Global health-care systems must prioritise rehabilitation (original) (raw)
Related papers
2019
Background: To inform global health policies and resources planning, this paper analyzes evolving trends in physical rehabilitation needs, using data on Years Lived with Disability (YLDs) from the Global Burden of Disease Study (GBD) 2017. Methods: Secondary analysis of how YLDs from conditions amenable to physical rehabilitation have evolved from 1990 to 2017, for the world and across countries of varying income levels. Linear regression analyses were used. Results: A 66.2% growth was found in estimated YLD Counts amenable to physical rehabilitation: a significant and linear growth of more than 5.1 billion YLDs per year (99%CI: 4.8–5.4; r2 = 0.99). Low-income countries more than doubled (111.5% growth) their YLD Counts amenable to physical rehabilitation since 1990. YLD Rates per 100,000 people and the percentage of YLDs amenable to physical rehabilitation also grew significantly over time, across locations (all p > 0.05). Finally, only in high-income countries Age-standardized ...
Rehabilitation: The health strategy of the 21st century
Journal of rehabilitation medicine, 2017
There is strong evidence that population ageing and the epidemiological transition to a higher incidence of chronic, non-communicable diseases will continue to profoundly impact societies worldwide, putting more pressure on healthcare systems to respond to the needs of the people they serve. These trends argue for the need to address what matters to people about their health: limitations in their functioning that affect their day-to-day actions and goals in life. From its inception, rehabilitation, 1 of the 4 health strategies identified in the Declaration of Alma Ata in 1978, has had functioning as its outcome of interest. Its practitioners are from fields that include physical and rehabilitation medicine, occupational therapy, physiotherapy, speech and language therapy, orthotics and prosthetics, psychology, and evaluators of functioning interventions, including assistive technologies. Demographic and epidemiological trends suggest that the key indicators of the health of populati...
Archives of physical medicine and rehabilitation, 2016
To develop a comprehensive set of categories from the International Classification of Functioning, Disability and Health (ICF) as a minimal standard for reporting and assessing functioning and disability in clinical populations along the continuum of care. The specific aims were to specify the domains of functioning recommended for such ICF Rehabilitation Set and to identify a minimal set of environmental factors (EFs) to be used alongside the ICF Rehabilitation Sets when describing disability across individuals and populations with various health conditions. A secondary analysis of existing data sets was performed using regression methods (Random Forests and Group Lasso regression) and expert consultation. Along the continuum of care, including acute, early-post acute, and long-term and community rehabilitation settings. In the primary studies 9863 persons participated with various health condition. The number of respondents for whom the dependent variable data were available and u...
Towards a conceptual description of rehabilitation as a health strategy
Journal of Rehabilitation Medicine, 2011
Objective: a proposal for a conceptual description of rehabilitation was made in 2007 based on the International Classification of Functioning, Disability and Health. this conceptual description should foster the development of a common understanding of rehabilitation and its professions. the present paper aims to report on the development and current state of the discussions about this conceptual description and to provide the current version, which has been adopted by different European professional and scientific organizations. Methods: First, the history of the development of the conceptual description of rehabilitation is reported. Secondly, suggestions for modifications or amendments are introduced, and the resulting phrases and terms are presented and discussed. Discussion and conclusion: one major change to the conceptual description of rehabilitation is the explicit integration of the perspective of the disabled person. the relationship between person and provider is characterized as a partnership. However, it is argued that quality of life should not be introduced as a primary goal of rehabilitation. this conceptual description can foster a common understanding of the rehabilitation professions and provide a point of departure for clarifying the role of different professions and services within the broad field of rehabilitation. It can also serve to position rehabilitation as a major health strategy and to sharpen the perception of rehabilitation among external stakeholders.
ObjectiveTo explore and synthesize critical factors for the scale-up of comprehensive rehabilitation care for people with non-communicable disease in low-resourced settings.MethodsA core set of 81 articles were selected from two published scoping reviews. Using the principles of thematic analysis, the core set was analysed for factors that may directly or indirectly affect the feasibility or scale-up of rehabilitation. Categories and themes were formulated via an iterative team approach using the core set (n=81). Subsequently, we triangulated the thematic analysis against our findings from a feasibility study conducted in a low-resourced, urban, setting in South Africa. Next, a validation article set (n=63) was identified by updating the searches for the respective published reviews, and a purposeful sample of articles drawn from the validation set (n=13; 20%) was used to validate the factors identified in the primary analysis based on the principles of data saturation.FindingsA tot...
