Aamir Waheed Butt - Academia.edu (original) (raw)

Papers by Aamir Waheed Butt

Pakistan Armed Forces Medical Journal, 2020

Objective: To compare platelet rich plasma against local steroid injection in patients with chron... more Objective: To compare platelet rich plasma against local steroid injection in patients with chronic plantar fasciitis in terms of mean pain and functional scores. Study Design: Quasi-experimental study. Place and Duration of study: Armed Forces Institute of Rehabilitation Medicine (AFIRM) Rawalpindi, from May 2016 to Apr 2018. Methodology: A total of 120 patients having chronic plantar fasciitis were included in the study and were split into 2 groups. The group “A” (n=60) patients were injected with a single dose of autologous platelet rich plasma. The group “B” (n=60) patients received a single dose of methylprednisolone added with a local anesthetic agent. Functional and symptomatic evaluation was done using the American foot and ankle score and the visual analog scale respectively at baseline and at 6 months follow-up. Results: Mean visual analogue score was 7.83 ± 0.99 at baseline and 3.43 ± 1.30 at 6 months follow-up in group “A” and 7.90 ± 1.06 and 4.97 ± 1.16, respectively, i...

Objective: To compare the mean improvement in pain on Visual Analogue Scale by Suprascapular nerv... more Objective: To compare the mean improvement in pain on Visual Analogue Scale by Suprascapular nerve block and Intraarticular steroid injection in patients with hemiplegic shoulder pain. Study Design: Quasi-experimental study. Place and Duration of Study: Interventional Pain Management Center, Armed Forces Institute of Rehabilitation Medicine Rawalpindi, from Oct 2017 to Apr 2018. Methodology: A total of 60 patients with stroke and shoulder pain on hemiplegic side for at least 2 weeks were included, randomized by lottery into two groups; Group A receiving Suprascapular Nerve block with 5ml of 1% Lignocaine with Group B receiving Intra-articular 40mg Triamcinolone Acetonide plus 1ml of 1% Lignocaine injections. Mean change in pain scores on Visual Analogue Scale was calculated between score at baseline and at 4 weeks post-intervention. Results: Out of a total of 60 subjects, 34 (56.67%) were males and 26 (43.33%) were females. Mean duration of stroke was 7.50 ± 2.66 months. Mean pain c...

Pakistan Armed Forces Medical Journal, 2020

Objective: To report the seasonal trends of Guillain-Barre Syndrome in a cohort of Pakistani popu... more Objective: To report the seasonal trends of Guillain-Barre Syndrome in a cohort of Pakistani population from southern Punjab, Pakistan. Study Design: A retrospective observational study. Place and Duration of Study: Department of Physical Medicine & Rehabilitation, Combined Military Hospital Bahawalpur, from Jan 2016 to Oct 2018. Methodology: One-hundred and fifty-two individuals fulfilling the electrophysiological criteria of Guillain-Barre Syndrome were included from the records of the department and subdivided into four main subtypes on the basis of electrodiagnostic studies including Acute Inflammatory Demyelinating Polyneuropathy, Acute Motor Axonal Neuropathy, Acute Motor and Sensory Axonal Neuropathy, and Miller Fisher Syndrome. The seasons were divided as: summer; May to August, autumn; September and October, winter; November to February, and spring; March and April. Demographic characteristics, type of Guillain-Barre Syndrome, and month and season of presentation were inves...

Pakistan Armed Forces Medical Journal, 2015

Although very rare in twins, pediatric trigger thumb demands early identification and treatment f... more Although very rare in twins, pediatric trigger thumb demands early identification and treatment for successful resolution. The results are better in younger patients as it allows for motor learning and functional skills. However, for older or refractory patients surgical release is indicated. Recurrence is also common so follow up is needed. A case report of twin sisters is presented.

