Assessment of women’s satisfaction with physical therapy care in the immediate postpartum period: an observational studyABSTRACT
This study aimed to evaluate women’s satisfaction with physical therapy care during the immediate postpartum period. This is a cross-sectional study. The physical therapy approach was based on kinesiotherapy, massage therapy, electrophysical resources, and concluded with health education. Approximately seven to 15 days after hospital discharge, participants were contacted by phone and asked ten questions regarding the care provided by the physical therapist in the maternity ward during the immediate postpartum period. The study included 49 puerperal women with a mean age of 27 years (±3.7), mostly White, in stable unions, with complete secondary education, and multiparous; the predominant mode of delivery was vaginal childbirth (61.22%). All participants reported satisfaction with the care received, clarity of the instructions regarding the proposed exercises, and clarification of doubts. Three (6%) women felt the care took too long or caused discomfort, 70% (35) followed the instructions received at the maternity hospital at home, and 12% (seven) had difficulty following the instructions. All women stated they would like to have access to physical therapy care again if they had another baby; the average satisfaction with the physical therapy care received at the maternity hospital was 9.64. It was found that the women were satisfied with the physical therapy care at the maternity hospital, and most applied the instructions received at home.
Keywords:
Physical Therapy; Postpartum Period; Women’s Health
RESUMO
Este estudo teve como objetivo avaliar a satisfação de mulheres no puerpério imediato com o atendimento fisioterapêutico. Trata-se de um estudo transversal. A conduta fisioterapêutica foi baseada em cinesioterapia, massoterapia e recursos eletrofísicos, finalizando com educação em saúde. Cerca de 7 a 15 dias após alta hospitalar, foi realizado contato telefônico com as participantes do estudo, sendo realizadas 10 perguntas relacionadas ao atendimento prestado pelo fisioterapeuta na maternidade no período do puerpério imediato. Participaram do estudo 49 puérperas, com média de idade de 27 anos (±3,7), em sua maioria brancas, em união estável, ensino médio completo e multíparas; a via de nascimento predominante foi a vaginal (61,22%). Todas as participantes declararam satisfação com o atendimento recebido, clareza das orientações sobre os exercícios propostos e esclarecimento de dúvidas. Cerca de três (6%) das mulheres consideraram que o atendimento demorou ou causou incômodo, 70% (35) realizaram em casa as orientações recebidas na maternidade e 12% (7) tiveram dificuldade na execução das orientações. Todas as puérperas declararam que gostariam de ter acesso ao atendimento fisioterapêutico novamente caso tenham outro bebê; a satisfação média para o atendimento fisioterapêutico recebido na maternidade foi de 9,64. Constatou-se que as mulheres ficaram satisfeitas com o atendimento fisioterapêutico na maternidade e a maioria utilizou as orientações recebidas em casa.
Descritores:
Fisioterapia; Período Pós-Parto; Saúde da Mulher
RESUMEN
Este estudio tuvo como objetivo evaluar la satisfacción de las mujeres en el puerperio inmediato con la atención fisioterapéutica. Se trata de un estudio transversal. La conducta fisioterapéutica se basó en la kinesioterapia, la masoterapia y los recursos electrofísicos, y se terminó con educación sanitaria. Entre 7 y 15 días después del alta hospitalaria, se contactó por teléfono a las participantes del estudio para contestar 10 preguntas relacionadas con la atención brindada por el fisioterapeuta en el hospital de maternidad durante el posparto inmediato. Este estudio incluyó a 49 mujeres puerperales, con una edad media de 27 años (±3,7), en su mayoría blancas, en unión estable, educación secundaria completa y multíparas; la vía de parto predominante fue vaginal (61,22%). Todas las participantes declararon satisfacción con el servicio recibido, claridad de las instrucciones sobre los ejercicios propuestos y aclaración de dudas. Aproximadamente tres (6%) de las mujeres consideraron que la atención tomó tiempo o les causó molestias, el 70% (35) de ellas llevaron a cabo en el hogar las instrucciones recibidas en el hospital de maternidad y el 12% (7) tuvieron dificultades para cumplir las instrucciones. Todas las mujeres puerperales reportaron que les gustaría volver a tener acceso a la atención fisioterapéutica si tuvieran otro bebé; la satisfacción promedio con la atención fisioterapéutica recibida en el hospital de maternidad fue de 9,64. Se encontró que las mujeres estaban satisfechas con la atención fisioterapéutica en el hospital de maternidad y que la mayoría cumplían las instrucciones recibidas en el hogar.