Pilot and Feasibility Studies
Background: Multimorbidity (the coexistence of two or more chronic conditions in an individual) is a growing healthcare burden internationally; however, healthcare and disease management, including rehabilitation, is often delivered in single-disease siloes. The aims of this study were to (1) evaluate the safety and feasibility of multimorbidity rehabilitation compared to a disease-specific rehabilitation program in people with multimorbidity and (2) gather preliminary data regarding clinical outcomes and resource utilization to inform the design of future trials. Methods: A pilot feasibility randomized controlled trial with concealed allocation, assessor blinding, and intention-totreat analysis. Seventeen individuals with a chronic disease eligible for disease-specific rehabilitation (pulmonary, cardiac, heart failure rehabilitation) and at least one other chronic condition were recruited. The intervention group attended multimorbidity exercise rehabilitation and the control group attended disease-specific exercise rehabilitation. Participants attended twice-weekly exercise training and weekly education for 8 weeks. Feasibility measures included numbers screened, recruited, and completed. Other outcome measures were change in functional exercise capacity (6-minute walk test (6MWT)), health-related quality of life (HRQoL), activities of daily living (ADL), and resource utilization. Results: Sixty-one people were screened to recruit seventeen participants (nine intervention, eight control); one withdrew prior to rehabilitation. Participants were mostly male (63%) with a mean (SD) age of 69 (9) years and body mass index of 29 (6). The intervention group attended a mean (SD) of 12 (6) sessions, and the control group attended 11 (4) sessions. One participant (6%) withdrew after commencing; two (12%) were lost to follow-up. The intervention group 6MWT distance increased by mean (SD) of 22 (45) meters (95% confidence interval − 16 to 60) compared to 22 (57) meters (95% confidence interval − 69 to 114) (control). Conclusions: It was feasible to recruit people with multimorbidity to a randomized controlled trial of rehabilitation. A large RCT with the power to make significant conclusions about the impact on the primary and secondary outcomes is now required. Trial registration: The trial was registered with the Australian and New Zealand Clinical Trials Registry available at http://www.anzctr.org.au ACTRN12614001186640. Registered 12/11/2014.
BMJ Open
IntroductionNon-communicable diseases (NCDs) are the leading cause of death globally. Even though NCD disproportionally affects low-to-middle income countries, these countries including South Africa, often have limited capacity for the prevention and control of NCDs. The standard evidence-based care for the long-term management of NCDs includes rehabilitation. However, evidence for the effectiveness of rehabilitation for NCDs originates predominantly from high-income countries. Despite the disproportionate disease burden in low-resourced settings, and due to the complex context and constraints in these settings, the delivery and study of evidence-based rehabilitation treatment in a low-resource setting is poorly understood. This study aims to test the design, methodology and feasibility of a minimalistic, patient-centred, rehabilitation programme for patients with NCD specifically designed for and conducted in a low-resource setting.Methods and analysisStable patients with cancer, c...
Cardiac Rehabilitation Availability and Density around the Globe
EClinicalMedicine
Background: Despite the epidemic of cardiovascular disease and the benefits of cardiac rehabilitation (CR), availability is known to be insufficient, although this is not quantified. This study ascertained CR availability, volumes and its drivers, and density. Methods: A survey was administered to CR programs globally. Cardiac associations and local champions facilitated program identification. Factors associated with volumes were assessed using generalized linear mixed models, and compared by World Health Organization region. Density (i.e. annual ischemic heart disease [IHD] incidence estimate from Global Burden of Disease study divided by national CR capacity) was computed. Findings: CR was available in 111/203 (54.7%) countries; data were collected in 93 (83.8% country response; N = 1082 surveys, 32.1% program response rate). Availability by region ranged from 80.7% of countries in Europe, to 17.0% in Africa (p b .001). There were 5753 programs globally that could serve 1,655,083 patients/year, despite an estimated 20,279,651 incident IHD cases globally/year. Volume was significantly greater where patients were systematically referred (odds ratio [OR] = 1.36, 95% confidence interval [CI] = 1.35-1.38) and programs offered alternative models (OR = 1.05, 95%CI = 1.04-1.06), and significantly lower with private (OR = .92, 95%CI = .91-.93) or public (OR = .83, 95%CI = .82-84) funding compared to hybrid sources. Median capacity (i.e., number of patients a program could serve annually) was 246/program (Q25-Q75 = 150-390). The absolute density was one CR spot per 11 IHD cases in countries with CR, and 12 globally. Interpretation: CR is available in only half of countries globally. Where offered, capacity is grossly insufficient, such that most patients will not derive the benefits associated with participation.