Pakistan Armed Forces Medical Journal, 2018

Objective: To assess clinical presentations and subtypes of Guillain-Barre Syndrome (GBS) in Paki... more Objective: To assess clinical presentations and subtypes of Guillain-Barre Syndrome (GBS) in Pakistan. Study Design: Retrospective study. Place and Duration of Study: CMH Lahore, Abbotabad, Quetta & Armed Forces Institute of Rehabilitation Medicine form Jan 2007 to Feb 2015. Material and Methods: The relevant history, demographic features, clinical presentations and subtypes of GBS in 211 patients fulfilling the clinical and electrodiagnostic criteria were investigated. Results: The average age of the patients was 37.36 years (62.7% M, 37.3% F). Clinically 66.8%, 17.8% and 15.4% presented as ascending paralysis, simultaneous quadriparesis and paraparesis respectively. About 38.1% of the patients presented with cranial nerves involvement, 87.4% presented with areflexia while 59.5% reported pain. The GBS subtypes identified were acute inflammatory demyelinating polyneuropathy (21.9%), acute motor axonal neuropathy (38.9%), acute motor sensory axonal neuropathy (35.6%) and fisher syndr...

The Professional Medical Journal, 2008

Objective: To describe the pattern of Urodynamic evaluation at ArmedForces Institute of Rehab Med... more Objective: To describe the pattern of Urodynamic evaluation at ArmedForces Institute of Rehab Medicine, Rawalpindi. Study Design: Descriptive study. Materials and Methods: This studywas conducted on 466 patients reporting for urodynamic evaluation at Urodynamic/Incontinence Clinic at A F Instituteof Rehab Medicine from Feb 2003 to Dec 2006. We considered the age, gender, etiology, reason for referral, andpresenting complaints whereas results were formulated according to Classification of voiding disorders by Internationalsociety of Incontinence. Data was analyzed using statistical package forSocial Science version 10. Results: In all (466)patients, 58% were males and 42% were females. Mean age was 46.8 years. Increased frequency (61%) andincontinence (52%) were the most common presenting complaints, 158(34%) had spinal cord injuries, 58 were casesof myelodysplasias and 128 reported with stress incontinence. Urodynamic studies showed that 152(33%) hadhyperactive bladders, 110(24%) ha...

Sexuality and Disability, 2018

Physical disabilities such as a spinal cord injury (SCI) may change the sexual functioning of a p... more Physical disabilities such as a spinal cord injury (SCI) may change the sexual functioning of a person. The aim of this study was to estimate the frequency of sexual dysfunction (SD) in a cohort of Pakistani men with SCI and explore the influence of level and completeness of SCI, financial and educational status, and rural versus urban living on SD. Fifty-nine men with SCI (mean age: 32 ± 9 years) participated in the study. They were asked about sexual desire, sexual intercourse before and after SCI, type of penile erection they could achieve, methods they used to attain erection, attainment of orgasm and ejaculation, and the level of satisfaction with their sexual life. The majority (83.1%) possessed sexual desire but only 22% performed sexual intercourse following injury. Most men (81.4%) were able to achieve erection. The commonest type of erection was reflexogenic (n = 42) and masturbation was the preferred method (n = 35). Only 35.6% were successful in reaching orgasm and 13.6% had effective ejaculation. No one could have children following injury. The largest proportion (n = 20) reported somewhat satisfaction with their post-injury sexual life. Statistical analysis showed that men with incomplete lesions were significantly better in terms of sexual intercourse (p = 0.008) and achieving ejaculation (p = 0.001). Men of younger age were significantly better (p = 0.026) in terms of sexual desire. Educational grade, financial status, urban versus rural living, and the level of SCI did not significantly influence sexual desire, sexual intercourse, reaching orgasm, achieving erection or ejaculation, and satisfaction in sexual life. In conclusion, following SCI, most men in our sample possessed sexual desire and attained penile erection, however, less engaged in sexual intercourse, reaching orgasm, successful ejaculation, or becoming fathers. Individuals with an incomplete injury and younger age seemed more sexually active than those with a complete injury and older age. However, the majority were satisfied with their sexual life.

Cureus, 2017

Pakistan is one of the three countries in South East Asia that has an active postgraduate physica... more Pakistan is one of the three countries in South East Asia that has an active postgraduate physical medicine and rehabilitation (PM&R) training program. College of Physicians and Surgeons Pakistan (CPSP) offers a four-year structured training program in PM&R. It consists of clinical teaching, lectures, rotations in other specialties, and writing a research dissertation. The aim of this survey was to provide an objective analysis of the current PM&R training program, including the facilities available for training, the participation of residents in academic activities, and their participation in different PM&R procedures. Hospital ethics committee approval was obtained. The questionnaire had sections on informed consent; basic demographics; the different components of residency training; and selfassessement of competence in different procedural skills. It was approved by the dean of PM&R at CPSP. There are six accredited training centers in Pakistan. Twelve residents are undergoing residency training at four different centers (Dec 2015). Key persons were nominated at each center to facilitate data collection. All residents (100% response rate) completed the survey. Almost all had read the CPSP training manual. Most had submitted the research dissertation. Training facilities varied across different centers, with the military center being the best equipped. The self-assessed competence of residents in different PM&R procedures varied among different centers, but overall it conformed to the competency levels specified in the training manual. Overall PM&R residency training in Pakistan is satisfactory, but there is a need to strengthen the weak areas and standardize the training across all centers in the country.