Palabras clave:
Fisioterapia; Período Posparto; Salud de la Mujer
INTRODUCTION
Brazil registers about 2.54 million births per year, with 2.51 million occurring in a hospital environment1. Both pregnancy and childbirth can impact a woman’s recovery period, which takes place soon after childbirth. This is called postpartum period and is defined as the moment when the local and systemic changes that occurred in the mother’s body during pregnancy and childbirth return to the pre-pregnancy state. Frequently, women report musculoskeletal and circulatory discomfort, pain, difficulties in breastfeeding, caring for the newborn, sadness and depression2. The main complaints of pain and discomfort in the postpartum period include nipple trauma resulting from breastfeeding, intestinal discomfort, perineal pain or pain in the surgical incision of C-section, abdominal colic, low back pain, and functional limitations3 All these signs and symptoms can affect maternal self-care and newborn care4,5.
The postpartum period may require specialized care and the inclusion of physical therapists in the labor and postpartum care teams is essential to ensure the quality of care. According to Resolution No. 401/2011 by the Federal Council of Physical Therapy and Occupational Therapy (COFFITO), the physical therapist is a professional trained to work in the postpartum period aiming at prevention and treatment in order to maintain the functioning of the puerperal woman. Furthermore, physical therapist can also offer health guidance and improve the recovery and quality of life of the woman6,7; prevent and reduce edema in the lower limbs and vulva; improve muscle, postural and urinary function; foster adequate breastfeeding; reduce perineal pain and Cesarean scar pain; improve intestinal functioning, among other benefits8.
No Brazilian studies that evaluated women’s satisfaction with the physical therapy care received, since the presence of this professional is not yet mandatory in maternity hospitals. In this sense, studies that can evaluate the performance of this professional from the perspective of women could support the decision-making of managers, added to future research on the possible costs generated by hiring this professional. This study aimed to describe the profile of women cared for by physical therapists in a maternity hospital in the inland state of São Paulo, as well as to evaluate satisfaction with the physical therapy care received.
METHODOLOGY
This is a descriptive, observational cross-sectional study, followed the guidelines of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)9. This research was developed by the Women’s Health Research Laboratory team at UFSCar. The population was composed of women who gave birth in a maternity hospital in the inland state of São Paulo. Convenience samplings was employed.
The study included women aged 18 years or older, who received physical therapy care during the in-hospital postpartum period and who had a telephone/cell phone. Women who had postpartum complications that required hospitalization in the intensive care or whose babies had been admitted to the Neonatal intensive care were excluded.
The interventions conducted during hospitalization consisted of: stretching, pelvic mobility exercise, respiratory reeducation, metabolic exercises, massage therapy, transcutaneous electrostimulation for analgesia of pain originating on C-section and perineum at 100Hz frequency and 80μs pulse duration, relaxation, cryotherapy, manual lymphatic drainage, ambulation, awareness of the pelvic floor muscles and guidance on diastasis abdominis. Moreover, the women were instructed on postural care during the postpartum period, such as breastfeeding, getting out of bed, bathing and changing the newborn, carrying the baby on their lap and picking them up on low surfaces, such as bed or floor.
Data on the characterization of the sample and the information on the main complaints were collected through an evaluation form prepared by the research team.
The women were contacted by telephone by a blind evaluator, i.e., it was not the same physical therapist who served the woman at the maternity hospital. An interview was then conducted with the following questions (YES or NO answers): “Do you consider the work done by the physical therapist in the maternity ward useful?”; “Were the explanations given by the physical therapist provided clearly?”; “Did you think that the service/orientations bothered or demanded a lot of time?”; “During the orientation, were all your doubts clarified?”; “Did you perform/use any of the guidance received in the maternity ward?”; “Did you have difficulty performing any activity or guidance received when you went home?”; “Did you feel any pain, swelling or discomfort during or after the exercises given by the physical therapist?”; “If you have another child, would you like to be seen by the physical therapist again?”; “Would you like to add or ask something?”; “Finally, give a score from 0 to 10 for the physical therapy service in the maternity ward.”
The data were stored in an Excel database. Descriptive statistical analysis was used; categorical variables were expressed as frequencies and continuous variables as mean and standard deviation. The research was conducted from June to September 2018.
RESULTS
Of the 107 women eligible for the study, 49 were included and 58 were excluded due to the impossibility of telephone contact. The maternity hospital in the study mostly serves women from the public health system and does not have physical therapists on the team.
The mean age of the mothers was 27 years (3.7 years). The mean gestational age was 38.44 (1.20 weeks). Regarding characteristics of the newborns, the mean body mass was 3,211 (273.61) grams, and the 5-minute Apgar score had a mean of 9.81 (0.32). Table 1 shows the data on the characterization of the study participants, collected with the physical therapy evaluation form applied before the treatment. Table 2 shows the data on the complaints most frequently reported by women in the postpartum period.
