Saúde e funcionalidade no puerpério: aspectos biopsicossociais do cuidado materno-infantil
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Data
2024-02-19
Autores
Pereira, Thalita Rodrigues Christovam [UNIFESP]
Orientadores
Aveiro, Mariana Chaves [UNIFESP]
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
A presente Tese de Doutorado é composta por dois estudos complementares relacionados a temática de saúde materno-infantil e com grande relevância no contexto atual, tanto do ponto de vista acadêmico quanto social. O Estudo I, intitulado “Exercícios no tratamento da diástase dos músculos retos abdominais no puerpério: uma revisão sistemática”, é uma revisão sistemática e teve como objetivo sintetizar a evidência sobre os protocolos de exercícios terapêuticos no tratamento de diástase dos músculos retos abdominais (DMRA) em puérperas após o parto vaginal. Foi realizada uma busca eletrônica nas bases de dados PubMed/MEDLINE, Embase, Web of Science, Scopus, LILACS e CINAHL considerando publicações até agosto de 2023 nos idiomas inglês, português e espanhol. Foram incluídos 14 estudos que usaram exercícios para tratamento da DMRA e a avaliação por meio da escala PEDRO indicou que os estudos qualidade metodológica razoável à excelente. Os exercícios investigados pelos autores variaram em relação ao tempo de início do tratamento após o parto, duração do tratamento e frequência. Os principais tipos de exercício abordados foram relacionados a exercícios abdominais tradicionais, exercícios focados no músculo transverso do abdome ou nos músculos retos abdominais, exercícios para estabilização central, exercícios isométricos-isotônicos, exercícios suspensos e exercícios de ioga. A grande heterogeneidade dos protocolos de intervenção e dos métodos de avaliação da DMRA dificultou a comparação entre os estudos e prejudicou a síntese de evidências. Embora os exercícios terapêuticos abdominais pareçam contribuir para a redução da DMRA, os parâmetros em relação ao tipo de exercício, frequência, duração, intensidade e momento ideal de início do tratamento ainda não estão bem estabelecidos na literatura. Logo, os protocolos de exercícios necessitam de padronização e maior investigação científica. Já o Estudo II é um estudo descritivo de corte transversal intitulado “Funcionalidade e estratégias de cuidados pessoais de mulheres no puerpério em tempos de pandemia por COVID-19: um estudo observacional transversal” e teve como objetivo compreender a funcionalidade e as estratégias de cuidados pessoais, bem como rede de apoio, queixas de desconfortos e disfunções de puérperas, bem como o acesso ao cuidado em saúde prestado por fisioterapeutas ao longo do ciclo gravídico puerperal durante a Emergência em Saúde Pública de Importância Nacional decorrente da pandemia de COVID-19. Este estudo foi realizado em ambiente virtual e as participantes foram divididas em Grupo A (mulheres com bebês menores de seis meses) e Grupo B (mulheres com bebês com idade igual ou superior a seis meses). Foram investigados hábitos e cuidados em saúde; dados obstétricos e parto; contexto pandêmico; aspectos do trabalho; relações pessoais; rede de apoio, queixas de desconfortos e a funcionalidade foi avaliada utilizando a versão brasileira do questionário World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). No geral, pelo menos metade das puérperas apresentou limitação moderada na maioria dos domínios do WHODAS 2.0. Puérperas com bebês menores de seis meses apresentaram maior dificuldade para Mobilidade e Autocuidado em comparação às puérperas com bebês mais velhos. Além disso, mais da metade das participantes de ambos os grupos obtiveram limitação grave para Atividades domésticas. Marido e/ou companheiro(a) foi a principal fonte de rede apoio para as puérperas de ambos os grupos. O apoio no puerpério ofertado por pais/sogros, amigos e/ou vizinhos, alguém contratado, profissionais de saúde e grupos de apoio à maternidade foi mais frequente para puérperas com bebês menores. Já para a ajuda com o bebê apenas os grupos de apoio à maternidade estiveram mais presentes para puérperas com bebês menores. Por fim, queixas de desconfortos ou disfunções ao longo do ciclo gravídico puerperal tenderam a permanecer elevadas em relação ao relatado antes da gestação. No entanto, o acesso ao tratamento especializado com fisioterapeutas foi baixo no período, o que indica que este tipo de assistência ainda não é amplamente difundido, limitando o cuidado integral à saúde.
