Community-based Rehabilitation Practice Research Articles

Identifying evidence to define community-based rehabilitation practice in China using a case study approach with multiple embedded case study design

BackgroundThis study examined community-based rehabilitation (CBR) practice in China on the basis of the development of an evaluation system using current evidence in a real context.MethodsA multiple embedded case study design was used to interpret both quantitative and qualitative data. In Part 1, a thematic analysis was conducted to identify the different levels of evidence available in CBR programs in China. Identified themes were then associated with the literature to form a system to code, categorise, and rank the obtained evidence. In Part 2, CBR practice was examined in 12 CBR programs by using the developed evaluation system with the CBR matrix and CBR framework.ResultsSix themes under three categorised levels of evidence for demonstrating quality of practice were found. An evaluation system of program practice, based on existing standards to define levels of evidence, was created and used with the CBR matrix and CBR framework to evaluate the quality of practice in 12 CBR programs. The results of a within-case analysis revealed the strengths and areas for improvement in each program. An across-case analysis by using identified correlations revealed the characteristics of CBR practice in China, as demonstrated in the interaction of core CBR components. The content elements of CBR programs were significantly correlated with health outcomes, social development, education, and empowerment. Empowerment was significantly correlated with participant governance and community ownership.ConclusionThe proposed evaluation system, as developed in a real context, is feasible for monitoring and identifying the strengths of and areas for improvement in CBR programs. This study described the characteristics and interaction of different CBR components in CBR practice in China and is pertinent for enhancing the evidence-based practices and quality of CBR programs in China.

Ethics and Community-Based Rehabilitation: Eight Ethical Questions from a Review of the Literature.

Purpose: This article reviews the literature regarding ethics and community-based rehabilitation (CBR) with the goal of identifying and analyzing ethical considerations associated with this approach. Method: We conducted a critical interpretive review of the academic literature related to CBR in low- and middle-income countries and to indigenous communities in high-income countries. Using an inductive analysis of the collected articles, we identified five key topic areas related to ethical considerations. We then critically appraised this literature and developed eight questions that reflect areas of ethical tension, uncertainty, or debate. Results: The five key topic areas are partnerships among stakeholders, respect for culture and local experience, empowerment, accountability, and fairness in programme design. The eight ethical questions are linked to these topics and associated with how CBR practices reflect commitments to equity, respect, inclusion, participation, and social justice. Conclusion: Continued engagement with ethical considerations associated with CBR can help to strengthen the foundations of this important and influential approach. It is crucial that all those involved in CBR projects, including physiotherapists, pay careful attention to the development of partnerships that, despite asymmetries among stakeholders, are respectful and effective.

Outcomes and impact of community-based rehabilitation programmes in Chinese communities

Purpose: To identify the most common and most valued outcomes of community-based rehabilitation (CBR) in Chinese communities and to map these to the CBR evaluation framework.Method: A multiple, embedded case study design was used. Four CBR programmes in China met the criteria for inclusion and participated. Data collection, via participant “story telling”, followed the procedures of the most significant change technique (MSC) over a period for five months. Content analysis with thematic coding was used to detect the common significant changes described in “top-rated” stories and in the entire pool of stories. Meta-analysis using the CBR framework was carried out to enrich the understanding of programme outcomes.Results: A total of 101 stories were collected in the two rounds of story collection from the four programmes. Aggregated results demonstrated that, across all programmes, 78.21% of stories focused on changes in people with disabilities, 9.9% described aspects of programme development, 8.91% reported on outcomes related to CBR workers, and only 2.97% were focused on advocacy. When mapped against the elements of the CBR framework the MSCs among these four programmes were (1) psychosocial changes, (2) increased family participation and (3) improved physical functioning.Conclusions: CBR practice in Chinese communities remains orientated towards an approach of functional rehabilitation rather than community-based inclusive development.Implications for rehabilitationCommunity-based rehabilitation is a strategy for community-based inclusive development.Commonly reported significant outcomes of community-based rehabilitation programmes in China focus on changes in psychosocial and physical status of people with disabilities and family participation.Community-based rehabilitation in China continues to focus on traditional rehabilitation. New efforts and directions are needed to also include goals of equity and community inclusion.Further efforts to promote the use of CBR guideline with the goal of facilitating inclusion and equal participation are strongly recommended.