Methodology: All new cases of war wounded soldiers with peripheral nerve injuries were consecutiv... more Methodology: All new cases of war wounded soldiers with peripheral nerve injuries were consecutively enrolled. Physical examination and electrodiagnostic study was carried out by experienced physiatrists. Data was entered in pretested especially designed questionnaire which was analysed using SPSS version 17.0. Seddon's classification system was used to assess the severity of injury. Results: There were 418 cases of peripheral nerve injuries with 504 different nerve segments. Mean age was 29.41 ± 8 years. Blast was the main cause of nerve injury in 244 (48.5%) cases followed by gunshot in 215 (42.7%) and 45 (8.9%) cases had nerve injuries secondary to fall, burial under debris and motor vehicle accidents. Eighty six (17%) cases had multiple nerve injuries. Most commonly injured nerve was ulnar (20.6%) followed by sciatic (16.7%), median (16.5%), radial (16.3%), peroneal (8.7%), brachial plexus (8.5%), axillary (4.8%), tibial (2%), femoral (1.8%), long thoracic (0.4%) and others (3.8%). Axonotmesis was seen in 459 (91.1%) cases, 44 (8.7%) cases revealed neurotmesis and 1 (0.2%) case had neuropraxia. Conclusion: Peripheral nerve injuries are a major component of war related injuries mainly involving the upper limbs. Electrodiagnostic studies help in assessing severity and determining prognosis. Precise documentation of severity of nerve injuries is important to estimate the burden on our resources and to extend rehabilitation services.

Objectives: The purpose of this study was to determine frequency, character, approximate location... more Objectives: The purpose of this study was to determine frequency, character, approximate location and intensity of neuropathic pain in spinal cord injury and its impact on the quality of life. Study Design: A cross-sectional survey Place and Duration of Study: Armed Forces Institute of Rehabilitation Medicine (AFIRM), Rawalpindi from Feb 2009 to Feb 2010. Material and Methods: Through non-probability convenience sampling 87 patients of both genders diagnosed with spinal cord injury based on American Spinal Injury Association criteria and admitted within a year of injury were included. Those in spinal shock, having poor cognition, inability to communicate, concurrent brain injury and history of chronic pain before injury were excluded. The history, localization and characteristics of the pain and interference with life activities were recorded. Neuropathic pain of patients was evaluated with Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale. Visual analogue scale was used...

Spinal Cord, 2010

Study design: A cross-sectional survey. Objectives: To document bowel care practices of chronic s... more Study design: A cross-sectional survey. Objectives: To document bowel care practices of chronic spinal cord injury (SCI) patients in Pakistan.

Objectives: To identify short comings in the stroke rehabilitation referral and consultation in P... more Objectives: To identify short comings in the stroke rehabilitation referral and consultation in Pakistan. Study Design: Observational study. Place and duration of study: Stroke Clinic at Armed Forces Institute of Rehabilitation Medicine (AFIRM) Rawalpindi from March 2005 to ...

Journal of rehabilitation medicine, Jan 19, 2017

To provide an update on disability and outline potential barriers and facilitators for implementa... more To provide an update on disability and outline potential barriers and facilitators for implementation of the World Health Organization Global Disability Action Plan (GDAP) in Pakistan. A 6-day workshop at the Armed Forces Institute of Rehabilitation Medicine, Islamabad facilitated by rehabilitation staff from Royal Melbourne Hospital, Australia. Local healthcare professionals (n = 33) from medical rehabilitation facilities identified challenges in service provision, education and attitudes/approaches to people with disabilities, using consensus agreement for objectives listed in the GDAP. Respondents agreed on the following challenges in implementing the GDAP: shortage of skilled work-force, fragmented healthcare system, poor coordination between acute and subacute healthcare sectors, limited health services infrastructure and funding, lack of disability data, poor legislation, lack of guidelines and accreditation standards, limited awareness/knowledge of disability, socio-cultural ...

