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RESUMO - A artroplastia total da anca (ATA) e do joelho (ATJ) requerem reabilitação estruturada para otimizar a recuperação funcional. Este estudo avaliou a conformidade da reabilitação no Serviço de Medicina Física e de Reabilitação (MFR) do Hospital Professor Doutor Fernando Fonseca (HFF) com os referenciais internos para tempo até ao início, carga terapêutica e duração do programa.
Realizou-se um estudo observacional retrospetivo (janeiro–setembro de 2024), com 527 utentes: 325 ATA (61,7%) e 202 ATJ (38,3%). A conformidade foi operacionalizada por três critérios: início precoce (≤1 dia pós-cirúrgico), carga adequada (≥16 sessões) e duração adequada (≥6 semanas), bem como pelo cumprimento simultâneo dos três critérios.
O início precoce verificou-se em 53,7% dos casos (ATA: 50,8%; ATJ: 58,4%). A carga adequada foi cumprida por 17,3% (ATA: 18,2%; ATJ: 15,8%) e a duração adequada por 15,2% (ATA: 13,5%; ATJ: 17,8%). O cumprimento simultâneo ocorreu em 6,5% (ATA: 5,2%; ATJ: 8,4%). Os utentes da ATA apresentaram idade média superior à ATJ (75,96 vs. 68,74 anos; p < 0,001). Em análise ajustada, o sexo masculino associou-se a maior probabilidade de cumprir carga, duração e cumprimento simultâneo, sugerindo a necessidade de explorar e monitorizar potenciais assimetrias por sexo no cumprimento dos critérios.
Conclui-se que existe conformidade parcial: o início é precoce em cerca de metade dos episódios, enquanto a carga terapêutica e a duração ficam frequentemente aquém dos limiares definidos. Recomenda-se a operacionalização de metas monitorizáveis e o acompanhamento sistemático por indicadores e auditorias periódicas, de forma a reduzir a variabilidade e reforçar a comparabilidade interna.
ABSTrACT - Total hip arthroplasty (THA) and total knee arthroplasty (TKA) require structured rehabilitation to optimise functional recovery. This study assessed compliance of rehabilitation delivered by the Physical and Rehabilitation Medicine (PRM) service at Hospital Professor Doutor Fernando Fonseca (HFF) with internal reference standards for time to initiation, therapeutic dose and programme duration. A retrospective observational study was conducted (January–September 2024) including 527 patients: 325 THA (61,7%) and 202 TKA (38,3%). Compliance was operationalised using three criteria-early initiation (≤1 postoperative day), adequate therapeutic dose (≥16 sessions) and adequate duration (≥6 weeks)-as well as simultaneous compliance with all three. Early initiation occurred in 53,7% of cases (THA: 50,8%; TKA: 58,4%). Adequate dose was achieved by 17,3% (THA: 18,2%; TKA: 15,8%) and adequate duration by 15,2% (THA: 13,5%; TKA: 17,8%). Simultaneous compliance was observed in 6,5% (THA: 5,2%; TKA: 8,4%). THA patients were older than TKA patients (mean 75,96 vs 68,74 years; p < 0,001). In adjusted analyses, male sex was associated with a higher likelihood of meeting the dose and duration criteria and simultaneous compliance, supporting the need to explore and monitor potential sex-related differences in compliance. In conclusion, compliance with internal reference standards was partial: early initiation occurred in about half of episodes, whereas therapeutic dose and programme duration frequently fell below the predefined thresholds. Implementing explicit, monitorable targets and routine indicator-based monitoring with periodic audits is recommended to reduce variability and strengthen internal comparability of practice.
ABSTrACT - Total hip arthroplasty (THA) and total knee arthroplasty (TKA) require structured rehabilitation to optimise functional recovery. This study assessed compliance of rehabilitation delivered by the Physical and Rehabilitation Medicine (PRM) service at Hospital Professor Doutor Fernando Fonseca (HFF) with internal reference standards for time to initiation, therapeutic dose and programme duration. A retrospective observational study was conducted (January–September 2024) including 527 patients: 325 THA (61,7%) and 202 TKA (38,3%). Compliance was operationalised using three criteria-early initiation (≤1 postoperative day), adequate therapeutic dose (≥16 sessions) and adequate duration (≥6 weeks)-as well as simultaneous compliance with all three. Early initiation occurred in 53,7% of cases (THA: 50,8%; TKA: 58,4%). Adequate dose was achieved by 17,3% (THA: 18,2%; TKA: 15,8%) and adequate duration by 15,2% (THA: 13,5%; TKA: 17,8%). Simultaneous compliance was observed in 6,5% (THA: 5,2%; TKA: 8,4%). THA patients were older than TKA patients (mean 75,96 vs 68,74 years; p < 0,001). In adjusted analyses, male sex was associated with a higher likelihood of meeting the dose and duration criteria and simultaneous compliance, supporting the need to explore and monitor potential sex-related differences in compliance. In conclusion, compliance with internal reference standards was partial: early initiation occurred in about half of episodes, whereas therapeutic dose and programme duration frequently fell below the predefined thresholds. Implementing explicit, monitorable targets and routine indicator-based monitoring with periodic audits is recommended to reduce variability and strengthen internal comparability of practice.
Descrição
Palavras-chave
Artroplastia total da anca Artroplastia total do joelho Reabilitação Medicina Física e de Reabilitação Protocolos clínicos Conformidade Indicadores de desempenho Hospital Prof. Doutor Fernando Fonseca Total hip arthroplasty Total knee arthroplasty Rehabilitation Physical Medicine and Rehabilitation Clinical protocols Compliance Performance indicators
Contexto Educativo
Citação
Editora
Universidade Nova de Lisboa, Escola Nacional de Saúde Pública