sociodemographic data and work-related questions, a structured questionnaire containing questions related to the performance of physiotherapy in PHC that presents situations from the CHA's work routine, and a semi-open survey investigating patients to be referred to physiotherapy. For the final assessment, the same instruments were reapplied, except for the sociodemographic questionnaire.

Results:

After the intervention, in the comparison between groups, there was a difference in the risk perception index in the axis of musculoskeletal disorders (p = 0.032) and in the identification of cases of childhood changes (p = 0.012). In the intragroup comparison, the intervention group showed a difference in risk perception in the health of the older persons and in most of the items of the referral survey (p < 0.05 for all).

Conclusion:

Matrix support can contribute to the shared construction of knowledge, as well as to the activation of physiotherapy in PHC by CHAs.

Keywords:
Community health agents; Health care support professionals; Physiotherapy; Primary health care

Thematic axis	Theoretical focus I	Didactic strategies I	Theoretical focus II	Didactic strategies II	Home
Child health	Child development monitoring	– Videos illustrating child development milestones; – Videos illustrating typical and atypical development	Respiratory disorders	– Simulation of mouth breathing using a clothespin on the nose; – Themed game of seven errors with images of the repercussions of mouth breathing	Analysis of the child's health record
Women's health	– Women with multiple roles and their care; – Pelvic floor (PF) and urinary incontinence (UI)	– Images with the female and male pelvic floor; – Simulation of the functioning of the pelvic floor with a balloon; – Myths and truths	Pregnancy and its repercussions	– Exercises to strengthen the PF; – Preparatory exercises for childbirth and positioning the baby inside the uterus	Identification of clinical cases of women and men (relatives or friends) who present with UI
Adults’ health	Chronic venous disease	– Images with the stages of the disease; – Evaluation of a volunteer participant; – Exercise demonstration; – Word search	– Workers’ health; – Musculo-skeletal pain	– Staging cases; – Exercises and stretches at work, work postures that prevent pain	Identification of clinical cases
Older people's health	– Aging process and most common diseases; – Risk of falling	Simulation of difficulties experienced by older people with reduced senses	Changes in the vestibular system	– Simulation of vertigo with a volunteer; – Labyrinthine stimulation exercises	Identification of clinical cases

Variable	CG (n = 6)	IG (n = 7)	p-value
Sex
Female	2 (33.3)	4 (57.1)	0.54
Male	4 (66.7)	3 (42.9)	0.54
Age	43 ± 10	43 ± 11	0.74
Zone
Urban	2(33.3)	2 (28.6)	0.74
Rural	4 (66.7)	5 (71.4)	0.74
Education
High school	3 (50.0)	6 (85.7)	0.04 ^* * p ≤ 0.05
Higher education	3 (50.0)	1 (14.3)	0.04 ^* * p ≤ 0.05
Time working	16 ± 4	15 ± 8	0.01^* * p ≤ 0.05

Conditions	Before matrix support workshops						p-value
	Control group (n = 6)			Intervention group (n = 7)
	1	2	3	1	2	3
RPIMD	0.5	0.5 - 1.0	0.60 ± 0.08	0.7	0.2 - 1.0	0.70 ± 1.11	0.24
RPIO	0.8	0.4 - 1.0	0.70 ± 1.11	0.6	0.2 - 1.0	0.60 ± 0.11	0.60
RPIA	0.7	0.5 - 1.0	0.70 ± 0.06	0.7	0.5 - 1.0	0.80 ± 0.08	0.15
RPIMC	1.0	0.0 - 1.0	0.70 ± 0.18	0.6	0.0 - 1.0	0.70 ± 0.14	0.48
IDVC	1.5	0.0 - 3.0	1.30 ± 0.49	2.0	0.0 - 4.0	2.10 ± 0.50	0.95
IDRF	2.0	0.0 - 10.0	3.80 ± 1.68	2.0	0.0 - 5.0	1.70 ± 0.71	0.02^* * p ≤ 0.05.
IDWH	3.0	0.0 - 15.0	4.60 ± 2.24	5.0	4.0 - 25.0	11.00 ± 3.36	0.06
IDCVC	1.0	0.0 - 3.0	1.20 ± 0.54	3.0	0.0 - 4.0	2.40 ± 0.68	0.35
IDUI	0.0	0.0 - 0.0	0.00 ± 0.00	0.0	0.0 - 2.0	0.60 ± 0.29	0.01^* * p ≤ 0.05.
IDCC	0.0	0.0 - 0.0	0.00 ± 0.00	0.0	0.0 - 0.0	0.00 ± 0.00	0.00
Conditions	After matrix support workshops						p-value
	Control group (n = 6)			Intervention group (n = 7)
	1	2	3	1	2	3
RPIMD	0.6	0.0 - 1.0	0.50 ± 0.36	1.0	0.7 - 1.0	0.90 ± 0.13	0.03^* * p ≤ 0.05.
RPIO	0.6	0.2 - 1.0	0.50 ± 0.32	0.8	0.6 - 1.0	0.80 ± 0.17	0.21
RPIA	0.5	0.5 - 0.7	0.60 ± 0.12	0.7	0.7 - 1.0	0.80 ± 0.12	0.74
RPIMC	0.7	0.3 - 1.0	0.70 ± 0.25	1.0	0.6 - 1.0	0.90 ± 0.12	0.14
IDVC	2.5	1.0 - 5.0	2.80 ± 1.47	5.0	1.0 - 6.0	4.10 ± 1.67	0.84
IDRF	10.0	0.0 - 25.0	10.80 ± 8.40	10.0	4.0 - 30.0	13.40 ± 8.20	0.96
IDWH	2.5	2.0 - 12.0	4.30 ± 3.90	5.0	3.0 - 8.0	5.70 ± 1.97	0.29
IDCVC	3.0	0.0 - 8.0	3.20 ± 3.12	4.0	3.0 - 10.0	5.40 ± 2.87	0.83
IDUI	0.0	0.0 - 2.0	0.50 ± 0.83	3.0	1.0 - 20.0	5.60 ± 6.47	0.10
IDCC	2.0	0.0 - 3.0	1.70 ± 1.50	3.0	1.0 - 15.0	5.60 ± 5.53	0.01^* * p ≤ 0.05.

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[1] * Correspondence: samarasmg@gmail.com