Pakistan Armed Forces Medical Journal, 2020

Objective: To compare platelet rich plasma against local steroid injection in patients with chron... more Objective: To compare platelet rich plasma against local steroid injection in patients with chronic plantar fasciitis in terms of mean pain and functional scores. Study Design: Quasi-experimental study. Place and Duration of study: Armed Forces Institute of Rehabilitation Medicine (AFIRM) Rawalpindi, from May 2016 to Apr 2018. Methodology: A total of 120 patients having chronic plantar fasciitis were included in the study and were split into 2 groups. The group “A” (n=60) patients were injected with a single dose of autologous platelet rich plasma. The group “B” (n=60) patients received a single dose of methylprednisolone added with a local anesthetic agent. Functional and symptomatic evaluation was done using the American foot and ankle score and the visual analog scale respectively at baseline and at 6 months follow-up. Results: Mean visual analogue score was 7.83 ± 0.99 at baseline and 3.43 ± 1.30 at 6 months follow-up in group “A” and 7.90 ± 1.06 and 4.97 ± 1.16, respectively, i...

Objective: To compare the mean improvement in pain on Visual Analogue Scale by Suprascapular nerv... more Objective: To compare the mean improvement in pain on Visual Analogue Scale by Suprascapular nerve block and Intraarticular steroid injection in patients with hemiplegic shoulder pain. Study Design: Quasi-experimental study. Place and Duration of Study: Interventional Pain Management Center, Armed Forces Institute of Rehabilitation Medicine Rawalpindi, from Oct 2017 to Apr 2018. Methodology: A total of 60 patients with stroke and shoulder pain on hemiplegic side for at least 2 weeks were included, randomized by lottery into two groups; Group A receiving Suprascapular Nerve block with 5ml of 1% Lignocaine with Group B receiving Intra-articular 40mg Triamcinolone Acetonide plus 1ml of 1% Lignocaine injections. Mean change in pain scores on Visual Analogue Scale was calculated between score at baseline and at 4 weeks post-intervention. Results: Out of a total of 60 subjects, 34 (56.67%) were males and 26 (43.33%) were females. Mean duration of stroke was 7.50 ± 2.66 months. Mean pain c...

Pakistan Armed Forces Medical Journal, 2020

Objective: To report the seasonal trends of Guillain-Barre Syndrome in a cohort of Pakistani popu... more Objective: To report the seasonal trends of Guillain-Barre Syndrome in a cohort of Pakistani population from southern Punjab, Pakistan. Study Design: A retrospective observational study. Place and Duration of Study: Department of Physical Medicine & Rehabilitation, Combined Military Hospital Bahawalpur, from Jan 2016 to Oct 2018. Methodology: One-hundred and fifty-two individuals fulfilling the electrophysiological criteria of Guillain-Barre Syndrome were included from the records of the department and subdivided into four main subtypes on the basis of electrodiagnostic studies including Acute Inflammatory Demyelinating Polyneuropathy, Acute Motor Axonal Neuropathy, Acute Motor and Sensory Axonal Neuropathy, and Miller Fisher Syndrome. The seasons were divided as: summer; May to August, autumn; September and October, winter; November to February, and spring; March and April. Demographic characteristics, type of Guillain-Barre Syndrome, and month and season of presentation were inves...

Pakistan Armed Forces Medical Journal, 2015

Although very rare in twins, pediatric trigger thumb demands early identification and treatment f... more Although very rare in twins, pediatric trigger thumb demands early identification and treatment for successful resolution. The results are better in younger patients as it allows for motor learning and functional skills. However, for older or refractory patients surgical release is indicated. Recurrence is also common so follow up is needed. A case report of twin sisters is presented.

Pakistan Armed Forces Medical Journal, 2018

Objective: To assess clinical presentations and subtypes of Guillain-Barre Syndrome (GBS) in Paki... more Objective: To assess clinical presentations and subtypes of Guillain-Barre Syndrome (GBS) in Pakistan. Study Design: Retrospective study. Place and Duration of Study: CMH Lahore, Abbotabad, Quetta & Armed Forces Institute of Rehabilitation Medicine form Jan 2007 to Feb 2015. Material and Methods: The relevant history, demographic features, clinical presentations and subtypes of GBS in 211 patients fulfilling the clinical and electrodiagnostic criteria were investigated. Results: The average age of the patients was 37.36 years (62.7% M, 37.3% F). Clinically 66.8%, 17.8% and 15.4% presented as ascending paralysis, simultaneous quadriparesis and paraparesis respectively. About 38.1% of the patients presented with cranial nerves involvement, 87.4% presented with areflexia while 59.5% reported pain. The GBS subtypes identified were acute inflammatory demyelinating polyneuropathy (21.9%), acute motor axonal neuropathy (38.9%), acute motor sensory axonal neuropathy (35.6%) and fisher syndr...

