Access To Rehabilitation Services Research Articles

Pilot of a multicomponent program for people with dementia and their care partners: Health services staff expectations, experiences and observations

There is increased recognition of the need to improve post-diagnostic pathways for people with dementia and their care partners living in the community to access rehabilitation services to support independence and wellbeing. However, there is minimal evidence on implementing rehabilitation services for this population. The study aimed to present the expectations and experiences of allied health staff involved in piloting the Sustainable Personalised Interventions for Cognition, Care and Engagement (SPICE) program based at an outpatient clinic of a public rehabilitation hospital. Over twelve weeks, the program combines small group and dyadic evidence-based interventions including cognitive stimulation therapy, occupational therapy, physical activity, care partner education, and dietetics. A qualitative exploratory methodology was used with pre- and post-program interviews conducted with ten allied health staff. Questions were designed to elicit the expected and actual benefits and challenges of the initial implementation of the multicomponent program. The multidisciplinary team were motivated by the potential for the SPICE program to meet an important service gap, and confident people with dementia and their care partners would benefit. Staff reported enjoyment, satisfaction, and confidence in delivering the program, and believed the multiple components had synergistic effects on participants, particularly regarding social connection and functional engagement. While staff had pre-program concerns regarding retention, participant fatigue, and managing challenging situations, these were not realised. At times, staff observed program intensity to cause unintended stress for some care partners. Resourcing and strategies to ensure sustainability were identified as important by staff, as well as the need for ongoing support to participants post-program. Overall, the SPICE program exceeded expectations and was rewarding for staff. Further work to refine and evaluate the program is necessary to support its potential to continue providing dementia rehabilitation to promote the independence and wellbeing of people with dementia and care partners living in the community.

Impact of model physiotherapy centres in reducing the burden among the caregivers of children with neurodevelopmental disorders in the rural area of Tamil Nadu: a study protocol

BackgroundApproximately 1 in 8 children under the age of 6 in Tamil Nadu are diagnosed with neurodevelopmental disorders (NDD), yet only a fraction of these children receives proper medical care. The unequal distribution of healthcare services is mainly due to the lack of accessibility, especially in rural areas, leading to a significant burden on caregivers. This research aims to alleviate caregiver burden and reduce disability in preschool children by establishing model clinics or specialized outreach centers in rural villages, supported by SRM Institute of Science and Technology under the Unnat Bharat Abhiyan Scheme.(UBA-SRMIST).MethodsThe study will commence with screening all preschool children registered in Anganwadi in the designated villages. Tailored model clinics will be set up in these villages based on the prevalence of NDD. Once established, children diagnosed with NDD will undergo rehabilitation for a year. Baseline and endline assessments will be conducted to evaluate the effectiveness of the model center on both the child's disability and the caregiver burden.DiscussionThis research will demonstrate the effectiveness of a model outreach center in rural villages in reducing disability levels in children and alleviating caregiver burden by eliminating the need for long travels to access rehabilitation services. The findings of this study will not only contribute to the objectives of UBA-SRMIST in uplifting villages but also facilitate the creation of registries and provision of data to the government for the implementation of policies that address the current disparities in healthcare access.Trial registration Trail has been registered under Clinical Trials Registry—India (CTRI/2024/06/069196).

Access to rehabilitation services for families of children with disabilities in Ghana

Background: Early rehabilitation interventions can significantly mitigate the effects of disabilities in children as they grow older. However, families of children with disabilities (CWDs) in resource-deprived settings face limited opportunities to access rehabilitation services for their children resulting in largely unmet rehabilitation needs.Aim: This study assessed knowledge of families of CWDs on rehabilitation services and accessibility to services for their children.Setting: The study was carried out in the selected districts in the Upper West Region, Ghana.Methods: Families that knew about rehabilitation services and acknowledged their child’s need for one were the subjects of this cross-sectional, quantitative study, using a researcher-administered questionnaire. STATA software was utilised for analysis.Results: Over half of the participants, 113 (54.85%), attempted to access rehabilitation services for their children, but only 31 (27.18%) were successful. The barriers to access included financial problems (n = 197 [95.63%]), shyness (n = 167 [81.07%]), transportation issues (n = 155 [75.24%]), community discouragement (n = 145 [70.39%]) and the attitudes of healthcare providers (n = 145 [70.39%]). Among those who accessed rehabilitation services, over half reported dissatisfaction with travel distance and associated costs (n = 18 [58.06%]), as well as travel time and wait time for services (n = 15 [48.39%]). Participants with no formal education (adjusted odds ratio [AOR] = 0.22; 95% confidence interval [CI]: 0.07, 0.59) and those who agreed that negative attitudes from health personnel were a barrier to access (AOR = 0.08, 95% CI: 0.00–1.01) were less likely to access rehabilitation services for their children.Conclusion: The low access to rehabilitation services suggests that many CWDs may miss relevant rehabilitation services that could improve their health outcomes and functioning. Policy interventions are required to facilitate families’ access to rehabilitation services for their children.Contribution: This study contributes to the literature on rehabilitation care in Ghana and provides a foundation for further research in rehabilitation care in the Upper West Region, as it is the first of its kind conducted in the region.

