Programa de intervenção padronizada para estímulo do desempenho motor de prematuros hospitalizados e autoeficácia materna para cuidado

Abstract

The objective of this study is to examine the influence of an educational motor intervention program offered to mothers on the motor performance of hospitalized premature infants and on maternal self-efficacy perceptions regarding care. This is a quasi-experimental pilot study developed in two stages: 1. cross-cultural validation of the Maternal Education Program Manual, based on The Norwegian Physiotherapy Study Preterm Infants, which proposes maternal training for motor stimulation of hospitalized premature infants. 2. application of the program to mothers of premature newborns hospitalized in the Neonatal Intensive Care Unit. The study sites were the Neonatal Intensive Care Unit and the Outpatient Clinic for follow-up of at-risk newborns at the University Hospital of Western Paraná. Eighteen preterm newborns with a gestational age greater than 28 weeks and less than or equal to 32 weeks and their mothers participated in the study, excluding those with malformations and/or a diagnosis of neurological injury; adolescent mothers; illiterate mothers or those who did not speak Portuguese fluently; mothers who had a diagnosis of a mental disorder or used psychotropic medication. The preterm newborns were randomly divided into two groups: Comparison Group, nine premature newborns who received only the standard routine guidelines of the sector, and Intervention Group, whose nine mothers, in addition to the usual guidelines of the unit, participated in the Maternal Education Program developed by the physical therapist, author of this thesis. The standardized intervention program consisted of meetings between mothers and the physical therapist during their child's hospitalization, three times in the first week, twice in the second week, and once in the third week. In addition, the mothers performed motor stimulation for three weeks, with two daily sessions of 10 minutes each. Participants in both groups were evaluated at three points in time: 1. hospitalization, when the newborns reached 34 weeks; 2. at 37 weeks of gestational age, during hospitalization; 3. at three months of age after conception, at the premature infant follow-up clinic. Motor development was assessed using the Test of Infant Motor Performance. Maternal self efficacy in neonatal care was measured using two specific instruments: Perception of Maternal Parenting Self-Efficacy, applied during hospitalization, and the Preterm Parenting & Self-Efficacy Checklist – Brazilian version, at the follow-up clinic. The data were analyzed using descriptive statistics to characterize the sample and compare the groups, using Student's t-test, Wilcoxon-Mann-Whitney test, and Fisher's exact test, considering the small sample size. The significance level adopted in all analyses was 5% (α=0.05). The motor performance of the intervention group was higher after the motor intervention (p=0.001). There was no statistical difference in the third assessment, after hospital discharge (p=0.117). In maternal self-efficacy, assessed by the Preterm Parenting & Self-Efficacy Checklist in relation to motor performance, a positive correlation was also observed, with a tendency toward statistical significance (p=0.078; 95% CI: 0.05 to 0.74). It was concluded that the motor intervention performed by the mothers had a positive effect immediately after the end of the intervention, but this was not sufficient to maintain the evolution of motor performance at three months. Mothers with greater self efficacy tended to have children with better motor performance.