Factors associated with access to physical rehabilitation for victims of traffic accidents

Sousa, Kelienny de Meneses; Oliveira, Wagner Ivan Fonsêca de; Alves, Emanuel Augusto; Gama, Zenewton André da Silva

doi:10.1590/S1518-8787.2017051006429

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Articles • Rev. Saúde Pública 51 • 2017 • https://doi.org/10.1590/S1518-8787.2017051006429 copy

Factors associated with access to physical rehabilitation for victims of traffic accidents

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

Evaluate the level of access to physical rehabilitation for survivors of traffic accidents and the associated factors.

METHODS

A cross-sectional study performed in Natal, Northeastern Brazil, through a telephone survey of 155 victims of traffic accidents admitted to an emergency hospital between January and August of 2013, with a diagnosis of fracture, traumatic brain injury or amputation. Participants were identified in the database of the reference hospital for care of traffic accident victims. We calculated point estimates and confidence interval (95%CI) for the frequency of subjects who had access, in addition to multivariate analysis (logistic regression) between access (dependent variable) and sociodemographic, clinical, and assistance variables.

RESULTS

Among the 155 respondents, the majority were adolescents and adults between 15–29 years of age (47.7%), men (82.6%), education up to high school (92.3%), income of up to two minimum wages (78.0%) and bikers (75.5%). Although 85.8% of traffic accident survivors reported the need for physical rehabilitation, there was little access (51.6%; 95%CI 43.7–59.4) and a delay to start the physical rehabilitation (average = 67 days). We classified factors associated with access to physical rehabilitation as: (i) unmodifiable individuals in the short term – family income greater than two minimum wages (OR = 3.7), informal worker (OR = 0.11) or unemployed (OR = 0.15) and possession of a private health care plan (OR = 0.07); and (ii) assistance modifiable by service management – written referral for physical rehabilitation (OR = 27.5) and perceived need of physical rehabilitation (OR = 10).

CONCLUSIONS

This study found a low and slow access to physical rehabilitation for individuals potentially in need. The associated factors were the organizational processes of health care (health information and referral) and social determinants (income, occupation and private health care plan).

Accidents, Traffic; Rehabilitation Services; Health Services Accessibility; Quality of Health Care

Variable	Frequency	Percentage
Sociodemographic variables

Gender
Male	128	82.6
Female	27	17.4
Age (years)
7–14	10	6.4
15–29	74	47.7
30–65	59	38.0
66–80	12	7.7
Marital status
Married	54	34.8
Single	101	65.1
Education
Middle school	70	45.2
High school	73	47.1
Higher education	12	7.7
Occupation
Student	23	14.8
Retiree	14	9.0
Unemployed	12	7.7
Informal worker	29	18.7
Employed	77	49.7
Income (minimum wage)
1–2	121	78.0
> 2	34	21.9
Private health care plan
Yes	13	8.4
No	142	91.6

Traffic accident variables

Type of accident
Fall	17	11.0
Run over	21	13.5
Collision	117	75.4
Type of vehicle
Motorcycle	114	73.5
Automobile	11	7.1
Non-motorized transport	30	19.3
Type of victim
Driver	106	68.3
Passenger	27	17.4
Pedestrian	22	14.1

Clinical functional variables

Lesion diagnosis
Amputation
Yes	7	4.5
No	148	95.9
Fracture
Yes	129	83.2
No	26	16.8
Traumatic brain injury
Yes	18	11.6
No	137	88.3
Soft tissue injury
Yes	15	9.3
No	140	90.3
Site of injury
Upper limbs	72	46.5
Lower limbs	89	57.4
Functional limitation
Self-care	131	84.5
Ambulation	109	70.3
Mobility	141	91.0
Difficulty of return to work	101	95.2
Perceived need for PR
Yes	133	85.8
No	22	14.2
Time until return to work (months)
0–2	21	26.9
3–4	20	25.6
6–14	37	47.4
Loss or inability of employment*	27	25.4

Clinical assistance variables

Orthopedic surgery
Yes	108	69.7
No	46	30.3
Immobilization with plaster cast
Yes	45	29.0
No	110	71.0
Hospital rehabilitation
Yes	27	17.4
No	128	82.6
Length of stay (days)
0–2	39	25.2
3–8	41	26.5
9–22	37	23.9
23–120	38	24.5
Referral to PR
Yes	80	51.6
No	75	48.4
Information about PR
Yes	86	55.5
No	69	44.5

Variable	Average (n)	Frequency (n)	Percentage	95CI%
Access (yes)
General	-	80 (155)	51.6	43.7–59.4
Public	-	51 (155)	32.9	25.5–40.2
Private	-	29 (155)	18.7	12.6–24.7

Time of access (in days)
General	66.6 (80)	-	-	51.0–82.3
Public	74.0 (51)	-	-	62.1–85.8
Private	56.4 (29)	-	-	49.7–63.0