Accessing Rehabilitation after Upper Limb Reconstructive Surgery in Cervical Spinal Cord Injury: A Qualitative Study.

To investigate the barriers and facilitators to rehabilitation experienced by individuals with cervical SCI after upper limb (UL) reconstructive surgery. We conducted a prospective cohort study with a follow-up period of up to 24 months. Data collection occurred at two academic and two Veterans Affairs medical centers in the United States. Participants were purposively sampled and included 21 adults with cervical SCI (c-SCI) who had received nerve or tendon transfer surgeries and 15 caregivers. We administered semi-structured interviews about participants' experiences of accessing rehabilitation services after surgery. Four themes emerged from the data: (1) participants encountered greater obstacles in accessing therapy as follow-up time increased; (2) practical challenges (e.g., insurance coverage, opportunity costs, transportation) limited rehabilitation access; (3) individuals with c-SCI and their caregivers desired more information about an overall rehabilitation plan; and (4) external support systems facilitated therapy access. Individuals with c-SCI experience multilevel barriers in accessing rehabilitation care after UL reconstructive surgeries in the United States. This work identifies areas of focus to mitigate these challenges, such as enhancing transparency about the overall rehabilitation process, training providers to work with this population, and developing, testing, and disseminating rehabilitation protocols following UL reconstruction among people with c-SCI.

Perception of community reintegration among individuals with spinal cord injury in northwest Nigeria: a qualitative description

Purpose To explore the meaning of community reintegration and strategies for promoting community reintegration based on the lived experiences of individuals with spinal cord injury in northwest Nigeria. Material and Methods Using a qualitative description, we purposively recruited people with spinal cord injury residing in Kano, Nigeria. Eight focus groups were conducted to gather relevant information about the meaning and strategies for community reintegration, based on the lived experiences of the participants. Results A total of 64 people aged 18-60 years completed the study. Most of the participants had lived with spinal cord injury for more than five years. The individuals perceived community reintegration as a multi-dimensional concept reflected by five major themes namely: living life as usual, gainful engagement, a basket of opportunities, courage and support, and acceptance of destiny. Furthermore, the participants considered education and awareness about spinal cord injury, supportive and enabling environment, equal opportunities, care and moral support, and accessible health and rehabilitation services as critical for promoting community reintegration. Conclusion Community reintegration is a multidimensional process, and its promotion in northwest Nigeria requires a multisectoral approach.

Home-based transitional cardiac telerehabilitation in older adults post coronary artery bypass grafting: A randomized controlled trial

This randomized controlled trial evaluated the effectiveness of a 12-week home-based transitional cardiac telerehabilitation (Hb-T-CTR) program on health-related quality-of-life and therapeutic self-care in older adults’ post-Coronary Artery Bypass Grafting (CABG). The intervention group (n = 57) underwent Hb-T-CTR, incorporating preoperative counseling, postoperative education, a culturally adapted video, home visits, and telephone counseling, while the control group (n = 61) received standard care. Using the Coronary Revascularization Outcome Questionnaire and the Sidani Doran Therapeutic Self-Care Measure, data were collected at three time points. Results showed significant improvements in overall scores for both health-related quality of life (t1=3.386, P = 0.001; t2=4.224, P < 0.001) and therapeutic self-care (t1=7.104, P < 0.001; t2=4.242, P < 0.001) in the intervention group compared to controls. This telehealth approach provides convenient and accessible rehabilitation services for older adults’ post-CABG and highlights the importance of integrating Hb-T-CTR into routine care for personalized rehabilitation. This study underscores the potential of telehealth tools in overcoming barriers and enhancing patient-centered interventions.