The Professional Medical Journal, 2008

Objective: To describe the pattern of Urodynamic evaluation at ArmedForces Institute of Rehab Med... more Objective: To describe the pattern of Urodynamic evaluation at ArmedForces Institute of Rehab Medicine, Rawalpindi. Study Design: Descriptive study. Materials and Methods: This studywas conducted on 466 patients reporting for urodynamic evaluation at Urodynamic/Incontinence Clinic at A F Instituteof Rehab Medicine from Feb 2003 to Dec 2006. We considered the age, gender, etiology, reason for referral, andpresenting complaints whereas results were formulated according to Classification of voiding disorders by Internationalsociety of Incontinence. Data was analyzed using statistical package forSocial Science version 10. Results: In all (466)patients, 58% were males and 42% were females. Mean age was 46.8 years. Increased frequency (61%) andincontinence (52%) were the most common presenting complaints, 158(34%) had spinal cord injuries, 58 were casesof myelodysplasias and 128 reported with stress incontinence. Urodynamic studies showed that 152(33%) hadhyperactive bladders, 110(24%) ha...

Sexuality and Disability, 2018

Physical disabilities such as a spinal cord injury (SCI) may change the sexual functioning of a p... more Physical disabilities such as a spinal cord injury (SCI) may change the sexual functioning of a person. The aim of this study was to estimate the frequency of sexual dysfunction (SD) in a cohort of Pakistani men with SCI and explore the influence of level and completeness of SCI, financial and educational status, and rural versus urban living on SD. Fifty-nine men with SCI (mean age: 32 ± 9 years) participated in the study. They were asked about sexual desire, sexual intercourse before and after SCI, type of penile erection they could achieve, methods they used to attain erection, attainment of orgasm and ejaculation, and the level of satisfaction with their sexual life. The majority (83.1%) possessed sexual desire but only 22% performed sexual intercourse following injury. Most men (81.4%) were able to achieve erection. The commonest type of erection was reflexogenic (n = 42) and masturbation was the preferred method (n = 35). Only 35.6% were successful in reaching orgasm and 13.6% had effective ejaculation. No one could have children following injury. The largest proportion (n = 20) reported somewhat satisfaction with their post-injury sexual life. Statistical analysis showed that men with incomplete lesions were significantly better in terms of sexual intercourse (p = 0.008) and achieving ejaculation (p = 0.001). Men of younger age were significantly better (p = 0.026) in terms of sexual desire. Educational grade, financial status, urban versus rural living, and the level of SCI did not significantly influence sexual desire, sexual intercourse, reaching orgasm, achieving erection or ejaculation, and satisfaction in sexual life. In conclusion, following SCI, most men in our sample possessed sexual desire and attained penile erection, however, less engaged in sexual intercourse, reaching orgasm, successful ejaculation, or becoming fathers. Individuals with an incomplete injury and younger age seemed more sexually active than those with a complete injury and older age. However, the majority were satisfied with their sexual life.

Cureus, 2017

Pakistan is one of the three countries in South East Asia that has an active postgraduate physica... more Pakistan is one of the three countries in South East Asia that has an active postgraduate physical medicine and rehabilitation (PM&R) training program. College of Physicians and Surgeons Pakistan (CPSP) offers a four-year structured training program in PM&R. It consists of clinical teaching, lectures, rotations in other specialties, and writing a research dissertation. The aim of this survey was to provide an objective analysis of the current PM&R training program, including the facilities available for training, the participation of residents in academic activities, and their participation in different PM&R procedures. Hospital ethics committee approval was obtained. The questionnaire had sections on informed consent; basic demographics; the different components of residency training; and selfassessement of competence in different procedural skills. It was approved by the dean of PM&R at CPSP. There are six accredited training centers in Pakistan. Twelve residents are undergoing residency training at four different centers (Dec 2015). Key persons were nominated at each center to facilitate data collection. All residents (100% response rate) completed the survey. Almost all had read the CPSP training manual. Most had submitted the research dissertation. Training facilities varied across different centers, with the military center being the best equipped. The self-assessed competence of residents in different PM&R procedures varied among different centers, but overall it conformed to the competency levels specified in the training manual. Overall PM&R residency training in Pakistan is satisfactory, but there is a need to strengthen the weak areas and standardize the training across all centers in the country.