This PhD Thesis is composed of two complementary studies related to maternal and child health topic and with great relevance in the current context, both from an academic and social point of view. Study I, entitled “Exercises in the treatment of diastasis of the rectus abdominis muscles in the postpartum period: a systematic review”, is a systematic review and aimed to synthesize the evidence on therapeutic exercise protocols in the treatment of diastasis recti abdominis (DRA) in postpartum women after vaginal birth. An electronic search was carried out in the PubMed/MEDLINE, Embase, Web of Science, Scopus, LILACS and CINAHL databases considering publications up to August 2023 in English, Portuguese and Spanish. Fourteen studies that used exercise to treat DRA were included and the evaluation using the PEDRO scale indicated that the studies had fair to excellent methodological quality. The exercises investigated by the authors varied in relation to the time of starting treatment after childbirth, duration of treatment and frequency. The main types of exercise covered were related to traditional abdominal exercises, exercises focused on the transverse abdominis muscle or rectus abdominis muscles, core stabilization exercises, isometric-isotonic exercises, suspension exercises and yoga exercises. The great heterogeneity of intervention protocols and DRA assessment methods made comparisons between studies difficult and hampered evidence synthesis. Although therapeutic abdominal exercises seem to contribute to the reduction of DRA, the parameters related to the type of exercise, frequency, duration, intensity and ideal time to start treatment are not yet well established in the literature. Therefore, exercise protocols require standardization and greater scientific research. Study II is a cross-sectional descriptive study entitled “Functioning and personal care strategies of postpartum women in times of COVID-19 pandemic: a cross-sectional observational study” and aimed to understand the functioning and the personal care strategies, support networks, complaints of discomfort and dysfunctions of postpartum women, as well as acess the health care provided by physiotherapists throughout the pregnancy puerperal cycle during the Public Health Emergency of National Importance resulting from the COVID-19 pandemic. This study was carried out in a virtual environment and participants were divided into Group A (women with babies under six months of age) and Group B (women with babies aged six months or older). Health habits and care; obstetric and childbirth data; pandemic context; aspects of work; personal relationships; support networks, complaints of discomfort were investigated and functioning were assessed using the Brazilian version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaire. Overall, at least half of the postpartum women had moderate limitations in most WHODAS 2.0 domains. Postpartum women with babies under six months of age had greater difficulty with mobility and self-care compared to postpartum women with older babies. Furthermore, more than half of the participants in both groups had severe limitations in domestic activities. Husband and/or partner was the main source of support network for postpartum women in both groups. Support in the postpartum period offered by parents/in-laws, friends and/or neighbors, someone hired, health professionals and maternity support groups was more frequent for postpartum women with younger babies. For help with the baby, only maternity support groups were more present for postpartum women with younger babies. Finally, complaints of discomfort or dysfunction throughout the pregnancy and puerperal cycle tended to remain high in relation to what was reported before pregnancy. However, access to specialized treatment with physiotherapists was low during the period, which indicates that this type of assistance is not yet widespread, limiting comprehensive health care.
This PhD Thesis is composed of two complementary studies related to maternal and child health topic and with great relevance in the current context, both from an academic and social point of view. Study I, entitled “Exercises in the treatment of diastasis of the rectus abdominis muscles in the postpartum period: a systematic review”, is a systematic review and aimed to synthesize the evidence on therapeutic exercise protocols in the treatment of diastasis recti abdominis (DRA) in postpartum women after vaginal birth. An electronic search was carried out in the PubMed/MEDLINE, Embase, Web of Science, Scopus, LILACS and CINAHL databases considering publications up to August 2023 in English, Portuguese and Spanish. Fourteen studies that used exercise to treat DRA were included and the evaluation using the PEDRO scale indicated that the studies had fair to excellent methodological quality. The exercises investigated by the authors varied in relation to the time of starting treatment after childbirth, duration of treatment and frequency. The main types of exercise covered were related to traditional abdominal exercises, exercises focused on the transverse abdominis muscle or rectus abdominis muscles, core stabilization exercises, isometric-isotonic exercises, suspension exercises and yoga exercises. The great heterogeneity of intervention protocols and DRA assessment methods made comparisons between studies difficult and hampered evidence synthesis. Although therapeutic abdominal exercises seem to contribute to the reduction of DRA, the parameters related to the type of exercise, frequency, duration, intensity and ideal time to start treatment are not yet well established in the literature. Therefore, exercise protocols require standardization and greater scientific research. Study II is a cross-sectional descriptive study entitled “Functioning and personal care strategies of postpartum women in times of COVID-19 pandemic: a cross-sectional observational study” and aimed to understand the functioning and the personal care strategies, support networks, complaints of discomfort and dysfunctions of postpartum women, as well as acess the health care provided by physiotherapists throughout the pregnancy puerperal cycle during the Public Health Emergency of National Importance resulting from the COVID-19 pandemic. This study was carried out in a virtual environment and participants were divided into Group A (women with babies under six months of age) and Group B (women with babies aged six months or older). Health habits and care; obstetric and childbirth data; pandemic context; aspects of work; personal relationships; support networks, complaints of discomfort were investigated and functioning were assessed using the Brazilian version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaire. Overall, at least half of the postpartum women had moderate limitations in most WHODAS 2.0 domains. Postpartum women with babies under six months of age had greater difficulty with mobility and self-care compared to postpartum women with older babies. Furthermore, more than half of the participants in both groups had severe limitations in domestic activities. Husband and/or partner was the main source of support network for postpartum women in both groups. Support in the postpartum period offered by parents/in-laws, friends and/or neighbors, someone hired, health professionals and maternity support groups was more frequent for postpartum women with younger babies. For help with the baby, only maternity support groups were more present for postpartum women with younger babies. Finally, complaints of discomfort or dysfunction throughout the pregnancy and puerperal cycle tended to remain high in relation to what was reported before pregnancy. However, access to specialized treatment with physiotherapists was low during the period, which indicates that this type of assistance is not yet widespread, limiting comprehensive health care.
Descrição
Citação
PEREIRA, Thalita Rodrigues Christovam. Saúde e funcionalidade no puerpério: aspectos biopsicossociais do cuidado materno-infantil. 2024. 154 f. Tese (Doutorado Interdisciplinar em Ciências da Saúde) - Instituto de Saúde e Sociedade, Universidade Federal de São Paulo, Santos, 2024.