Barriers and Enablers for Accessing Rehabilitation Services: Findings From the Rehabilitation Choices Study, Part 1—Healthcare Professionals' Perspectives

ABSTRACTIntroductionGlobally, there is an increasing demand for quality medical rehabilitation services. This is the first article of a two‐part series showing the findings from the Rehabilitation Choices study in which the main aim was to understand the current landscape of decision‐making, enablers and barriers to access appropriate rehabilitation services in the Australian setting. In Part 1, these insights were sought from a healthcare professionals' perspective.MethodsThis was an exploratory, qualitative study, using semi‐structured interviews with a discussion guide that was codesigned together with rehabilitation clinicians and rehabilitation researchers. Themes and sub‐themes were identified using an inductive approach.ResultsWe interviewed a heterogeneous group of 31 professionals who are involved in making referral decisions about rehabilitation or who design and deliver rehabilitation programs, including specialist rehabilitation physicians and other medical doctors across in‐patient, outpatient, and primary care settings, allied health professionals, rehabilitation service managers, nurses, multicultural health liaison officers and rehabilitation research scientists. Three key themes relevant to barriers and enablers to service access were identified from the data: defining rehabilitation; a lack of timely access to patient and rehabilitation service data; and patient diversity not expected by the system.ConclusionsHealthcare professionals who make decisions about rehabilitation referrals and services feel that it was necessary for them to keep up to date with information relating to rehabilitation services. There was some concern regarding what rehabilitation constituted and what services were available for different clinical indications. They also indicated that current systems did not consider diversity among patients' needs and goals. Their recommendations included the need for better communication pathways, improved referral systems and resources that could help provide best practice of rehabilitative care in the future.Patient or Public ContributionThree study team members had a lived experience of rehabilitation as a patient or carer, and previous experience participating in qualitative research. They worked with the study team to codesign the recruitment strategy, participant‐facing communications, the interview discussion guide, and the approach to the conduct of activities with participants and in the interpretation and contextualization of findings and all were involved in writing this manuscript.

Technological Features of Immersive Virtual Reality Systems for Upper Limb Stroke Rehabilitation: A Systematic Review.

Stroke is the second most common cause of death worldwide, and it greatly impacts the quality of life for survivors by causing impairments in their upper limbs. Due to the difficulties in accessing rehabilitation services, immersive virtual reality (IVR) is an interesting approach to improve the availability of rehabilitation services. This systematic review evaluates the technological characteristics of IVR systems used in the rehabilitation of upper limb stroke patients. Twenty-five publications were included. Various technical aspects such as game engines, programming languages, headsets, platforms, game genres, and technical evaluation were extracted from these papers. Unity 3D and C# are the primary tools for creating IVR apps, while the Oculus Quest (Meta Platforms Technologies, Menlo Park, CA, USA) is the most often used headset. The majority of systems are created specifically for rehabilitation purposes rather than being readily available for purchase (i.e., commercial games). The analysis also highlights key areas for future research, such as game assessment, the combination of hardware and software, and the potential integration incorporation of biofeedback sensors. The study highlights the significance of technological progress in improving the effectiveness and user-friendliness of IVR. It calls for additional research to fully exploit IVR's potential in enhancing stroke rehabilitation results.

Examining Barriers to Rehabilitation and Addressing Rehabilitation Needs Among Persons With Forced Migration Experiences: Interdisciplinary Perspectives

Globally, human displacement is at a record high. According to the United Nations High Commissioner for Refugees, 110 million people have been forcibly displaced worldwide owing to persecution, mass conflict, or human rights violations. Conflicts continue to rage in different parts of the world such as Ukraine, Palestine, Sudan, and Tigray. Large-scale political upheaval is also on the rise in many countries such as Haiti, Venezuela, and Iran. Natural disasters fueled by climate change will further contribute to large-scale forced migration. Persons with forced migration experiences (PFMEs) tend to have significant rehabilitation needs because of high risk of physical injuries, mental trauma, and exacerbation of pre-existing health problems during displacement. Rehabilitation practitioners in host countries must be well equipped to address the complex needs of this population. However, there is currently limited literature to guide best practice. In this article, a group of interdisciplinary professionals examine rehabilitation needs among PFMEs, provide examples of established and emerging rehabilitation interventions with PFMEs in the context of asylum and resettlement, identify barriers to accessing rehabilitation services in host countries, and propose avenues for professional advocacy in this area.