The Applicability of eLearning in Community-Based Rehabilitation

Community-based rehabilitation (CBR) strives to enhance quality of life for individuals with disabilities and their families by increasing social participation and equalizing opportunities in the global south. Aligning with the Sustainable Development Goals, CBR also aims to address the high rates of poverty faced by individuals with disability. Empowerment, a pillar of CBR, involves strengthening the capacity of people with disabilities, their families, and their communities to ensure reduction of disparities. This article outlines a scoping review that guided by the question: “What is known from the existing literature about the applicability of eLearning for capacity building in CBR?” This review did not uncover literature related to eLearning in CBR; however findings suggest that other disciplines, not explicitly tied to CBR, currently use eLearning to educate and empower professionals in the global south. We argue that eLearning technology could be an effective and sustainable solution for CBR programming in the global south for capacity development. Such technology could increase individuals with disabilities’ access to education and could provide opportunities for wider dissemination of knowledge, beyond typical funding cycles. With a goal of informing future CBR practice in eLearning, this article concludes by highlighting key lessons taken from other disciplines that have utilized eLearning in the global south.

What We Can Learn from Developing Countries: The Community Based Rehabilitation Model

This article challenges the notion that we have much to learn from developing countries as well as much to offer to them. The article describes the philosophy, model and services of Community-Based Rehabilitation (CBR) as one example of what developing countries have to offer us. We discuss parallels between the CBR model and strategies used in the U.S. to meet education and rehabilitation needs and illuminate CBR practices from which we can learn.

A process for the systematic review of community-based rehabilitation evaluation reports: formulating evidence for policy and practice.

A methodological framework for conducting a systematic, mostly qualitative, meta-synthesis of community-based rehabilitation (CBR) project evaluation reports is described. Developed in the course of an international pilot study, the framework proposes a systematic review process in phases which are strongly collaborative, methodologically rigorous and detailed. Through this suggested process, valuable descriptive data about CBR practice, strategies and outcomes may be synthesized. It is anticipated that future application of this methodology will contribute to an improved evidence base for CBR, which will facilitate the development of more appropriate policy and practice guidelines for disability service delivery in developing countries. The methodology will also have potential applications in areas beyond CBR, which are similarly "evidence poor" (lacking empirical research) but "data rich" (with plentiful descriptive and evaluative reports).

How do carers of disabled children cope? The Ugandan perspective

Community-based rehabilitation (CBR) was recommended by the World Health Organization in 1989 as the strategy for improving the quality of life of disabled people and their families, which should be built on local knowledge and practices. In Uganda, there is no documentation on how services relate to local knowledge. There is a need for increased knowledge and understanding of how family members cope with their disabled children to provide the basis for future service development. A qualitative phenomenological design was used to develop an in-depth understanding of how Ugandan families cope with their disabled children in their own communities. Data were collected from 52 families with children with disabilities from five impairment groups, through interviews and observations in three districts of Uganda, one urban, two rural. There are many children with disabilities who are included, loved and cared for by their families. A lot of time and money is spent on seeking a cure. The extended family systems are breaking down and the main burden of caring for a disabled family member generally falls on one, sometimes two, female carers. Male members act as gatekeepers, controlling the key decisions concerning the child and the associated resources. CBR should move the focus of their services away from the disabled individual towards the whole family. It is important to provide accurate information about causes and prevention of impairments, the realities of a cure, support and respite for the female carers, and opportunities for the involvement of fathers. This methodology is a practical mechanism for collecting data that have the potential to positively influence and guide the development of CBR practice in the locality. At a conceptual level the data support the philosophy of inclusion, social integration, the importance of trust and respect, and utilizing a holistic approach. These are eminently transferable to other settings.

What We Can Learn from Developing Countries: The Community Based Rehabilitation Model

This article challenges the notion that we have much to learn from developing countries as well as much to offer to them. The article describes the philosophy, model and services of Community-Based Rehabilitation (CBR) as one example of what developing countries have to offer us. We discuss parallels between the CBR model and strategies used in the U.S. to meet education and rehabilitation needs and illuminate CBR practices from which we can learn.