Table 3 shows the data related to the interview conducted regarding physical therapy care.
At the end of the interview, the women were asked to give a score from 0 to 10, with 0 being very dissatisfied and 10 very satisfied, for the care provided by the physical therapist in the maternity hospital. The mean was 9.64. Women who commented on the researcher praised the attention, care and thanked them, as they considered the care very valid.
Satisfaction of the puerperal women in relation to physical therapy care. São Carlos (SP), 2018
DISCUSSION
The study revealed that all postpartum women interviewed found the physical therapist’s work in the maternity hospital useful, considering the explanations clear and the doubts well clarified. Most mothers followed the instructions received and all would like to be seen by a physical therapist in future pregnancies. A Brazilian study10 assessed the knowledge of 446 women about the role of physical therapists in women’s health. It demonstrated that about 80% of the participants had already heard of or believed that physical therapists could work in prenatal care, labor, childbirth or the postpartum period, which also reveals the need to expand the dissemination of the work of physical therapists specialized in women’s health. Note that 86% of the participants had higher education, which suggests greater access to information related to the topic. In our study, the sample was composed of women treated in the public health network, most of whom had completed high school.
This study results show that the profile of women cared for in the maternity hospital, aged 20-30 years old and with complete high school, is similar to that seen throughout the country11-13. However, unlike the national trend, in which Cesarean sections increased and vaginal deliveries decreased from 2000 to 2019, most women in the study had vaginal childbirths14. Data from the Ministry of Health indicate that, between 2018 and 2022, 56.9% of births in Brazil were Cesarean sections15.
The participants reported pain and discomfort in the immediate puerperal period. Among the most reported pains are the perineal and abdominal16. In this study, 20% reported abdominal pain and 26% perineal pain, but these were not the most frequent. Abdominal pain is prevalent in women who have undergone Cesarean section, due to the surgical incision and increased uterine tone17,18. Perineal pain, common among postpartum women, can cause limitations in daily activities and lead to early weaning2.
Edema, especially in the limbs and perineal region, was the most common complaint, with causes ranging from immobilization in bed, complications, pain or fear, impairing lymphatic drainage, especially after C-section4. In vaginal childbirth, perineal edema results from dilation for the passage of the baby, lacerations, or episiotomy19. To treat these symptoms, techniques such as kinesiotherapy (especially pelvic mobility exercises), electrostimulation, postural guidance for breastfeeding, cryotherapy, massage therapy and lymphatic drainage20-26, were used, improving the self-care of the woman and the newborn.
The women were satisfied with the physical therapy. They all considered the service useful, perceived explanations as clear, had their doubts solved and would like to be seen again if they had another child. National studies indicate that satisfaction with the physical therapist’s care is associated with the attention provided, communication skills and clarity in explanations, which corroborates the favorable comments of the participants about the attention and care received with the physiotherapy care27-29. All the items analyzed were positively evaluated, only three women considered that the care bothered or was too long, only 21% felt pain and/or discomfort during or after the exercises, probably related to postpartum pain17,19.
This research also showed that some puerperal women had difficulty in performing some activity at home and/or did not adhere to the guidance provided by the physical therapist. This finding corroborates a systematic review study30 in which the puerperal woman will be able to spend most of her time taking care of the baby after childbirth, reducing her demand for physical activities.
The care provided, the reception, and the humanized practices are extremely important for the satisfaction of the user17, but note that satisfaction surveys describe temporary results, requiring continuous improvement, since they reflect the conditions of the service provided, such as the evaluation of the health system31.
One of the main limitations of this study was the small sample, as well as the fact that it was conducted in a single maternity hospital in inland state of São Paulo. Thus, the results here presented should not be generalized. Nevertheless, participants’ characteristics in this study are similar to the profile of Brazilian users of the public health network. Moreover, the results provide relevant information on satisfaction with physical therapy care in the postpartum period, which is not always offered in Brazilian public maternity hospitals. These findings can be useful to improve the services provided in maternity hospitals by showing the importance of the presence of physical therapists in maternity hospitals, in order to meet the needs of postpartum women more efficiently. Moreover, these results may support future investigations that further explore the impact of physical therapy care during the puerperal period.
CONCLUSION
The profile of the participants who received physical therapy care in this study was predominantly composed of White women, in a stable union, with completed high school, multiparous and who had experienced vaginal childbirth. It was found that the postpartum women were satisfied with the physical therapy care received. Moreover, they reported that they were able to ask questions about the postpartum period. Patient satisfaction suggests that the performance of the physical therapist collaborates with maternal well-being during hospitalization.
DATA AVAILABILITY STATEMENT
The data underlying this study are available in the published article.
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