People with Disabilities and Financial Challenges in Access to Rehabilitation Services: Evidence of Socioeconomic Inequality in Iran.

People with disabilities (PWD) typically face a range of obstacles when accessing healthcare, particularly when compared with the general population. This challenge becomes more pronounced for PWDs in lower socioeconomic groups. This study aimed to assess the socioeconomic-related disparity in financial access to rehabilitation services among Iranian PWDS. A total of 766 Iranian PWDs aged ≥18 years participated in this cross-sectional study. We employed the concentration index (C) to estimate socioeconomic inequality in accessing rehabilitation services. In this study, 766 Iranian adults aged 18 to 70 took part, with a mean age of 36.50 (SD, ±10.02) years. The findings revealed that 72.15% (n = 469) of participants had to borrow money to cover the costs of rehabilitation services. The concentration index (C = -0.228, P = 0.004) demonstrated a notable concentration of inadequate financial access to rehabilitation services among individuals with lower socioeconomic status (SES). Decomposition analysis identified the wealth index as the primary contributor to the observed socioeconomic disparities, accounting for 309.48%. Our findings show that socioeconomic inequalities disproportionately impact PWDs in lower socioeconomic groups. It is recommended that efforts be made to enhance the national capacity for monitoring the financial protection of PWDs and to develop equitable mechanisms that promote prepayment and risk pooling, thus reducing reliance on out-of-pocket payments at the time of service utilization.

A scoping review protocol of the rehabilitation needs of people with brain tumours.

Every year 480 people are diagnosed with a primary brain tumour in Ireland. Brain tumours can vary in type, location, treatment, and progression but neurological impairments are a consistent feature. Such neurological disability creates significant symptom burden that can seriously impact peoples' functional ability and quality of life. Rehabilitation can improve functional prognosis (motor and cognitive) and quality of life in people with brain tumours. However, research and experience consistently show that people with brain tumours can have difficulties accessing rehabilitation services. Our scoping review will investigate the research evidence concerning the rehabilitation needs of people with brain tumours. The scoping review will be conducted in line with Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) reporting guidelines. Relevant databases (PubMed, Embase, CINAHL+, PsychINFO, PEDro) and grey literature sources will be searched. Publications relating to international rehabilitation practices will be included. A data extraction table will be created to facilitate narrative synthesis of the results. This scoping review will examine the scope of the literature on the rehabilitation needs of people with brain tumours. The findings will inform a research project entitled "Surgery, radiotherapy, chemotherapy, but now what? Exploring the rehabilitation needs of people with brain tumours in Ireland". An article reporting the results of the scoping review will be submitted to a scientific journal and presented at relevant national and international conferences.

Characterization of an Italian population with neurological disorders in a rehabilitation setting using ClinFIT.

To examine the functioning profile of people with neurological disorders who access rehabilitation services through ClinFIT Generic-30. The functioning profile of people with neurological disorders accessing rehabilitation services was examined using the ClinFIT Generic-30, and the results compared with existing core set (neurological health conditions acute and post-acute,stroke, Multiple Sclerosis, Traumatic Brain Injury,Spinal Cord Injury). Data for 364 people were analysed. The 10 most commonly impaired ICF categories included 3 for Body Functions (exercise tolerance functions (b455), mobility of joint functions (b710), and muscle power functions (b730)) and 7 for Activities and Participation (carrying out daily routine (d230), handling stress and other psychological demands (d240), changing basic body position (d410), maintaining a body position (d415), transferring oneself (d420), walking (d450), and moving around (d455)), while the ICF categories that were severely impaired (ICF qualifiers 3 and 4) in more than 30% of the study cohort were: muscle power functions (b730), carrying out daily routine (d230), walking (d450), moving around (d455), doing housework (d640), and assisting others (d660). The current study data suggests that ClinFIT Generic-30 appears to effectively identify impairments and/or restrictions, as perceived by individuals affected by selected healthconditions. ClinFIT Generic-30 is a tool that can be used to characterize functioning profile in people with different neurological disorders and to collect important information not addressed by the disease-specific core sets (neurological health conditions acute and post-acute,stroke, Multiple Sclerosis, Traumatic Brain Injury,Spinal Cord Injury).

