Perspectives of rural indigenous peoples on medical rehabilitation: A scoping review

Abstract

Comprehensive review of the literature concerning Indigenous peoples has previously found “rehabilitation has been grossly neglected by health researchers”, despite the disproportionate representation in this patient populations. Indigenous peoples in Canada, USA, New Zealand, and Australia continue to experience elevated rates of systematic racism and impacts of colonialism, live in or come from rural and remote environments and have determinants of health that differ from settler populations. The current literature focuses on health deficits, however little is documented on the resiliencies or perspectives of rural Indigenous peoples. The goal of this scoping review is to document broadly the current body of literature concerning the experiences of rural Indigenous peoples with medical rehabilitation. Using methodology from Arksey and O’Malley (2005), SCOPUS and PubMed were searched with terms describing populations of Indigenous peoples in Canada, USA, New Zealand, and Australia, medical rehabilitation professionals and conditions, and rurality, then screened by title, abstract, and full article, with 13 articles included. Rehabilitation populations included chronic pain, brain injury, stroke and acquired communication disorders, pediatric developmental disability, diabetic amputation, and spinal cord injury. Distinct worldview, including emphasis on spirituality and healing, holistic approach, and learning styles were highlighted, including differing priorities from health care providers. Interdependence of family and community networks was a strong resiliency, with meaningful roles and inclusion despite deficits. Funding issues for both allopathic and traditional medicines and healers were identified as gaps. Communication, perception of hierarchy and “cultural invisibility” with health care professionals were sources of frustration. Changing practice guidelines towards patient centred care and social determinants of health must necessarily reflect understandings of different worldview, and be grounded in cultural safety. Physiatrists should engage with participatory action research to inform holistic care partnerships with Indigenous patients and communities for improved medical rehabilitation.