Methodology: All new cases of war wounded soldiers with peripheral nerve injuries were consecutiv... more Methodology: All new cases of war wounded soldiers with peripheral nerve injuries were consecutively enrolled. Physical examination and electrodiagnostic study was carried out by experienced physiatrists. Data was entered in pretested especially designed questionnaire which was analysed using SPSS version 17.0. Seddon's classification system was used to assess the severity of injury. Results: There were 418 cases of peripheral nerve injuries with 504 different nerve segments. Mean age was 29.41 ± 8 years. Blast was the main cause of nerve injury in 244 (48.5%) cases followed by gunshot in 215 (42.7%) and 45 (8.9%) cases had nerve injuries secondary to fall, burial under debris and motor vehicle accidents. Eighty six (17%) cases had multiple nerve injuries. Most commonly injured nerve was ulnar (20.6%) followed by sciatic (16.7%), median (16.5%), radial (16.3%), peroneal (8.7%), brachial plexus (8.5%), axillary (4.8%), tibial (2%), femoral (1.8%), long thoracic (0.4%) and others (3.8%). Axonotmesis was seen in 459 (91.1%) cases, 44 (8.7%) cases revealed neurotmesis and 1 (0.2%) case had neuropraxia. Conclusion: Peripheral nerve injuries are a major component of war related injuries mainly involving the upper limbs. Electrodiagnostic studies help in assessing severity and determining prognosis. Precise documentation of severity of nerve injuries is important to estimate the burden on our resources and to extend rehabilitation services.

Objectives: The purpose of this study was to determine frequency, character, approximate location... more Objectives: The purpose of this study was to determine frequency, character, approximate location and intensity of neuropathic pain in spinal cord injury and its impact on the quality of life. Study Design: A cross-sectional survey Place and Duration of Study: Armed Forces Institute of Rehabilitation Medicine (AFIRM), Rawalpindi from Feb 2009 to Feb 2010. Material and Methods: Through non-probability convenience sampling 87 patients of both genders diagnosed with spinal cord injury based on American Spinal Injury Association criteria and admitted within a year of injury were included. Those in spinal shock, having poor cognition, inability to communicate, concurrent brain injury and history of chronic pain before injury were excluded. The history, localization and characteristics of the pain and interference with life activities were recorded. Neuropathic pain of patients was evaluated with Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale. Visual analogue scale was used...

Spinal Cord, 2010

Study design: A cross-sectional survey. Objectives: To document bowel care practices of chronic s... more Study design: A cross-sectional survey. Objectives: To document bowel care practices of chronic spinal cord injury (SCI) patients in Pakistan.

Objectives: To identify short comings in the stroke rehabilitation referral and consultation in P... more Objectives: To identify short comings in the stroke rehabilitation referral and consultation in Pakistan. Study Design: Observational study. Place and duration of study: Stroke Clinic at Armed Forces Institute of Rehabilitation Medicine (AFIRM) Rawalpindi from March 2005 to ...

Journal of rehabilitation medicine, Jan 19, 2017

To provide an update on disability and outline potential barriers and facilitators for implementa... more To provide an update on disability and outline potential barriers and facilitators for implementation of the World Health Organization Global Disability Action Plan (GDAP) in Pakistan. A 6-day workshop at the Armed Forces Institute of Rehabilitation Medicine, Islamabad facilitated by rehabilitation staff from Royal Melbourne Hospital, Australia. Local healthcare professionals (n = 33) from medical rehabilitation facilities identified challenges in service provision, education and attitudes/approaches to people with disabilities, using consensus agreement for objectives listed in the GDAP. Respondents agreed on the following challenges in implementing the GDAP: shortage of skilled work-force, fragmented healthcare system, poor coordination between acute and subacute healthcare sectors, limited health services infrastructure and funding, lack of disability data, poor legislation, lack of guidelines and accreditation standards, limited awareness/knowledge of disability, socio-cultural ...