Lived experiences of South African rehabilitation practitioners during coronavirus disease 2019.

In South Africa, the sharp rise in people with severe illness because of coronavirus disease 2019 (COVID-19) in early 2020, meant that health systems needed to adapt services and operations, including rehabilitation services. Important insights into the lived experiences of rehabilitation personnel enacting these adaptations in an African context are limited. The aim of this study was to explore the lived experiences of rehabilitation practitioners working in the public sector in South Africa during the COVID-19 pandemic. A phenomenological approach and a duo-ethnographic design were used. A recruitment letter was circulated requesting volunteers. Maximum variation sampling was used to select the 12 participants of this study. Data were collected through interviews via Zoom, and critical conversations were facilitated by a non-rehabilitation partner who is known for challenging health inequities. The interviews were audio-recorded and transcribed verbatim. Data were analysed through elements of qualitative content and thematic analysis. Data were coded, categorised, clustered into concepts and formulated into themes. Three themes were identified: (1) 'Management became the enemy', (2) 'Tired of being resilient' and (3) 'Think out of the box…think on our feet'. The results of this study highlighted new ways of practice, innovative adaptations, and usage of resources and platforms. This study highlights the re-imagining of accessible rehabilitation services that could lead to deeper onto-epistemological shifts amongst the rehabilitation practitioners.

Pengembangan Aplikasi Pose Detection untuk Asesmen Kemajuan Fisioterapi Pasien Pasca Stroke dari Jarak Jauh

Assessment has an important role in determining the diagnosis and subsequent treatment plan. In an effort to increase access and effectiveness of rehabilitation, this research aims to develop a mobile application that is able to report the results of post-stroke patient pose assessment remotely. Telemedicine approaches in post-stroke rehabilitation have become increasingly popular, allowing patients to access rehabilitation services remotely. This is especially beneficial for patients who live in remote areas or have limited mobility. Telemedicine also allows for real-time patient monitoring, allowing adjustments to rehabilitation plans as needed. The mobile app is designed to provide easy access to rehabilitation programs that can be tailored to individual patient needs. In addition to making access easier, this application is equipped with a monitoring feature that allows health professionals to follow patient progress in detail. Data collected from patients' daily exercise and activities provides valuable insight into their progress, which can be used in tailoring rehabilitation plans in real-time. The development of this mobile application technology has great potential to improve rehabilitation outcomes for post-stroke patients. Testing by three experts with two experts as healthy patients and stroke patients, as well as one patient who acts as a medical personel to monitor, shows that from the graph, healthy patients tend to be consistent. On the other hand, post-stroke patients tend to be inconsistent. These results indicate that this application is effective for identifying patient movements during the rehabilitation process. Although there are several obstacles, such as delays in predictions on some devices, this application has great potential to improve the quality of life of post-stroke patients. Thus, the development of a pose detection application for remotely assessing the progress of physiotherapy in post-stroke patients has great potential in improving rehabilitation outcomes. The app facilitates patient access to appropriate, personalized and effective care, while providing medical personnel with objective and accurate data for monitoring and adjusting rehabilitation plans. This is a significant step in advancing the care of post-stroke patients.

"I Had to Know About It, I Had to Find It, I Had to Know How to Access it": Experiences of Access to Rehabilitation Services Among People Living with Long COVID.

The aim of this qualitative study is to understand the need for, access to, and quality of rehabilitation services for people living with Long COVID. Little is known about the experiences of people living with Long COVID accessing rehabilitation services. Therefore, we explored health concerns leading people living with Long COVID to seek help to address functional concerns and their experiences with accessing and participating in rehabilitation. Interpretive description guided exploration of participants' experiences with Long COVID rehabilitation in Alberta, Canada. Semi-structured interviews were completed with 56 participants recruited from: three publicly funded Long COVID clinics, a specialized private physiotherapy clinic, a telephone-based rehabilitation advice line, and a Workers' Compensation Board-funded Long COVID rehabilitation program. Recruitment through mass media coverage allowed us to include people who did not access rehabilitation services. Data analysis was informed by Braun and Clarke's reflexive thematic analysis. Four themes were identified: (1) the burden of searching for guidance to address challenges with functioning and disability; (2) supportive relationships promote engagement in rehabilitation; (3) conditions for participation in safe rehabilitation; and (4) looking forward - provision of appropriate interventions at the right time. Our findings highlight the experiences of accessing rehabilitation services for people living with Long COVID. Results suggest approaches to Long COVID rehabilitation should be accessible, multi-disciplinary, flexible, and person-centred.