Variable	General access (%)	OR	95CI%	p	Public access (%)	OR	95CI%	p
Income (minimum wage)a
> 2	72.7	3.2	1.37–7.45	0.005	42.4	1.7	0.78–3.84	0.168
1-2	45.5				29.8
Education
Higher education^b	75.0	-	-	0.177	33.3	-	-	0.939
High school	53.4	0.28	0.07–1.12	0.073	31.5	1.04	0.28–3.82	0.949
Middle school	45.7	0.38	0.10–1.52	0.174	34.3	0.92	0.25–3.36	0.900
Marital status
Married	58.5	0.65	0.33–1.28	0.217	41.5	0.54	0.27–1.10	0.090
Single	48.0				28.0
Occupation^a
Employed^b	63.6	-	-	0.009	39.0	-	-	0.076
Retiree	64.3	0.44	0.17–1.13	0.089	50.0	0.68	0.25–1.86	0.460
Unemployed	33.3	1.02	0.31–3.37	0.963	33.3	1.56	0.45–4.91	0.442
Informal worker	27.6	0.28	0.08–1.03	0.056	10.3	0.78	0.21–2.83	0.709
Student	43.5	0.21	0.08–0.55	0.001	30.4	0.18	0.05–0.65	0.009
Private health plan^a
Yes	61.5	1.56	0.48–4.98	0.454	7.70	0.17	0.02–1.21	0.043
No	50.7				35.2
Type of victim
Pedestrian^b	38.1	-	-	0.198	14.3	-	-	0.187
Passenger	42.3	2.07	0.79–5.41	0.136	34.6	3.30	0.91 – 11.9	0.068
Driver	56.1	1.19	0.36–3.86	0.770	35.5	3.17	0.73 – 13.7	0.122
Type of accident^a
Collision^b	55.2	-	-	0.227	37.9	-	-	0.051
Run over	42.9	0.44	0.15–1.28	0.132	14.3	0.35	0.09–0.28	0.115
Fall	35.3	0.61	0.23–1.56	0.301	17.6	0.27	0.07–0.98	0.046
Motorcycle
Yes	58.3	1.44	0.69–3.00	0.329	35.9	1.80	0.78–4.17	0.164
No	44.7				23.7
Lower limbs injury
Yes	56.2	1.53	0.81–2.91	0.186	33.7	1.09	0.55–2.14	0.804
No	45.5				31.8
Self-care limitations
Yes	55.0	2.44	0.97–6.09	0.051	33.6	1.22	0.47–3.18	0.672
No	33.3				29.2
Perceived need for PR^a
Yes	58.6	14.2	3.18–63.1	0.000	37.6	12.6	1.65–96.9	0.002
No	9.1				4.50
Orthopedic amputation^a
Yes	85.7	6.0	0.70–51.1	0.065	71.4	5.54	1.03–29.6	0.026
No	50.0				31.1
Soft tissue injury^a
Yes	40.0	0.59	0.20–1.76	0.489	6.70	0.12	0.01–1.00	0.023
No	52.9				37.7
Written referral^a
Yes	82.5	20.5	9.06–46.5	0.000	57.5	18.9	6.9–51.2	0.000
No	18.7				6.7
Orthopedic surgery^a
Yes	63.9	5.79	2.65–12.6	0.000	39.8	3.22	1.37–7.56	0.006
No	23.4				17.0
Hospital rehabilitation
Yes	63.0	1.75	0.74–4.12	0.194	44.4	1.82	0.78–4.26	0.160
No	49.2				30.5
Immobilization with plaster cast^a
Yes	58.2	0.39	0.19–0.81	0.011	38.2	0.41	0.18–0.95	0.029
No	35.6				20.0
Information about PR^a
Yes	74.4	9.63	4.6–20.20	0.000	48.8	6.34	2.8–14.42	0.000
No	23.2				13.0
Length of stay (days)^a
0–2^b	23.1	-	-	0.001	10.3	-	-	0.014
3–8	65.9	6.42	2.40–17.2	0.000	39.0	5.60	1.67–18.7	0.005
9–22	56.8	4.37	1.62–11.7	0.003	37.8	5.32	1.56–18.2	0.008
23–120	60.5	5.11	1.90–13.7	0.001	44.7	7.08	2.10–23.9	0.002

Variable	Categories	n (% access)	Adj OR	95CI%	p
Model 1 – General access to physical rehabilitation^a

Occupation	Employed^c	49 (63.6)			0.018
	Unemployed	4 (33.3)	0.15	0.02–0.96	0.046
	Informal worker	8 (27.6)	0.11	0.03–0.43	0.001
Family income (minimum wage)	> 2	24 (72.7)	3.72	1.07–13.00	0.039
	1-2	55(45.5)
Perceived need for PR	Yes	78 (58.6)	10.00	1,30–76.53	0.027
	No	2 (9.1)
Written referral	Yes	66 (82.5)	27.50	9.52–79.42	< 0.001
	No	14 (18.7)

Model 2 – General access to physical rehabilitation in the public health system^b

Private health care plan	Yes	1 (7.7)	0.07	0.008–0.59	0.014
	No	50 (35.2)
Written referral	Yes	46 (57.5)	23.00	8.22–68.24	< 0.001
	No	5 (6.7)

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence: Kelienny de Meneses Sousa. Departamento de Saúde Coletiva – UFRN. Campus Central. Centro de Ciências da Saúde. Av. Senador Salgado Filho, 3000 Lagoa Nova. 59078-970 Natal, RN, Brasil. E-mail: kelienny@gmail.com