Instrumentos de apoio à gestão estratégica e ao desempenho organizacional dos fisioterapeutas em unidades privadas de fisioterapia

O sucesso de uma gestão baseada na estratégia reside, no aproveitamento racional e eficiente dos seus recursos humanos, financeiros e organizacionais, bem como na sua capacidade para concretizar objectivos e alcançar resultados. Esta dissertação foi elaborada baseando-se no pressuposto que, a selecção e a aplicação de um Instrumento de Apoio à Gestão em unidades privadas de fisioterapia (UPF’s) permitirão induzir níveis acrescidos de melhoria do desempenho individual e/ou organizacional. Constituiu objectivo geral da mesma contribuir para a sensibilização e a difusão alargada das ferramentas de apoio à gestão que, aplicadas naquelas unidades, poderiam induzir níveis acrescidos de melhoria do desempenho. Definiram-se ainda três objectivos específicos consubstanciando preocupações relacionadas com a reprodução do conhecimento especializado em gestão, com a sua aplicação específica no terreno e com a subjacente criação de valor individual e organizacional. A metodologia utilizada foi a abordagem de Estudo de Caso, inspirada na técnica focus-group, aplicada a três UPF’s, e os resultados obtidos através das análises efectuadas permitiram identificar a ausência da aplicação de instrumentos de apoio à gestão e de avaliação de desempenho, bem como níveis elevados de desempenho, satisfação e autonomia nos profissionais de fisioterapia, constituindo estes a base para justificar a necessidade urgente da elaboração de um plano de implementação de um sistema de avaliação de desempenho nas unidades estudadas. /ABSTRACT: The success of a management based on strategy relies in the rational and efficient use of its human, financial and organizational resources, as well as its ability to achieve objectives and results. This thesis was developed, based on the assumption that the selection and application of a management support instrument in private physiotherapy units would induce higher levels of individual performance and / or organization. It was general objective the contribution to the sensibilization and diffusion of tools to support management, which applied in those units, could induce higher levels of performance. There were defined three specific objectives which concerned whereabouts with the reproduction of specialized knowledge in management, with its specified applicability in the work field and with the underneath creation of individual and organizational value. The applied methodology was a case study, inspired by the focus-group technique applied in three private physiotherapy units, and the results obtained through the analysis allowed the identification of lack of use of any support management tools and performance evaluation, as well as high standard levels of performance, satisfaction and professional autonomy in physical therapists, being this the base for justifying the urgent need for developing an implementation plan of a performance evaluation system applied to these units.

Increased physical activity and fitness above the 50th percentile prevents the institutionalization of elderly people: a cross-sectional pilot study.

Introduction Institutionalization in a nursing home restricts autonomy, most notably free will, free choice, and free action. Decreased physical activity and fitness are predictive of disability and dependence (Rikli & Jones, 2013; Tak, Kuiper, Chorus, & Hopman-Rock, 2014); however little is known about the impact of these factors on institutionalization. Thus, this study aimed to analyze the impact of physical activity and fitness and on the risk of elderly people without cognitive impairment become institutionalized. Methods This cross-sectional study involved 195 non-institutionalized (80.14.4yrs) and 186 institutionalized (83.85.2yrs) participants. Cognitive impairment was assessed using Mini-Mental State Examination, physical activity was assessed using the International Physical Activity Questionnaire, and measures of physical fitness were determined by the Senior Fitness Test. Results: Multivariate binary logistic analysis selected 4 main predictors of institutionalization in both genders. The likelihood of becoming institutionalized increased by +18.6% for each additional year of age, while it decreased by -24.8% by each fewer kg/m2 in BMI, by -0.9% for each additional meter performed in the aerobic endurance test and by -2.0% for each additional 100MET-min/wk of physical activity expenditure (p<0.05). Values ≤50th percentile (age ≥81yrs, BMI≥26.7kg/m2, aerobic endurance ≤367.6m, and physical activity ≤693MET-min/wk) were computed using Receiver Operating Characteristics analysis as cut-offs discriminating institutionalized from non-institutionalized elderly people. Conclusion The performance of physical activity, allied to an improvement in physical fitness (mainly BMI and aerobic endurance) may prevent the institutionalization of elderly people without cognitive impairment only if they are above the 50th percentile; the following is highly recommend: expending ≥693MET-min/wk on physical activity, being ≤26.7kg/m2 on BMI, and being able to walk ≥367.6m in the aerobic endurance test, especially above the age of 80 years. The discovery of this trigger justifies the development of physical activity programs targeting the pointed cut-offs in old, and very old people. References Rikli, R., & Jones, C. (2013). Development and validation of criterion-referenced clinically relevant fitness standards for maintaining physical independence in later years. Gerontologist, 53, 255-267. Tak, E., Kuiper, R., Chorus, A., & Hopman-Rock, M. (2014). Prevention of onset and progression of basic ADL disability by physical activity in community dwelling older adults: a meta-analysis. Ageing Res Rev, 12, 329-338.

A randomized controlled trial on the effects of combined aerobic-resistance exercise on muscle strength and fatigue, glycemic control and health-related quality of life of type 2 diabetes patients

Aim: to evaluate the effects of a 12-weeks combined aerobic-resistance exercise therapy on fatigue and isokinetic muscle strength, glycemic control and health-related quality of life (HRQoL) in moderately affected type 2 diabetes (T2DM) patients. Methods: a randomized controlled trial design was employed. Forty-three T2DM patients were assigned to an exercise group (n = 22), performing 3 weekly sessions of 60 minutes of combined aerobic-resistance exercise for 12-weeks; or a no exercise control group (n = 21). Both groups were evaluated at a baseline and after 12-weeks of exercise therapy for: 1) muscle strength and fatigue by isokinetic dynamometry; 2) plasma glycated hemoglobin A1C (HbA1C); and 3) HRQoL utilizing the SF-36 questionnaire. Results: the exercise therapy led to improvements in muscle fatigue in knee extensors (-55%) and increased muscle strength in knee flexors and extensors (+15 to +30%), while HbA1C decreased (-18%). In addition, the exercising patients showed sizeable improvements in HRQoL: physical function (+53%), vitality (+21%) and mental health (+40%). Conclusion: 12-weeks of combined aerobic-resistance exercise was highly effective to improve muscle strength and fatigue, glycemic control and several aspects of HRQoL in T2DM patients. These data encourage the use of aerobic and resistance exercise in the good clinical care of T2DM.