Cross-sectional Study on Functional Outcomes and Quality of Life in Saudi Arabian Patients with Strokes

Abstract Introduction: Stroke, a leading cause of mortality and disability globally, significantly impacts quality of life (QOL) through various impairments. In Saudi Arabia, stroke incidence necessitates detailed research to inform public health strategies. This study aims to assess post-stroke patients’ QOL using a customised questionnaire addressing culturally relevant aspects, hypothesising that demographic factors and healthcare access significantly influence outcomes. Methods: This cross-sectional study, conducted from January to September 2023, included 1530 Saudi Arabian stroke patients, ensuring diverse demographic representation. Data were collected through structured questionnaires, including health-related QOL and stroke-specific QOL scales, focusing on functional outcomes and QOL. Statistical analysis utilised SPSS version 28.0, employing descriptive and inferential methods, with a significance level set at &lt;0.001. Results: Participants were predominantly aged 18–24 (26.8%) and 45–64 (26.8%), with a mean age of 36.23 years (standard deviation [SD] ≈14.83). Gender distribution was 44.4% female and 55.6% male. A significant proportion held a bachelor’s degree (45.8%), and the majority resided in urban areas (73.2%). Moderate satisfaction with the rehabilitation programme was reported (mean = 3.07, SD = 1.010), with improvements in motor skills (mean = 3.22, SD = 0.855) and daily activities (mean = 3.16, SD = 0.889). A strong positive correlation between functional improvement and QOL was observed (r = 0.722, P &lt; 0.001). Financial and logistical challenges were noted, with 60.1% of participants experiencing financial difficulties. Conclusions: The study highlights the positive impacts of rehabilitation programmes on functional abilities and QOL amongst Saudi Arabian stroke patients, despite financial and logistical challenges. These findings emphasise the need for accessible and cost-effective rehabilitation services, tailored to the unique needs of this population, to enhance long-term well-being and independence.

A Comprehensive Review of Rehabilitation

Rehabilitation is an essential aspect of healthcare aimed at enabling individuals with disabilities or chronic health conditions to achieve and maintain optimal functioning. This multidimensional process spans physical, mental, and social domains, utilizing advanced techniques like virtual reality, robotics, and artificial intelligence. The global disability-adjusted life years (DALYs) underscore the need for accessible and inclusive rehabilitation services. This review aims to explore various types of rehabilitation, innovative interventions, challenges, and future directions, highlighting the role of evidence-based practices in improving patient outcomes.

Physical Disabilities and Rehabilitation Services in Khartoum State, Sudan

Background: The study aimed to compile a profile of people with physical disabilities in Khartoum State, Sudan, while identifying disability types, challenges and satisfaction with services. &#x0D; Methods: The study made use of a quantitative, cross-sectional design. Convenience sampling was employed to select 25% of the population of people with physical disabilities in Khartoum state, consisting of a sample of 467 participants. A self-developed, reliable questionnaire consisting of closed-ended questions was used to collect the data. Test-retest reliability has been determined through a pilot study of the questionnaires. Descriptive statistics was used to analyse the data. All the necessary ethical considerations were adhered to during the implementation of the study. Results: In our sample, 48.4% were children with disabilities who were less than 10 years old. Among the participants, amputations (30.8%) and cerebral palsy (30.3%) were the major types of physical disability. About 60% of the respondents were using assistive devices and out of these, 78.9% maintained their assistive devices themselves. Finances (70.5%) and transportation (42.7%) were the major barriers to accessing health services. Of the 84% who had access to physiotherapy services, 95.8% were satisfied with the services. Unemployment rates among people with physical disabilities were high in our sample.&#x0D; Conclusion: High prevalence of children with CP in our sample indicates the need for the prevention of disability and increased rehabilitation support. The high number of persons with amputation shows the need for prevention of injuries and prevention of and care in diabetes. Unemployment among physically disabled individuals is apparently high in our sample from Khartoum state. Although there were barriers to accessing services like finance and transportation, the majority of those recruited could access rehabilitation services. Many are using assistive devices and maintain them themselves. The participants were satisfied with the services they received. Recommendations: Prevention of disability, access to rehabilitation services and empowerment of people with disabilities need to be promoted, with inclusive education and appropriate workforce policy to reduce poverty. More investigation into disability services in rural Sudan is needed.

The association of a disability-targeted cash transfer programme with disability status and health-care access: a quasi-experimental study using a nationwide cohort of 4·3 million Chinese adults living with severe disabilities

Cash transfer is a crucial policy tool to address inequality. The objective of this study was to investigate the association between China's disability-targeted cash transfer programme and disability status, as well as equitable access to rehabilitation and medical services. For this quasi-experimental study, we drew data from the nationwide administrative cohort of individuals with disabilities between Jan 1, 2015, and Dec 31, 2019. Individuals were enrolled in the cohort if they were aged 18 years or older, had severe disabilities as defined by the Chinese Government, and had available cash transfer information for at least 4 consecutive years, without having started receiving cash transfer benefits at the time of enrolment. We used a quasi-experimental design with propensity score matching to estimate the effects of cash transfers on disability status, access to rehabilitation services, and access to medical treatment. The primary outcomes were development of new disability and reduction of existing disabilities. Secondary outcomes were use of rehabilitation services, financial barriers as a major obstacle to accessing rehabilitation services, use of medical services by individuals who had an illness in the previous 2 weeks, and financial barriers as a major obstacle to accessing medical services. From an initial pool of 51 356 125 individuals with disabilities registered in the administrative system, 2 686 024 individuals were eligible for analysis, of whom 2 165 335 (80·6%) were cash transfer beneficiaries and 520 689 (19·4%) non-beneficiaries. After propensity score matching, the cohort included 4 330 122 adults with severe disabilities. Cash transfer beneficiaries had significantly lower odds of developing new disabilities over time than non-beneficiaries (odds ratio [OR] 0·90, 95% CI 0·86-0·94; p<0·0001) and higher odds of having a reduced number of disabilities over time (1·17, 1·10-1·25; p<0·0001). Compared with non-beneficiaries, cash transfer beneficiaries were more likely to use rehabilitation services (2·12, 2·11-2·13; p<0·0001) and medical services (1·74, 1·69-1·78; p<0·0001), and less likely to report financial hardship to access rehabilitation services (0·53, 0·52-0·54; p<0·0001) and medical services (0·88, 0·84-0·93; p<0·0001) at the study endpoint. The receipt of cash transfers was associated with improved disability status and increased access to disability-related services. The findings suggest that cash transfers could be a potential method for promoting universal health coverage among individuals living with disabilities. China National Natural Science Foundation.

A scoping review protocol of the rehabilitation needs of people with brain tumours

Background: Every year 480 people are diagnosed with a primary brain tumour in Ireland. Brain tumours can vary in type, location, treatment, and progression but neurological impairments are a consistent feature. Such neurological disability creates significant symptom burden that can seriously impact peoples’ functional ability and quality of life. Rehabilitation can improve functional prognosis (motor and cognitive) and quality of life in people with brain tumours. However, research and experience consistently show that people with brain tumours can have difficulties accessing rehabilitation services. Our scoping review will investigate the research evidence concerning the rehabilitation needs of people with brain tumours. Methods: The scoping review will be conducted in line with Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) reporting guidelines. Relevant databases (PubMed, Embase, CINAHL+, PsychINFO, PEDro) and grey literature sources will be searched. Publications relating to international rehabilitation practices will be included. A data extraction table will be created to facilitate narrative synthesis of the results. Conclusions: This scoping review will examine the scope of the literature on the rehabilitation needs of people with brain tumours. The findings will inform a research project entitled “Surgery, radiotherapy, chemotherapy, but now what? Exploring the rehabilitation needs of people with brain tumours in Ireland”. An article reporting the results of the scoping review will be submitted to a scientific journal and presented at relevant national and international conferences.